Health and Life 215
Closed panel systems are staffed by MD's who also function as employees in the HMO facility.
HMO-type providers are classified by having:
45 days
How many days in advance must an insurance company that wishes to cancel an individual health insurance policy give to the policy owner?
24
How many hours of continuing education must a newly licensed agent acquire every two years?
100
How many members are association groups required to have?
Death must occur as a result of an occupational related accident.
In order for an accidental death benefit to be paid, what condition has to be met?
The beneficiary receives a guaranteed income no matter how long he/she lives.
In the settlement option known as Life Income Option:
The beneficiary receives a guaranteed income no matter how long they live.
In the settlement option known as Life Income Option:
the equivalent of
Insurance law states that the HMO contract is_________a personal health insurance contract.
Risk Pooling
Insurance provides protection from the total loss from risk through the concept of:
All groups must be priced the same regardless of health status.
The Florida Employees Health Care Access Act dose not require that:
COBRA
The Florida Health Insurance Continuation Act is a mirror of the federal act known as :
19
The Florida Health Insurance Coverage Continuation Act applies to groups of ____ and under.
19 and under
The Florida Health Insurance Coverage Continuation Act applies to groups of ______?
Forms
The OIR continuing regulation of insurance company activities includes policy______ and provisions.
15
The code states that a request for claim forms must be acknowledged before___ days has elapsed from the time of the request.
It provides the sequence of beneficiaries.
The common disaster provision, in a beneficiary designation:
States
The criteria to qualify for Medicaid are established by the _________:
Treatment for self inflicted injuries.
The definition of Comprehensive Health Care Services would not include what?
Residual disability.
The definition of disability that would insure income rather than condition?
2 years
The insured has a maximum number of years to bring legal action against an insurer, it is:
Three
With three partners in a business, how many life insurance policies will be required to insure an entity buy-sell plan?
Primary
Workers comp and the VA are considered what type of provider to eligible recipients?
True.
Workers compensation is not a part of OASDI.
$5,000
Workers compensation programs are state regulated plans. If a worker is killed in an on the job accident, his family will receive what amount of money as a death benefit?
Gross premium
The premium that reflects mortality rates, assumed interest, and the policy's share of the company's operating expenses.
and cannot be required to pay additional damages under the law.
The principle of Workers Compensation laws is the employer is considered liable for all on the job injuries and:
and cannot be required to pay additional damages under the law
The principle of workers comp laws is that the employer is considered liable for on the job injuries and...:
the period of time starting on the policy effective date during which there is no coverage for illnesses.
The probationary period in a disability income policy is:
the period of time starting on the policy effective date during which there is no coverage for illness.
The probationary period in a disability income policy is?
Increasing term
What is the type of term insurance in which the death benefit remains the same, but the premium increases each time the term ends?
Accidental Death and Dismemberment
What kind of health policy would require a beneficiary designation?
A convertible Term policy.
What kind of policy can be changed from a non-cash value contract to one that is a cash value developing without medical underwriting?
20 year endowment
What kind of policy will pay the face amount of the policy to the owner after 20 years?
The contract purchaser
What party determines the elimination period?
The principle of pooling
What principle states "spreading the income loss created by an individual's death among many persons so the cost for each individual is small"?
Implied authority
What type of authority permits the agent to print business cards with the insurers logo?
The named beneficiary
What would the major difference in the policies written as a cross-purchase or as an entity buy-sell?
120 days
When a service member leaves the military, their term insurance will remain in effect for?
made an offer to buy
When an applicant completes the questions on the application and submits payment for at least 1 month's premium they have:
Viatical settlement
When an insured policy owner makes a transfer-for-value(sells the policy) without addressing the matter of insurable interest, the exchange is called a:
Irrevocable
When an owner must obtain the beneficiary's consent to change the beneficiary of a life insurance policy it is considered:
It is possible to convert $3,000 or more of industrial insurance policies into one ordinary life policy.
When dealing with industrial insurance, what applies when an insured wishes to convert to an ordinary policy?
when they want to borrow money outside the policy
When do policy owners exercise the collateral assignment clause?
When they want to borrow money outside the policy.
When do the policy owners usually use the collateral assignment?
continuing care
When entering______ the recipients are usually mobile and able to participate in communal activities.
age or sex
When errors due to mistakes in______, which affect premiums, are discovered after death, the death benefit is prorated to match the proper amount of benefit for the premium paid.
physicians
Medicare part B covers_______ services in or out of the hospital.
