Health exam missed questions

Any licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to

10 YEARS

To attain "fully insured" status under social security, an individual must have earned how many credits?

40 CREDITS (10 years of work, but based on top 35 years of earnings)

For purpose of determining its financial condition, fulfillment of its contractual obligations and compliance with Mass law, the Commissioner will examine the affairs of each insurer as often as deemed necessary. Each domestic insurer must be examined at least once every ___ years

5 YEARS

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA within how many days

60 days

Presumptive Disability

A provision that is found in most disability income policies which specifies the conditions that will automatically qualify the insured for full disability benefits. full loss of sight, hearing, speech, complete loss of the use of limb(s), most cancers

Where would Randall go to purchase a Medigap policy to supplement his insurance needs? A. A private insurance company B. Medigap policies are only available through an employer C. Randall must submit an application through the federal government's website for approval D. Through an auto insurer

A. private insurance company

which of the following does the insuring clause NOT specify? a. the insurance company b. the name of the insured c. a list of available doctors d. covered perils

C. a list of available doctors

Which Social Security status does a worker with 6 quarters of coverage during the last 13-quarter period have? a. Partially insured b. Fully insured c. Currently insured d. Not insured

Currently insured To be considered "currently insured" you must have 6 quarters of coverage during the last 13-quarter period

What is the medicare enrollment period?

Jan 1st to March 31st each year

Randall purchased a Medicare advantage plan as well as a Medigap insurance policy. If he needed to use his policies to cover a medical expense, would Medigap provide the needed coverage?

NO Medigap would deny coverage because Medicare advantage is already present.

Which of the following is NOT true regarding an optionally renewable policy? a. insurer can only cancel for reasons stipulated in the policy b. renewability is at the option of the insurer c. non-renewal can happen on the anniversary date d. policy premiums can increase at each renewal

a

an insured purchased a health insurance policy with a renewability clause that states the policy is 'guaranteed renewable'. This means that as long as the required premiums are paid, the policy will continue until the insured... a. reaches age 65 b. dies c. reaches age 100 d. becomes disabled

a. will renew til 65 (when they are eligible for medicare) premium can be adjusted throughout renewal

if an individual willfully violates the Fair Credit Reporting Act, what is the maximum civil penalty? a. $1000 b. $2500 c. $5000 d. $10000

b. $2500

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? a. 7 days b. 10 days c. 31 days d. 60 days

b. 10 days *****the grace period is 7 days if the premium is paid weekly, 10 days if monthly and 31 days all other modes******

if an insured decides to reduce the coinsurance amount on her plan, what can she expect? a. higher deductible b. higher monthly premium c. stop-loss increase d. a lower lifetime benefit payout

b. a higher monthly premium The greater the portion the insurance company pays, the greater the premium charged.

utilization management consists of an evaluation of the appropriateness, necessity, and quality of healthcare and may include a. cost-saving services b. concurrent and prospective review c. preventative care d. coordination of benefits

b. concurrent/prospective review

which of the following is not a characteristic 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. contracting with insurance companies Contracts are between the insured and the HMO, not an insurance company.

which of the following is another name for a primary care physician in an HMO a. specialist b. gatekeeper c. subscriber d. referring physician

b. gatekeeper (because the PCP acts as a gatekeeper... any need to go to a specialist must go through the PCP for a referral)

If a member of a Blue Cross/Blue Shield (BC/BS) obtains medical treatment from a non-participating provider, the insurer will pay a. the entire amount billed, minus copays and deductibles b. the entire amount billed on a 50/50 coinsurance basis c. the amount that would have been paid to a participating provider d. Nothing. BC/BS i a closed panel system

c. BC/BS is responsible for the amount that would have been paid to a participating provider.

