Accident and Health Exam
What is the smallest dollar civil penalty that will be assessed for a single act of misrepresentation? A: $200 B: $500 C: $1,000 D: $10,000
A: $200 Civil fines for misrepresentation can range between $200 and $10,000.
Other than when an agent or insurer sells a supplement not approved by the director, all other violations may incur a minimum fine of: A: $500 B: $1,000 C: $5,000 D: $10,000
A: $500 Other than a producer or insurer marketing a supplement not approved for sale, all of the other violations may incur a minimum fine of $500 and a maximum of $5,000.
Under HMO minimum standards for basic health care services, the annual maximum on mental health inpatient services is: A: 10 days B: 31 days C: 60 days D: 120 days
A: 10 days Under HMO minimum standard law, the annual maximum for mental health inpatient services is 10 days per year.
Under an Accident and Health policy, an insurance company must provide appropriate forms to the insured within a maximum of how many days after the loss? A: 15 B: 30 C: 45 D: 60
A: 15 The Claim Forms provision specifies that the insurer must provide claim forms within 15 days of notice of claim.
If there is a complaint against an LHSO with the Department of Insurance, the LHSO has ____ to respond in writing to the complaint. A: 21 days B: 30 days C: 31 days D: 45 days
A: 21 days If there is a complaint against an LHSO with the department of insurance, the LHSO has 21 days to respond in writing on the subject of the complaint.
N has a LTC policy that covers one consecutive year of benefits no matter how often he requires care. This is an example of: A: Calendar Days B: Service Days C: Elimination (Waiting) Period D: Probationary Period
A: Calendar Days If a LTC policy has a set time frame for benefits is an example of a policy with Calendar days.
B applies for a health policy and pays the initial premium. B's agent must issued a: A: Conditional Receipt B: Unconditional Receipt C: Binder D: Statement of Good Health
A: Conditional Receipt If initial payment is made when an application is taken, a conditional receipt is issued that specifies when coverage may begin and the terms of underwriting and coverage.
Which of the following provisions is optional in a health policy? A: Illegal Occupation B: Legal Actions C: Change of Beneficiary D: Grace Period
A: Illegal Occupation In individual health policies, the Illegal Occupation clause is optional for the insurer to add to the contract.
An example of a rider that deletes or limits coverage is an: A: Impairment Rider B: Preexisting Condition Rider C: Waiver of Premium D: Exclusion Rider
A: Impairment Rider The Impairment rider is the way the insurer will name a specific loss that will not be covered by a policy due to a preexisting condition.
L has a major medical policy. Ten years ago, L survived cancer but was sick again five years ago and fully recovered. Unfortunately, L has just be notified that he has relapsed again. Although L has suffered through multiple catastrophic losses, the policy is still providing coverage. L most likely has a policy with: A: Lifetime Benefit Limit B: Annual Limit C: Per Cause Limit D: Indemnity Limit
A: Lifetime Benefit Limit Benefits that are covered for an extended period of time up to a maximum dollar amount is a lifetime limit.
H has Disability Insurance through her employer. H has suffered a covered disability and has been informed by the group insurer that she is eligible to received benefits for up to 3 years maximum. H has: A: Long-Term Group Benefits B: Short-Term Group Benefits C: Long-Term Care Benefits D: Short-Term Indemnity Benefits
A: Long-Term Group Benefits If a Group Disability policy pays benefits for 2 years or more, it is considered a Long-Term group disability policy.
While individuals own their contracts group policies are owned by the employer and referred to as A: Master contract B: Employee contracts C: Return of Premium D: Gap policies
A: Master contract While the individual owns their own policy, all employees are covered under one master contract and owned by the employer.
An insured drops the health policy she has had for many years because producer J told her that all health conditions are covered even though that is untrue. Producer J has engaged in A: Misrepresentation B: Twisting C: False Advertising D: Defamation
A: Misrepresentation Communicating false, untrue or misleading information to an insurance consumer by a producer is an act of misrepresentation.
All of the following are CORRECT under Medicare supplement minimum standards EXCEPT: A: Policies must be issued as noncancelable. B: Payments on benefits may not be labeled as usual or customary. C: Supplements cannot pay benefits on losses resulting for sickness any differently than accidents. D: Except for replacement, it is illegal for an agent to sell a supplement to an insured that already owns one.
