Insurance Learn As You Go Health

What is the maximum civil penalty per violation if an unauthorized entity violates the Commissioner's cease and desist order?

$25,000

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 percentage of individually-owned disability income is taxable?

0%

How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insuranceprovide in this state?

12 months

A client has a new individual disability income policy 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

Which of the following disability income policies would have the highest premium?

15-day waiting period/ 10- year benefit period

The division of insurance has requested information regarding an insurer's underwriting policies via email. How many days does the insurer have to respond to this request?

20 days

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?

50/50

Under the uniform required provision proof of loss under a health insurance policy should normally be filed within how many days

90 days of a loss

What is a material misrepresenation?

A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company

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

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?

Adjust the benefit in accordance with the increased risk.

Long-term care insurance policies must cover which of the following

Alzheimer's Disease

Assuming that all of the following people are covered by a High Deductible Health Plan and are claimed as dependents on anyone's tax returns, which would NOT be eligible for a Health Savings Account?

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

While a claim is pending, an insurance company may require

An independent examination as often as reasonably required

In order to get a nonresident license in this state, a producer must

Apply and pay a fee to a nonresident state that reciprocates.

When must an insurer offer a long- term care insurance policyholder the option of purchasing inflation protection?

At the time of purchase

The premium charged for exercising the Guaranteed Insurability Rider is based upon the insured's

Attained Age

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

Broader in general

Kevin and Nancy are married; Kevin is the primary breadwinner and has a health insurance policy that covers both him and his wife. Nancy has an illness that requires significant medical attention. Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Which of the following options would be best for Nancy at this point?

COBRA

Which of the following reports will provide the underwriter with the information about an insurance applicant's credit?

Consumer report

An insurance producer just sold an insurance policy to his sister. What kind of business is this?

Controlled

All of the following are true about group disability income insurance EXCEPT

Coverage applies both on and off the job

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

Critical illness

Which of the following is considered a qualifying event under COBRA?

Divorce

An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day

Elimination period

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

Entire contract clause

Items stipulated in the contract that the insurer will not provide coverage for are found in the

Exclusions

Producers who wish to sell variable life insurance in this state must be registered with what entity?

FINRA

As it pertains to group health insurance, COBRA stipulates that

Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.

When the Commissioner believes that a person has engaged in an unfair method of competition or unfair trade practices, before issuing a cease of desist order, the Commissioner must

Hold a hearing

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

Impairment rider

In which of the following locations would skilled care most likely be provided?

In an institutional setting

Who makes up the Medical Information Bureau?

Insurers

he 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

A guaranteed renewable disability insurance policy

Is renewable at the insureds option to a specified age

What statement best describes the free look provision?

It allows the insured to return the policy within 10 days for a full refund or premiums if dissatisfied for any reason

Which of the following statements is NOT true concerning Medicaid?

It consists of 3 parts

Concerning Medicare Part B, which statement is INCORRECT?

It is fully funded by Social Security taxes

Which of the following states is NOT correct concerning the COBRA Act of 1985?

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

To sign up for a medicare prescription drug plan, individuals must first be enrolled in

Medicare Part A

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs

Metal Level Classification

The primary eligibility requirement for Medicaid benefits is based upon

Need

An insured purchased a disability income policy with a 10-year benefit period. The policy stated a 20-day probationary period for illness. If the insured is hospitalized with an illness two weeks after the policy was issued, how much will the policy pay?

Nothing, illness is not covered during the first 20 days of the contract

How often must insurance companies doing business in Colorado file financial statements with the Commissioner?

Once a year

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?

Pay a special deductible on his major medical policy

Which of the following provisions is mandatory for health insurance policies?

Physical examination and autopsy

All of the following are covered by Part A of Medicare Except

Physician's and surgeon's services

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

Plan A

federal fair credit reporting act

Regulates consumer reports

Long-term care insurance will not exclude coverage for a loss or confinement that is the result of a pre-existing condition beginning within 6 months following the effective date of coverage. However, the Commissioner may extend the 6 month limitation period to

Specific age groups

What is the best way to change an application?

Start over with a fresh application.

Which of the following terms describe the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?