What is the maximum period that an insurer would pay benefits in accordance with an additional monthly benefit rider? a. For the duration of the disability or the contract, depending on which ends first b. 1 month c. 1 year d. 2 years

c. 1 year Stipulates that the insurer will pay benefits comparable to what social security would pay. *Will pay for 1 year then assume that social security will begin payment*

which of the following terms relates to disability income insurance? a. coinsurance stop/loss b. deductibles c. insurable interest d. residual benefit

d. residual benefit

Units with the same or similar exposure to loss are referred to as

homogenous

Regarding the PPACA health care tax credit, which of the following is true?

persons receiving medicaid are not eligible

an insurance advisers license may be issues to a corporation if the officers of the corporation are found to be

qualified in all respects for licenses as advisers

all of the following are features of a health insurance plan purchased on the health insurance marketplace except: a. dollar limits on essential benefits b. guaranteed renewability c. coverage for emergency services d. coverage for pre-existing conditions

a. dollar limits on essential benefits health plans are restricted from applying a dollar limit on essential benefits, nor can they apply a dollar limit on the amount of benefits paid during the insured's lifetime.

Which of the following does NOT need to be included on the first page of a Medicare supplement policy? a. premium rates b. renewal provision c. continuation provision d. the companies right to change premium rates based on the policyholders age

a. premium rates

which of the following does not need to be included in the first page of a Medicare supplement policy? a. premium rates b. renewal provision c. continuation provision d. the company's right to change premiums based on the policyholder's age

a. premium rates

which of the following is not a characteristic of a managed care plan? a. risk retention b. comprehensive case management c. preventive care d. controlled access of providers

a. risk retention managed care plans don't retain the risk, but contract with a provider to serve their members

an insured's health insurance policy pays benefits according to a list which indicates the amounts payable under each type of treatment/procedure. This means the policy provides benefits on what basis? a. scheduled b. service c. cash d. reimbursement

a. scheduled

which of the following is a limited lines license? a. a business entity license b. a portable electronics license c. a temporary insurance producer license d. a nonresident producer license

b. a portable electronics license

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 The secondary insurer will cover what the primary insurer did not pay such as coinsurance and the deductible

what percentage of individually-owned disability income benefits are taxable? a. 0% b. 50% c. 100% d. Amount paid by the insured

a. 0% Premiums are paid with after tax dollars so benefits can't be income taxed.

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. 3 DAYS

Who makes up the Medical Information Bureau? a. former insured b. insurers c. physicians and paramedics d. hospitals

b. insurers (around 400 insurance companies)

what is franchise insurance? a. it is group insurance b. it is blanket insurance c. it is health insurance for small groups whose numbers are too small to qualify for true group insurance d. it provides insurance for franchises such as restaurant or hotel chains

c

In group insurance what is the policy called a. certificate of insurance b. Master policy c. Entire contract d. certificate of authority

c. master policy you idiot

every small employer must offer at least how many health plans? a. none b. one c. two d. three

c. two

which of the following statements is INCORRECT regarding group health insurance? a. to be eligible, must be a full-time employee b. costs are lower than individual plans c. the underwriter evaluates the group as a whole vs. individual underwriting d. each individual must be accepted into or rejected by a group policy

d. the groups risk-profile determines whether the group will be accepted/rejected

For how many days of skilled nursing facility care will Medicare pay benefits? a. 30 days b. 60 days c. 90 days d. 100 days

d. 100 days

An agent's first-year commission CANNOT exceed what percentage of the renewal commission for servicing a Medicare Supplement policy in its second year? a. 10% b. 50% c. 100% d. 200%

d. 200%

which statement is required to be printed on the first page of a health insurance policy which says that the policy's benefits are limited? a. benefit notice b. statute of limitations c. limited benefit statement d. limited policy notice

d. limited policy notice

a producer who includes a statement or omits a statement which may tend to mislead or deceive, the person addressed has committed a. defamation b. twisting c. coercion d. misrepresentation

d. misrepresentation making false statements with the intent to defraud another

On an Accidental Death and Dismemberment (AD&D) insurance policy, the death benefit payable is known as the a. face amount b. capital sum c. policy limit d. principal sum

d. principal sum

an employee is insured by a group major medical plan that is provided through her employer. The employer contributes 75% of premium, employee contributes 25%. If the insured received a benefit from the policy in the amount of $1000, hwo much is taxed as income? a. 1000 b. 750 c. 250 d. 0

d. $0 taxed group medical and dental expenses benefits are received tax free by the employee.

