Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024), Exams of Nursing

Download Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) and more Exams Nursing in PDF only on Docsity! Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) usually, but not always the person covered by the policy - Correct Answer ✅ policy owner the person who is paid when a claim is submitted - Correct Answer ✅ beneficiary acts as a legal representative of the insurance company - Correct Answer ✅ agent/producer representative of the Insured, not the insurance company - Correct Answer ✅ broker The chance or uncertainty of loss - Correct Answer ✅ risk the chance of experiencing a loss (without the possibility of gain). Only downside, no upside. - Correct Answer ✅ Pure risk Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) s the chance of loss one accepts in the hope of realizing a gain - Correct Answer ✅ Speculative risk staying away from risky activities altogether - Correct Answer ✅ Risk avoidance reduce the chance of something bad happening - Correct Answer ✅ Risk reduction Get someone else to accept the risk - Correct Answer ✅ Risk shifting transfer a portion of your risk to the Insurer - Correct Answer ✅ Buying insurance the individual or business that opts not to buy insurance retains the entire risk - Correct Answer ✅ Risk Retention an insurance concept that states that some portions of the insurance industry prefer that we be made only whole after a Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) payroll taxes levied on employees, employers, and the self-employed. - Correct Answer ✅ Not covered by social security (Worked for 10 years) payroll taxes levied on employees, employers, and the self-employed. Retirement Benefits; Disability Income Benefits; and Survivor Benefits. - Correct Answer ✅ FICA Fully Insured Worked less than ten years. Only eligeable for Survivor Benefits - Correct Answer ✅ Currently Insured Averages earnings over time period. Either way, the more a worker has paid into Social Security, the more the worker (or dependents) Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) will get out of it. (What you get at age 65) - Correct Answer ✅ Average Indexed Monthly Earnings Full retirement benefit someone is entitled to at age 65 (some cases, 66-67) - Correct Answer ✅ Primary Insurance Amount (PIA). the person must be disabled for 5 months before starting to receive Disability Benefits - Correct Answer ✅ elimination period (Disability) the selection and classification of risks. - Correct Answer ✅ underwriting A person who tracks the lifespan and chance of illness or accident based on specific factors - Correct Answer ✅ actuary Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) predict the age at which people in a given group are likely to die (Used by life insurers) - Correct Answer ✅ Mortality table predict how often people in a given group are likely to get sick or have an accident. (Used by health insurers) - Correct Answer ✅ Morbidity table Insurance agents - Correct Answer ✅ field underwriters Applicants who are too risky are declined - Correct Answer ✅ declined risks the tendency for high risk people to be more likely to apply for insurance than low risk people. - Correct Answer ✅ Adverse selection Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) may even be in a similar geographic area - Correct Answer ✅ community rating The one overriding contract that can affect the lives of hundreds or thousands - Correct Answer ✅ Master Contract a booklet explaining the coverage and an identification card - Correct Answer ✅ Certificate of Insurance an insurance plan administered by an employer to cover employees, officers, and even the board of directors (but not shareholders because they aren't employees). - Correct Answer ✅ Single Employer Group Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) When two or more employers join forces to meet minimum member requirements and in other ways jointly provide insurance for their employees - Correct Answer ✅ Multiple Employer Group a Group Insurance plan in which the entire cost of coverage for all eligible group members is covered by the organizing entity, usually the employer - Correct Answer ✅ non-contributory plan all or part of the costs of coverage must be paid by individual group members - Correct Answer ✅ contributory plan after the probationary period when an employee is eligible to receive health insurance - Correct Answer ✅ eligibility period a month in which all employees who have become eligible to enroll can - Correct Answer ✅ open enrollment Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) period "add on" programs that are reasonably priced because of volume discounts - Correct Answer ✅ voluntary plans Optional plans offered to the employees that they pay for out of pocket (Aflac) - Correct Answer ✅ Voluntary Employer- Sponsored (Worksite) Plans pay a specified dollar over and above any other insurance a worker already has - and there is no