Insurance Exam Questions

Insurable interest and consent

A life insurance policy has a legal purpose if both of which of the following elements exist?

Prepaid plan

A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called

$12000, all of which is taxable

A noncontributory group disability income plan has a 30-day waiting period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive

Sudden and unforseen

A person steps off a street care and trips and breaks his ankle. This type of injury can be described as blank. Results from an accident rather than a sickness

5 years

After a cybersecurity event, an insurer or third-party service provider must conduct a prompt and thorough investigation. Once the event has been resolved, the insurer must maintain all records related to the event for no less than

Commission

All of the following are regulated areas of the insurance industry EXCEPTa)Trade practices.b)Investments.c)Commissions.d)Agents. Blank are negotiated between the insurer and agent

Benefits are taxable to the employer

All of the following are true regarding Key Employee Disability Income insurance EXCEPTa)Benefits are taxable to the employer.b)The employer owns the policy.c)Benefits are paid to the employer to retrain a new person.d)Premiums are not tax deductible for the employer.

Skilled care

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

Consideration Clause

An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she had not met the conditions specified in the

100 members

An association could buy group insurance for its members if it has annual meeting, is contributory, has a constitution and by-laws, and has least blank members

$102

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?

Waiver

An insurance company receives an application with some information missing and issues the policy anyway. What is this called?

The replacing insurer

An insured buys a Medicare Supplement insurance policy from a new insurer; this policy will replace one provided to her by another insurer. Which of the following must provide her with a Notice of Replacement?

Nonscheduled

An insured does not have to pay coinsurance or deductibles on a full-series mouth x-ray, but does have to pay a deductible to get his cavities filled. Which dental plan does he have? Diagnostic and preventative services are generally not subject to coinsurance or deductible in blank plans, but basic and major services are.

Medical reimbursement benefit

An insured severely burns her hand, but is not classified as disabled. What would cover at least a portion of the insured's medical expenses?

Amanda is 67 and is covered by a basic medical expense policy

Assuming that all of the following people are covered by a High Deductible Health Plan and are not claimed as dependents on anyone's tax returns, which would NOT be eligible for a Health Savings Account? a)Joe is 40 and is not covered by any other health insuranceb)Amanda is 67 and is covered by a basic medical expense policyc)Andy is 55 and is covered under a dental care policyd)Jenny is 60 and also has a long-term care insurance plan

at the time of application or upon delivery of the policy

At what point must an outline of coverage be delivered?

COBRA

Dependents of employees are eligible to receive group health insurance under the employee's plan. If the employee and the dependent become legally separated or divorce, or if the employee dies, the dependent will be eligible for COBRA benefits for up to 36 months.

30 months

Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?

20

Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days?

18 months

HIPAA requires that the individual has a previous continuous creditable health coverage for at least blank. It must also have the gap coverage for eligibility is a period of 63 or less days. And an individual who has used up COBRA continuation coverage is eligible. And an individual who doesn't qualify for medicare may be eligible.

6 months

How long is an open enrollment period for Medicare supplement policies. It guarantees the applicants the right to buy Medigap once they first sign up for Medicare Part B.

90 days

How many days after being licensed to place business transactions in Ohio must an insurer have an antifraud program in place?a)15 daysb)30 daysc)45 daysd)90 days

3 years

How often must the Superintendent examine financial affairs of domestic insurers?

5 days

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

30 days

If an agent has an administrative action taken against him or her in another jurisdiction, how many days does the agent have to report this to the Superintendent after the final disposition?

100%

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

Broader in general

In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is

Occasional nursing or rehabilitative care

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

Insurer to the insured

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?

Alzheimer's disease

Long-term care policies MUST cover

extra payments

Medicare MSAs may cover dental, vision, or long-term care not already covered under Medicare. These benefits require blank from the insured

Outpatient Hospital Treatment

Medicare Part A services do NOT include which of the following? a)Outpatient Hospital Treatmentb)Post hospital Skilled Nursing Facility Carec)Hospitalizationd)Hospice Care

8 am and 9pm

Permissible calling hours for telemarketers are between blank

Not tax deductible

Premium payments for personally-owned disability policies are

totally tax deductible

Premiums paid by self-employed sole proprietors or partners for medical expense insurance are blank.

Parts A and B of Medicare

Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?

The insurer will return a percentage of the premiums paid

Regarding the return of premium option for LTC policies, what happens to the premium if the policy lapses?

The Federal Fair Credit Reporting Act

Regulates consumer reports

taxable

Taxation of long-term care insurance. Excessive benefits may be blank. Regardless of whether or not the insured can deduct individual long-term care premiums, the benefits are received income tax free by the individual.

Telemarketers

The National Do Not Call Registry was created to regulate?

