Test Questions
All employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
$102
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
The commissioner must examine every domestic insurer at least once every
5 years
How is emergency care covered for a member of an HMO?
A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area
Under which condition would an employee's group medical benefits be exempt from income taxes?
An employee's group medical benefits are generally exempt from taxation as income
What coverage, written in conjunction with hospital expense policies, covers surgeons' fees, anesthesiologist, and the operating room?
Basic Surgical Expense
All of the following are true of the Key Person disability income policy EXCEPT
Benefits are considered taxable income to the business
Which of the following provisions requires that any policy language that is in conflict with the state statutes of the state in which the insured resides is automatically amended to conform with those of the state of residence?
Conformity with State Statutes
Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as
Contracts of adhesion
The purpose of managed care health insurance plans is to
Control health insurance claims expenses
All of the following are true about group disability income insurance except
Coverage applies both on and off the job
A licensee decides to terminate his residency in this state. Which of the following would be an appropriate action?
Delivering the license to the commissioner within 30 days
Which of the following is considered a qualifying event under COBRA
Divorce
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.
An insurance company has published a brochure that inaccurately portrays the advantages of a particular insurance policy. What is this example of?
False advertising
Which of the following is correct regarding business overhead expense insurance?
Premiums are tax deductible
What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered?
Probationary Period
Which of the following answers does not describe the principal goal of a PPO
Provide medical services only from physicians in the network
Insurers may change which of the following on a guaranteed renewable health insurance policy?
Rates by class
Who pays the annual agent appointment fees?
The Insurer
Who chooses a primary care physician in an HMO
The individual member
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 definitions would make it easier to qualify for total disability benefits?
The more liberal "own occupation"
How does a member of an HMO see a specialist
The primary care physician refers the member
Under what condition are group disability income benefits received by an employee NOT taxable as income?
When the benefits received are equal or less than the employee's percentage of the contribution
which of the following riders would not cause the Death benefit to increase?
payor benefit rider
When a licensee is accused of any act, omission, or misconduct that would subject the licensee to a license suspension or revocation, with the approval of the commissioner, the license may be surrendered for a period of
Time to be set by the commissioner
Under the L&H Guaranty Association, the maximum benefit one contract holder may receive in benefits, regardless of the number of contracts held, is
$5,000,000
An insured is covered under 2 group health plans - under his own and his spouse's. He has 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 (second company will cover what the first company will not pay, such as deductibles and coinsurance)
If the commissioner is scheduling a hearing for a potential violation of the insurance code, what is the minimum required notice.
10 days
Insurance companies are required to provide proof of loss forms to the claimant within how many days after receipt of notice of loss?
15
After appointing an agent, how long does an insurer have to file with t eh commissioner a notice of appointment?
15 days
The time limit of certain defenses provision prohibits insurers from denying a claim due to misrepresentation, as long as the policy has been in force for at least
2 years
what is the continuing education requirement in Ethics for agents in this state
3 hours every 2 years
An employer responsible for paying part or all of the premium for a group life or group health plan cannot willfully fail to pay the premium without first giving the employees how many days' advance notice?/
45
What is the elimination period for social security disability benefits?
5 months
What is the waiting period on a Waiver of Premium rider in life insurance policies?
6 months
What is the waiting period on a waiver of premium rider in life insurance policies?
6 months
All of the following are correct about the required provisions of a health insurance policy EXCEPT
A reinstated policy provides immediate coverage for an illness.
An applicant for an individual 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
How soon must a newborn child of an insured be covered under an individual or group health insurance plan
From the moment of birth
A father purchases a life insurance policy on his teenage daughter and adds the payor of benefit rider. In which the following scenarios will the rider waive the payment of premium
If the father is disabled for more than 6 months
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
Which of the following allows the insurer to relieve a minor insured from premium payments if the minor's parents have died or become disabled?
Payor benefit
The commissioner is empowered to adopt rules and regulations governing the transactions by all of the following individuals and entities except
Policyholders
Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?
Residual disability
Which of the following special policies covers unusual risks that are NOT normally included under AD&D coverage?
Special risk policy (it covers on the specific hazard or risk identified in the policy, such as a race car driver test-driving a new car)
The regulation of the insurance industry primarily rests with
The State
what is the contract provision that allows the insurer to non-renew health coverage if certain events occur?
conditionally renewable
If an insurer accepts premium payments by credit card, who is responsible for paying the fees charged by a credit card company?
insurer accepting payment
A 37-year old owns a policy with a guaranteed insurability rider. the policyowner would like to increase the benefit amount offered by the policy. what documentation will be required?
no documentation
which of the following is correct regarding the taxation of group medical expense premiums and benefits?
premiums are tax deductible and benefits are not taxed
A father owns a life insurance policy on his 15-year old daughter. The policy contains the optional Payor Benefit rider. If the father becomes disabled, what will happen to the life insurance premium?
the insured's premiums will be waived until she is 21
when employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles?
they carry over from the old plan to the new plan
