CO Health Insurance Exam- Exam FX

Which of the following is considered a qualifying event under COBRA? A Divorce B Marriage C Relocation D Promotion

A

What type of care is Respite care? A 24-hour care B Relief for a major care giver C Daily medical care, given by medical personnel D Institutional care

B

An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she has not met the conditions specified in the A Consideration Clause. B Insuring Clause. C Pre-existing Conditions Clause. D Eligibility Clause.

A

Before a customer's agent delivers his policy, the insurer makes a last-minute change to the policy. The agent informs the customer of this change, and he accepts it. What must the agent do now? A The agent should ask the customer to sign a statement acknowledging that he is aware of the change. B Nothing. After the explanation, the agent is not legally bound to do anything else. C The agent must notify the beneficiary of the change in policy. D If the change would affect the premium, the agent must have the customer sign a statement acknowledging the change.

A

Concerning Medicare Part B, which statement is INCORRECT? A It is fully funded by Social Security taxes (FICA). B It is known as medical insurance. C It offers limited prescription drug coverage. D It provides partial coverage for medical expenses not fully covered by Part A.

A

Medicare Part A services do NOT include which of the following? A Outpatient Hospital Treatment B Post hospital Skilled Nursing Facility Care C Hospitalization D Hospice Care

A

The primary eligibility requirement for Medicaid benefits is based upon A Need. B Whether the claimant is insurable on the private market. C Age. D Number of dependents.

A

Under what condition are group disability income benefits received by an employee NOT taxable as income? A When the benefits received are equal or less than the employee's percentage of the contribution. B When the employer makes all the premium payments. C When the employee is 59 ½. D When the amount of the benefit is equal or less than the amount of contributed by the employer

A

In comparison to consumer reports, which of the following describes a unique characteristic of investigative consumer reports? A The customer has no knowledge of this action. B The customer's associates, friends, and neighbors provide the report's data. C They provide additional information from an outside source about a particular risk. D They provide information about a customer's character and reputation.

B

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? A Community-based organization professionals B Attending physician C Registered nurses D Licensed practical nurses

B

Regarding Medicare SELECT policies, what are restricted network provisions? A They determine premium rates. B They help avoid adverse selection. C They condition the payment of benefits. D They determine who can be insured.

C

The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called A Occupational coverage. B Workers compensation. C Nonoccupational coverage. D Unemployment coverage.

C

What is the goal of the HMO? A Providing free health services B Limiting the deductibles and coinsurance to reduce costs C Providing health services close to home D Early detection through regular checkups

D

A Medicare supplement plan must have at least which of the following renewal provisions? A Guaranteed renewable B Conditionally renewable C Nonrenewable D Noncancellable

A

For Medicare Part A, a person must be age 65 or otherwise qualify A. True B. False

A

Medicare Advantage is also known as A Medicare Part D. B Medicare Part A. C Medicare Part B. D Medicare Part C

D

In Colorado, When rating small employer group, small employer carriers may use all of the following factors EXCEPT A Gender. B Age of employees. C Geographic location. D Family composition.

A

Which of the following is INCORRECT concerning Medicaid? A It is solely a federally administered program. B It provides medical assistance to low-income people who cannot otherwise provide for themselves. C It pays for hospital care, outpatient care, and laboratory and X-ray services. D The federal government provides about 56 cents for every Medicaid dollar spent.

A

Which of the following must the patient pay under Medicare Part B? A 20% of covered charges above the deductible B 80% of covered charges above the deductible C All reasonable charges above the deductible according to Medicare standards D A per benefit deductible

A

Which of the following statements about occupational vs. nonoccupational coverage is TRUE? A Disability insurance can be written as occupational or nonoccupational. B Group medical expense policies and individual medical expense policies always cover both occupational and nonoccupational injuries. C Individual disability policies never cover nonoccupational injuries. D Only group disability income policies can be written on an occupational basis

A

The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as A Proof of loss. B Legal actions. C Time limit on certain defenses. D Payment of claims.

