Health Insurance
Which of the following statements is NOT true concerning Medicaid? a) It is intended to provide medical assistance for certain categories of people who are needy. b) It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income. c) It is a state program. d) It is funded by state and federal taxes.
b) It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income.
For how many days of skilled nursing facility care will Medicare pay benefits? a) 60 b) 90 c) 100 d) 30
c) 100
All of the following actions could be grounds for the Director to suspend or revoke an insurance license, EXCEPT a) A producer has their license suspended or revoked in another state. b) A producer demonstrates a lack of trustworthiness or competence. c) A producer uses poor judgment in binding a risk. d) A producer is convicted of a felony.
c) A producer uses poor judgment in binding a risk.
Which of the following riders would NOT increase the premium for a policyowner? a) Payor benefit rider b) Waiver of premium rider c) Multiple indemnity rider d) Impairment rider
d) Impairment rider
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? a) 20 b) 100 c) 80 d) 3
a) 20
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply? a) 5 days b) 7 days c) 10 days d) 3 days
a) 5 days
A hospital indemnity policy will pay a) A benefit for each day the insured is in a hospital. b) Income lost while the insured is in the hospital. c) All expenses incurred by the stay in the hospital. d) Any expenses incurred by the stay in the hospital, minus coinsurance payments and deductibles.
a) A benefit for each day the insured is in a hospital.
Rebating is an unfair trade practice and is regulated by law. All of the following would be considered to be rebating EXCEPT a) An agent misrepresents policy benefits to convince a policyowner to replace policies. b) An agent offers the use of his lake house to person as an inducement to buy. c) An agent offers to share his commission with a policyholder. d) An agent offers tickets to a baseball game as an inducement to buy insurance.
a) An agent misrepresents policy benefits to convince a policyowner to replace policies.
The classification "small employer" means any person actively engaged in a business during the preceding calendar year employed a) At least 2 and not more than 50 persons. b) At least 5 and not more than 75 persons. c) At least 10 and not more than 100 persons. d) At least 3 and not more than 25 persons.
a) At least 2 and not more than 50 persons.
Which of the following is true of benefits provided in a health insurance policy for insureds that are diagnosed with diabetes? a) Benefits may be subject to deductibles and copayments not greater than those applied to any other covered illness. b) Benefits are limited to treatment received in a hospital or physician's office. c) Benefits must be provided without deductibles or copayment. d) Benefits for diabetes care and treatment must be added as an optional coverage.
a) Benefits may be subject to deductibles and copayments not greater than those applied to any other covered illness.
Kevin and Nancy are married; Kevin is the primary breadwinner and has a health insurance policy that covers both him and his wife. Nancy has an illness that requires significant medical attention. Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Which of the following options would be best for Nancy at this point? a) COBRA b) Apply for social security benefits c) Apply for coverage under the same group policy that covers Kevin d) Convert to an individual insurance policy with 31 days so she won't have to provide evidence of insurability
a) COBRA
Long-term care coverage may be available as any of the following options EXCEPT a) Endorsement to a health policy. b) Group long-term care. c) Individual long-term care. d) Endorsement to a life policy.
a) Endorsement to a health policy.
In long-term care (LTC) policies, as the benefit period lengthens, the premium a) Increases. b) Remains unchanged. c) LTC premiums are not based on benefit periods. d) Decreases.
a) Increases.
The type of dental plan which is incorporated into a major medical expense plan is a/an a) Integrated dental plan. b) Supplemental dental plan. c) Stand-alone dental plan. d) Blanket dental plan.
a) Integrated dental plan.
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.
An insurance producer license contains all of the following information EXCEPT a) Name of the insurer(s) represented by the licensee. b) Issuance date and expiration date of the license. c) Name and address of the licensee. d) Producer identification number.
a) Name of the insurer(s) represented by the licensee.