A: Policies must be issued as noncancelable. Under Medicare Minimum Standard law, Medicare supplements must be at least Guaranteed Renewable.
J has a policy with a $100 annual deductible on her individual health policies. J's premium amount is most likely: A: very high B: very low C: free
A: very high Lower deductible usually means very high premiums in a medical policy.
Medigap Supplements must meet one of _____ forms approved by the National Association of Insurance Commissioners. A: 5 B: 10 C: 15 D: 20
B: 10 The NAIC has approved ten different forms under which a Medigap policy can be written.
Under law, a LTC policy must provide consecutive coverage for at least: A: 6 months B: 12 months C: 24 months D: 36 months
B: 12 months Under law, a Long Term Care policy must provide at least 12 consecutive months of coverage.
Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 C: 20 D: 30
B: 15 The Claim Forms provision specifies that the insurer must provide claim forms within 15 days of notice of claim.
It is the insured's responsibility to notify the principal about a claim under an Accident and Health policy within: A: 7 days B: 20 days C: 1 month D: 12 months
B: 20 days The Notice of Claim provision states that the insured must notify the insurer of a loss within 20 days of the actual loss.
The most strict definition of a total disability is: A: Own Occupation B: Any Occupation C: Partial Occupation D: Residual Occupation
B: Any Occupation The more strict, Any Occupation, is the most difficult of total disability to qualify for since an insured is unable to do any job duties for which they are suited, educated or experience for.
All of the following may be covered under a Long Term Care Policy EXCEPT: A: Adult Day Care B: Children's Day Care C: Respite Care D: Assisted living facility
B: Children's Day Care Adult day care, respite care, and assisted living facilities are all benefits that may be covered under a long term care contract.
The part of a contract that specifies which expenses may or may not be covered is known as the: A: Exclusion B: Eligible Expense provision C: Insuring Agreement D: Consideration Clause
B: Eligible Expense provision The Eligible Expense provision will specify what expenses may or may not be covered and for what potential amount.
When an insured is covered under a group plan, the law that helps them port coverage from one carrier to another without preexisting conditions applying is known as: A: COBRA B: HIPAA C: HIPPO D: PPO
B: HIPAA The IL Health Insurance Portability and Accountability ACT (HIPAA)
Which of the following rights of renewability give the insured the most control over a policy? A: Optionally Renewable B: Noncancelable C: Cancelable D: Period of Time
B: Noncancelable Noncancelable right of renewability guarantees premium cost and renewability of the policy as long as the owner pays the premium on time.
Which entity listed below has the authority to issue a limited lines producer license? A: The Illinois Insurance Board B: The Director C: Fire D: An insurance company
B: The Director The Director of insurance has the authority to grant licensing authority to any company, person or other entity so required to obtain such a license.
Once a producer has a felony conviction entered officially against him, what action is most likely to be taken pertaining to his producer license? A: The Director can do nothing until the producer's appeals rights have been exhausted through all state and/or federal courts. B: The producer will have his license revoked. C: The producer will have his license revoked with a mandatory fine. D: Each felony is reviewed on the facts by the Director to determine whether or not license termination is warranted.
B: The producer will have his license revoked. The Director will terminate the producer's license with a possible civil fine attached.
A producer who makes misleading comparisons between a product an insured owns and a policy the producer is trying to sell as a replacement is an activity known as A: Misappropriation B: Twisting C: Defamation D: Rebating
B: Twisting Twisting is a special type of misrepresentation utilized when an unethical producer is trying to convince an insured to drop their current policy in favor of the what the producer is selling, while providing misleading information
V's agent told her that by paying the premium initially upon application, the insurer will provide coverage immediately. V has just be given a: A: Conditional Receipt B: Unconditional Receipt C: HIPAA release form D: Statement of Good Health
B: Unconditional Receipt A Binder is also known as an Unconditional Receipt and stipulates that coverage will begin immediately upon payment but is not common in life or health policies.
The effect of the application with initial premium payment is: A: Coverage is guaranteed to start at initial payment B: a conditional receipt is given but coverage may not begin until a paramedical exam is completed during underwriting C: A binder will exist D: No coverage will be given until delivery and the agent collecting a statement of continued good health.
B: a conditional receipt is given but coverage may not begin until a paramedical exam is completed during underwriting If the insured makes an initial payment when an application is taken, a conditional receipt is issued but coverage may not begin until a paramedical is completed.
