Health Insurance Multi Choice Question Prep

How many eligible employees must be included in a contributory plan? A. 75% B. 90% C. 100% D. 50%

A. 75%

To be eligible for tax credits under the ACA, individuals must have income that is what percent of the Federal Poverty Level? A. Between 10% and 100% B. Between 100% and 400% C. Higher than 300% D. Less than 10%

B. Between 100% and 400%

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

B. Care can be provided outside of the service area

Which of the following is the most common time for errors and omissions to occur on the part of an insurer? A. Application process B. Policy delivery C. Policy renewal D. Underwriting

B. Policy Delivery

Which of the following losses will be covered by a group medical expense policy? A. An intentionally self-inflicted injury B. An elective cosmetic surgery C. A pre-existing condition D. An injury resulting from active military duty

C. A pre-existing condition

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should A. Return any unearned premium B. Increase the premium C. Adjust the benefit in accordance with the decreased risk D. Replace the policy with a new one

C. Adjust the benefit in accordance with the decreased risk

In Ohio, a temporary license may be issued for any of the following reasons EXCEPT A. Agent's disability B. Agent's military service C. Agent's retirement D. Agent's death

C. Agent's retirement

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy? A. An individual who doesn't qualify for Medicare may be eligible B. The gap of coverage for eligibility is a period of 63 or less days C. An individual who was previously covered by group insurance for 6 months is eligible D. An individual who has used up COBRA continuation coverage is eligible

C. An individual who was previously covered by group insurance for 6 months is eligible

A children's group is planning a summer camp. What kind of accident and health policy could cover all dependents without requiring individual applications and identifying each of the children attending the camp? A. Group accident and sickness policy B. Travel policy C. Blanket policy D. Franchise policy

C. Blanket policy

Medicaid is sponsored by what kind of sources? A. Federal only B. State only C. Both state and federal D. Private companies

C. Both state and federal

Which of the following best describes an insurance company that has been formed under the laws of this state? A. Alien B. Foreign C. Domestic D. Sovereign

C. Domestic

Which of the following is NOT covered by a Health Maintenance Organization (HMO)? A. Routine physicals B. Well-baby care C. Elective services D. Immunizations

C. Elective services

An insurance company assures its new policyholders that their premium costs will not increase for a period of at least 5 years. Due to the increasing financial strain, they plan to raise premium costs for all insureds by 10% for the next 2 years. What term best describes this act? A. Unfair discrimination B. Errors and ommisions C. Fraud D. Defamation

C. Fraud

Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? A. Elimination Period B. Probationary Period C. Free Look Period D. Grace Period

C. Free Look Period

Which type of dental care would cover operative treatment of the mouth? A. Endodontics B. Orthodontics C. Oral Surgery D. Restorative

C. Oral Surgery

Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death? A. Double the amount of the death benefit B. Refund of premiums C. Principal sum D. Capital sum

C. Principal sum

Which of the following is true regarding limited health insurance policies? A. They are limited to those enrolled in a group health plan B. They cover every need of a health insurance policy holder C. They only cover specific accidents or diseases D. They cover all sicknesses or accidents that are not specifically excluded

C. They only cover specific accidents or diseases

An insured owes his insurer a premium payment. Since then, he incurs medical expenses. The insurer deducts the unpaid premium amount from the claim amount and pays the insured the difference. What provision allows for this? A. Proof of loss B. Payment of claims C. Unpaid premium D. Legal action

C. Unpaid premium

An insured's disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin? A. 5 B. 3 C. 2 D. 1

D. 1 year

S is a sole business proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct? A. 25% B. 50% C. 75% D. 100%

D. 100%

An insured was involved in an accident and could not perform her current job for 3 years. If the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan? A. 1 month B. She would not receive any benefits C. 3 years D. 2 years

D. 2 years

Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required? A. 35% B. 10% C. 15% D. 20%

D. 20%

Agents who change their state of residence must notify the superintendent within how many days of any change in address? A. 10 B. 15 C. 20 D. 30

D. 30

A 63 year old man is planning to be employed until age 68. When will he be eligible for Medicare? A. As soon as he retires at age 68 B. Age 70, if still employed C. Age 69 1/2 if no longer employed D. Age 65, regardless of his employment status

D. Age 65, regardless of his employment status

Which of the following expenses is NOT covered by a health insurance policy? A. Hospital B. Disability C. Dental D. Funeral

D. Funeral

An insurer hires a representative to advertise its company at a local convention. The representative lies about the details of some of the policies, in an attempt to secure more business for the company. Who is responsible for the representative's claims? A. The rep B. The underwriters C. The agent D. The insurer

D. The insurer

In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT A. Must have dependents B. Must be working in a covered classification C. Must be actively at work D. Must be a full time employee

A. Must have dependents

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, as 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

A. The insurer does not have the right to conduct an autopsy (The physical exam and autopsy provision gives the insurer the right to examine the insured, at its own expense, as often as may be reasonable necessary while a claim is pending. The insurer also usually has the right to conduct an autopsy, if not forbidden by state law)

Who is the beneficiary in a credit health policy? A. The lending institution B. The insurer C. The estate of the borrower D. The Federal Government

A. The lending institution

What is the minimum age for obtaining an insurance license in this state? A. 16 B. 18 C. 19 D. 21

B. 18

What is the max time period between Superintendent's exam of books and records of domestic insurers? A. 1 year B. 2 years C. 3 years D. 5 years

