Podcast
Questions and Answers
How soon is the insured required to give notice of claim?
How soon is the insured required to give notice of claim?
20 days
If forms are not furnished, what should the insured do?
If forms are not furnished, what should the insured do?
Submit written proof of the occurrence, nature of the loss, and extent of loss to the insurer.
Premium payments for personally-owned disability income policies are tax deductible.
Premium payments for personally-owned disability income policies are tax deductible.
False (B)
How long after a policy's effective date may an insurer cancel the policy?
How long after a policy's effective date may an insurer cancel the policy?
Under an individual disability policy, what is the minimum schedule of time in which claim payments must be made to an insured?
Under an individual disability policy, what is the minimum schedule of time in which claim payments must be made to an insured?
What is the name of the statement that indicates a policy is limited?
What is the name of the statement that indicates a policy is limited?
Which health insurance provision describes the insured's right to cancel coverage?
Which health insurance provision describes the insured's right to cancel coverage?
Which groups may be eligible for benefits under the Healthy New York Program?
Which groups may be eligible for benefits under the Healthy New York Program?
How soon following a covered loss must an insured submit written proof to the insurance company?
How soon following a covered loss must an insured submit written proof to the insurance company?
In a life settlement transaction, how many days does the owner have to rescind the contract after receipt of the proceeds?
In a life settlement transaction, how many days does the owner have to rescind the contract after receipt of the proceeds?
Which of the following is not covered under Basic Hospital Expense coverage?
Which of the following is not covered under Basic Hospital Expense coverage?
Optional policy provisions can be changed by an insurer, as long as the changes do not adversely affect the policyholder.
Optional policy provisions can be changed by an insurer, as long as the changes do not adversely affect the policyholder.
Benefits from Business Overhead Expense (BOE) policies are usually limited to 6 months.
Benefits from Business Overhead Expense (BOE) policies are usually limited to 6 months.
What is the difference between the Medicare approved amount for a service or supply and the actual charge?
What is the difference between the Medicare approved amount for a service or supply and the actual charge?
What is the amount a physician or supplier bills for a particular service or supply?
What is the amount a physician or supplier bills for a particular service or supply?
What types of services may NOT be provided under long-term care's assisted living care?
What types of services may NOT be provided under long-term care's assisted living care?
A policy that covers medical costs related to a specific condition is called what?
A policy that covers medical costs related to a specific condition is called what?
In a replacement situation, what must be considered?
In a replacement situation, what must be considered?
The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children up to the age of?
The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children up to the age of?
Every authorized domestic insurer will be examined at least how often?
Every authorized domestic insurer will be examined at least how often?
What type of medical expense policy establishes benefits based on prevailing charges?
What type of medical expense policy establishes benefits based on prevailing charges?
If Cassie accumulates medical bills from a burn but is not classified as 'disabled', which coverage would help?
If Cassie accumulates medical bills from a burn but is not classified as 'disabled', which coverage would help?
How are the three basic charges for medical expense insurance grouped?
How are the three basic charges for medical expense insurance grouped?
Which provision concerns the insured's duty to provide the insurer with notice of a loss?
Which provision concerns the insured's duty to provide the insurer with notice of a loss?
Health insurance could provide payments for loss of income.
Health insurance could provide payments for loss of income.
Will a group health plan pay for an employee injured in a car wreck while working?
Will a group health plan pay for an employee injured in a car wreck while working?
A reinstated policy provides immediate coverage for illness.
A reinstated policy provides immediate coverage for illness.
Are premium payments for personally-owned disability income policies tax deductible?
Are premium payments for personally-owned disability income policies tax deductible?
What is the maximum amount of co-insurance in New York's major medical plans?
What is the maximum amount of co-insurance in New York's major medical plans?
Which employment would be covered under the NYS Disability Benefit Law?
Which employment would be covered under the NYS Disability Benefit Law?
Medicare Advantage is known as?
Medicare Advantage is known as?
Every insurer must file a fraud prevention plan within how many days?
Every insurer must file a fraud prevention plan within how many days?
Who is entitled to mental health benefits through Timothy's Law?
Who is entitled to mental health benefits through Timothy's Law?
Which of the following does NOT describe a principal goal of a Preferred Provider Organization?
Which of the following does NOT describe a principal goal of a Preferred Provider Organization?
Regarding long-term care coverage, as the elimination period gets shorter, what happens to the premium?
Regarding long-term care coverage, as the elimination period gets shorter, what happens to the premium?
How much of a given employee's income would be covered under a short-term disability plan?
