CH 16-20 Quiz Q's

Medicare part C is: 1. orginal part A and B 2, avaible to those who are enrolled in Medicare Part a and B 3. government inusrance

2, avaible to those who are enrolled in Medicare Part a and B

The insuring clause 1. states amount of premium to be collected 2. States the scope and limits of the coverage 3. specifies additional time given to pay past due premiums

2. States the scope and limits of the coverage

Provding incorrect, misleading, incomplete or matirially untue information in an application for an insurance license will result in 1. loss of business income 2. a license suspension or revocation 3 class b misdemeanor 4. business interruption

2. a license suspension or revocation

T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take?

increase her policy's coverage amount

T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect?

less than 5,000 regardless of the cause

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

monthly

notice of claims provision requires a policyowner to

notify an insurer of a claim within a specified time

What is the purpose of the time of payment of claims provision?

prevents delayed claim payments made by the insurer

With Optionally Renewable Health policies, the insurer may

renew the policy annually and determine whether or not to renew it

When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following?

residual disability

An individual Disability Income insurance applicant may be required to submit all of the following information EXCEPT

spouse's occupation

In a life settlement, the agreement may be recinded if which of the following occurs? 1. the insured dies within 15 days after the transaction is completed 1. the insured dies within 90 days after the transaction is completed 1. the insured dies within 45 days after the transaction is completed 1. the insured dies within 5 days after the transaction is completed

the insured dies within 15 days after the transaction is completed

The incontestability period in a group life policy is 1. two years 2. four years 3. one year 4. three years

two years

An insurer that refuses to issue any contract of insurance or cancel or decline to renew such contract becasue of the sex, maritial status or sexual orientation of an individual has engaged in:

unfair discrimination

Any individual producer, adjuster or consultant who violates any provision of the insurance code or final order of the director shall pay to the general fund of the state treasury a civil penalty in an amount of not more than: 1. 500 per offense 2. 10,000 per offense 3. 1,000 per offense 4. 5,000 per offense

1,000

A producer is a liscened individual who represents himslef or herself and may act be appointed by 1. an insurer 2. an insurance advisor 3. a consultant 4. a specalist

1. an insurer

Which of the following is the most important facto when deciding how much disability income coverage an applicant should purchase? 1. applicants monthly income 2. applicants health 3. applicants previous disabilities 4. applicants occupation

1. applicants monthly income

The guarantee of insurability option provides a long-term care policyowner the ability to 1. buy additional coverage at a later date 2. cancel the policy at anytime 3. pay the same premium for life 4. add the insured's spouse at a later date

1. buy additional coverage at a later date

M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company's underwriting department request's M's medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes, EXCEPT: 1. changing the policies provisions 2. attach the rider excluding specified coverages 3. deny coverage 4. approve with a higher premium

1. changing the policies provisions

P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim? 1. claim will be denied 2. claim will be partially paid 3. claim will be denied and policy terminated

1. claim will be denied

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? 1. file written proof or loss 2. nothing 3. contact the insurer again requesting forms 4. file a lawsuit

1. file written proof or loss

Each of the following coverages may be provided by a long-term care insurance policy, except: 1. inpatient care 2. intermediate care 3. adult day care 4, respite care

1. inpatient care

What must the policy owner provide to the insurer for validation that a loss has occured 1. proof of loss 2. proof of claim 3. proof of coverage 4. proof of payment

1. proof of loss

The purpose of the Oregon Life and Health Guaranty Association is to 1. protect policyholders in the event of an insurer incolvency 2. provide insuranc eproducts to all who need them 3. regulate insurer that sell annuities only 4. monitor the financial health of life and health insurers

1. protect policyholders in the event of an insurer incolvency

Insurance licensed individuals may chare comminssions on the same piece of business as long as 1. they are licensed in the same line of insurance 2. they reside in the same state 3. they are both salaried employees 4. they work for the same insurer

1. they are licensed in the same line of insurance

Why is it important that the director of insurance approve policy forms? 1. to make sure that the contract contains no unfair provisions 2. to preotect the consumer against redlining 3. to protect the financial stability of all insurers 4. to make sure that rates are adequate and not unfairly discreminatory

