Exam (elaborations)
NC MEDICARE SUPPLEMENT & LONG TERM CARE INSURANCE LICENSING QUESTIONS AND ANSWERS
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NC MEDICARE SUPPLEMENT & LONG TERM CARE INSURANCE LICENSING QUESTIONS AND ANSWERS
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1-79 of 79-Both applicant & agent must sign application containing terms designed to disclose
duplicate or replacement policies
-Agents shall list any other health policies they've sold to applicant within the last 5
years that are no longer active.
-If replacement, "Notice Regarding Replacement of Medicare Supplement Insurance"
must be signed by both agent & applicant with each retaining a copy.
-Insurer must waive time periods if already fulfilled under original policy. e.g.
probationary periods, etc...
-Individual cannot have more than 1 such policy. Illegal for agent to sell a Medigap to
someone who has Medicare Advantage unless switching to original Medicare.
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Med Supp Application & Replacement
-Comparisons of policies will be fair & accurate
-Avoid sale or issuance of excessive insurance. Do they have A&H?
-On first page "Notice to buyer: This policy may not cover all your medical expenses"
-High pressure tactics are prohibited.
-Twisting is prohibited
-Cold lead advertising is prohibited
-All ads must be submitted to Commissioner for approval at least 90 days prior to use.
-On or before March 1st, ea insurer must report policy #s & issue dates for each state
resident that has duplicate med supp policies
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Marketing Standards for Med Supp
Skilled
Intermediate
Custodial
Medicare only pays for skilled care
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Levels of Nursing Home Care
, A private organization composed of practicing physicians and other health care
professionals in each state that is paid by the Centers for Medicare & Medicaid
Services under contract to review the care provided to Medicare beneficiaries.
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QIO (Quality Improvement Organization)
-Hospital stays >150 days for first benefit period or no longer than 90 days after using
up lifetime reserve
-Private rooms unless medically necessary
-Physician's or surgeon's fees (Medicare Part B)
-Luxury or convenience items rented from hospital
-Private duty nursing
-Tests or exams conducted/ billed by 3rd party or similar hospital charges incurred on
outpatient basis.
-Inpatient psych care of > 190 days during lifetime
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Medicare Part A does not cover
-Must document impairments in specified # of ADLs
-Alzheimer's, dementia or other forms of cognitive impairment MUST be covered
under LTC policy.
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