Delaware Health Insurance Statutes and Regulations Flashcard

Front

What is automatically covered under a parent's individual health policy from birth?

Back

A newborn

Answer explanation

A newborn is automatically covered under a parent's individual health policy from birth, ensuring immediate health care access. Other options like a spouse, pre-existing conditions, or a midwife are not automatically included.

Front

Optional provision in individual health insurance policies: Entire contract, Change of occupation, Grace period, Coverage for newborns

Back

Change of occupation

Answer explanation

The 'Change of occupation' provision is optional, allowing insurers to adjust coverage based on the insured's job changes. In contrast, 'Entire contract', 'Grace period', and 'Coverage for newborns' are typically standard provisions.

Front

What does Regulation 1304 prohibit in individual accident and health policies?

Back

Misleading provisions

Answer explanation

Regulation 1304 prohibits misleading provisions in individual accident and health policies to ensure clarity and transparency for policyholders, making 'misleading provisions' the correct answer.

Front

Eligible group for blanket health coverage according to Delaware statutes? Options: Employees, Retirees, Unemployed individuals, Self-employed individuals

Back

Employees

Answer explanation

According to Delaware statutes, employees are eligible for blanket health coverage, making them the correct choice. Retirees, unemployed, and self-employed individuals do not qualify under this specific provision.

Front

What must group health policies include according to Delaware statutes?

Back

Incontestability

Answer explanation

According to Delaware statutes, group health policies must include an incontestability clause, which prevents insurers from contesting the validity of the policy after a certain period, ensuring policyholders' rights.

Front

What is required for small employer health insurance in Delaware?

Back

Coverage for businesses with 2-50 employees

Answer explanation

In Delaware, small employer health insurance is specifically designed for businesses with 2-50 employees, making this the correct choice. The other options do not accurately reflect the requirements for small employer coverage.

Front

In the context of Medicare Secondary Payor, which coverage typically pays first? Options: Medicare, Employer group health coverage, Medicaid, Long-term care insurance

Back

Employer group health coverage

Answer explanation

In Medicare Secondary Payor situations, employer group health coverage typically pays first before Medicare, as it is considered primary coverage for individuals with both types of insurance.

Front

What must be provided before selling a Long-Term Care policy in Delaware?

Back

NAIC Shopper’s Guide

Answer explanation

In Delaware, before selling a Long-Term Care policy, the NAIC Shopper’s Guide must be provided to help consumers understand their options and make informed decisions.

Front

What is prohibited during the open enrollment period for Medicare Supplement policies?

Back

Medical underwriting

Answer explanation

During the open enrollment period for Medicare Supplement policies, medical underwriting is prohibited. This means insurers cannot use health status to deny coverage or charge higher premiums.

Front

What is required before conducting an HIV test for insurance underwriting in Delaware?

Back

Written informed consent

Answer explanation

Before conducting an HIV test for insurance underwriting in Delaware, written informed consent is required. This ensures that the individual is aware of the test and agrees to it, protecting their rights and privacy.