Exam
Most LTC plans have, which of the following features
Guaranteed renewability
To be eligible for group, health, insurance, and employee must meet all of the conditions except
Have dependents
How soon must licenses inform the commissioner of a change of address
Within 30 days
An insured involved in an accident and cannot perform her car and job for three years. If the insured could reasonably perform another job, utilizing similar skills after one month for how long would the insured be receiving benefits under an occupation disability plan
2 years
An employee shirt 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 his maximum monthly premium for cobra coverage?
$102
What is the maximum fine for paying a commission or any other compensation to a person who not properly licensed for acting as an insurance producer in the state?
$500
What percentage of individually owned disability income benefits is taxable
0%
Uninsured pay monthly premium of $100 for her health insurance. What would be the duration of the grease. Under her policy
10 days
For group, medical and dental expense, insurance, what percentage of premium paid by the employer is deductible as a business expense
100%
In order to a lot of Social Security disability benefits, the claimant must be able to demonstrate that the disability will, last, at least
12 months
What is the limiting age for dependent children of being insured in blanket policies?
26 years old
An insured has a major medical policy with a $500 deductible and a coinsurance clause of 80/20 if he incur medical expenses of $4000, the insurer would pay
2800 Subtract deductible then divide by 80%
The minimum number of credits required for partially insurance status for Social Security disability benefits is
6 credits
Underwriting for disability insurance is unique due to the type of risk involved. Which of the following situations illustrates this
A construction worker pays a higher premium and receives a poorer classification of disability.
Which of the following individuals may be eligible for coverage on the health insurance marketplace
A permanent resident lawfully present in the US
When the insured purchased his health policy, he was a window washer. He has since change occupation, and now manages a library. If the insurance is notified of the insurance change of occupation, the insure would.
Adjust the benefit in accordance with the decreased risk
What are the 4 elements of insurance contract
Agreement (offer and acceptance), consideration, competent parties, and legal purpose
In which Medicare supplemental policies are the core benefits found
All plans
In reference to the standard Medicare supplement benefits plan what does the term standard mean?
All providers will have the same coverage options and conditions for each plan
Uninsured has been quoted an estimated cost for procedure from their health carrier. This quote must include all of the following, except.
An exact and final price of the procedure
Which of the following types of agent authorities also called perceived authority
Apparent
The classification small employer means any person actively engaged in a business that at least 50% of its working days during the proceeding year employed
At least one, but not more than 50 people
If an insurer meets the states financial requirements and is approved to transact business in the state is considered to be
Authorized
If an insurer meets the states financial requirements and is approved to transact business in estate is considered what type of insurer
Authorized or admitted
Dental plan that provides coverage based upon a specific mask scheduled amount for each procedure and pays on a first dollar basis with no deductible or coinsurance is a
Basic or scheduled plan
All of the following are true of the key person, disability income policy, except
Benefits are considered taxable income to the business.
To be eligible for tax credits under the ACA individuals must have income that is what percent of the federal poverty level
Between 100% and 400%
Which of the following following options best depicts how the eligibility members for group health insurance is determined
By conditions of employment
In the event of a divorce, which of the following would allow a divorcee to continue receiving group health coverage under under an insured spouses plan for additional 36 months
COBRA
A producer who fails to separate premium monies from his own personal funds is guilty of
Commingling
Health health insurance plan that covers all accident and sickness that are not specifically excluded from the policy is referred to as a
Comprehensive plan
An insured is admitted to the hospital for surgery on a herniated disc. The insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insured schedule. This is called.
Concurrent review
What is the contract provision that allows the insured to non-renew health coverage of certain events occur
Conditionally renewable
What is the correct provision that allows the insurer to non-renew health coverage if certain events occur
Conditionally renewable
Which of the following is not a cost receiving service in a medical plan?
Denial of coverage
Which of the following is not a cost saving service in a medical plan?
Denial of coverage
What is part e
Duties after an accident or loss
Concerning group, medical, and dental insurance, which of the following statements is not correct
Employee benefits are tax deductible the year in which they were received
OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary motive coverage
End stage renal failure
An insurance company assures this new policy holders at their minimum cost will not increase for period at least five years however, due to increasing financial strain, they plan to raise premium cost for all insured by 10% of the next two years. What term best describes this act.
Fraud
What entities make up the medical information bureau?
Insurers
And health insurance if a doctor charges $50 more than what the insurance company considers us usual customer and reasonable the extra cost
Is not covered
What is the benefit of experience rating?
It allows employers with low claims experience to get lower premiums.
The producer receives a premium from his client. He fails to remit the premium to the company, after the insurer makes a written demand the producers guilty of.
Larceny
In group insurance what is the policy called?