The duration of time the premiums are payable.
Whole Life is classified by:
30
Medicare supplements and long term care policies have a ____ day free look rather than the normal 10 days.
30 day
Medicare supplements and long-term care policies have a _______day free look rather than the normal 10 days.
Guaranteed renewable
Medicare supplements must be:
5 years
Suitability information collected by agents and insurers must be retained for ________years for review.
Limited life pay policy
A life insurance policy that continues to provide protection after the premium period has ended.
a limited pay life policy
A life insurance policy that continues to provide protection after the premium period has ended.
2 years
A life policy is considered incontestable after it has been in force for a period of ____:
Churning
A logical, but misleading presentation is made to a consumer.
Post-Claims underwriting.
A major prohibition in the NAIC model Long Term Care Regulations concern?
Policy Design
A major way to control health insurance cost is by_____:
Be disenrolled from
"Notice to Buyer" When you enroll in this HMO, you will________ medicare.
Field
"Rating up in age" is used in ________ underwriting.
No deductible.
A FIRST DOLLAR policy refers to a policy that has:
24,24
A ___month exclusion and a ___ month look back is permitted for preexisting conditions for one person groups.
The return of premium clause
A merchandising idea that returns to the beneficiary all of the premium paid during the insureds life as well as the policy's face value.
The misrepresentation was material to the issue of the contract
A misrepresentation on an application may only prevent recovery if any of the following apply except?
A variable annuity unit.
A statistical symbol used to calculate the amount of each payment.
Accelerated death benefit
Allows an insured policyowner to become in part their own beneficiary.
21 days
How many days must the grace period be extended for persons 64 and over?
One
How many guarantees are there in the variable life product?
Non-Cancelable
Guarantees a fixed premium to a specific age:
12
HIPPAA requires that any person with____months of creditable coverage, who does not have access to other health insurance, must be given access to another insurance policy.
5
How many visits to a dermatologist without a primary care physician referral are HMO's required to provide every year?
5 years
How often are HMO's required to have a full audit?
as often as is reasonably necessary
How often may an insurer require that an insured approved physician examine the insured receiving disability income benefits?
65
How old does one have to be to qualify for Medicare?
The policy lapses.
If the cash value account of a flexible premium universal life policy reaches zero, the policy owner must make a premium payment or:
7.5%
Individuals may currently deduct personal NONREIMBURSED medical expenses that exceed____ of adjusted gross income.
Personal
Insurance contracts may not be assigned because they are not_____:
A traditional IRA allows an individual to save money for retirement with pre-tax income.
Is a traditional IRA funded with pre or post tax funds?
The employer
Lower costs in group insurance are primarily due to the administrative work done by the:
Time
Mortality tables to be accurate must be based on a large cross section of people and also a large cross section of _______.
Comprehensive
Most Major medical policies written today are described as:
Premium
Non-cancelable and guaranteed renewable provisions are similar and must be renewed, except that the _________is fixed in the non-cancelable policy.
named beneficiary
Policy cash values and death benefits cannot be attached by the insureds creditors if left to an______:
Moral
Poor credit or dishonest business practices would be considered a _____hazard.
54
Sex is a premium factor. In younger age groups, women's health insurance premiums tend to be about 20 to 25% higher than men's premiums for the same age. However, as the age rises the two health premiums become more equal, and about age____ they cross as men then become more susceptible to health problems than women.
Maintenance
The HMO contract is not an insurance policy. It is a health _______ contract on the subscribers body.
Preventative
The HMO since the services are prepaid, encourages the individual to see a doctor early so that ______ measures can be taken.
distribution
The annuity distribution method is normally selected at the time of_________:
Loading
The anticipated future expense or _____ is added to the net single premium to arrive at the gross premium.
Centers for Medicare and Medicaid Services.
The entity that finances Medicare.
Centers for Medicare and Medicaid Services
The entity that finances Medicare?
Capitation
The fixed amount paid to a provider by the HMO.
5
The minimum number of ADL's that a long term care policy must take into account is:
Total disability.
The minimum requirement for activation of the waiver of premium clause.
The value of annuitants separate account.
The monthly income received by an annuitant with a variable annuity will increase when this increases.
Non-cancelable
The most advantageous health policy type to the owner and has the most stringent underwriting:
Per Stirpes
The term that would designate the children of a deceased named beneficiary as recipients of a death benefit:
Accidental means
This is the most restrictive definition in ADD&D policies.