Social Security

The Ohio Public Employee Retirement Systems (OPERS) replaces?

tax free

The buy-sell coverage benefits are blank

policyholder

The employer receives the master policy; each employee receives a certificate of insurance. All employees have the same coverage under the master contract. The employer is the blank

Aleatory

The insured pays a small amount of premium for a large amount of risk on the part of the insurance company

Utmost good faith

The insurer must be able to rely on the statements in the application, and the insured must be able to rely on the insurer to pay valid claims. In the forming of an insurance contract, this is referred to as

HICs

The main goal of them is to reduce the cost of healthcare by utilizing preventative care

Warranty

This is a statement guaranteed to be true. When an applicant is applying for an insurance contract, the statements he or she makes are generally not warranties but representations. Representations are statements that are true to the best of the applicant's knowledge

90 days

US Armed Forces reservists called to active duty after August 21, 1990, who were covered under a disability policy provided by their employers, have a right to reinstate such coverage upon release from active duty if they apply within blank days of discharge or one year after hospitalization continuing after discharge. Coverage must be the same as is offered to other employees at the time of application and can exclude conditions arising as a result of military duty

60 days

Under the ACA, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event?

90 days

Under the Uniform Required Provisions, proof of loss under a health insurance policy normally should be filed within blank of a loss

1 year

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

1 year

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 firstb)1 monthc)1 yeard)2 years

To renew the policy until the insured has reach age 65

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

If paid by the individual, the premiums are tax deductible

Which of the following is INCORRECT concerning taxation of disability income benefits? a)If the insured paid the premiums, any disability income benefits are tax-free.b)If the benefits are for a permanent loss, the benefits paid to the employee are not taxable.c)If paid by the individual, the premiums are tax deductible.d)If the employer paid the premiums, income benefits are taxable to the insured as ordinary income.

To minimize the insured's level of liability in the event of loss

Which of the following is NOT a goal of risk retention?a)To minimize the insured's level of liability in the event of lossb)To reduce expenses and improve cash flowc)To increase control of claim reserving and claims settlementsd)To fund losses that cannot be insured

Routine dental care

Which of the following is NOT covered under Part B of a Medicare policy?

acute care in a hospital

Which of the following is NOT covered under a long-term care policy?a)Adult day careb)Hospice carec)Home health cared)Acute care in a hospital

Coverage for catastrophic medical expenses

Which of the following is NOT true of basic medical expense plans?a)Low dollar limitsb)Coverage for catastrophic medical expensesc)No deductiblesd)First-dollar coverage

It will continue for 180 days even if the owner disposes of the business

Which of the following is NOT true regarding a temporary license in this state?a)It does not require a written examination.b)It will continue for 180 days even if the owner disposes of the business.c)It can be issued to a designee when a licensed agent enters active U.S. military service.d)It can be issued to a spouse of the deceased agent

Benefits are considered taxable income to the business

Which of the following is not true of Disability Buy-Sell coverage?a)It is typically written to cover partners or corporate officers of a closely held business.b)Premium payments are not deductible to the business.c)The policies provide funds for the business organization to purchase the business interest of a disabled partner.d)Benefits are considered taxable income to the business.

Benefits must aid in the prevention of illness

Which of the following is required for a Medicare Advantage Plan to provide supplemental benefits?a)Benefits must incur direct and indirect medical costs.b)Benefits must aid in the prevention of illness.c)Benefits must be covered under a Medicare Part A plan.d)Benefits must be covered under a Medicare Part B plan.

It requires all employers, regardless of the number or age of employees, to provide extended group health coverage

Which of the following statements is NOT correct concerning the COBRA Act of 1985?a)It requires all employers, regardless of the number or age of employees, to provide extended group health coverage.b)It covers terminated employees and/or their dependents for up to 36 months after a qualifying event.c)It applies only to employers with 20 or more employees that maintain group health insurance plans for employees.d)COBRA stands for Consolidated Omnibus Budget Reconciliation Act.

policyowners

With participating policies, blank are entitled to dividends, which, in the case of mutual companies, are nontaxable because they are considered a return of excess premiums.

Exchange of unequal values

aleatory nature of an insurance contract. The amount of the premium the insured pays is much less than the potential loss assumed by the insurer

Group Disability Income

are attributed to employee contributions are not taxable, but benefits payments that are attributed to the employer contributions are taxable to the employee

ERISA

has a complex series of rules that cover pension, profit-sharing stock bonus, and most "welfare benefit plans," such as health and life insurance. Golden parachutes are NOT monitored by blank

Flexible Spending Account

is a form of cafeteria plan benefit funded by salary reduction. The employees are allowed to deposit a certain amount of their paycheck into an account before paying income taxes. FSA benefits are subject to annual maximum and "use-or-lose" rule.

Accidental injury

is covered immediately, but to protect the insurer against adverse selection, losses resulting from sickness are covered only if the sickness occurs at least 10 days after the reinstatement date.

Health Insurance Marketplace

plans and most private insurance plans must cover a list of specific vaccines without charging a copayment or coinsurance when provided by an in-network provider

Medicare SELECT

policy issued in this state must not restrict payment for covered services provided by non-network providers if the services are for symptoms requiring emergency care and it is not reasonable to obtain such services through a network provider

income tax free

the benefits received by the business in a disability buy-sell policy are

step therapy

type of prior authorization. Medicare requires the insured to first try a certain, less expensive drug on the plan's Formulary that has been proven effective for most people with the same condition before the insured can move up to a more expensive drug.

Retention

usually results from three basic desires of the insured: to reduce expenses and improve cash flow, to increase control of claim reserving and claim settlements, and to fund losses that cannot be insured.

5 months

what is the elimination period for social security disability benefits?