Health Insurance Review

In a case where an individual's health is insured by both their own policy and their spouse's policy, which policy pays in the event of an illness?1. Only the individual's policy pays.2. Both policies pay the full amount.3. The individual's policy pays first, the spouse's policy pays the remaining up to coverage amount.4. The policy that was purchased first pays first, the second policy pays the remaining up to coverage amount.

15 days

What is the maximum amount of time an insurer has to provide the claimant the forms for filing proof of loss?1. 7 days2. 15 days3. 30 days4. 90 days

15 days

How long after being entitled to disability benefits will an individual be eligible to receive Medicare benefits?1. immediately2. 1 year3. 2 years4. at age 65

2 years

Which of the following is the time limit on certain defenses after which the policy becomes incontestable?1. 12 months2. 18 months3. 2 years4. 5 years

2 years

What is the difference between copayment and coinsurance?1. A copayment is a set percentage, while coinsurance is a set dollar amount.2. A copayment is a set dollar amount, while coinsurance is set as a percentage.3. A copayment is an amount of money that must be paid up-front annually before benefits begin.4. Coinsurance is an amount of money that must be paid up-front annually before benefits begin.

A copayment is a set dollar amount, while coinsurance is set as a percentage.

Which of the following is TRUE of a point of service plan?1. Patients must submit claim forms for all services received.2. The difference in cost between in-network and out-of-network is relatively small.3. A patient's care is coordinated by an in-network primary care physician.4. A patient may see any provider for any condition for the same cost and does not need to consult a primary care physician.

A patient's care is coordinated by an in-network primary care physician.

Which of the following is true of a cancelable policy?1. The insurer may only cancel on the premium due date.2. A cancelable policy is most adventageous for the insured.3. It relieves the insurer from paying valid existing claims.4. All unearned premiums must be returned to the insured.

All unearned premiums must be returned to the insured.

What does first dollar coverage mean?1. The policy is primary to a secondary insurance policy.2. The insured pays the deductible first before coverage begins.3. As soon as covered medical expenses are incurred, the policy begins to pay.4. The insurer pays the insured first and then the insured pays the provider directly.

As soon as covered medical expenses are incurred, the policy begins to pay.

Which type of coverage pays the operating costs of a small business when the owner becomes disabled?1. Business overhead expense disability insurance2. Individual expense disability insurance3. Key person expense disability insurance4. Buy-Sell expense disability insurance

Business overhead expense disability insurance

What is the major reason that insurance regulators are often critical of dread disease insurance policies?1. The plans tend to be much more expensive than major medical alternatives.2. They exclude illnesses that are related to pre-existing conditions.3. It is hard to predict which illness a person is likely to contract.4. Buyers often think they are getting broader coverage than they actually purchase.

Buyers often think they are getting broader coverage than they actually purchase.

Which of the following is the most common method to supplement Medicare coverage?1. Medicaid2. Group health insurance3. Employer Health Insurance4. Coverage offered by private insurers

Coverage offered by private insurers

Which of the following coverage types pays a monthly cash benefit following the elimination period for total disability due to accident or sickness?1. Disability income insurance2. Credit disability insurance3. Recurrent disability insurance4. Workers compensation disability insurance

Disability income insurance

Obtaining consumer information reports under false pretenses is prosecutable by which of the following?1. USA Patriot Act2. Fair Credit Reporting Act3. State laws where the applicant resides4. Securities and Exchange Commission

Fair Credit Reporting Act

Which plan is most commonly paired with a High Deductible Health Plan? 1. Emergency Medical Account (EMA)2. Flexible Spending Account (FSA)3. Health Reimbursement Account (HRA)4. Health Savings Account (HSA)

Health Savings Account (HSA)

What is the waiver of premium provision?1. In a long term care contract, the premium is waived after the insured has been confined for a specific period of time.2. In a life insurance policy, the insured may request a waiver of premium during times of financial hardship.3. In a disability policy, the premium is waived after the insurance benefit period has been passed4. In a health insurance policy, the premium is waived after the maximum out of pocket has been paid by the insured.

In a long term care contract, the premium is waived after the insured has been confined for a specific period of time.

How are issues of ambiguity usually resolved because insurance contracts are contracts of adhesion?1. In favor of the insured because the insurance company drafts the language in the contract.2. in favor of the insured because insurance companies often do not adhere to the more specific contract principles.3. In favor of the insurer because most issues arise from misrepresentation on the part of the insured.4. In favor of the insurer because the insured frequently does not adhere to the requirements of the contract.