V has a policy with a Guaranteed Insurability Rider. V was 30 years old when the contract was issued but now, at age, 40, she would like to buy more coverage which is allowed under the rider. For the extra coverage amount V will pay premiums based on: A: age 30 B: age 40 C: an average between issuance and when she uses the rider D: Neither age. No extra premium is required
B: age 40 Even though V is allowed to buy the extra coverage no matter what her health may be, the extra benefits is based off of attained age premiums. Since V is 40 when she uses the rider, the extra coverage premiums is based off age 40.
K has a basic policy along with a major medical policy. K suffers a loss and receives notice by the insurer that an additional $300 is owed before the major medical policy will pay for all of K's losses. K must satisfy: A: Deductible B: corridor deductible C: stop loss D: coinsurance
B: corridor deductible If an insured has comprehensive major medical coverage, all money owed after the basic plan has paid first dollars but before the major medical policy will pay benefits is known as the corridor/integrated deductible.
Which of the following insureds would be eligible for a Medicare supplement if they were under age 65? A: an insured who is collecting disability B: end stages of renal failure C: All of the above D: None of the Above
B: end stages of renal failure An under 65 insured is eligible for a Medicare supplement if they qualify for Medicare which would require the insured to be on social security disability for 2 years or more or be at the end stage of a renal impairment.
All of the following actions by a producer could lead to license suspension, revocation or denial, EXCEPT: A: being incompetent in the transactions of insurance business. B: failure to pay federal income taxes. C: using dishonest business practices. D: being unworthy of trust.
B: failure to pay federal income taxes. A producer can have a license terminated for failure to pay Illinois state income taxes; there is no mention in the code of failure to pay federal income taxes.
X who holds no insurance licensure of any kind asks his neighbor Y, if Y is happy with his property insurance on his house and that X would be happy to help Y secure a better policy at a lower cost. X A: is guilty of a felony and will go to prison for 5 or more years if convicted. B: has committed a misdemeanor violation that could result in a prison term of up to 1 year. C: is just trying to be helpful and has violated no laws in Illinois. D: can avoid any possibility of criminal prosecution as long as X does not follow through with the offer and never mentions the idea again.
B: has committed a misdemeanor violation that could result in a prison term of up to 1 year. Anyone who sells, solicits or negotiates insurance in Illinois is guilty of a Class A misdemeanor which can result in a jail sentence of up to one year. X has solicited the sale of an insurance product without a license to do so.
The trust officer of a bank, while performing the incidental duties of his employment, advises bank customers from time to time about maters related to insurance policies. This trust officer A: is guilty of a Class A misdemeanor. B: is exempted from any producer licensing requirements based on these activates. C: must be licensed in all major lines of insurance. D: must be paid by commission when performing such duties for a bank or other financial institution.
B: is exempted from any producer licensing requirements based on these activates. Illinois allows specific occupations to be exempt from licensing if the duties they perform relating to insurance are incidental and no direct payment of income derives from any insurance product.
All of the following Premium Fund Trust Account disbursements are allowed, EXCEPT: A: net premiums due an insurer. B: payment to producer's business phone carrier. C: gross premiums due an insurer. D: revenue the producer is authorized to retain.
B: payment to producer's business phone carrier. A producer is not allowed to use PFTA money to pay operating expenses.
G is considering replacing their existing health insurance policy. The agent tells G a misleading comparison of coverage intended to convince G to replace her existing coverage. The action of the agent is known as: A: misrepresentation B: twisting C: defamation D: rebating
B: twisting When agent makes misleading comparisons to induce replacement it is a form of misrepresentation known as twisting.
The maximum fine for twisting is: A: $200 B: $500 C: $10,000 D: three times commissions paid
C: $10,000 The fine for misrepresentation is no less than $200 nor more than $10,000 which is paid into the county in which the State Attorney has completed successful prosecution.
Health Care FSA contributions are limited to _______ per year. A: $5,000 B: $3,000 C: $2,700 D: $3,250
C: $2,700 The IRS limits (2019) single FSA contributions to $2,700 per year with a $5,000 family limit for family dependent accounts (when a husband and wife each make an equal and maximum contribution).
