Health Exam
Other than for a qualified life event, when can a change be made in benefits for a Flexible Spending Account (FSA)
During the open enrollment period
In a disability policy, the probationary period refers to the time
During which illness-related disabilities are excluded from coverage
The period fo time immediately following a disability during which benefits are not payable is
Elimination period
In order for an alumni association to be eligible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the association
Has been active for five years minimum
An insured has an individual disability income policy with a 30-day elimination period. He becomes disabled on June 1st for 15 days. When will he collect on his disability
He wont collect anything
An insurer devises an intimidation strategy in order to corner a large portion of the insurance market. Which of the following best describes this practice?
Illegal
When an insured reinstated his major medical policy he was involved in an accident that required hospitalization. When would this accident be covered upon reinstatement of the policy
Immediately
Which of the following riders would NOT increase the premium for a policyowner
Impairment rider
In LTC policies the benefit period lengthens, the premium
Increases
In long-term care, polices, as the benefit period lengthens the premium
Increases
The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT
Individual tax deduction for premiums paid
Which of the following best describes a misrepresentation
Issuing sales material with exaggerated statements about policy benefits
Which of the following is correct about group health insurance
It cannot exclude newborn children from coverage
Which of the following statements is NOT true concerning Medicaid
It consists of 3 parts; Part A: hospitalization, Part B: doctors services, Part C: disability income
Which of the following is NOT true regarding a flexible spending account
It does not have limits on contributions
Concerning Medicare Part B, which statement is INCORRECT?
It is fully funded by Social Security taxes (FICA)
Which of the following is INCORRECT concerning Medicaid
It is solely a federally administered program
Which of the following time periods is the general enrollment period for Medicare Part B
January 1- March 31 each year
In a group health policy, a probationary period is intended for people
Join the group after the effective date
Which of the following is NOT considered a misrepresentation as it pertains to unfair trade practices
Making comparisons between different policies
Which of the following statements pertaining to Medicare Part A is correct
Medicare Part A is automatically provided when an individual qualifies for Social Security benefits ate age 65
In health insurance the length of the grace period varies according to
Mode of premium payment
A long term care insurance shopper's guide must be provided in the format developed by which of the following
NAIC
If an insured is injured while committing an illegal act and his health insurance policy contains the Illegal Occupation provision what percentage of the claim will be paid
Nothing
All of the following are the most common variations in a Long-Term Care policy EXCEPT
Number of family dependents
Which statement best describes agreement as it relates to insurance contracts
One party accepts the exact terms of the other party's offer
When may HIV-related test results be provided to the MIB?
Only if the individual is not identified
Medicare Part A services do NOT include which of the following?
Outpatient Hospital Treatment
Under which of the following organizations are the practicing provisions compensated on a fee-for-service basis
PPO
Which of the following statements is INCORRECT concerning Medicare Part B coverage
Part B coverage is provided free of charge when an individual turns 65
A participating insurance policy may do which of the following?
Pay dividends to the policyowner
An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would
Pay the claim
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to a stated age with the company having the right to increase premiums on the entire class
Who might receive dividends from a mutual insurer?
Policyholders
An insured was diagnosed two years ago with kidney cancer. She was treated with surgeries and chemotherapy and is now in remission. She also has a 30-year smoking history. The insured is now healthy enough to work and has just stared a full time job. Which describes the health insurance that she will most likely receive
She would be covered under her employers group health insurance plan, without higher premiums
HMOs are known as what type of plans
Service
If an insurer terminates an employment with a producer, how long does the insurer have to notify the Commissioner
30 days
Patricia, a producer from NC moves to RI. She is required by RI law to file a change of address and provide certification within
30 days
Within how many days after a decision is made by the Commissioner may an aggrieved party make a written request for a hearing that relates to the order by which they were aggrieved
30 days
Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within
90 days of a loss
Company C is developing its own advertising script to be used in their radio advertising campaign for their LTC polices. Which of the following words or phrases would be allowed
"Benefits paid directly to you"
What is the minimum penalty for an insurance producer working for a foreign company that fails to comply with the insurance rules of RI
$300
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
10 days
How many days before a hearing much the commissioner issue the accused person a notice that the hearing is taking place
10 days
If an insured pays a health insurance premium, each month, how long would the grace period by under the policy
10 days
If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits
12 credits
How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state
12 months
If an insurance producer allows his or her license to expire, how soon must the producer reinstate the license to avoid having to pass the written examination
12 months
Legal services insurance is considered
Accident and health insurance
Group health insurance is characterized by all of the following EXCEPT
Adverse selection
In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible?