B

What is the grace period if the premium is paid monthly? A. 7 days B. 10 days C. 15 days D. 31 days

B

What is the maximum dollar limit that must be provided under a sickness and accident insurance policy for annual prostate cancer screening for early prostate cancer in men? A $60 B $65 C $35 D $50

B

Which of the following best describes the Medical Information Bureau (MIB)? A. It is a rating organization for health insurance B. It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance C. It is a government agency that collects medical information on the insured from the insurance companies D. It is a member organization that protects insured against insolvent insurers

B

Which statement accurately describes group disability income insurance? A Short-term plans provide benefits for up to 1 year. B The extent of benefits is determined by the insured's income. C In long-term plans, monthly benefits are limited to 75% of the insured's income. D There are no participation requirements for employees.

B

How many pints of blood will be paid for by Medicare Supplement core benefits? A Everything after first 3 B 1 pint C First 3 D None; Medicare pays for it all

C

All of the following statements about Medicare supplement insurance policies are correct EXCEPT A They cover Medicare deductibles and copayments. B They supplement Medicare benefits. C They are issued by private insurers. D They cover the cost of extended nursing home care.

D

An insured has Medicare Part D coverage. He has reached his initial benefit limit and must now pay 50% of his prescription drug costs. What is the term for this gap in coverage? A Bridge B Blackout period C Latency period D Donut hole

D

The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract? A Adhesion B Personal C Unilateral D Conditional

D

Which one of the following is an eligibility requirement for Social Security disability income benefits? A Currently employed status B Fully insured status C Experiencing at least one year of disability D Being at least 50 years of age

B

Which of the following statements concerning Medicare Part B is correct? A It is provided automatically to anyone who qualifies for Part A. B It pays on a first dollar basis. C It pays 100% of Medicare's standards for reasonable charges. D It pays for physician services, diagnostic tests, and physical therapy.

D

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage? A $100 B $102 C $25 D $25.50

B

All of the following statements about Medicare Part B are correct EXCEPT A It is financed by monthly premium B It is financed by tax revenues. C It is a compulsory program. D It covers services and supplies not covered by Part A.

C

Insurers may change which of the following on a guaranteed renewable health insurance policy? A Individual rates B No changes are permitted. C Rates by class D Coverage

C

Mrs. B applied for a Medicare Supplement policy one month before her 65th birthday. The policy was issued on her birthday, January 31. Her producer mailed the policy by certified mail, and Mrs. B received the policy on February 5. How many days does she have to examine the policy and decide whether or not to keep the policy? A 10 days from the date it was received B 30 days from the date of the application C 30 days from the date it was received D 30 days from the date it was issued

C

What is the main difference between coinsurance and copayments? A With coinsurance, the insurer pays all of the cost. B Coinsurance is a set dollar amount. C Copayment is a set dollar amount. D With copayments, the insured pays all of the cost.

C

As a condition of initial licensure, an individual applicant for a producer license in one line of authority will be required to complete approved prelicensing education of how many hours? At least 3 of these hours will pertain specifically to ehtics and 4 to state laws. A 20 hours B 32 hours C 40 hours D 50 hours

D

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is A Within 45 days. B Weekly. C Biweekly. D Monthly.

D

Which of the following is true regarding inpatient hospital care for HMO members? A Care can only be provided in the service area. B Services for treatment of mental disorders are unlimited. C Inpatient hospital care is not part of HMO services. D Care can be provided outside of the service area.

D

Which of the following would be an example of a limited accident and health insurance policy? A An accidental death and dismemberment policy B A Medicare policy C A long-term care policy D Adread disease policy

D

How often must the Commissioner examine all insurers to guard against insurance company insolvency? A At least once every 3 years B Every time the Certificate of Authority is renewed C Annually D At least once every 5 years

D

In all individual and small employer health benefit plans, how long is the grace period for persons receiving the federal advance payment tax credit? A 10 days B 30 days C 2 months D 3 months

D

In order to facilitate responses to inquiries from the Division of Insurance, companies must maintain all records for at least A 12 months from any date on the document. B 4 years from the date on the document. C 52 weeks from the time the document was last accessed. D The current calendar year, plus the 2 prior calendar years.

