Accident and Health Missed Questions
Each of the following is necessary for an insurance license to be renewed, EXCEPT: a) completion of continuing education credits b) passing a state exam c) payment of license renewal fee d) completing a renewal application
b
Once a reinstatement application is completed by an insured, the insurer must inform him or her whether or not reinstatement has been approved within: a) 60 days b) 10 days c) 30 days d) 45 days
d
A rider added to a disability income contract that limits coverage is known as an exclusion rider. This rider may also be referred to as: a) an impairment rider b) a cost of living rider c) an accidental death rider d) a benefit rider
a
All of the following statement are true regarding the insuring clause of a health insurance policy, EXCEPT: a) the provision identifies the length of time that an insured's representations are contestable b) the provision is generally found on the face page of the policy c) it identifies the policy period d) it states that both accidents and sickness can be covered
a
An accidental death and dismemberment rider may be added to a disability income policy or purchased as a separate contact. The death benefit paid by this rider is known as the: a) principal sum b) capital sum c) lump sum d) partial
a
Under a hospital expense or reimbursement plan, covered benefits are paid to which of the following? a) the insured b) the beneficiary c) the policy owner d) the medical examiner
a
What is the most common definition of "total disability" as used in the disability income insurance field today? a) unable to perform the duties of your own occupation b) unable to perform any occupation for which you are suited by training, education and experience c) unable to perform any occupation d) unable to perform at least half of your duties by reason of training and experience
a
What provision found in health insurance policy protects an insurer against an insured owning duplicate coverage or purchasing more insurance than needed? a) coordination of benefits b) preexisting conditions c) exclusion provision d) insuring provisions
a
A grace period is included in all policies of health insurance. This period shall be allowed for payment of a premium in default. If a policy is paid with weekly premiums, its grace period will not be less than: a) 5 days b) 7 days c) 10 days d) 14 days
b
A producer who guarantees the payment of dividends by a policy of insurance has engaged in: a) twisting b) misrepresentation c) defamation d) rebating
b
A short term disability policy usually has a benefit payout period of: a) more than 2 years b) less than 2 years c) more than 1 year d) less than 1 year
b
Each of the following is a requirement that must be present in long-term care coverage in order for the plan to be qualified, EXCEPT: a) it must included a renewal provision of at least "guaranteed renewable" b) it must included a cash surrender value in case benefits are never used c) it cannot pay expenses that are reimbursable under Medicare d) It must only provide benefits for long-term care services
b
Generally, in a health insurance policy that has been reinstated, sickness coverage beings: a) 30 days after reinstatement b) 10 days "" c) 5 days "" d) 90 dyas ""
b
An illegal comparison of insurance of insurance policies made by a producer which persuades an insured to lapse, surrender or cancel another policy currently in force is known as : a) sound business practice b) misrepresentation c) rebating d) replacement
b -- also called twisting
Which of the following best describes the primary purpose of managed care? a) to provide comprehensive first dollar coverages b) to control health insurance claim expenses c) to provide a mechanism for health care for all d) to reduce a member or subscriber out-of-pocket expenses
b -- also to influence subscriber behavior
Policies providing hospice care benefits are not required to cover: a) psychological treatment benefits b) home health care c) care for terminally ill persons d) ambulance expenses
b -- designed to provide pain management type care for those who are terminally ill
Which of the following is a power or duty of the Superintendent or Commissioner of Insurance? a) to examine domestic companies once every 2 years b) to compute the reserves of life insurance companies c) to prosecute producers who break insurance laws d) to set life insurance premium rates
b -- determine amt that an insurance company must hold in reserve in order to pay future claims
A Point of Service (POS) is a hybrid arrangement that combines the assets of a traditional HMO and a PPO. Such plans allow treatment inside or outside the "network". If the POS requires that a member insured provide notification of treatment outside the network, which of the following generally must be notified? a) the network manager b) the provider contractor c) the gatekeeper d) the medical provider
c
A disability income policy must include 12 uniform policy provisions. An insurer may include a disability policy of any of several optional uniform policy provisions or clauses. Which of the following is an optional uniform provision that may appear in such a policy? a) recurrent disability clause b) free-look provison c) conformity with state statues clause d) santa clause
c
A testimonial used in an advertisement for an accident and health insurance plan mustL a) be generally true b) be applicable to a homogeneous group c) be genuine and represent the author's current opinion d) be supported by independent research
c
