Podcast
Questions and Answers
What action will the insurer take if the applicant dies unexpectedly after submitting the application and receiving a conditional receipt?
What action will the insurer take if the applicant dies unexpectedly after submitting the application and receiving a conditional receipt?
If a policyholder becomes disabled after adding a waiver of premium rider for a pre-existing condition, what is the insurer's likely response?
If a policyholder becomes disabled after adding a waiver of premium rider for a pre-existing condition, what is the insurer's likely response?
What coverage will a 67-year-old Medicare beneficiary receive for a pre-existing condition diagnosed six months after purchasing a Medicare Supplement policy?
What coverage will a 67-year-old Medicare beneficiary receive for a pre-existing condition diagnosed six months after purchasing a Medicare Supplement policy?
What could be a consequence for an agent who recommends replacing an old life insurance policy with a new one that has higher fees?
What could be a consequence for an agent who recommends replacing an old life insurance policy with a new one that has higher fees?
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How are the medical expenses benefits coordinated for an employee covered by two health insurance plans?
How are the medical expenses benefits coordinated for an employee covered by two health insurance plans?
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If a long-term care policyholder uses adult daycare services but does not meet the criteria for skilled care, what is the likely outcome regarding coverage?
If a long-term care policyholder uses adult daycare services but does not meet the criteria for skilled care, what is the likely outcome regarding coverage?
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What is the insurer's obligation upon learning an applicant's HIV status during underwriting?
What is the insurer's obligation upon learning an applicant's HIV status during underwriting?
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How does the decline of coverage by two employees affect the small employer's eligibility for group health coverage?
How does the decline of coverage by two employees affect the small employer's eligibility for group health coverage?
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What occurs when a client receives a conditional receipt after applying for life insurance but is hospitalized shortly after?
What occurs when a client receives a conditional receipt after applying for life insurance but is hospitalized shortly after?
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What is the role of the Florida Guaranty Fund when a health insurer becomes insolvent?
What is the role of the Florida Guaranty Fund when a health insurer becomes insolvent?
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What violation occurs if an insurance ad misrepresents the coverage of dental care included in a Medicare Advantage plan?
What violation occurs if an insurance ad misrepresents the coverage of dental care included in a Medicare Advantage plan?
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In the case of a policyholder with a pre-existing condition applying for individual health insurance, can coverage be denied?
In the case of a policyholder with a pre-existing condition applying for individual health insurance, can coverage be denied?
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How is the premium determined for a family applying for the Florida Healthy Kids program if their income exceeds the Medicaid eligibility threshold?
How is the premium determined for a family applying for the Florida Healthy Kids program if their income exceeds the Medicaid eligibility threshold?
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What happens to the life insurance policy when a key employee resigns?
What happens to the life insurance policy when a key employee resigns?
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What provision might protect a long-term care policyholder who forgets to pay their premium due to cognitive impairment?
What provision might protect a long-term care policyholder who forgets to pay their premium due to cognitive impairment?
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What occurs if an agent fails to complete a replacement form when replacing a long-term care policy?
What occurs if an agent fails to complete a replacement form when replacing a long-term care policy?
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Study Notes
Application and Underwriting
- If an applicant dies after applying for life insurance and receiving a conditional receipt, but before the underwriting is complete, the insurer generally pays the claim.
- Medical exam results unrelated to insurability do not impact or invalidate the claim
Policy Riders
- A waiver of premium rider is often dependent on pre-existing conditions disclosed.
- If a pre-existing condition is disclosed during underwriting for a waiver of a premium rider, the waiver of premium is likely approved, and the condition doesn't cause the plan to be canceled or partial premiums refunded
Medicare Supplement Insurance
- Medicare Supplement policies usually offer coverage immediately, regardless of pre-existing conditions, that were disclosed during open enrollment.
- Individuals should seek clarification on their specific policy's details if they have questions about pre-existing condition clauses
Replacement Regulations
- Insurance agents who recommend replacements while misrepresenting information or concealing fees could face license suspension (twisting).
- There are likely consequences for insurance agents who replace policies without following the proper procedures.
Coordination of Benefits
- The payer of employee-sponsored health insurance typically processes the claim and will pay for benefits/expenses first.
- Separate insurance plans might coordinate benefits according to negotiated agreements.
Long-Term Care Policy Standards
- Coverage for adult daycare services depends on policy specifics.
- Coverage for adult day services is conditional and depends on if the adult day care services are included in the policy provisions
HIV/AIDS Coverage
- Insurance companies cannot discriminate based on HIV status.
- Coverage for HIV-related conditions is generally offered without exclusions specific to HIV
Small Employer Group Coverage
- The eligibility of a small employer group for coverage is not affected by the actions of individual employees if certain thresholds are met
Conditional Receipt
- A conditional receipt, after paying the initial premium, does not guarantee immediate coverage.
- Acceptance of a conditional receipt often implies a potential temporary period without insurance, until underwriting is complete
Florida Guaranty Fund
- The Florida Guaranty Fund provides a safety net, paying claims if an insurer becomes insolvent, potentially up to a stated limit.
Advertising Standards
- Insurance ads must be truthful and accurately reflect coverage details, avoiding misleading statements.
- False advertising claims could be penalized
Pre-existing Conditions
- The length of time a pre-existing condition has existed may influence insurance eligibility
- For individual health insurance, a pre-existing condition that preceded the applicant's application can potentially be grounds for denial unless specific provisions prevent that.
Florida Healthy Kids Corporation
- Family income may affect premium levels in the Florida Healthy Kids program
- Premium calculations should reflect specific program details
Insurable Interest
- Maintaining insurable interest may be required in policies purchased for a specific reason (like an employer insuring an important employee).
- Termination or changes in situations that affect insurable interest, like an employee leaving or changing positions, may affect certain aspects of the policy.
Unintentional Lapse
- Policyholders may have provisions like automatic premium loans or waiver of premium provisions to help protect them against unintentional lapses due to situations like cognitive impairment, if part of the policy
Medicare Advantage
- Switching from Medicare Advantage to Original Medicare generally requires enrollment during a specific period (the Annual Election Period).
Replacement Forms
- Failure to complete necessary forms during a policy replacement could lead to cancellation or rejection.
- Properly completing necessary forms is essential for a successful change to a new plan.
Dread Disease Policy
- Dread Disease policies are generally limited to specific conditions explicitly listed in the policy.
- Claims outside the specified criteria in a policy are usually not covered.
Fraud Investigation
- Insurance regulatory bodies have the power to investigate and potentially suspend agents' licenses in the case of misrepresentation claims.
- Actions taken may vary and are typically dependent on the specific conditions of the situation.
Sliding
- Adding fees without explicit disclosure constitutes a violation (sliding), as opposed to other possible violations
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Description
Explore the key aspects of life insurance underwriting and various policy riders, including waiver of premium riders. This quiz covers how pre-existing conditions affect insurance claims and coverage immediately following the application. Perfect for understanding replacement regulations and Medicare supplement insurance.
