Insurance Questions Most Missed

Because an agent is using stationery with the logo of an insurance company, applicants for insurance assume that the agent is authorized to transact on behalf of that insurer. What type of agent authority does this describe?

Apparent

Which of the following would NOT be an underwriting consideration for a health insurance applicant?

Applicant's Sexual Orientation

Under a Key Person disability income policy, premium payments

Are made by the business and are not tax-deductible

When must an insurance company present an outline of coverage to an applicant for a Medicare supplement policy?

At the time of application

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

Attending Physician's Statement

Which of the following is NOT an enrollment period for Medicare Part A applicants?

Automatic enrollment (3 types: initial, general, and special enrollment periods)

All of the following are requirements of eligibility for Social Security disability income benefits EXCEPT?

Being age 65

It is mandatory for all new policies to include surgical and nonsurgical treatment for all of the following EXCEPT?

Broken cervical vertebrae

When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply?

Case management provision

Which of the following would NOT be used in preventive care?

Chemotherapy

Forcing a client to buy insurance from a particular lender as a condition of granting a loan is defined as?

Coercion

Earning commissions based on transactions with a person's friends and family is called?

Controlled Business

Which rider, when added to a disability income policy, provides for changes in the benefits payable based on changes in the consumer price index?

Cost of living adjustment rider

Joe has been diagnosed with a quickly-spreading, fatal form of cancer; his oncologist predicts that he will live for a month. He applies for an individual health insurance policy. What risk classification will he most likely receive?

Declined

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

Defamation

Who can provide skilled nursing care?

Doctor

Concerning group Medical and Dental insurance, which of the following statements is INCORRECT?

Employee benefits are tax deductible the year in which they were received

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

Which of the following statements is correct concerning taxation of long-term care insurance?

Excessive benefits may be taxable

Which of the following are the authorities that an agent can hold?

Express and implied

An insurance company assures its new policyholders that their premium costs will not increase for a period of at least five years. However, due to increasing financial strain, they plan to raise premium costs for all insureds by 10% over the next two years. What term best describes this act?

Fraud

Under which of the following disability income plans would the benefits be subject to income tax?

Group

A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis?

Guaranteed

What insurance concept is associated with the names Weiss and Fitch?

Guides describing company financial integrity

Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage?

Health Maintenance Organization Plan

Medicaid provides all of the following benefits EXCEPT

Income assistance for work-related injury

In order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to participate to do all of the following EXCEPT

Increase benefits for a period of one year

Issue age policy premiums increase in response to which of the following factors?

Increased benefits

In long-term care policies, as the benefit period lengths, the premium?

Increases

Who is responsible for making sure that agents are properly trained in the use of the suitability standards for LTC policies?

Insurer

Which of the following entities has the authority to make changes to an insurance policy?

Insurer's executive officer

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

Insuring clause

What is the benefit of experience rating?

It allows employers with low claims experience to get lower premiums

Which of the following is true regarding a term health policy?

It is nonrenewable

Which of the following is INCORRECT concerning Medicaid?

It is solely a federally administered program

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

All of the following are characteristics of a Major Medical Expense policy EXCEPT?

Low maximum limits (Major medical expense contracts are characterized by high maximum limits, blanket coverage, coinsurance, and a deductible)

All of the following are true regarding the Medical Information Bureau (MIB) EXCEPT?

MIB reports are based upon information supplied by doctors and hospitals

If a dental plan is integrated, it is combined with what type of plan?

Medical

An insurance company wants to obtain the insurance history of an applicant. Which source releases coded information to insurers regarding information included on previous insurance applications?

Medical Information Bureau

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

Medical reimbursement benefit

Which of the following statements is NOT correct?

Medicare Advantage must be provided through HMOs.

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

Monthly

Under the Fair Credit Reporting Act, individuals rejected for insurance due to information contained in a consumer report?

Must be informed of the source of the report

On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are

Not taxable since the IRS treats them as a return of a portion of the premium paid

Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the?

Notice Regarding Replacement

In long-term care insurance, what type of care is provided with intermediate care?

Occasional nursing or rehabilitative care

When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called?

Overinsurance

An underwriter may reject an application for health insurance if the rejection is based upon which of the following?

Prescription usage

Under which provision can a physician submit claim information prior to providing treatment?

Prospective Review

Which of the following answers does NOT describe the principal goal of a Preferred Provider Organization?

Provide medical services from physicians in the network

A situation in which a person can only lose or have no change represents?

Pure Risk

Which of the following is NOT provided by an HMO?

Reimbursement

What provision can reduce the disability benefit based upon the insured's current income?

Relation of earnings to insurance

Under the Fair Credit Reporting Act, if the consumer challenges the accuracy of the information contained in his or her report, the reporting agency must?

Respond to the consumer's complaint

Which of the following is NOT covered under Plan A in Medigap insurance?

The Medicare Part A deductible

Which of the following does NOT have to be disclosed in a long-term care (LTC) policy?

The aggregate amount of premiums due

Which of the following is NOT a characteristic of a group long-term disability plan?

The benefit can be up to 50% of one's yearly income

Peril is most easily defined as

The cause of loss insured against

In comparison to consumer reports, which of the following describes a unique characteristic of investigative consumer reports?

The customer's associates, friends, and neighbors provide the report's data

How do employer contributions to a Health Savings Account affect the insured's taxes?

The employer contributions are not included in the individual insured's taxable income

In a group policy, who is issued a certificate of insurance?

The individual insured

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

The insured

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

The insurer can increase the policy premium on an individual basis

An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?

The pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one is picking up where the old one left off

An insured makes regular contributions to his Health Savings Account. How are those contributions treated in regards to taxation?

They are tax deductible

What types of services may NOT be provided under the long-term care's assisted living care?

Visits by a registered nurse

All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT?

When the employer chooses the renew the plan

When is the insurability conditional receipt given?

When the premium is paid at the time of application

What is the maximum fine for each violation of the Utilization Review Act, provided the violation was deliberate?

$15,000

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay?

$5,000

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

$900

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

10 years

Individuals who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their adjusted gross income?

10%

It is considered to be an unfair trade settlement practice if an insurer fails to acknowledge communications with respect to an insurance claim within?

15 days of receipt

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

15-day waiting period/10-year benefit period

If an insurer believes that inaccurate or misleading information was provided in the policy's application, it may contest a claim within how many years?

2 Years

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

3 Days

A director denies a license application. 15 days later, the applicant notifies the Director that he wants a hearing to be conducted regarding the decision. Within how many days must the hearing be held?

30

Assuming that a child is unmarried and does not attend school on a full-time basis, children are considered to be dependent until age

30

The director denies an application, and the applicant requests a hearing to contest the decision 25 days later. Within how many days must the hearing occur?

30

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

30 Months

What is the elimination period for Social Security disability benefits?

5 Months

How many outpatient treatment visits must be included in coverage for alcoholism during the lifetime of the policy?

60

Where would Long-term care services be rendered?

A nursing home or one's own home

Which of the following losses will be covered by a group medical expense policy?

A pre-existing condition

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

All providers will have the same coverage options and conditions for each plan

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?

An individual who was previously covered by group health insurance for 6 months is eligible