A&H policies include several uniform provisions, one of which is called the "claim form" provision. An insurer is required to send a proof of loss form to an insured within what period of time after notice of loss has been provided by the insured? a) 20 days b) 10 days c) 15 days d) 90days
c
The waiver of premium benefit included in a disability income policy waives premiums if the policy owner/ insured is disabled for how many consecutive days? a) 30 b) 60 c) 90 d) 180
c -- any premiums paid during the 90 days will be refunded
Each of the following is a power and duty of the Superintendent or Commissioner of Insurance, EXCEPT: a) suspends insurance licenses but only after a hearing b) approves life insurance premium rates c) prosecutes producers for criminal activity d) examines an insurer for solvency
c -- job of the State's Attorney General
When purchasing LTC coverage an individual selects the level of benefit he or she desires. Most plans offer at least 3 daily benefits such as $100, $150, or $200. Most policies also provide the same level of benefits for institutional care but only a percentage of that benefit for home health care. Which of the following is true with regard to such benefits? a) the benefit for home health care will be greater than that for skilled nursing care b) the benefit for skilled nursing care is less than the benefit for custodial care c) the benefit for intermediate care is less than that provided for home health care d) the benefit for skilled nursing is greater than that provided for home health care
d
Which health insurance policy provision states that in consideration of the payment of a premium, the insurer agrees to pay policy benefits to an insured upon receipt of a written proof of loss? a) the consideration clause b) the river of premium provision c) time limit on certain defenses clause d) the insuring clause
d
Which of the following is not owed a fiduciary duty by an insurance producer? a) an insurance client b) insurance agency personnel c) an insurer d) The Insurance Commissioner
d
Which statement is not correct when describing the Medical Information Bureau? a) the Mob helps to detect any adverse health conditions of the applicant b) compares health data from previous applications against current application information c) may be used to compare information collected for the Attending Physician Statement d) provides the malpractice history of the attending physician
d
Generally, statistical information may be used in accident and health insurance advertising as long as it is: a) approved by formula b) in easy-to-read print c) accompanied by a policy summary d) accurate and relevant
d -- cannot be used to imply that broader benefits are provided
Long-term care insurance coverage may be secured through each of the following, EXCEPT: a) a group long-term care plan b) a rider added to a life insurance policy c) an individual long-term care policy d) a rider added to a disability income plan
d -- generally requires the pmt of an additional premium as well
The outline of coverage for an A&H policy must include all but: a) exclusions b) reductions c) limitations d) riders
d -- only included if selected by the owner
An illegal sales practice where a producer induces a client to lapse or surrender a policy as a result of an unfair comparison of policies best describes: a) misrepresentation b) perjury c) defamation d) coercion
a
Disability income policies may be referred to as contracts of indemnity. Insurers limit the monthly benefit amount one can purchase for which of the following reasons? a) to prevent malingering on the part of an insured b) the insurer cannot afford to reduce its reserves c) due to state regulations d) so that it may limit adverse reactions
a
In the event a Long Term Care policy is replaced, a Notice Regarding Replacement form must be provided to and signed by the applicant at what time? a) at time of policy application b) within 30 days following policy delivery c) the notice only applies to disability income policies d) anytime during the underwriting process
a
Medical treatment provided for an individual who is injured as a result of attempted suicide is generally: a) excluded b) covered in full c) subject to limitations in the policy d) included in major medical plan
a
Most Commissioners of Insurance approve which of the following? a) premium rates charged for insurance contracts b) insurance regulations c) commission schedules for producers d) underwriting procedures utilized by carriers
a
The fact that A&H policy premium payment of $850 must be paid each year in return for coverage is stipulated in which of the following sections of the policy? a) insuring clause b) beneficiary provision c) premium payment provision d) consideration clause
a
What type of insurance pays for the lost services of an employee who is disabled? a) key person insurance b) business overhead expense insurance c) residual disability income insurance d) disability buy-out insurance
a
Which of the following is a primary purpose of the elimination period which appears in a Long-Term Disability policy? a) to allow an insurer to lower costs for everyone's benefit b) to allow insurers to increase the premium c) to guarantee that the insurer will provide benefits for everyone d) to weed out malingerers and moral hazards
a
Which of the following is true with regard to a group medical plan that excluded coverage for abortion procedures? a) it must cover medical expenses that are incurred as a result of complications resulting from an abortion b) it excluded coverage for expenses that are incurred as a result of complications due to an abortion c) it will exclude coverage for expenses incurred when the life of the mother is endangered d) abortion expenses may not be excluded in any group or individual health plan
