Health Insurance - Nc

Medicare Part A begins automatically at age 65. This is the age at which most individuals become eligible for Medicare benefits. Medicare Part A covers hospital insurance and helps to pay for inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. It is important for individuals to enroll in Medicare Part A around their 65th birthday to ensure they have coverage when they become eligible.

A domestic insurer refers to an insurance company that is organized and operates under the laws of a specific state. In this case, the insurer is organized under the laws of the State of North Carolina, making it a domestic insurer.

When an employee is injured while driving in the employ of the company, the coverage for the employee comes from the company's Workers Compensation policy. Workers Compensation insurance provides benefits to employees who are injured or become ill as a result of their job. It covers medical expenses, lost wages, and rehabilitation costs for the injured employee. General Liability insurance typically covers third-party claims for bodily injury or property damage, while the employee's health policy only covers personal medical expenses unrelated to work. Therefore, in this scenario, the correct answer is FYI's Workers Compensation.

The correct answer is 20 employees because the Consolidated Omnibus Budget Reconciliation Act (COBRA) requires employers with at least 20 employees to offer continued health insurance coverage to employees and their dependents after they lose their job or experience a reduction in work hours. COBRA allows individuals to maintain the same level of coverage they had while employed, but they must pay the full premium themselves.

The underwriting department is responsible for evaluating, selecting, and distributing risks. They assess the potential risks associated with insurance policies and determine the appropriate premiums to charge. This department plays a crucial role in ensuring that the insurance company maintains a profitable portfolio by carefully analyzing and managing risks.

Morbidity refers to the occurrence of illness or disease in a population. In the context of health insurance, it is used to assess the risk of an individual or group developing a particular health condition. Factors such as income, sex, and age can influence morbidity rates as they may impact access to healthcare, prevalence of certain diseases, and overall health status. However, intelligence is not typically considered a factor in determining morbidity as it does not directly affect the likelihood of developing a disease or illness.

If an agent's license is inactive, it means that the agent is not authorized to transact any insurance business for which a license is required. This means that the agent cannot legally sell or provide insurance services until their license is reactivated.

The beneficiary is the person who has rights in a policy only after the death of the insured. They are the individual or entity designated by the policy owner to receive the benefits or proceeds from the insurance policy upon the insured's death. The beneficiary does not have any rights or access to the policy while the insured is still alive.

The employee requiring abdominal surgery after food poisoning in the lunch room would not be considered accidental because food poisoning is typically not considered an accidental event. Accidental events usually involve unexpected and unintentional incidents, such as injuries caused by falling objects, severing a hand while working, or falling from a height. Food poisoning, on the other hand, is generally caused by consuming contaminated food and is not typically considered an accidental event.

Activities of Daily Living (ADLs) are basic self-care tasks that individuals perform on a daily basis to maintain their personal hygiene and independence. Eating and dressing are two examples of ADLs as they involve essential tasks related to nourishment and maintaining personal appearance. These activities are fundamental for individuals to meet their basic needs and carry out their daily routines.

Concealment refers to the act of intentionally withholding or not disclosing important information that a party to an insurance contract knows and should communicate. This can include not revealing previous medical conditions, prior accidents, or other relevant details that could affect the insurance coverage or premiums. Concealment can lead to the denial of a claim or the cancellation of the insurance policy.

When an individual license is terminated, it means that it is no longer valid or in effect. In this case, the correct answer is "On the death of the licensee." This means that if the person who holds the license passes away, the license is considered terminated and no longer valid. This could be due to legal requirements or the need to transfer the license to another person or entity after the licensee's death.

The Insurance Commissioner is selected through an election by the people. This means that the citizens of the state have the opportunity to vote for their preferred candidate for the position of Insurance Commissioner. This democratic process allows for the Commissioner to be chosen based on the will and choice of the people, ensuring that the position is held by someone who has gained the trust and support of the public.

If a policy is returned to the insurer within 10 days of its delivery, the applicant is entitled to a full refund of the premium paid. This means that 100% of the premium will be returned to the applicant in this scenario.