D. 5 years (Domestic insurers must be examined at least once every 3 years regarding their condition, fulfillment of contractual obligations, and compliance with applicable laws. The exam may be deferred for a longer period that cannot exceed 5 years)

A tornado that destroys property would be an example of which of the following? A. A loss B. A physical hazard C. A peril D. A pure risk

C. A peril

A policyowner is reading a statement on the first page of his health insurance policy, which says "this is a limited policy." What is the name of this statement? A. Limited Policy Notice B. Policy Limitation Notice C. Statute of Limitations D. Limited Benefit Statement

A. Limited Policy Notice

What is the shortest possible elimination period for group short-term disability benefits provided by an employer? A. 0 days B. 30 days C. 60 days D. 90 days

A. 0 days

According to OBRA, what is the minimum number of employees required to constitute a large group? A. 100 B. 15 C. 20 D. 50

A. 100

Each person licensed as an agent or solicitor is required to complete how many hours of approved continuing education instruction every 2 years? A. 24 B. 22 C. 26 D. 18

A. 24

An insurer must notify the consumer in writing that an investigative consumer report has been requested, within how many days of the initial request? A. 3 days B. 5 days C. 10 days D. 30 days

A. 3 days (if a consumer report is requested, the insurer must notify the consumer at least 3 days following the initial request)

The open enrollment for an HIC must last for a minimum of how many days? A. 30 B. 60 C. 90 D. 15

A. 30

Underwriting for disability insurance is unique due to the type of risk involved. Which of the following situations illustrates this? A. A construction worker pays a higher premium and receives a poorer classification of disability B. A stunt person pays a low premium and receives a superior classification of disability C. An attorney pays a higher premium and receives a poorer classification of disability D. A secretary pays a higher premium and receives a superior classification of disability

A. A construction worker pays a higher premium and receives a poorer classification of disability

Which of the following groups seeking group health insurance would represent a bad risk for underwriters? A. A group that changes insurance annually B. A group that pays low premium C. A group that has a noncontributory plan D. A group that has a large number of members

A. A group that changes insurance annually

Under which condition would an employee's group medical benefits be exempt from income taxes? A. An employee's group medical benefits are generally exempt from taxation as income B. An employee's group medical benefits are never exempt from taxation as income C. When the premiums and other unreimbursed medical expenses exceed 6.5% of the employee's adjusted gross income D. When the premiums and other unreimbursed medical expenses exceed 7.5% of the employee's adjusted gross income

A. An employee's group medical benefits are generally exempt from taxation as income

Which of the following would be considered a routine procedure? A. Annual check-up B. Endodontics C. Orthodontics D. Prosthodontics

A. Annual check-up

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. Are made by the business and are not tax-deductible

Which of the following statements regarding Business Overhead Expense policies is NOT true? A. Benefits are usually limited to 6 months B. Premiums paid for BOE are tax deductible C. Any benefits received are taxable to the business D. Leased equipment expenses are covered by the plan

A. Benefits are usually limited to 6 months

A group policy used to provide accident and health coverage on a group of persons being transported by a common carrier, without naming the insured persons individually is called A. Blanket policy B. Universal policy C. Comprehensive policy D. Limited benefit policy

A. Blanket policy

Which of the following options best depicts how the eligibility of members for group health insurance is determined? A. By conditions of employment B. Eligibility is not determined, but simply accepted C. By the physical conditions of the applicants at the time of employment D. In such a manner as to establish individual selection as to the amounts of insurance

A. By conditions of employment

Which of the following insurance coverages would be allowed with an MSA? A. Long-term care B. Medicaid C. Medicare D. Individual health insurance

A. Long-term care

An insurance producer who by contract is bound to write insurance for only one company is classified as a/an A. Captive agent B. Solicitor C. Broker D. Independent producer

A. Captive agent

What term is used to describe when the medical caregiver provides services to only members or subscribers of a health organization, and contractually is not allowed to treat other patients? A. Closed panel B. Corridor C. Probationary D. Open panel

A. Closed panel

A health insurance plan that covers all accidents and sickness that are not specifically excluded from the policy is referred to as a A. Comprehensive plan B. General plan C. Service plan D. Broad plan

A. Comprehensive plan

Which of the following is NOT a characteristic of a service of an HMO plan? A. Contracting with insurance companies B. Providing free annual checkups C. Encouraging early treatment D. Providing care on an outpatient basis

A. Contracting with insurance companies

What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan? A. Diagnostic and preventative care B. A broad coverage area C. A low monthly premium D. Low cost deductibles

A. Diagnostic and preventative care

Who can provide skilled nursing care? A. Doctor B. Spouse C. Family Member D. Community volunteer

A. Doctor

An applicant has a history of heart disease in his family, so he would like to buy a health insurance policy that strictly covers heart disease. What type of policy is this? A. Dread disease coverage B. Single indemnity protection C. Term health coverage D. Scheduled benefit coverage

A. Dread disease coverage

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

A. Early detection through regular check-ups

Which type of dental treatment involves the dental pulp within the teeth? A. Endodontics B. Oral Surgery C. Soft Dental D. Root Canal

A. Endodontics

Which of the following statements is correct concerning taxation of long-term care insurance? A. Excessive benefits may be taxable B. Benefits may be taxable as ordinary income C. Premiums may be taxable as income D. Premiums are not deductible in any case

A. Excessive benefits may be taxable

Which of the following would be considered peril? A. Fire B. Smoking C. Driving too fast for conditions D. Playing golf in a thunderstorm