a
Which of the following summarizes the benefits and features of a long-term care policy? a) outline of coverage b) underwriting considerations c) an impairment rider d) limitation and exceptions
a
Which of the following types of insurers issues participating life insurance policies? a) mutual insurer b) non-admitted insurer c) surplus lines insurer d) a fraternal mutual company
a
Which provision states that no action can be brought against an insurer (by the insured) until 60 days after written proof of loss has been furnished to the insurer? a) legal action b) notice of claim c) proof of loss d) claim forms
a
Which statement is false when discussing policy illustrations? a) only guaranteed elements on the contract must be listed b) the use of footnotes is prohibited c) the regulations apply to both individual and group policies d) they protect against unfair sales solicitations
a
Why would an applicant for health insurance be classified as a declined risk? a) since their risk factors and characteristics result in a declined application b) since their health history is favorable c) due to the fact that the applicant is part of an excluded group d) due to the face that the applicant is rated by a stepped-up basis method
a
Initial agent underwriting is called: a) field underwriting b) physician reporting c) credit reporting d) home office underwriting
a -- application begins the field underwriting. The duties include determining which risks are desirable and submitting the respective application to underwriting
Jocko owns a disability income policy. When it was originally purchased, Jocko was a police officer. 7 years later, he changed jobs and became a librarian. This change of occupation will allow the insurer to engage in which of the following? a) reduce the premium b) increase the premium c) increase the monthly benefit d) reduce the monthly benefit
a -- change to a less hazardous job means you reduce the premium .If you change to a more hazardous job, you decrease the monthly benefit
Which of the the following is true with regard to HIPPA? a) an individual must have 12 months of creditable coverage which may come from more than 1 employer b) an individual must have 6 months of creditable coverage which may come from more than one employer c) an individual must have 8 months of creditable coverage in order to be eligible for COBRA d) an individual must have no pre-existing conditions in order to be covered under HIPPA
a -- in order to reduce any pre-existing condition waiting period
Employer group health insurance provides access to dependents if the covered employee has a special needs dependent child who is covered by the plan, which of the following is true? a) coverage will remain in force for as long as the dependent child lives b) coverage continues for the dependent as long as the plan remains in force and appropriate premiums are paid c) coverage will be provided for the dependent up to age 18 d) coverage is only provided if proof of dependency is provided at each renewal
b
The A&H policy provision which limits the use of evidence other than the contract language and the application best describes: a) the notice of claim provision b) the entire contract provision c) the incontestable provision d) the legal action provision
b
The waiting period that must be satisfied before premiums will be waived under an accident and health contract is: a) 2 months b) 3 months c) 6 months d) 9 months
b
All of the following are known as required uniform policy provisions, EXCEPT: a) change of beneficiary b) time limit on certain defenses c) grace period d) illegal occupation
d
Twisting Is a form of a misrepresentation. Which of the following is considered a form of twisting? a) a producer offers something of value not listed in the policy b) a producer makes an illegal inducement to influence the surrender of a policy c) failing to provide claim forms in a timely fashion d) representing oneself as a producer when in fact he or she is not
b
What often occurs with the deductible for preventative dental care? a) it is waived by the dentist b) it is waived by the insurer c) it is a required payment d) deductibles do not exist in dental care plans
b
Which of the following insurers has its principal office in one particular State but is authorized to solicit or transact insurance products in this State? a) non-admitted insurer b) foreign insurer c) fraternal insurer d) alien insurer
b
Which of the following involves occasional nursing and rehabilitative care that must be based upon a doctor's orders and only performed by or under the supervision of skilled medical personnel? a) respite care b) intermediate care c) skilled care d) custodial care
b
Which of the following is not considered to be one of the Required Uniform Accident and Health policy provisions? a) grace period b) free-look provision c) time of payment of claims d) claim forms
b
Which of the following is true with regard to the replacement of an individual long-term care insurance plan? a) long term care insurance policies may not be replaced b) any pre-existing condition limitation in the new long-term care plan is waived c) any non-forfeiture benefit in the policy will be terminated d) replacement of any accident and health insurance policy is only permitted if it occurs within the first 3 years of issuance
b
Written proof of loss must be supplied to an insurer within what period of time? a) 30 days from the date of loss b) 90 days from the date of loss c) 120 days from the date of loss d) 60 days from the date of loss
b
An insurance adviser may also be referred to as: a) a broker b) a consultant c) an agent d) an attorney