If a policy owner of a Medicare Supplement becomes eligible for Medicaid, a supplement can be suspended for up to ______ as long as they give the insurer notice within 90 days of being eligible for Medicaid. A: 6 months B: 12 months C: 24 months D: 36 months
C: 24 months If an owner qualifies for Medicaid, they can suspend their supplement for up to 24 months as long as they notify the insurer within 90 days of becoming eligible for Medicaid.
How many separate accounts exist under the life and health guarantee association? A: 4: Variable, HMO, Life, and Health B: 3: Variable, Life, and Health C: 2: Life and Health D: 1: Life and Health
C: 2: Life and Health There are two separate accounts for Guarantee Associations, Life and Health.
Under an AD&D policy, loss must occur within __________ of the accident. A: 30 days B: 60 days C: 90 days D: 100 days
C: 90 dyas Under an AD&D policy, loss must occur within 90 days of a covered loss.
Which of the following persons is NOT exempt from being producer licensed? A: The president of a life insurance company. B: The underwriter at the home office of a property insurer. C: A funeral director who solicits the sale of a life policy. D: A secretary at the home office of an insurance company
C: A funeral director who solicits the sale of a life policy. All persons who work with or for an insurance company, who are not being paid a direct commission based on the sale, solicitation or negotiation of an insurance contract are exempt from licensing requirements.
Which statement pertaining to license suspension, revocation or denial is NOT TRUE? A: All revoked licenses must be surrendered to the Director either by mail or in person. B: A business entity license can be revoked if a manager was aware that a producer was in engaged in a violation but did not report the activity or take corrective action. C: A license suspension cannot be less than six months nor longer than two years in durations. D: A cause for termination can be the failure of a producer to satisfactorily repay an Illinois Student Loan.
C: A license suspension cannot be less than six months nor longer than two years in durations. A producer license suspension is for a period of time deemed appropriate by the Director; there is no statutory minimum or maximum suspension period.
If an insurer is approved to sell auto insurance that provides a $100 refund after one year if the insured is accident-free during the year, why is this NOT rebating? A: Because auto insurance is exempted from rebating laws B: $100 is the statutory refund limit by an insurer. C: Because the refund is part of the contract that was approved for sale by the Director. D: $200 is the statutory refund limit by an insurer and the amount shown I under this limit.
C: Because the refund is part of the contract that was approved for sale by the Director. Value offered to induce a sale is only a rebate if it is not part of the contract of insurance, therefore in this case the $100 is part of the policy and not a rebate.
Which of the following rights of renewability will most likely have the lowest premium cost? A: Noncancelable B: Guaranteed Renewable C: Cancelable D: Guaranteed Noncan
C: Cancelable The Cancelable renewability option means a policy can be terminated at any time by either party. The insurer must give a specific number of days of notice to the insured before the policy is terminated. Since the insurer has right to cancel at any time, this makes the policy one of the least expensive options.
Which mandatory provision states that a policy holder cannot change an irrevocable beneficiary unless that beneficiary gives written consent to be changed? A: Mandatory Revocability B: Irrevocable Beneficiary Designation C: Change of Beneficiary Provision D: Entire Contract
C: Change of Beneficiary Provision The Change of Beneficiary clause is mandatory in health policies and allows the policy owner to change a beneficiary without consent unless the beneficiary is designated as an irrevocable beneficiary.
All of the following riders would add benefits to a health policy EXCEPT: A: Guaranteed Insurability Rider B: Waiver Of Premium C: Impairment Rider D: Multiple Indemnity Rider
C: Impairment Rider The Impairment rider is the way the insurer will name a specific loss that will not be covered by a policy due to a preexisting condition. Impairment riders are exclusionary and will always delete or limit coverage.
J has an FSA through her employer. Towards the end of the year, J has $1,000 that she has not used for reimbursement. When the new policy year goes into effect, which of the following will happen with J's unused $1,000 balance? A: J will be allowed to roll over the $1,000. B: J will only be allowed to roll over half of the unused money. C: J will lose the unused $1,000 but be allowed to fully fund the account for the next policy year. D: J will be allowed to roll over the $1,000 but will have to pay taxes.
C: J will lose the unused $1,000 but be allowed to fully fund the account for the next policy year. Unless an employer amends an existing plan to allow up to a $500 maximum rollover credit, Flexible Spending Accounts have annual limits and a use it or lose it rule, which means any unused benefits are forfeited and are not allowed for rollover in the next policy year.