Which of the following documents provides a disclosure of a Medicare supplement policy? a) Outline of coverage b) Buyer's guide c) Statement of renewal provisions d) Policy summary
a) Outline of coverage
What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered? a) Probationary period b) Contestable period c) Elimination period d) Grace period
a) Probationary period
Which health insurance provision describes the insured's right to cancel coverage? a) Renewal provision b) Policy duration provision c) Insuring clause d) Cancellation provision
a) Renewal provision
Which of the following is NOT a feature of a guaranteed renewable provision? a) The insurer can increase the policy premium on an individual basis. b) The insured has a unilateral right to renew the policy for the life of the contract. c) Coverage is not renewable beyond the insured's age 65. d) The insured's benefits cannot be reduced.
a) The insurer can increase the policy premium on an individual basis.
Which of the following is NOT true regarding partial disability? a) This is a form of insurance that covers part-time workers. b) The insured can still report to work and receive benefits. c) Benefit payments are typically 50% of the total disability benefit. d) An insured would qualify if he couldn't perform some of his normal job duties.
a) This is a form of insurance that covers part-time workers.
An insured pays a monthly premium of $100 for a health insurance policy. What would be the duration of the grace period under the policy? a) 7 days b) 10 days c) 31 days d) 60 days
b) 10 days
An individual long-term care policy must be delivered to the applicant within how many days after its approval? a) 15 days b) 30 days c) 45 days d) 10 days
b) 30 days
#9. Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis? a) Home health care b) Adult day care c) Residential care d) Assisted living
b) Adult day care
All health insurance policies issued in this state must provide coverage for maternity services. How many hours of inpatient care must be provided to a mother after a delivery by caesarian section? a) At least 48 b) At least 96 c) At least 24 d) At least 36
b) At least 96
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
Which of the following statements is correct concerning taxation of long-term care insurance? a) Premiums are not deductible in any case. b) Excessive benefits may be taxable. c) Benefits may be taxable as ordinary income. d) Premiums may be taxable as income.
b) Excessive benefits may be taxable.
Which of the following is NOT among the lines of authority for which an insurance producer may qualify in the state of Missouri? a) Personal lines b) Group health insurance c) Surplus lines d) Variable life and annuities
b) Group health insurance
How often must a health carrier provide a certificate of compliance to the Department of Insurance indicating that the carrier has established grievance procedures for each of its health benefit plans? a) Twice a year b) Once a year c) Once every 3 years d) Once every 5 years
b) Once a year
Which statement accurately describes group disability income insurance? a) Short-term plans provide benefits for up to 1 year. b) The extent of benefits is determined by the insured's income. c) In long-term plans, monthly benefits are limited to 75% of the insured's income. d) There are no participation requirements for employees.
b) The extent of benefits is determined by the insured's income.
When a health carrier uses retrospective review procedures, within how many days of receipt of information must the carrier make the determination? a) 48 hours b) 15 calendar days c) 30 working days d) 24 hours
c) 30 working days
If a policyholder declines the nonforfeiture benefit, what must the insurer provide to the client upon the lapse of the policy? a) A full refund of premiums b) Pro Rata premiums c) A contingent benefit d) An aleatory benefit
c) A contingent benefit
An insurance contract must contain all of the following to be considered legally binding EXCEPT a) Consideration. b) Competent parties. c) Beneficiary's consent. d) Offer and acceptance.
c) Beneficiary's consent.
All of the following are true about group disability Income insurance EXCEPT a) The waiting period starts at the onset of the injury or sickness. b) The longer the waiting period, the lower the premium. c) Coverage applies both on and off the job. d) Benefits are usually short term.
c) Coverage applies both on and off the job.
Which of the following best describes the aleatory nature of an insurance contract? a) Ambiguities are interpreted in favor of the insured b) Policies are submitted to the insurer on a take-it-or-leave-it basis c) Exchange of unequal values d) Only one of the parties being legally bound by the contract
c) Exchange of unequal values
The Director may suspend, revoke, refuse to renew an insurance producer license for any one or more of the following causes, EXCEPT a) Improperly withholding or converting money received in the course of doing insurance business. b) Failing to comply with any administrative or court order directing payment of state or federal income tax. c) Failing to notify the Director of a change of address. d) Violating any insurance law or regulation
c) Failing to notify the Director of a change of address.
