AD Banker Chapter 8 Quiz
All of the following could be approved as Long-Term Care facilities, except:
A sanitarium for weight loss
If a premium was not submitted with the application, the producer must deliver the policy and explain the benefits and collect the premium. The policy then becomes the Offer and the premium is the:
Acceptance
This type of coverage is used for replacing the insured's loss of earnings.
Disability income
What do ADLs trigger?
Long Term Care Insurance
A policy issued as a preferred risk will be issued with a:
Lower than standard rate
W has a health insurance policy with an 80/20 coinsurance provision and a $1,000 deductible that is payable each year. If in January W has an outpatient procedure that cost $900, how much will W have to pay, assuming a new deductible must be met?
$900
If an employer has less than ______ employees, Medicare will be the primary payer for those eligible for Medicare.
20
How long is the free look period for a Medicare Supplement policy?
30 days
A qualified Long-Term Care Policy may exclude losses incurred from preexisting conditions for no longer than ______ months from the effective date of coverage.
6
An individual is eligible for a Medicare Supplement as early as age:
65
Generally, an individual is eligible to enroll in Medicare at age:
65
Originally, Medicare was for U.S. citizens age _______ and over.
65
Every LTC Policy that provides benefits of homecare or community-based services shall provide all of the following, except:
Acute care
Overseas foreign travel emergency coverage is a Medicare supplement:
Additional
All of the following practices may never be used when advertising health insurance, except:
Advertising a group's product endorsement, if the insurer has any control over the group
Other than the applicant, which signature is required on an application?
Agent
A long-term care policy can exclude from coverage all of the following, except:
Alzheimer's disease
What type of Long-Term Care policy can be renewable and convertible, and can also be purchased at lower rates than for individual coverage?
An Employer Group Policy
When Harry completed his insurance application, the agent discovered that he was under treatment for a chronic condition. In order to gather the necessary information, Harry's agent ordered a/an:
An attending physician statement
If an individual starts receiving Social Security retirement benefits at age 62, when are they eligible for Part A benefits?
Automatically at age 65
Which of the following terms and definitions do not match?
Blanket insurance -- Insurance that provides payments made daily for a specified number of days
It is determined that Charles, an agent representing the Timely Payment Insurance Company, has misled the consuming public in an advertisement for one of the company's products. As a result of such action, which of the following is true?
Both Charles and the Timely Payment Insurance Company will be held accountable
When an agent misleads the public in an advertisement, ___________are held accountable.
Both the insurer and agent
A person who purchases a Medicare Supplement policy cannot enroll in Medicare Part _________.
C
When insurance advertisements include a comparison of similar accident and health insurance products, which of the following is not a major factor in the comparison?
Cash values
All of the following are exclusions under an LTC policy, except:
Chemical dependency on one's own prescription drugs
All of the following are sources that insurers may look at for information regarding the insurability of a prospective insured, except:
College Degree
If premium is paid at the time of application, the agent will provide the applicant with a:
Conditional receipt
Premium is considered the policyowner's:
Consideration
Upon receipt of an application, the insurer's underwriter may issue the contract with exclusions or limitations. This means that:
Coverage is issued, but there are limits on the insurer's obligation to pay
If questions are incomplete on an application and the insurer issues the policy, a claim is:
Covered since the insurer issued the contract based on an incomplete application
The Medical Information Bureau provides information to the insurer regarding the individual risk of an applicant and does not include:
Credit score
This type of policy covers the treatment and care of the insured's teeth.
Dental expense
Which of the following would be considered a pre-existing condition?
Diabetes
Which of the following products replaces lost income when one is unable to work due to a condition for which therapeutic and rehabilitative care services is often necessary?
Disability Insurance
Field underwriting is very important:
Due to the risk of a moral hazard
The Minimum Benefit Standards under a qualified LTC policy include all of the following, except:
Every LTC policy must be issued as noncancellable
Home Health Care benefits under a LTC Policy may be limited or excluded by:
Excluding benefits for conditions caused by war or acts of war
No insurer or agent may unnecessarily replace a policyholder's Long-Term Care insurance policy or replace it with a policy that offers:
Fewer benefits and a greater premium
___________ is the initial step of the total process of insuring a health risk.
Field underwriting
A long-term care policy typically provides daily benefits?
For 2 years, 5 years, to age 65 or lifetime
When Harold became no longer eligible for coverage under his employer's group benefit program, which of the following statements accurately reflects the conversion privilege defined by his group contract?
