Aubree test 4

How does a Medicare claim get started? Medical provider contacts Medicare Applicant contacts medical provider Medicare contacts medical provider Medicare contacts applicant

Medical provider contacts Medicare

All of the following may be named as exclusions in a group disability income policy EXCEPT: Preexisting conditions Self-inflicted injuries Pregnancy Participation in a felony

Pregnancy

Two of the long-term care chronically ill activities of daily living (ADLS) are speaking and incontinence. eating and dressing. bathing and hearing. sleeping and walking.

eating and dressing.

Under The Consolidated Omnibus Budget Reconciliation Act (COBRA), how many months of coverage are available? six months twelve months eighteen months twenty-four months

eighteen months

The premium of a proposed disability income policy could be lowered by increasing the cost-of-living rider benefit. elimination period. monthly benefit. benefit period.

elimination period.

All of the following are true about term life insurance policies EXCEPT the: face amount is paid if the insured dies during the policy period. face amount is paid if the insured survives to the end of the policy period. insured must answer medical questions on the application. insured can choose the premium payment mode.

face amount is paid if the insured survives to the end of the policy period.

For Social Security purposes, a person with 40 quarters of coverage is considered currently insured. conditionally insured. fully insured. partially insured.

fully insured

If a life agent sells a whole life policy to a prospect on behalf of an insurer without an appointment, the insurer is relieved of any liability because there is no appointment. agent is automatically appointed by default of transacting insurance. insurer must submit a notice of appointment to the Commissioner. agent is fined for unauthorized transaction without an appointment.

insurer must submit a notice of appointment to the Commissioner.

An example of a third-party administrator is an employee who settles health insurance claims. outside organization that processes claims for an employer's self-funded group plan. employee who is responsible for evaluating the relative quality of competing group health and welfare benefits offered to her employer by insurers. agent's supervisor who takes part of his commission.

outside organization that processes claims for an employer's self-funded group plan.

What is the most liberal definition of disability? any occupation own occupation occupation for which you can easily qualify occupation you can easily qualify for after minimum education

own occupation

The adult day care coverage level of a long-term care policy provides for part-time home health care for the frail elderly. full-time nursing at home for a convalescent elder. part-time nursing at a facility for elderly who live at home. full-time nursing care for elders who live in assisted living centers.

part-time nursing at a facility for elderly who live at home.

What is covered by Part A of Medicare? Outpatient hospital treatment. Prescription drugs. Hospitalization. Physicians' services.

Hospitalization

An insured has a disability income policy with a $1,500 monthly benefit and a 30-day elimination period. The insured is unable to work for 120 days following an accident. What amount will the policy pay? $1,500 $3,000 $4,500 $6,000

$4,500

What maximum amount of employer-provided group-term life insurance is tax-free (excluded from an employee's income)? $25,000 $50,000 $75,000 $100,000

$50,000

The Maple Insurance Company has only the Milehigh Manufacturing account for disability income insurance for all of Milehigh's employees. A high concentration of these insureds is in one location. Oak Grove Insurance Company previously had the account along with many other large manufacturing companies around the country. Choose from below the correct statement(s) regarding the "law of large numbers" as it relates to these two insurers: 1. Oak Grove can use the law of large numbers better than Maple 2. Catastrophic loss exposure was the same for both insurers 3. The more employees insured, the better a company can predict the injury of any one employee 1 and 3 2 and 3 1 only All of the above

1 only

Which is the most expensive LTC policy? 14 day elimination period, 3 year benefit period 14 day elimination period, 5 year benefit period 180 day elimination period, 5 year benefit period 90 day elimination period, 5 year benefit period

14 day elimination period, 5 year benefit period

How much continuing education is an agent who holds the life-only and/or accident & health license AND property and/or casualty broker- agent license required to complete? 25 hours per license term for each license 24 hours per license term for either license 25 hours per license term for either license 24 hours per license term for each license

24 hours per license term for either license

Dependent children are eligible for coverage under the employee's group life insurance policy through age: 19 24 26 Any age, there is no age limitation for dependent children to be covered

26

According to Section 1729.2 of the California Insurance Code, within how many days is an insurance producer applicant or licensee required to notify the insurance commissioner, in writing, of changes in background information after an application has been submitted or a license has been issued? 15 20 30 45

30

All of the following apply to variable life insurance, EXCEPT: A guarantee is provided by the insurer for the performance of the fund. Their funds are invested in equity investments like stocks. A securities license is needed for an agent to sell variable products to the public. They often contain mutual funds as their investment.