deductible involved - Correct Answer ✅ Supplemental Accident Benefit policies pay a predetermined benefit Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) A statement made on an application for insurance that the applicant gaurentees to be true (Not allowed in life and health insurance forms) - Correct Answer ✅ Warranty statement regarding a material fact that the applicant believes to be true to the best of the applicant's knowledge and belief - Correct Answer ✅ Representation (in a policy agreement) a lie about a material fact - Correct Answer ✅ Misrepresentation An intentional non-disclosure of hiding material facts - Correct Answer ✅ Concealment The insurer has made a legally enforceable promise - Correct Answer ✅ Unilateral Non-negotiable contract (take it or leave it) - Correct Answer ✅ Contract of adhesion Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) When one party or another has the potential to recieve dramatically different level of benefits relative to the cost of receiving those benifits - Correct Answer ✅ Aleatory the voluntary surrendering of a right - Correct Answer ✅ Waiver means that once you waive a right, you have no grounds to complain about the consequences - Correct Answer ✅ Estoppel A clause, or part of the contract - Correct Answer ✅ Provision optional provisions not included in the original policy but which are added at a later time (Aka extension or an endorsement) - Correct Answer ✅ Riders Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Controls all aspects of a insurance policy - Correct Answer ✅ Owner specifies the policy owners rights (Transfer ownership, borrow against the policy etc.) - Correct Answer ✅ Ownership Clause insurable interest exists if the applicant would suffer financially if the Insured were to die or become ill - Correct Answer ✅ insurable interest requirement Explain the underwriting process to the applicant and provide disclosures as required by law. • If the applicant does not complete a portion of the appli- cation, the applicant must personally make the changes and sign or initial them. • If the agent makes a mistake on the agent's portion Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) giving Insureds at least 10 days after delivery of the policy to review the policy and terminate coverage. Policies sold to the elderly (Medicare Supplement and Long Term Care) must have a 30 day Free Look Clause. - Correct Answer ✅ Free look clause 31 day grace period on premium payments. The company may charge interest on late payments - Correct Answer ✅ Grace period clause • after the first 2 years, • an honest mistake is incontestable by the Insurer; • fraud is incontestable by Life Insurers and Group Health Insurers; but • fraud remains contestable forever by Individual Health Insurers - Correct Answer ✅ Contestable clause Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) prohibits the Insurer from charging a reinstatement fee Within the time limits provided by state law, I may reinstate if I: • submit a reinstatement application within three years (which triggers a new incontestable period on statements in the new application); • pay any outstanding policy loans (if the Life policy permitted policy loans); • pay missed premiums plus interest; and • provide proof of insurability - Correct Answer ✅ Reinstatement Clause After submitting the claim, the Insured must wait 60 days prior to filing any lawsuit. And any lawsuit must be filed within 3 years Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) - this time limit is also referred to as a Statute of Limitations - Correct Answer ✅ Time Limit on Lawsuits Clause policy will pay as a lump sum the face value of the policy - Correct Answer ✅ Principal sum provides for a Life policy to pay a specified multiple of the face value if the Insured dies as a result of an accident the death cannot be attributed to a sickness and the death must occur within 90 days - Correct Answer ✅ Multiple Indemnity Rider The primary beneficiary is first in line. If the primary beneficiary is alive at the time the Insured dies, the Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) trustee is instructed to provide money to the trust beneficiary (big spender) only under specific circumstances (such as no more than $500 per week), cannot be seized by creditors - Correct Answer ✅ Spendthrift Trust Policy can only be adjusted, not voided - Correct Answer ✅ Misstatement of age or gender At its own expense, the Insurer has the right to conduct as many physical exams upon the Insured as are reasonable. The Insurer may perform one autopsy unless prohibited by state law. - Correct Answer ✅ Physical Exam and Autopsy Clause Healthcare for the elderly (Also will help disabled people after they have collected disability for 24 months) - Correct Answer ✅ Medicare Healthcare for the poor - Correct Answer ✅ Medicade Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Unable to engage in any gainful activity due to physical or mental impairments (Minimum 12 month span). - Correct Answer ✅ Fully Disabled $255 funeral help % of PIA paid to survivor (After 10 years) - Correct Answer ✅ Survivor benefits (State to state program) Injured on the Job, covers med expenses Die on the job Benefit paid to spouse Disabled on job, disabilities income payment - Correct Answer ✅ Workers Comp Work comp (Can't sue employer). Amount controlled by state law Can get all medical expenses and get SOME of their wages back but not all (2/3 usually) Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Disability only paid until retirement, then Social security takes over Employer pays the premium - Correct Answer ✅ Sole remedy for hurt on the job Medical information bureau, private non-profit company created by insurance companies to share information between insurers, pre-notice for report required for insured Any information on application may be shared with MIB MIB report may be requested by insurance company IF a claim is filed later on, updated MIB report may be sent to insurance company Records cannot include a company's underwriting decision Can't report amount of insurance Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Required in divorce settlement, requires vested interest in the policy, need beneficiary's permission to borrow from policy, transfer or diminish the policy's value, retains vested interest even if they die first - Correct Answer ✅ irrevocable beneficiary Premature death Create an estate To counteract taxes Gaurentee insurability Cash value account Creditor life insurance Protect businesses Employee compensation - Correct Answer ✅ Reasons to buy life insurance Temporary insurance that pays upon death but does not build up a cash value savings account - Correct Answer ✅ Term insurance Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Only applies to term policies, when client outlives term of policy - Correct Answer ✅ Expire A life policy that builds up cash value - Correct Answer ✅ Permanent Policy The amount to be paid to the insured upon death - Correct Answer ✅ face value (Death benefit, proceeds) Payment paid to insurance company for policy (usually fixed) - Correct Answer ✅ Premium 31 day grace period begins when you fail to make the premium by the due date - Correct Answer ✅ Grace period Termination of policy due to non-payment after the 31 day grace period - Correct Answer ✅ Lapse Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Outlive the whole life policy OR the insured died - Correct Answer ✅ Maturity A producer must have reasons to believe that the policy he/she sold to someone is suitable Human life approach: maintain standard of living Needs approach: what client actually needs - Correct Answer ✅ Life insurance suitability The premium does not change throughout the life of the policy - Correct Answer ✅ Level premium term policies After the level term policy can extend coverage without providing proof of insurability. The premium will go up each year, due to higher attained age and no proof of insurability. Max age of 65. Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Increasing premium as time goes on - Correct Answer ✅ Graded/graduated premium whole life Proof of insurability from whole life to term life - Correct Answer ✅ Conversion (Whole life) When a policy is transferred to a creditor and the creditor names itself as the beneficiary - Correct Answer ✅ Collateral (temporary) assignment The procedure by which the transfer is accomplished - Correct Answer ✅ assignment clause Owner transfers the owner's entire interest in the policy to the assignee - Correct Answer ✅ absolute assignment The policy and the application constitute the entire agreement between the parties Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Only executive officers are authorized to make changes to the policy Statements in the contracts (by the insured) are representations, not warranties - Correct Answer ✅ Entire contract clause 10 days to hang onto the policy and void it at any time for any reason. Begins at policy reception, not issue - Correct Answer ✅ Free-look clause (return/exchange provision) After two years all claims in the application are protected from being contested - Correct Answer ✅ Incontestable clause Age and gender remain forever contestable. Company adjusts death benefits accordingly to the amount the premium would have purchased at the correct age or gender (adjust the face value based on premium) - Correct Answer ✅ Misstatement of age or gender clause outlines how, when, and where Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) premium payments should be made - Correct Answer ✅ Premium payment clause defines the rules surrounding policy loans Only applies to Permanent policies Grants the Insured the right to borrow against the accumulated cash value States the interest rate (usually 8 percent) Requires that enough collateral be in the cash value account to pay both the loan and the interest. So, the full cash value can never be