Coordination of benefits is the process used to determine the order in which multiple insurance plans will pay for a claim when a claimant is covered by more than one plan. This ensures that the claimant does not receive more than 100% of the total eligible expenses. The primary plan, typically the plan in which the claimant is enrolled as the primary policyholder, pays first, and the secondary plan pays any remaining expenses up to its coverage limits. This process helps prevent overpayment and ensures fair distribution of benefits among the multiple insurance plans.

Replacement refers to the transaction where an individual purchases a new insurance policy to replace an existing policy. This typically occurs when the policyholder wants to switch to a different insurance provider or obtain a new policy with better terms or coverage. The existing policy is terminated and replaced with the new one. This process is commonly done to ensure that the policyholder has the most suitable insurance coverage for their needs.

The man in the scenario slipped and fell down a flight of stairs at his workplace, resulting in paralysis. Since this injury occurred at his workplace, he will likely be able to collect disability income benefits from Workers Compensation. Workers Compensation is a form of insurance that provides benefits to employees who are injured or become ill as a result of their job. It covers medical expenses, rehabilitation costs, and a portion of lost wages for the injured worker.

A mutual insurer is an insurance company that is owned by its policyholders. This means that the policyholders are also considered the owners of the company and have a say in its operations and decision-making processes. In a mutual insurer, any profits made by the company are typically distributed back to the policyholders in the form of dividends or reduced premiums. This ownership structure is different from a capital stock insurer, where ownership is held by shareholders, and a fraternal insurer, which is a type of mutual insurer that operates on a nonprofit basis. A reciprocal exchange is a different type of insurance organization where policyholders exchange insurance contracts with one another.

The main master policy owner of a group health insurance contract is the employer. This means that the employer is responsible for purchasing and maintaining the group health insurance policy for their employees. The employer typically negotiates the terms and coverage options with the insurance provider and pays the premiums on behalf of the employees. The employer also has the authority to make changes to the policy and add or remove employees from the coverage.

Terminally ill persons would need hospice care because it is a type of care that focuses on providing comfort and support to individuals who are nearing the end of their life. Hospice care aims to improve the quality of life for patients and their families by addressing their physical, emotional, and spiritual needs. It involves a multidisciplinary team of healthcare professionals who work together to manage pain, provide symptom relief, and offer emotional support. Hospice care can be provided in various settings, including the patient's home, a hospice facility, or a hospital.

The correct answer is "After the first six months of disability." This means that the insured will be eligible for a waiver of premium benefit only after they have been disabled for at least six months. This benefit allows the insured to stop paying premiums for their disability insurance policy while they are disabled, providing financial relief during this period.

The Insurance Commissioner may suspend or revoke an applicant's insurance license for various reasons, including being refused a license in another state, willfully misrepresenting insurance policy provisions, and mishandling funds received during insurance transactions. However, reporting a change of address to the Commissioner in 8 days is not a valid reason for suspension or revocation.

The Fair Credit Reporting Act requires a reporting company to respond to a consumer's complaint that his file contains inaccurate information. This act is designed to promote accuracy, fairness, and privacy of consumer information held by reporting companies. It gives consumers the right to dispute inaccurate information in their credit reports and requires reporting companies to investigate and correct any errors.

Stop-loss coverage is a type of insurance that protects an insurance company from excessive losses by limiting the amount they have to pay out in claims. In this scenario, the insurance company will only pay claims once a self-insured, specified limit has been reached. This means that the company will not have to pay for claims below this limit, reducing their financial risk. Stop-loss coverage is commonly used by self-insured employers or groups to protect themselves from large and unexpected claims expenses.

The Insurance Commissioner has the right to suspend or revoke the license of an agent if they lack authority from an insurer named on a binder for coverage. This means that if an agent is not authorized by the insurer to provide coverage, the Insurance Commissioner can take action against them by suspending or revoking their license. This is done to ensure that only authorized agents are selling insurance and to protect consumers from unauthorized or fraudulent practices.

Incontestability is the correct answer because it is a policy provision that prevents an insurer from voiding a policy for misstatements after a specific period of time, usually 2 years. This provision is designed to protect policyholders from having their coverage revoked based on innocent or unintentional misrepresentations made when applying for the policy. After the incontestability period expires, the insurer cannot use misstatements as a reason to cancel the policy or deny claims.

