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NY Accident and Health 17- 52 /newest
release/2024/
If an insurance company obtains an investigative consumer report on a prospective insured , it MUST inform the prospect that it is permitted to do so under which of the following Federal laws? - The Fair Credit Reporting Act What is the Fair Credit Reporting Act? - established procedures that consumer-reporting agencies must follow in order to ensure that records are confidential, accurate, relevant, and properly used Obtaining consumer information reports under false pretenses is prosecutable by which of the following? - Fair Credit Reporting Act When requesting a consumer report on a applicant, from whom must their insurer obtain consent? - The applicant How many years must credit information be retained? - 7 years What is the Gramm-Leach-Bliley Act? - Establishes rules for financial institutions on privacy notices that must be sent to consumers informing what information is collected, how it's shared and used, and how it is protected. Which federal law requires financial institutions to provide the consumer with information on how personal information is used? - Gramm-Leach-Bliley Act Which was NOT established under the Patient Protection and Affordable Care Act (ACA)? - High deductible health plans (HDHP) (HDHP is established by the IRS and not the ACA) Which insurance plans are commonly offered through the worksite (employer sponsored)? - Medicare (offered by the federal government) The benefits paid by Medicare are most similar to? - Major medical
How long after being entitled to social security benefits will an individual be eligible to receive Medicare benefits? - 2 years All the following can be used to qualify for Medicare Parts A and B EXCEPT - financial need Medicare? - A federal program of health insurance for persons 65 years of age and older, people who have be entitled for social security disability, or people who have permanent kidney failure etc... What is the primary qualifier for Medicare? - Age What is the primary qualifier for Medicaid? - Financial need What is Medicare part B? - medical insurance that covers outpatient medical services; services from doctors and other health care providers, home health care, medical equipment Which statement regarding Medicare is FLASE? - Part A paid for following your retirement What is Medicare part A? - hospital insurance; inpatient hospital stays, care in skilled nursing facility, hospice care, and some home health care. Under the Medicare Part B home health care benefit, all of the following are eligible expenses EXCEPT - blood transfusions Under Medicare supplement Policy, preexisting conditions CANNOT be excluded after how many months from the effective date of the policy? - 6 months Which of the following plans can be purchased to provide coverage in place of Medicare Parts A and B combined? - Medicare Advantage (part C) Which part of Medicare is also known as Medicare Advantage? - Part C What part of Medicare covers prescription drugs? - Part D
What is Medicaid? - A federal and state funded program for those whose income and resources are insufficient to meet the cost of the necessary medical care. Which of the following determines whether a person passes the financial test to qualify for Medicaid? - state law Eligibility for Medicaid benefits is primarily based upon which factor? - income and net worth Sherri qualifies for Medicaid even though he has assets of $250,000. What type of Long Term policy does Sherri have? - long-term care partnership policy Which is the minimum number offthe 6 Activities of Daily Living (ADL) an insured must be incapable of performing in order to trigger the benefits of a Long Term Care Policy? - 2 HIPAA applies to groups of how many participants? - 2 In a Medical Expense policy, newborns are covered only if - any required premium is paid within 31 days of the birth. The Affordable Care Act offers cost-sharing reductions such as lower co-payment, coinsurance, and out-of-pocket limits to insureds in what metal tier plan category? - Sliver Under the employer shared responsibility provision of the Affordable Care Act, an employer is exqmpt from penalties for not offering health insurance coverage if the employer has less than how many full-time employees? - 50 Which is NOT an essential benefit required under the Affordable Care Act? - Adult oral and vision care What is the main difference between the levels of coverage offered through the ACA? - percentage of coinsurance
What is coinsurance? - The amount you pay for covered health care after you meet your deductible. Copayment - An amount of money that is paid at the time of medical service Deductible - Amount you must pay before you begin receiving any benefits from your insurance company Which regulation was established by the Federal Trade Commission and Federal Communications Commission to protect consumers? - National Do Not Call List How often do organizations need to check the Do Not Call Registry in order to stay in compliance? - Every 31 days The National Do Not call list pertains to what type of calls? - unsolicited sales calls What is the federal legislation that was established to set rules for commercial email advertisements? - CAN-SPAM What does a Long Term Care policy cover? - respite care Which level of Long Term Care must be provided occasionally by a skilled practitioner following doctor's orders? - Intermediate care What is the minimum level of renewability for a Long Term Care policy as required by State Law? - Guaranteed renewable According to the National Association of Insurance Commissioner's Model Law regulating the sale of Long Term Care insurance, your first year's rommission on an LTC sale could be no more than what amount if your second year's renewal commission is $400? - $800 (double) Which is NOT required by a Long Term Care contract? - Prior hospitalization
