Health Insurance Quizzes

Another term used to describe "no deductible" is

First dollar basis

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?

Free look period

In North Carolina, statutes, rules, and regulations that govern insurance companies, insurance transactions, and insurance agents are

Insurance Code.

The Medical Information Bureau (MIB) was created to protect

Insurance companies from adverse selection by high risk persons.

Which of the following entities has the authority to make changes to an insurance policy?

Insurer's executive officer

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

Monthly

An insured has health insurance that covers them at work and at home. This policy was written on what basis?

Occupational

What is the official name for the Social Security program?

Old Age Survivors Disability Insurance

A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy?

Pregnancy will be covered immediately.

Which of the following describes taxation of individual disability income insurance premiums and benefits?

Premiums are not tax deductible, and benefits are not taxable.

Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen?

Pro rata benefit reduction

Discrimination between individuals of the same class in the amount of premiums or rates charged for any policy of insurance is

Prohibited by law.

What is the main purpose of the Life and Health Insurance Guaranty Association?

Protect consumers against solvent insurers

In which type of HMO model are physicians actually paid employees of the HMO, practicing in the HMO's own facility?

Staff

If an applicant does not receive a copy of the new insurance policy, who would be held responsible?

The agent

What is the purpose of COBRA?

To provide continuation of coverage for terminated employees

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?

Unlimited

What is the typical deductible for basic surgical expense insurance?

$0

A noncontributory group disability income plan has a 30-day elimination period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive

$12,000, all of which is taxable

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

In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there?

10

The required privacy disclosure notice must be provided by insurer to current policyholders at least once in any period of

12 months

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 their leg and is off work for 45 days. How many days of disability benefits will the policy pay?

15 days

How soon before the child's attainment of limiting age must proof of intellectual or physical disability be provided to an insurer, in order for coverage to continue on the child?

31 days

What is the waiting period on a Waiver of Premium rider in life insurance policies?

6 months

Unreimbursed medical expenses paid for the insured may be claimed as deductions if the expenses exceed what percentage of the adjusted gross income?

7.5%

Which of the following does the Insuring Clause NOT specify?

A list of available doctors

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

Adjust the benefit in accordance with the decreased risk.

When transacting business in this state an insurer formed under the laws of another country is known as an

Alien insurer

All of the following would be considered rebating EXCEPT

An agent misrepresents policy benefits to convince a policyowner to replace policies.

In insurance, an offer is usually made when

An applicant submits an application to the insurer.

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 requirements of eligibility for Social Security disability income benefits EXCEPT

Being age 65

A group policy used to provide accident and health coverage on a group of persons being transported by a common carrier, without naming the insured persons individually is called

Blanket policy

Which of the following is true regarding inpatient hospital care for HMO members?

Care can be provided outside of the service area

An applicant knowingly fails to communicate information that would help an underwriter make a sound decision regarding coverage. This is an example of

Concealment

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

If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days?

Conversion provision

Which of the following is NOT true regarding Basic Surgical Expense coverage?

Coverage is unlimited.

All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT

Death benefits are paid only if death occurs within 24 hours of an accident.

If an insured changes his payment plan from monthly to annually, what happens to the total premium?

Decreases

Which of the following terms describes making false statements about the financial condition of any insurer that are intended to injure any person engaged in the business of insurance?

Defamation

A waiver of premium provision may be included with which kind of health insurance policy?

Disability income

With respect to the Consideration Clause, which of the following would be considered consideration on the part of the applicant for insurance?

Payment of premium

If the applicant has not fully met the requirements for licensing, the Commissioner will

Refuse to issue the license and notify the applicant in writing.

The amount of Social Security disability benefits is based upon the worker's Primary Insurance Amount (PIA), which is calculated from their Average Indexed Monthly Earnings over which years? Which years of income may be deleted from calculation?

Their highest 35; lowest 5

Hospital indemnity

hospital confinement indemnity policy will provide payment based on/The number of days confined in a hospital.

To maintain their insurance license, agents are required to complete how many hours of continuing education every 2 years?

24 hours

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 Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children of the insured up to the age of

26

What is the continuing education requirement in Ethics for agents in this state?

3 hours every 2 years

Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace?

A permanent resident lawfully present in the U.S.

All of the following statements concerning workers compensation are correct EXCEPT

A worker receives benefits only if the work related injury was not his/her fault.

In a disability policy, the probationary period refers to the time

During which illness-related disabilities are excluded from coverage.

An insured has medical insurance coverage through 2 different providers, both covering the same expenses on an expense-incurred basis. Neither company knows in advance that the insured has coverage through any other insurers. The insured submits a claim to both insurers. How should the claim be handled?

Each insurer should pay a proportionate share of the claim.

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

Entire contract clause

All of the following actions can be described as twisting EXCEPT

Explaining to client the advantages of permanent insurance over term and suggesting changing policies

Todd has been informed that he has a hernia which requires repair. When Todd researches the cost, he learns that his insurance plan will cover 200 points worth of surgical expenses. Each point represents $10, which means that $2000 of his surgery will be covered by his insurance plan. What system is Todd's insurance company using?

Relative value

An insured has submitted a fraudulent claim on a health insurance policy 1 year after the policy issue. The insurer paid the claim, but a year later discovered that the claim was fraudulent. The insured was convicted of a felony. Which of the following statements is true regarding the payment of claim?

The insured may be ordered to pay restitution (i.e., pay the amount of claim back to the insurer).

An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true?

The insured was in compliance with the policy requirements regarding claims.