Health
For how many days of skilled nursing facility care will Medicare pay benefits A. 100 B. 30 C. 60 D. 90
A. 100
A health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective? A. Immediately B. After 14 days C. After 21 days D. After 31 days
A. Immediately
Medicaid provides all of the following benefits EXCEPT A. Family planning services B. Income assistance for work-related injury C. Home health care services D. Eyeglasses
B. Income assistance for work-related injury
Group health insurance is characterized by all of the following EXCEPT A. Conversion Privilege B. Adverse selection C. A master Contract D. Lower administrative costs.
B. Adverse Selection
An 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? A. $25.50 B. $100 C. $102 D. $25
C. 102
If a person is disabled at age 27 and meets social securities definition of total disability, how many work credits must he/she have earned to receive benefits? A. 6 credits B. 40 credits C. 12 credits D. 20 credits
C. 12 Credits
In a replacement Situation all of the following must be considered EXCEPT: A. Limitations B. Exclusions C. Assets D. Benefits
C. Assets
Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses A. First-dollar coverage B. Corridor deductible C. Stop-loss limit D. Out-of-pocket limit
C. Stop-loss limit
Which of the following riders would NOT increase the premium for a policy owner? A. Payor Benefit Rider B. Waiver of Premium Rider C. Multiple Indemnity Rider D. Impairment Rider
D. Impairment Rider
COBRA applies to employers with at least ______? A. 20 employees B. 80 employees C. 60 employees D. 50 employees
A. 20 employeed
Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray? A. 50/50 B. 75/15 C. 80/20 D. 90/10
A. 50/50
A guaranteed renewable disability insurance policy A. Is renewable at the insured's option to a specified age B. Is renewable at the option of the insurer to a specified age of the insured C. Is guaranteed to have a level premium for the life of the policy D. Cannot be cancelled by the insured before age 65
A. Is renewable at the insured's option to a specified age
Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is A. Monthly B. Within 45 days C. Weekly D. Biweekly
A. Monthly
Which of the following statements is CORRECT about social security? A. To be eligible, one must meet certain requirements B. It is more than income received while employed C. It is very easy to quality for disability benefits D. It is designed for people over 59 1/2
A. To be eligible, one must meet certain requirements
Once the person meets the stringent requirements for disability benefits, how long is the waiting period under Social Security before any benefits will be paid? A. 90 days B. 5 months C. 12 months D. Benefits will be pain immediately
B. 5 Months
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? A. Community-based organization professionals B. Attending physician C. Registered nurses D. Licensed practical nurses
B. Attending physician
The provision that provides for the sharing of expenses between the insured and the insurance company is A. Divided Cost B. Coinsurance C. Stop-loss D. Deductible
B. Coinsurance
An insured becomes disabled at the age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive social security benefits? A. Have reached the age of 25 B. Have accumulated 6 work credits in the past 3 years C. Have accumulated 20 work credits in the past 10 years D. Have accumulated 40 work credits
B. Have accumulated 6 work credits in the past 3 year
What is another name for social security benefits A. Survivor Benefits B. Old Age, survivors, and disability insurance C. Medicare Benefits D. Disability and long term insurance
B. Old Age, survivors, and disability insurance
Which of the following will vary the length of the grace period in health insurance policies? A. The term of the policy B. The mode of the premium payment C. The length of any elimination period D. The length of time the insured has been insured
B. The mode of the premium payment
Which of the following is considered a qualifying event under COBRA? A. Relocation B. Promotion C. Divorce D. Marriage
C. Divorce
Long-Term care coverage may be available as any of the following options EXCEPT A. Individual long-term care B. Endorsement to a life policy C. Endorsement to a health policy D. Group long-term care
C. Endorsement to a health policy
In which of the following locations would skilled care most likely be provided? A. In an outpatient setting B. At a physician's office C. In an institutional setting D. At the patient's home
C. In an institutional Setting
A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT A. Limb B. Life C. Income D. Eyesight
C. Income
Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is A. Biweekly B. Within 45 days C. Monthly D. Weekly
C. Monthly
Which of the following is NOT covered under Plan A in Medigap insurance? A. The 20% Part B coinsurance amounts for medicare approved services B. The first three pints of blood each year C. The medicare part A is deductible D. Approved hospital costs for 365 additional days after Medicare benefits end
C. The Medicare Part A is deductible
Which of the following is true regarding elimination periods and the cost of coverage ? A. The longer the elimination period, the higher the cost of the coverage B. Elimination periods have no effect on the cost of coverage C. The longer the elimination period, the lower the cost of coverage D. The shorter the elimination period, the lower the cost of coverage
C. The longer the elimination period, the lower the cost of coverage
Representations are written or oral statements made by the applicant that are A. Guaranteed to be true B. Found to be false after further investigation C. Immaterial to the actual acceptability of the insurance contract D. Considered true to the best of the applicant's knowledge