All of the following are required disclosure forms at application EXCEPT: A: HIPAA B: HIV C: MIB D: None of the Above
C: MIB The two disclosure forms that may be required at policy application is the HIPAA release form and the HIV consent form.
The statute that requires disclosure provisions is: A: Exclusions B: preexisting condition C: Minimum Standards D: HIPAA
C: Minimum Standards The purpose of Minimum standards is to establish certain provisions and wording be included as well as disclosing certain information to the policyholder while excluding restrictive definitions.
If a person is insured under an AD&D policy and loses both of their arms they are considered to be: A: Permanently disabled B: Partially Disabled C: Presumptively Disabled D: Capitally Disabled
C: Presumptively Disabled If an insured loses two limbs under an AD&D policy, they are considered to be Presumptively disabled and benefits continue without cost.
Which of the following statements are CORRECT about a Health Savings Account? A: The HSA plan is only available to large businesses B: The HSA contribution is only tax deductible if an insured itemizes C: The HSA must be coordinated with an HDHP D: The IRS does not set a limit on annual contributions paid in to an HSA
C: The HSA must be coordinated with an HDHP A HSA must be coordinated with a High Deductible Health Plan (HDHP). The HSA is available to any size businesses and there are limits set on pre-tax contributions, even if the insured does not itemize on their taxes.
All of the following are CORRECT about Waiver of Premium EXCEPT: A: Premiums are not waived immediately upon disability B: All premiums paid from the start of disability are eventually reimbursed if a disability is long term C: The insurer never has a right to request a medical exam to determine if a waiver is applicable D: Waiver of premium is usually only found in disability income insurance
C: The insurer never has a right to request a medical exam to determine if a waiver is applicable The insurer has a right to periodically request a medical of an insured whose policy is under waiver to determine if the waiver is still applicable.
All of the following is CORRECT about a HIPAA consent form EXCEPT: A: The insurer has permission to access medical records of the insured B: The insurer has access to medical records for up to 3 years, unless revoked in writing by the insured C: The signed permission form defines the limits of use of information on the insured for underwriting for all insurers they may apply through D: The notification form allows the private medical information to be used in underwriting
C: The signed permission form defines the limits of use of information on the insured for underwriting for all insurers they may apply through Although the HIPAA release form allows the insurer to access medical records for up to 3 years and defines the limits in which the information can be used, it only gives consent for one particular insurer to access health information on the proposed insured.
Producer J has just received a policy offer from an insurer on behalf of an application J recently wrote. J must deliver the policy and collect the first premium payment. Within how many days must J accomplish this action without violating fiduciary duty? A: Within 10 days B: Within 30 days C: Within 90 days D: Within 20 days
C: Within 90 days A producer must deliver a policy and collect the first premium within 90 days from the issuance of a policy on behalf of an insurer offering the coverage.
Under HIPAA regulations a small group is defined as: A: a minimum of 1 employee but not more than 100 B: a minimum of 2 employees but not more than 100 C: a minimum of 2 employees but not more than 50 D: a minimum of 3 employees but not more than 50
C: a minimum of 2 employees but not more than 50 A small employer is defined under HIPAA as a group that has at least 2 employees but not more than 50.
Defamation occurs when A: a producer demonstrates that the premium rates for an insurance plan he is promoting is less expensive than the plan a competitor is promoting. B: an insurance company advertises that their industry rating is better than 99% of all other carriers in the country. C: an agency prints and distributes flyers claiming that a competitor will soon be filing bankruptcy and they are a better choice therefore with whom to do business. D: The President of a life insurance company signs off on a plan to advertise for prospects in a state his company is not licensed in.
C: an agency prints and distributes flyers claiming that a competitor will soon be filing bankruptcy and they are a better choice therefore with whom to do business. Stating a licensed entity is about to be in financial trouble to induce the public to steer away from them is an act of defamation by the maker of such statements.
An agent shows an insured a brochure that the agent created that has misleading comparisons of policies. The maximum fine under law for this offense is: A: $200 B: $500 C: $5,000 D: $10,000
D: $10,000 The fine for misrepresentation is no less than $200 nor more than $10,000 which is paid into the county in which the State Attorney has completed successful prosecution.
V has an HMO who has been financial impaired, the most the HMO Guarantee Association will pay for V's claims is: A: $100,000 B: $250,000 C: $300,000 D: $500,000
D: $500,000 The limit under an HMO Guarantee Association is $500,000 aggregate per natural person.
