California Department of Insurance CA-Life-Accident-and-Health Exam Dumps - Actual Questions Answers

When a family policy covers children, the coverage is typically provided as term insurance for a fixed amount, and it often includes provisions that automatically cover new additions to the family without an additional charge. All children living with the family, including those adopted or born after the policy is issued, are generally covered. However, evidence of insurability is not typically required to convert the children's term insurance coverage to permanent insurance. This conversion option allows for flexibility in ensuring continued coverage as children grow older.

The PPACA (also known as the Affordable Care Act) established health benefits exchanges, also referred to as American Health Benefits Exchanges or Health Insurance Marketplaces. These exchanges are designed to facilitate the purchase of health insurance by individuals and small businesses. The exchanges provide a platform where various insurance plans are listed and compared, making it easier for consumers to find affordable coverage. They are particularly aimed at individuals who do not have access to employer-sponsored insurance and small businesses seeking competitive insurance options for their employees.

Definition: Coinsurance is a cost-sharing mechanism in health insurance policies where the insured and the insurer each pay a specified percentage of the covered medical expenses after the insured has paid the deductible.

Mechanism: Once the insured meets the deductible, they are responsible for a portion of the remaining costs, typically expressed as a percentage (e.g., 20%), while the insurer pays the rest (e.g., 80%).

Example: If an insured person has a health policy with an 80/20 coinsurance split and incurs $1,000 in covered medical expenses after meeting their deductible, they would pay $200 (20%), and the insurer would pay $800 (80%).

Purpose: Coinsurance helps manage healthcare costs by sharing the financial responsibility between the insurer and the insured, encouraging cost-effective use of medical services.

Regulations: California insurance laws require clear disclosure of coinsurance terms in policy documents to ensure that consumers understand their financial obligations.

References:

California Department of Insurance guidelines on health insurance cost-sharing.

Standard health insurance policy provisions.