A. Fire (fire is a peril (cause of loss). Hazards increase the chance of peril occurring)

All of the following would fall under the definition of Durable Medical Equipment EXCEPT A. Hospital blankets B. Oxygen equipment C. Wheel chairs D. Hospital bed

A. Hospital blankets

Issue age policy premiums increase in response to which of the following factors? A. Increased benefits B. Increased deductibles C. Inflation D. Age

A. Increased benefits

Which of the following entities has the authority to make changes to an insurance policy? A. Insurer's executive officer B. Department of Insurance C. Broker D. Producer

A. Insurer's executive officer

The type of dental plan which is incorporated into a major medical expense plan is a/an A. Integrated dental plan B. Supplemental dental plan C. Stand-alone dental plan D. Blanket dental plan

A. Integrated dental plan

Under workers comp, which of the following benefits are NOT included? A. Legal benefits B. Medical and rehabilitation beneifts C. Income benefits D. Death benefits

A. Legal benefits

If a dental plan is integrated, it is combined with what type of plan? A. Medical B. Secondary dental C. Supplemental D. Life

A. Medical

An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits? A. No benefits B. Full benefits C. Partial benefits D. Full benefits until the blindness lifts

A. No benefits

In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received? A. No tax B. Tax deductible C. State income tax D. Federal income tax

A. No tax

When is the annual open enrollment for state insurance exchanges? A. Nov. 1 - Jan. 31 B. Dec. 1 - Dec. 31 C. Jan 1 - Feb. 28 D. Dec. 1 - Mar. 1

A. Nov. 1 - Jan. 31

In long-term care insurance, what type of care is provided with intermediate care? A. Occasional nursing or rehabilitative care B. Nonmedical daily care C. Daily care, but not nursing care D. Intensive care

A. Occasional nursing or rehabilitative care

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date? A. Optionally Renewable B. Conditionally Renewable C. Guaranteed Renewable D. Noncancellable

A. Optionally renewable

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

A. Outpatient Hospital care

A participating insurance policy may do which of the following? A. Pay dividends to the policyowner B. Provide group coverage C. Pay dividends to the stockholder D. Require 80% participation

A. 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 broker her leg. The insurance company would A. Pay the claim B. Hold the claim as pending until the end of the grace period C. Deny the claim D. Pay half of her claim because the insured had an outstanding premium

A. Pay the claim

Which of the following does NOT need to be included on the first page of a Medicare supplement policy? A. Premium rates B. Renewal provision C. Continuation provision D. The company's right to change premiums based on the policyholder's age

A. Premium rates (Medigap policies must include a renewal or continuation provision that is appropriately captioned and on the first page of the policy. It must include any reservation by the company of the right to change premiums and any automatic renewal premium increases based on the policyholder's age)

Under a disability income policy, the insurer does not pay a monthly benefit that is equal to the insured's previous income. The reason for paying a benefit amount that is less than the insured's income is to A. Prevent overutilization and malingering B. Prevent the insured from obtaining excess insurance C. Enable the insurer to provide affordable coverage D. Enable the insurer to reduce variable costs

A. Prevent overutilization and malingering

In Medicare prescription drug plans, step therapy refers to A. Prior authorization B. Formulary tiers C. Types of benefits D. A type of rehabilitative service

A. Prior Authorization

Under which provision can a physician submit information prior to providing treatment? A. Prospective Review B. Concurrent Review C. Anticipatory Treatment D. Suspended Treatment

A. Prospective Review

Which of the following is one of the supplemental health care services provided by a health insuring corporation on an outpatient-only basis and not in combination with other supplemental health care services? A. Specialty HIC B. Limited service HIC C. Preventative care HIC D. Outpatient HIC

A. Specialty HIC

Which of the following groups would most likely be covered under a blanket accident policy? A. Students at a public school B. Office workers for a retail business C. Factory workers at the automobile assembly plant D. Independent contractors who work for a general contractor

A. Students at a public school

A provision found in insurance policies which prevents the insured from collecting twice for the same loss is called A. Subrogation B. Consent to settle loss C. Right to salvage D. Appraisal

A. Subrogation

During the Medicare Advantage open enrollment period, an individual may do all of the following EXCEPT A. Switch from an Original Medicare Plan to a Medicare Advantage Plan B. Disenroll from the current Medicare Advantage Plan and return to Original Medicare C. Switch to another Medicare Advantage Plan with drug coverage D. Switch to another Medicare Advantage Plan without drug coverage

A. Switch from an Original Medicare Plan to a Medicare Advantage Plan (they can do so during general open enrollment Oct. 15-Dec. 7)

In a group policy, who is issued a certificate of insurance? A. The individual insured B. The healthcare provider C. The insurance company D. The employer

A. The individual insured

Who chooses a primary care physician in an HIC? A. The individual member B. HIC members do not have a primary care physician C. The insurer D. A referral physician

A. The individual member

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

A. They cover the cost of extended nursing home care

How many tiers must be included in each treatment category of a Medicare prescription drug plan formulary? A. 1 B. 2 C. 3 D. 4

B. 2 (Prescription drug plans under Part D must include formulary, with at least 2 tiers for each treatment category. These tiers must establish the varied costs of covered drugs)

The inflation protection feature in LTC policies issued in Ohio must provide protection for inflation at what percent annually? A. 2% B. 5% C. 6% D. 8%

B. 5%

To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters? A. 4 credits B. 6 credits C. 10 credits D. 40 credits

