Health and Accident Flashcards

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Questions and Answers

The reason for a business having a Business Overhead Expense Disability Plan is to cover:

The cost of providing group disability insurance to the employees

Fixed business expenses (correct)

The owner's loss of income

All business-related expenses and salaries

Which of these types of coverage is best described as a short term medical policy?

Conversion coverage

Provisional coverage

Interim coverage (correct)

Transitional coverage

What action must P take during the open enrollment period for non-contributory group Major Medical insurance?

Agree to a physical examination

Authorize for payroll deductions

Sign an enrollment card (correct)

Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business?

Business owner becoming disabled Signup and view all the answers

What is the difference between group insurance and blanket health policies?

Blanket health policies do not issue certificates Signup and view all the answers

The Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for:

Health information Signup and view all the answers

Which characteristic is associated with a large group disability income policy?

No medical underwriting Signup and view all the answers

What type of designation would fulfill a policyowner's need to change the beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy permanently?

Irrevocable Signup and view all the answers

What does the Coordination of Benefits provision do?

Prevents an insured covered by two health plans from making a profit on a covered loss Signup and view all the answers

What provision in a Group Health policy allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date?

Waiting Period Signup and view all the answers

Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?

Reimbursement Signup and view all the answers

Which statement is true regarding a minor beneficiary?

Normally, a guardian is required to be appointed in the Beneficiary clause of the contract Signup and view all the answers

How does group insurance differ from individual insurance?

Premiums are lower Signup and view all the answers

When T files a claim, his employer's plan is considered the:

Primary carrier Signup and view all the answers

Which of the following claims are typically excluded from Medical expense policies?

Intentionally self-inflicted injuries Signup and view all the answers

Study Notes

Business Overhead Expense Disability Plan

Designed to cover fixed business expenses.
Does not include employee group disability insurance, owner's income loss, or salaries.

Short Term Medical Policy

Best represented by interim coverage.
Other terms like provisional, transitional, and conversion coverage are misleading for this definition.

Non-contributory Group Major Medical Insurance

New employees must sign an enrollment card during the open enrollment period.
Authorization for payroll deductions, physical examinations, or state registration are not mandatory actions.

Business Disability Buy-Sell Policy

Assists in the sale of a business primarily when the business owner becomes disabled.
Other factors like insolvency or death of the owner are not the main focus.

Group Insurance vs. Blanket Health Policies

Blanket health policies do not issue certificates, differentiating them from group health policies.
Group health plans may cater to specific groups like airline passengers.

HIPAA Privacy Protection

Provides privacy protection specifically for health information.
Financial information, insolvency, and overinsurance are not included.

Large Group Disability Income Policy

No medical underwriting is a main characteristic.
Other aspects like waiting periods or benefit limitations do not apply.

Accidental Death and Dismemberment (AD&D) Insurance Beneficiary Designation

An irrevocable designation makes the beneficiary change permanent.
Revocable and primary designations can be altered without consent.

Coordination of Benefits Provision

Prevents profit from covered loss if an insured is covered by two health plans.
Ensures equity in benefit payouts rather than allowing additional profit.

Waiting Period in Group Health Policy

A provision that allows the insurer to delay coverage for 30 days post-effective date for a covered illness.
Grace Period, Postponement Period, and Elimination Period serve different functions.

Hospital Expense Policy Benefits

Reimbursement policy pays benefits to policyholders under a Hospital Expense policy.
Other types like limited, special risk, or blanket may not apply.

Minor Beneficiaries

Typically require a guardian appointed in the beneficiary clause until reaching age 21.
Misconceptions about immediate proceeds or estate debt responsibilities must be clarified.

Group Insurance vs. Individual Insurance

Group insurance generally has lower premiums than individual insurance plans.
Evidence of insurability and pre-existing conditions often complicate individual insurance.

Coordination of Benefits for Dual Coverage

Primary carrier designates the employer’s group plan when filing a claim.
Secondary carrier would apply to the spouse’s plan as a dependent.

Exclusions in Medical Expense Policies

Intentionally self-inflicted injuries are commonly excluded.
Treatments for conditions like alcohol addiction, mental illness, or auto accident injuries generally remain covered.

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Description

Test your knowledge with these flashcards on Health and Accident insurance concepts. Covering topics from Business Overhead Expense Disability Plans to short-term medical policies, this quiz is designed to reinforce your understanding of insurance coverage essentials.