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Questions and Answers
Questions and Answers
What does the Coordination of Benefits provision prevent?
What does the Coordination of Benefits provision prevent?
- Allows an insured to make a profit on a covered loss
- Allows an insurer to defer paying a claim for work-related injury
- Prevents an insured from changing insurers during a claim
- Prevents an insured from making a profit on a covered loss (correct)
Accidental Death benefits will be paid to:
Accidental Death benefits will be paid to:
- R's estate
- P and Q's estate
- P only (correct)
- Q's estate
The benefits under a Disability Buy-Out policy are:
The benefits under a Disability Buy-Out policy are:
- Payable to the company or another shareholder (correct)
- Taxable to the beneficiary
- Normally paid after a short elimination period
- Normally paid in installments
Which term describes the reimbursement of benefits for a beneficiary's injuries caused by a third party?
Which term describes the reimbursement of benefits for a beneficiary's injuries caused by a third party?
Which mode of payment is NOT used by health insurance policies?
Which mode of payment is NOT used by health insurance policies?
Which of the following claims are typically excluded from Medical expense policies?
Which of the following claims are typically excluded from Medical expense policies?
If the insured and primary beneficiary are both killed in the same accident, where are the death proceeds directed under the Uniform Simultaneous Death Act?
If the insured and primary beneficiary are both killed in the same accident, where are the death proceeds directed under the Uniform Simultaneous Death Act?
Which characteristic is associated with a large group disability income policy?
Which characteristic is associated with a large group disability income policy?
What does a business overhead expense policy cover?
What does a business overhead expense policy cover?
What is issued to each employee of an employer health plan?
What is issued to each employee of an employer health plan?
What is the reimbursement of benefits for injuries caused by a third party?
What is the reimbursement of benefits for injuries caused by a third party?
The MINIMUM percentage of eligible employees that must be covered by employer-paid group health plans is:
The MINIMUM percentage of eligible employees that must be covered by employer-paid group health plans is:
Which type of coverage is best described as a short-term medical policy?
Which type of coverage is best described as a short-term medical policy?
What happens if the primary beneficiary of an AD&D policy dies before the insured?
What happens if the primary beneficiary of an AD&D policy dies before the insured?
Which contracts permit the remaining partners to buy out the interest of a disabled business partner?
Which contracts permit the remaining partners to buy out the interest of a disabled business partner?
Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident?
Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident?
An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
Which of the following medical expenses does Cancer insurance NOT cover?
Which of the following medical expenses does Cancer insurance NOT cover?
How much of the death benefit will T's mother receive after S's death?
How much of the death benefit will T's mother receive after S's death?
What type of designation would allow permanent changes to a beneficiary on an AD&D insurance policy?
What type of designation would allow permanent changes to a beneficiary on an AD&D insurance policy?
What does the Health Insurance Portability and Accountability Act (HIPAA) protect?
What does the Health Insurance Portability and Accountability Act (HIPAA) protect?
What is the MAXIMUM J will receive after cutting off his finger?
What is the MAXIMUM J will receive after cutting off his finger?
When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which type of plan?
When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which type of plan?
How are employer-paid premiums for employee coverage treated for tax purposes?
How are employer-paid premiums for employee coverage treated for tax purposes?
Questions and Answers
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Study Notes
Study Notes
Coordination of Benefits
- Prevents insureds covered by multiple health plans from profiting on a covered loss.
Beneficiary Designation in AD&D Policy
- In the event of simultaneous deaths, proceeds from the Accidental Death and Dismemberment (AD&D) will go solely to the primary beneficiary.
Disability Buy-Out Policy
- Benefits are payable to the company or another shareholder, not to the disabled individual.
Subrogation
- Refers to the insurer's right to seek reimbursement from a third party responsible for a loss.
Payment Modes in Health Insurance
- Health insurance policies do not use a single premium payment mode.
Exclusions in Medical Expense Policies
- Intentional self-inflicted injuries are typically excluded from coverage.
Uniform Simultaneous Death Act
- If the insured and primary beneficiary die together, proceeds go to the insured's contingent beneficiary.
Large Group Disability Policies
- Typically do not require medical underwriting, making coverage more accessible.
Business Overhead Expense Policy
- Covers essential business expenses such as rent and utilities during the owner's disability.
Health Plan Documentation
- A policy is issued to each employee participating in an employer’s health plan.
Insurer Rights for Third Party Injuries
- Subrogation allows insurers to cover claims and pursue responsible third parties.
Group Health Plan Coverage Requirements
- A minimum of 100% of eligible employees must be covered if the employer pays the entire premium.
Short-Term Medical Policy
- This is referred to as interim coverage.
Contingent Beneficiary Proceeds
- If the primary beneficiary has died, proceeds will directly go to the contingent beneficiary.
Disability Buy-Sell Agreements
- These contracts allow remaining partners to buy out the interest of a disabled partner.
Disability Income Insurance
- Provides salary payments for employees injured and unable to work.
Accidental Death and Dismemberment Benefits
- Benefits are paid for specific accidental injuries, such as loss of eyesight from an accident.
Cancer Insurance Coverage Limitations
- Cancer insurance does not cover arthritis.
Death Benefit Distribution
- In the case of co-primary beneficiaries, if one passes, the other retains the full benefit, while the contingent beneficiary receives nothing.
Irrevocable Beneficiary Designation
- A permanent change to a beneficiary on an AD&D policy requires consent from the existing beneficiary.
HIPAA Privacy Protections
- Provides privacy protections specifically for health information.
Maximum Benefit for Finger Loss in AD&D Policy
- The maximum benefit for losing a finger under an AD&D policy would be $25,000, defined as the capital sum.
Contributory Health Plans
- In contributory plans, employees pay a portion of the premium contributing to their coverage.
Tax Treatment of Group Medical Expense Insurance
- Employee premiums paid by an employer are tax-deductible as business expenditures.
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