B. 6 credits

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within A. 60 days of loss B. 90 days of loss C. 20 days of loss D. 30 days of loss

B. 90 days of loss

Which statement best defines a Multiple Employer Welfare Arrangement (MEWA)? A. A group health plan that covers medical expenses arising from work related injuries B. A joining together by employers to provide health benefits for employee C. A plan that provides hospice care for terminally ill employees D. A government health plan that provides health care for the unemployed

B. A joining together by employers to provide health benefits for employee

All of the following are correct about the required provisions of a health insurance policy EXCEPT A. The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract B. A reinstated policy provides immediate coverage for an illness C. Proof-of-loss forms must be sent to an insured within 15 days of notice of claim D. A grace period of 31 days is found in an annual pay policy

B. A reinstated policy provides immediate coverage for an illness

Which of the following long-term care benefits would provide coverage for functionally impaired adults on less than 24 hour basis? A. Home health care B. Adult day care C. Residential care D. Assisted living

B. Adult day care

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

B. All providers will have the same coverage options and conditions for each plan

When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision A. Because of the misstatement occurred more than 2 years ago, it has no effect B. Amounts payable under the policy will reflect the insured's correct age C. The contract will be deemed void because of the misstatement of age D. The elimination period will be extended 6 months for each year of age misstatement

B. Amounts payable under the policy will reflect the insured's correct age

Which of the following can be a reason for cancellation or non-renewal of a health policy by a health insuring corporation? A. Medical history B. An intentional misrepresentation of material fact C. A previous health claim D. A disability

B. An intentional misrepresentation of material fact

Which of the following hospice expenses would NOT be covered in a cost-containment setting? A. Special hospital bed B. Antibiotics C. Tylenol D. Morphine

B. Antibiotics

An insured purchased a policy to provide coverage on himself, his wife, and their 2 children. All of them would need to prove insurability EXCEPT A. The 2 children B. Any children born to them after the inception of the contract C. The insured D. The insured's wife

B. Any children born to them after the inception of the contract

Which of the following types of agent authority is also called "perceived authority"? A. Fiduciary B. Apparent C. Express D. Implied

B. Apparent

In a replacement situation, all of the following must be considered EXCEPT A. Exclusions B. Assets C. Benefits D. Limitations

B. Assets

An agent is suspected of committing an illegal business practice. What can be issued that would legally ban the agent from committing this act again? A. Stop-action decree B. Cease and desist order C. Writ of noncompliance D. Restrain of trade order

B. Cease and desist order

An insured has medical insurance through 2 different providers, both covering the same expenses on an expense-incurred basis. Neither company knows in advance that the insured has coverage through any other insurers. The insured submits a claim to both insurers. How should the claim be handled? A. The insured should receive full benefits from each insurer B. Each insurer should pay a proportionate share of the claim C. One of the insurers will pay fully, while the other will not pay any benefits D. Once the insurers discover the duplicate coverage, the policies would most likely be cancelled, and no claim paid

B. Each insurer should pay a proportionate share of the claim

Regarding health insurance, all of the following are tax-deductible EXCEPT A. Employer paid group Accidental Death and Dismemberment B. Employee paid group disability income C. Employer paid group health insurance D. Employer paid group LTC

B. Employee paid group disability income (When the employer pays for group premiums, they are tax-deductible to the employer. When the employee pays for a portion of the group disability premiums, they are not tax-deductible to the employee)

Under a typical health insurance policy, claims that result from injuries while the insured was intoxicated or under the influence of drugs are generally A. Covered with a 90 days' waiting period B. Excluded C. Covered D. Covered, but an extra premium is charged when a claim is filed

B. Excluded

When an agent's appointment has been terminated, the insurer must notify the Superintendent within how many days? A. 10 B. 15 C. 30 D. 60

C. 30

The authority granted to an agent through the agent's contract is referred to as A. Absolute authority B. Express authority C. Apparent authority D. Implied authority

B. Express authority

Which of the following is another name for a primary care physician in an HIC? A. Main physician B. Gatekeeper C. Screener D. Tracking physician

B. Gatekeeper

Which of the following types of LTC is NOT provided in an institutional setting? A. Intermediate care B. Home health care C. Custodial care D. Skilled nursing care

B. Home health care

What is franchise insurance? A. It is blanket insurance B. It is health coverage for small groups whose numbers are too small to qualify for true group insurance C. It provides insurance for franchises, such as a restaurant or hotel chain D. It is group insurance

B. It is health coverage for small groups whose numbers are too small to qualify for true group insurance

All of the following statements concerning Medicaid are correct EXCEPT A. Persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits B. Medicaid is a state funded program that provides health care to persons over age 65, only C. Individual states design and administer the Medicaid program under broad guidelines established by the federal government D. Individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care

B. Medicaid is a state funded program that provides health care to persons over age 65, only

Which of the following statements is NOT correct regarding Medicare? A. Medicare Part B provides physician services B. Medicare advantage must be provided through HMOs C. Medicare advantage may include prescription drug coverage at no cost D. Medicare Part A provides hospital care

B. Medicare advantage must be provided through HMOs

Only the agent is involved in completing the agent's report. The agent's statement is A. Included in the "entire contract" B. Not included in the "entire contract" C. Only included in the "entire contract" if it provides information upon which the underwriting decision was made D. Usually included in the "entire contract"