Corridor
Which of the following is NOT an exclusion in medical expense insurance polices
Coverage for dependents
A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
Critical illness
All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT
Death benefits are paid only if the death occurs within 24 hours of an accident
What is an important feature of a dental expense plan that is NOT typically found in a medical expense insurance plan
Diagnostic and preventive care
Which of the following does the insuring clause NOT specify
A list of available doctors
Coverage for the services of licensed midwives is
A mandatory benefit in individual group policies
Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace
A permanent resident lawfully present in the US
All of the following are correct about the required provisions of a health insurance policy EXCEPT
A reinstated policy provides immediate coverage for an illness
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
A statement that is sufficiently clear to identify the insured and the nature of the claim
All of the following statements concerning workers compensation are correct EXCEPT
A workers receives benefits only if the work related injury was not his/her fault
Regarding a PPO, which of the following is correct when selecting a primary care physician?
All of the above
Which if the following provides coverage on a first-dollar basis
Basic expense
Which of the following is NOT required to be stated in the outline of coverage provided with a long term care policy
Basic information about supplementary policies
Which of the following statements regarding Business Overhead Expense polices is NOT true
Benefits are usually limited to six months
In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is
Broader in general
An insurance company has published a brochure that inaccurately portrays the advantages of a particular policy. What is this an example of
False advertising
A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of deductible do they have in their policy
Family
The presumptive disability provision assumes that the insured is totally disabled upon loss of all of the following EXCEPT
Feeling
If an insured is not required to pay a deductible, what kind of coverage does he/she have
First dollar
What phase begins after a new policy is delivered
Free look period
An insured involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured still is able to perform his current job. To what extend will he receive Presumptive Disability benefits
Full benefits
The guaranteed purchase option is also referred to as the
Future increase option
Which of the following is another name for a primary care physician in an HMO
Gatekeepr
Regarding long-term care coverage, as the elimination period gets shorter, the premium
Gets higher
If a medical organization bears part of a patients risk in healthcare related costs, what type of organization is it
HMO
If a medical organization bears part of a patients risk in healthcare relates costs, what type of organization is it
HMO
Regarding the taxation of Business Overhead policies
Premiums ARE deductible, and benefits ARE taxed
Which of the following describes taxation of individual disability income insurance premiums and benefits
Premiums are NOT tax deductible and benefits are NOT taxable
On an Accidental Death and Dismemberment policy, the death benefit is payable known as the
Principal sum
Which of the following is NOT mandatory under the Uniform Provision Law as applied to accident and health policies
Probationary Period
A Medicare SELECT policy does all of the following EXCEPT
Prohibit payment for regularly covered services if provided by non-network providers
A large employer decides to self-insurer their employee health care program. To protect against the financial risk of self-insuring the company should
Purchase stop loss insurance
Insurers may change which of the following on a guaranteed renewable health insurance policy
Rates by class
Insurers may change which of the following on a guaranteed renewable health insurance policy?
Rates by class
Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses
Stop-loss limit
Insureds have the right to do which of the following if they have NOT received the proper claim forms within 15 days of their notice to the insurer of a covered loss under a major medical policy?