b -- also called a counselor or analyst
All of the following may be ordered by an underwriter when there are questions about a proposed insured's health, EXCEPT: a) lab tests b) an interview with the Attending Physician c) an interview with the proposed insured through a medical questionaire d) blood tests
b -- completes the Attending Physician Statement but is not required to submit to an interview
Which of the following best describes the deductibility of individual dental premiums? a) premiums are deductible to the insured b) premiums are not deductible by an insured c) premiums are deductible up to $500 per year d) premiums are deductible if they are payroll deducted by the employer
b -- considered a personal expense
What type of disability income policy may have its premiums increased for an entire class of policies? a) noncancelable b) guaranteed renewable c) conditionally renewable d) optionally renewable
b -- example: all truck driers, all police officers, etc
Which of the following is not a minimum standard requirement for Medigap insurance? a) Medigap plans must be guaranteed renewable for ife b) Medigap plans must have a 20-day free-look c) Medigap plans must cover pre-existing conditions after 6 months d) Medigap plans must have annual automatic adjustments to reflect changes in Medicare deductibles and copayments
b -- must include at least a 30-day free-look period
Which of the following statements is true with regard to Medicare Part A: a) an individual is eligible once they reach age 62 b) an individual is eligible once they reach age 65 c) an individual is eligible if they are age 65 and not working d) all individuals age 65 are automatically eligible for Part A
b -- one must apply for it and pay a premium
A residual disability benefit may be added to an individual disability income policy. The benefit would provide coverage for which of the following? a) total permanent disability b) partial disability c) total temporary disability d) temporary disability
b -- rider pays if the insured cannot perform all of their duties and benefit is proportionate to the insured's percentage of lost income
A major medical policy provides coverage for medial expenses and hospital care. Each of the following is a characteristic of this type of insurance, EXCEPT: a) an initial deductible b) home health care c) coinsurance d) larger limits of insurance
b -- the others are the 3 primary characteristics
According to the time of payment of claims provision, insurers must provide payment of disability income benefits not less frequently than: a) daily b) weekly c) monthly d) quarterly
c
All of the following are considered to be insurance transactions, EXCEPT: a) contract issuance b) delivery of an insurance policy c) filing of a claim d) collection of premiums
c
An agent intentionally lists on the application that a sale is not intended to replace an existing contract. Later on, it is determined that the policy did in fact resale an existing contract. Which of the following best describes the action taken by the producer? a) defamation b) larceny c) replacement d) rebating
c
An insured suffers a covered illness. He or she must notify the insurer of loss within: a) 5 days b) 10 days c) 15 days d) 20 days
d
Disability income policies generally include a waiting period which functions like a deductible. Which of the following is a primary purpose of a waiting or elimination period when it appears in a long-term disability policy? a) to weed out malingerers and other moral hazards b) it allows an insurer to increase the premium c) to permit an insurer to lower the cost of everyone's benefit d) to guarantee that the insurer will provide benefits for everyone
c
During the underwriting process, who is the attending physician? a) a disinterested physician b) the insurance company's physician c) the applicant's physician d) the holder's physician
c
Insurers selling long-term care insurance are required to provide a new purchaser with a free-look of at least a) 10 days b) 20 days c) 30 days d) 60 days
c
Medicare coverage included hospital insurance and supplementary medical insurance as well as other coverages. Each of the following is excluded by Part B of Medicare, EXCEPT: a) routine foot care b) dentures c) office visits d) fluoride treatments
c
The assignment or transfer of one's interest in a policy to another is allowed. Which of the following best describes the concept of assignment? a) a legal transfer of the insurer's rights and interest under a policy b) the legal transfer of the proposed insured's rights and interest under a policy c) the legal transfer of the policy owner's rights and interest under a policy d) the legal transfer of the insured's rights and interest under a policy
c
Which of the following entities is responsible for remitting a producer's appointment fee? a) an insurance agency b) the Department of Insurance c) an insurance company d) the producer
c
Which of the following is a similarity of Medicare and long-term care? a) both provide benefits for hospital confinement b) both provide health benefits for those with limited assets c) both provide benefits for home health care d) both provide benefits for loss of income
c
Which of the following should a producer consider when replacing a health insurance policy? a) that there are no exclusions present in the new plan b) that the cost of the new plan is at least equal to or less than the replaced policy c) that benefits are similar and coverage for pre-existing conditions is not lost d) that benefits are equivalent even if the cost of the new plan is a bit more expensive
c