Key person insurance is a type of life insurance policy that a corporation can purchase to protect itself financially in the event of the death of a key employee, such as a senior sales manager. This insurance policy provides the company with funds to cover the financial losses that may occur due to the absence of the key employee, such as lost revenue, recruitment and training costs for a replacement, and potential business disruptions. It helps the company to continue its operations smoothly and minimize the financial impact of losing a key member of the team.

A family deductible refers to a single deductible amount that applies to all members of the same family. This means that once the total amount of medical expenses for the family reaches the deductible, the insurance coverage kicks in. It provides the right to single family member deductibles, meaning that if an individual within the family incurs medical expenses that meet their own deductible amount, their coverage will also begin. This type of deductible is beneficial for families as it allows them to pool their medical expenses together and reach the deductible faster.

The law of large numbers is a mathematical rule that states that as the number of individual but similar exposure units increases, it becomes easier to predict losses. This means that by increasing the sample size, the average outcome becomes more predictable and stable. In the context of insurance, this principle allows insurers to accurately estimate the probability of losses occurring and set appropriate premiums.

ERISA stands for the Employee Retirement Income Security Act. It is a federal act that aims to protect participants in group retirement plans, such as pensions and 401(k) plans. ERISA ensures that employees receive the benefits they are entitled to and establishes rules for plan administration, fiduciary responsibilities, and reporting and disclosure requirements. This act plays a crucial role in promoting pension equality and transparency in the management of employee retirement plans.

The feature of a Self-Insured (Self-Funded) Plan is that claims are paid out of their own funds instead of funding claims through an insurer. This means that the company takes on the financial risk of paying for their employees' healthcare expenses instead of relying on an insurance company to cover those costs. This can be advantageous for large companies or entrepreneurs who have the financial resources to manage and pay for these claims directly. Additionally, this type of plan typically does not require evidence of insurability, meaning employees do not need to provide proof of their health status to be eligible for coverage.

Agents are required to complete 24 hours of continuing education every two years, which is equivalent to one biennial year. This means that they are not required to complete continuing education on an annual basis, but rather every two years.

To join a group insurance plan without proving insurability, an employee must join the plan during the enrollment period. This is the designated time period when employees are allowed to enroll in the group insurance plan. Joining the plan while eligible but after the enrollment period, during the probationary period, or during the elimination period would not guarantee the employee's eligibility without proving insurability. Therefore, joining during the enrollment period is the correct answer.

The Certificates of Insurance are issued to the group members in group insurance. This is because the certificates serve as proof of coverage for each individual member within the group. By issuing the certificates to the group members, they have access to the necessary information regarding their insurance coverage and can utilize it when needed. The group sponsor, employer, and plan administrator may also have access to this information, but the primary recipients are the group members themselves.

After the death of a natural person who holds a valid insurance license, the license always terminates. This means that the license is no longer valid and cannot be transferred to another person. The death of the license holder automatically cancels the license and it cannot be used by anyone else.

The insured driving too fast can be considered a morale risk because it reflects a lack of responsibility and disregard for safety. This behavior can have negative consequences, such as accidents or violations, which can impact the insured's reputation and potentially lead to higher insurance premiums. It also indicates a potential lack of judgment and self-control, which can be seen as a character flaw and affect the insured's overall trustworthiness.

Deductibles, coinsurance, and co-payments in a health insurance policy are cost-effective choices that have the effect of cost sharing. This means that the policyholder and the insurance company share the costs of healthcare expenses. The policyholder pays a portion of the costs through deductibles, coinsurance, and co-payments, while the insurance company covers the remaining portion. This sharing of costs helps to reduce the financial burden on both the policyholder and the insurance company, making it a cost-effective option for managing healthcare expenses.

In managed care, the members' choice of providers is most restrictive in an HMO (Health Maintenance Organization) plan. HMOs typically require members to choose a primary care physician (PCP) who acts as a gatekeeper for all healthcare services. Referrals from the PCP are usually necessary for seeing specialists or receiving specialized care. Additionally, HMOs often have a limited network of providers, and coverage may be limited or nonexistent for out-of-network services. This level of restriction on provider choice distinguishes HMOs from other types of managed care plans like PPOs (Preferred Provider Organizations) or Point of Service plans.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a qualifying event allows an employee who is covered by health insurance to choose to continue their coverage. This means that even if the employee's employment status changes, such as through termination, they have the option to maintain their health insurance benefits for a certain period of time. This ensures that the employee and their dependents can still have access to healthcare even after leaving their job.