Submit the description in their own words on a plain sheet of paper
All of the following would be classified as "limited insurance cover" EXCEPT
Supplement Social Security coverage
Which of the following would basic medical expense coverage NOT cover
Surgeon's services
An insured who has an Accidental Death and Dismemberment policy loses her left arm in an accident. What type of benefit will she most likely receive from this policy
The CAPITAL amount in a lump sum
Who makes the rules and regulations that pertain to metabolic disease screening for newborns
The Department of Health
Which of the following is true regarding elimination periods and the cost of coverage
The LONGER the elimination period, the LOWER the cost of coverage
How do employer contributions to a Health Savings Account affect the insured's taxes?
The employer contributions are NOT included in the individual insureds taxable income
Which statement regarding qualifications for Social Security disability benefits is NOT true
The individual must be at least 65 years old
Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to
The insured
An insured is anxious to get treatment for a health condition and is convinced that a specialist is needed to cure the condition. If the insured has a PPO plan which of the following is true
The insured can select any specialist, but non-network specialist will have higher out of pocket costs
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing home facility, which of the following conditions must be met
The insured must first have been hospitalized for 3 consecutive days
Which of the following is NOT a feature of a guaranteed renewable provision
The insurer can increase the policy on an individual basis
Which of the following statements is INCORRECT a. the insurer does not have the right to conduct an autopsy b. the physical exam and autopsy provision gives the insurer the right to examine the insured at its own expense c.The physical exam and autopsy provision gives the insurer the right to examine the insured as often as may be reasonably necessary while a claim is pending d.The insurer also has the right to conduct an autopsy if not forbidden by state law
The insurer does not have the right to conduct an autopsy
All of the following are characteristics of group health insurance EXCEPT
The parties that hold a group health insurance contract are the employees and employer
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
W and his wife decided 13 months ago to add a new member to the family. However, the couple has had trouble conceiving. W's health insurance plan must provide coverage for medical necessary expenses of diagnosis and treatment of infertility if
The plan includes pregnancy related benefits
Following a camping trip, Junior noticed he had returned with an unwelcome visitor; a tick. Concerned about Lyme disease, Junior visited his doctor and soon learned he had acquired the disease. Junior's medical expense insurance policy will cover diagnostic testing and long-term antibiotic treatment of the diseases, provided
The policy was purchased or renewed January 1, 2004
A producer selling insurance is not subject to any state jurisdictions. The coverage offered to a potential insured is not fully provided by any authorized company in this state. Which of the following must happen
The producer must disclose the lack of coverage to the applicant
Insurers usually do not reimburse claimants for 100% of income lost due to disability. What is the reason for insurer limitations on coverage amounts?
To provide an incentive for the insured to return to work
When an insurer issues an individual health insurance policy, that is guaranteed renewable the insurer agrees
To renew the policy until the insured has reached age 65
What is the purpose of a benefit schedule
To state what and how much is covered in the plan
Which of the following statements is INCORRECT regarding the definition of total disability
Total disability is the inability to perform partial duties of any occupation for which a person is suited by reason of education, training or experience
Premiums paid off by self-employed sole proprietors or partners for medical expense insurance are
Totally tax deductible
Which characteristic does NOT describe manged care
Unlimited access to provders
Which characteristic does NOT describe managed care
Unlimited access to providers
In forming an insurance contract, when does acceptance usually occur?
When an insurer's underwriter approves coverage
In insurance an offer is usually made when
an applicant submits an application to the insurer
What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application
as long as the policy is in force
How many days after receiving a request from an insurer who feels it was wrong must the Commissioner hold a hearing
20 days
COBRA applies to employers with at least
20 employees
Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required
20%
What is the penalty tax for nonqualified distributions form a health savings account
20%
The relation of earnings to insurance provision allows the insurance company to limit the insureds benefit to his/her average income over the last
24 months
An employer must include the option of membership in a licensed qualified HMO in service areas when 25 or more employees reside if that employer at least
25 employees
The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children of the insured up to the age of
26
An insurer must notify the consumer in writing that an investigative consumer report has been requested, within how many days of the initial request
3 days
What is the period of coverage for events such as death or divorce under COBRA
36 months
How long must an insurer's advertisements must be kept on file
4 years
Joe age 63, was disabled and can no longer work. He meets the Social Security definition of total disability. How many work credits must Joe have to accumulated to have the status of fully insured
40 credits
An insurer that issues contracts for health care coverage that include a provision for the coordination of benefits must comply with any written requests for
45 days
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?