Why are underwriting requirements so carefully reviewed in a replacement policy sale? a) to ensure that the new replacement policy will indeed be issued b) to ensure commissions will be paid c) to prevent the existing policy from being lapsed before the replacement policy is issued d) to meet the requirements of the State insurance department
c
`What mandatory provision allows the insured to send in proof of loss in any reasonable form? a) reasonable expectation clause b) proof of loss provision c) claim form provision d) grace period provision
c
AD&D policies provide a benefit for the severance of a limb. In addition, such policies may also cover the loss of sight, speech and hearing. The loss of sight is an example of which of the following? a) partial disability b) residual disability c) presumptive disability d) total disability
c -- loss of use of limbs due to an accident is also included
Which of the following must be offered by an insurer as an optional benefit in a long-term care policy? a) death benefit b) viatical benefit option c) non-forfeiture options d) adult day care option
c -- no long-term care policy can be issued unless it offers a non-forfeiture benefit option to the applicant
Once a specific amount of benefit is initially covered by Part D of Medicare, a gap exists before more costs are covered. This gap in coverage that exists under the prescription drug plan is known as: a) the donut maker b) catastrophic coverage c) a donut hole d) whole life coverage
c -- once this is incurred, catastrophic drug coverage begins
Which of the following types of insurance carrier is formed without any capital stock? a) stock company b) authorized company c) mutual company d) foreign company
c -- owned by its policyholders and surplus may be shared with the policyholders in the form of a dividend
A stock insurer and mutual insurer differ according to: a) profits b) domicile c) ownership d) capital
c -- stock is owned by shareholders and mutual is owned by policyholders
Which of the following does not require an additional premium in order to be included in a disability income policy? a) accidental death b) guaranteed insurability option c) waiver of premium d) accidental dismemberment
c -- waiting period is 90 days
A disability income policy provides Toby with a total disability benefit of $3,000 per month. The plan includes a 30-day elimination period. Toby is disabled for 8 months. What portion of his income benefits are going to be taxable? a) $21,000 b) $3,000 c) $24,000 d) $0
d
A major medical policy provides coverage for basic medical expenses after an initial deductible. Once this deductible is satisfied the insurer will pay up to is: a) stated limits b) corridor of coverage c) stop loss amt d) coinsurance amt
d
A policy owner may have his policy reinstated after a lapse is a reinstatement application is completed and approved. Once this application is submitted, an insurer must notify the insured of its approval or declination within: a) 31 days b) 60 days c) 30 days d) 45 days
d
A surplus lines insurance carries is also referred to as a: a) authorized insurer b) admitted insurer c) non-concurrent insurer d) non-admitted insurer
d
According to model legislation for long-term care insurance, insurers must offer an applicant the right to purchase coverage that allows for the increase in the amount of benefits based on reasonable anticipated increases in the cost of services covered by the policy. This coverage is known as: a) non-forfeiture options b) guaranteed renewable coverage c) prospective allotments d) inflation protection
d
All are covered under an Errors and Omissions policy, EXCEPT: a) an incorrect review of insurance contract benefits b) a review of group plan benefits c) incompetent or negligent opinion or advise d) fraudulent misappropriation of collected premiums
d
An optional health insurance policy provision which allows the insurer to adjust benefit payments under certain situations or permits the insured to receive a reduced premium in other circumstances, best describes: a) payment of claims b) time limit on certain defenses c) relation of earnings to insurance provision d) change of occupation
d
Health Maintenance Organizations are an alternative to health care provided by commercial insurers. Which of the following statements is true regarding HMOs? a) claim forms are submitted to each HMO facility b) HMOs differ from commercial insurers in that the latter delivers medical care c) an HMO functions on a reimbursement basis d) HMOs deliver medical care
d
Health insurance policies all include a renewability provision. Premiums may not be increased on which type of health insurance policy? a) conditionally renewable b) guaranteed renewable c) optionally renewable d) non-cancelable
d
Joan is covered by a disability policy in her occupation as an inside salesperson. One of her hobbies is sky diving. She later leaves her job and becomes a paid instructor at a sky diving school . How will this affect her disability policy? a) the monthly benefit will be increased b) it will be cancelled c) the policy premium will be increased d) the monthly benefit will be reduced
d
To be eligible for SS disability benefits the individual must be disabled for at least: a) 3 months b) 6 months c) 9 months d) 12 months
d
A guaranteed insurability rider includes option dates which permit an insured to purchase additional amounts of insurance in the future. These coverage amounts are provided on which of the following bases? a) without paying a premium b) by paying the original age premium c) on a relative schedule basis d) without providing insurability
d -- premiums are based on insured's attained age at the time of election
