Health Insurance Study questions

What is the typical deductible for basic surgical expense insurance?

0

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

10 monthly

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

Which of the following does the Insuring Clause NOT specify?

A list of available doctors

This state provided for a temporary license for all of the following EXCEPT

A producer's retirement.

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 statement that is sufficiently clear to identify the insured and the nature of the claim.

When a group Medicare Supplement policy is terminated by the policyholder and not replaced, the issuer must offer each certificate holder

An individual policy.

Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as

Any occupation - more restrictive than other definitions.

What document describes an insured's medical history, including diagnoses and treatments?

Attending Physician's Statement

Which of the following provides coverage on a first-dollar basis?

Basic expense

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?

Employers are no longer forced to offer HMO plans.

The provision that states that both the printed contract and a copy of the application form the contract between the policyowner and the insurer is called the

Entire contract

Which of the following statements is correct concerning taxation of long-term care insurance?

Excessive benefits may be taxable.

An insured's home is damaged in an earthquake. He finds out that his homeowners policy will NOT cover the loss, because earth movement is listed in his policy's

Exclusions

What insurance term best describes perils that are NOT insured against?

Exclusions

Which one of the following is an eligibility requirement for Social Security disability income benefits?

Fully insured status

What are the 2 types of Flexible Spending Accounts?

Health Care Accounts and Dependent Care Accounts

A life insurance policy has a legal purpose if both of which of the following elements exist?

Insurable interest and consent

Annuities are purchased to

Liquidate an estate.

Which of the following best describes the unfair trade practice of defamation?

Making derogatory oral statements about another insurer's financial condition

On its advertisement, a company claims that it has funds in its possession that are, in fact, not available for the payment of losses or claims. The company is guilty of

Misrepresentation.

Which of the following will vary the length of the grace period in health insurance policies?

Mode of premium payment

An insured purchased an insurance policy 5 years ago. Last year, she received a dividend check from the insurance company that was not taxable. This year, she did not receive a check from the insurer. From what type of insurer did the insured purchase the policy?

Mutual

In Minnesota, what are the continuing education (CE) requirements for nonresident producers?

Nonresident producers only need to fulfill the CE requirements in their home state.

In respect to the consideration clause, which of the following is consideration on the part of the insurer?

Promising to pay in accordance with the contract terms

All of the following are true regarding rebates EXCEPT

Rebates are allowed if it is in the best interest of the client.

When an insurer combines two periods of disability into one, the insured must have suffered a

Recurrent disability.

Which health insurance provision describes the insured's right to cancel coverage?

Renewal provision

Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?

Residual disability

It would be considered unfair discrimination to ask an insurance applicant about which of the following and then use that information as a rating factor to determine insurability?

Sexual orientation

The Comprehensive Health Association contracts with all of the following entities to provide coverage for their subscribers EXCEPT

Surplus lines insurers.

Who determines the eligibility and contribution limits of an HRA?

The employer

Which statement accurately describes group disability income insurance?

The extent of benefits is determined by the insured's income.

Who chooses a primary care physician in an HMO?

The individual member

An insured had $500 left in his Health Reimbursement Account when he quit his job. What happens to that money?

The insured can have access to the $500 at his previous employer's discretion.

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?

The insured is in an accident and incurs a large claim.

Which of the following is correct regarding selecting a primary care physician in a PPO plan?

The insured may choose medical providers not found on the preferred list.

Which of the following is NOT a feature of a guaranteed renewable provision?

The insurer can increase the policy premium on an individual basis.

The Commissioner may examine the affairs and condition of all of the following insurance companies doing business in the State, EXCEPT

There are no exceptions.

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

Unearned premiums are retained by the insurance company.

The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract?

conditional

An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?

consideration

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?

no benefits

Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?

none

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

Continuing education must be completed every

2

The time limit of certain defenses provision prohibits insurers from denying a claim due to misrepresentation, as long as the policy has been in force for at least

2 years

Once an individual has successfully passed a licensing exam, for how many year(s) are the results valid?