5 days
Once the person meets the stringent requirements for disability benefits, how long is the waiting period under Social Security before any benefits will be paid?
5 months
Which of the following statements is NOT true regarding health insurance policy provisions
All additional provisions written by insurers are cataloged by their respective states
In which Medicare supplemental policies are the core benefits found?
All plans
All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT
An association of 35 people
Which of the following would NOT be included for the treatment of insulin treated diabetes
An experimental diabetes treatment method
An elimination (waiting) period may NOT have to be satisfied for a disability in which of the following
An insured suffers a relapse of a prior disability within 6 months of the initial covered disability
If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association, that would be considered
An unfair trade practice
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
The benefits from a business overhead expense insurance policy
Are limited to covered expenses and are taxable to the business
Long term care coverage may be sold in all of the various ways EXCEPT
As part of a Medicare supplement policy by the use of an endorsement
The premium charged for exercising the Guaranteed Insurability Rider is based upon the insured's
Attained age
An underwriter is reviewing an applicant with an extensive medical history. Which of the following would give the underwriter a better understanding of how the applicant has been treated for various illnesses
Attending Physicians Statement
What document describes an insureds medical history, including diagnoses and treatments
Attending Physicians Statement
If an insurer meets the state's financial requirements and is approved to transact business in the state, it is considered what type of insurer?
Authorized
In addition to participation requirements, how does an insurer guard against adverse selection when underwriting group health
By requiring that the insurance be incidental to the group
Which of the following is true regarding inpatient hospital care for HMO members
Care can be provided outside of the service area
If an agent advises a policyholder to replace an insurance policy but only does so for the purpose of making commissions, the agent has committed an act of
Churning
A banker is ready to close on a customers loan. The bank is prepared to offer the loan but only if the customer purchases a life insurance policy from the bank in the amount of the loan. This is an example of
Coercion
Forcing a client to buy insurance from a particular lender as a condition of granting a loan is defined as
Coercion
The provision that provides for the sharing of expenses between the insured and the insurance company is
Coinsurance
An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?
Consideration
When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?
Consideration
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
Consideration clause
Regarding the consideration clause, which of the following is NOT correct
Consideration of the insurer and the insured must be equal
Which of the following reports will provide the underwriter with the information about an insurance applicants credit
Consumer report
Contracts that are prepared by one party to the other party on a take it or leave it basis are classified as
Contracts of adhesion
The purpose of managed care health insurance plans is to
Control health insurance claims expenses
What is the purpose of the gatekeeper in an HMO
Controlling costs
Which of the following meets the insureds personal needs and is provided by nonmedical personnel
Custodial care
The amount a self-insured company will pay out of pocket for health insurance coverage before a stop loss policy goes into effect is referred to as the
Deductible
Applications for policies advertised by what method must include a statement announcing that the policy excludes pre-existing conditions from coverage
Direct response
A waiver of premium provision may be included with which kind of health insurance policy
Disability income
Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer
Disability income
All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT
Dividends from a mutual insurer
All of the following are features of a health insurance plan purchased on the health insurance marketplace EXCEPT
Dollar limits on essential benefits
A Major Medical Expense policy would exclude coverage for all of the following treatments EXCEPT
Drug addition
Long term care coverage may be available as any of the following options EXCEPT
Endorsement to a health policy
Under the Affordable Care Act, maternity, pregnancy, and preventive care services are considered
Essential
Which of the following best describes the aleatory nature of an insurance contract
Exchange of unequal values
What are 2 types of Flexible Spending Acounts
Health Care Accounts and Dependent Care Accounts
Health Savings Accounts are designed to
Help individuals save for qualified health expenses
Which of the following types of LTC is NOT provided in an institutional setting
Home health care
Which of the following is NOT a Medicaid qualifier
Insurability
A life insurance policy has a legal purpose if both of which of the following elements exist
Insurable interest and conset
The Medical Information Bureau was created to protect
Insurance companies from adverse selection by high risk persons
All of the following must sign an application for health insurance EXCEPT the
Insurer
Which of the following can legally bind coverage
Insurer
Which of the follpwing entities can legally bind coverage
Insurer
Who must pay for the cost of a medical examination required in the process of underwriting?