In favor of the insured because the insurance company drafts the language in the contract.

Which is a primary difference between individual and group health insurance? 1. Individual insurance requires evidence of insurability.2. Group insurance requires evidence of insurability.3. Group insurance usually has a lower adverse selection rate.4. Individual insurance includes an eligibility period.

Individual insurance requires evidence of insurability.

What does it mean if a health policy is optionally renewable?1. The insured has the option to refuse to renew the policy if the premium increases.2. The insured has the option to refuse to submit to physical examinations required to renew the policy.3. Insurer may elect NOT to renew only under conditions specified in the policy.4. Insurer may elect NOT to renew for any reason only on the policy anniversary or premium due date.

Insurer may elect NOT to renew for any reason only on the policy anniversary or premium due date.

What is an impairment rider?1. It indefinitely extends the time to provide the proof of loss until after an impairment is resolved.2. It allows the reinstatement of a policy when an impairment is deemed to have caused the policy lapse.3. It lists specific conditions in the contract that are excluded from the contract4. It states that a contract can be cancelled and premiums refunded if the policyholder was mentally impaired at time of issue.

It lists specific conditions in the contract that are excluded from the contract

In which type of insurance is individually purchased coverage commonly more economical than group offered coverage?1. Disability insurance2. Major medical insurance3. Long term care insurance4. Medicare supplemental insurance

Long term care insurance

What is a MIB report?1. credit information on an applicant used in the underwriting process2. medical information on an applicant for assessing life or health insurance risk3. information on an applicant's moral character collected from interviews of associates4. information on an applicant's medical condition collected via a physician's physical examination.

Medical information on an applicant for assessing life or health insurance risk

Which insurance plans are commonly offered through the worksite (employer sponsored) EXCEPT? 1. Medicare2. Dental Insurance3. Long Term Care Insurance4. Supplemental Disability Insurance

Medicare

Under normal conditions which of the following is TRUE for proof of loss when a single loss is claimed?1. The insured has 90 days from the date of loss to provide proof of loss.2. The insured has 30 days from the date of loss to provide proof of loss.3. The insured is not required to file proof of loss if unable to submit it at time of loss.4. The insured has two years to file proof of loss if unable to submit it at the time of loss.

The insured has 90 days from the date of loss to provide proof of loss.

In which of the following types of contracts is only one party is legally required to do something after the insured has completed the act of paying the premium?1. Conditional2. Unilateral3. Personal4. Warranty

Unilateral

How does a noncancelable policy differ from a guaranteed renewable policy?1. With the noncancelable policy, the insurer may increase the premiums by classifications.2. With the noncancelable policy the insurer may increase premiums only based on the terms of the policy.3. With the noncancelable policy, the insured may never increase the premiums under any circumstances.4. With a guaranteed renewable policy, the insured may renew annually, with the noncancelable the insured may not cancel the policy.

With the noncancelable policy the insurer may increase premiums only based on the terms of the policy.

How do warranties differ from representations?1. a warranty is guaranteed to be true, a representation is believed to be true to the best of one's knowledge.2. a representation is guaranteed to be true, a waranty is believed to be true to the best of one's knowledge.3. a warranty is issued by the insurer, a representation is a statement provided by the applicant.4. an incorrect representation automatically voids a contract, whereas an incorrect waranty must be proven.

a warranty is guaranteed to be true, a representation is believed to be true to the best of one's knowledge.

What does the grace period protect the policyholder from?1. an unintentional lapse of the policy2. a change in mind about the initial purchase of the policy3. mistakingly omitting a beneficiary from the initial contract4. having to prove whether a condition is pre-existing

an unintentional lapse of the policy

Which one of the following is particularly important for an insurance producer to explain to a client upon delivery of a life insurance policy?1. the effective date2. any exclusions3. premium due dates4. loan interest rates

any exclusions

Which type of receipt makes the insurer liable for the risk from the date of application, regardless of the applicant's insurability?1. binding receipt2. conditional receipt3. inspection receipt4. temporary receipt

binding receipt

Which of the following may be thought of as a time deductible rather a dollar deductible in a disability income policy because benefits are not payable during that time?1. elimination period2. probationary period3. benefit period4. grace period

elimination period

According to the time of payment of claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT 1. for claims involving periodic payments.2. if the death is a suicide or due to a pre-existing condition.3. when the policy is in the incontestability period4. if the insured is able to eventually return to work.

for claims involving periodic payments.