1. to make sure that the contract contains no unfair provisions

In a life settlement, after the provider has recieved the insurer or group adminstrator's acknowledgment that ownership of the policy or interest in the certificate has been transferred, when must proceeds be sent to the policyowner? 1. within three business days 2. within ten business days 3. within five business days 4. by the end of the first month after transfer

1. within three business days

N is covered under an individual Disability policy with a 30-day Elimination period and a monthly benefit of $500. N is totally disabled for 3 1/2 months. N's total benefit received on this claim is:

1250

An insurer must provide insured with claim forms within __ days after recieving notice of loss

15

A temp liscense may be issued to a person designated by the director without requiring a state exam for a period up to 1. 180 days 2. 30 days 3. 90 days 4. 365 days

180 days

What is the minimum number of all an insured must be unable to perform to qualify for Long term Care benefits?

2

When selling a long term insurance policy, an insurer must offer to a preosepcting insured which of the following? 1. coverage for hospital confinement 2. an inflation benefit 3. a life insurance death benefit 4. medicare select coverage

2. an inflation benefit

Which of the following best describes what the legal actions provision of an accident and health policy requires? 1. an insured must settle a claim within 60 days after proof of loss is submitted 2. an insured must wait at least 60 days after proof of loss has been submitted before a lawduit can be filed 3. an insured must settle a claim within 30 days after proff of loss is submitted

2. an insured must wait at least 60 days after proof of loss has been submitted before a lawduit can be filed

Which of the following is true with regards to transacting insurance business in Oregon? 1. in order to secure an adjuster liscense, a pre-licesing education course must be completed 2. brokering business is not primitted in oregon 3. a resident of this state may hole a nonresident oregon license 4. any change of address must be reported to the director within 15 days

2. brokering business is not primitted in oregon

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income? 1. travel 2. disability income 3. major medical 4. indemnitiy

2. disability income

An underwrited determines that an applicants risk should be recategorized due to health issue. this policy may be issued with a 1. extended contestable period 2. exclusion for the medical condition 3. delayed effective date 4. concealment clause

2. exclusion for the medical condition

Which of these factors do not play a role in the underwriting of a health insurance policy? 1. avocations 2. maritial status 3. credit status 4. occupation

2. maritial status

All of the following requirements must be satisfied before a person may be issued a resident insurance liscence, except 1. must pass a state exam 2. must complete 10 hours of insurance education 3. must be a oregon resident 4. must be comptent and trustworthy

2. must complete 10 hours of insurance education

J has a Disability Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this? 1. limited coverage 2. nonoccupational coverage 3. occupational coverage 4. workers comp coverage

2. nonoccupational coverage

Which of the following statements about a guaranteed renewable health insurance policy is correct? 1. policy can be can cancelled at any time by the company 2. premiums normally increase at time of renewal 3. premiums normally decrease at time of renewal

2. premiums normally increase at time of renewal

The legal action provision of an insurance contract is designed to do all of the following, EXCEPT: 1. protect the insured from having claim research delayed 2. protect the producer 3. give the insured guidelines for pursing legal action against and insurer 4. provide the insurer adequiate time to research a claim

2. protect the producer

All of these are considered sources of underwriting information about an applicant EXCEPT 1. medical informaiton bureau 2. rating services 3. inspection report 4. credit report

2. rating services

K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequeuntly accepts. which policy provision specifies that coverage may be restored in this situation? 1. free-look 2. reinstatement 3. grace period 4. consideration

2. reinstatement

Which mode of payment is NOT used by health insurance policies? 1. annual premium 2. single premium 3. semi-annual premium 4. monthly premium

2. single premium

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called 1. grace period 2. time limit on certain defenses 3. insuring 4. free-looking

2. time limit on certain defenses

Disability policies do NOT normally pay for disabilities arising from which of the following? 1. accidents 2. war 3. sickness 4. negligence

2. war

The canidate for a producer license must complete a pre-licensining course in the amount of:

20 hours for life and 20 hours for health

A licensed producer must complete how many hours of continuing education every two years to maintain the license?

