Life and Health Exam

In order to safeguard the insured from paying an unreasonable amount, many major medical policies contain an out-of-pocket

.health care expenses payable by the insured.

The Pennsylvania Insurance Department is responsible for all of the following EXCEPT

.shareholders.

Rob, Joe, and Mike are brothers who have a $60,000 "first-to-die" joint life policy covering all three of their lives. If Joe dies first, the policy

.will not provide further insurance protection.

Falsifying the terms, benefits, advantages, or conditions of an insurance policy is an example of which of the following?

Misrepresentation

An insurer may take an applicant's marital status into account when determining:

Who is eligible for dependent coverage

A consumer is purchasing an annuity resulting from a recommendation. An insurance producer shall make reasonable efforts to obtain the financial condition tax status, and investment objectives of the consumer

prior to the purchase

The PRIMARY purpose of respite care is to

provide temporary relief to the patient's primary caregiver

Six years after a disability policy was issued, an insured changed occupations from less hazardous to more hazardous and failed to notify the insurer. Under the Change of Occupation provision, if a claim is filed the insurer will

reduce the benefit to an amount the actual premium paid would have purchased at the more hazardous occupation,

If the application is made part of the policy, the policy shall contain a provision that the statements in the application, in the absence of fraud, are considered

representations.

The amount of insurance provided by a variable life insurance policy depends upon the investment experience of the insurer'e

separate accounts.

An individual who is NOT acceptable by an insurer at standard rates because of health, habits, or occupation is called a

substandard risk.

An insurance producer is appointed to transact insurance on behalf of

the appointing insurer

An intentional false written or oral statement made by a producer for the purpose of replacing an existing policy to the detriment of the insured is

twisting.

Nancy purchased a life insurance policy with a face amount of $250,000. Over a period of years, the cash value in the policy accumulates to $50,000, and the face amount of the policy has become $300,000. This is an example of a

universal life policy.

A reason for using consumer reporting agencies to gather information about insurance applicants is to obtain

verifiable information at little expense to the insurer.

Medicare Part B pays what percent of approved charges for physician and surgeon services?

.80

As a form of level premium permanent insurance, ordinary life insurance accumulates a reserve that eventually

.equals the face amount of the policy.

The insured and the primary beneficiary of a life insurance policy were in a car together when they were involved in an accident. The insured was killed instantly and the beneficiary died 10 days later. Which policy provision will protect the rights of the contingent beneficiary to receive the policy benefia?

Common disaster clause.

A life annuity ceases payments to the annuitant at

death

In Pennsylvania, the first year sales commission payable for long-term care insurance cannot exceed

50% of the first year premium

Misrepresenting pertinent policy provisions relating to coverage after a loss is:

A concealment in insurance applications

The securities component of index whole life insurance is considered which of the following? A.An effective hedge against inflation. B. A recommended approach for higher earnings. C.A less expensive manner for obtaining whole life insurance. D.A way of reducing taxes on earnings from a whole life policy.

A.An effective hedge against inflation.

The responsibility for regulating the insurance continuing education requirements and approving insurance continuing education courses of instruction belongs to the A.Pennsylvania Insurance Commissioner. B.Pennsylvania Department of Education. C.Guaranty Association Board of Directors. D.National Association of Insurance Commissioners.

A.Pennsylvania Insurance Commissioner.

The Pennsylvania Insurance Commissioner is empowered to A.set rates for insurance coverages in Pennsylvania. B.pass state laws relating to insurance in Pennsylvania. C.write policy forms for insurance coverages in Pennsylvania. D.examine the affairs of any person engaged in the business of insurance in Pennsylvania

A.set rates for insurance coverages in Pennsylvania

Prior to annuitization, what is the nonforfeiture value of an annuity?

All premiums paid, plus interest, minus any withdrawals and surrender charges.

An insurer would consider which of the following in determining whether to accept a group life plan

Average age

The purpose of the spendthrift clause in a life insurance policy is to A.determine the order of death if the insured and beneficiary die in the same accident. B. prevent creditors of a beneficiary from claiming any future death benefits payable to the beneficiary. C.allow the insured to directly pay death benefit proceeds to a creditor. D.establish the payout of death benefits if the primary beneficiary dies before the contingent beneficiary

B. prevent creditors of a beneficiary from claiming any future death benefits payable to the beneficiary.

A producer's underwriting duties include which of the following? A.issuing the policy B. setting premium amounts C.declining or accepting an application D.completing applications and collecting initial premiums

B. setting premium amounts

The two perils in health insurance are accident and A.loss. B.sickness. C.liability. D.job-related injury.