18 Months
HMO's must provide a minimum open enrollment of 30 days every:
Inflation risk
What is the risk assumed by the buyer of a fixed annuity?
Employer, who then receives and retains a master contract.
An application for group coverage is signed by the?
Yes the IRS has a maximum nontaxable benefit.
Does the IRS become involved with Long-Term Care policy benefits?
Yes, the IRS has a maximum nontaxable benefit limit.
Does the IRS become involved with long term care policy benefits?
Limited pay life policy.
A life insurance policy that continues to provide protection after the premium period has ended is called?
Primary
A multiple location agency must designate a _______ agent for each location.
False
A mutual company makes a profit for its stockholders.
60 days.
A new benefit period will start after a Medicare recipient has not been hospitalized for _______ days.
Group
HMO's operate most extensively through individual or through group enrollment plans?
If a sale cannot be made with honesty, fairness, and objectivity, it must not be made at all.
An agent's personal creed:
An immediate annuity.
An annuity that will begin making monthly payments within 1 month.
15
1999 group regulations now permit a _____percent plus or minus rate variance from the approved community rate, to compensate for health changes and/or claims experience.
A. Encourage uniformity of state insurance laws B. Preserve state regulation of insurance C. Help protect the interests of policy owners
3 Objectives of the NAIC?
Physical Moral Morale
3 Types of hazards:
A. Accidental Death and Dismemberment B. Disability Income C. Medical Expense
3 main forms of health insurance:
115%
A health rated small group premium may not exceed____ of the regular group rate.
HMO
A health service that charges a flat fee for medical care it provides at its own clinic.
the policy premium and the face value remain constant for the term of the policy
A level term policy is one on which:
60,120
A claimant lawsuit must not be filed quicker than_______days after proof of loss has been provided on an uncontested claim, and_____days on a contested claim.
Standard
A conditional insurability receipt functions only if the applicant is a ______risk:
Total or partial income loss because of disability
A disability income policy is designed to provide benefits for what?
Total or partial income loss due to a disability.
A disability income policy is designed to provide benefits for which of the following occurrences?
Misrepresentation
A failure to clearly bring to mind a fact or condition either innocently or intentionally to deceive.
Co-Payment
A flat dollar amount that is paid to the provider by the recipient, at each service occurrence.
20
A notice of claims must be given to the insurer within____days for claims that are pending. No bills required.
Manifested
A preexisting condition that was diagnosed by a physician or treated within a stated period, prior to health insurance taking effect. It must have _______prior to the date of the policy.
Basic
A prepaid limited health service organization(PLHSO) is limited to _______services?
Deny the claim, rescind the contract, and refund all premium.
A prospect for disability income insurance has a mild form of diabetes that is controlled by diet. When completing the application he doe not mention the diabetes because he does not regard it as a serious condition. The insurance company issues a standard policy and 18 months later his diabetic condition worsens. He files a claim for total disability, what would the insurance company likely do?
90
A provider may refuse to renew if it provides ___ days notice and offers policyholders any other coverage available.
During the annuitants lifetime with no refund upon his or her death.
A strait life annuity pays regular income:
Chronic
A treatable illness from which one will not normally recover?
Inflation
A variable annuity offers a possible hedge against what?
employer who then receives and retains a master contract
An application for group coverage is signed by the:
Age, sex, health
Acceptable premium factors in life policies.
Coercion
An agent uses mental force or threat of force to transact insurance.
Fair Credit Reporting Act
Act which attempts to protect an individuals right to privacy.
annually
Actuaries, when using the interest factor as one of the three factors in designing and pricing the product make two assumptions with regards to the interest. First, it assumes a specific net rate of interest that will remain constant during the life of the policy. Secondly, insurance premiums are presumed to be paid ________, in advance.
60 days
After the deductible, Medicare part A will pay 100% of the bill for how long?
State
After years of court cases, state and federal law, Public 15( The McCarron-Fergusan Act) made it clear that the insurance industry should be regulated by the______:
State
Agents who are security licensed may sell variable annuities because they are NASD approved, but they must also be insurance licensed by the_____:
Felony charges
Aiding as an agent for or acting as an unauthorized insurer will subject the perpetrator to ______ and a loss of all licensure.
Unfair discrimination
Altering a policy that is not available by contract to all purchasers.
