Health Insurance

Within how many days of requesting an investigation consumer report must an insurer notify the consumer in writing that the report will be obtained?

3 days

Which of the following must be present in all Medicare Supplement plans?

Plan A

Medical payment coverage on a homeowners policy applies to medical costs incurred within how many years of the accident?

3

Once an individual has successfully passed a licensing exam, for how many year(s) are the results valid?

3

All of the following would be considered rebating except

An agent misrepresents policy benefits to convince a policyowner to replace policies

In life insurance, producers are permitted to share or split commissions, provided that

Both are properly licensed for the line of insurance

What type of policy allows the insurance company to cancel a policy at any time?

Cancellable

Which of the following is not a characteristic or service of an HMO plan?

Contracting with insurance companies

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as

Contracts of adhesion

Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service?

Copayment

Which of the following would be considered an advertising injury?

Damaged to a business' reputation

After receiving a subpoena to appear at a hearing, any person who fails to appear or refuses to testify may be

Held in contempt of court

Which of the following riders would not increase the premium for a policyowner?

Impairment rider

In long term care (LTC) policies, as the benefit period lengthens, the premium

Increases

On its advertisement, a company claims that it has funds in its possession that are, in fact, not available for the payment of losses or claims. The company is guilty of

Misrepresentation

Under an individual disability income policy, the minimum schedule of time in which claim payments must be made to an insured is

Monthly

How soon after a notice of hearing is made may the hearing be conducted?

No less than 20 days

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?

Payment of claims

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area known as

Usual, customary, and reasonable

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

Within 90 days or as soon as reasonably possible, but not to exceed 1 year

Once an agent has met the requirements to sell long term care insurance, how often must he or she complete the 4 hours of training?

Every 2 years

The commissioner must examine the affairs and conditions of every insurer licensed in the state not less frequently than

Every 5 years

When a group Medicare Supplement policy is terminated by the policyholder and not replaced, the issuer must offer each certificate holder

An individual policy

Any regularly salaried employee of a licensed insurer, without license or other qualification, may act on behalf of that insurer in the negotiation of insurance for that insurer, provided

A licensed producer participates in the sale of insurance

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?

Attending physician

What document describes an insured's medical history, including diagnoses and treatments?

Attending physician's statement

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

Which of the following defines a peril?

Cause of loss

When both parties to a contract must perform certain duties and follow rules of conduct to make the contract enforceable, the contract is

Conditional

Which of the following statements about occupational vs nonoccupational coverage is true?

Disability Insurance can be written as occupational or nonoccupational

Who can provide skilled nursing care?

Doctor

Who makes up the Medical Information Bureau?

Insurers

If a health care plan has characteristics of an HMO and PPO, what type of plan is it?

POS

To what organization must all admitted insurers belong?

The Insurance Guaranty Association

Which of the following will vary the length of the grace period in health Insurance policies?

The term of the policy

Which of the following will vary the length of the grace period in health insurance policies?

The term of the policy

Which of the following statement is most correct concerning the changing of an irrevocable beneficiary?

They can be changed only with the written consent of the beneficiary

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of payment claims

In a commercial general liability policy, which of the following forms covers losses that occur, start, or are discovered during the policy period, regardless of when the date is actually reported by the insured?

Occurrence

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

The insured

In disability income insurance, the time between the onset of an injury or sickness and when benefits begin is known as the

Elimination period

Which of the following licensees are not compensated directly related to the amount of insurance sold?

Insurance consultant

A client has a new individual disability income with a 20-day probationary period and a 30-day elimination period. Ten days later, the client breaks their leg and is off work for 45 days. How many days of disability benefits will the policy pay?

15 days

An individual just lost his job. Under COBRA, for how many months is this individual entitled to keep his health insurance coverage?

18 months

Producer licenses must be renewed every

2 years

What is the minimum required number of hours of relicensing education per line of authority in this state?