D. Considered to be true to the best of the applicants knowledge.
Which of the following includes information regarding a person's credit, character, reputation, and habits? A. Consumer History B. Insurability report C. Agents Report D. Consumer Report
D. Consumer Report
How many pints of blood will be paid for by Medicare Supplement core benefits? A. None, Medicare pays for it all B. Everything after first 3 C. 1 pint D. First 3
D. First 3
Which of the following types of LTC is NOT provided in an institutional setting? A. Custodial Care. B. Skilled Nursing Care C. Intermediate Care D. Home Health Care
D. Home Health Care
Whose responsibility is it to determine if all of the questions on an application have been answered? A. The insure B. The applicant C. The beneficiary D. The agent
D. The agent
L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay? A. $2,500 (the entire bill) B. $900 (deductible +20% of the bill after the deductible) C. $500 (amount of deductible) D. $1000 (deductible + 20% of the entire bill)
B. $900 (deductible + 20% of the bill after deductible)
A client has a new individual disability income policy with a 20-day probationary period and a 30-day elimination period. Ten days later, the client breaks there leg and is off work for 45 days. How many days of disability benefits will the policy pay.? A. 10 Days B. 15 Days C. 25 Days D. 45 Days
B. 15 Days
Which of the following does the insuring clause NOT specify? A. The name of the insured B. A list of available doctors C. Covered perils D. The insurance company
B. A list of available doctors
When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision A. Because the misstatement occurred more than 2 years ago, it has no effect B. Amount payable under the policy will reflect the insured's correct age C. The contract will be deemed void because of the misstatement of age D. The elimination period will be extended 6 months for each year of age misstatement
B. Amounts payable under the policy will reflect the insureds correct age
An agent makes a mistake on the application and then corrects his mistake by physically entering the necessary information. Who must then initial that change? A. Agent B. Applicant C. Executive officer of the company D. Insured
B. Applicant
Regarding long-term care coverage, as the elimination period gets shorter, the premium A. Gets lower B. Gets higher C. Remains constant D. Premiums are not based on elimination periods
B. Gets Higher
Most LTC plans have which of the following features? A. Open Enrollment B. Guaranteed renewability C. No elimination period D. Variable Premiums
B. Guaranteed Renewability
An insured bcomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have to receive Social Security disability benefits? A. Have reached the age of 25 B. Have accumulated 6 work credits in the past 3 years C. Have accumulated 20 work credits in the past 10 years D. Have accumulated 40 work credits
B. Have accumulated 6 work credits in the past 3 years
What are the 2 types of Flexible Spending Accounts? A. Medical Savings Accounts and Health Reimbursement Accounts B. Health Care Accounts and Dependent Care Accounts C. Health Care Accounts and Health Reimbursement Accounts D. Medical Savings Accounts and Dependent Care Accounts
B. Health Care Accounts and Dependent Care Accounts
Medicaid provides all of the following benefits EXCEPT A. Family planning services B. Income assistance for work-related injury C. Home Health care services D. Eyeglasses
B. Income assistance for work-related injury
The type of dental plan which is incorporated into a major medical expense plan is a/an A. Blanket Dental Plan B. Integrated dental plan C. Supplemental dental plan D. Stand-alone dental plan
B. Integrated Dental Plan
The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as A. Part B B. Part C C. Part D D. Part A
D. Part A
In respect to the consideration clause, which of the following is consideration on the part of the insurer? A. Offering a secondary policy to the applicant B. Offering an unconditional contract C. Explaining policy revisions to the applicant D. Promising to pay in accordance with the contract terms
D. Promising to pay in accordance with the contract terms
An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her for medical expenses. What term describes the condition she has met? A. Out-of-pocket limit B. Maximum loss threshold C. Maximum loss D. Stop-loss limit
D. Stop-loss limit
Which of the following is true about the requirements regarding HIV exams? A. Results may be disclosed to the agent and the underwriter. B. Prior informed oral consent is required from the applicant. C. HIV exams may not be used as a basis for underwriting. D. The applicant must give prior informed written consent.