30 days every 18 months
An HMO must provide an open enrollment for:
NAIC
An association of the 50 state commissioners that make recommendations, usually adapted by the states, for the standardization of policy provision and consumer protection rules:
Has reached full retirement age;
An eligible disabled worker will be denied Social Security Disability income if:
$50,000
An employer may provide, and deduct as a business expense, the cost of any amount of group insurance. The maximum amount an employee may receive is before he/she may receive before he/she must report an excess economic benefit is:
A single premium annuity.
An immediate annuity must also be an:
10%
An individual may tax deduct medical expense, only to the extent that the premium cost for insurance and any un-reimbursed charges exceed_____ of his/her adjusted gross income.
A domestic insurance company
An insurance company that is incorporated under the laws of your state and has its home office in that state is known as a :
Case Management
An insurer control that often reduces excessive expense for ongoing illness.
permanent flat
An often-used method of rating applicants is based on their occupation or their hobbies. Those ratings are called:
Preferred Provider Organization(PPO)
An organization designed to combine small employers together into a group to purchase medical expense insurance for their employees is called a :
A multiple Employer Trust
An organization designed to combine small employers together into a group to purchase medical expense insurance for their employees is called a:
HMO
An organization that provides a wide range of comprehensive health care services for its members, who typically are enrolled on a group basis and pay a fixed contribution for services of participating physicians and hospitals.
Absolute
An owner may assign some of the rights in a policy. There are two types of assignment: (1) One is a collateral assignment used to secure loans. (2) The other one effectively changes the ownership of the contract. It is called an _________assignment.
Twisting
Cause an existing policy to be surrendered and replaced by the agents insurer purpose of creating additional premiums and commissions.
3 contracts
In a three person partnership, an Entity Purchase plan would require how many contracts?
Provide insurance coverage at an earlier date than that of the policy delivery.
Besides acknowledging payment of the initial premium, the purpose of a conditional receipt is to?
10 pay life policy
Between a straight life, 20 pay life, 10 pay life, or a 24 pay life policy: which would accumulate cash value the fastest?
A $10,000 whole life policy.
Bill Drake purchased a 10k life insurance policy in 1993 and paid premiums for several years. Although the policy had lapsed before he died in Jan 2004, a 10k death benefit was paid, What kind of life policy did Mr. Drake have?
Group travel providers
Blanket policies are usually marketed to:
They are offered on both group an individual basis.
Blue Cross/Shield plans are offered in group or individual plans?
Stock redemption plans
Business continuation plans may be designed as entity plans. In close corporations the entity plans are classified as:
Stock Redemption Plans
Business continuation plans may be designed as entity plans. In close corporations the entity plans are classified as?
Stock-redemption plans
Business continuation plans may be designed as entity plans. In close corporations the entity plans are classified as?
it contains a maximum total benefit
Business overhead insurance is considered a valued contract because:
requires that an applicant be advised that a credit report may be requested, if that is the case.
Fair credit reporting act.
nonforfeiture values
Cash values are the same as:
Prepaid health clinics
Cannot use the term HMO and should not be confused with an HMO that delivers a full range of services.
Boycott
Coercion and intimidation. Restraint or monopoly in the business of insurance.
20%
Coinsurance requirement may be as high as ____ of the eligible medical expense.
reimbursement
Commercial insurance companies function on the 2 stage ________ approach.
10
Composite rating may not be used for groups under ______emplyees:
10
Composite rating may not be used for groups under____ employees.
Annual renewable term.
Contract type most used for group life insurance.
Standard
Core benefits in medicare supplement contracts are mandated to be:
Mandatory
Coverage for bone marrow transplants is _____ provided the particular procedure is determined to be acceptable and not experimental.
Decreasing Term
Credit Life, which is sold to ensure amortized loans is a form of __________?
20 Days
HMO's are required to pay their providers claims in______days:
Yes the face value can be adjusted to fit the insureds current needs.
Does a universal life policy have an adjustable face value?
When the employer has paid the premium.
Disability income benefits are considered taxable income to a disabled person when?
The recipients employer has paid the premiums.
Disability income benefits are considered taxable income when?
delayed disability
Disability policies allow a certain amount of eligibility time during which disability may develop from an accident. This is known as ______:
No, they have no rights in the contract.
Do beneficiaries and insureds who are not the policy owner have significant rights to influence optional parts of the policy?
No! There are minimum/maximum deductibles and a back-up high deductible policy is required for catastrophic illnesses.
Do medical savings Accounts avoid strict Federal regulation?
No a Roth IRA has no age limit
Does a Roth IRA have to start distribution at 65?