Which of the following is exempted from the incontestability provision in insurance policies?1. fraudulent misstatements2. pre-existing conditions3. change in health4. changes in the insurance code

fraudulent misstatements

Which of the following, by definition, provides benefits for expenses incurred as a result of in-hospital medical treatment and surgery as well as certain outpatient expenses such as doctor's visits, laboratory tests, and diagnostic services?1. blanket insurance2. dread disease insurance3. hospitalization insurance4. long term care insurance

hospitalization insurance

What is the primary advantage for obtaining a reinstatement of a policy rather than obtaining a new one?1. No proof of insurability is required2. insured original issue age is used3. No application is required4. outstanding loans are cancelled

insured original issue age is used

How do most disability policies handle the case of a recurrent disability occurring at least 90 days after the first claim?1. It is handled as a continuation of the existing claim.2. it is excluded from coverage because benefits have already been paid.3. it must be handled as a new claim for a new period of disability, requiring a new elimination period.4. it must be handled as a new claim for a new period of disability, without requiring a new elimination period.

it must be handled as a new claim for a new period of disability, requiring a new elimination period.

In which of the following cases are premiums paid by a business NOT tax deductible as a business expense?1. key person disability income insurance2. group disability income coverage for its employees3. individual disability income coverage for its employees4. when benefits received by employees are taxable as income.

key person disability income insurance

A group conversion option may be used in all the following instances EXCEPT1. the termination of the master policy.2. loss of coverage due to loss of employment.3. loss of eligibility on the part of a class of insureds.4. a life-changing event, such as marriage, divorce, or childbirth.

life-changing event, such as marriage, divorce, or childbirth.

Which of the following must be given to the insurer within 20 days after occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible?1. evidence of insurability2. notice of claim3. proof of loss4. supporting evidence for the claim

notice of claim

Which of the following is considered the major advantage of HIPAA?1. portability2. increased coverage3. qualified beneficiaries4. tax deductibility of certain medical expenses

portability

Which of the following is a characteristic of Preferred Provider Organizations (PPOs)?1. prearranged costs for services rendered2. providers receive a flat monthly amount for each user3. ability to receive care at the same cost from any provider4. emergency treatment is restricted to pre-selected hospitals

prearranged costs for services rendered

During which period of a Disability Income Policy is coverage effective but during which no benefits will be paid under the policy?1. benefit period2. elimination period3. grace period4. probationary period

probationary period

In which of the following must a beneficiary change request be filed in writing to the insurer and is made effective by the insurance company recording the change in its records?1. designation option2. recording method3. endorsement method4. succession of beneficiaries

recording method

Some states require life insurance policies to include a provision that gives the insurer the right, at its own expense, to do which of the following?1. require an autopsy2. perform a financial audit of the insured3. investigate the claims made on the application4. perform a medical examination on the beneficiary

require an autopsy

A basic vision care package includes all of the following EXCEPT1. safety glasses.2. the annual eye exam.3. lenses and frames.4. contact lenses.

safety glasses.

Which of the following determines whether a person passes the financial test to qualify for Medicaid? 1. state law2. federal guidelines3. American with Disabilities Act4. The Social Security Administration

state law

What is it called when an insurance company tries to recover from a different insurance policy all or part of its losses resulting from a claim?1. secondary beneficiary2. subrogation3. coordination of benefits4. conversion

subrogation

All of the following are required signatures on a life insurance application EXCEPT1. the agent.2. the applicant.3. the minor in a juvenile policy.4. the proposed insured.

the minor in a juvenile policy.

Which of the following occurs immediately after the application is submitted and the initial premium paid?1. the underwriting process begins2. the applicant's references are checked3. the beneficiaries are selected4. the insurance goes into effect.

the underwriting process begins

Managed care plans increase efficiency by all of the following means EXCEPT 1. increasing beneficiary cost sharing.2. controlling inpatient admissions and length of stay.3. selectively contracting with health care providers.4. transferring the management of costs to the insureds.

transferring the management of costs to the insureds.

All of the following are requirements to qualify for Social Security disability benefits EXCEPT when1. credited with the appropriate number of quarters of coverage.2. total and permanent disabled for at least 5 months.3. disability expected to last for 12 months or end in death.4. unable to work in occupation in which the worker was trained or educated.

unable to work in occupation in which the worker was trained or educated.