D. The applicant must give prior informed written consent.
Which of the following is Not the consideration in a policy? A. Something of value exchanged between parties. B. The premium amount paid at the time of application. C. The promise to pay covered losses. D. The application given to a prospective insured.
D. The application given to a prospective insured
Which of the following is NOT a feature of a guaranteed renewable provision? A. The insured has a unilateral right to renew the policy for the life of the contract B. Coverage is not renewable beyond the insured's age 65 C. The insured's benefits cannot be reduced D. The insurer can increase the policy premium on an individual basis
D. The insurer can increase the policy premium on an individual basis
Hospital indemnity/hospital confinement indemnity policy will provide payment based on A. The type of illness B. The premiums paid into the policy C. The medical expense incurred D. The number of days confined in a hospital
D. The number of days confined in a hospital
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT A. The insurer must provide the insured a written notice of the cancellation B. Claims incurred before cancellation must be honored C. An insurance company may cancel the policy at any time D. Unearned premiums are retained by the insurance company
D. Unearned premiums are retained by the insurance companies
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT A. The insurer must provide the insured a written notice of the cancellation B. Claims incurred before cancellation must be honored C. An insurance company may cancel the policy at any time D. Unearned premiums are retained by the insurance company
D. Unearned premiums are retained by the insurance company
Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending? A. None at all B. 1 examination per week of the week of the claim processing period C. 2 examinations per week of the claim processing period D. Unlimited
D. Unlimited
Which of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract? A. Concealment B. Indemnity C. Representation D. Warranty
D. Warranty
Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid. A. 5 Months B. 12 Months C. Benefits will be paid immediately D. 90 days
A. 5 Months
An insured pays a $100 premium every month for his insurance coverage, yet the insurer promises to pay, $10,000 for a covered loss. What characteristic of an insurance contract does this describe? A. Aleatory B. Good Health C. Adhesion D. Conditional
A. Aleatory
What document describes and insured's medical history, including diagnoses and treatments? A. Attending Physician's Statement B. Physician's Review C. Individual Medical Summary D. Comprehensive Medical History
A. Attending Physician's Statement
When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following ? A. Consideration B. Legal Purpose C. Contract of Adhesion D. Acceptance
A. Consideration
Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? A. Free look period B. Grace period C. Elimination period D. Probationary period
A. Free look period
Which of the following statements is not correct concerning the COBRA act of 1985? A. It requires all employers, regardless of the number of age of employees, to provide extended group health coverage B. It covers terminated employees and/ or their dependents for up to 36 months after a qualifying event. C. It applies only to employers with 20 or more employees that maintain group health insurance plans for employees. D. COBRA stands for Consolidated Omnibus Budget Reconcililation Act
A. It requires all employers, regardless of the number or age of employees, to provide extended group health coverage.
Which of the following is NOT covered under Plan A in Medigap insurance? A. The Medicare Part A deductible B. Approved hospital costs 365 additional days after Medicare benefits end C. The 20% Part B coinsurance amounts for Medicare approved services D. The first three pints of blood each year
A. The Medicare Part A deductible
Which of the following is NOT a feature of a noncancellable policy? A. The insurer may terminate the contract only at renewal for certain conditions. B. The premiums cannot be increased beyond the amount stated in the policy. C. The guarantee to renew coverage usually applies until the insured reaches a certain age. D. The insured has the right to renew the policy for the life of the contract.
