Examfx homemade

Which of the following statements is INCORRECT?

A licensee is barred from charging a fee in addition to a commission to a person for the sale, solicitation or negotiation of a contract of insurance for commercial business.

Which of the following does the Insuring Clause NOT specify?

A list of available doctors

An insured carries health insurance with two different providers and is covered on an expense incurred basis. He has an appendectomy and files the claims to both insurers. Neither company is notified in advance that the insurer has other coverage. What should each insurer pay?

A proportionate amount

How often must the Commissioner examine rating organizations?

Every 5 years

If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?

5 days

For the purpose of examination by the department, insurers must keep a record of all financial files for at least

5 years

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

A hospital indemnity policy will pay

A benefit for each day the insured is in a hospital,

Health insurance policies providing maternity benefits must also provide coverage for postpartum inpatient hospital care. How much coverage must be provided for

At least 96 hours

A man is still employed at age 65 and is now eligible for Medicare. He wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him?

Both group health and Medicare

Which of the following options best depicts how the eligibility of members for group health insurance is determined?

By conditions of employment

What process will the insurance company use to monitor the insured's hospital stay to make sure that everything is proceeding according to schedule?

Concurrent review

A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as

Critical Illness

In a group policy, the contract is between

Employer and insurance company

Which of the following are the main factors taken into account when calculating residual disability benefits?

Present earnings and earnings prior to disability

Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?

Principal sum

Which type of a hospital policy pays a fixed amount each day that the insured is In a hospital?

indemnity

Which of the following is NOT a metal level of coverage offered under the Patient Protection and Affordable Care Act?

iron

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

What is the maximum period that an insurer would pay benefits in accordance with an Additional Monthly Benefit rider?

1 year

In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective?

100%

All of the following are true of the Key Person disability income policy EXCEPT

Benefits are considered taxable income to the business

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

Insurer to the insured

Which of the following is NOT true regarding a flexible spending account?

It does not have limits on contributions

If a business owner becomes totally disabled, a Business Overhead Expense policy will pay all of the following EXCEPT

Loss of the owner's income.

All of the following statements describe a MEWA EXCEPT

MEWAs are groups of at least 3 employers.

All of the following statements concerning Medicaid are correct EXCEPT

Medicaid is a state funded program that provides health care to persons over age 65, only.

Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?

None General disability policies do not cover losses caused by war, military service, intentionally self-inflicted injuries, overseas residence, or injuries suffered while committing or attempting to commit a felony.

Which of the following is true regarding benefits paid to disabled employees?

They may be subject to taxation if the premium was paid by the employer.

What is the purpose of COBRA?

To provide continuation of coverage for terminated employees

Under what condition are group disability income benefits received by an employee NOT taxable as income?

When the benefits received are equal or less than the employee's percentage of the contribution

Which of the following information regarding an insured is NOT included in an Investigative Consumer Report, which is requested by an underwriter?

medical history

Which type of dental care would cover operative treatment of the mouth?

oral surgery

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

18 months

When a producer died, his surviving spouse needed to maintain the insurance agency until it could be sold. Without passing an examination, she could qualify for a temporary license for a maximum period of

180 days

A producer has successfully completed 52 hours of continuing education (CE). How many hours can the producer apply to her current reporting perlod, and how many

24 hours will be applled to the current reporting period, and 24 can be applied to the period immediately following.

Licensees must make a report of any action taken against them in another jurisdiction or by another governmental agency In Pennsylvania within how many days of the final disposition of the matter?

30

The amount of disability benefits that an insured receives often depends upon the insured's

Income at the time of the application.

In order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to participate to do all of the following EXCEPT

Increase benefits for a period of one year

On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are

Not taxable since the IRS treats them as a return of a portion of the premium paid

When is the annual open enrollment for state insurance exchanges?

November 1 through January 31

An insured's health claim internal appeal was denied. The insurer must do all of the following EXCEPT

Offer a payment plan

Which of the following is NOT correct regarding false statements by a person engaged in the business of insurance?

Only written statements can be considered fraud

When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called

Overinsurance

What is the period of coverage for events such as death or divorce under COBRA?

36 months

How much inpatient care must be provided, following a vaginal delivery, by health insurance policies that provide maternity benefits?

48 hours

Which of the following is an example of a producer's fiduclary responsibilities?

A producer promptly forwarding premiums to the insurance company

How long is an open enroliment period for Medicare supplement policles?

6 months

Which of the following is an eligibility requirement for all Social Security Disability Income benefits?

