HEALTJH

According to the Time Payment of Claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT:

• If the insured fails to provide proof of loss within the specified time frame
• If the policyholder requests a delay in payment
• If the insurer suspects fraud in the claim
• If the policy specifies a waiting period before payment and for claims involving periodic payments

What does coinsurance mean?

• The maximum amount you will have to pay out of pocket for covered services in a plan year
• The amount you pay for covered healthcare services before your insurance starts to pay
• The total amount you must pay for healthcare services before your insurance begins to pay
• The insurer and the insured share expenses over the deductible

The life insurance policy will not be truly effect until all of the following occur EXCEPT:

• The producer has explained the policy to the client
  

• The policyholder changes beneficiaries.
• The policyholder fails to pay the premiums.
• The policyholder cancels the policy before the maturity date.

Which of the following coverage types pays a monthly cash benefit following the elimination period for total disability due to accident or sickness?

• Critical Illness Insurance
• Life Insurance
• Homeowners Insurance
• Disability Income Insurance

The period beginning at the time of an insured loss that an insured must wait before benefits are payable is called the:

• limination period

• coverage period
• loss duration
• waiting time

Managed care plans increase efficiency by all of the following EXCEPT:

• increasing administrative costs
• limiting the choice of healthcare providers
• transferring the management of costs to the insureds
  

• requiring pre-authorization for all services

Under an individual policy, and insured who CANNOT perform the duties of his/her own occupation for a specific period of time is

• Partially disabled
• Temporarily disabled
• Fully disabled
• Totally disabled

How do most disability policies handle the case of a recurrent disability occurring at least 90 days after the first claim?

• it must be handled as a new claim for a new period of disability, requiring a new elimination period

• Recurrent disabilities are only covered if they occur within 30 days of the initial claim.
• Recurrent disabilities are considered as new claims and not covered.
• Recurrent disabilities are covered, but with reduced benefits compared to the initial claim.

A producer who makes false statements about the financial condition of an insurer may be found guilty of

• Embezzlement
• Money laundering
• defamation

• Tax evasion

Which of the following requires the claim information to be submitted to the insurer prior to treatment to determine whether the treatment is covered and how much the insured's plan will pay?

• Pre-approval
• -pre certification provision

• Post-authorization
• Prior-approval