on a LTC policy, what is the minimum percentage of one year's nursing home benefits dollar amount that must be equated to total home health care? a. 25% b. 50% c. 75% d. 100%

b. 50%

when must a producer notify the Dept of Insurance of a change of address? a. within 30 days b. within 15 days c. within 10 days d. immediately

change of address must be reported within 30 days

within how many days must a carrier send an insured a written acknowledgement of the receipt of the insured's grievances? a. 10 days b. 15 days c. 20 days d. 30 days

b. 15 days

Non-qualified distributions from an MSA are included in the employee's gross income and subject to a penalty tax of a. 10% b. 20% c. 25% d. 50%

b. 20%

A hearing may Not occur sooner than how many days after the notice of hearing is served? A) 10 B) 21 C) 30 D) 51

b. 21 days

the medicare supplement renewal must be equal to commissions in which year a.1st b.2nd c.3rd d.4th

b. 2nd

Which of the folllowing statements concerning Medicare part B is correct? a. it's provided automatically for anyone who qualifies for Medicare part A b. it pays on a first dollar basis c. it pays 100% of Medicare's standards for reasonable charges d. It pays for physician services, diagnostic tests, and physical therapy

d. Medicare part B pays 80% of outpatient medical costs after the deductible has been met, physician and outpatient hospital services, and other medical/health services such as diagnostic testing and physical therapy

who determines if a particular group of employees can be excluded from group health coverage? a. the employee union b. the department of insurance c. the employer d. the insurer

c. the employer

Insurers CANNOT transact insurance in this state without a a. certificate of authority b. broker's license c. certificate of insurance d. letter of clearance

certificate of authority

how soon must an insurer send Medicare Supplement advertisements to the Commissioner before they are distributed? a. 7 days b. 10 days c. 14 days d. 15 days

d. 15 days

Medicare Part A services do NOT include which of the following? a. hospitalization b. hospice care c. private duty nursing d. post hospital skilled care nursing facility

c. private duty nursing

which of the following types of insurers is owned by stockholders? a. reciprocal b. fraternity c. stock d. mutual

c. stock

an employer is no longer able to afford the group health insurance plan and it terminates, however, one employee is still receiving coverage under the plan. Why?

The employee is totally disabled

which of the following is NOT correct concerning the COBRA act of 1985? a. It requires all employers, regardless of age or # of employees, to provide group health coverage b. it covers terminated employees and/or their dependents for up to 36 months after a qualifying event c. it applies to employers with only 20+ employees that maintain health insurance for employees d. COBRA means Consolidated Omnibus Budget Reconciliation Act

a. the cobra act only applies to employers with 20+ employees

In order to collect Social Security disability benefits, the claimant must be able to demonstrate that the disability will last at least a. 12 months b. life c. 24 months d. until age 65

a. 12 months (or something leading to death)

An insured was involved in an accident and could not perform her current job for 3 years. If the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan? a. 2 years b. 1 month c. the insured would not receive any benefits d. 3 years

a. 2 years under 'own occupation' plan, if the insured cannot perform their current job for 2 years, benefits will be issues (even if they can perform similar jobs).... after the 2 years, if they can perform similar jobs, no benefits will be paid

When comparing the administrative costs of group health vs individual health coverage, group health coverage is a. lower (cheaper) b. higher (more expensive) c. comparable d. equal

a. Cheaper/Lower

Esther worked for 45 years and is now retired at 65 years old. What premium cost will she be expected to pay for Medicare Part A coverage? a. zero premium dollars b. cost based on her age c. premium cost will be based on her age d. Esther will have a one time flat fee of $500

a. Zero premium dollars She paid into social sec benefits for 10 years so no longer has to pay a premium.

Occasional visits by which medical professional will not be covered under LTC's home health care? a. attending physician b. registered nurses c. licenses practical nurses d. community based organization professionals

a. attending physician

The purpose of managed care health insurance plans is to a. control health insurance claims expenses b. provide for the continuation of coverage when an employee leaves the plan c. provides access to the largest number of physicians as possible d. coordinate benefits

a. control health insurance claims expense Managed care is a system for delivering health care and health care services, characterized by arrangements with selected providers, programs of ongoing quality control, and utilization review and financial incentives for members to use providers and procedures covered by the plan.