Stop-Loss Limit

Regarding investigations of insurers, the Colorado Commissioner of Insurance may

Subpoena witnesses whenever he/she deems necessary

A provision found in insurance policies which prevents the insured from collecting twice for the same loss is called

Subrogation

Which of the following would an accident-only policy NOT cover?

Surgery to repair a wrist damaged by tendonitis

All of the following provisions must be included in an insurer's anti-fraud plan EXCEPT

Suspension of producer's licensure.

Which of the following is NOT covered under a "core" policy, Plan A in Medigap insurance?

The Medicare Part A deductible

Before a customer's agent delivers his policy, the insurer makes a last-minute change to the policy. The agent inform the customer of this change, and he accepts it. What must the agent do now?

The agent should ask the customer to sign a statement acknowledging that he is aware of the change

Before a customer's agent delivers his policy, the insurer makes a last-minute change to the policy. The agent informs the customer of this change, and he accepts it. What must the agent do now?

The agent should ask the customer to sign a statement acknowledging that he is aware of the change

Rating factors DO NOT reflect differences due to the nature of the groups assumed to select particular health plans. Rating factors DO produce premiums for identical groups that differ only by

The amount of the plan design.

Insurable interest can be best described by which of the following?

The applicant must experience a financial loss due to an accident or sickness that befalls the insured

If a business wants to buy a disability income policy on a key employee, which of the following is considered the applicant?

The employer

Which statement regarding qualifications for Social Security disability benefits is NOT true?

The individual must be at least 65 years old.

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

The insured is in an accident and incurs a large claim

Which of the following is NOT a feature of a guaranteed renewable provision

The insurer can increase the policy premium on an individual basis

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

The mode of the premium payment

An insured notifies the insurance company that he has become disabled. What provision states that claims bust be paid immediately upon written proof of loss/?

Time of Payment of Claims

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

Time of Payment of Claims

Believing a producer has violated provisions of the insurance code, the commissioner will schedule a hearing

To allow the producer to show why penalties should not be assessed

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 65

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT

Unearned premiums are retained by the insurance company.

A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would life to change the primary beneficiary to his sister. Which of the following is true?

Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at any time

A deductible is

a specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits

The patient protection and affordable care act includes all of the following provisions EXCEPT

individual tax deduction for premiums paid

Which of the following best describes the MIB?

it's a non profit organization that maintains underwriting information on applicants for life and health insurance-

In a group health policy, a probationary period is intended for people who

join the group after the effective date

Under workers compensation, which of the following benefits are NOT included?

legal benefits

HMOs may pay for services ...

not covered by medicare

Insurers must complete claims investigations:

promptly

Todd has been informed that he has a hernia which requires repair. When Todd researches the cost, he learns that his insurance plan will cover 200 points worth of surgical expenses. Each point represents $10, which means that $2000 of his surgery will be covered by his insurance plan. What system is Todd's insurance company using?

relative value

Sarah is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true?

there is nothing wrong with the above situation

Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?

5 months

In all individual and small employer health benefit plans, how long is the grace period for persons receiving the federal advance payment tax credit?

3 months

After a client signs a disclosure statement regarding additional fees charged by a producer, the producer must keep a copy of the statement for at least

3 years from the date of completion of the services.

An insurer must process a clean electronically submitted health claim within

30 days

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

36 months

Which of the following is NOT a qualifying event which allows an individual to join group coverage during a special enrollment period?

An individual loses coverage after committing insurance fraud.

An agenst makes a mistake on the application and then correct his mistake by physically entering the necessary information. Who must then initial that change?

Applicant

An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery, the agent collects the applicant's premium check, answers any questions the applicant may have, and then leaves - what did he forget to do?

Ask her to sign a statement of good health

How often must the commissioner examine all insurers to guard against insurance company insolvency?

At least once every 5 years

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

Conditional

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 has not met the conditions specified in the

Consideration Clause

Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called?

Key employee disability insurance

The corridor deductible derives its name from the fact that it is applied between the basic coverage and the

Major Medical Coverage

Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?

The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's deductible

Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?

Unlimited

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes

Waiver of Premium Rider

In regards to biologically based mental illnesses and mental disorders, group health policies in Colorado

must provide the same coverage that is provided for a physical illness