24 hours

All premium funds recieved by a resident insurance producer shall be accounted for an maintained in a trust account seperate from all other business and personal funds. a resident insurance producer may not commingle or otherwise combine premiums with any other personal or non insurance business moneys. records of trust account transactions must be kept by the producer for 1. 4 years 2. 1 year 3. 3 years 4. 2 years

3. 3 years

the individual most likely to buy a medicare supplement policy would be a 1. 62 year old male covered by medicaid 2. uninsured 60 year old male 3. 68 year old male covered by medicare 4. unemployed 64 year old female

3. 68 year old male covered by medicare

Violation of any provision of the insurance code for which a greater penalty is not otherwise provided by the insurance code or by other applicable laws of this state, in additoion to any applicable prescribed denial, suspension or revocation of any certificate or license or any civil forfeiture is a 1. Class a felony 2. Reciprocal hazard 3. Class a misdemeanot 4. Class c felony

3. Class a misdemeanor

WHenever the director shall have reason to beleive that any person engaged in the business of insurance is engaging in this state in an unfair or illegal method of competition, he or she will: 1. a refusal to renew 2. cancellation of appointment 3. a cease and deisst order 4. a liscnece termination order

3. a cease and deisst order

The life and health guaranty fund is funded by which of the following? 1. governors council 2. state legislature 3. all isureres authorized in oregon 4. tax funds

3. all isureres authorized in oregon

If an insurer terminates a producer who has acted on its behalf in the sale of insurance products, the insurer will 1. revoke the producer's license 2. suspend the producer's liscene 3. cancel the producer appointment 4. cancel the producer commission

3. cancel the producer appointment

K applies for a life insurance policy on herself and submits the initial premium with the application. She is given a receipt by the agent stating that coverage begins immediately if the application is approved. What kind of receipt was used? 1. inital premium 2. binding 3. conditional 4. contingent

3. conditional

Which of the following health policy provisions states that the producer does not have the authority to change the policy or waive any of its provisions? 1. time limit on certain defenses 2. change of beneficiary 3. entire contract 4. reinstatement

3. entire contract

Which of the following is considered to be unfair claim practice? 1. a claimant taking an insurer to artibration 2. settling a claim for the face amount of coverage 3. failing to settle claims promptly after relavant information has been collected by the insurer 4. an insurer paying a legitimate claim within a resonable time

3. failing to settle claims promptly after relavant information has been collected by the insurer

Which of the following actions constitutes an unfair sales practice as stipulated by Oregon Insurance regulations 1. replacement 2. legal inducement 3. false advertising 4. sharing commissions

3. false advertising

Which of the following will a long term care plan typically provide benefits for? 1. death 2. disability income 3. home health care 4. unemployment

3. home health care

Which type of plan normally includes hospice benefits? 1. workers comp 2. group life plans 3. managed care plans 4. short-term disability plans

3. managed care plans

If a person covered by a group life insurance policy dies during the conversion period, how will the insurer respond? 1. hold payment for 31 days 2. rescind the contract 3. pay the claim

3. pay the claim

What is considered to be a characteristic of a conditionally renewable health insurance policy? 1. policy may be renewed at the discreation of the insured 2. policy may be amended by insurer at any time 3. premiums may increase at time of renewal 4. premiums may increase at any time

3. premiums may increase at time of renewal

Which of the following is a legal activity? 1. rebating 2. twisting 3. replacement 4. defamation

3. replacement

A prepaid application for individual disability income insurance was recently submitted to an insurer. When the insurer recieved the MIB report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. which of the following actions would the insurance company not take? 1. send initial premium back to applicant 2. send notice to the applicant that the coverage was declined 3. send a notice to the MIB that the applicant was declined 4. send a notice to the agent that the applicant was declined

3. send a notice to the MIB that the applicant was declined

An insurer may not, on the basis of the status of an insured or prospective insured, deny, cancel, or refuse to issue or renew an insurance policy fot which of the following reasons? 1. nonpayment of a premium 2. material misrepresntaion on an application 3. the insured is a victom of domestic violence or sexial violence

3. the insured is a victom of domestic violence or sexial violence

The free-look period included in a medicare supplement or long-term care plan is:

30 days

a producer must report to the director any admin action against him in another jurisdiction or governmental agency withing how many days of a final disposition of the matter?

30 days

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?