A. The insurer may terminate the contract only at renewal for certain conditions
Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called ________? A. Business overhead expense disability insurance B. Key employee disability insurance C. Blanket Disability Insurance D. Long-Term Disability
B. Key Employee Disability Insurance
The corridor deductible derives its name from the fact that it is applied between the basic coverage and the A. Limited Coverage B. Major Medical Coverage C. Comprehensive Expense Coverage D. Interval Expense Coverage
B. Major Medical Coverage
Which of the following statements pertaining to Medicare Part A is correct? A. Each individual covered by Medicare Part A is allowed one 90-day benefit period per year B. Medicare part A is automatically provided when an individual qualifies for Social Security benefits at age 65 C. For the first 90 days of hospitalization, medicare part a pays 100% of all covered services except the initial deductible D. Individuals with ERSD do not qualify for part A
B. Medicare part A is automatically provided when an individual qualifies for Social Security benefits at age 65
An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability Benefits? A. Full benefits until the blindness lifts B. No Benefits C. Full Benefits D. Partial Benefits
B. No benefits
An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loves the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits? A. Full Benefits until the blindness lifts B. No Benefits C. Full Benefits D. Partial Benefits
B. No benefits
Insurers may change which of the following on a guaranteed renewable health insurance policy? A. No changes are permitted B. Rates by class C. Coverage D. Individual rates
B. Rates by class
Who chooses a primary care physician in an HMO? A. A referral physician B. The individual member C. HMO subscribers do not have a primary care physician D. The insurer
B. The individual member
In which of the following situations would Social Security Disability benefits NOT cease? A. The individual has undergone therapy and is no longer disabled B. The individual's son gets a part-time job to help support the family C. The individual reaches age 65 D. The individual dies
B. The individual's son gets a part-time job to help support the family
Which of the following statements is true regarding coinsurance? A. The smaller the percentage that is paid by the insured, the more consistent the required premium will be B. The larger the percentage that is paid by the insured, the lower the required premium will be. C. The larger the percentage that is paid by the insured, the higher the required premium will be. D. The smaller the percentage that is paid by the insured, the lower the required premium will be.
B. The larger the percentage that is paid by the insured, the lower the required premium will be.
Regarding Medicare SELECT policies, what are restricted network provisions? A. They help avoid adverse selection B. They condition the payment of benefits C. They determine who can be insured D. They determine premium rates
B. They condition the payment of benefits
All of the following statements about medicare supplement insurance policies are correct EXCEPT A. They are issued by private insurers B. They cover the cost of extended nursing home care C. They cover medicare deductibles and copayments D. They supplement Medicare Benefits
B. They cover the cost of extended nursing home care
What is the purpose of coinsurance provisions? A. To share liability among different insurance companies B. To help the insurance company to prevent overutillization of the policy C. To have the insured pay premiums to more than one company D. To ensure payment to the doctors and hospitals
B. To help the insurance company to prevent overutilization of the policy
A deductible is A. An insurer's obligation to the service provider B. A nominal fee for the use of an insurer's services. C. A specific dollar amount that the insured must pay first before the insurance company will pay the policy benefits D. A percentage of the medical bill the insured must pay before services will be rendered
C. A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain A. An estimate of the total amount of medical and hospital expense for the loss B. A complete physician's statement C. A statement that is sufficiently clear to identify the insured and the nature of the claim D. A statement from the insured's employer showing that the insured was unable to work
C. A statement that is sufficiently clear to identify the insured and the nature of the claim
Which of the following provides coverage on a first-dollar basis? A. Supplementary Major Medical B. Limited Major Medical C. Basic Expense D. Accident expense
C. Basic Expense
A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following? A. The business manager's salary B. Disability insurance to the owner C. Cash to the owner's business partner to accomplish a buyout D. The rent money for the building
C. Cash to the owner's business partner to accomplish a buyout
Which of the following entities can legally bind coverage? A. Federal Insurance Board B. Agent C. Insurer D. The insured
C. Insurer
Who makes up the Medical Information Bureau? A. Former Insured B. Physicians and Paramedics C. Insurers D. Hospitals
C. Insurers
