EXAM FX mistakes
Which of the following is NOT a power held by the commissioner?
Set the premium rates for insurance sold in this state
All of the following individuals may qualify for Medicare health insurance benefits EXCEPT AA person age 45 who has a permanent kidney failure. BA person under age 65 who is receiving Social Security disability benefits. CA retired person age 50. DA healthy person age 65.
A retired person age 50.
Which type of care is NOT covered by Medicare? ARespite BHospital CLong-term care DHospice
Long-term care
When may HIV-related test results be provided to the MIB?
Only if the individual is not identified
Medicare Part A services do NOT include which of the following? AHospitalization BHospice Care COutpatient Hospital Treatment DPost hospital Skilled Nursing Facility Care
Outpatient Hospital Treatment
Which of the following is true regarding the cash value in term life insurance policies?
There are no cash values.
In order to get a nonresident license is this state a producer must
apply and pay a fee to a non-resident state that reciprocates.
What is the purpose of a gatekeeper in an HMO?
controlling costs
In a disability policy, the probationary period refers to the time
during which illness-related disabilities are excluded from coverage.
which one of the following is an eligibility requirement for social security disability income benefits?
fully insured status.
Which of the following is NOT a medicaid qualifier? a residency b insurability c income level d age
insurability
AN insurer uses MIB reports for all of the following EXCEPT
justifying denial of policy
which of the following acts allows an individual to switch from one group health plan to another while applying shorter waiting periods for pre existing conditions?
medicaid
A producer who failed to comply with state continuing education requirement is guilty of a
misdemeanor
all of the following are true regarding rebates EXCEPT
rebates are allowed if its in the best interest of the client.
what is the purpose of a benefit schedule?
schedule of benefits
An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA
within 60 days.
an individual recently lost her job. she intends to convert her group policy to an individual policy. in order to avoid proving insurability, the coverage must occur within
31 days
What is the max number of employees allowed in order to qualify in a group policy?
50 employees
After an insurance company exam, the commissioner must file a written report within how many days?
60 days
An insured suffered a loss. in order to avoid her having a claim denied, she must submit written proof of loss within
90 days - 1 year
which type of policy would be used to cover the property insurance needs of a business?
Businessowners
what is the purpose of the impairment rider in a health insurance policy?
EXCLUDE coverage for a specific impairment.
Which type of insurance is based on mutual agreements among subscribers?
RECIPROCAL insurance
A company created a defective product. Which of the following terms describes the company's legal responsibility
Strict Liability (doesn't depend on actual negligence or intent to harm)
the uniform provision law that prevents an insurance company from altering its agreement with a policyholder by referring to documents from altering its agreement with a policyholder by referring to documents or other items not contained in the policy is called
entire contract provision
All of the following are characteristics of group health insurance plans EXCEPT
The parties that hold a group health insurance contract are the employees and the employer.
An insurance form that requires a claim to made during the policy period if it is to be covered by the policy is called a
claims-made Form
Which of the following is NOT a feature of a variable life insurance policy
nonguaranteed death benefit
An agent who knowingly misrepresents material information for the purpose of inducing an insured to lapse, forfeit, change of surrender a life insurance policy of annuity has committed an illegal practice known as:
twisting
What is the maximum fine for insurers who allow producers to transact insurance for them without appointments
$25
For how many days of skilled nursing facility care will Medicare pay benefits? A100 B30 C60 D90
100 days
If a person is disabled at 27 and meets social security's definition of total disability, how many work credits must he/she have earned to receive benefits?
12 credits
According to the time limit on certain defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny claim after the policy has been in force for a minimum of how many years?
2 years
If license is revoked an applicant may not apply for another license for another
2 years
what is the maximum age for a catastrophic plan?
30
How long is the free look in medicare supplement insurance policy?
30 days
how long is an open enrollment period for medicare supplement policies
6 months
Under the mandatory uniform provision Legal Actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to
60 days after written proof of loss has been submitted.
All of the following are true regarding worker's compensation except a) A worker receives benefits only if the work related injury was not his/her fault. b) Workers compensation laws are established by each state c) All states have workers compensation d) Benefits include medical, disability income, and rehabilitation coverage.
A) A worker receives benefits only if the work related injury was not his/her fault.
which of the following statements is NOT true regarding health insurance policy provisions.
All additional provisions written by insurers are cataloged by their respective states.
All of the following qualify for Medicare Part A EXCEPT AAnyone who is willing to pay a premium. BAnyone that qualifies through Social Security. CAnyone who is at the end stage of renal disease. DAnyone who is over 65, not covered by Social Security, and is willing to pay premium.