Indemnity
Duplication of benefit provisions are excluded from these types of policies?
A. The loss must be definite and measurable B. The loss must be predictable C. The loss must be due to chance D. The loss exposures must be randomly selected E. The exposure must avoid "adverse selection" F. The loss exposure must be large
Elements of insurable risk.
Outline of Coverage
Every health contract issued must contain a _______page which is a shortened version of the contract.
14
Everyone who purchases a life insurance policy must receive a Buyer's Guide. The buyer's guide may be given at the time of the application. If the state law requires a ___ day free look after delivery, then the policy guide may be presented to the applicant at policy delivery.
Units
Family policies cover one spouse on a whole life policy with the other members covered with specified amounts of term. These are often sold in pre-packaged _______:
15 members
Federal law requires maternity benefits in group insurance for groups with over:
Units
Fixed annuity language deals in dollars and interest percentages. Variable annuities deal in ___-either accumulation or annuity.
Outpatient
Florida Law states that _______surgery must be covered on all health policies.
Free insurance
Florida Law strictly prohibits offering an applicant what?
14 day
Florida State law requires a _____free look for a full refund after policy delivery.
12,12
Florida law prohibits individual health insurance policies, other than disability income, from excluding coverage for a pre-existing condition for longer than ___ months, following the effective date of coverage for a condition that had manifested ___ months prior to coverage.
Change of agents name.
Florida law requires notification to the DOI within 60 days regarding:
14 days
Florida state law requires a ____day free look for a full refund after policy delivery.
Disability buyouts and business overhead expense
Forms of medical insurance considered Valued Policies include?
Disability Buy Outs and Business Overhead Expense
Forms of medical insurance that are considered "Value Polices".
Office of insurance regulation
HMO's contracts in Florida must be approved by the:
False
Genetic analysis is commonly used as a source of underwriting information?
Modified Community
Group carriers must use the ________ methodology.(Same price for everyone in the category)
100
Group health insurance requires what percentage of eligible individuals must be provided coverage under a noncontributory plan?
A. Rates are usually more favorable than individual policies. B. Policies are usually written as one year renewable term plans. C. Members may assign their incidents of ownership.
Group life insurance:
24,24
Group policies (2-50) may exclude preexisting conditions for no longer than___months with a ___month look back.
Efficiency and Economy
HMO's Act was designed to increase the _________ of health care.
Annual
HMO's are required to make _____ reports of their activities.
Insurer
Has a right to conduct an autopsy on the body of the insured to determine the cause of death:
Controlled business
Having private contract such as family business or single corporation and do no other public business.
Coverage can be issued with a rider excluding a specific condition.
How can a person with a recurring ailment purchase health insurance at a standard rate?
Designate a named beneficiary.
How can an insured protect the proceeds of his life insurance policy from his/her creditors?
90 days
How far in advance does an insurance provider have to notify an insured if they are going to refuse to renew the contract?
Until the child is 16
How long may the spouse of a deceased worker receive benefits for a dependent child?
60 days
How many days can a qualified account be withdrawn and held for between custodial accounts before the ten percent excise penalty is applied?
Invested in separate accounts selected by the policy owner.
In a variable Universal Life policy, cash values are:
Cafeteria Plans
IRS Section 125 contains regulations for:
Decreasing term
If a person is buying a new warehouse and he is going to finance that warehouse over twenty years, what term would he normally purchase?
Option to convert
If a person wishes to eventually own a cash value or equity type of policy, what feature would he want to be sure to have on his term policy?
will pay the proceeds if it would have issued the policy as a standard risk to the proposed insured had they lived.
If a proposed insured(standard risk) dies before the policy is issued but while in possession of a conditional receipt, the company will:
Accumulation units
In a variable annuity, a contract owners interest in his/her separate account is stated in terms of?
The capital sum.
In an AD&D policy what is the reason that the policy is categorized as a health policy?
The application and the initial premium
In an insurance contract, the consideration given by the applicant in exchange for the insurers promise to pay benefits is:
the applicants selected physician
If an insurance company declines to issue insurance to an applicant on basis of a MIB report, the MIB will release medical information to the _________only and not the applicant.
180,5
If an insurer withdraws a policy form and cancels existing contracts without offering a replacement, it must provide___days notice and is prohibited from issuing any coverage in Florida for ___ years.
The policy lapses.