borrowed!. - Correct Answer ✅ Loan values clause optional provisions usually are exclusions that help the company avoid paying claims - Correct Answer ✅ Optional Provisions (riders) Voids coverage if the insured commits suicide within the first two years of the policy. refund of premiums without interest - Correct Answer ✅ Suicide clause Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) pay the premium. - Correct Answer ✅ Automatic premium loan rider ensure that a policy does not lapse if the insured suffers a disability and cannot work. - Correct Answer ✅ Waiver of Premium rider waives the premium just like the Waiver of Premium Rider, PLUS it provides a stated amount of income replacement benefit for the duration of the disability. - Correct Answer ✅ Waiver of Premium with Disability Income Rider The cost of the policy may go up, but so will the face value. Basically the policy follows the trend of the currency (CPI, Consumer Price Index). They can ONLY go up, so this is basically a increasing term policy. - Correct Answer ✅ Cost of Living Rider Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Offers the insured specified increases in the policy's death policy death benefit at very specific intervals or events such as certain birthdays or when the insured gets married or has a child. The premium charged for the additional insurance will be based on the insured's attained age - Correct Answer ✅ Guaranteed insurability rider A rider that would return the premium paid into the policy. This rider dramatically adds to the monthly payment due to the company each month, but is not considered part of the actual premium. - Correct Answer ✅ Return of Premium Term Rider A rider that allows the beneficiary to receive, upon the insureds demise, the death benefit and the cash value. Usually not extended beyond age 65. - Correct Answer ✅ Return of cash value term rider Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Whole life to insured, convertible term life riders on family members, or business partners - Correct Answer ✅ Additional insured term rider Prevents a young person from having to pay the premium until a specified age if the policy owner dies and the premium can no longer be paid - Correct Answer ✅ Payor Benefit rider (Applicant waiver provision) Only mutual insurance companies Overcharge in premium returned to policy holders Law prohibits garentee of dividend Generally not in term insurance, but used in whole life - Correct Answer ✅ Dividend option Buy a miniature paid up whole life policy Dividend used as a single net premium payment to purchase as much paid-up insurance as possible Free of sales commissions and expenses - Correct Answer ✅ HELP!!! Additional paid-up insurance Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) not taxable, but the interest is. - Correct Answer ✅ Accumulate at interest dividend option The company sends you a check with the value of the dividend. the company send the policy owner a check when the dividend is issued (on the anniversary date) Law prohibits any guarantee on policy dividends. Almost completely exclusive to whole-life policies - Correct Answer ✅ Cash dividend option The dividend is used to payoff part or all of the policies premium. - Correct Answer ✅ Reduced premium dividend option The dividend is used to reduce the total length of time the own has to pay the whole life policy - Correct Answer ✅ Paid-up life dividend option Borrow against the cash value Use the living trust Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Surrender and terminate the policy - Correct Answer ✅ Cash Value options IF the policy is fore-fitted, the cash value is returned to the insured NOT taken by the company - Correct Answer ✅ Non- forfeiture of cash value Extended term insurance Reduced-paid up insurance Cash - Correct Answer ✅ Non-forfeiture options Uses the cash value to buy a term policy (same face value as the canceled who life policy and extend coverage as long as the cash value from the prior policy will allow). This is the default option. - Correct Answer ✅ Extended term insurance Exchanges the cash value for a "reduced paid-up while life policy" The new policy will have a smaller death benefit, but no more premiums. Basically, the cash is used to make a single premium payment to buy as large a policy as possible Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) given the insured's attained (current) age. - Correct Answer ✅ Reduced paid-up insurance Take the money and run. This nullifies the 3-year right of reinstatement privilege - Correct Answer ✅ Cash Complete an application within 3 years Payback the premiums with interest repay loans with interest provide proof of insurability - Correct Answer ✅ Reinstatement of lapsed policy Lump sum check (default method) - Correct Answer ✅ Cash settlement option ... - Correct Answer ✅ Annuity settlement option Invests the money and earns interest Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Buying life insurance plans on employees