Life and Health Simulation Exam Missed Questions
What is typical deductible for basic surgical expense insurance?
$0 , coverage is limited.
If an insurer imposes a maximum lifetime benefit for breast cancer treatment using stem cell transplants, this limit must be ast least
$100.000
An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?
$500 ,
An insured has a $10000 term life pollicy. The annual premium was due Feb 1, however insured failed to pay premium. He died Feb 28, what would benefic receive?
$9800 (10k minus 200 premium unpaid)
What is maximum first-year commssion that a producer may receive for the sale of a medicare supp policy?
%200 of the commission paid for the servicing of the policy in the second yera
Which of the following long term care benefits would provide coverage for care functionally impaired adults on a less than 24 hr basis?
Adult day care
Which of the following is the best reason to purchase life insurance rather than annuities?
To create an estate. (Creates immediate estate when insured dies)
How many pairs of glasses in 12 month period will vision expense insurance plan cover?
1
The insured under a $100,000 life insurance policy with a triple indemnity rider for accidental death was killed in a car accident. It was determined that the accident was his fault. The triple indemnity rider in the policy specifies that the death must not be contributed to by the insured in any manner. In this case, what will the policy beneficiary receive?
100000 . Indemnity is void cuz it was his fault
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
A client has a new individual disability income policy with a 20 day probationary period and a 30 day elim period. Ten days later, the client breaks their leg and is off work for 45 days. How many days of disability will poly pay?
15 days . Probationary period refers to amount of time coverage is not available for illness related disability, so doesnt apply to leg. Elim period is time that must elapse between onset of disability and when benefits paid. 45 - 30 = 15
How many hours of continuing education must be completed in ethic and MO law each licensing period?
3 credit hours
Within how many days of requesting an investigative consumer report must an insurer notify the consumer?
3 days
If a health carrier providing prescription drug coverage makes any deletions in its health benefit plan's prescription drug formulary, within how many days of the deletion must it notify the affected enrollees?
30 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, actual benefits payments start month 6
The minimum number of credits required for partially insured status for Social Security disability benefits is:
6 Credits during last 13 qtr period
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
A Straight Life policy has what type of premium?
A level annual premium for the life of the insured
Which of the following best describes the concept that the insured pays a small amount of premium for a large amount of risk on the part of the insurance company?
Aleatory
When an annuity is written, whose life expectancy is taken into account?
Annuitant
In an annuity, the accumulated money is converted into a stream of income during which period of time?
Annuitization Period
in Insurance, producers are permitted to share or split commissions if
Both are properly licensed for the line of insurance
If more than one family member covered under the same major medical policy is injured in the same accident, the family only has to pay on deductible. This is due to the:
Common accident provision
Because insurance policy is a legal contract, it must conform to state laws governing contacts which require all of the following elements except?
Conditions - are part of policy structure, consideration is essential
Which of the following authorities is required to conduct a financial examination of the states insurers?
Director, every 5 years
The provision in a health insurance policy that ensures that the insurer cannot refer to any doc not in contract
Entire contact clause, required by law
When the insured selects the extended term nonforfeiture option, the cash value will be used to purchase term insurance with what face amount?
Equal to the original amount of the policy as long as the CV will purchase.
An applicant is denied insurance because of information found on a consumer report. Which of the following requires that the insurance company supply the applicant with the name and address of the consumer reporting company?
Fair Credit Reporting Act
True of false: Medicare Advantage must be provided through HMOS
False. Medicare Part A provides hospital care; Medicare Part B provides Doctors and Physician services. Med Advtanage offers expanded benefits for a fee through private health insurance programs such as HMOS or PPOs
Which of the following provisions in universal life policies stipulates that a written notice of the termination of coverage must be sent to the policyowner?
Grace period and lapse - written notice 30 days prior to term. Grace period 30 days after
Who makes up the Medical Information Bureau?
Insurers
Which of the following entities has the authority to makes changes to an insurance policy?
Insurers executive officer
Which provision of a life insurance policiy states the insurer's duty to pay benefits upon the death of the insured, and to whom the benefits will be paid?
Insuring clause
All of the following are nonforfeiture options except:
Interest only.
A married couple owns a permanent policy which covers both of their lives and pays the death benefit only upon the death of the first insured. Which policy is that?
Joint Life - covers lives of two insures, rates are blended, pays upon death of first insured, policy ends
The type of settlement option which pays throughout the lifetimes of two or more beneficiaries is called
Joint and survivor
Your client wants both protection and savings from the insurance, and is willing to pay premiums until retirement at age 65. What would be the right policy for this client?
Limited Pay Whole Life - premium payments will cease at her age 65, but coverage will continue to her death or age 100
Which of the following programs expands individual public assistance programs for people with insufficient income and resources?
Medicaid , needs tested program administered by the states to provide assistance to persons who are not able to provide for themselves
An applicant for a health insurance policy returns completed app with check for first premium. She receives conditional receipt 2 weeks later.
Neither approved app or policy
During replacement of life insurance, a replacing insurer must do which of the following?
Obtain a list of all life insurance policies that will be replaced
A rider attached to a life insurance policy that provides coverage on the insureds family members is called the
Other-insured rider
With respect to the Consideration Clause, which of the following would be considered consideration on the part of the applicant for the insurance?
Payment of Premium (the two types of consideration on the part of an insurance applicant are payment of premiums and representations on the application
Which applicant would not qualify for Keogh Plan
Someone who works 400 hrs per year
Group life insurance policies delivered in this state must contain all of the following provisions except:
Statements of applicant are considered warranties
Which of the following is not the consideration in the policy?
The application given to prospective insured
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. (cap amount = perfcentage of princiapl amt. for loss of one limb or eye. PRinc amoutn is 2 limbs)
An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true?
The insured was in compliance with the policy requirements regarding claims
What is the purpose of COBRA?
To provide continuation of coverage for terminated employees (The Consolidated Omnibus Budget Reconcilliation Act of 1985 requires
True or false : The annuitant assumes the risks on investment?
True
True or false. Reinstatement provision requires the policyowner to pay all overdue premiums with interest before policy is reinstated?
True
An insured owns a life insurance policy. To be able to pay some of her medical bills, she withdraws a portion of the policy's cash value. There is a limit for a withdrawal and the insurer charges a fee. What type of policy does the insured most likely have?
Universal Life
Which of the following provisions is not mandatory in your state for health polys?
Unpaid premiums. Just claim forms, reinstatement, and legal actions
Is creditor policy owner in credit life?
Yes
Mode of premium payment affect length of grace period?
Yes, 7 days on weekly prem, 10 on month, 31 on all other
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 actions
How must a replacing producer respond to an applicant wishing to replace existing life insurance?
the producer must provide the applicant with a Notice Regarding Replacement