Questions and Answers
What does the Coordination of Benefits provision prevent?
Accidental Death benefits will be paid to:
The benefits under a Disability Buy-Out policy are:
Which term describes the reimbursement of benefits for a beneficiary's injuries caused by a third party?
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Which mode of payment is NOT used by health insurance policies?
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Which of the following claims are typically excluded from Medical expense policies?
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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?
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Which characteristic is associated with a large group disability income policy?
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What does a business overhead expense policy cover?
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What is issued to each employee of an employer health plan?
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What is the reimbursement of benefits for injuries caused by a third party?
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The MINIMUM percentage of eligible employees that must be covered by employer-paid group health plans is:
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Which type of coverage is best described as a short-term medical policy?
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What happens if the primary beneficiary of an AD&D policy dies before the insured?
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Which contracts permit the remaining partners to buy out the interest of a disabled business partner?
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Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident?
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An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
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Which of the following medical expenses does Cancer insurance NOT cover?
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How much of the death benefit will T's mother receive after S's death?
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What type of designation would allow permanent changes to a beneficiary on an AD&D insurance policy?
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What does the Health Insurance Portability and Accountability Act (HIPAA) protect?
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What is the MAXIMUM J will receive after cutting off his finger?
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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?
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How are employer-paid premiums for employee coverage treated for tax purposes?
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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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Description
This quiz covers key concepts of health insurance policies, including coordination of benefits, beneficiary designations, and subrogation. Understand the intricacies of disability buy-out policies and exclusions in medical expense policies. Test your knowledge on important regulations and practices in health insurance.