Anyone who is willing to pay a premium.
An applicant gives her agent a completed application and the initial premium. What can the agent issue her that acknowledges the initial premium payment.
Conditional Receipt
Which of the following is not a Mandatory Uniform Provision?
Conformity with State Statute & waiver of premium
All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT APrescriptions might be covered, unlike Medicare. BHealth care costs can be budgeted. CThere are no claims forms required. DElective cosmetic procedures are covered.
Elective cosmetic procedures are covered.
The guaranteed purchase option is also referred to as the
Future increase option
Which of the following is NOT a cause of loss form for commercial lines insurance?
General
Medicaid provides all of the following benefits EXCEPT AEyeglasses. BFamily planning services. CIncome assistance for work-related injury. DHome health care services.
Income assistance for work-related injury.
which of the following is NOT true regarding a noncancellable policy? a. insured has the unilateral right to renew the policy for the for the life of the contract and may discontinue paying premiums to cancel it. b. Insurer can increase the premium above what is stated in the policy if claims experience is greater than expected. c. Insurer cannot cancel the policy d. the guarantee to renew coverage usually only applies until the insured reaches age 65.
Insurer can increase the premium above what is stated in the policy if claims experience is greater than expected.
Which of the following statements concerning Medicare Part B is correct? AIt is provided automatically to anyone who qualifies for Part A. BIt pays on a first dollar basis. CIt pays 100% of Medicare's standards for reasonable charges. DIt pays for physician services, diagnostic tests, and physical therapy.
It pays for physician services, diagnostic tests, and physical therapy.
Which of the following statements is NOT correct regarding Medicare? AMedicare Part B provides physician services. BMedicare Advantage must be provided through HMOs. CMedicare Advantage may include prescription drug coverage at no cost DMedicare Part A provides hospital care.
Medicare Advantage must be provided through HMOs.
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? AMedicare Advantage BMedicare SELECT CMedicare Part A DMedicare Supplement
Medicare SELECT
in commercial auto coverage policy, which of the following coverage forms applies to automobile transporting property for a commercial enterprise?
Motor carrier
In surety bonding, whose performance is guaranteed?
Obligor
Regarding the taxation of Business Overhead policies, a) premiums are deductible, and benefits are taxed b) premiums are not deductible, and benefits are taxed c) premiums are deductible, but benefits are deductible. d)premiums are not deductible, but expenses paid are deductible.
Premiums are deductible, and benefits are taxed.
A Medicare SELECT policy does all of the following EXCEPT AProvide payment for full coverage under the policy for covered services not available through network providers. BProvide for continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program. CProhibit payment for regularly covered services if provided by non-network providers. DMake full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare SELECT policy to each applicant.
Prohibit payment for regularly covered services if provided by non-network providers.
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.
HMOs are known as what types of plans
Service
If a basic medical insurance plan's benefits are exhausted, what type of plan will then begin covering those losses?
Supplementary major medical
Who sets standards for persons who act as agents for Nonprofit Health Service Plan Corporations?
The Commissioner
No life insurance policy or certificate may be issued or delivered by an insurer organized in Minnesota until it has been approved by
The insurance commissioner
All of the following statements about Medicare supplement insurance policies are correct EXCEPT AThey are issued by private insurers. BThey cover the cost of extended nursing home care. CThey cover Medicare deductibles and copayments. DThey supplement Medicare benefits.
They cover the cost of extended nursing home care.
If an insured is not entirely satisfied with a policy issued, the insured may return it to the insurance company and receive a refund of the entire premium paid, at which of the following times?
Within 10 days of when the policy was DELIVERED.
Which of the following is not a medicaid qualifier?
insurability
riley reads an agreement on the first page of her policy which includes a list losses that will be covered by her insurer. what is the name of this agreement?
insuring clause
which of the following best describes a major medical expense.
it provides catastrophic medical coverage beyond basic benefits on a usual, customary and reasonable basis.
an applicant for a disability insurance policy has a heart condition of which they are unaware and therefore they answer no to the question pertaining to heart problems on their application. their answer is considered to be a
representation
How soon following an occurrence of a covered loss must an insured submit written proof of loss to the insurance company
within 90 days
An employee has a FSA with $5,000 annual benefit. This year the employee used $3,000. What would be the amount of the benefit available to the employee next year.
$5000 (fsa is use or lose annually)
which one of the following is not covered under long-term care policy?