If the cash value account of a flexible premium universal life policy reaches zero, the policyowner must make a premium payment or:
6 months
In Florida all members of a group must be insured, however in groups of 2 o 50 the insurer can consider preexisting conditions for as long as 12 months and a "look back" prior to issue for as long as ____:
No minimum number
In Florida what is the minimum number of employees required to have a state approved group?
The plan must cover all eligible members.
In a NONCONTRIBUTORY group health plan the plan must:
Elimination Period
In a disability Income Policy, this is considered a form of deductible:
Insuring Clause
In a life insurance policy, the promise by the company to pay certain benefit is the:
Insuring clause.
In a life insurance policy, the promise by the insurance company to pay certain benefits is the:
75%
Insurers, to avoid adverse selection, in a CONTRIBUTORY group plan will often have a minimum participation requirement of:
Rebating
Involves actions whereas certain clients have received financial benefits.
Health Maintenance Organization(HMO)
Is another term for "comprehensive health care">
Is free of any federal income tax if taken in a lump sum.
Is the death benefit paid to a named beneficiary taxable?
NO
Is the spendthrift clause automatically included as an integral part of a standard policy?
Exclusions Clause
Issues such as pre-existing conditions, suicide, and self-inflicted injuries are found in which policy feature?
Guaranteed Renewable
Jack has an insurance policy that must be renewed as long as the premiums are paid, what type of policy does Jack have?
$500,000
Jose, is the wealthy owner and insured under a $500,000 life insurance policy. He is killed skydiving. He had paid total premiums of $25,000. How much of the death benefit will be estate taxable.
Only to show recent dividend history without any future commitment.
Many mutual companies can show dividend histories for over 100 years, therefore they can:
Aleatory.
Like other insurance contracts, health policies are considered:
Cancer
Limited risk or "dread disease" policies are written to cover specific types of debilitating illnesses. The most common limited risk policy is the ______ policy.
Dread disease policies.
Limited risk policies are also known as:
Renewable
Long term care polices must be guaranteed ________.
Comprehensive
Major medical plans, when not used to supplement First Dollar Plans, are called _________Major medical.
Misrepresentation
Making a statement that is not entirely true about a policy or transaction.
Small businesses and sole proprietors.
Medical savings accounts were designed to help whom?
65
Medicare part A is mandatory for recipients of social security over age _______>
Provide for the gaps in Medicare.
Medicare supplement policies are primarily designed to:
Part B
Medicare________pays for things such as, diagnostic lab tests, x-rays, ambulance services, medical supplies, medical equipment and so forth.
Zero
Minimum number of employees required in Florida for group insurance?
Sliding
Misrepresenting that a specific ancillary coverage is included in the original price charging an applicant for supplementary coverages without informed consent.
developed from the deaths of millions over long periods of time.
Mortality figures are normally developed by studying and interpreting statistics:
Flat daily rate basis
Most long term care contracts pay on a :
Joint-Life
Multiple protection policies combine whole life with a _________ rider on one insured.
Does not include co-insurance.
Not a feature of Medicare part A
Severity
Occupation is a very important factor in underwriting health insurance. It has a direct bearing on the probability of disability. The other consideration Is the average_____of disability.
Closed panel HMO
Often described as the most efficient method to deliver health care:
liquidate
One of the major obligations of the Office of Insurance Regulation is that it will rehabilitate or____ insurers if necessary to protect consumers.
August 1-31
One person groups are limited to one open enrollment period per year_____________:
50%
Partial disability will normally pay for only three to six months. What percentage of disability income is the normal payment for partial disability?
Income tax free
Personal insured financed disability income policy benefits are considered by IRS to be?
30 days
Producer name or address changes must be filed with the insurance commission within:
Lower
Reentry permits a healthy insured to reenter the pool at a _______rate than the contracted rate by proving he/she is still an insurable risk.
a proportion of the purchased benefit equal to the percent of total income lost because of the disability.
Residual Disability contract pay:
The accelerated death benefit.
Rider that allows an insured policy owner to become, in part, their own beneficiary.
Loss
Risk is the descriptive word for "uncertainty regarding ______.
only after
The COLA rider is only effective in meeting the problem of inflation_________ the start of the disability.
125s
Section _____plans contribute to employee morale by giving them choices to fit their individual perceived needs.
pay as you go
Social security is a form of:
An outline of the benefits provided.
Statements made on the insurance application generally do not provide what?
Coinsurance Clause
States that in a health policy, the insured and the insurance company will share the cost of covered losses.