B.sickness.

The MAJOR factor in determining the benefit amount paid under a disability income policy is A.occupation. B.wages. C.age. D.gender

B.wages.

The Commissioner may take disciplinary action against a licensee for any of the following reasons EXCEPT:

Being convicted of a summary offense

An insurance producer who makes an agreement that unreasonably restrains the business of insurance may have violated regulations against

Boycott, coercion and intimidation

The purpose of a coordination of benefits provision is to A.allow participants to choose benefits. B.avoid claims overpayment. C.determine the amount of the claim. D.duplicate benefits of two plans.

C.determine the amount of the claim.

Though an individual's producer contract does not specifically address his practice of providing clients with insurance advice, his power or authority to do so is considered A.apparent. B.express. C.implied. D. Inherent

C.implied.

The process by which an insurer decides to whom to issue a policy is known as A.adverse selection. B.risk classification. C.assignment. D.underwriting

D.underwriting.

Sometimes when there is ambiguous wording in an insurance contract, the courts may rely on what doctrine to determine it coverage applies?

Doctrine of reasonable expectations

An applicant purchases a life insurance policy to avoid the forced sale of assets upon his death. What is this action called?

Estate conservation

In contracts, which of the following describes the term consideration?

Exchange of something of value.

A cease and desist order issued against a producer:

Prohibits a specific practice listed in the order

An individual buys an annuity that will pay her spouse an income for 20 years. If the spouse dies within that time, the income will be the remainder of the period. What kind of annuity did the insured buy?

Temporary annuity certain

A temporary insurance producer's license may be issued without examination to:

The executor of the estate of a deceased licensed insurance producer

No active insurance license will be revoked until:

The producer has been afforded the right to a hearing on the changes

An annuity that guarantees a given number of income payments, whether or not the annuitant is alive to receive them, is referred to as

a life annuity certain.

Knowingly accepting insurance business from an individual who is NOT licensed to provide that business, can result in

a penalty imposed by the insurance commissioner that may include license revocation.

An illness or disease which is first diagnosed and treated while the policy is in force is considered

a preexisting condition.

A single deductible applying to both medical and dental insurance coverages is referred to as

a scheduled deductible.

A licensee who collects money from an insured and holds it for payment to the insurer is

acting in a fiduciary capacity

An immediate annuity begins making payments after the

first premium has been paid

A group health insurance Certificate of Coverage is

given to the employee as proof of coverage.

Each application for long-term care insurance shall contain clear and unambiguous questions to determine the health condition of the applicant EXCEpT applications for

guaranteed issue

A producer who offers a potential insured $50 from their commission as an incentive to buy insurance is guilty of

inducement.

According to the provision Conformity with state statutes, what must an insurer do if state statutes change, and as a result, one of its policies conflicts with those statutes?

insured under the policy to remain or to change to a new policy that meets the new statutes

An annuitant dies during the accumulation period. What happens to the cash in the annuity?

it is paid to the beneficiary

Competency of an individual to enter into an insurance contract is determined based on

payment of premium,

The cost of a long-term care policy is based on all of the following EXCEPT

personal income.

A document that specifies the most important provisions of a purchased policy is known as a

policy summary

Group disability benefits are tax free to the insured when the

premiums are paid by the recipient.

Each of the following are characteristics of a fixed annuity contract EXCEPT

.funds are invested in a separate account.

The types of life insurance generally used to cover key employee indemnification are

A.universal, term, and whole life insurance.

A temporary producer license can be issued in any of the following circumstances EXCEPT

any circumstance the commissioner deems to be in the public interest.

A producer's actions or deeds demonstrate what kind of authority?

apparent

Shari receives monthly income from her life annuity. If Shari dies 36 months after the monthly annuity payments begin, the balance of the annuity fund if

awarded as a lump sum to the estate of the policyowner.

The settlement option that pays a specified amount to an annuitant, but pays no residual value to a beneficiary is know as

D.life income

Companies issue preferred risk policies with reduced premiums with the expectation of

better than normal mortality experience.

Sally has named her daughter, Martha, as beneficiary on her $100,000 life insurance policy. In order to change the beneficiary she is REQUIRED to get Mother's signature. What kind of beneficiary designation is this considered?