Acute care in a hospital
All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT
An association of 35 people.
which of the following is NOT an insurer but an organization formed to provide insurance benefits for members of an affiliated lodge or religious affiliation?
Fraternal benefit society.
how long does the insured under the Notice of Claim Provision (a Mandatory Uniform Provision), have to submit a claim?
20 days
Once an individual has passed their licensing exam for how many years are the results valid?
3 years (includes grace)
Which of the following cannot obtain a temporary license?
An employee of a retiring producer until the training of the new personnel is complete.
which of the following statements about occupational vs. non occupational coverage is true?
Disability can be written as occupational or nonoccupational.
an insured's cancelable health insurance policy is being cancelled. one day before the policy is scheduled to end, he is involved in major accident and is hospitalized for a week. which of the following best describes the coverage that he would receive?
Full benefits, as if the policy were still completely in effect.
All of the following are features of catastrophic plans EXCEPT
High Premiums
which of the following riders would not increase premium for a policy owner? a) impairment rider b) payor benefit rider c) waiver of premium d) multiple indemnity rider
Impairment rider
Which of the following is provided by skilled medical personnel to those who need occasional medical occasional medical assistance or rehabilitative care?
Intermediate care
If a dental plan is integrated, it is combined with what type of plan?
Medical
Does HO-4 cover structural damage?
No
If the insurer cancels a health policy that contains an optional cancellation provision, by giving the insured 5 days prior written notice, any unearned premium will be
Returned to the insured on a pro-rata basis
Insureds have the right to do which of the following if they have NOT received the proper claim forms within 15 days of their notice to the insurer of a covered loss under a major medical policy? a) Demand full payment immediately for the claim b) Speak with a claims adjuster or another representative from the insurance company c) Submit the description in their own words on a plain sheet of paper d) be reimbursed any co payment or deductible on the claim.
Submit the description in their own words on a plain sheet of paper.
all of the following would be considered as "limited insurance coverage" EXCEPT
Supplement social security coverage
In which of the following situations would Social Security Disability benefits NOT cease? AThe individual has undergone therapy and is no longer disabled BThe individual's son gets a part-time job to help support the family CThe individual reaches age 65 DThe individual dies
The individual's son gets a part-time job to help support the family
Purpose of a benefit schedule?
To state what and how much is covered in the plan
Guaranteeing future dividends is considered to be an unfair or deceptive act known as ___.
misrepresentation
Which of the following must the patient pay under Medicare Part B? A80% of covered charges above the deductible BAll reasonable charges above the deductible according to Medicare standards CA per benefit deductible D20% of covered charges above the deductible
20% of covered charges above deductible
how many CE credits must be completed within each licensing period
24
Which of the following terms refers to the period of time during which the annuitant makes premium payments into an annuity?
Accumulation period
The state of Minnesota has enacted a plan designed to promote the availability of health insurance to small employers. To be eligible for coverage, which of the following requirements must be met.
Employ 2-50 employees.
Emily, the 10-year-old daughter of Bob, was in an auto accident and sustained injuries that will require her to use a wheelchair for the rest of her life, Bob is applying for health insurance. Which of the following
If the policy is issued, Emily will be covered as a dependent, and coverage related to her disability will not be limited due to pre-existing conditions.
Medicare Part B covers all of the following Except
Long-term care services
Which of the following is NOT covered under Plan A in Medigap insurance? AThe first three pints of blood each year BThe Medicare Part A deductible CApproved hospital costs for 365 additional days after Medicare benefits end DThe 20% Part B coinsurance amounts for Medicare approved services
The Medicare Part A deductible
The state of Minnesota has enacted a plan designed to promote the availability of health insurance to small employers. To be eligible for coverage, which of the following requirements must be met?
The business must employ at least 2 people on 50% of its working days.
What is necessary in order to be eligible to receive benefits from a Long-Term Care policy
The insured must be unable to perform some activities of daily living.
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met? AThere is no benefit provided under Medicare Part A for skilled nursing care. BThe insured must cover daily copayments. CThe insured must have first been hospitalized for 3 consecutive days. DThe insured must have a Medicare supplement insurance policy.
The insured must have first been hospitalized for 3 consecutive days.
how does insurance distribute the financial consequences of individual losses.
it transfers risks to all persons insured
An insurer that holds a Certificate of Authority in the state in which it transacts business is considered a/an
AUTHORIZED insurer
which of the following must be received by the insurer before a claim will be paid?