B. Not included in the "entire contract"

When an individual is covered under 2 health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called A. Pro-rata coverage B. Overinsurance C. Double indemnity coverage D. Fraternal coverage

B. Overinsurance

Which of the following best describes the type of care provided by HICs? A. Major medical B. Preventative C. Fee for service D. Elective

B. Preventative

Which of the following is NOT provided by an HIC? A. Patient care B. Reimbursement C. Services D. Financing

B. Reimbursement

Which type of care re-establishes functional use of natural teeth? A. Repair B. Restorative C. Fillings D. Functionality

B. Restorative

If an agent has an administrative action taken against him or her in another jurisdiction, how many days does the agent have to report this to the Superintendent after the final disposition? A. 7 days B. 15 days C. 30 days D. 45 days

C. 30 days

Which of the following components of dental insurance does NOT require the payment of a deductible? A. Cosmetic dentistry B. Routine and preventative mainantence C. Routine and major restorative care D. Orthodontic care

B. Routine and preventive care

An individual was denied coverage under Social Security because his disability did not meet the strict definitions of total disability used by Social Security. Which of the following would provide disability income coverage? A. Workers comp B. SIS rider C. Medicare Supplement Insurance D. Major Medical Supplement

B. SIS rider (Social insurance supplement riders are used to supplement or replace benefits that might not be payable under social security disability. If the insured has been denied coverage under social security, a SIS or social security rider would be applicable)

Carlos' health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. Carlos' policy provides benefits on a A. Cash basis B. Schedule basis C. Reimbursement basis D. Service basis

B. Scheduled basis (this type of payment covers the cost of treatment, not to exceed the maximum shown in the schedule)

Which of the following documents contain all information necessary to enable a consumer to make an informed choice as to whether or not to enroll in the health insuring corporation? A. Buyer's guide B. Solicitation document C. Coverage Specification document D. Outline of coverage

B. Solicitation document

Events in which a person has both the chance of winning or losing are classified as A. Retained risk B. Speculative risk C. Insurable D. Pure risk

B. Speculative risk

Once the initial benefit limit in Medicare Part D is reached, how is the beneficiary affected? A. Medicare Part A will cover all costs B. The beneficiary is then responsible for a portion of the prescription drug cost C. The beneficiary is then responsible for 75% of prescription drug costs D. The beneficiary is no longer responsible for prescription drug costs

B. The beneficiary is then responsible for a portion of the prescription drug cost (once the initial benefit limit is reached, the beneficiary is responsible for paying 25% of the prescription drug cost)

A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid? A. The insured will have to select a plan from which to collect benefits B. The benefits will be coordinated C. Neither plan would pay D. Each plan will pay in equal shares

B. The benefits will be coordinated

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. The customer's associates, friends, and neighbors provide the report's data

An applicant is considered to be high-risk, but not so much that the insurer wants to deny coverage. Which of the following is NOT true? A. The insurer can rate-up the policy B. The insurer will issue a conditional coverage C. The insurer can increase the premium D. The insurer can add exclusions to the policy

B. The insurer will issue a conditional coverage

Which of the following will vary the length of the grace period in health insurance policies? A. The term of the policy B. The mode of the premium payment C. The length of any elimination period D. The length of time the insured has been insured

B. The mode of the premium payment

Which of the following statements is most correct concerning the changing of an irrevocable beneficiary? A. They may be changed only on the anniversary date of the policy B. They can be changed only with the written consent of that beneficiary C. They may be changed at any time D. They can never be changed

B. They can be changed only with the written consent of that beneficiary

Which of the following is NOT a goal of risk retention? A. To fund losses that cannot be insured B. To minimize the insured's level of liability in the event of loss C. To reduce expenses and improve cash flow D. To increase control of claim reserving and claims settlements

B. To minimize the insured's level of liability in the event of loss

What is the purpose of a benefit schedule? A. To list the insured's copayments and deductibles B. To state what and how much is covered in the plan C. To include the average charges for procedures D. To provide the dates for the payment of benefits

B. To state what and how much is covered in the plan (Some medical expense insurance plans contain a benefit schedule, which very specifically states exactly what is covered in the plan and for how much)

Under the mandatory uniform provision Notice of Claim, written notice of a claim must be submitted to the insurer within what time provision? A. Within 10 days B. Within 20 days C. Within 30 days D. Within 60 days

B. Within 20 days (this mandatory provision requires the insured to give the insurer, or its agent, written notice of a claim within 20 days of the loss or as soon as reasonably possible. If the nature of disability is such that the insured is legally incapacitated, this requirement is waived)

Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months? A. 12 months B. 24 months C. 30 months D. 36 months

C. 30 months

According to the telemarketing sales rules, what are the permissible calling hours for telemarketing calls? A. 7 am - 7 pm B. 7 am - 9 pm C. 8 am - 9 pm D. 10 am - 10 pm

C. 8 am - 9 pm

Under the ACA, special enrollment period allows an individual to enroll in a qualified health plan within how many days after a qualifying event? A. 10 B. 30 C. 60 D. 90

C. 90 Days

What is the max amount the Insurance Guaranty Association will pay in benefits to any one individual (unless the benefits are for basic hospital, medical, and surgical insurance and major medical insurance)? A. $100,000 B. $250,000 C. $300,000 D. $500,000

C. $300,000 (the association is not liable to expand more than $300,000 in the aggregate with respect to any one individual, unless the benefits are for basic hospital, medical, and surgical insurance and major medical insurance (which is $500,000))