The maximum number of in-hospital days coverage provided by an individual policy under minimum standards is: A: 30 days B: 45 days C: 90 days D: 180 days
D: 180 days One period of hospital continuous in-patient confinement coverage under a policy is a maximum of 180 days.
The minimum grace period under law for an individual HMO police may not be less than: A: 10 days B: 15 days C: 30 days D: 31 days
D: 31 days Under HMO law, a grace period for an individual contract may not be less than 31 days.
The insured wants to file a lawsuit against an insurer. Under the Legal Actions provision, how long must the insured wait before filing the lawsuit? A: 20 days B: 30 days C: 45 days D: 60 days
D: 60 days Under the Legal Actions mandatory provision, the insured must wait 60 days before filling a legal action against an insurer.
Which of the following Coinsurance clauses is most likely to have the least expensive premiums? A: 90/10 B: 80/20 C: 75/25 D: 60/40
D: 60/40 The larger percentage paid by the insured in a coinsurance clause, the less expensive the premium will generally be.
Under an AD&D policy a death must occur within _____ from loss to be considered an accident. A: 10 days B: 30 days C: 60 days D: 90 days
D: 90 days Under IL minimum standards, a death must occur within 90 days of loss to be considered death from an accident.
Consideration for the insured is: A: to pay the premium on time B: to tell the truth on the application C: to pay covered losses D: A and B Only
D: A and B Only Consideration on part of the insured is to tell the truth on the application and pay the premium on time.
Renewability of a Long Term Care policy must be at least: A: Noncancelable B: Guaranteed Renewable C: Cancellable D: A and B only
D: A and B only Long Term Care policy issued in IL must be at least favorable as Noncancelable or Guaranteed Renewable.
Which of the following is a prohibited investment option into which to place Premium Fund Trust Account monies? A: US government securities maturing in no longer than one year. B: A non-interest bearing bank account in an institution under the jurisdiction of Illinois courts. C: Highly rated commercial paper. D: A brokerage account in which options futures are traded.
D: A brokerage account in which options futures are traded. PFTA money must be put in safe, secure and conservative accounts as regulated by state law which strictly prohibits placing such monies into accounts where risk to principal is great such as securities options, stock futures or purchasing equities on margin.
Which of the following are required legal elements of a contract? A: Offer and Acceptance B: Consideration C: Competent Parties and Legal Purpose D: All of the Above
D: All of the Above A contract is a legal agreement and is enforceable by law when all four elements of offer/acceptance, consideration, competent parties, and legal purpose are met.
Which of the following Disability Policies names a business as the beneficiary? A: Key Person B: Disability Buyout C: Business Overhead Expense D: All of the Above
D: All of the Above In all of the listed policies, the business is the beneficiary of the policy.
Which of the following out of pocket expenses require the insured to share cost with the insurer? A: Deductible B: Copayment C: Coinsurance D: All of the Above
D: All of the Above The purpose of deductible, coinsurance, and copayments is to allow the insured to share expense with the insurer and reduce premium cost.
Under an individual health insurance policy, the insurance company may do all of the following EXCEPT: A: Request an autopsy if not forbidden by law B: Refuse policy reinstatement C: Pay benefits as stated in the contract D: Alter the grace period with proper written notice to all affected parties
D: Alter the grace period with proper written notice to all affected parties The grace period is a mandatory provision stated in a health policy and cannot be changed.
All of the following would be eligible for survivor benefits through Social Security EXCEPT: A: A widow who is age 50 and disabled B: A child age 16 who lost an insured parent C: Dependent parents who are age 63 D: An insured worker who is age 62
D: An insured worker who is age 62 Survivor benefits are for people who have had an insured worker die. Widows who are disabled ages 50-59, children up until age 18/19 if still in high school and dependent parents age 62 or older are eligible for social security benefits.
Which of the following will be the least expensive premium based off the Mode of Premium payment? A: Monthly B: Quarterly C: Semiannual D: Annual
D: Annual Annual is the least expensive option for premium payment. The longer the mode of premium, generally the more expensive a policy will be.
Major Medical Policies: A: Provide first dollar coverage with limited benefits. B: Take a Managed Care approach with in-network discounts. C: Allow an employee to take money pre-tax out of their paycheck into a special account for medical expenses. D: Are reimbursement, expense-based policies, with high maximum coverage.