what is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan? a. diagnostic and preventative care b. a broad coverage area c. a low monthly premium d. low cost deductibles

a. diagnostic and preventative care

which of the following is considered a qualifying event under cobra? a. divorce b. marriage c. relocation d. promotion

a. divorce

all of the following are places where care can be administered for a medical plan EXCEPT a. eye centers b. doctors office c. surgicenters d. urgent care centers

a. eye centers

which of the following is true regarding health insurance? a. it could provide payments for loss of income b. disability coverage is excluded c. it provides death benefit coverage d. it only covers expenses related to healthcare

a. it could provide payments for loss of income

which one is not a characteristic of long term group disability plan benefits? a. the benefit can be up to 50% of ones yearly income b. the benefit can be up to 66 and 2/3% of ones monthly income c. the benefit may go to age 65 d. the elimination period is the same as the short term plan's benefit period

a. the benefit is based off MONTHLY income

an employee is covered under COBRA. His previous premium payment was $100/month... His employer now collects $102/month. Why? a. to cover the employer's administrative costs b. penalty for termination c. premiums go up yearly regardless of health conditions d. to cover other employees who qualify to bypass premium payments

a. to cover admin costs the employer is permitted to collect extra premium (no more than 102%) to cover administrative costs

which of the following services will NOT be provided by an HMO? a. unlimited coverage for treatment of drug rehabilitation b. treatment of mental disorders c. inpatient hospital care outside the service area d. emergency care

a. unlimited coverage for treatment of drug rehabilitation

Under HIPAA portability, which of the following are NOT protected under required benefits? a. mentally ill b. groups of one or more c. pregnant women d. self-employed

b. Groups of one or more Legislation took effect that ensures portability of group insurance coverage and includes benefits that affect small employers, self-employed, pregnant women, and the mentally ill. HIPAA applies to groups of two or more.

In cases where a covered employee is eligible for Medicare benefits to treat end stage renal disease with dialysis for kidney transplant, which of the following is correct? a) Medicare is primary for the first 12 months of treatment and then employer group insurance is secondary b) Medicare is the secondary payer during the first 30 months of treatment c) Medicare in the employer group insurance plan will share the cost equally d) Because Medicare does not cover treatment of ESRD the group plan

b. Medicare is SECONDARY during the first 30 months of treatment Group coverage covers the first 30 months then Medicare will take over

If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following? a. exclude coverage for on-the-job injury b. adjust the benefit in accordance with the increased risk c. cancel the policy d. increase the premium

b. adjust the benefit in accordance with the increased risk

Which types of care could be provided at a community center? a. intermediate care b. adult day care c. respite care d. skilled care

b. adult day care

the commissioner may suspend or modify the filing requirements for a. any form of coverage regardless of risk if such coverage is made on a replacement-only basis b. any kind of insurance or classes of risks for which the rates cannot be practically filed before they are used c. any insurer that is currently under receivership by the Commissioner's office d. all insurers whose sole business deals with surplus lines of insurance coverage

b. any kind of insurance or classes of risks for which the rates cannot be practically filed before they are used

which of the following is true regarding inpatient hospital care for HMO members? a. inpatient hospital care is not part of HMO services b. care can be provided outside the service area c. care can only be provided in the service area d. services for treatment of mental disorders are limited

b. care can be provided outside the service area

which of the following is not a typical type of LTC coverage? a. home health care b. child day care c. skilled nursing care d. residential care

b. child day care

What option allows the insured to periodically increase benefit levels without providing evidence of insurability? a. level premium b. guarantee of insurability c. Guarantee renewable d. annual increase

b. guarantee of insurability Guarantee of insurability option allows the insured to periodically increase benfits without providing evidence of insurability. *usually limited to a 5% compounded annual increase*

an employee is on an extended leave of absence when the employer changes group health plans from one carrier to another. what might the employee notice before returning to work? a. suspended coverage b. limited coverage c. increased benefits d. no change in coverage

b. limited coverage

which of the following used to be called medicare + choice plans a. original medicare plan b. medicare advantage c. medicare supplement plans d. medical insurance

b. medicare advantage

When may HIV-related test results be provided to the MIB? a. only when the results are negative b. only if the individual is not identified c. under all circumstances d. when given authorization by the patient

b. only when the individual is not identified

the benefits in medical expense insurance are a. taxed when they reach 25000 per year b. received tax free by the individual c. taxable d. nonexistent

