Health 2

All of the following are true regarding rebates EXCEPT a) Rebates are allowed if it's in the best interest of the client. b) Rebates are only allowed if specifically stated in the policy. c) Rebating can be anything of economic value, given as an inducement to buy. d) Dividends are not considered to be rebates.

a

In long-term care insurance, what type of care is provided with intermediate care? a) Occasional nursing or rehabilitative care b) Nonmedical daily care c) Daily care, but not nursing care d) Intensive care

a

Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer? a) Disability Income b) Major Medical c) Dental Expense d) Basic Medical Expense

a

When delivering a policy, which of the following is an agent's responsibility? a) Collect payment at time of delivery b) Issue the policy if the applicant is present c) Approve or decline the risk d) Collect medical statement from physician

a

Which of the following types of LTC is NOT provided in an institutional setting? a) Home health care b) Custodial care c) Skilled nursing care d) Intermediate care

a

Within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained? a) 3 days b) 5 days c) 10 days d) 14 days

a

An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true? a) The group plan will pay depending on the employee's recovery. b) The group plan will not pay because the employee was injured at work. c) The group plan will pay. d) The group plan will pay a portion of the employee's expenses.

b

An insured has an Accidental Death & Dismemberment policy with a principal value of $50,000. He loses sight in both eyes in a hunting accident. How much will he receive? a) $0 b) $50,000 c) $100,000 d) $25,000

b

Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off? a) Submit written notification to his major medical insurance company b) Pay a special deductible on his major medical policy c) Wait 6 months in order to be covered again d) Nothing needs to be done. The hospital's billing staff will make the appropriate arrangements.

b

How many accounts must the Tennessee Life and Health Insurance Guaranty Association maintain? a) 2 accounts: life insurance and health insurance b) 3 accounts: life insurance, annuities, and health insurance c) 3 accounts: insurance, annuities, and variable products d) 2 accounts: life insurance and annuities

b

In a replacement situation, all of the following must be considered EXCEPT a) Exclusions. b) Assets. c) Benefits. d) Limitations.

b

In forming an insurance contract, when does acceptance usually occur? a) When an insured submits an application b) When an insurer's underwriter approves coverage c) When an insurer delivers the policy d) When an insurer receives an application

b

Insurable interest can be best described by which of the following? a) It is not necessary for the insured to be aware of the insurable interest or give permission for the insurance that is to be written b) The applicant must experience a financial loss due to an accident or sickness that befalls the insured. c) The insured must be genuinely interested in the life of the applicant. d) All beneficiaries need to have notification of their status.

b

The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as a) Proof of loss. b) Legal actions. c) Time limit on certain defenses. d) Payment of claims.

b

What is another name for social security benefits? a) Survivor benefits b) Old Age, Survivors, and Disability Insurance c) Medicare benefits d) Disability and long-term care insurance

b

Which of the following is NOT a characteristic or a service of an HMO plan? a) Providing care on an outpatient basis b) Contracting with insurance companies c) Providing free annual checkups d) Encouraging early treatment

b

Which of the following is NOT true regarding partial disability? a) An insured would qualify if he couldn't perform some of his normal job duties. b) This is a form of insurance that covers part-time workers. c) The insured can still report to work and receive benefits. d) Benefit payments are typically 50% of the total disability benefit.

b

Which of the following would be required to be licensed as an insurance producer? a) An insurance company director who performs executive, administrative and managerial duties b) A salaried employee who advertises and solicits insurance c) A person whose activities are limited to producing insurance advertisements d) A salaried full-time employee who furnishes information for group insurance

b

All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT a) Health care costs can be budgeted. b) There are no claims forms required. c) Elective cosmetic procedures are covered. d) Prescriptions might be covered, unlike Medicare.

c

In long-term care (LTC) policies, as the benefit period lengthens, the premium a) LTC premiums are not based on benefit periods. b) Decreases. c) Increases. d) Remains unchanged.

c

In terms of Medicare supplement insurance, which of the following means expenses of health maintenance organizations associated with the delivery of health care services which expenses are analogous to incurred losses of insurers? a) Incurred loss expense b) General expenses c) Health care expenses d) HMO Expenses

c

What is the purpose of coinsurance provisions? a) To ensure payment to the doctors and hospitals b) To share liability among different insurance companies c) To help the insurance company to prevent overutilization of the policy d) To have the insured pay premiums to more than one company.

c

Which of the following is true regarding duplication of Medicare benefits? a) The extent of duplication depends upon the Medicare supplement plans that are bought. b) Medicare supplement policies can duplicate a certain percentage of benefits. c) Medicare supplement policies cannot duplicate any Medicare benefits. d) Medicare supplement policies can duplicate all available Medicare benefits.

c

Which of the following statements is NOT true concerning Medicaid? a) It is funded by state and federal taxes. b) It is intended to provide medical assistance for certain categories of people who are needy. c) It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income. d) It is a state program.

c

An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss? a) Incontestability b) Physical Exam and Autopsy c) Legal Actions d) Time of Payment of Claims

d

In a Disability Income policy, all of the following are considered presumptive disabilities EXCEPT a) Loss of hearing. b) Loss of two limbs. c) Loss of speech. d) Loss of one eye.

d

Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT a) When used to replace or supplement benefits payable under other social insurance programs. b) When the insured is eligible for Social Security benefits but before the benefits begin. c) If the insured has been denied coverage under Social Security. d) When the amount payable under Social Security is more than the amount payable under the rider.

d

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the a) Incontestability clause. b) Consideration clause. c) Probationary period. d) Insuring clause.

d

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs? a) Guaranteed and nonguaranteed b) Grandfathered and nongrandfathered c) Risk classification d) Metal level classification

d

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) A statement from the insured's employer showing that the insured was unable to work. b) An estimate of the total amount of medical and hospital expense for the loss. c) A complete physician's statement. d) A statement that is sufficiently clear to identify the insured and the nature of the claim.

d

What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan? a) A broad coverage area b) A low monthly premium c) Low cost deductibles d) Diagnostic and preventive care

d

Which of the following is NOT provided by an HMO? a) Services b) Financing c) Patient care d) Reimbursement

d

Which of the following would NOT be considered a limited coverage policy? a) Accident insurance b) Cancer insurance c) Credit insurance d) Major medical expense insurance

d

Which of the following would provide an underwriter with information concerning an applicant's health history? a) A medical examination b) The agent's report c) The inspection report d) The Medical Information Bureau

d