How much of a given employee's income would be covered under a short-term disability plan?
Do benefits stop at the annuitant's death with an annuity certain?
Do benefits stop at the annuitant's death with an annuity certain?
What is a Payor Benefit Rider?
What is a Payor Benefit Rider?
What does a Guaranteed Insurability Rider allow the policyowner to do?
What does a Guaranteed Insurability Rider allow the policyowner to do?
What is the purpose of a Cost of Living Rider?
What is the purpose of a Cost of Living Rider?
What does an Accidental Death Rider provide?
What does an Accidental Death Rider provide?
When does the insurer pay the death benefit in a survivorship life policy?
When does the insurer pay the death benefit in a survivorship life policy?
What type of annuity does K have if he begins receiving payments 2 months after purchasing a $90,000 annuity?
What type of annuity does K have if he begins receiving payments 2 months after purchasing a $90,000 annuity?
After how many days can a ruling from a civil penalty hearing be enforced as a judgment without court proceedings?
After how many days can a ruling from a civil penalty hearing be enforced as a judgment without court proceedings?
What is a Fixed Settlement Option?
What is a Fixed Settlement Option?
What is true regarding the cash value in a Universal life policy?
What is true regarding the cash value in a Universal life policy?
When is a certificate of appointment valid until?
When is a certificate of appointment valid until?
What settlement option should a policy owner choose if they want to pay a portion of the proceeds annually to their spouse upon their death?
What settlement option should a policy owner choose if they want to pay a portion of the proceeds annually to their spouse upon their death?
What is the penalty tax for nonqualified distributions to a health savings account?
What is the penalty tax for nonqualified distributions to a health savings account?
What can contribute proof of death for insurance benefits payment?
What can contribute proof of death for insurance benefits payment?
Under the uniform required provisions, proof of loss under a health insurance policy should normally be filed within how many days?
Under the uniform required provisions, proof of loss under a health insurance policy should normally be filed within how many days?
Which provision must be included on the first page of a Medicare supplement policy that states the insurer's right to change premium amounts?
Which provision must be included on the first page of a Medicare supplement policy that states the insurer's right to change premium amounts?
If an insured has a $500 deductible and coinsurance of 80/20, how much would the insurer pay for $4,000 in medical expenses?
If an insured has a $500 deductible and coinsurance of 80/20, how much would the insurer pay for $4,000 in medical expenses?
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in which part?
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in which part?
What is the dividend option where the policy-owner uses dividends to purchase a term policy for one year called?
What is the dividend option where the policy-owner uses dividends to purchase a term policy for one year called?
What is it called when insurers negotiate contracts with providers to provide services at a favorable cost?
What is it called when insurers negotiate contracts with providers to provide services at a favorable cost?
What best describes the 'first-dollar coverage' principle in basic medical insurance?
What best describes the 'first-dollar coverage' principle in basic medical insurance?
What are the three basic types of coverage?
What are the three basic types of coverage?
What happens if a policy provision conflicts with state statutes?
What happens if a policy provision conflicts with state statutes?
What is a feature of a variable annuity?
What is a feature of a variable annuity?
What is true regarding installments for a fixed period annuity settlement option?
What is true regarding installments for a fixed period annuity settlement option?
What settlement option should a client consider if they plan to retire at age 50 and want income until social security and other funds become available?
What settlement option should a client consider if they plan to retire at age 50 and want income until social security and other funds become available?
What would be true if John receives benefits from his disability income policy after suffering an accident on the job?
What would be true if John receives benefits from his disability income policy after suffering an accident on the job?
Do benefits stop at the annuitant's death with an annuity certain?
Do benefits stop at the annuitant's death with an annuity certain?
What does 'life contingency' mean?
What does 'life contingency' mean?
How would a Cross Purchase plan work between two equal partners worth $150,000?
How would a Cross Purchase plan work between two equal partners worth $150,000?
Is there a limit on when benefits are paid in a Business Overhead Expense (BOE) plan?
Is there a limit on when benefits are paid in a Business Overhead Expense (BOE) plan?
What decreases in a decreasing term policy?
What decreases in a decreasing term policy?
What limits health insurance coverage even though sickness is a peril covered?
What limits health insurance coverage even though sickness is a peril covered?
How long does an insurer have to comply with a consumer's request for information on an Investigative Consumer Report?
How long does an insurer have to comply with a consumer's request for information on an Investigative Consumer Report?
Which insurance principle states that an insured may only receive benefits for the amount lost?