b. received tax free by the individual

All of the following are true regarding the federal Fair Credit Reporting Act EXCEPT a. The customer must be notified if adverse action is taken as a result of the report b. reports may be sent to anyone who requests one c. insurers are not required to give customers a copy of the report d. it applies to credit reports ordered in connection with insurance, banking, and employment

b. reports may be sent to ANYONE who requests one. cannot be sent to just anyone

which entity has the option of including optional provisions in a health insurance policy? a. the federal government b. the insurer c. the state d. the policyholder

b. the insurer (insurance company or producer)

what is the maximum period that an insurer would pay benefits in accordance with an additional monthly benefit rider? a. for the duration of the disability or the contract, whichever ends first b. 1 month c. 1 year d. 2 years

c. 1 year its assumed that social security would cover the benefit after the 1 year

how much does it typically cost for someone to purchase disability income insurance? a. 5% annual income b. 10% annual income c. 1-3% annual income d. A flat $500 charge

c. About 1-3% annual income

A dentist is off work for 4 months due to a disability. His dental assistants salary would be covered by a. key employee disability b. partnership disability c. business overhead insurance d. disability income

c. business overhead insurance will cover all business expenses (salaries besides owners, and rent) if the owner is disabled

If an insured decides to reduce the coinsurance amount on her major medical insurance, what can the insured expect? a) A lower lifetime benefit payout b) Stop-loss increase c) A higher monthly premium d) A higher deductible

c. higher monthly premium

Under the Fair Credit Reporting Act, individuals rejected for insurance due to information contained in a consumer report a. must be advised that a copy of the report is available to anyone who requests it b. may sue the reporting agency in order to get inaccurate info corrected c. must be informed of the source of the report d. are entitled to obtain a copy of the report from the party who ordered it

c. must be informed of the source of the report (The name and address of the credit reporting company who provided the report.)

which of the following factors would be an underwriting consideration for a small employer carrier? a. health status b. medical history of the employees c. percentage of participation d. claims experience

c. percentage of participation a small employer plan is only available if 75% of employees elect to accept coverage

Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required? a. 35% b. 10% c. 15% d. 20%

d. 20% 20% coinsurance rate is a core benefit in Part B Medicare supplement policies

A person receives his Medicare Supplement policy and is not satisfied with the provisions. He can return the policy for a full premium refund if he does so within how many days? a. 10 days b. 15 days c. 21 days d. 30 days

d. 30 days

Under the mandatory uniform provision Legal Actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to a. 90 days after written proof of loss has been submitted b. one year after the occurrence of a disability c. 30 days after the loss d. 60 days after written proof of loss has been submitted

d. 60 DAYS (but no later than 3 years after written proof of loss)

The Omnibus Reconciliation Act of 1990 (OBRA) requires that large group health plans with 100 employees or more must provide primary coverage for nonretired , disabled individuals under what maximum age? a. 50 b. 55 c. 60 d. 65

d. 65

The Omnibus budget reconciliation act of 1990 requires that large group health plans must provide primary coverage for disabled individuals under a. 50 b. 55 c. 60 d. 65

d. 65

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?

d. all providers will have the same coverage options and conditions for each plan

all of the following statements are goals of TRICARE except... a. control escalating costs b. improve overall access to health care for members c. provide faster, more convenient access to civilian healthcare d. create a more limited system of health care

d. create a more limited system of health care the goal of TRICARE is to create a more effective system to receive healthcare.

which of the following health care plans would most likely provide the insured with comprehensive health care coverage? a. group dental insurance plan b. medical surgical expense plan c. basic medical expense plan d. health maintenance organization

d. health maintenance organization HMOs provide a package of comprehensive health care services that include routine medical physicals, immunizations, baby care, family planning, treatment of sickness/injury, etc.

in group insurance the primary purpose of the coordination of benefits provision is to a. prevent lawsuits between the insurance companies about a claim b. insure the payments of claims by all policies are in effect at the time of the claim c. encourage hospitals to keeo their charges reasonable d. to prevent overinsurance

d. to prevent overinsurance

An applicant completes the application and submits it to the insurer along with a premium check. When is the applicant's offer considered accepted? a. the insurance company request a medical exam b. applicant signs the conditional receipt c. delivery of the policy d. the insurance company accepts the risk

d. when the insurance company accepts the risk (approves the application)