Which of the following, by definition, provides benefits for expenses incurred as a result of in- hospital medical treatment and surgery as well as certain outpatient expenses such as doctor's visits, laboratory tests, and diagnostic services? - hospitalization insurance Which of the following policies provides a specified income benefit if an insured person becomes incapable of working? - Disability Income Dakota has a sedentary computer job and so being active is important. To suppprt an active lifestyle, Dakota eats well, does not smoke, and regularly exercises, which has resulted in a clean medical history. A life insurer gives Dakota a discounted rate given the classification is most likely what type of risk? - Preferred (Healthy/good) Jonnie works on a fishing boat for most of the week, and when docked, passes the time at the local bar drinking and smoking. Even though Jonnie has a family history of diabetes, eating healthy and exercise are not priorities. A life insurer charges Jonnie the standard premium for a higher attained age given the classification is most likely what type of risk? - Substandard (unhealthy) Which rating provides the least expensive premium? - preferred Which is NOT a reason why someone may receive a rated or substandard rating on their policy? - Age Chris is driving at a high rate of speed when the vehicle leaves the road, colludes with a tree, and causes Chris to be treated at the hospital. This is an example of which of the following perils that health insurance is designed to cover? - Accident Sam has been feeling tired for many weeks, and after several medical tests, is diagnosed with chronic fatigue syndrome. This is an example of the peril that health insurance is designed to cover known as - Sickness What is the source of an accidental injury known as? - peril The majority of health insurance claims are from which peril? - sickness
What kind of tables are utilized by health Insurance companies during underwriting? - Morbidity tables what is underwriting? - The process of assessing the amount of risk you present to a potential insurer. How do insurance companies protect themselves against adverse selection when underwriting individual health insurance policies? - They pay for AIDS testing of all applicants Who created the Medical Information Bureau and why was it created? - the insurance companies to use as an underwriting tool The ability of an applicant to meet an insurer's underwriting requirements is also Known as - Insurability Which policy contains a Corridor Deductible? - Comprehensive Major Medical Which health insurance policy requires a beneficiary designation? - Travel accident What would a mandatory second surgical opinion likely result in? - Higher premium cost Jim has a Major Medical policy when a covered illness results in a hospital bill of $10,298.37. Jim's company pays $8,214.15. All of the following could account for the difference EXCEPT the - Elimination period Lynn owns a Comprehensive Major Medical policy with a $1,000 Base Plan, a $500 Corridor Deductible, and an 80/20 Coinsurance Clause, If she incurs medical bills of $5,500 following a covered illness, how much will the company pay? - 4, A claimant must complete and return the claim forms within how many days of the loss or as soon thereafter as reasonably possible? - 90 days All life insurance and health insurance contracts contain all of the following EXCEPT - inmaterial representations
Dr. Martin purchases a $20,000 per month Own Occupation Disability Income policy, and Dr. Foster buys an identical policy. Dr. Martin loses his right hand in a boating accident at age 35 and is paid $240,000 per year for the rest of his life. Dr. Foster pays his premium until age 65 and never files a disability claim. This clearly demonstrates that insurance policies are what kind of contracts? - Aleatory Contracts Which comparison of a Probationary Period to an Elimination Period is TRUE? - Disability Income policies can contain both. A Health Maintenance Organization (HMO) differs from a traditional insurer in that an HMO - emphasizes preventive medicine The group conversion option is allowed for all of the following EXCEPT - during the annual benefits enrollment period. Ann's Major Medical policy lapsed 6 months ago. When she fills out her reinstatement application, the company can ask for no more than how many days of - 60 days What is the maximum amount of time the insured has to file legal action against the insurer after written proof of loss is provided? - 3 years Which of the following is TRUE of a point of a service plan? - A patient's in-network care is coordinated by a primary care physician. All of the following are TRUE regarding incomplete applications EXCEPT - the incomplete application can be accepted with the missing information added later. Which rider will protect against inflation by increasing disability income benefits annually after the start of a disability? - cost of living adjustment In a disability income policy, the specified period of time after the effective date and before coverage goes into effect is the - probationary period. What is the major reason that insurance regulators are often critical of dread disease insurance policies? - Buyers often think they are getting broader coverage than they actually purchase.
What is a beneficiary? - A person or group who is legally entitled to receive the death be Which statement about COBRA is FALSE? - An insured person who quits their job forfeits their rights under COBRA Which federal law provides for the continuation of Group Medical Expense coverage for departing employees and their dependents? - COBRA