as a part of an overall compensation package. The employee and company join forces to buy insurance on the employee. Premiums and death benefits are shared by the employee and the company. - Correct Answer ✅ Split dollar plans The employer pays the employee in the future for work done today. IF the employee dies prior to retirement age, the beneficiary will receive the death benefit. In retirement the employee can surrender the policy and take the cash value when he is in a lower tax bracket. - Correct Answer ✅ Deferred compensation plan Almost always annually renewable term. Do not have free look (10 day) provision. - Correct Answer ✅ Group life insurance Face value of new policy cannot exceed that of the old policy. If moving to a new job can convert difference in coverage to an individual policy. Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) 31 day grace period (60 days if employer does not notify employees) IF insured dies during grace period, death benefit still paid. New premium based on attained age at time of conversion. Usually required to convert from term to whole life Does not apply when employer switches from one carrier to another The new policy is an individual policy and paid for by the individual. Any portion of the coverage paid for over $50,000 must be reported as income. - Correct Answer ✅ Conversion privilege (From group to individual insurance) The growth of money is tax deferred. IF the policy lapses or is surrendered, money exceeding premiums are taxed. Any cash value that exceed premiums payed is taxable. Death benefit is ALWAYS tax free. - Correct Answer ✅ Cash value taxation An endowment age earlier than 100. The cash value accumulates and achieves the face value earlier than age Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) 100. Higher premiums than standard whole life. Most expensive of all types of life insurance. - Correct Answer ✅ Endowment life insurance Occurs when your cash value grows too fast. When it happens you lose all the tax benefits of a life insurance policy. Loans from MEC's are taxable where the loan amount exceeds the premium amount. - Correct Answer ✅ Modified Endowment Contracts A hybrid of permanent and temporary coverage - Correct Answer ✅ Combination Policy Components of the policy are adjustable to meet the needs of the policy holder. If the insured wants to increase the death benefit, proof of insurability is required. - Correct Answer ✅ Adjustable life The premium correlates to the companies financial success. There is a cap on premium increases. Policy may have to shrink the face value rather than pay higher premiums. Policy Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Money set aside in an IRA is tax deductible in the year contributed and is tax deferred. ALL of the money is taxed as ordinary income. Contributions are tax deductible. The account grows tax deferred. Only earned income (wages, salaries, tips, commissions, bonuses) can be put into IRA. Individuals who are active participants in an Employer-Sponsored Qualified Retirement Plan - such as a 401(k) - are NOT eligible to deduct contributions if their adjusted gross income rises above specified limits. For eligible individuals, annual contributions are capped. - Correct Answer ✅ Traditional IRA Allows a person with sufficient earned income to contribute to an IRA for the benefit of the stay at home spouse. - Correct Answer ✅ Spousal IRA Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Money contributed is not tax-deductible, BUT all the accounts earnings grow tax free. No income tax on these earnings. EVER. No age limit on contributions. Money can be held in this account for life and given tax-free to heirs. - Correct Answer ✅ Roth IRA Portion of pre-tax salaries into investment accounts where it grows tax deferred. Matching from employer is common. Investment choice directed by employee. Cap on contributions. - Correct Answer ✅ 401 (k) Public schools and non profits. Pre-tax contributions and tax deferred growth. - Correct Answer ✅ 403 (b) Employees receive a potion of company profits. Contributions vary at the companies discretion. Contributions must be Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) "reoccurring and substantial". - Correct Answer ✅ Profit sharing pension plans Guaranteed specific retirement benefit paid for by employer. Formula determines how much is received by employee. - Correct Answer ✅ Defined benefit pension plans Employer contributes a specific amount each year to the plan. Employee is responsible for choosing the investment from choices offered by the retirement plan service. Must be funded regardless of company profits. - Correct Answer ✅ Defined contribution pension plans Self-Employed person can contribute a specified amount to a retirement fund. Contributions are tax deducible for the business. - Correct Answer ✅ Keogh (HR 10) plan Simpler to create and operate than a Keogh plan. - Correct Answer ✅ Simplified Employee Pension Plan (SEP) Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) The annuity pays a specified amount until the funds are exhausted - Correct Answer ✅ Fixed amount annuity certain Payments every month as long as the beneficiary is alive. The insurer determines the monthly payment based on a number of factors. - Correct Answer ✅ Life annuity Pays a set amount until the annuitant dies. This is the default annuity. - Correct Answer ✅ Straight life annuity Same as life annuity, but payments will continue to be paid even if annuitant dies for a specified period of time - Correct Answer ✅ Life annuity with period certain Payments for the whole life of the annuitant. If annuitant dies early, the remaining balance of the amount will be given to the annuitants estate. - Correct Answer ✅ Life annuity with amount certain (Refund life annuity) Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Payments continue until both annuitants have dies. - Correct Answer ✅ Joint and survivor life annuity pay out Guaranteed rate of return. - Correct Answer ✅ Fixed Dollar (Conventional) annuity Owner can chose the investment option. Account is valued in terms of shares or annuity units. When payout begins, the company calculates how many annuity unites it will pay the person each month. The units will remain constant, but the value of the units themselves will fluctuate. The annuitant can chance to a fixed annuity during the payout period. - Correct Answer ✅ Variable annuities Ties the growth of the cash value to an economic index. Pays the greater of a guaranteed minimum rate of return or a rate of return based on a particular economic index. - Correct Answer ✅ Equity indexed annuities Earnings in this annuity accumulate tax deferred. - Correct Answer ✅ Non-Qualified annuity using after-tax dollars Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Funded with pretax dollars, grows tax deferred. - Correct Answer ✅ Qualified annuity using pretax dollars Policies that are designed to help cover medical expences when the insured is sick or is involved in an accident. - Correct Answer ✅ Medical Expense Insurance Designed to replace part of the insured lost income if the insured becomes totally disabled and unable to work as a result of an accident or illness. - Correct Answer ✅ Disability Income Insurance Flat dollar amount the insured pays out of pocket each time a service is rendered. - Correct Answer ✅ copayment The company and the insured will share the payment of covered expenses after the deductible. Typically the company pays 80% and the individual pays 20%. - Correct Answer ✅ Coinsurance Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Company wont pay health claims that arise from the insureds occupation of or involvement in a felony or pursuit of an illegal action (There is no provision for this in life insurance, only health insurance) - Correct Answer ✅ Illegal occupation provision May exclude health insurance coverage if the accident claim arises from the insured us of alcohol. Rare in modern health policies. - Correct Answer ✅ Intoxicants or Narcotics provision Prevents individual insured from profiting by owning multiple individual policies with the same company. In this situation, the companies will pay its proportional share. - Correct Answer ✅ Other Insurance with this insurer provision Prevention from profiting by having multiple policies with different companies. - Correct Answer ✅ Insurance with Other Insurers Provision Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) The Insured has the right to cancel the policy at any time without affecting any pending claims - Correct Answer ✅ Cancellation Provision If the language of a health insurance contract does not conform to state law, it shall automatically be amended so that it does. - Correct Answer ✅ Conformity with state statuses provision Before paying a health insurance claim, the insurer must deduct the past due premiums plus interest from the benefits - Correct Answer ✅ Unpaid premiums provision A health policy that excludes payment for specific preexisting conditions - Correct Answer ✅ Exclusion rider/Exclusion Waiver/Impairment Rider Options: Medical, hospital, surgical. No deductible and only cover the most elemental health care needs. - Correct Answer ✅ Base (Basic) Medical plans Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) A list of medical procedures and how much the company will pay for each. - Correct Answer ✅ Schedule of Indemnities The company will pay for the UCR based on the region where the surgery is performed and the remainder is covered by the insured. - Correct Answer ✅ URC (Usual, reasonable, customary) Non-surgical services of physicians for the treatment of accident or illness - Correct Answer ✅ Basic medical policy Pays for every expense in a hospital except for doctors and surgeons. Allowable expenses include Daily benefit rate (daily dollar amount) and everything that is not room an board (Miscellaneous expenses) - Correct Answer ✅ Basic Hospital Policy Covers