Which insurance principle states that an insured may only receive benefits for the amount lost?
How many years must life settlement brokers keep records of commission and compensation disclosures?
How many years must life settlement brokers keep records of commission and compensation disclosures?
Which benefit would cover at least a portion of Cassie's medical expenses after she burns her hand?
Which benefit would cover at least a portion of Cassie's medical expenses after she burns her hand?
Which of the following is not covered under Basic Hospital Expense coverage?
Which of the following is not covered under Basic Hospital Expense coverage?
Which document helps ensure that full and fair disclosure is provided to the recipient of a policy?
Which document helps ensure that full and fair disclosure is provided to the recipient of a policy?
How many days of inpatient care for treatment of mental disorders must be provided under Timothy's Law?
How many days of inpatient care for treatment of mental disorders must be provided under Timothy's Law?
When will Medicare cover nursing home care?
When will Medicare cover nursing home care?
What determines the extent of benefits offered under group disability income insurance?
What determines the extent of benefits offered under group disability income insurance?
What are the characteristics of a group long-term disability plan?
What are the characteristics of a group long-term disability plan?
What is the maximum amount of coinsurance in New York's major medical plans?
What is the maximum amount of coinsurance in New York's major medical plans?
Under SIMPLE plans, the employer makes a matching contribution equal to what percent of the employee's annual wages?
Under SIMPLE plans, the employer makes a matching contribution equal to what percent of the employee's annual wages?
What type of review process do employers use to evaluate the effectiveness of the utilization review process?
What type of review process do employers use to evaluate the effectiveness of the utilization review process?
What does naming beneficiaries as a class mean?
What does naming beneficiaries as a class mean?
How does the premium change in a decreasing term policy?
How does the premium change in a decreasing term policy?
What does the guarantee of insurability option in long-term care policies allow?
What does the guarantee of insurability option in long-term care policies allow?
What is a 1035 Exchange?
What is a 1035 Exchange?
How long do benefit periods for individual short-term disability policies usually continue?
How long do benefit periods for individual short-term disability policies usually continue?
Which nonforfeiture option provides coverage for the longest period of time?
Which nonforfeiture option provides coverage for the longest period of time?
Who may share in the commission from the sale of a life insurance policy?
Who may share in the commission from the sale of a life insurance policy?
What types of services may NOT be provided under long-term care's assisted living care?
What types of services may NOT be provided under long-term care's assisted living care?
What is reinsurance?
What is reinsurance?
Which life insurance settlement option guarantees payments for the lifetime of the recipient?
Which life insurance settlement option guarantees payments for the lifetime of the recipient?
If a court ordered payment for a loss that was not covered in the policy, what legal concept does this exemplify?
If a court ordered payment for a loss that was not covered in the policy, what legal concept does this exemplify?
What type of annuity does an individual have if the income payments begin 2 years after purchase?
What type of annuity does an individual have if the income payments begin 2 years after purchase?
What is the purpose of the New York State Partnership for LTC?
What is the purpose of the New York State Partnership for LTC?
What is an example of a peril?
What is an example of a peril?
Which Medicare supplement plans would be available to a reasonably healthy 91-year-old female?
Which Medicare supplement plans would be available to a reasonably healthy 91-year-old female?
In which situations can a policy-owner be allowed to sell a life insurance policy for a life settlement contract?
In which situations can a policy-owner be allowed to sell a life insurance policy for a life settlement contract?
What does the Life Income Joint and Survivor settlement option guarantee?
What does the Life Income Joint and Survivor settlement option guarantee?
What is true for both equity indexed annuities and fixed annuities?
What is true for both equity indexed annuities and fixed annuities?
Flashcards
Payor Benefit Rider
Payor Benefit Rider
Premiums are covered if the payor becomes disabled or dies, but the death benefit remains unchanged.
Guaranteed Insurability Rider
Guaranteed Insurability Rider
Allows the policyowner to increase the death benefit at specific ages or life events.
Cost of Living Rider
Cost of Living Rider
Adjusts the death benefit in line with inflation, preserving purchasing power.