A guarantee is provided by the insurer for the performance of the fund.

The replacement of life insurance and annuity contracts requires which of the following: A statement to the effect that the policy being applied for is replacing a prior one. A disclosure by the applicant that they own other policies. That laws apply alike for group or individual plans. All the above.

A statement to the effect that the policy being applied for is replacing a prior one.

Which of the following are commonly covered by medical expense policies? Expenses covered by a workers' compensation policy Accidental injuries Intentionally self-inflicted injuries Elective cosmetic surgeries

Accidental injuries

Which of the following is not an acceptable risk to the underwriting department of an insurance company? Preferred Sub-standard Standard All are acceptable risks

All are acceptable risks

All of the following are eligible for dependent coverage under an employer's group health insurance policy EXCEPT: The employee's spouse All children under age 26 All unmarried grandchildren under age 21 who live with the covered employee A child who is both incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition and chiefly dependent upon the employee for support and maintenance

All unmarried grandchildren under age 21 who live with the covered employee

An example of a morale hazard in relation to a life insurance application would be: The insured is color blind. Misstating health history to an insurance company. A person suffering bouts of severe depression. An individual has an indifferent attitude about participating in activities that may be damaging to his health.

An individual has an indifferent attitude about participating in activities that may be damaging to his health.

What is the penalty for unlawfully acting as an agent or broker for, or aiding an insurer without a certificate of authority? Up to 1 year imprisonment $500 $100 per month that the agent continues the violation Any penalty for applicable misdemeanor, plus $500, plus $100 per month that the agent continues the violation

Any penalty for applicable misdemeanor, plus $500, plus $100 per month that the agent continues the violation

Long-term care coverage can be sold in various ways. Which of the following is one of these ways? As part of an auto policy. As part of a life insurance policy through the use of an endorsement. As a part of a comprehensive homeowner umbrella policy. All of the above are ways in which long-term care coverage can be sold.

As part of a life insurance policy through the use of an endorsement.

What is REQUIRED when an application reveals conditions that require more information? Attending physician's statement. Investigative consumer report. Physical examination. Agent's report.

Attending physician's statement.

Which program is designed to provide medical assistance to people with low incomes? Social Security. Medicare. Workers' Compensation. Medi-Cal.

Medi-Cal.

Which of the following is not a feature of a major medical insurance policy? Capitation Deductibles Coinsurance Maximum benefit limits

Capitation

By adopting a self-funded health plan, an employer will have greater flexibility in all areas of the planning, EXCEPT: Claims severity Benefits provided Cost Group size

Claims severity

In the business of insurance, concealment is defined by all of the following statements, EXCEPT: Concealment can be intentional Concealment does not occur if no inquiry is made Concealment is grounds for declination by the insurer Concealment can be unintentional

Concealment does not occur if no inquiry is made

Oscar owns a whole life policy that he has been paying into for many years. He would like to continue having life insurance and can afford to make the premium payments, but needs about 30% of the cash value for a couple of years. What would be the best course of action for Oscar to take? Continue making the premium payments to keep the contract in force and borrow from cash value. Find another source of funds. He has no access to cash value until the age of 100. Find another source of funds. Whole life policies do not build cash value. Since he must surrender the policy to get any money out he can do so, then buy another policy with the other 70% of the funds he received from the cash value.

Continue making the premium payments to keep the contract in force and borrow from cash value.

