Life and Health Insurance Guide Exam Flashcards

Which of the following legislation was made by the National Association of Insurance Commissioners (NAIC) to set up standard provisions for all individual health insurance policies?

Answer: The Uniform Individual Accident and Sickness Policy Provisions Law

The National Association of Insurance Commissioners (NAIC) developed the Uniform Individual Accident and Sickness Policy Provisions Law. This legislation established a set of standard provisions that must be included in all individual health insurance policies, ensuring consistency and consumer protection across different insurers and states. It aims to standardize policy language and requirements.

When an insured person switches to a more dangerous employment, some individual health insurance policies have provisions that allow insurers to modify medical plan premiums. This provision is known as:

Answer: The “Change of Occupation” provision

The 'Change of Occupation' provision in individual health insurance policies allows the insurer to adjust benefits or premiums if the insured changes to a more hazardous or less hazardous occupation. If the new occupation is more dangerous, the insurer may reduce benefits or increase premiums to reflect the increased risk. This provision ensures the policy accurately reflects the insured's risk profile.

A company is an "Applicable Large Employer (ALE)" if:

Answer: Had an average of 50 or more combined full-time or full-time equivalent employees during the prior calendar year

Under the Affordable Care Act (ACA), an employer is considered an 'Applicable Large Employer (ALE)' if they had an average of 50 or more full-time employees (including full-time equivalent employees) during the prior calendar year. This definition is crucial because ALEs are subject to specific requirements, such as the employer shared responsibility provisions, which mandate offering affordable health coverage to full-time employees.

The employer is financially liable for the payment of claims to covered persons under a self-funded health plan. Which of these would reduce financial risks associated with high plan utilization?

Answer: Stop-loss insurance

Stop-loss insurance is designed to protect self-funded employers from catastrophic financial losses due to unexpectedly high healthcare claims. It sets a limit on the amount the employer will pay out of pocket, either per individual claim or in total for the plan year. This transfers the risk of very high plan utilization and large claims to an insurance company, significantly reducing the employer's financial exposure.

Companies that offer an employer-sponsored medical insurance plan must cover all dependents under the age of:

Answer: 26

The Affordable Care Act (ACA) mandates that health insurance plans, including employer-sponsored ones, must allow young adults to remain on their parents' health insurance until they turn 26 years old. This provision applies regardless of whether the dependent is married, a student, or financially dependent. It aims to expand health coverage for young adults who might otherwise lack insurance.

Different benefits and/or premium payments may be provided by employers to different employee groups as long as:

Answer: Employees are not grouped by gender

Federal laws, such as Title VII of the Civil Rights Act, prohibit discrimination in employment, including benefits, based on protected characteristics like gender. While employers can differentiate benefits for legitimate business reasons (e.g., full-time vs. part-time employees), grouping employees by gender to provide different benefits or premiums would constitute illegal discrimination. Benefit structures must be non-discriminatory.

Most short-term disability income benefits last between 6 months and:

Answer: 24 months

Short-term disability income benefits are intended to provide income replacement for a limited period when an employee is temporarily unable to work due to illness or injury. While specific policy terms can vary, most short-term plans typically offer benefits for a maximum duration ranging from 6 months up to 24 months. For disabilities lasting longer than this period, long-term disability insurance would generally apply.

Special Needs Plans (SNPs) are Medicare Advantage coordinated care plans for special needs patients, particularly those with chronic diseases. Which is not a chronic condition?

Answer: Seasonal allergies

Special Needs Plans (SNPs) are Medicare Advantage plans tailored for individuals with specific chronic conditions that require specialized care coordination. Chronic conditions are long-lasting and often require ongoing medical management, such as diabetes or heart disease. Seasonal allergies, while bothersome, are typically acute and temporary, not a severe, long-term chronic condition that would qualify someone for an SNP.

Which of these is not usually covered by long-term care insurance?

Answer: Care provided by family members

Long-term care insurance is designed to cover the costs of professional care services, such as those provided in nursing homes, assisted living facilities, or by licensed home health aides. While family members often provide valuable care, the insurance policies typically do not reimburse for care provided by unpaid family members. The coverage is specifically for services rendered by qualified, paid professionals.

Underwriting is required for most individual long-term care insurance, thus applicants with poor health may be denied or offered coverage:

Answer: A lower coverage amount and/or coverage with higher premiums

Underwriting for individual long-term care insurance involves assessing an applicant's health and risk factors. Individuals with pre-existing conditions or poor health are considered a higher risk for needing care sooner or for longer durations. To account for this increased risk, insurers may offer coverage with reduced benefits (lower coverage amount), impose higher premiums, or in some cases, deny coverage entirely.

A health maintenance organization (HMO) pays people back for covered medical services by:

Answer: Flat fee

Health Maintenance Organizations (HMOs) commonly use a capitation payment model, where they pay healthcare providers a fixed amount per patient (a 'flat fee') for a specified period, regardless of how many services the patient utilizes. This capitated payment incentivizes providers to manage care efficiently and focus on preventive services to control costs, rather than being paid for each individual service.

Health maintenance organization (HMO) insurers utilize this cost-controlling method:

Answer: Required selection of a primary care provider by insured individuals

A core cost-controlling method for Health Maintenance Organizations (HMOs) is requiring members to select a primary care provider (PCP). The PCP acts as a 'gatekeeper,' coordinating all medical care, providing referrals to specialists, and ensuring that services are medically necessary. This system helps to manage utilization, prevent unnecessary specialist visits, and control overall healthcare costs.

What annuity guarantees a minimum interest rate?

Answer: Fixed

A fixed annuity guarantees a minimum interest rate on the principal invested, providing predictable growth and ensuring the principal's safety. The insurance company bears the investment risk, offering the annuitant a stable and secure return. In contrast, variable and index-linked annuities have returns tied to market performance, without a guaranteed fixed interest rate.

What qualifications do life and health insurance advisors need to market variable annuities?

Answer: Securities license

Variable annuities are considered securities because their value fluctuates based on the performance of underlying investment sub-accounts. Therefore, individuals who market or sell variable annuities must hold a securities license, such as a FINRA Series 6 or Series 7, in addition to their state life insurance license. This ensures they are qualified to explain the investment risks and features to clients.

A beneficiary of a life insurance policy can work with the insurance company to turn a death benefit payment into an annuity. The disadvantage of this payment method:

Answer: All of the above

Converting a life insurance death benefit into an annuity means the payout is distributed over time, which takes longer than a lump sum. Annuity withdrawals can incur surrender charges if taken out early, making it expensive to access the money. Furthermore, the earnings portion of annuity payments is typically taxable as ordinary income, unlike the generally tax-free lump-sum death benefit.

Life insurance policy cash value withdrawals are normally non-taxable until:

Answer: The cash value exceeds the total premiums paid into the policy

Life insurance cash value withdrawals are generally treated as a return of premiums paid (cost basis) and are non-taxable until the total amount withdrawn exceeds the cumulative premiums paid into the policy. Once the withdrawals surpass this cost basis, any subsequent amounts are considered taxable gains. This is known as the 'first-in, first-out' (FIFO) tax rule for cash value distributions.