Accidental Death Rider
Accidental Death Rider
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Survivorship Life Policy
Survivorship Life Policy
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Immediate Annuity
Immediate Annuity
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Fixed Settlement Option
Fixed Settlement Option
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Universal Life Policy Cash Value
Universal Life Policy Cash Value
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Civil Penalty Judgement
Civil Penalty Judgement
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Certificate of Appointment Validity
Certificate of Appointment Validity
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Medicare Supplement Policy Requirement
Medicare Supplement Policy Requirement
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Health Savings Account Penalty
Health Savings Account Penalty
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Group Disability Income Taxation
Group Disability Income Taxation
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Annuity Certain
Annuity Certain
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First-Dollar Coverage
First-Dollar Coverage
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Basic Hospital Expense
Basic Hospital Expense
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Long-Term Care Insurance Partnership
Long-Term Care Insurance Partnership
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Timothy's Law
Timothy's Law
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Variable Annuities
Variable Annuities
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Decreasing Term Policy
Decreasing Term Policy
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Proof of Loss Deadline
Proof of Loss Deadline
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Claim Notice Requirement
Claim Notice Requirement
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Individual Policy Payment Schedule
Individual Policy Payment Schedule
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Nonforfeiture Options
Nonforfeiture Options
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Cross Purchase Plan
Cross Purchase Plan
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Investigative Consumer Report Disclosure
Investigative Consumer Report Disclosure
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Outline of Coverage
Outline of Coverage
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Life Income Joint and Survivor Option
Life Income Joint and Survivor Option
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Reinsurance Definition
Reinsurance Definition
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Life Settlement Rescission Period
Life Settlement Rescission Period
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Surgeons' Fees Coverage
Surgeons' Fees Coverage
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Optional Policy Provisions Modification
Optional Policy Provisions Modification
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Business Overhead Expense (BOE) Policies
Business Overhead Expense (BOE) Policies
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BOE Premium and Benefit Taxation
BOE Premium and Benefit Taxation
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Excess Charge
Excess Charge
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Actual Charge
Actual Charge
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Assisted Living and Registered Nurses
Assisted Living and Registered Nurses
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Dread Disease Policy
Dread Disease Policy
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Replacement Situations
Replacement Situations
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Adult Child Coverage
Adult Child Coverage
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Insurer Examination Frequency
Insurer Examination Frequency
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Medical Expense Charge Classification
Medical Expense Charge Classification
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Notice of Claim Provision
Notice of Claim Provision
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Disability Income Coverage
Disability Income Coverage
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Group Health Plan and Work-Related Injuries
Group Health Plan and Work-Related Injuries
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Reinstated Policy Waiting Period
Reinstated Policy Waiting Period
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Personal Disability Income Premium Deductibility
Personal Disability Income Premium Deductibility
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Co-Insurance Percentage
Co-Insurance Percentage
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Disability Benefit Law Coverage
Disability Benefit Law Coverage
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Medicare Advantage Alternative Name
Medicare Advantage Alternative Name
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Fraud Prevention Plan Filing Deadline
Fraud Prevention Plan Filing Deadline
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Timothy's Law Coverage Area
Timothy's Law Coverage Area
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Preferred Provider Organization Goal
Preferred Provider Organization Goal
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Elimination Period and Premiums
Elimination Period and Premiums
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Short-term Disability Income Coverage
Short-term Disability Income Coverage
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Annuity Certain Benefits Termination
Annuity Certain Benefits Termination
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Proof of Loss Submission Timeline
Proof of Loss Submission Timeline
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Disability Benefits Taxation
Disability Benefits Taxation
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Study Notes
Life Insurance Riders
- Payor Benefit Rider: Premiums are covered if the payor becomes disabled or dies; death benefit remains unchanged.
- Guaranteed Insurability Rider: Allows the policyowner to increase the death benefit at certain ages or significant life events.
- Cost of Living Rider: Adjusts the death benefit in line with inflation to maintain purchasing power.
- Accidental Death Rider: If the insured dies in an accident, the death benefit is increased, typically as a multiple of the face amount.
Policy Mechanics
- Survivorship Life Policy: Death benefit is paid out only upon the death of the last insured.
- Immediate Annuity: Payments begin within 2 months of purchase.
- Fixed Settlement Option: Principal and interest are liquidated over a predetermined period; payments made in equal installments.
- Universal Life Policy Cash Value: Cash value is credited with a current interest rate and backed by a lower guaranteed rate.
Legal and Regulatory Aspects
- Civil Penalty Judgement: A ruling can be enforced as a judgement after 120 days without court action.
- Certificate of Appointment Validity: Valid until license suspension, expiration without renewal, or termination by the insurer.
- Medicare Supplement Policy Requirement: Continuation Provision must be included on the first page to outline premium change rights.
Tax and Financial Considerations
- Health Savings Account Penalty: Nonqualified distributions incur a 20% penalty in addition to tax.
- Group Disability Income Taxation: Employer-funded benefits are fully taxable to the employee as ordinary income.