As defined by the California insurance code, "insurance" is a: Risk Gamble Peril Contract

Contract

Hospital Indemnity Insurance provides money for all of the following, EXCEPT: Out-of-pocket expenses Non-medical expenses Incidental expenses Medical expenses

Medical expenses

Deductibles, coinsurance, and co-payments in a health insurance policy are cost-effective choices that have the effect of: Cost sharing Cost avoidance Cost evasion Cost containment

Cost sharing

Kim has purchased a new car. The salesman told Kim of a program that will make the loan payments if Kim were to become disabled as the result of sickness or injury. Kim would pay for the plan by having higher bank loan payments. Identify the form of insurance the salesman has described to her. Travel accident insurance Long-term care insurance Credit health insurance Credit life insurance

Credit health insurance

Which of the following conditions would NOT be included among the chronic illness triggers of a long-term care policy? Aizheimer's Dementia Incontinence Deafness

Deafness

Which government agency would possibly provide coverage if you ran out of coverage under your own health insurance? Department of Health Care Services (DHCS) Department of Insurance Social Security Health Insurance Counseling & Advocacy Program (HICAP)

Department of Health Care Services (DHCS)

When referring to an insurance contract, when must a representation be made? Only after a policy is issued Either at the time of or after policy issuance Only before a policy is issued Either at the time of or before policy issuance

Either at the time of or before policy issuance

Joe has a disability income policy. It contains a(n) that states the insured must wait for a specific number of days from the time he may become disabled to the time he is entitled for benefits. Facility of payment clause Elimination period clause Deductible clause Probationary period clause

Elimination period clause

The rules regarding life insurance policy illustrations are intended to ensure all of the following, EXCEPT: Ensure that the disclosures that are required in connection with illustrations are specified. Ensure that illustrations do not mislead purchasers of life insurance and annuities. Ensure that the illustration specifies that both guaranteed and non-guaranteed elements will continue unchanged for all years shown. Ensure that illustrations are understandable by prescribing standard formats to be followed when illustrations are used.

Ensure that the illustration specifies that both guaranteed and non-guaranteed elements will continue unchanged for all years shown.

What would we call a representation which fails to correspond with its stipulations or assertions? False Frivolous Fatal Fraud

False

HICAP (Health Insurance Counseling & Advocacy Program) helps to provide to the senior community information on Medicare, health insurance, and retirement planning. What else is true in connection with HICAP? HICAP does not endorse or sell any types of insurance HICAP charges a fee for this service Both are true Both are false

HICAP does not endorse or sell any types of insurance

The Department of Insurance has jurisdiction over all the following EXCEPT: Medicare Supplement Plans PPOS Workers' Compensation HMOS

HMOS

Which of the following is not correct about long-term care insurance? Can be purchased in a group plan. Does not provide coverage for an acute care unit of a hospital. Provides coverage for at least 12 months in a row. Has built-in upward adjustments for the possible future changes in Medicare long-term care coverage.

Has built-in upward adjustments for the possible future changes in Medicare long-term care coverage.

Who submits the claim for Medicare Part A? Claimant Physician Hospital Pharmacy

Hospital

Arnold and Bertha are married and work for different firms. Arnold has group health insurance through his company that also insures Bertha. Likewise Bertha has group health insurance also covering Arnold. Select the correct statement below about how benefits are affected by the coordination of benefits provision in both plans. If Bertha files a medical claim Arnold's company is considered secondary. If Arnold files a medical claim Bertha's company is considered primary. First the secondary insurer will decide what it won't pay for which will dictate what the primary insurer will pay. Since both Arnold and Bertha are covered by a group plan neither insurer will pay if the other insurer is primary.

If Bertha files a medical claim Arnold's company is considered secondary.

An individual might purchase LTC protection out of concern for all of the following, EXCEPT: Inevitable cost of health care Increasing probability of needed services Existing medical coverage Ineligibility for Medigap coverage

Ineligibility for Medigap coverage

If an insurer is not able to meet financial obligations when due, the insurer would be considered: Insolvent Impaired Non-admitted Unauthorized

Insolvent

Which of the following is true concerning an implied warranty? It is understood by all parties. It doesn't have to be in writing. It has no application to insurance. All warranties in insurance are implied warranties.

It doesn't have to be in writing.

Which of the following is correct about a Third Party Administrator? It is the department of an insurer that handles the payment of claims. It is a person who works for a life agent and helps in the solicitation of health insurance . It is an independent company that provides administrative services for self- funded plans. All of the above are incorrect.

