Health

For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?

Loss of eyesight due to an accidental injury

An insured is covered by Workers' Compensation and a group Major Medical plan. Which of the following statements BEST describes how a claim would be handled if the insured were injured on the job?

Major Medical would be applied first, less any deductible and the coinsurance amount, and workers' Compensation would cover the balance of the medical expenses

An insured is covered by Wokers' Compensation and a group Major Medical plan. Which of the following statements BEST describes how a claim would be handled if the insured were injured on the job?

Major Medical would be applied first, less any deductibles and the coinsurance amount, and Workers' Compensation would cover the balance of the medical expenses

A full-time employee who is suffering from chronic kidney failure and requires dialysis is eligible for medical coverage under which of the following plans?

Medicare

An insurance company MUST do which of the following to properly terminate a producer's appointment?

Notify the producer of the termination at least 30 days before the effective date of termination

The legal term that permits an insurance company to transact business in Mississippi is called a certificate of

authority

Dental care indemnity plans

reimburse services only after the carrier receives a bill

Most insurance companies use the usual, customary, and reasonable (UCR) charges to

reimburse the employee for expenses charged by the medical facilities

If a producer allegedly committed an unfair marketing practice the Commissioner of Insurance MUST

schedule a hearing before imposing any penalties

Under a Disability policy the Elimination period is

similar to a deductible but expressed in terms of time rather than dollars

Insurance company employees MUST be licensed if they

solicit potential clients for producers

The Commissioner of insurance MAY examine the records of an insurance company in order to determine the

solvency of the company

The purpose of the Insuring clause in an Accident and Health policy is to

specify the conditions under which benefits are payable

Failing to complete the maximum continuation education requirements established by regulations can result in

suspension of license

P received a $2,000 benefit from an employer-paid Disability Income policy. The tax status of this benefit makes the $2,000

taxable to the employer

Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?

Add a newborn child to the policy without providing proof of insurability

Which of the following Long-Term Care insurance plan designs allows only days on which the insured receives paid care to count toward the Elimination Period?

Calander day design

A type of health contact that allows the remaining partners in a business to buy in a business to buy out the interest of a disabled business partner is known as

Disability Buy-Sell

Which of the following conditions is typical of a Major Medical policy?

It contains a deductible and coinsurance

Which of the following is CORRECT about Medicare?

It is a hospital and medical expense insurance program

Which of the following statements is generally CORRECT about a major medical policy?

It provides benefits for reasonable and necessary medical expenses, subject to policy limits

Which of the following statements about a Dismemberment provision in a health insurance policy is CORRECT?

It provides benefits for the loss of specific part of the body

Which of the following statements is CORRECT about the Medicaid program?

It provides medical assistance for participants who are blind

The Time of Payment of Claims provisions states that the intervals between Disability Income Benefit payments may NOT exceed

one month

The primary purpose of the Life and Health Insurance Guaranty Association is to

pay legitimate claims filed against liquidated insurance companies

An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:

pay the claim but deduct the unpaid premium

Basic cancer plans pay for all of the following EXCEPT

physical therapy

To enroll in Medicare Part C, an individual must

already be enrolled in Medicare Parts A and B

An insurance company formed under the laws of Cananda would be known in Mississippi as

an alien company

The Fair Credit Reporting Act requires that

applicants be advised that a consumer report may be requested

The Commissioner of insurance has the authority to impose which of the following penalties on a producer who has violated insurance law?

A monetary fine

Which of the following situations describes a representation?

A prospect's statement on an application that is held to be substantially true

As defined for Social Security benefit purposes, disability is the inability of an insured to be gainfully employed because of a medically determined physical or mental impairment that has lasted or may be expected to last at LEAST how long?

6 months

A doctor who is receiving Disability Income benefits is not able to return to work full-time but continues practing

A Residual Benefit clause

A $100,000 group Accidental Death and Dismemberment policy will pay double indemnity if the insured dies in a commercial airplane crash. If the insured is killed when flying to a business meeting on a commercial flight, the policy will pay a MAXIMUN of

$200,000

An insured is hospitalized for 2 weeks and receives a bill for $2,100. The insured has a Major Medical Policy with a $100 deductible. The Coinsurance is 80/20, figured after reducing the bill by the deductible amount. The insured is expected to pay a total of

$500

If a person whose application for a license was denied request a hearing, the Commissioner of Insurance must hold the hearing within a MAXIMUM of how many days after receipt of the request?