3

Should the Commissioner request information from a certificate holder, licensee, or other person under the jurisdiction of the Commissioner, they must comply with the request within the time specified in the request. If no time specified, they must comply within

30 days

The classification Small Employer means any person actively engaged in a business that on at least 50% of its working days during the preceding year employed no more than

50 eligible employees.

How long is an open enrollment period for Medicare supplement policies?

6 months

Benefit periods for individual short-term disability policies will usually continue from

6 months to 2 years

After an insurance company examination, the Commissioner or the examiner appointed by the Commissioner must file a written report of the examination within

60 days

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

60%

Once an individual is licensed as an insurance producer for life or accident and health insurance, how many hours of training must he or she initially complete to sell long-term care insurance?

8

An insurance producer must disclose his or her name and the name of the agency or insurer they represent

Before a personal solicitation.

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

Care can be provided outside of the service area.

The provision that provides for the sharing of expenses between the insured and the insurance company is

Coinsurance

Health service benefits for the treatment of emotionally handicapped children must be provided in a residential treatment facility that is licensed by

Commissioner of Human Services.

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

When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?

Consideration

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as

Contracts of adhesion

A small company offers group health insurance to its employees, but recently has decided to terminate the health insurance contract, leaving the workers without insurance. What can the employees do regarding their insurance?

Convert to an individual health policy

Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service?

Copayment

All of the following are true about group disability Income insurance EXCEPT

Coverage applies both on and off the job.

Which of the following is NOT an exclusion in medical expense insurance policies?

Coverage for dependents

A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as

Critical illness

Which of the following is a specified dollar amount that the insured must pay before the policy benefits begin?

Deductible

Which agreement specifies how a business will transfer hands when one of the owners dies or becomes disabled?

Disability Buy-Sell

This arrangement specifies who will purchase a disabled partner's interest in the event he or she becomes disabled.

Disability buyout

What is the goal of the HMO?

Early detection through regular checkups

Which of the following would not be an allowable reason for an employee's health insurance coverage to be terminated or restricted?

Employee absent from work for an extended period of time because of total disability

According to agency law, the producer always represents the

Insurance Company.

In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost

Is not covered.

A guaranteed renewable disability insurance policy

Is renewable at the insured's option to a specified age.

Which of the following is NOT true regarding a flexible spending account?

It does not have limits on contributions.

Concerning Medicare Part B, which statement is INCORRECT?

It is fully funded by Social Security taxes (FICA).

Which of the following is NOT true regarding coverage for chemical dependency in health policies in this state?

It is only available in individual policies.

Which of the following is true of a PPO?

Its goal is to channel patients to providers that discount services.

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?

Medicare SELECT

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?

Neither approved the application nor issued the policy

On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are

Not taxable since the IRS treats them as a return of a portion of the premium paid.

An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?

Offer the supplement policy on a guaranteed issue basis

What is a definition of a unilateral contract?

One-sided: only one party makes an enforceable promise.

Medicare Part A services do NOT include which of the following?

Outpatient Hospital Treatment

Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?

Pay a special deductible on his major medical policy

Which of the following applies to partial disability benefits?

Payment is limited to a certain period of time.

Which of the following provisions is mandatory for health insurance policies?

Physical examination and autopsy

A guaranteed renewable health insurance policy allows the

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.

Which of the following are the main factors taken into account when calculating residual disability benefits?

Present earnings and earnings prior to disability

Which of the following is true of noncontributory life insurance plans?

The plan is completely paid for by the employer.

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims

What is the purpose of "business income coverage" in a commercial property policy?

To protect against the loss of profits and fixed expenses that must continue to be paid during restoration following a direct loss to the premises

A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would like to change the primary beneficiary to his sister. Which of the following is true?

Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at any time.

In forming an insurance contract, when does acceptance usually occur?

When an insurer's underwriter approves coverage

Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT

When the amount payable under Social Security is more than the amount payable under the rider.

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

Within 90 days or as soon as reasonably possible, but not to exceed 1 year

Can an individual who belongs to a POS plan use an out-of-network physician?

Yes, and they may use any preferred physician, even if not part of the HMO

An insured pays her t Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

pay the claim