ILLINOIS ACCIDENT AND HEALTH INSURANCE EXAM

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ILLINOIS ACCIDENT AND HEALTH INSURANCE EXAM

Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -72 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: Short Term Disability

Answer:

Elimination period of 1 to 7 days. Benefits could start in two weeks and continue for 2 years. Most popular payment period is 26 weeks of benefits. Must be completely disabled. Can be flat amount or limited to 50-70% of gross weekly income.

Question 2: Non-cancelable Renewability

Answer:

As long as premiums are paid, the insurer cannot cancel or modify the policy in any way or change the premium rate.

Question 3: Miscellaneous Expense Benefit

Answer:

-Operating room -Lab fees -Drugs (Over the counter only) -Anesthetics -Dressings

Question 4: Covered by Basic Hospital

Answer:

-Diagnostic Xray/Lab fees -Radiology therapy -In-patient Doctor Treatments

-Ambulance Service

Question 5: Time Limit on Certain Defenses aka Contestable period

Answer:

After a specified period of time, usually two years, an insurer cannot void a policy or deny payment of a claim based upon misstatements by the applicant except for fraudulent misstatements.

Question 6: Group Disability Insurance

Answer:

Provides weekly or monthly can payment to employees who are disabled from an illness or accident.Employer is the policy holder. Employees get a certificate of insurance.

Question 7: Preferred Provider Organization (PPO)

Answer:

Offers services to PPO members at pre-arranged reduced rates

FEE FOR SERVICE

Question 8: Blue Cross: Hospital

Blue Shield: Doctor

Answer:

Pre-payment to cover hospital services. Utilizes contracted hospitals and physicians. Payments made directly to hospital and/or doctor.

Question 9: Optionally Renewable

Answer:

Allows insurers the option of not renewing the policy but only on the policy anniversary date or premium due date.

Question 10: Major Medical Payment

Answer:

-Deductible called a corridor -80/20 coinsurance

Question 11: Small Employer

Answer:

No more than 25 employees

Question 12: Conditional Approval

Answer:

More restrictive that conditional insurability. Provides that the insurance coverage is effective as top the date the application is approved.

Question 13: Long Term Disability

Answer:

Provides benefits after Short Term Disability ends. Can be as short as 2 years or go until age 65.

Question 14: Medicare Part B

Answer:

Most people pay a monthly premium of $135.50 for part b if their income is less than $85,000 for a single individual or $170,000 for a married couple.Annual deductible of $185.

Question 15: Individual Health

Answer:

Individual underwriting. Rates are charged based on health and occupation.Special pricing offered to those in excellent health/workout regularly.

Question 16: Health Maintenance Organization (HMO)

Answer:

Primary care physician. Pre-paid fixed amount for each enrollee. Must see PCP once a year. Required to get a referral from PCP to see a specialist.

Covers:

-Emergency care -Inpatient care -Physician care -Mental health services -Alcohol/drug abuse -Preventative care Cannot exclude a pre existing condition for more than one year from the effective date of coverage.

Question 17: Elimination Period

Answer:

Period of time immediately following the start of disability, when benefits are not paid. Longer elimination period = cheaper premiums.

Question 18: Medicare Supplement (Medigap)

Answer:

-Free look = 30 days -Deductible of $1350 for part a, $183 for part b, $400 for part d (optional)

Question 19: Occupational vs Non-occupational

Answer:

Occupational: Covered on or off the job.

Non-occupational: Covers only non-work related disabilities.

Question 20: Partial Disability

Answer:

Able to perform some aspects of the job, but not all of them. (i.e. surgeon loses a hand. cannot perform surgery but can still be a physician.)

Question 21: Minimum Free Look Period

Answer:

10 Days

Question 22: Point of Service

Answer:

Insured picks a primary care physician and this doctor is the reference source for all the medical services provided to the patient.

Question 23: Business Disability Buyout

Answer:

Buy-Sell agreement. In the event of a totally disabled business partner, the policy pays a stated benefit for the purpose of buying out the business interest of the disabled partner.Proceeds are not taxable.

Question 24: Health Reimbursement Account (HRA)

Answer:

Solely employer funded. Reimburses employees for medical expenses up to a stated amount.Employers gets a tax deduction for payments.Only available to current employees.