30

A licensee MUST notify the Commissioner of insurance by any means acceptable of an address change within

30 days

The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured's age on the policy application?

Adjust the benefits

A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD&D) policy. In this situation, the producer should take which of the following actions?

Answer the routine application questions, meet with the prospect to obtain any additional information, and have the prospect sign the application

Which of the following kinds of policies typically contain a limited daily room and board benefit and provides coverage on an in-hospital basis only?

Basic Hospital

Social Security provides all of the following types of benefits EXCEPT

Dismemberment

A benefit that is NOT included as one of the ten Essential Health Benefits is

Elective Surgery

The policy provision that prevents an insurance company from altering its agreements with a policyowner by referring to documents or other items not contained in the policy is called the

Entire Contract provision

An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event of being disabled should purchase which of the following riders?

Guaranteed Insurability

Benefits for treatment of which of the following conditions would commonly be EXCLUDED in a Major Medical policy?

Intentionally self-inflicted injuries

A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?

Pay full benefits

The statement that an insured MUST give an insurance company to show that a loss actually occurred is a

Proof of Loss

Which of the following provisions establishes a procedure for restoring a policy after it has lapsed because of nonpayment of premium?

Reinstatement

Which of the following information is included in the Consideration clause in an Accident and Health policy?

Schedule an amount of premium payments

A producer has taken an application for an individual Disability Income policy, collected a premium, and given the applicant a conditional receipt. Which of the following statements is CORRECT about this situation?

Since the producer collected a premium when taking the application, the insured is guaranteed coverage as of the date of the application

After the expiration of COBRA or State Continuation laws, which of the following statements is CORRECT about an employee who quits the job and wants to convert the group accidental and health coverage to an individual policy?

The employee has a maximum of six months to convert

Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?

The insured may periodically increase the amount of benefits payable under the policy

A prospect submits an Accident and Health application with the premium and receives a conditional receipt. The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of the following statements is CORRECT about this situation?

The policy is in force

Which of the following statements about a policy delivery is CORRECT?

The producer should explain the policy to the insured to increase the chance that the insured will understand the policy's benefits and keep it

A producer submits an application to an insurance company without the initial premium. If the company issues the policy, the producer should promptly deliver the policy and collect the initial premium for which of the following reasons?

The prospect does not have coverage until the policy is delivered and the premium is paid

Which of the following statements is CORRECT about the benefits of a group Short-term Disability Income policy?

They are payable when expenses exceed Workers' Compensation benefits

Under an Accidental Death and Dismemberment policy, in which of the following circumstances will an autopsy NOT be performed?

When it is prohibited by law

A producer must deliver an Outline of Coverage to a prospective insured who is eligible for Medicare at which of the following times?

When the policy is delivered

Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member

ceases to fall within the eligible classifications

Under federal law, a tax except Health Savings Account can only be opened for an individual who is

covered by a qualified High Deductible Health Plan

Benefits produced under Long Term Care policies must be related to long-term treatment of or expenses incurred by all of the following conditions EXCEPT

death

Group vision insurance plans typically provide insurance benefits that cover the cost of

eye exams, lenses, frames, and contact lenses

The term that allows the type of responsibility expected of any producer toward funds entrusted to that producer's care in connection with the transaction of insurance is

fiduciary

An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may

increase the deductible to adjust for the occupational difference

The coinsurance clause is an individual Medical Expense policy refers to the

insurance company's right to require the insured to share a certain percentage of the cost of each claim

An employee who owns an individual Disability Income policy is injured in an automobile accident and files Proof of Loss with the insurance company. Under the Payment of Claims provision in the policy, the company will likely pay the policy benefits to the

insured

The commissioner of insurance must revoke the license of any producer who

is convicted by final judgement of a misdemeanor

An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for

martial status and occupation

In determining how much Disability Income insurance a prospective insured could purchase, the MOST important factor to be considered is the insured's

monthly income