Have attained fully insured status

Underwriting Is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT

Premiums always stay the same

All of the following are unfair claims settlement practices EXCEPT

Suggesting negotiations in settling the claim

Which of the following is another name for a primary care physician in an HMO?

gatekeeper

What is the contract provision that allows the insurer to nonrenew health coverage if certaln events occur?

Conditionally renewable

In a long-term care policy, pre-existing condition limitations

Must appear as a separate paragraph and be clearly labeled.

Under the Fair Credit Reporting Act, individuals rejected for insurance due to information contained in a consumer report

Must be informed of the source of the report.

When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, it is called

Preferred Provider Organization (PPO)

A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy?

Pregnancy will be covered immediately

What type of information is NOT included in a certificate of insurance?

The cost the company is paying for monthly premiums

Which of the following statements concerning group health insurance is CORRECT?

The employer is the policyholder.

Which statement accurately describes group disability income insurance?

The extent of benefits is determined by the insured's income.

Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to

The insured Payments for loss of life benefits are to be made to the designated beneficiary. If no beneficiary has been named, payment proceeds are to be paid to the deceased insured's estate. Claims other than death benefits are to be paid to the insured or the insured's estate, unless otherwise assigned by the insured.

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a réason for the insurance cómpany to cancel the policy?

The insured is in an accident end incurs a large claim,

An applicant is considered to be high-risk, but not so much that the insurer wants to deny coverage. Which of the following is NOT true?

The insurer will issue a conditional coverage.

Who is the beneficiary in a credit disability income policy?

The lending institution

An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?

The old policy should stay in force until the new policy is issued.

Regarding Medicare SELECT policies, what are restricted network provisions?

They condition the payment of benefits

When transacting business in this state an insurer formed under the laws of another country is known as a/an

alien insurer

A producer sold an Insurance policy. Subsequently, his license was suspended. In this case, how much of the commission will the producer receive?

all

What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided?

application

a group prescription drug plan, the insured typically pays what amount of the drug cost?

co-payment

Which of the following authorities is authorized to issue a temporary insurance producer's license?

commissioner

Which of the following is NOT an essential element of an insurance contract?

counteroffer

Regarding Medicare SELECT policies, what are restricted network provisions?

d) They condition the payment of benefits.

Under a typical health insurance policy, claims that result from injuries while the insured was intoxicated or under the influence of drugs are generally

excluded

If an insured worker has earned 40 quarters of coverage, the worker's status under Social Security disability is

fully insured

How are HMO territories typically divided?

geographic areas

A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?

immediately

Which of the following factors about the insured determines the amount of disability benefit that the insured will receive?

income

In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received?

no tax

Which of the following occupations would have the lowest disability insurance premiums?

personal trainer

Which of the following is an example of a producer's fiduciary responsibllitles?

producer promptly forwarding premiums to the insurance company

All of the following long-term care coverages would allow an insured to receive care at home EXCEPT

skilled care

Which of the following is true regarding the childhood immunization benefit in medical plans issued in this state?

thats a mandatory benefit

All of the following benefits are available under Social Security EXCEPT

welfare benefits

In the event of a divorce, which of the following would allow a divorcee to continue receiving group health coverage under an insured spouse's plan for an additional 36 months?

COBRA

An insurance company is domiciled in Montana and transacts insurance in Wyoming. Which term best describes the insurer's classification in Wyoming?

Foreign A foreign insurer is domiciled in one state and transacts insurance in another. A domestic insurer transacts insurance in the domicile state (in this case, Montana). An alien insurer is domiciled in one country and transacts insurance in another.

All of the following are correct about the required provisions of a health insurance policy EXCEPT

A reinstated policy provides immediate coverage for an illness.

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

A statement that is sufficiently clear to identify the insured and the nature of the claim.

A licensed producer moving to Pennsylvania may become licensed as a resident if the producer submits a completed application within how many days of establishing residence in Pennsylvania with proof of licensing from their prior home state?

90 days

Which of the following Medicare supplement plans would be avallable to a reasonably healthy 91-year-old female?

A-N

An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?

Adjust the claim benefit to reflect the insured's true age

A 63-year-old man is planning to be employed until age 68. When will he be eligible for Medicare?

Age 65, regardless of his employment status

A producer sold an insurance policy. Subsequently, his license was suspended. In this case, how much of the commission will the producer receive?

All

What term best describes the act of wlthholding materlal information that would be cruclal to an underwriting decision?

Concealment

Which of the following Includes information regarding a person's credit, character, reputation, and habits?

Consumer report Consumer reports include written and/or oral information regarding a consumer's credit, character, reputation, and habits collected by a reporting agency from employment records, credit reports, and other public sources.

Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen?

Pro rata benefit reduction