owners rights – answer if an individual health insurance policy provides a death benefit, the
policyowner will be able to designate a beneficiary and, unless the beneficiary designation is
irrevocable, to change the beneficiary. the power to change the beneficiary is provided in the
change of beneficiary provision. the policyowner also has the right to make any other change
without the consent of the beneficiaries.
dependent children benefits – answer the group coverage may be extended to cover the
insureds dependents. eligible dependents include the insureds children, spouse, dependent
parents, and anyone else upon which dependency can be proven.
every policy providing coverage for a dependent child until a specified age will not terminate
that coverage if the child is dependent upon the insured and is incapable of self support
because of physical or mental handicaps. proof of the dependency is required within 31 days of
the child attaining the maximum age. upon request, proof of dependency is required annually
after a 2 year period following attainment of maximum age
modes of premium payment – answer higher frequency of payments = higher premium
payments
nonduplication and coordination of benefits – answer the purpose of the coordination of
benefits (COB) provision, found only in group health plans, is to avoid duplication of benefit
payments and overinsurance when an individual is covered under multiple group health
insurance plans. the provision limits the total amount of claims paid from all insurers covering
the patient to no more than the total allowable medical expenses
primary plan – answer the plan that is responsible for providing the full benefit amounts as it
specifies.
secondary or excess plan – answer once the primary plan has paid its full promised benefit, the
insured submits the claim to the secondary provider for any additional benefits payable
(including deductibles and coinsurance). in no case will the total amount the insured receives
exceed the costs incurred or the total maximum benefits available under all plans.
loss – answer amount covered by primary plan = amount covered by secondary plan
occupational coverage – answer provides benefits for illness, injury or disability resulting from
accidents that occur on or off the job
nonoccupational coverage – answer only covers claims that result from accidents or sickness
occurring off the job
personally owned health insurance – answer premium payments on personally owned disability
income policies are non deductible by the individual. however, desability income benefits are
recieved income tax free by the individual.
in either medical expense insurance policies or long term care insurance policies, premiums
paid by the individual policyholder are deductible as a medical expense to the extent that when
added to all other unreimbursed medical expenses, the total exceeds 7.5% of the taxpayers
adjusted gross income. however, there is a limit on the amount of premium that can be
deducted depending on the age of the insured (taxpayer) at the end of the year. the IRS sets
annual limits for that amount, and any premium above these limits will not be considered a
medical expense, and therefore, cannot be tax deductible. the provision only applies if the
insured itemizes these deductions on his/her tax return
employer provided health insurance-premiums – answer paid by the employer for disability
income insurance for its employees are deductible as a business expense and are not covered as
taxable income to the employee.
employer provided health insurance- benefits – answer received by an employee that are
attributable to employer contributions are fully taxable to the employee as income
Download full pdf here https://learnexams.com/search/study?query=