Office of Insurance Regulation
The Department of Financial Services and the___________ are responsible for the enforcement of the insurance code.
Per Stirpes
Term that designates the children of a deceased named beneficiary as recipients of the death benefit.
Symbol
Term used to describe a variable annuity distribution segment unit is statistical:
Speculative and Pure
The 2 classes of risk are:
Dismemberments
The AD&D Contract pays a specific "Capital" amounts for designated:
Dismemberments
The AD&D contract pays specific "capital" amounts for designated:
Custodial
The Adult Day Care facility's primary focus is:
A. monthly income of the annuitant is stable B. the annuitant need not worry about the securities market C. loading charges are usually less
The advantages of the Fixed Annuity over the Variable Annuity is?
Overlap or Duplicate
The agent must explain the extent to which the proposed new coverage will_______the existing coverage.
Pooling of risk and the law of large numbers
The basic principals of insurance are?
Reasonable Cost
The basis for Medicare reimbursement under part A is:
Long-term care
The basis for ______ benefits is normally a daily fixed dollar amount.
the home care provider
The beneficiary of Respite Care Provisions is generally the:
The home care provider
The beneficiary of respite care provisions is normally?
A signed statement specifying the agents commission on the transaction.
The duties of the replacing insurer include all the following except:
Capitation
The fixed amount paid to the provider by the HMO.
Employer
The group probationary period is established by the:
45
The insurance code states that any reinstatement application, upon which the company takes no action within____days, is legally reinstated.
Coinsurance Clause
The insured and the insurance company will share the cost of covered losses.
The benefit paid is a small percentage of the face amount of the policy and is not determined by the actual cost of care
The life insurance Contract Long Term Rider benefit:
The flow of insureds through the group
The main concept that distinguishes group insurance:
Post claims underwriting
The major prohibition in the NAIC model Long term care regulation:
5 months
The mandatory waiting period for OASDI disability is how many months?
accumulation period
The name of the period during which the variable annuity is building, whether it be a flexible premium or a single premium annuity is the:
Single
The net single premium can be defined as the _______amount needed today to fund future death benefits.
60%
The normal amount of income that can be replaced by a long-term disability policy?
Provide indigent medical expense coverage.
The objective of Medicaid:
To provide the indigent medical expense coverage.
The objective of Medicaid:
Security
The phrase "peace of mind" benefits of life insurance derives from the _______it provides those dependent upon the insured after death.
assignment
The right of _________is built into most commercial health policies.
Purchasing pools
The small Employers Access Act is designed to provide small employers the option and ability to provide health care benefits to their employees through the creation of:
coinsurance and deductible
The supplementary Major Medical plan wraps around the basic First Dollar policy. It has two distinguishing features that involved retention of risk. What are these two features?
No deductible.
The term FIRST DOLLAR policy refers to a policy that has:
Front end Load
The term describing a sales charge that is deducted from the first few premium payments is called a:
Principal, interest rate, duration of payments
The three main elements of an annuity contract:
Fixed period, fixed amount
The two annuity distribution methods that have a guarantee of principal.
Renew or convert
The two options found in term contracts?
A personal contract.
The unique characteristic that allows life insurance to be assigned or sold is that it is not a :
45 days
There are cancellable policies that were in effect before the rules that prohibited selling cancellable contracts. In such cases there is a regulation requiring a minimum____notice.
Extra percentage tables
There are several ways to "rating" high risk applications. The most used for health issues involves a numeric system. It is also known as?
Straight Whole
There are three common methods of premium financing. The oldest and once most common is_____life. Premiums are paid from issue date until the insured dies or reaches age 100 when the policy matures.
The return of premium clause.
There is a policy merchandising idea that returns to the beneficiary all of the premium paid during the insured's life as well as the policies face value:
Aleatory Contract
There is a possibility for either parties to lose. What is the term for this kind of contract?
A 20 year Endowment.
This policy will p ay the face amount of the policy to the owner after 20 years.
Agency
Under the law of _______ an agent is the lawful representative of the principal.
dollar amount
Under the surgical schedule method, every surgical procedure is assigned a __________ by the insurer.
A. Retirement B. Disability C. Death
Three benefits associated with OASDI.
A. Builds cash value B. Matures at 100 C. Level premium
Three elements of a whole life contract
A. Develops cash value B. A level premium feeds the policy C. It matures at 100
Three elements that make whole life insurance work?
A. The flow of insured's through the group. B Lower loading costs at the insurers level. C. group insurance is normally convertible under Florida law.