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay? A. $10,000 B. $7,500 C. $5,000 D. $0

C. $5,000

In some cases, in order for an insurer to legally disclose privileged information to appropriate sources, the insured must sign an authorization form. What is the maximum amount of time that can legally pass between the completion of the form and the disclosure of information? a) 1 month b) 6 months c) 1 year d) 2 year

C. 1 year (no more than one year may pass between the time na insured signs an authorization form and the time when the insurer discloses privileged information. This form is not necessary for legal disclosure in all cases)

To qualify for disability income benefits under Social Security, an individual's disability must be expected to result in death or last for at least A. 5 months B. 6 months C. 12 months D. 2 years

C. 12 months (Individuals will qualify for social security disability income benefits are hard if they are unable to perform any job and the disability is expected to last at least 12 months or result in death)

The maximum duration of a temporary license in this state is A. 30 days B. 90 days C. 180 days D. 1 year

C. 180 days

If an employee remains on an employer group health plan within a company that has 20 employees and signs up for Medicare, which of the following coverages will be primary? A. Individual Health Policy B. Medicare C. Employer Group Health Plan D. Medicaid

C. Employer Group Health Plan (if an employee remains on the group health plan and signs up for Medicare, Medicare will be the primary coverage for groups with fewer than 20 employees, and the group coverage will be primary for groups with 20 or more)

All of the following health insurance disability benefits are income tax free EXCEPT A. Key-person disability benefits B. Personally-owned individual disability insurance C. Employer-paid group disability D. Employee-paid group disability

C. Employer-paid group disability (employer paid group disability benefits are income taxable)

What insurance concept is associated with the names Weiss and Fitch? A. Types of mutual companies B. Index used by stock companies C. Guides describing company financial integrity D. Policy dividends

C. Guides describing company financial integrity

Events or conditions that increase the chances of an insured loss occurring are referred to as: A. Risks B. Perils C. Hazards D. Exposures

C. Hazards

In which of the following cases would a credit disability policy be issued? A. A person receiving disability benefits cannot receive a credit disability policy B. If an insured has filed bankruptcy and his premiums are waived, he can be issued a credit disability policy C. If an individual is in debt on a specific creditor, payments will be made for him/her until the return to work D. If a person receives disability benefits, he or she is eligible for credits on their group policies for future disabilities

C. If an individual is in debt on a specific creditor, payments will be made for him/her until the return to work

Which of the following is INCORRECT concerning taxation of disability income benefits? A. If the insured paid the premiums, any disability income benefits are tax-free B. If the benefits are for a permanent loss, the benefits paid to the employee are not taxable C. If paid by the individual, the premiums are tax deductible D. If the employer paid the premiums, income benefits are taxable to the insured as ordinary income

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

Which authority is NOT stated in an agent's contract but is required for the agent to conduct business? A. Assumed B. Express C. Implied D. Apparant

C. Implied

An insured's hospital policy states that it will pay him a flat fee of $75 per day for each day he is hospitalized. The policy pays benefits on what basis? A. Expense B. Service C. Indemnity D. Reimbursement

C. Indemnity (indemnity policies do not pay expenses or bills; they merely provide the insured with a stated benefit amount for each day the insured is confined in a hospital)

Which of the following is true regarding health insurance? A. It provides death benefit coverage B. It only covers expenses related to health care C. It could provide payments for loss of income D. Disability coverage is excluded

C. It could provide payments for loss of income

All of the following statements are true of a Combination Dental Plan EXCEPT A. It covers diagnostic and preventative care on the usual, customary, and reasonable basis B. It uses a fee schedule for other dental services C. It is also known as the Superimposed Plan D. It is basically a combination of a scheduled and nonscheduled dental plan

C. It is also known as the Superimposed Plan

Which of the following is true of a PPO? A. Claim forms are completed by members on each claim B. No copayment fees are involved C. Its goal is to channel patients to providers that discount services D. The most common type of PPO is the staff model

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

All of the following would be qualified as a dependent under a Dependent Care Flexible Spending Account, EXCEPT A. Matt must be constantly watched due to his violent muscle spasms which often lead to Matt injuring himself B. Pete is severely autistic and refuses to take care of his own personal needs, which are taken care of by his father C. Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair D. Joe was paralyzed from the neck down in a car accident and is cared for by his wife

C. Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair

All of the following are characteristics of a Major Medical Expense policy EXCEPT A. Blanket coverage B. Coinsurance C. Low maximum limits D. Deductibles

C. Low maximum limits

All of the following are true regarding the Medical Information Bureau (MIB) EXCEPT A. MIB reports contain previous insurance info B. Insurers may not refuse to accept an application solely due to information in an MIB report C. MIB reports are based upon information supplied by doctors and hospitals D. MIB information is reported to underwriters in coded form

C. MIB reports are based upon information supplied by doctors and hospitals

What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid? A. Comprehensive review B. Supplementary chart C. Prospective review D. Concurrent review

C. Prospective Review

HICs are known as what type of plans? A. Consumer driven B. Reimbursement C. Service D. Health saving

C. Service (The HIC provides benefits in the form of services rather than in the form of reimbursement for the services of the physicians or hospital)

Regarding long-term care policies, which of the following would NOT be included in activities of daily living? A. Dressing B. Eating C. Sleeping D. Bathing

C. Sleeping

The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as A. Right to Rescission B. Principle of Indemnity C. Subrogation D. Adverse Selection

