Free Iowa Accident & Health practice questions

Answer: C. At least one year

Iowa's individual market reform chapter defines qualifying existing coverage to include group health insurance whose benefits are similar to or greater than those of the standard health benefit plan, but only where that policy has been in effect for at least one year. Thirty days is a different measurement in the same section: an eligible individual is a resident who has qualifying coverage now or had it within the preceding thirty days, or who had a qualifying event within that window. Six months and 18 months are not periods this definition uses.

Answer: D. 58 percent

Under 191 IAC 39.28(3)(b), a long-term care rate schedule increase is calculated so that accumulated incurred claims plus the present value of future projected incurred claims, both figured without active life reserves, are at least the sum of four components. The first component is the accumulated value of the initial earned premium times 58 percent; the present value of future projected initial earned premiums also uses 58 percent. The 85 percent figure applies to the components built from prior and future rate increases, not to the initial premium. The 70 percent figure is the share of projected additional premium from an exceptional increase that must be returned to policyholders in benefits. The 65 percent figure is not part of this calculation.

Answer: C. She is entitled to continue her coverage under the group policy despite the divorce.

Iowa's long-term care rule gives an insured whose group eligibility depends on a relationship with another person the right to continue coverage under the group policy when that relationship ends through death or dissolution of marriage. A divorce is a dissolution of marriage, so her right to continue survives it. The same rule defines continuation as maintaining coverage under the existing group policy subject only to timely payment of premium, so it is not conditioned on underwriting, proof of insurability or the policyholder's consent.

Answer: D. A short-term nonrenewable policy lasting less than 12 months

Iowa Admin. Code r. 191-36.5(6) bars a policy from limiting or excluding coverage by type of illness, accident, treatment or medical condition except for listed categories. Paragraph (d)(4) permits excluding conditions arising out of interscholastic sports only for short-term nonrenewable policies under 12 months in duration. An eighteen-month nonrenewable term exceeds that limit, and a guaranteed renewable major medical policy is not short-term nonrenewable coverage. The exception listed for disability income protection policies is incarceration, not interscholastic sports.

Answer: B. Its application to other persons or circumstances is left unaffected by the ruling.

The severability rule for chapter 37 provides that when a provision, or its application to some person or circumstance, is held invalid, neither the rest of the chapter nor that provision's application to other persons or circumstances is affected. The ruling against one issuer therefore leaves the provision in force as to other issuers. Nothing in the rule makes the provision unenforceable or suspended statewide, or ties its continued force to readoption or a bulletin.

Answer: A. It is kept apart and not combined with the experience of the issuer's other forms.

Iowa's filing rule generally requires an issuer to pool the experience of all its policy or certificate forms of the same type within a standardized plan when it runs the refund or credit calculation under rule 191-37.23. The rule makes one exception: forms acquired through an assumption reinsurance agreement are not pooled with the issuer's other forms for that calculation. That exception rules out treating the assumed form like any other form, and pooling happens only within the same type, never across every type. The rule contains no commissioner credibility finding that would bring an assumed form back into the pool.

Answer: A. It is considered approved once 30 days pass without a specific disapproval

Iowa requires a Medicare Select issuer to file proposed plan-of-operation changes before implementing them, and such a change is treated as approved after 30 days unless the commissioner specifically disapproves it. Waiting indefinitely for written approval is wrong because the rule supplies approval by the passage of 30 days. Taking effect on filing is wrong because the change must be filed before it is implemented and approval comes only after the 30 days run. A 90-day period is not the period the rule sets. Changes to the network provider list are handled separately: an updated list goes to the commissioner at least quarterly.

Answer: A. Nursing service around the clock, given by registered nurses or under their supervision

Under Iowa Admin. Code r. 191-36.4(2)(a), a policy's definition of hospital may not be more restrictive than one requiring that the institution operate pursuant to law, be primarily and continuously engaged in providing medical, diagnostic and major surgical facilities for inpatient care, and, under subparagraph (3), furnish nursing service 24 hours a day by registered graduate professional nurses or under their supervision. Requiring round-the-clock nursing by RNs or under their supervision therefore stays within that baseline. Demanding that every hour be worked personally by RNs drops the supervision alternative and is narrower than the rule allows. The baseline lets surgical facilities be on the premises or available on a prearranged basis, so barring prearranged facilities is too restrictive, and the baseline sets no bed count, so a 100-bed minimum adds a condition the rule does not permit.

Answer: B. A 30-mile radius

Iowa Code Sec. 514C.2 requires an insurer that already covers skilled nursing care to also cover that care when it is delivered in a hospital, if the patient has been reclassified from acute to skilled care and no designated skilled nursing or swing beds are available in the hospital or another facility within thirty miles. The insurer reimburses at the skilled nursing care rate. The statute sets the distance at thirty miles, so a radius of 15, 50 or 100 miles misstates it.

Answer: C. At least ten hours of initial outpatient training in a twelve-month period, plus up to two hours of follow-up in each later year

Iowa Code Sec. 514C.18 has the department of health and human services, in consultation with the Iowa affiliate of the American diabetes association, develop certification standards for diabetes education programs. Those standards cover at least ten hours of initial outpatient self-management training in any continuous twelve-month period, and as much as two hours of follow-up training in each later year. The choice with two initial hours and ten follow-up hours reverses the statute's figures. The choice with six initial hours and four follow-up hours matches neither number the statute sets. The choice with a sixty-day window and no later training conflicts with both the twelve-month period and the yearly follow-up the statute describes.