the cost of surgery including fees of surgeons, anesthesiologists and post-operative care. - Correct Answer ✅ Basic surgical policy Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Medical expense coverage designed to pay injuries or death associated with accidents only. This covers groups like civic organizations, camps, religious organizations etc. - Correct Answer ✅ Blanket policies Policies covering specific diseases (Indemnity) - Correct Answer ✅ Dread Disease policies Pays its benefits when you show that you have contracted the disease. Benefits are paid to you as you wish (Stated value, Non-indemnity) - Correct Answer ✅ Critical illness policies Information in the application is a representation not a warranty. The insurer must attach a copy of the application to the group policy. - Correct Answer ✅ Copy of the application provision If the insured waives group coverage but then later wants to join during an open enrollment period, proof of insurance may be required. - Correct Answer ✅ Evidence of insurability provision Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) An insured must provide the company with written notification in 20 days - Correct Answer ✅ Notice of claim provision The company must provide claim forms to the insured within 15 days of receiving the notification of loss - Correct Answer ✅ Claim form provision The insured must, within 90 days of the loss provide the company with written proof of loss - Correct Answer ✅ Proof of loss provision The company must pay claims in 60 days - Correct Answer ✅ Time of payment claims provision Reasonable number of physical exams and one autopsy - Correct Answer ✅ Physical exam and autopsy provision Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) if a family has two group policies, each family member is deemed to have only one primary policy, the other spouses policy will be the secondary policy - Correct Answer ✅ Coordination of benefits clause Continued group coverage for former employees for a specified period of time. Does not apply to those terminated for gross misconduct. Persona has 60 days to select coverage. 18 months for terminated employee or dependents. 29 months for disabled employee or dependents and 36 months for dependents of divorced or deceased worker - Correct Answer ✅ COBRA Medical expense and disability income premiums paid by the employer are tax deductible for employer, but premiums are not taxable income to the employee - Correct Answer ✅ Medical premiums and taxes Employees never pay income taxes on benefits paid under a medical expenses policy. Employees don't pay income taxes on benefits paid under a Disability Income policy IF the Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Subscribers can choose not to coordinate their care through a primary physician and still receive some coverage - Correct Answer ✅ HMO Point of Service plan the employer is responsible for funding the plan, administering the plan, paying claims and taking the rist that there will be adequate funding to pay the claims Often buy stop loss coverage from a regular insurance company - Correct Answer ✅ Employer self-funded plan Employer must offer plan. Reduces the employee's taxable income. The employer may also contribute. Third party administrator will reimburse employees for eligible expenses. Use it or lose it! - Correct Answer ✅ Flexible Savings Account (FSA) Like a bank account the consumer draws from. Hoping that the consumer will treat it more thriftily because they can use the money later in retirement. Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) High deductible health policy Pre-tax advantaged pre-funded savings account to be used to cover the deductables - Correct Answer ✅ Consumer Directed Health Plans Medical expense policy with a high deductible and a maximum out of pocket spending limit. Savings account used to cover routine medical expenses. Back-up with high deductible health plan. - Correct Answer ✅ High Deductible Health Policy Discontinued in 2003 due to over-regulation. - Correct Answer ✅ Medical Savings Account Any individual or business may participate. Money put in is tax-deductible. Annual balance rolled over. Balance accrues tax-deferred and can be used for any retirement - Correct Answer ✅ Health Savings Account Washington Life/Health Insurance Exam Questions and Answers (Latest Update 2024) Funded by the employer to reimburse employee claims. Contributions only made by the employer. Rollover. Non- portable. - Correct Answer ✅ Health reimbursement account Federal health insurance for people 65 and older, chronic kidney disease, widow(ers) over age 50, and people with disability benefits for 29 months. - Correct Answer ✅ Medicare title 18 No premium payment. Home visits. Some hospital care. Hospice care. 90-days in-patient hospital services per benefit period (Benefit period begins when entering hospital, ends when being out of hospital for 60 consecutive days). - Correct Answer ✅ Medicare Part A (Hospital insurance)