Master policy
What is the part c
Medicare Advantage
Medicare advantage is also known as
Medicare Part C
An insured is involved in a car accident. In addition to Leslie injuries he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later to what extent will the insured receive presumptive disability benefits
No benefits
A 55-year-old employee has worked part-time for his new employer for three months now, but has not offered insurance what factor has limited the employees eligibility?
Number of hours worked per week
And are most dental plans while limitations are post for denture replacement
Once every five years
Under which of the following organizations are the practice and providers comp compensated on a fee for service basis
PPO
Which of the following statement is incorrect concerning Medicare part B coverage?
Part b coverage is provided free of charge when an individual turn 65
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following
Parts A and B of Medicare
A woman obtain health coverage through the marketplace on October 1 two weeks later she finds out that she has three months pregnant. Which of the following is true about coverage for pregnancy.
Pregnancy will be covered immediately
Medicare part d provides
Prescription drug benefit
Pertaining to insurance which of the following is an example of a producers, fiduciary responsibility
Promptly forwarding premiums to the insurance company
Under which provision kind physician, submit, claim information prior to providing treatment
Prospective review
What would a physician utilize if he or she wanted to know if a treatment is covered under the insurance plan and at what rate will it be paid?
Prospective review
Insured may change, which of the following on a guarantee, renewable health insurance policy
Rates by class
Which services are associated with the standard and poors and AM best
Rating the financial strength of insurance companies
What type of dental repair would cover the cost of fillings?
Restorative
Which type of care reestablishes functionally used to natural teeth
Restorative
In cases of loss, the indemnity provision and insurance policies
Restore an insured person to the same financial state as before the loss
Regarding cost containment and medical plans, what type of review process to employers and ensures use to evaluate the utilization review process, and the effectiveness of the professionals involved in large insurance claims
Retrospective review
Regarding cost containment in medical plans, what type of review process to employers and ensures used to evaluate the utilization review process in the effectiveness of professionals, involves in large insurance claims
Retrospective review
An insured wants to name her husband as the beneficiary for house policy and retain all rights of ownership. Husband should be named as what type of beneficiary.
Revocable
Which of the following is not covered under plan a Medigap insurance?
The Medicare Part A deductible
Which type of information is not included in the certificate of insurance
The cost the company is paying for monthly premiums
An insurance, institution producer or insurance support organization, may not disclose any personal or privileged information about an individual collected or received in connection with an insurance transaction unless
The disclosure is with the written authorization of the individual
Who chooses a primary care physician in HMO?
The individual member
In terms of parties to a contract, which of the following does not describe a competent party
The person must have at least completed secondary education.
Which of the following is correct about Medicare?
The program is divided into four parts (A-D).
Which state has jurisdiction over a group policy that covers individuals that reside in more than one state
The state in which the policy was delivered
The purpose of COBRA
To provide continuation of coverage for terminated employees
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience and geographic areas, known as
Usual, customary and reasonable
What types of services may not be provided under long-term care assisted-living care
Visits from nurses
Which of the following is another term for an authorized insurer?
admitted
A health insurance plan that covers all accidents and sicknesses that are not specifically excluded from the policy is referred to as a
comprehensive plan
Three types of agent authority
express, implied, apparent
What is part a
hospital insurance
What do individuals use to transfer their risk of loss to a larger group?
insurance
Insurance is a contract that protects the insured from what
loss
What is part D
prescription drugs
All of the following are activities of daily living, except
speaking
Wagering on a sporting event is known as what type of risk
speculative
For the purpose of insurance risk is defined as
the uncertainty or chance of loss
All of the following statements about Medicare supplement insurance policies are correct, except
they cover the cost of extended nursing home care
An insurance company receives an application with some information missing and issues the policy anyway what is this called?
waiver
What is part B
medical insurance
The person who does not lock the doors to his or her house shows an indifferent attitude. This person presents what type of hazard.
morale
The insurer organized to return a profit to the stockholders is what type of insurer
stock company
Who owns stock companies
stockholders
In order to collect Social Security disability benefits, the claimant must be able to demonstrate that the disability will last at least
12 months
All of the following cases show when a small employer medical plan cannot be renewable, except
When the employer chooses to renew the plan.
Insured health plans must provide mental health benefits on a nondiscriminatory basis for the diagnosis and treatment of biologically based mental health disorder for children, adolescence, under what age
19 years okd
And insured makes truthful statements on the application for insurance, and pay the required premium. It is known as which of the following.
Consideration
A person applying for a resident insurance producer license must make application to the commissioner on the uniform application
I have successfully passed the examinations for the lines of authority for which the person has applied
For the reported losses of an insured group to become more likely to equal statistical probability of loss for that particular class, the insured must become
Larger
An insurance policy paid a non-taxable dividend to the insured one year and nothing the next from what type of insured the insured purchase the policy
Mutual
Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage
No, the group must be formed for a purpose other than obtaining group insurance.