C. Subrogation

Which of the following is NOT covered under Plan A in Medigap insurance? A. The 20% Part B coinsurance amounts for Medicare approved services B. The first 3 pints of blood each year C. The Medicare Part A deductible D. Approved hospital costs for 365 additional days after Medicare benefits end

C. The Medicare Part A deductible

What type of information is NOT included in a certificate of insurance? A. The procedures for filing a claim B. the length of coverage C. The cost the company is paying for monthly premiums D. The policy benefits and exclusions

C. The cost the company is paying for monthly premiums

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

C. The extent of benefits is determined by the insured's income

How are excess funds in an employee's HSA handled? A. The funds are applied toward the next years' deductible B. The funds are not tax deductible C. The funds can be carried forward to the next year D. The funds are forfeited

C. The funds can be carried forward to the next year

The insuring clause of a disability policy usually states all of the following EXCEPT A. The insurance against loss is provided B. The types of losses covered C. The method of premium payment D. The identities of the insurance company and the insured

C. The method of premium payment

An individual applies for a life policy. Two years ago he suffered a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. He has also been hospitalized for drug abuse, but does not remember this when applying for insurance. The insurer issues the policy and learns of his history one year later. What will probably happen? A. The insurer will sue and the insured for committing fraud B. Because the insured is currently not a drug user, his policy will not be affected C. The policy will not be affected D. The policy will be voided

C. The policy will not be affected

A policy with a 31 day grace period implies A. The policy is incontestable after 31 days of delivery B. The policy benefits must be paid within 31 days after a claim is submitted C. The policy will not laps for 31 days if the premium is not paid when due D. The policyholder may return the policy for a full refund within 31 days

C. The policy will not laps for 31 days if the premium is not paid when due

How does a member of an HIC see a specialist? A. The member must go out of network B. The member is allowed to choose his/her own specialist C. The primary care physician refers the member D. The insurer chooses the specialist

C. The primary care physician refers the member

Which of the following is an example of a producer's fiduciary duty? A. A duty to base all transactions upon the principle of Utmost Good Faith B. The obligation to tell the truth to the best of one's knowledge C. The trust that a client places in the producer in regard to handling premiums D. An obligation to state every known fact about the policy the producer is selling

C. The trust that a client places in the producer in regard to handling premiums

In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, allow how many days for payment? A. Within 10 calendar days B. Within 15 working days C. Within 31 days of birth D. Within a reasonable period of time

C. Within 31 days of birth

Which of the following insurance principles states that ambiguities in a policy will always be construed in favor of the insured? A. Unilateral B. Indemnity C. Utmost good faith D. Adhesion

D. Adhesion (insurance company draws up the contract and the insured must adhere to the contract as written. Because of this, any ambiguities in a policy will always be interpreted in favor of the insured)

What is the maximum period of time during which an insured may contest fraudulent misstatements made in a health insurance application? A. 90 days after the effective policy date B. 6 months after the effective policy date C. 1 year after the effective policy date D. As long as the policy is in force

D. As long as the policy is in force

At what point must an Outline of Coverage be delivered? A. At any point up to 30 days after policy delivery B. At the time of application only C. Upon delivery of the policy only D. At the time of application or upon delivery of the policy

D. At the time of application or upon delivery of the policy

What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur? A. Optionally renewable B. Noncancellable C. Guaranteed renewable D. Conditionally renewable

D. Conditionally renewable

Which of the following meets the insured's personal needs, and is provided by non-medical personnel? A. Skilled care B. Assisted living C. Intermediate care D. Custodial care

D. Custodial care (care for meeting personal needs such as assistance in eating, dressing, or bathing, provided under a doctor's orders, but by non-medical personnel)

Because of the history of cancer in her family, Julie purchased a policy that specifically covers the expense of treating cancer. Her policy would be classified as what type of policy? A. Family History Cancer Policy B. Specified Health Policy C. Term Health Policy D. Dread Disease Policy

D. Dread Disease Policy

Every subscriber of a health insuring corporation is entitled to a/an A. Proof of insurability B. Certificate of insurance C. Buyers guide D. Evidence of coverage

D. Evidence of coverage

Most LTC plans have which of the following features? A. No elimination period B. Variable premiums C. Open enrollment D. Guaranteed renewability

D. Guaranteed Renewablility

An association could buy group insurance for its members if it meets all the following requirements EXCEPT A. Has a constitution and by-laws B. Holds annual meetings C. Is contributory D. Has at least 50 members

D. Has at least 50 members (needs at least 100)

Regarding major medical plans A. Higher stop-loss means higher premium B. Lower stop-loss means level premium C. Lower stop-loss means lower premium D. Higher stop-loss means lower premium

D. Higher stop-loss means lower premium (when the insured's out-of-pocket expenses reach the stop-loss, the insurance company then provides coverage at 100% of eligible expenses for the remainder of the year. The higher stop-loss, the lower the premium will be.)

