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Section 1
Match disability income, medical expense, managed care, Medicare supplement, group, long-term care, and limited-benefit coverage to the stated need
Preview
Preview: Life and Health General: Health Policy Types (16/130 scored)
Preview includes- 4 of 7 lesson topics
- 1 overview segment
- 3 core concepts
- 2 exam tips
Lesson Topics
- Disability income vs. medical expense coverage
- Major medical and managed-care plan selection
- Medicare Supplement purpose
- Group versus individual coverage
Overview
Health-policy questions are matching problems: identify what financial risk the client wants transferred, then choose the product whose benefit trigger and scope fit that risk.
Core Concepts
- Disability income insurance replaces a portion of earned income when a covered disability prevents work; it is not primarily designed to reimburse ordinary medical bills.
- Business overhead expense coverage helps reimburse eligible operating expenses during an owner’s covered disability; disability buyout coverage is designed to fund a business-interest purchase after a qualifying disability; key-employee disability coverage protects the business against economic loss tied to a key person.
- Medical expense coverage pays or reimburses covered health-care expenses subject to the policy’s deductible, copayment, coinsurance, network, preauthorization, exclusion, and benefit rules.
Exam Tips
- Underline the loss the client is trying to protect against before reading the answer choices.
- When two products both sound plausible, compare benefit trigger, who receives the benefit, and whether the payment is scheduled cash or reimbursement of covered expense.
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Section 2
Match term, whole, universal, variable, indexed, joint, and survivorship life designs to a client need
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Section 3
Apply ownership, beneficiary, premium, loan, nonforfeiture, dividend, assignment, and settlement provisions
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Section 4
Apply mandatory claim, grace, reinstatement, legal action, beneficiary, and renewability provisions
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Section 5
Apply Texas licensing, appointments, temporary-license, continuing-education, records, and notification requirements
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Section 6
Complete and deliver an application with the required signatures, disclosures, premium handling, and explanations
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Section 7
Apply group conversion, life settlements, third-party ownership, and personal or business needs analysis
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Section 8
Handle applications, initial premiums, receipts, underwriting information, submission, and policy delivery
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Section 9
Apply Texas required health benefits, Medicare supplement, AIDS testing, long-term care, and small-group requirements
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Section 10
Distinguish Medicare Parts A, B, C, and D for a stated coverage need
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Section 11
Apply Texas life and annuity marketing, disclosure, free-look, grace, loan, and prohibited-provision rules
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Section 12
Distinguish HMO, PPO, POS, HDHP, HSA, HRA, and FSA arrangements
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Section 13
Apply coordination of benefits, subrogation, managed care, occupational coverage, and disability definitions
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Section 14
Distinguish immediate, deferred, fixed, variable, and indexed annuity structures
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Section 15
Select a rider or exclusion that addresses the stated risk without changing unrelated coverage
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Section 16
Calculate or interpret deductibles, coinsurance, copayments, elimination periods, eligible expenses, and benefit limits
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Section 17
Apply Texas unfair-practice, claims, advertising, rebating, discrimination, fraud, and agent-duty rules
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Section 18
Apply insurable interest, representations, risk classification, replacement, and contract formation rules
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Section 19
Apply Texas HMO evidence-of-coverage, enrollment, cancellation, and nonrenewal rules
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Section 20
Distinguish qualified and nonqualified plans and the stated tax treatment of premiums or benefits
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Section 21
Explain replacement, privacy, exclusions, ratings, contract characteristics, and insurable interest accurately
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Section 22
Apply applicable marketplace, essential-benefit, subsidy, and employer-notification concepts identified by the outline
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Section 23
Distinguish Medicare and Medicaid eligibility, administration, and coverage roles
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Section 24
Apply Texas group life, credit life, replacement, and nonforfeiture requirements
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Section 25
Determine beneficiary, owner, dependent, premium, and tax consequences from the stated policy facts
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Section 26
Apply Texas HMO out-of-network claim requirements to the stated facts
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