Proof of loss
what is the purpose of an impairment rider
attachment to an insurance policy that excludes or limits coverage for a specific health impairment. Also called an impairment waiver
which of the following best describes a rebate?
a producer returning part of her commission to her client, as an inducement to buy.
A retail shop owner is insured under a business overhead expense policy that pays a maximum monthly benefit of $2500. His Actual monthly expenses are $3000. If the owner becomes disabled, the monthly benefit payable under his policy will be
$2500
what is the maximum fine for an insurer's who allow producers to transact insurance for them without regulation?
$300
randy loses his full-time job because his role in the company has become obsolete. How long must he be given the option of continuing his group health insurance coverage, provided that he doesn't find coverage somewhere else?
18 months
Health insurance carriers who wish to stop doing business in the small employers market must notify the Commissioner and each small employer how many days in advance?
180 days
should the commissioner request information from a license, they have how many days to comply?
30 days
if a producer transacts insurance without being appointed by that insurer, for all offenses, the insurer will pay
<300
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? A20 B100 C80 D3
20 days
Which of the following statements is CORRECT concerning the relationship between Medicare and HMOs? AMedicare Advantage is Medicare provided by an approved HMO only. BAll HMOs and PPOs charge premiums beyond what is paid by Medicare. CHMOs may pay for services not covered by Medicare. DHMOs do not pay for services covered by Medicare.
HMOs may pay for services not covered by Medicare
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations? AMedicare Part A BPreferred CMedicare SELECT DMedicare Advantage
Medicare SELECT
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as
usual, customary and reasonable.
What is the maximum penalty per offense for transacting insurance without a certificate of authority?
$1,000 ($100 minimum)
an individual is approaching retirement age and is concerned about having proper coverage should he have to be placed in a LTC facility. His agent told him that the LTC policies would provide necessary coverage at all of the following levels EXCEPT
acute
which of the following is the closest name term to authorized insurer
admitted
An insured was diagnosed two years with kidney cancer. she was treated with surgeries and chemotherapy and is now in remission. She also has a 30- year smoking history. The insured is now healthy enough to work and has just started a full-time job. Which is describes the health insurance that she will most likely receive?
She would be covered under her employer's group health insurance plan, without higher premiums
if after a hearing, it is determined that an insurer or producer is violating Minnesota insurance laws, the commissioner will issue
cease and desist order
to be valid, an insurance policy must have all of the following EXCEPT
countersignature
in a homeowners policy, which of the following coverages provides protection against bodily injury and property damage claims against the insured?
coverage E
which of the following homeowners coverage forms applies to condos owners?
Ho-6
What is the purpose of the claims made form?
To allow insurers to determine adequate rates for unknown losses claimed in the future
when an insurer advertise its membership in the minnesota insurance guaranty association
at no time
in group insurance, the primary purpose of the coordination of benefits provision is to
prevent lawsuits between insurance companies involved in the claim.
Under the Payment of Claims provision, to whom will the insured's benefits be paid if the insured is deceased?
primary beneficiary
which of the following is NOT true of Disability Buy-sell coverage?
Benefits are considered taxable income to business
Which of the following kinds of group insurance is designed for groups of people who are exposed to common hazard?
Blanket life
Major Medical expense policy would exclude coverage for all of the follow treatments except
Drug addiction
Which of the following premium modes would result in the highest annual cost for an insurance policy?
Monthly
which of the following provisions states that it is the insured's responsibility to notify the insurer of a loss within a specified number of days?
Notice of Claim
The purpose of the reinstatement provision is...
To determine the process for reactivating coverage once a policy has lapsed.
which of the following is not correct concerning taxation of disability income benefits.
if paid by the individual, the premiums are tax deductible.
when an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. when would this accident be covered upon reinstatement of the policy?
immediately
Concerning Medicare pt. B, which of the statements is incorrect? a) it provides partial coverage for medical expenses not fully covered by Part A b)it is fully funded by social security taxes (FICA) c) it is known as medical insurance d) it offers limited prescription drug coverage
it is fully funded by social security taxes (FICA)
for a contract to be enforceable by law, the purpose of the contract must be
legal and not against public policy.
How soon after a notice of hearing is made may the hearing be conducted?
no less than twenty days
which statement best describes agreement as it relates to insurance contracts?
one party accepts the exact terms of the other party's offer
A producer must file with the secretary of state when
operating under a name other than the producer's legal name.
an insured wants to cancel her health insurance policy. which portion of the contract would explain cancellation rights?
renewability provision
when an insurer examination is ordered by the commissioner, who pays for the cost of examination?
the insurance department