Coverage and Benefits
- Annuity Certain: Provides income for a selected time frame, regardless of the annuitant's death.
- First-Dollar Coverage: Basic medical insurance does not require deductibles for hospital, surgical, and medical expenses.
- Basic Hospital Expense: Does not cover surgeon's fees.
Medicare and Long-Term Care
- Long-Term Care Insurance Partnership: Combines private LTC insurance with Medicaid coverage for nursing home care preparedness.
- Timothy's Law: Mandates a minimum of 30 days of inpatient care for mental health disorders under insurance policies.
Annuity Features
- Variable Annuities: Benefit payment amounts are not guaranteed; no minimum interest rate assurance.
- Decreasing Term Policy: Face amount decreases while premiums remain level.
Claims and Proofs
- Proof of Loss Deadline: Claims should be filed within 90 days after a loss occurs.
- Claim Notice Requirement: Insured is expected to notify the insurer of a claim within 20 days.
Disability Insurance
- Individual Policy Payment Schedule: Claims must be paid monthly under individual disability policies.
- Nonforfeiture Options: Reduced paid-up option provides coverage until age 100 but reduces face value based on cash value.
Additional Key Terms
- Cross Purchase Plan: Partners purchase insurance on each other’s lives for business protection.
- Investigative Consumer Report Disclosure: Insurers must comply with requests for information within 5 days.
- Outline of Coverage: Ensures full and fair policy disclosure to consumers.
Miscellaneous
- Life Income Joint and Survivor Option: Provides lifetime income for multiple recipients, with continued payments to a designated beneficiary after the death of one.
- Reinsurance Definition: An agreement between the ceding insurer (originating company) and the assuming insurer (purchasing additional coverage).### Life Settlements and Insurance Rights
- Life settlement contract allows the owner to rescind within 15 days after receiving settlement proceeds.
- Surgeons' fees are not covered under Basic Hospital Expense coverage.
Policy Provisions and Benefits
- Optional policy provisions may be modified by insurers if changes are not detrimental to policyholders.
- Business Overhead Expense (BOE) policies typically offer benefits for up to 6 months for business expenses during total disability.
- BOE premiums are tax-deductible for businesses but benefits received are taxable as income.
Medicare and Charges
- The difference between Medicare's approved amount and actual charge is termed Excess Charge.
- Actual Charge refers to what a physician bills for services rendered.
Long-Term Care and Insurance Policies
- Long-term care's assisted living options generally do not include registered nurse visits.
- A policy covering specific medical costs for a condition is called a Dread Disease Policy.
Replacement Situations and Child Coverage
- In replacement situations, all factors must be assessed except for Assets.
- The Patient Protection and Affordable Care Act mandates coverage for adult children up to the age of 26.
Insurer Examination and Charge Classification
- Insurers and rate organizations are examined at least once every 5 years.
- Medical expense insurance charges are categorized into Hospital, Surgical, and Medical.
Claims and Health Insurance
- Notice of Claim Provision mandates insured to provide timely notification to the insurer of any loss.
- Health insurance can cover loss of income due to disability.
Group Health Policies and Reinstatement
- Group health plans do not cover work-related injuries; workers must rely on worker’s compensation.
- Reinstated policies provide immediate coverage for accidental injury but require a 10-day waiting period for illness coverage.
Disability Income and Co-Insurance
- Premiums for personal disability income policies are not tax-deductible.
- The maximum co-insurance percentage in New York's major medical plans is 25%.
Employment Types and Medicare Advantage
- Employment types covered under NYS Disability Benefit Law include jobs like advertising executive.
- Medicare Advantage is also known as Medicare Part C.
Fraud Prevention and Mental Health Benefits
- Insurers must file a fraud prevention plan within 120 days of requirement.
- Timothy's Law provides mental health benefits to New York residents under group health or school health policies.
Preferred Provider Organization Goals
- A principal goal of a Preferred Provider Organization is not to limit benefits strictly to in-network physicians.
Long-Term Care Policies and Employer Disability Plans
- Shorter elimination periods for long-term care result in higher premiums.
- Short-term disability plans typically cover about 70% of an employee's income.
Annuities and Proof of Loss
- Benefits from annuities certain do not terminate at the annuitant's death; these are fixed-term annuities lacking life contingencies.
- Insureds must submit proof of loss within 90 days or as soon as reasonable, not exceeding 1 year.
Disability Benefits Taxation
- Disability income benefits received from employer-funded plans are taxable income to the employee.
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