D

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? A Coverage options and conditions comply with the law, but will vary from provider to provider. B All plans must include basic benefits A-N. C Coverage options and conditions are developed for average individuals. D All providers will have the same coverage options and conditions for each plan.

D

Health insurance policies become incontestable after what time period from the policy issue? A 1 year B 18 months C 2 years D 3 years

C

Once a person becomes eligible for Medicare supplement plans, and during the open enrollment period, coverage must be offered on a guaranteed issue basis. A. True B. False

A

Which of the following would NOT be considered a limited coverage policy? A Accident insurance B Cancer insurance C Credit insurance D Major medical expense insurance

D

Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid? A 90 days B 5 months C 12 months D Benefits will be paid immediately.

B

The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as A Part D. B Part A. C Part B. D Part C.

B

All of the following individuals may qualify for Medicare health insurance benefits EXCEPT A A person age 45 who has a permanent kidney failure. B A person under age 65 who is receiving Social Security disability benefits. C A retired person age 50. D A healthy person age 65.

C

Insurers must provide health insurance claim forms within how many days? A 5 B 7 C 15 D 20

C

The Medical Information Bureau (MIB) was created to protect A Insurance departments from lawsuits by policyowners. B Insureds from unreasonable underwriting requirements by the insurance companies. C Medical examiners that perform insurance physical examinations. D Insurance companies from adverse selection by high risk persons.

D

5Who makes up the Medical Information Bureau? A Former insured B Physicians and paramedics C Insurers D Hospitals

C

Medicaid provides all of the following benefits EXCEPT A Eyeglasses. B Family planning services. C Income assistance for work-related injury. D Home health care services.

C

Under a Key Person disability income policy, premium payments A Are made by the business and are not tax-deductible. B Are made by the employee and are not tax-deductible. C Are made by the employee and are tax-free. D Are made by the business and are tax-deductible.

A

In accident and health policies issued in this state, an insured must submit proof of loss within how many days? A 15 days B 20 days C 60 days D 90 days

D

All insurers that terminate employment with a producer are required to notify the Commissioner within how many days following the effective date of the termination? A 20 days B 30 days C 45 days D 10 days

B

An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true? A The group plan will pay. B The group plan will pay a portion of the employee's expenses. C The group plan will pay depending on the employee's recovery. D The group plan will not pay because the employee was injured at work and they will have to rely on workers compensation instead

D

All of the following long-term care coverages would allow an insured to receive care at home EXCEPT A Skilled care. B Custodial care in insured's house. C Respite care. D Home health care.

A

How does a member of an HMO see a specialist? A The member is allowed to choose his or her own specialist. B The primary care physician refers the member. C The insurer chooses the specialist. D HMOs do not cover specialists.

B

An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits? A Have accumulated 40 work credits B Have reached the age of 25. C Have accumulated 6 work credits in the past 3 years D Have accumulated 20 work credits in the past 10 years

C

How long is a newborn covered without notification to the insurer? A From the moment of birth, and the insurer must be notified within 90 days B A newborn is not covered without notification to the insurer. C From the moment of birth, and the insurer must be notified within 31 days D From the time labor has begun, and the insurer must be notified within 31 days

C

What document describes an insured's medical history, including diagnoses and treatment? A. Individual Medical Summary B. Comprehensive Medical History C. Attending Physician's Statement D. Physician's Review

C

Which of the following is NOT covered under a long-term care policy? A Adult day care B Hospice care C Home health care D Acute care in a hospital

D

Which type of a hospital policy pays a fixed amount each day that the insured is in a hospital? A Surgical B Blanket C Medigap D Indemnity

D

Which of the following would provide an underwriter with information concerning an applicant's health history? A A medical examination B The agent's report C The inspection report D The Medical Information Bureau

D