. Irrevocable

In a hospital indemnity plan, an elimination period refers to the number of days

. an insured must wait before becoming eligible to receive benefits for each hospital stay

Sarah is insured under a $100,000 10-year level term life insurance policy. If Sarah dies during the third year of the policy period, her beneficiaries will receive

.$100,000

EXCEPT for fraud, what is the time limit after issue for an insurer to deny an individual health insurance claim based on material misrepresentation in the application for the insurance?

.1 year

Long-term care insurance is any insurance policy or rider designed to provide coverage for a MINIMUM benefit period of

.1 year

In Pennsylvania, when an accident and health policy requires payment of a specific premium or subscription fee to provide coverage for a newborn, how many days after the birth is the payment due?

.60

In determining whether a pre-existing condition applies, the enrollee CANNOT have more than how many days' gap in Health insurance?

.63

The levels of coverage defined in the Affordable Care Act are A.HMO, EPO, POS, and PPO. B.Bronze, Silver, Gold, and Platinum. C. Individual, Parent-Child, Spousal, and Family. D.Child Only, Limited Benefit Plan, Catastrophic, and Major Medical

.Bronze, Silver, Gold, and Platinum.

An insured owns a Whole Life insurance Policy on himselt. He would also like coverage for his son. One way the insured can accomplish this goal is to purchase a

.Child Term Rider.

For the insured, what changes are made to both coverage and premiums under the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage in comparison to the original group coverage?

.Coverage and premium expenses remain the same.

The federal law that requires insurance companies to explain their information-sharing practices to their customers is the

.Gramm-Leach-Bliley Act.

An alternative to a life settlement is

.an accelerated death benefit rider

Making a statement that is false or maliciously critical of the financial condition of an insurer is known as

.defamation.

The additional tax penalty for withdrawals from a qualified plan before age 59 1/2 is not waived for

.distributions for a first new home.

An individual with disability insurance suffers an injury and becomes disabled. The disability benefits do NOT begin for 30 days after the accident. This time period is known as the

.elimination period

Generally, rates charged for insurance may NOT be

.excessive, inadequate, or unfairly discriminatory.

For licensing purposes, the producer's principal place of business or residence in any state determines the producers

.home state.

After the hearing, if the Insurance Commissioner has determined a licensee has committed a violation of Pennsyivania Insurance Laws, what can the insurance Commissioner do?

.impose an administrative penalty

An insurer MUST offer a Long-Term Care Policy or certificate that

.is subject to post claims underwriting.

Failure to fulfill the continuing education requirements of Pennsylvania insurance laws will result in a C.license revocat

.license revocation.

An insurance producer may NOT withdraw funds from a premium trust account to

.pay claims to an insured

Medicare supplement policies are provided by

.private insurers.

The Pennsylvania Insurance Department has both the right and the duty to complete which task in regards to licensed insurers

.provide financial rehabilitation

In Pennsylvania, a Long Term Care policyholder has the right to return the policy for a refund of the premium within how many days of he policy deliver

30

in Pennsylvania, group and individual health insurance policies shall provide coverage for mammographic examination for women at what age?

40 years

The primary purpose of the Fair Credit Reporting Act is to A.forewarn an insurer about an applicant's recent bankruptcy. B.protect consumers from insurers who have filed for bankruptcy. C.protect consumers with guidelines regarding credit reporting and distribution. D.alert insurers regarding applicants who may have poor credit histories and may be adverse risks

alert insurers regarding applicants who may have poor credit histories and may be adverse risks

A primary advantage of a limited payment policy over a continuous premium whole life policy is that a limited payment policy

allows the policyowner to pay for the policy in a shorter period of time.

A life insurance policy's double indemnity provision would apply when the policyowner's death occurs due to

an accident

An insurance producer shall NOT act as a representative of an insurer until that producer has become

an appointed producer of that insurer

A type of annuity that provides a guaranteed accumulation or payout is called

annuity certain.

The dividend option where the insurer issues the policyowner a check for the dividend amount is called a

cash dividend option.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allows an employee to

continue group medical insurance by self-paying the premiums after employment has been terminated.

Dividends are NOT subject to taxation because they are

equivalent to returning a premium.

An insurance producer is required to report all of the following EXCEPT

failure to pay property tax

A contract will be deemed invalid if

one party was declared not competent

Individual disability income policies usually limit the monthly benefit to a percentage of an insured's income to reduce

over insurance.