It is an independent company that provides administrative services for self- funded plans.

What does the incontestable clause of a life insurance policy do? It insures the insurance company will not be liable for the acts of fraud by its agents. It keeps the cash value from losing value if the premium is not paid. It keeps the insurer from canceling the policy if, after 2 years, there is a discovery of error, concealment, or misstatement by the policy owner. All the above.

It keeps the insurer from canceling the policy if, after 2 years, there is a discovery of error, concealment, or misstatement by the policy owner.

A disability policy is issued and premiums are paid on an annual basis on the 1st of January. At the first anniversary, the insured decides they do not want to renew the policy and they do not pay the premium. On the 8th day after the premium due date, the insured submits a claim for medical expenses. How will the company respond to the claim? It will not be paid because the policy expired on the anniversary date. It will be paid because the loss was not reported within the grace period. It will be paid because the insured did not request a formal cancellation. It will be paid because the loss occurred within the grace period.

It will be paid because the loss occurred within the grace period.

If a premium is overcharged in the early years, and then remains constant throughout the premium paying period, though the risk of dying increases, it is called a premium. Net Natural Level Gross

Level

From lowest to highest, which is the CORRECT order of initial premiums for life insurance policies? Single premium, modified premium, ordinary life. Ordinary life, modified life, single premium. Modified premium, ordinary life, single premium. Modified premium, single premium, ordinary life.

Modified premium, ordinary life, single premium.

All of the following would be considered an accident as it relates to health insurance, EXCEPT: Sarah gets hurt when she is hit by another car. The driver of the other car was running a red light. Molly intentionally injures herself by falling off her bike. Harry trips on a rock while hiking causing him to sprain his ankle . All of the above would be considered an "accident" for health insurance purposes.

Molly intentionally injures herself by falling off her bike.

Which of the following is not legal when determining premium rates for life or disability insurance? Age Nationality Gender All the above may not be used

Nationality

Which of the following (recall) provisions of a disability contract is likely to change the contract least and cost the most? Continuous indemnity contract Non-cancelable contract Expense arrangement contract Guaranteed renewable contract

Non-cancelable contract

A policy specifically excludes insurance protection for those hazards occurring while working on the job. The category this policy falls under is: Occupational policies Non-occupational policies Cancelable policies Full coverage policies which are illegal in California

Non-occupational policies

The guaranteed insurability rider provides that the policyholder can purchase more insurance: On the lives of his dependents at certain specified ages. On his own life at specified ages provided the policy owner is insurable. On his own life at certain specified ages without proof of insurability. Any time during the policy owner's life, on his own life, without proof of insurability.

On his own life at certain specified ages without proof of insurability.

When may a representation be withdrawn? At any time as long as both parties agree Only after the policy is in effect It can never be withdrawn Only before the insurance is in effect

Only before the insurance is in effect

An employer allows each employee to choose insurance in addition to the basic insurance plan. Who pays the premium for the voluntary life insurance? All employees, whether or not they choose to participate Only the employees who choose to purchase it Only the employer Both the participating employees and the employer

Only the employees who choose to purchase it

What is a typical disability provision for group disability policies? Any-Occupation Own-Occupation Any-Occupation for a short period, then Own-Occupation Own-Occupation for a short period, then Any-Occupation

Own-Occupation for a short period, then Any-Occupation

If a worker is now earning only $25K a year working part-time ($35K a year less than he earned a couple of years ago) and is earning less because of a disability, this disability would normally be called: Total and temporary Presumptive Partial Permanent

Partial

Which of the following is true about a service provider as it relates to health insurance? Service type doctors usually provide better service compared to other health care providers. Payments are made directly to the provider. Payments are made directly to the insureds. Blue Cross and Blue Shield are legally prevented from having service providers in their network.

Payments are made directly to the provider.

Which type of exposure can be best defined as a condition or situation where the exposure to financial loss is presented to an individual or family from causes such as injury, disability, death, sickness, or unemployment? Personnel loss exposure Personal property loss exposure Liability loss exposure Personal loss exposure

Personal loss exposure

Regarding the difference between mortality tables for annuities and life insurance, choose the correct statement from the following: Annuitants die sooner. Annuitants and policy insureds live the same length of time. Policy insureds die sooner. All of these statements are incorrect.

