Practice Exam 1

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 Insurer

The relation of earnings to insurance provision allows the Insurance company to limit the Insured's benefits to his/her average income over the last

24 months

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

Exclusions

No long-term policy may contain provisions that are less than

Guaranteed renewable

An insurance company that routinely ignores all letters and phone calls from insureds that have filed claims is

Guilty of an unfair claim settlement practice

What is NOT provided in an institutional setting?

Home health care

When would a misrepresentation on the insurance application be considered fraud?

If it is intentional and material

If an insurer violates a state regulation for long-term care policies, what is the maximum fine the insurer may have to pay?

3 times the amount of commissions paid on each policy in violation

What is the maximum age for qualifying for a catastrophic plan?

30

Long-term care policies MUST cover

Alzheimer's disease

An applicant for a health insurance policy returns a completed application to her agent along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point?

Neither approved the application nor issued the policy

Do Medicare supplement insurance policies cover the cost of extended nursing home care?

No

If an individual needs skilled care, does long-term care coverage allow an insured to receive care at home?

No

Can a group that is formed for the sole purpose of obtaining group insurance quality for group coverage?

No the group must be formed for a purpose other than obtaining group insurance

The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called

Nonoccupational coverage

The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility home health care and hospice care is know as

Part A

What is not covered by Part A of Medicare?

Physician's and surgeon's services

An insured want to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The Insured should her named as what type of beneficiary?

Revocable

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

The insured

What is the purpose of coinsurance provisions?

To help the insurance company to prevent over-utilization of the policy

Which of the following determines whether disability insurance benefits are taxed?

Whether the premiums were tax deductible

A Specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits

deductible

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

5 days

The Director may refuse to issue a license if a licensee's aggregate amount of premiums on controlled business exceeded the aggregate amount of premiums on all other insurance business during

2 calendar years immediately preceding the extension date of the license

What is the maximum probationary period under a sickness policy?

6 months

A person is in the process of becoming permanently licensed as a producer. A temporary producer's license may be issued for a maximum period of

90 days

Which of the following is an example of a producer's fiduciary responsibilities?

A producer promptly forwarding premiums to the insurance company

Which statement accurately does describes the Changed of Beneficiary provision?

Any policy that has a death benefit must also have a Change of Beneficiary provision

The Director issued a written notice about a hearing for a business entity. The hearing is scheduled for May 1st. The affected business entity should receive the notice no later than

April 20th

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force

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

Attending physician

An insurer publishes intimidating brochures that portray the insurer's competition as financially and professionally unstable. Which of the following best describes this act?

Illegal under any circumstances

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 insure. The producer could be found guilty of

Defamation

Applications for policies advertised by what method must include a statement announcing that the policy excludes pre-existing condition coverage?

Direct response

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

What is NOT a benefit of a POS Plant?

It allows guaranteed acceptance of all applicants

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

Join the group after the effective date

Can a producer's license be reinstated within 24 months without having to pass a written exam?

No

In the event a licensed producer dies, a temporary license will be issued to the deceased producer's representative. This temporary license will allow the license to perform all of the following acts EXCEPT

Solicit Insurance

In order for a firm to maintain it registration as a legal insurance company, what must it do?

Submit a biennial fee to the Director

Disclosure requirements for Medicare Supplements do not include this

The advertisement may apply affiliation with the Medicare program

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

Which of the following entitles determines who can receive a Limited Lines Producer License?

The company that the person represents

Anytime more than 50% of the total premiums collected by a producer comes from themselves, his of her spouse, employed of own business

controlled business