31 days

T is recieving 3,000/month from a disability income policy in which T's employer had paid the premiums. how are the 3,000 benefits payments taxable? 1. benfits are partially taxable to T 2. benefits are tax-free to T 3. benefits are taxable to T's employer 4. Benefits are taxable to T

4. Benefits are taxable to T

A reimbursement policy pays what amount of covered long term care expenses? 1. all expenses regardless of the policy limits 2. a daily dollar amount regardless of the actual incurred expenses 3. the usual, customary, and reasonable expenses regardless of the policy limits 4. actual covered expenses up to the daily maximum

4. actual covered expenses up to the daily maximum

Medicare supplement policies are primarily purcahsed by individuals age 65 and older. which of the following must be provided to a purchaser by the producer when a medicare supplement policy is being solcited? 1. fair credit reporting form 2. policy summation 3. notice regarding replacement 4. buyers guide

4. buyers guide

health insurance benefits not covered due to an act of war are: 1. given a longer probationary period 2. charged a higher premium 3. assigned to a reinsurer 4. excluded by the insurer in the contract provsions

4. excluded by the insurer in the contract provsions

which of the following is not included in the policy face? 1. name of insured 2. name of insurer 3. free-look provision 4. exclusions

4. exclusions

Medicare Part B does NOT cover 1. medical equipment rental 2. occupational therapy 3. physician and surgeon services 4. inpatient hospital services

4. inpatient hospital services

Which of these statements concerning an individual disability income policy is true? 1. premiums are normally tax-deducitble 2. age of insured determines the amount of the benefits 3. benefits are normally taxed 4. normally includes an elimination period

4. normally includes an elimination period

Which long term care insurance statement is true? 1. inflation protection is unsually not covered 2. benefits are usually payable for alchol rehabilitation 3. can only be offered to individuals under the age of 70 4. pre-existing condition must be covered after the coverage has been in force for 6 months.

4. pre-existing condition must be covered after the coverage has been in force for 6 months.

Each of the following is a power and duty of the director of insurance, except: 1. suspends insurance liscense 2. approves life insurance premium rates 3. examines an insurer for solvency 4. presecutes agents who violate insurance laws

4. presecutes agents who violate insurance laws

Which of the following is a generic document which contains, and is limited to, language that describes the items a prospective purchaser should review when purchasing life insurance 1. policy index cost 2. outline of coverage 3. policy suppary 4. shoppers guide

4. shoppers guide

Qualified Long-Term Care policies may take into consideration an applicant's pre-existing conditions for a maximum of not more than __ month(s) prior to the effective date of coverage.

6 months

B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?

Disability income

M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?

Earned, but unpaid benefits

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

Entire contract

WHich of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?

Entire contract policy provision

The sections of an insurance contract which limit coverage are called

Exclusions

A life insurerer must keep all advertisments used in the solicitation of its products for a period of 1. two years 2. five years 3. three years 4. four years

Four years

Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class?

Guaranteed renewable

Which health policy clasue specfied the amount of benefits to be paid?

Insuring

The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the:

Insuring clause

Which of the following indicies is most useful for policyowners whose main concern is death protection and are not as concerned with the build-up of cash value?

Life insurance net payment cost index

Z owns a Disability Income policy with a 30-day Elimination period. Z contracts pneumonia that leaves him unable to work from January 1 until January 15. Z then becomes disabled from an accident on February 1 and the disability lasts until July 1 the same year. Z will become eligible to receive benefits starting on

March 1st

If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses? 1. medicare supplement 2. long-term care 3. indemnity 4. medicaid

Medicare Supplement

When an insured has the same disability within a specified time period and the insurance company provides the same benefits without a new waiting period, the second disability is covered under which of the following benefits?

Recurrent Disability

What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?

Submit the claim in any form

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is

Time limit on certain defenses

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?

Waiver of premium rider

in health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments

after an insured has become totally disable as defined in the policy

A disability income policyowner recently submitted a claim for a chronic neck problem that has now resultied in total disability. the orginal neck injury was never disclosed to the insurer at the time of application. how will the insurer handle this claim?

claim will be paid and coverage will remain in force

K completes an application for a disability policy but does not pay the initial premium. The company approves the policy standard and the agent delivers the policy. K then pays her initial premium 3 days later. At what point does K's policy take effect?

date the initial premium is collected

Non-occupational disability coverage is designed for

employees who suffer non-work related disabilities, cince work-related disabilities are covered in workers comp

Whith accidental death and dismemberment policies, what is the purpose of the grace period?

gives thw policyowner additional time to pay overdue premiums