Every insurer marketing Long-Term Care insurance must establish marketing procedures to ensure all of the following EXCEPT a) Excessive insurance will not be sold. b) Every reasonable efforts is made to identify an applicant's other insurance. c) LTC policies are marketed effectively to prospective insureds. d) Comparisons of policies are fair and accurate.
c) LTC policies are marketed effectively to prospective insureds.
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) Partial benefits b) Full benefits until the blindness lifts c) No benefits d) Full benefits
c) No benefits
Which of the following does NOT have to be disclosed in a long-term care (LTC) policy? a) Any limitations or conditions of eligibility for LTC benefits b) Any riders or endorsements c) The aggregate amount of premiums due d) The meaning of the terms "reasonable" and "customary"
c) The aggregate amount of premiums due
Which of the following is true about the requirements regarding HIV exams? a) Prior informed oral consent is required from the applicant. b) HIV exams may not be used as a basis for underwriting. c) The applicant must give prior informed written consent. d) Results may be disclosed to the agent and the underwriter.
c) The applicant must give prior informed written consent.
The period of time immediately following a disability during which benefits are not payable is a) The grace period. b) The residual period. c) The elimination period. d) The probationary period.
c) The elimination period.
Which of the following best describes the "first-dollar coverage" principle in basic medical insurance? a) The insurer covers the first claim on the policy. b) Deductibles and coinsurance are taxed first. c) The insured is not required to pay a deductible. d) The insured must first pay a deductible
c) The insured is not required to pay a deductible.
If an insurer imposes a maximum lifetime benefit for breast cancer treatment using stem cell transplants, this limit must be at least a) $25,000. b) $50,000. c) $75,000. d) $100,000.
d) $100,000.
Which of the following is a mandatory coverage in all health benefit plans? a) Maternity care b) Accident-only c) Specified disease d) Bone marrow transplant
d) Bone marrow transplant
If an insured changes his payment plan from monthly to annually, what happens to the total premium? a) Stays the same b) Doubles c) Increases d) Decreases
d) Decreases
All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT a) An offer of employment. b) Stocks, securities, or bonds. c) An offer to share in commissions generated by the sale. d) Dividends from a mutual insurer.
d) Dividends from a mutual insurer.
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.
An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits? a) Partial benefits b) Full benefits for 2 years c) No benefits d) Full benefits
d) Full benefits
Which of the following is NOT required to cover early intervention services for children? a) Medicare b) Blue Cross c) Blue Shield d) Medicaid
d) Medicaid
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 a) Concealment. b) Unfair claim practice. c) Rebating. d) Misrepresentation.
d) Misrepresentation.
A long-term care insurance shopper's guide must be provided in the format developed by which of the following? a) Office of Insurance Regulation b) Director c) Medical Information Bureau d) NAIC
d) NAIC
What must a health carrier do within 72 hours of receiving a request for an expedited review? a) Provide written confirmation of the carrier's decision b) Acknowledge receipt of the request c) Notify the requesting enrollee of the carrier's established written procedures for an expedited review d) Notify the requesting enrollee of the carrier's determination
d) Notify the requesting enrollee of the carrier's determination
What is a definition of a unilateral contract? a) Two or more parties go into a contract understanding there may be an unequal exchange of value b) One author: the company wrote the contract; the insured must accept it as written. c) If one party makes a condition, the other party can counteroffer. d) One-sided: only one party makes an enforceable promise
d) One-sided: only one party makes an enforceable promise
In forming an insurance contract, when does acceptance usually occur? a) When an insurer delivers the policy b) When an insurer receives an application c) When an insured submits an application d) When an insurer's underwriter approves coverage
d) 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 a) When used to replace or supplement benefits payable under other social insurance programs. b) When the insured is eligible for Social Security benefits but before the benefits begin. c) If the insured has been denied coverage under Social Security. d) When the amount payable under Social Security is more than the amount payable under the rider.
d) When the amount payable under Social Security is more than the amount payable under the rider.