What is the benefit of experience rating? A. It helps employers with high claims experience to get group coverage B. It helps employees with low claims experience to become exempt from group premiums C. It allows employers with high claims experience to obtain insurance D. It allows employers with low claims experience to get lower premiums

D. It allows employers with low claims experience to get lower premiums

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

D. It is a compulsory program

All of the following statements describe a MEWA EXCEPT A. MEWAs can be sponsored by insurance companies B. MEWA employers retain full responsibility for any unpaid premiums C. MEWAs can be self-insured D. MEWAs are groups of at least 3 employers

D. MEWAs are groups of at least 3 employers

In group insurance, what is the policy called? A. Entire contract B. Certificate of authority C. Certificate of insurance D. Master policy

D. Master policy

Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations? A. Medicare Advantage B. Medicare Part A C. Preferred D. Medicare SELECT

D. Medicare SELECT

An insured purchases 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? A. Reciprocal B. Nonprofit service organization C. Stock D. Mutual

D. Mutual

Premium payments for personally-owned disability income policies are A. Eligible for tax credits B. Tax deductible C. Tax deductible to the extent that they exceed 10% of the adjusted gross income of those itemizing deductions D. Not tax deductible

D. Not tax deductible

A 55 year old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility? A. The total amount of time worked for the company B. Age C. Income D. Number of hours worked per week

D. Number of hours worked per week

Regarding the PPACA health care tax credit, which of the following is true? A. Tax credits are based upon the taxpayer's or family's expected annual medical expenses B. All wage earners who purchase a health care insurance are eligible for the tax credit C. Tax credits are sent to the tax payer to reduce monthly insurance premiums D. Persons receiving Medicaid are not eligible

D. Persons receiving Medicaid are not eligible (under PPACA, states can extend Medicaid to people under 138% of the poverty level. People on public coverage programs such as Medicaid are not eligible for the health care tax credit

Underwriting is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT A. Due to age or health, the policy may change dramatically B. Pre-existing conditions that were previously covered may not be covered under the replacing policy C. Benefits may change D. Premiums always stay the same

D. Premiums always stay the same

Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen? A. Full distribution of each policy's benefit B. Termination of two of the policies C. Termination of all of the policies D. Pro rata benefit reduction

D. Pro rata benefit reduction

Medicare SELECT policy does all of the following EXCEPT A. Make full and fair disclosure in writing of the provisions, restrictions, and limitations of Medicare SELECT policy to each applicant B. Provide payment for full coverage under the policy for covered services not available through network providers C. Provide for continuation of coverage in the event that Medicare SELECT policies discontinued due to the failure of the Medicare SELECT program D. Prohibit payment for regularly covered services if provided by non-network providers

D. Prohibit payment for regularly covered services if provided by non-network providers

Health policies must provide certain benefits for mammographies and cytologic screenings. All of the following types of policies are exempt from this requirement EXCEPT A. Specified disease or accident policies B. Medicare Supplement policies C. Hospital indemnity policies D. Public employee benefit plans

D. Public employee benefit plans (The mammography and cytologic screening provisions also apply to employer health care plans and public employee benefit plans established in Ohio. They do not apply to hospital indemnity or Medicare Supplement policies, or to policies that only provide coverage for specific diseases or accidents)

Under the Fair Credit Reporting Act, if the consumer challenges the accuracy of the information contained in his or her report, the reporting agency must A. Defend the report if the agency feels its accurate B. Change the report C. Send an actual certified copy of the entire report to the consumer D. Respond to the consumer's complaint

D. Respond to the consumer's complaint

Which type of dental care would cover the cost of fillings? A. Endodontics B. Orthodontics C. Oral surgery D. Restorative

D. Restorative

In contrasting stock insurers with mutual insurers, which statement is true? A. Stock dividends are tax free while policy dividends are taxable B. Nonparticipating policies can pay out dividends to the policyholders C. Mutual insurers are owned by the shareholders and issue participating policies D. Stock insurers are owned by the shareholders and issue nonparticipating policies

D. Stock insurers are owned by the shareholders and issue nonparticipating policies (stock insurers are owned by their shareholders/stockholders. Their policies are labeled nonparticipating since the insureds do not share in the divisible surplus (dividends)

Which state has jurisdiction over a group policy that covers individuals that reside in more than one state? A. The state of employer's choice B. All states in which covered individuals reside C. The state in which the majority of individuals live D. The state in which the policy was delivered

D. The state in which the policy was delivered

Which of the following is true regarding METs? A. They make deals with local hospitals to provide low cost coverage to the needy B. They provide insurance for larger corporations C. They provide insurance companies with medical information on applicants D. They allow several small employers to purchase less expense insurance together

D. They allow several small employers to purchase less expense insurance together

How are employer contributions of Health Reimbursement Accounts treated in regards to taxation? A. They are taxed as regular business expense B. They are treated as income tax for the employer C. They are excluded from all taxation D. They are tax deducible

D. They are tax deducible

An insured makes regular contributions to his Health Savings Account. How are those contributions treated in regards to taxation? A. They are considered after-tax contributions B. They are not deductible C. They are taxed as income D. They are tax deductible

D. They are tax deductible

Under the Physical Exam and Autopsy provision, how many times can an insured have the insured examined, at its own expense, while a claim is pending? A. None at all B. 1 exam per week of the claim processing period C. 2 exams per week of the claim processing period D. Unlimited

D. Unlimited

Which type of healthcare services are provided for unforeseen conditions of a kind that usually requires medical attention without delay but does not pose a threat to the life, limb, or permanent health of the injured or ill person? A. Supplemental health care B. Priority one care C. Emergency care D. Urgent care

D. Urgent care

Under what condition are group disability income benefits received by an employee NOT taxable as income? A. When the employer makes all the premium payments B. When the employee is 59 1/2 C. When the amount of the benefit is equal or less than the amount of contributed by the employer D. When the benefits received are equal or less than the employee's percentage of the contribution

D. When the benefits received are equal or less than the employee's percentage of the contribution