Policy insureds die sooner.

Health maintenance organizations (HMOS) are required to provide for all of the following services EXCEPT: Physicians services Emergency services Prescription drugs Preventive services

Prescription drugs

Negotiating an insurance policy means which of the following? Promising a commission rebate to an existing insured if she renews Issuing an insurance binder Accepting a premium payment Cold calling prospective insureds and asking if they would like a quote

Promising a commission rebate to an existing insured if she renews

A possibility of financial loss resulting from the ownership of property is known as: Insurable interest Indemnity Valuation Property loss exposure

Property loss exposure

The guaranteed insurability option provides the ability to: Double the amount of the death benefit in the event of accidental death. Access a portion of the death benefit in the event of serious illness. Purchase additional insurance regardless of insurability. Waive premium payments in the event of disability.

Purchase additional insurance regardless of insurability.

One important method of dealing with risk is to avoid it. All of the following describe risk avoidance EXCEPT the insured: Never leaving his house after dark. Never flying in an airplane. Sensing the possibility of a lawsuit and therefore giving his pet Bengal tiger to a local zoo. Recognizing that his driving skills are deteriorating and therefore increasing the liability limit on his auto policy.

Recognizing that his driving skills are deteriorating and therefore increasing the liability limit on his auto policy.

A sailor in the merchant marines has contacted you and expressed interest in life insurance. What important planning step will you take to determine this sailor's needs in order to provide an appropriate policy? Refer to mortality tables. Assess the current buy/sell needs. Review key employee insurance requirements. Review the person's overall financial goals.

Review the person's overall financial goals.

Variable life insurance policies and variable annuities are primarily governed by which agency? FBI NAIC SEC ЕРО

SEC

An agent who sells long-term care insurance owes his policyholders and prospective clients all of the following EXCEPT: Sincerity Duty of honesty Duty of good faith Fair dealing

Sincerity

Which of the following is a characteristic of nonqualified annuities? Mandatory participation. Tax-deductible contributions. Limits on contributions. Tax-deferred earnings.

Tax-deferred earnings.

If you were signed up with a Preferred Provider Organization (PPO) which of the following statements could you say about this program. The doctors are paid on a capitation basis rather than fee-for-service. If you go to a doctor that is not a part of the PPO network, the PPO will pay nothing. The PPO has agreed to pay for services with a prearranged price depending on the type of service provided. You are able to select any doctor or health care facility you want with no reduction in what the PPO will pay these providers.

The PPO has agreed to pay for services with a prearranged price depending on the type of service provided

Which contract provides for the systematic liquidation of a fund? mortgage redemption insurance life insurance annuity disability insurance

annuity

Who must sign a statement acknowledging that a life insurance policy is to be replaced by an applicant? The applicant and the agent The applicant and the beneficiary The applicant The agent

The applicant and the agent

The Common Disaster provision is designed to protect the interests of which of the following? The final or tertiary beneficiary The primary beneficiary The insurer and insured The contingent or secondary beneficiary

The contingent or secondary beneficiary

How does the cost recovery rule apply when a life insurance policy is surrendered for its cash value? The insurer retains the cost basis. The entire cash value surrendered is taxable. The cost basis of the policy is exempt from taxation. The insured receives only the cost basis.

The cost basis of the policy is exempt from taxation.

Life insurance policies are: There are no standard life insurance policies. issued in standard forms by the NAIC. issued in standard forms by the ISO. issued in standard forms by states.

There are no standard life insurance policies.

From the choices listed below, choose the one that best describes "insolvency" as it relates to insurance. The inability of an insurer to meet financial obligations to policy owners as a result of a deficient amount of paid-in-capital. The denial of a claim payment by an insurer because of fraudulent intent by the insured. The inability of an insurance firm to write business in a state other than that firm's domicile state because of restrictions placed upon it by the Commissioner. The inability of the CA Insurance Guaranty Association to provide financial backing to a specific insurer as the result of that insurer not paying contributions to the Association.