D: Are reimbursement, expense-based policies, with high maximum coverage. Major Medical policies are expense-based reimbursement policies with large lifetime benefits and out of pocket charges borne by the insured.
Which of the following factors is acceptable to use on the part of an insurer in determining premium pricing in the insurance marketplace? A: Basing increased cost for a life insurance policy on total blindness. B: Basing rejection of health insurance coverage on partial blindness. C: Basing rejection of property insurance to an insured on the basis geographical location of the property. D: Charging an fifty-year old person more premium for life insurance than a thirty-year old.
D: Charging an fifty-year old person more premium for life insurance than a thirty-year old. Basing premium rates on blindness, whether partial or total or property insurance based on geography are illegal trade practices. Basing life insurance rates on the age of the insured is accepted and sound actuarial science.
Under a BOE policy, all of the following losses will be insured EXCEPT: A: Business Loans B: Monthly Rent for the Business' building C: Employee Salary D: Employer Salary
D: Employer Salary In a Business Overhead Expense (BOE) policy, the employer's salary will not be insured through the policy. Loans, Rent, and Employee Salary are all covered under the policy.
J has a policy that pays $100 a day for a hospital stay. J has a: A: Major Medical Policy B: PPO C: HMO D: Hospital Indemnity Plan
D: Hospital Indemnity Plan Hospital Indemnity plans are basic policies that provide first dollar coverage for a specific loss.
Which of the following policies are tax deductible for the insured? A: Individual disability insurance B: Key Person C: Buy/Sell Agreements D: None of the Above
D: None of the Above Individual disability policies, and any other disability policies in which a business is the beneficiary are not tax deductible.
Part B of Medicare covers all of the following benefits EXCEPT: A: Doctor's visit B: psychiatric care C: home health services D: None of the Above
D: None of the Above Since Part B of Medicare covers doctor's visits, including psychiatric care, and home health services, none of the answers are the exception.
All of the following provisions found in a health policy are optional EXCEPT: A: Change of Occupation B: Illegal Occupation C: Intoxicant and Narcotic Usage D: None of the Above
D: None of the Above The Change of Occupation, Illegal Occupation, and Intoxicant and narcotics clauses are all examples of optional provisions found in individual health policies.
Which of the following elements is part of the entire contract clause? A: The exchange of value between the parties B: The agreement between the policyholder and insurer C: The amount of time the insured has to send a policy back for a full refund D: None of the Above
D: None of the Above The entire contract is a policy, copy of application, riders and endorsements.
All of the following are optional provisions EXCEPT: A: Change of Occupation B: Illegal Occupation C: Intoxicant and Narcotic Use D: Proof of Loss
D: Proof of Loss The Proof of Loss provision is mandatory and states that an insured must provide written proof of loss forms within 90 days of the loss.
Which of the following is true regarding Noncan right of renewability? A: Only the insurer has a right to end coverage B: An insurer can cancel a policy for any reason C: The insured will receive a premium discount for this option D: The premium is always level.
D: The premium is always level. Noncancelable right of renewability guarantees premium cost and renewability of the policy as long as the owner pays the premium on time.
What is the main purpose of Regulation 919? A: To assure that insurance claimants are treated in a prompt and courteous manner B: To encourage insurance companies to make claim forms available to all claimants within 30 days. C: To help minimize groundless legal actions by insureds against insurance companies relating to claims. D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct.
D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. When complaints against insurance companies are made to the Department of Insurance regarding claims practices, they are recorded and analyzed to help the Director decide which companies need to be examined for their nonfinancial conduct.
K has a major medical policy and was in a horrific car accident. After 4 months in the hospital K is released but is paralyzed from the neck down. Considering K's circumstances, what is the maximum time the insurer will require Proof of Loss? A: 30 days B: 60 days C: 90 days D: Within 1 year
D: Within 1 year Since K's loss is so catastrophic, proof of loss provision states that while forms should be sent back to the insurer within 90 days of the loss, up to one year in the case where an insured is legally incapacitated.
All risk in an LHSO delivery is borne by: A: the insured B: the subscriber C: the department of insurance D: the provider
D: the provider All risk that is delivered in a Limited Health Service Organization is borne by the organization or its providers.