Harold had 31 days to convert his policy to an individual plan
All the following qualify for Medicare Part A, except:
Healthy individuals who are under age 65 and not covered by Social Security, but are willing to pay the Part A premium
Part A of Medicare is known as:
Hospital Insurance
Which of the following is not covered by a long-term care policy?
Hospitalization
Medicare benefit payments are made to the medical provider:
If the benefit has been assigned
An applicant determined to have below average risk of loss would be:
Issued a preferred policy
Which of the following is correct concerning an LTC policy?
It may define a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage
Any policy designed to provide coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital is the definition of:
Long-Term Care
What health insurance product is designed to provide coverage for necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital?
Long-Term Care
Howard talks to his agent Jane about buying a critical illness policy from the XYZ insurance company to cover his wife Deborah, and naming his daughter Mary as the beneficiary in case of death. Jane told him that she would need signatures from all of the following, except:
Mary
A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as:
Medicaid
If an individual has limited assets and low income, which of the following would most likely cover the cost of long-term care?
Medicaid
Which statement regarding Medicare is not true?
Medicare is the primary payor to any employer group health plan coverage
The chart that shows the chance of a disability at any given age is called a:
Morbidity Table
This rider will provide paid-up coverage if the insured cancels or lapses the policy due to nonpayment of premium.
Nonforfeiture
Which of the following must be given to consumers under the provisions of the Fair Credit Reporting Act (FCRA)?
Notice of Information Practices
An insurer offering Medicare Supplements to senior clients must:
Offer Core Benefit Plan A if it sells any of the other plans
It is illegal for most telemarketers or sellers to call a number listed _____________.
On the National Do Not Call Registry
In respect to Accident and Sickness Insurance advertising, all of the following are true, except:
Only a comparison of benefits is required when insurers advertise by comparisons of like products
Which of the following is not provided under Part A of Medicare?
Outpatient Hospital Treatment
Which statement is incorrect concerning Part B of Medicare?
Part B covers prescription drugs up to $1,500 annually
A specified period that must elapse before new coverage goes into effect for a given condition is known as which of the following?
Probationary period
Company expenses to issue and administer a policy include all Refund of unearned premiumof the following, except:
Refund of unearned premium
Which Long-Term Care definition does not match the coverage?
Residential Care -- Health care provided in one's home under a planned program established by his/her attending physician
Which type of LTC coverage is designed to provide relief for the primary caregiver of a long-term care patient?
Respite Care
Which of the following exclusions applies to Long-Term Care coverage?
Rest Cures
If an individual is age 65 or over and continues to work, Medicare is usually the _________ insurer to any employer group health plan the individual participates in.
Secondary
Long-Term Care policies may not be written as which of the following?
Short-term policies
Accidental Injury is a:
Sudden, unexpected and unforeseen event
The Initial Enrollment Period for Medicare is 7 months in length. Which of the following are the start and stop dates for this period?
The 1st day of the 3rd month before the individual turns age 65 and the last day of the 3rd month after the month the individual turns age 65
Which of the following items does not become part of the insurance contract as defined in the entire contract clause?
The agent's report
What is the primary source of underwriting information for an individual health insurance policy?
The application
Randy has a preexisting condition for which coverage has been excluded since his Medicare Supplement Policy became effective 4 months ago. If Randy were to replace his Medicare Supplement Policy, what could be said about the preexisting condition under the new policy?
The exclusion will be waived to the extent it has already been satisfied under the original policy
Anna is seeking a Medicare Supplement Policy. An agent has explained that all supplements must contain some of the same items. Which of the following is false?
The insurer has the option to provide a Buyer's Guide and an Outline of Coverage
When it comes to underwriting a health insurance policy, and HIV or AIDS:
The insurer must approach the topic in a way that avoids unfair discrimination
If an employee is age 65 and still working, which of the following statements is correct?
The older employee must be offered the same benefits as younger employees
All of the following statements are true regarding Long-Term Care policies, except:
They must require prior confinement in a hospital as a condition for payment
The agent's primary underwriting role is:
To make sure the application provides the proper information
Which is true regarding the advertising of Accident and Sickness Insurance?
When insurers advertise that a group endorses a certain health product, the public must be made aware of any control the insurer may have regarding the group
Which of the following accidents would not be covered under the terms of a policy using 'accidental means' to define a covered loss?
Zachary breaks his ankle when he tries to jump aboard a street trolley that has already started moving
A premium is paid at the time of application and a conditional receipt is issued. If the policy is issued as applied for, coverage becomes effective:
the date of the conditional receipt