Readiness Exam Questions
Which health insurance provision ensures that multiple policies that provide the same benefits on an expense-incurred basis pay a proportionate share of a claim?
"Other insurance with other insurers" or "Coordination of benefits" provision.
An employee has a flexible spending account with a $5000 annual benefit. This year the employee used $3000. What would be the amount of the benefit available to the employee next year?
$5000
If an insured is injured while committing a crime what percentage of the claim will be paid?
0%
According to the metal level classification of health plans, what percentage of health care costs will be covered under a gold plan?
80%
What is it called when a doctor accepts the Medicare approved amount?
Assignment
In an employee group health insurance plan, the covered employee receives
Certificate of insurance
Which of the following is not a typical type of long-term care coverage
Child day care
Which of the following does not need to be included on the first page of a Medicare supplement policy?
Continuation provision
Under a group medical policy, prescription drugs are:
Covered by the employer and insurer
An employee dies having 6 quarters of coverage during the previous 13 quarter period. What status of coverage does the employee have under social security?
Currently Insured
Whose responsibility is it to ensure that the application for health insurance is complete and accurate?
the applicant
Which of the following is not true regarding an optionally renewable policy?
No renewal can happen on the policy anniversary date
A self-employed stock broker buys an individual disability policy that pays $1500 a month for a year long disability for 1 year. What amount of benefits is taxable?
None
Medicare Part A services do not include:
Private day nursing
An insured wants to cancel her health insurance policy. Which portion of the contract would explain cancellation rights?
Renewability Provision
Which of the following terms relates to disability income insurance?
Residual benefit
An individual was denied coverage under Social Security because his disability did not meet the strict definition of total disability used by social security. Which of the following would provide disability income coverage?
SIS Rider (Supplemental Income Support Rider)
When acting as a field underwriter, a producer is:
Seeking credible information about an applicant for health insurance
HICs are known as what type of plans?
Service Plans
What does the application of contract of adhesion mean?
Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured
Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care?
Skilled care
If an applicants health is poorer than that of an average applicant, the policy may be issued:
Substandard
Which of the following are considered activities of daily living in most long term care policies?
Eating and Dressing
The uniform provision law that prevents an insurance company from altering its agreement with a policy holder by referring to documents or other items not contained in the policy is called the:
Entire contract provision
Under the affordable care act... maternity, pregnancy and preventive care services are considered:
Essential
Which of the following is not considered a basic service under a health insuring corporation (HIC)?
Experimental infertility services
Care can be administered for a medical plan except:
Eye centers
In order for an alumni association to be eligible to purchase group health insurance for its members, all of these statements must be true except:
Has been active for five years minimum
Which account allows carry over
Health Savings Account (HSA)
An insured driver is involved in an accident in which he is disabled and his passenger and the other driver are injured. Which of the following will be covered by his disability income policy?
His lost income
In order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to all of the following except:
Increase benefits for a period of one year
What type of hospital care would a Health insuring corporation cover?
Inpatient hospital care
Which of the following in not true regarding a non cancellable policy?
Insurer can increase the premium above what is stated in the policy if claims experience is greater than expected.
Medicare Part B covers all of the following except:
Long-Term Care Services
Which of the following would be excluded from supplementary benefits under a Medicare advantage plan?
Meals
What Medicare part would a Medicare savings account fall under?
Medicare Part C, also known as Medicare Advantage.
A person has a history of DUIs l. To his insurer, this presents what type of hazard?
Moral
Who determines if a particular group of employees can be excluded from group health coverage?
The employer
Which of the following is a requirement for replacement of health policies?
The old policy must stay in force until the new policy is issued.
An insured recently received his major medical insurance policy. Only 20 days after the policy issue, while recreational rock climbing, the insured suffered a fall that requires hospitalization, surgery and physical therapy to repair his broken leg. Which of the following one is true?
The plan will not cover the expenses due to the hazardous avocation
An agents first year commission cannot exceed what percentage of the renewal commission for servicing a Medicare supplement policy in its second year?
100%
A core Medicare supplement policy (Plan A) is will cover the following expenses except:
20% of Part B Coinsurance amounts for Medicare approved services
An agent moves from an apartment to a new house in the same city. The agent must notify the director of the address change with how many days?
30 days
How much of a business must an employee own at any time in the year to be considered a highly-compensated employee?
5%