Dread disease insurance refers to supplemental insurance that is specifically designed to cover the expenses related to hospital confinement for the treatment of a specific illness, such as cancer. This type of insurance provides financial support to individuals diagnosed with a critical illness and helps cover the costs of medical treatments, hospital stays, and other related expenses. It is commonly referred to as dread disease insurance because it provides coverage for specific diseases that are often feared due to their severity and potential impact on a person's life.

The incontestability clause prevents the insurer from rescinding the insurance policy after it has been in effect for two years. This clause essentially states that after this time period, the insurer cannot contest or challenge the validity of the policy based on any misrepresentations or omissions made by the insured during the application process. It provides a level of protection for the policyholder, ensuring that once the policy has been in force for two years, the insurer cannot cancel or void it based on any previous discrepancies.

The code states that all insurers are required to have a department to investigate possible fraudulent claims from insureds. This means that insurers must have a specific team or division dedicated to examining and looking into any suspicious or potentially deceitful claims made by their policyholders. This is important to ensure that insurers can identify and prevent any fraudulent activities that may occur within their insured population, thereby protecting the integrity of the insurance system.

The 30-day free look period is a feature of Medicare Supplement Insurance (Medigap) policies. When a senior citizen turns 65 and enrolls in Medicare Part B, they become eligible to purchase a Medigap policy. During the 30-day free look period, they can review their policy, determine whether it meets their needs, and if not, cancel the policy and receive a full refund. This 30-day free look period is specific to Medigap policies for individuals who are 65 years of age or older and not for those under individual or group plans or at age 60 or older.

If an individual fails to send the documents after receiving a Notice of Seizure from the Commissioner, the penalty is a possible combination of 1 year in jail and/or a $1,000 fine. This means that the individual may be sentenced to serve up to 1 year in jail, or they may be required to pay a fine of $1,000, or they may face both penalties depending on the decision of the court. The severity of the penalty is determined by the court based on the specific circumstances of the case.

A person who refuses to submit books and records to the commissioner would be guilty of a misdemeanor. This means that they have committed a minor criminal offense, which is less serious than a felony. Refusing to provide books and records to the commissioner could be seen as obstructing an investigation or withholding important information, which is generally considered a punishable offense.

The correct answer is "Entire contract, grace period, reinstatement." These are common insurance policy provisions. The entire contract provision states that the policy and any attached endorsements constitute the entire agreement between the insured and the insurer. The grace period provision allows the insured a specified period of time after the premium due date to make payment without the policy lapsing. The reinstatement provision allows the insured to reinstate a lapsed policy by paying any outstanding premiums and meeting any other requirements set by the insurer.

The policyholder has the right to change life insurance policy beneficiaries. As the owner of the policy, they have the authority to make changes to the beneficiaries listed on the policy. This allows them to update or remove beneficiaries as needed, ensuring that the policy reflects their current wishes and circumstances. The policyholder has the power to make decisions regarding who will receive the life insurance benefits upon their death.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a qualifying event refers to certain life events that may cause an individual to lose their health insurance coverage. Divorce is considered a qualifying event as it often leads to a change in marital status, which can result in the loss of health insurance coverage provided by a spouse's employer.

The correct answer is "Within a specified number of days after injury occurs." This means that in order for the policyholder to receive the principal sum benefit of death in a disability policy, the death must happen within a certain timeframe after the injury occurs. This indicates that there is a time limit for the death to be considered related to the injury and be eligible for the benefit.

Making a recommendation to the customer after consulting on his/her needs would not be considered an unfair trade practice. This action is a normal part of the insurance business and is expected when providing services to customers. However, the other options listed in the question, such as making untrue or misleading statements, filing false financial statements, and misrepresenting policy terms, are all examples of unfair trade practices as they involve dishonesty and deception.