Insurer
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 is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitate care
Intermediate care
Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care
Intermediate care
All of the following statements about Medicare Part B are correct EXCEPT
It is a compulsory program
Which of the following is NOT true of legal services insurance
It is considered to be life insurance
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
Legal action
Under workers compensation, which of the following benefits is NOT included
Legal benefits
An insured purchased an insurance policy 5 years ago. Last year, she received a dividend check from the insurance company that was not taxable. This year, she did not receive a check from the insurer. From what type of insurer did the insured purchase the policy?
Mutual
An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply
NO coverage will apply, since the injury could have been foreseen
The primary eligibility requirement for Medicaid benefits is based upon
Need
An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point
Neither approved the application nor issued the policy
The classification "Small Employer" means any person actively engaged in a business that during the preceding year employed
No more than 50 eligible employees
Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?
None
An insured purchased a health insurance policy with a renewability clause that states the policy is "Guaranteed Renewable". This means that as long as the required premiums are paid, the policy will continue until the insured
Reaches age 65
any inducement offered to the insured in the sale of insurance policy that is not specified in the policy is an unlawful practice known as
Rebating
Which of the following is NOT provided by an HMO
Reimbursement
An insured had a heart attack while jogging but is expected to return to work in approximately 6 weeks. The Insureds disability income policy will
Replace a percentage of his lost income
Which of the following is true about the requirements regarding HIV exams
The application must give prior informed written consent
What happens if a non-member physician is utilized under the Point-Of-Service Plan
The attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount
As an employee of XYZ Industries, Shelly was insured member of a medical insurance plan. However XYZ Industries files for bankruptcy and closes its doors forever. Under these circumstances what happens to Shelly's Medical plan
The benefits of Shelly's plan may be continued for up to 18 months
Which of the following is NOT a feature of a noncancellable policy
The insurer may terminate the contract only at renewal for certain conditions
Health benefit plans which provide medical and surgical benefits with respect to mastectomy must provide coverage for all of the following EXCEPT
The mastectomy
The insuring clause of a disability policy usually states all of the following EXCEPT
The method of premium payments
Which of the following will vary the length of the grace period in health insurance policies
The mode of the premium payment
Which of the following definitions would make it easier to qualify for total disability benefits
The more LIBERAL "OWN occupation"
Which of the following is true regarding optional benefits with long term care policies
They are available for an additional premium
Regarding Medicare SELECT policies, what are restricted network provisions?
They condition the payment of benefits
All of the following statements about Medicare supplement insurance polices are correct EXCEPT
They cover the cost of extended nursing home care
Which of the following is true regarding Medicare supplement policies issued in this state
They must be guaranteed renewable
An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?
Time of Payment Claims
What is the purpose of the impairment rider in a health insurance policy
To exclude coverage for a specific impairment
A medical expense policy that establishes the amount of benefits paid based upon the prevailing charges which falls within the standard range of fees normally charged for a specific procedure by a doctor of a similar training and experience in that geographic area is known as
Usual, customary and reasonable
An insurance producer is selling coverage that is not fully insured by any domestic or foreign company. The producer has properly disclosed the lack of coverage to the applicant. When will the disclosure requirement NOT apply
When the producer is under jurisdiction of another department of state
Which of the following determines whether disability insurance benefits are taxed
Whether the premiums were tax deductible
Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time parameters
Within 20 days
An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA
Within 60 days
Which of the following is NOT a factor in determining qualifications for Social Security disability benefits
Workers occupation