Concerning Medicare Part B, which statement is INCORRECT A. It offers limited prescription drug coverage B. It provides partial coverage for medical expenses not fully covered by PART A. C. It is fully funded by social security taxes (FICA) D. It is known as medical insurance
C. It is fully funded by social security taxes (FICA)
The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as A. Payment of claims B. Proof of loss C. Legal Actions D. Time limit on certain defenses
C. Legal actions
In a Disability Income Policy, all of the following are considered presumptive disabilities EXCEPT A. Loss of two limbs B. Loss of speech C. Loss of one eye D. Loss of hearing
C. Loss of one eye
An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point? A. Approved the application B. Issued the policy C. Neither approved the application nor issued the policy D. Both approved the application and issued the policy
C. Neither approved the application nor issued the policy
With respect to the consideration clause, which of the following would be considered consideration on the part of the applicant for insurance? A. Providing Warranties on the Application B. Notice of policy cancellation C. Payment of premium D. Promise to renew the policy at the end of the policy period
C. Payment of premium
A hospital indemnity policy will pay ______ ? A. Income lost while the insured is in the hospital B. All expenses incurred by the stay in the hospital. C. Any expenses incurred by the stay in the hospital, minus coinsurance payments and deductibles D. A benefit for each day the insured is in a hospital
D. A benefit for each day the insured is in a hospital
Which is NOT a characteristic of group health insurance? A. Dependents of insureds can be covered under group health plans. B. Group coverage may be converted to individual coverage if the group contract is ended. C. The actual policy is called the " master contract" D. A policy is issued to each insured individual
D. A policy is issued to each insured individual.
When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should A. Replace the policy with a new one B. Return any unearned premium C. Increase the premium D. Adjust the benefit in accordance with the decreased risk
D. Adjust the benefit in accordance with the decreased risk?
Long-Term care insurance policies must cover which of the following. A. All mental disorders B. Treatment of alcoholism C. Injuries caused by an act of war D. Alzheimer's Disease
D. Alzheimer's Disease
An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery, the agent collect the applicant's premium check, answers any questions the applicant may have, and then leaves. What did he forget to do? A. Offer her a secondary policy B. Ask the applicant to sign a statement that acknowledges that the policy has been delivered C. Collect a late payment fee D. Ask her to sign a statement of good health
D. Ask her to sign a statement of good health
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30 day A. Blackout Period B. Probationary Period C. Waiver of benefits period D. Elimination period
D. Elimination Period
The HMO Act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How has this plan since changed? A. The source of funding has changed B. The minimum number of employees has decreased C. The minimum number of employees has increased D. Employers are no longer forced to offer HMO plans
D. Employers are no longer forced to offer HMO plans
Which of the following best describes the aleatory nature of an insurance contract? A. Only one of the parties being legally bound by the contract B. Ambiguities are interpreted in favor of the insured C. Policies are submitted to the insurer on a take-it or leave-it basis D. Exchange of unequal values
D. Exchange of unequal values
Which of the following riders would NOT increase the premium for a policy owner? A. Payor benefit rider B. Waiver of premium rider C. Multiple indemnity rider D. Impairment rider
D. Impairment rider
In long-term care(LTC) policies, as the benefit period lengthens, the premium ______ ? A. Remains unchanged B. LTC Premiums are not based on benefit periods C. Decreases D. Increases
D. Increases
Which of the following statements concerning medicare Part B is CORRECT? A. It is provided automatically to anyone who qualifies for part A B. It pays on a first dollar basis C. It pays 100% of Medicare's standards for reasonable charges D. It pays for physician services, diagnostic tests, and physical therapy
D. It pays for physician services, diagnostic tests, and physical therapy
In a Disability Income policy, all of the following are considered presumptive disabilities EXCEPT A. Loss of hearing B. Loss of two limbs C. Loss of speech D. Loss of one eye
D. Loss of one eye
To sign up for Medicare prescription drug plan, individuals must first be enrolled in A. Medicare Part B and C B. Medicare Parts A and C C. Medicare Part D D. Medicare Part A
D. Medicare Part A
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? A. Medicare Part A B. Medicare Supplement C. Medicare Advantage D. Medicare Select
D. Medicare Select
Which of the following statements is NOT correct? A. Medicare advantage may include prescription drug coverage at no cost B. Medicare part A provides hospital care C. Medicare part b provides physician services D. Medicare advantage must be provided through HMO's
D. Medicare advantage must be provided through HMO's
