producer417
New Member
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I purchased the A.D.Banker study at home book and found many parts of the book that are not clear. If any of you can shed some light on any of these topics, I would appreciate your help.
Health Basics
1. The book states "Every small employer carrier shall actively offer at least two health benefit plans. One must be an Essential (Basic) Health plan and the second a Standard Health Plan; both must offer maternity benefits as directed by legislation. The coveage provided under either plan is published by the state. Each plan offers an indemnity version, an HMO version, and a PPO version."
Does this mean that every small employer has to offer 6 plans (3 basic and 3 standard plans)? I'm confused.
2. "A small employer carrier will not use case characteristics other than age, geographic area, family composition, or any other rating factors other than actual claims experience."
This seems to contradict itself. Can the carrier use age and geographic area or not?
3. About HIPAA it says, "Any coverage prior to a break in continued coverage of 63 days or more, within the 12-month qualification period, will not be credited against a preexisting condition exclusion period."
Anyone speak English and care to translate that for me?
4. Provisions chapter: Optional Uniform Provisions, Insurance with other insurers.
"Benefits are determined by dividing the total benefits of policies known before the loss by total benefits of all policies known after the loss. This is referred to as the coordination of benefits for individual policies."
5. Medicare part D, "Example: a person who turns 65 in July may enroll in Part A, B, and D in April, with coverage effective July 1. This same person may enroll in Parts A, B, and D in October and Part A and B are effective July 1, but Part D is effective November 1."
I am assuming the "effective July 1" means the following July. Is this correct.
Also, for my clarification, these enrollees would not pay premiums until July, correct?
Thanks in advance for any clarifications of what they are trying to say.
This book seems to have been written and reviewed by insurance experts and not by professional trainers.
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6. Medicare Supplement Insurance - Replacement Requirements (replacing an existing Med Sup policy)
"Any sale of a Medicare Supplement policy is prohibited, unless the transaction would not insure more than 100% of the individual's actual medical expenses covered under the combined policies."
The 'not' here confuses me.
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7. Under Long Term Care exclusions - it states "Injury arising out of committing or attempting to commit a felony." I assume an insured would be covered by LTC if they were injured by another person who was committing a felony. Is this correct?
Health Basics
1. The book states "Every small employer carrier shall actively offer at least two health benefit plans. One must be an Essential (Basic) Health plan and the second a Standard Health Plan; both must offer maternity benefits as directed by legislation. The coveage provided under either plan is published by the state. Each plan offers an indemnity version, an HMO version, and a PPO version."
Does this mean that every small employer has to offer 6 plans (3 basic and 3 standard plans)? I'm confused.
2. "A small employer carrier will not use case characteristics other than age, geographic area, family composition, or any other rating factors other than actual claims experience."
This seems to contradict itself. Can the carrier use age and geographic area or not?
3. About HIPAA it says, "Any coverage prior to a break in continued coverage of 63 days or more, within the 12-month qualification period, will not be credited against a preexisting condition exclusion period."
Anyone speak English and care to translate that for me?
4. Provisions chapter: Optional Uniform Provisions, Insurance with other insurers.
"Benefits are determined by dividing the total benefits of policies known before the loss by total benefits of all policies known after the loss. This is referred to as the coordination of benefits for individual policies."
5. Medicare part D, "Example: a person who turns 65 in July may enroll in Part A, B, and D in April, with coverage effective July 1. This same person may enroll in Parts A, B, and D in October and Part A and B are effective July 1, but Part D is effective November 1."
I am assuming the "effective July 1" means the following July. Is this correct.
Also, for my clarification, these enrollees would not pay premiums until July, correct?
Thanks in advance for any clarifications of what they are trying to say.
This book seems to have been written and reviewed by insurance experts and not by professional trainers.
- - - - - - - - - - - - - - - - - -
6. Medicare Supplement Insurance - Replacement Requirements (replacing an existing Med Sup policy)
"Any sale of a Medicare Supplement policy is prohibited, unless the transaction would not insure more than 100% of the individual's actual medical expenses covered under the combined policies."
The 'not' here confuses me.
- - - - - - - - - - - - - - - - - -
7. Under Long Term Care exclusions - it states "Injury arising out of committing or attempting to commit a felony." I assume an insured would be covered by LTC if they were injured by another person who was committing a felony. Is this correct?
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