The inability of an insurer to meet financial obligations to policy owners as a result of a deficient amount of paid-in-capital.

From the choices below, select the answer that best reflects the concept of indemnification. A promise is given by only one party, the insurer. Either of the parties to the contract can assume the other is not concealing facts. The insured can not get back any more than the loss they have experienced. If it is determined that a statement in the contract is ambiguous, courts will favor the policyowner.

The insured can not get back any more than the loss they have experienced.

Gina, the beneficiary on a life insurance policy, dies before the insured dies. In California, when the insured eventually passes away, the death benefit goes to which of the following if the policy is still in effect? The State of California Gina's next of kin The insured's next of kin The insured's estate

The insured's estate

In a group life insurance policy who are the parties to the master contract? The employees and their dependents. The employer and the employees. The insurer and the employees. The insurer and the employer.

The insurer and the employer.

What is the first step in submitting Medicare claims? Medicare submits expenses to the Medicare supplement provider. The medical provider submits expenses to the patient. The medical provider submits expenses to Medicare. The patient submits expenses to Medicare.

The medical provider submits expenses to Medicare.

Which of the following is not correct regarding the disability benefits provided by Social Security? The payments received from this program are meant to entirely replace a worker's lost earnings. Total and permanent disability must continue for benefits to continue. To be eligible for benefits the worker must prove total and permanent disability for a minimum of 5 months just prior to receiving benefits. The earnings of a worker up to the time of disability determine the amount of benefits.

The payments received from this program are meant to entirely replace a worker's lost earnings.

While an insurer is paying the premium for a life insurance policy under the waiver of premium rider: The cash value does not increase. The dividend payments cease. The policy remains in full force in every respect. The insurer is named as the primary beneficiary.

The policy remains in full force in every respect

According to the California Insurance Code governing advertising standards what must appear on all printed insurance proposals? Notification of a free look. A certificate of authority disclosure. The insurer's rates. The word "insurance."

The word "insurance."

The purchase of an insurance policy by a consumer is the process of risk: Reduction Retention Avoidance Transfer

Transfer

Which of the following statements concerning the usual coordination of benefits provision is CORRECT? Medicare coverage is always primary to group medical coverage. Coverage under COBRA is primary to coverage as an active employee. Coverage under any plan with the provision is primary to coverage under any plan without the provision. When two plans both have the provision, coverage as an employee is primary to coverage as a dependent.

When two plans both have the provision, coverage as an employee is primary to coverage as a dependent.

All of the following information is gathered during the personal financial planning process EXCEPT a listing of the individual's assets and liabilities. information regarding a person's income and expenditures. a listing of a person's civic and professional organization memberships. information regarding an individual's investments.

a listing of a person's civic and professional organization memberships.

Subject to the restrictions of the California Insurance Code, any person capable of making a contract may be considered an insurer. an agent. a solicitor. a broker,

an insurer

The life insurance grace period allows the insured to: convert a term policy to cash value policy without evidence of insurability. reinstate the policy after it has lapsed for non-payment of premium. pay the premium after the due date without loss of coverage. return the policy for a full refund of premium.

pay the premium after the due date without loss of coverage

All of the following are features of a Preferred Provider Organization (PPO) EXCEPT dependents do not need referrals to see a specialist. providers are paid on a fee-for-service basis. employees have a choice of practitioners. primary care physicians act as gatekeepers.

primary care physicians act as gatekeepers

All of the following are included in mortality tables, EXCEPT: probability of living at end of year deaths at end of year age at beginning of year probability of death at the end of year

probability of living at end of year

Under Cal-COBRA all of the following would be considered qualifying events, EXCEPT: loss of dependent status retirement termination, regardless of conduct divorce or legal separation from covered employee

termination, regardless of conduct

All of the following statements about mortality tables are true EXCEPT actuaries use the tables to predict the number of deaths among a given number of people at a given age. the theory of probability is applied to numbers in the tables. the tables track a group of people from the year they were born until they all die. the numbers in the tables are based on past experience.

the tables track a group of people from the year they were born until they all die.