20 hours

During each licensing period, every licensee subject to Minnesota's continuing education requirement must complete a minimum of

24 credit hours

When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy?

31 days

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

In insurance, an offer is usually made when

An applicant submits an application to the insurer

Which of the following would not be an allowable reason for the cancellation of health coverage for an insured under a group policy?

An employee is absent from work for an extended period because of total disability

If an insurance company wishes to order an inspection report on an applicant to assist in the underwriting process, and if a notice of insurance information practices has been provided, the report could contain all of the following information, except the applicant's

Ancestry

If an insurer and the insured cannot come to an agreement as to the value of damaged property, they must follow which provision of the policy?

Appraisal

An insurer that holds a Certificate of Authority in the state in which it transacts business is considered an

Authorized insurer

Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT

Conditions

Which of the following terms describes making false statements about the financial condition of any insurer that are intended to injure any person engaged in the business of insurance?

Defamation

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

Legal Actions

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

An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

Pay the claim

Which of the following insures are owned by stockholders who have the usual rights of ownership, including the right of voting?

Stock

Which of the following would provide an underwriter with information concerning an applicant's health history?

The Medical Information Bureau (MIB)

What happens if a non-member physician is utilized under the Point-Of- Service plan?

The attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount.

What is the purpose of coinsurance provisions?

To help the insurance company to prevent overutilization of the policy

When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees

To renew the policy until the insured has reached age 65

All of the following statements are true regarding a noncontributory group life insurance plan except

Up to 25% of employees may contribute to the premium

A guaranteed renewable health Insurance policy allows the

policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class

In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost

Is not covered

An insured is in a car accident. After the accident is determine to be her fault, the police give her a breathalyzer test to determine whether or not she had been drinking alcohol before the accident. Her blood alcohol level is over legal limit. What type of health benefits will her health insurance policy pay for her injuries if the policy includes the narcotics and intoxicants provision?

No benefits

What is another name for social security benefits?

Old-Age, Survivors, and Disability Insurance

Which section of the policy explains the rights and characteristics of the contract?

Provisions

Any inducement offered to the insured in the sale of insurance products that is not specified in the policy is an unlawful practice known as

Rebating

The primary purpose of disability income insurance is to

Replace income lost due to a disability

Disability income policies can provide coverage for a loss of income when returning to work only part time after recovering from disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?

Residual disability

The Comprehensive Health Association contracts with all of the following entities to provide coverage for their subscribers except

Surplus lines insurers

Which of the following is not a feature of a noncancellable policy?

The insurer may terminate the contract only at renewal for certain conditions

Which of the following statements is true regarding coinsurance?

The larger the percentage that is paid by the insured, the lower the required premium will be

Which types of misrepresentation persuades an insured, to his or her detriment, to cancel, lapse, or switch policies from one to another?

Twisting

All applicants for life, annuity, or endowment contracts must be given notice concerning policyholder's rights in the event that their insurance company becomes

Insolvent

A policy available to business owners that provides payment for normal business expenses in the event that the owner is disable is called

Business overhead expense

Which of the following is not an exclusion in medical expense insurance policies?

Coverage for dependents

All of the following actions can be described as twisting except

Explaining to client the advantages of permanent insurance over term and suggesting changing policies

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?

$900 (deductible + 20% of the bill after the deductible [20% of $2000])

How many pints of blood will paid for by Medicare Supplement core benefits?

First 3

Which of the following entities is not an insurer but an organization formed to provide insurance benefits for members of an affiliated lodge or religious organization?

Fraternal benefit society

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

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause

According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that?

Platinum

All of the following are the most common variations in a long term care policy except

Number of family dependents

Which of the following types of long term care is provided mainly for the purposes of meeting the insured's need for activities of daily living?

Custodial care

When a producer was reviewing a potential customer's coverage written by another company, the producer made several remarks that were maliciously critical of that other insurer. The producer could be found guilty of

Defamation