Podcast
Questions and Answers
How much will the insured be responsible for if their covered expenses total $7,500 with a $1,500 deductible and 20% coinsurance?
How much will the insured be responsible for if their covered expenses total $7,500 with a $1,500 deductible and 20% coinsurance?
When will benefits start for a policyholder with a 60-day elimination period who becomes disabled on January 1st?
When will benefits start for a policyholder with a 60-day elimination period who becomes disabled on January 1st?
What is the insurer's obligation when a Medicare Supplement policyholder under 65 with a disability applies for a replacement policy during the open enrollment period?
What is the insurer's obligation when a Medicare Supplement policyholder under 65 with a disability applies for a replacement policy during the open enrollment period?
Under Florida law, how long must an insurer provide coverage for a dependent child after the insured dies?
Under Florida law, how long must an insurer provide coverage for a dependent child after the insured dies?
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Within how many days must an employee apply for conversion to individual coverage upon termination of a group health policy?
Within how many days must an employee apply for conversion to individual coverage upon termination of a group health policy?
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What does a guaranteed insurability rider allow a policyholder to do?
What does a guaranteed insurability rider allow a policyholder to do?
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What type of insurance is a cancer policy that pays $500 per day for hospitalization related to cancer?
What type of insurance is a cancer policy that pays $500 per day for hospitalization related to cancer?
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What provision in a disability policy prevents the insurer from voiding the policy after a certain period due to misstatements?
What provision in a disability policy prevents the insurer from voiding the policy after a certain period due to misstatements?
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What happens during the coverage gap (donut hole) for a Medicare Part D enrollee?
What happens during the coverage gap (donut hole) for a Medicare Part D enrollee?
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What action will an insurer take if a claimant misstates their age on an application?
What action will an insurer take if a claimant misstates their age on an application?
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What benefit does a long-term care policy provide if the insured qualifies under cognitive impairment?
What benefit does a long-term care policy provide if the insured qualifies under cognitive impairment?
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What occurs when an insured meets their annual out-of-pocket maximum of $5,000?
What occurs when an insured meets their annual out-of-pocket maximum of $5,000?
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What must an employee who declines group health coverage do to later enroll during the plan year?
What must an employee who declines group health coverage do to later enroll during the plan year?
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What happens if an insured with a noncancelable policy does not pay their premium?
What happens if an insured with a noncancelable policy does not pay their premium?
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What type of care does a Continuing Care Retirement Community (CCRC) provide?
What type of care does a Continuing Care Retirement Community (CCRC) provide?
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What is the purpose of the elimination period in a disability income policy?
What is the purpose of the elimination period in a disability income policy?
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Under Florida law, what condition must an insured meet to reinstate a lapsed health policy?
Under Florida law, what condition must an insured meet to reinstate a lapsed health policy?
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What is a primary benefit of a health plan that includes a high deductible and an HSA?
What is a primary benefit of a health plan that includes a high deductible and an HSA?
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Flashcards
Deductible
Deductible
The amount the insured pays before the policy starts covering expenses.
Coinsurance
Coinsurance
The percentage of covered expenses an insured pays after the deductible is met.
Elimination Period
Elimination Period
The period an insured must wait before disability benefits start.
Indemnity Insurance
Indemnity Insurance
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Time Limit on Certain Defenses
Time Limit on Certain Defenses
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Occupational Coverage
Occupational Coverage
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Non-Occupational Coverage
Non-Occupational Coverage
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Conversion Privilege
Conversion Privilege
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What happens during the Medicare Part D donut hole?
What happens during the Medicare Part D donut hole?
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What happens when an insurer discovers a claimant misstated their age on the application?
What happens when an insurer discovers a claimant misstated their age on the application?
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Benefit provided by a long-term care policy under cognitive impairment
Benefit provided by a long-term care policy under cognitive impairment
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What happens after reaching the out-of-pocket maximum?
What happens after reaching the out-of-pocket maximum?
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Can an employee enroll in a group plan during the plan year after initially declining?