Three features of group insurance:
A. Death B. Retirement C. Disability
Three named benefits of OASDI?
A. The contract must have been in place for 1 year. B. The normal grace period plus 21 days. C. A notice to a secondary addressee if one has been designated.
Three requirements for the adjusted grace period for Florida life contract holders over 64 years of age.
A. Morale B. Moral C. Physical
Three types of hazards in Life insurance:
occupation
To a greater degree than life insurance, underwriting health insurance contracts are concerned with the applicants:
6 of the last 13 quarters
To be eligible for social security disability benefits a worker is required to have a minimum of quarterly credits equal to:
COBRA
To qualify for mandated coverage under HIPPA, the last period of creditable coverage must have been under either a group health plan or ________.
Misleading statements
Untruthful statements regarding any conditions of the contract or the cause of the claim.
The present value of the applicants future earnings.
What is the principle involved in the use of the "Human Life Value" concept of determining the amount of life insurance to purchase?
The advertising code and the unfair practices act.
Two NAIC developed programs that most states have adopted into their own insurance codes:
Cash withdraw and a loan.
Two ways funds may be removed from a variable universal life policy's cash value.
31
Under insurance regulations, all group insurance for the members or their dependents is convertible within_____ days from the point of time the individual loses eligibility for the group coverage.
Accidental Means
What AD&D policy definition is considered too restrictive for approval by most state insurance regulators?
The contract of Adhesion.
What characteristic prohibits the agent from negotiating insurance contract provisions?
Stranger- originated life insurance
What does the acronym STOLI stand for?
Actuaries
What group of individuals in an insurance company is responsible for determining life insurance premium rates?
A written statement by the claimant covering the occurrence, nature, and extent of a loss.
What is a "proof of loss" statement?
Elimination Period
What is a major consideration involved in recurrent disabilities? A question arises regarding the ____________when a person is on disability for a time, then returns to work, but has to back on disability.
Medicaid
What is a state operated government health program?
A daily indemnity benefit.
What is the basis for most long-term care benefits?
Step Rate
What is the description of the premium changes in level term insurance?
403b
What is the designation of the plan that is available only to employees of not-for-profit organizations?
Inflation
What is the main reason for accepting the risk involved in variable life insurance?
2 months
What is the maximum age of the reported values allowed in a variable products annual report?
50
What is the maximum number of employees a company can have to be defined as a small number employer in the "Health Care Access Act"?
200%
What is the maximum percentage of premium increase permitted in group continuation contracts?
AMW Average monthly wages.
What is the most recent index used for determining Social Security retirement benefits?
13 to 26 weeks
What is the normal duration of group short term disability?
Deceptive sales presentations
What is the number one complaint regarding unethical behavior in insurance industry?
When the rebate is available to all insureds in the same actuarial class.
When is it acceptable for Florida or California producer to rebate a portion of commission?
Permanent flat extra premium
When rating a morale hazard the insurer will probably apply a:
Permanent flat rate extra premium
When rating a morale hazard the insurer will probably apply a:
Replacement Rule
When the agent knows the applicant is going to cash in a policy and use the funds to purchase a new insurance policy, this would be under the ______rule.
His best freind
Which of the following does not have an insurable interest in a young man?
The loss must be catastrophic
Which of the following is not an element of insurable risks?
Medicare and funeral expenses plus debts or current bills.
Which of the following normally comprise a deceased final expense in the needs analysis.
Social Clubs
Which of the following would not be eligible for establishing Group life insurance? *Labor Union *Trustee Groups *Employer and Employer Groups *Social Clubs
Business overhead Expense
Which of the form of insurance cannot be written as group insurance.?
The issuing entity.
Who bears the risk in a fixed annuity?
The SEC
Who must approve the prospectus?
The State and the Securities and Exchange Commission.
Who regulates the variable annuity?
Furnishes permanent protection in the sense that it does not have to be renewed or converted.
Whole life policy plusses:
The insurance market is aleatory contract
With insurance contracts there is a possibility for either of the parties to lose. What is the term that describes this type of contract?
Automatic
_____premium loan provisions are a safety factor for equity contracts that permit the company to borrow from cash values to pay the premium.
Domestic insurance company
an insurance company that is incorporated under the laws of Florida and has its home office in the state is called the following?
Churning
the practice whereby policy values in an existing insurance policy are used to purchase another policy or annuity contract with the same insurer to earn new premiums and commissions.
