Actual exam questions

What is the annual deductible for Medicare part B

$100

In order it maintain coverage under COBRA how soon from termination of employment must an employee exercise extension of benefits

60 days

Regarding Medicare part A coverage of hospital charges the plan will help pay for up to how many days per benefit period

90 days

Relation of Earnings to Insurance provision

Allows the insurance company to limit the insured's benefits to his/her average income over the last 24 months.

While a claim is pending, an insurance company may require

An independent examination as often as reasonably required

Which of the following statements is true concerning the alteration of optional policy provisions

An insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder.

What document describes an insureds medical history including diagnosis and treatments

Attending Physician's Statement

What describes the features of a comprehensive major medical policy

Basic medical expence benefits aee provided in a single packet

Which of the following includes information regarding a persons credit, character, reputation, and habits?

Consumer report

The gatekeeper of an HMO helps

Control specialist costs

What is a revocable beneficiary?

A named beneficiary who the insuredmay change without his/her consent.

All of the following are true about group disability income insurance EXCEPT

Coverage applies both on and off the job

periodontics (periodontist)

Diagnoses and treats disease of the supporting tissues and gums.

which of the following statements about occupational and nonoccupational coverage is true

Disability insurance can be written as both

The provision that states that both the printed contract and a copy of the application from the contract between the policy owner and the insurer is called

Entire contract

Medicare is funded by

Federal taxes

Medicare is funded mostly by

Federal taxes

In which of the following locations would skilled care most likely come from

In an institutional setting

In which HMO model provides its members with the greatest choice of physicians

Independent practice association

What best describes first dollar coverage

Insurer doesn't pay a deductible

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

Insurer to the insured

Which of the following entities has the authority to make changes to an insurance policy

Insurer's executive officer

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

The section of the health policy states the causes of eligible loss under which an insured is assumed to be disabled

Insuring clause

What is true about major medical health insurance

It is not designed to pay on a first dollar of expense basis

Which of the following statements concerning Medicare part B is correct

It pays for physician services, diagnostic tests, and physical therapy.

What of the following is true about a ppo

It's goal is to channel patients to providers that discount services

Which of the following is true of a PPO

Its goal is to channel patients to providers that discount services.

Which of the following is considered a presumptive disability under a disability income policy

Loss of two limbs

In franchise insurance premiums are usually

Lower than individual policies, but higher than group policies.

Under the affordable care act which classification applies to health plans based on the amount of covered cost

Metal level classification

A guaranteed renewable health insurance policy allows

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

All of the following are true regarding rebates except

Rebates are allowed if it's in the best interest of the client.

In the event of a loss, business overhead insurance will pay for

Rent

What is prosthodontics?

Replacement of natural teeth with artificial teeth or dentures covers bridgework

Part A of Medicare is financed by

Social security payroll taxes

Part A of social security is funded by

Social security payroll taxes

Part A of social security is funded primarily through

Social security payroll taxes

The insuring clause

The heart of an insurance policy. It contains the company's promise to the policyowner and describes the coverage provided and the policy limits.

In a group policy, who is issued a certificate of insurance?

The individual insured

Information on whether the free look provision applies will be in

The notice regarding replacement

A policy with a 31-day grace period implies

The policy will not lapse for 31 days if the premium is not paid when due

An individual purchased a Medicare supplement policy in march and decided to replace it two months later. His history of coronary artery disease is considered a pre-existing condition. What is true?

The pre existing condition waiting period fulfilled in the old policy will be transferred to the new policy picking up where the old one left off

take it or leave it

adhesion contract

What is the term used for an applicants written request to an insurer for the company to issue a contract based on the information provided

application

Which of the following losses will be covered by a group medical expense policy

pre-existing condition

The price of insurance for each exposure unit is known as

rate

When benefits are paid directly to the insured under a health insurance policy, the policy provides benefits on what type of basis?

reimbursement

Which of the following services would be covered by endodontics

root canal

A person requesting a hearing should file the request within how many days of the act giving rise to the grievance?

60 days

Following a 3 day hospital stay Medicare part A will pay up to how many days in a skilled nursing facility

100

In a non contributory health insurance plan what percentage of eligible employees must participate in the plan before the plan can become effective

100 percent

A producer has just received his insurance license. For how many days may the producer initially transact insurance for an insurer without an appointment?

15 days

How long is an open enrollment period for Medicare supplement policies?

6 months

How can a new physician be added to the PPO's approved list?

Agree to follow the PPO standards and charge the appropriate fees.

An insured pays a $100 premium every month for his insurance coverage, yet the insurer promises to pay $10,000 for a covered loss. What characteristic of an insurance contract does this describe?

Aleatory

Which of the following is not true of Disability BUY-Sell coverage

Benefits are considered taxable income to the business.

What is not true about business overhead expense policies

Benefits are usually limited to six months

The extraterritorial provision

Can be added to worker's compensation in order to provide that dates mandated coverage while temporarily working outside of the state

#3. When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best appLy

Case management provision

What policies cover injuries and illnesses that occur on and off the job

Full coverage

As it pertains to group health insurance, COBRA stipulates that

Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.

What option allows the insured to periodically increase benefit levels without providing evidence of insurability?

Guarantee of insurability

What are the three basic coverages for medical expense insurance

Hospital, surgical and medical

Which of the following is incorrect concerning taxation of disability income benefits

If paid by the individual, the premiums are tax deductible.

Which of the following riders would not increase The premium for a policy owner

Impairment Rider

Which of the following is not a penalty for willful violation of a commissioners order by an insurer

Imprisonment

Notice Regarding Replacement

Must inform the applicant of the 30-day free look provision of the replacing policy

In which type of HMO model does the HMO contract with at least two medical groups

Network

What type of care is provided with intermediate care?

Nursing and rehabilitation

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date?

Optionally renewable

When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called

Overinsurance

Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?

Pay a special deductible on his major medical policy

What applies to partial disability benefits

Payment is limited to a certain period of time

Worker's compensation benefits are regulated by which entity

State government

In major medical insurance policies when the insureds share of coinsurance reaches a certain amount the insured is no longer obligated to pay it the feature is known as

Stop loss

If a member of a Blue Cross/Blue Shield (BC/BS) obtains medical treatment from a non-participating provider, the insurer will pay

The amount that would have been paid to a participating provider

Premiums paid by a self-employed sole Proprietors or partners for medical expense insurance

Totally tax deductible

Individuals who have AlS automatically qualify for Medicare part a regardless of age

True

What is a peril?

cause of loss

Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT

conditions

Who can take a tax deduction for their share of the Social Security tax?

employers only

In disability income insurance the own occupation definition of disability applies

for the first 2 years of a disability

A morale hazard may exist due to

indifference to loss

Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to

insured

Under an individual disability income policy, the benefits must be paid on at least what schedule?

monthly