Can an employee enroll in a group plan during the plan year after initially declining?
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Consequences of non-payment for a noncancelable policy
Consequences of non-payment for a noncancelable policy
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What type of care does a Continuing Care Retirement Community (CCRC) provide?
What type of care does a Continuing Care Retirement Community (CCRC) provide?
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What is the elimination period in a disability income policy?
What is the elimination period in a disability income policy?
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How can a lapsed health policy be reinstated in Florida?
How can a lapsed health policy be reinstated in Florida?
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What is the primary benefit of a high-deductible health plan with an HSA?
What is the primary benefit of a high-deductible health plan with an HSA?
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Study Notes
Insurance Policy Provisions and Scenarios
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Deductible and Coinsurance: Insured responsible for $1,500 deductible + 20% of $7,500 covered expenses = $2,700
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Elimination Period (Disability Income): 60-day waiting period before disability income benefits begin
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Replacement Policies (Medicare Supplement): Individuals under 65 applying for Medicare Supplement replacement policies during open enrollment typically need proof of insurability, not automatic coverage like those over 65
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Dependent Coverage (Florida Law): Dependent coverage duration varies, depending on the child's age, such as until age 26 instead of 18, or until the end of the policy.
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Conversion of Group to Individual Coverage: Employees need to apply for conversion of group to individual coverage within 60 days of termination
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Guaranteed Insurability Rider (Disability Income): Allows for increased coverage without proof of insurability.
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Cancer Insurance Coverage (Indemnity): A fixed amount per day of hospitalization (e.g., $500) related to cancer.
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Misstatement in Policy Application: A specific provision against voiding the policy due to past misstatements on the application.
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Disability from Off-The-Job Injury (Group Disability): Non-occupational coverage applies.
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Preferred Provider Organization (PPO) Plans: Allow patients to see out-of-network providers, but at a higher out-of-pocket cost.
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Medicare Part D Coverage Gap (Donut Hole): During the donut hole period, costs increase for both generic and brand-name drugs.
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Misstated Age (Claim): Insurers may adjust claims or payments based on accurate age, rather than denying them entirely.
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Long-Term Care (Cognitive Impairment): Cognitive impairment may entitle individuals to daily living assistance, not just full payment of medical bills.
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Annual Out-of-Pocket Maximum: When the annual out-of-pocket maximum is met, the insurer pays 100% of future covered expenses for that year.
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Declining Group Health Coverage: Employees who decline group health coverage, except during open enrollment periods, typically must wait until the next enrollment period to sign up unless there's an exception in policy.
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Noncancelable policy: A policy that cannot be canceled by the insurer due to reasons other than the insured not paying premiums.
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Lapsed Health Policy (Reinstatement): Insurers may allow reinstated lapsed policies. The insured will need to pay back all overdue premiums and interest plus possibly additional administrative fees.
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High Deductible with HSA: Provides lower premiums with tax-free savings for medical expenses.
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Time Limits for Claims: Policies typically have deadlines for filing claims.
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Critical Illness Insurance: Provides lump-sum benefits for certain critical illnesses.
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Guaranteed Renewable Policies (Cancellation): Insurers require notice and possible refunds when canceling guaranteed renewable policies.
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Group Health Application: Insurers are required to offer coverage to a small employer group without exclusions.
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Dental Insurance: Typically includes routine procedures, such as exams and cleanings, not cosmetic treatments or hospital stays for complex dental work.
Policy Types and Features
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Major Medical Coverage: Broad medical coverage encompassing a spectrum of expenses.
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Indemnity Insurance: Provides a payment for specific losses (e.g., cancer hospitalization).
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Comprehensive Coverage: A broader type of insurance meant to cover broader aspects of a medical or other type of loss.
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Group Health Insurance: Coverage applicable to a group of individuals. This often includes employees at an organization.
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Description
Test your knowledge on various insurance policy provisions and scenarios, covering topics such as deductibles, waiting periods, replacement policies, and coverage conversion. This quiz is designed to enhance your understanding of key insurance concepts and laws.
