Health Law

Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount that the insurer will pay in the event of a loss. Q purchases a $500,000 life insurance policy and pays $900 in premiums over the first six months. Q dies suddenly and the beneficiary is paid $500,000. This exchange of unequal values reflects which of the following insurance contract features? - Aleatory Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount that the insurer will pay in the event of a loss. Qualified Long-Term Care policies may take into consideration an applicant's pre-existing conditions for a maximum of not more than 6 month(s) prior to the effective date of coverage. - R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity? - Residual Disability S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning: -November 1 must wait 60 days after written proof of loss before legal actions can be brought against the company S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? - 36 S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a: High-deductible health plan To be eligible for a Health Savings Account, an individual must be covered by a high-deductible health plan (HDHP), must not be covered by other health insurance (does not apply to accident insurance, disability, dental care, vision care, long-term care), must not be eligible for Medicare, and can't be claimed as a dependent on someone else's tax return. Stranger Originated Life Insurance (STOLI) has been found to be in violation of which of the following contractual elements? - Legal Purpose (Insurable Interest) Subrogation is the right for an insurer to pursue a third party that caused an insurance loss to the insured. This is done as a means of recovering the amount of the claim paid to the insured for the loss T and S are named co-primary beneficiaries on a $500,000 Accidental Death and Dismemberment policy insuring their father. Their mother was named contingent beneficiary. Five years later, S dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother receive?-0 T is still alive and the sole primary beneficiary while the mother is still the contingent beneficiary T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called: Time limit on certain defences T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect? - Less than $5,000 per month benefit regardless of the cause T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary? - Request of the change will be refused An irrevocable designation may not be changed without the written consent of the beneficiary. T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. Under the Model Group Coordination of Benefits provision, when T files a claim, his employer's plan is considered the: - Primary carrier Towns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take? - Increase her policy's coverage amount T was insured under an individual Disability income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefit payments, but later discovered that the fire was set by T in what was described as arson. What actions will the insurer take? - The insurer will rescind the policy, deny the claim, and recover all payments made T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition? - Insurer will likely treat as a pre-existing condition which may not be covered for one year Taking receipt of premiums and holding them for the insurance company is an example of: -fiduciary responsibility Testimonials used in Accident & Health insurance must meet all of the following requirements, EXCEPT: They must be approved by the Virginia Commissioner of Insurance. Testimonials used in Accident & Health insurance advertisements do not need to be approved by the Virginia Commissioner of Insurance. The Accident and Health Insurance Replacement Notice states that the failure to include material medical information on the application may provide a basis for the insurance company to: - deny any future claims and to refund the premium