Insurance exam
if an insured pays a health insurance premium each month, how long would the grace period be under the policy
10 days
which of the following statements is not true regariding health insurance policy provisions
All additional provisions written by insurers are cataloged by their respective states.
An elimination period may NOT have to be satisified for a disability in which of the following>
An insured suffers a relapse of a prior disability within 6-months of the initial covered disability
An insured recently received his major medical insurance policy. Only 20 after the policy issue, while recreational rock climbing, the insured suffered a fall that required hospitalization surgery and physical therapy to repair his broken leg. Which is true?
Both the deductible and coinsurance payments will be required
regarding the consideration clause, which of the following is not correct?
Consideration of the insurer and insured must be equal
Which of the following time periods is the general enrollment period for Medicare Part B
Jan 1- March 31
Which rider, when added to a disability policy, pays income during the six- month waiting period before Social Security benefits can begin?
additional monthly benefit
When agents, brokers, or solicitors handle premiums for an insurer, they are acting in which capacity?
as a fiduciary
HMO members pay a small fee when they see their primary care physicain. This fee is called a
copay
in health insurnce , the legnth of the grace period varies to
premium payment
what is the purpose of a benefit schedule
to state what and how much is covered
The Healthy New York program was created to make standardized health insurance coverage to
qualifying small employers
all of the following could qualify as a group for the purpose of purchasing group health insurance except
singe employer with 14 employees
which of the following is typical amount of protection offered by major medical expense policie sin New York
1 mil
which of the following is not a crucial factor in health insurance underwriting?
income
All of the following are true regarding the Federal Fair Credit Reporting Act except
insureres are not required to give customes a copy of the report
if an insured is injured while committing an illegal act and his health policy contains the illegal occupation provision, what percentage of the claim will be paid
none
which of the folllowing does not need to be included on the first page of a medicare supplement policy
premium rates
which of the following best describes the type of care provided by HMOs
preventive
which of the.followingmis not mandatory under the Uniform provisions law as applied to taccident and health policies
probationary period
To qualify for disability income benefits under social security , an individual's disability must be expected to result in death or last at least
1 year
a disability inccome policy has a waitying pweiod of 7 days. if the insured is disabled for 15 days, how many days of benefits will the policy pay?
8 days
1. An insured is anxious to get treatment for a health condition and is convinced that a specialist is need to cure the condition. If the insured has a PPO plan, which of the following is true?
The insured can select any specialist, but non-network specialists will have higher out- of- pocket costs.
WHen an individual obtains an insurance license for the primary purpose of writing insurance on him or herself, or for members of his or her immediate family or biusiness, thiss is called
controlled business
a dentist is offf work for 4 moths due to a disability his assistant sallary would be covered by
business overhead
in an employer group health insurance plan, the covered employee receives
certificate of insurance
highly compensated employee
5%
if a person qualifies for social security benefits after 5 month elimination period when will benefits begin?
?? A lump-sim of benefits will be paid at beginning of the 6th month which are retroactive to the beginning of the disability
HMOs are known as what type of plans?
?? Service
What is the major difference between private and government insurance programs?
government is funded by taxes
Under Hipaa portability, which of the following are not protexted under required benefits
groups of 1 or more
Regarding major medical plans
higher stoploss lower premium
which of the following is provided by skilled medical personnel to those who need occasional medical assitance or rehabilitative care
home health care
If an insured decides to reduce the coinsurance amount on her major medical insurance can the insured expect?
a higher monthly premium
If a person qualifies for Social security disability benefits after the 5 month elimination period, when will benefits begin?
a limp-sum of benefits will be paid at the beginning of the 6 moth which are retroactive to the beginning of the disability
Which policy rider added to a disability income policy may require that a benefit be paid as a "capital" sum?
accidental death and dismemberment
an insured intention did not disclose a material fact on aoolication. This would be considered
concealment
which of the following provisions give an employee the right to exchange group insurance for an individual policy within 60 days from termination of employment
conversion
An employee is covered under COBRA. His previous premium was $100 oer month. His employer now collects $102 each month. WHy does the employer collect an extra 42?
cover adminstrative costs
Which of the following meets the insured's personal needs and is provided by nonmedical personnel?
custodial care
all of the following are features of a health insurance plan purchased on the health insurance marketplace except
dollar limits on essential benefits
In health insurance, the length of the grace period varies according to the
mode of premium payment
Under the affordable care act, when would pregnancy be considered a pre- exisity condition?
never
with respect to the entire contract clause in health policies, who has the authority to make changes to an exisitying policy?
only an executive officer of the company
In group insurance, the primary purpose of the coordinatin of benefits provisionis to
overinsurance
which of the following is consideration on the part of an insurer?
paying a claim
regarding the ppaca health care tax credit which of the following is true
person receiving medicare are not eligible
The purpose of the fair credity reporting act is to
reports may be sent to any who
which of the following is a daily nursing and rehab care that can only be provided by medical personal
skilled care
for which of the following reasons may group coverage not be discontinued
the company's stock value lowers
all of the following are reasons for group insurance termination for dependents expect
the dependent reaches age 21
An applicant completes an application for a disability policy and pays the initial premium. The producer gives the applicant a condition receipt. Insurance coverage for the applicant will become effective when
the insrance company accepts the risk
what is the only difference between blanket insurance and group health insurance?
the insured members are not named
For which of the following reasons could an insurer terminate a long- term caure insurance policy?
// non payment
An insured wants to cancel her health insurance policy. which portionbof the contract would explain canellation rights
// renewability provision
A fraternal benefit society
//is operated for the benefits of members
When an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. When would this accident be covered upon reinstatement of the policy?
Immediately
An employer is no longer able to afford the group health insurance plan and the plan ends. However, one of the employees continues to receive coverage. Which of the following explains this?
?? The employee' health sacings acount pays for the coverage
Which of the following would be required to become licensed as an insurance producer?
A customer service representative who solicits no more than one policy a year
Which of the following is not a common exclusion found in most medical health policies
Dental procedure due to birth defect
Which act was introduced to reduce the cost of health care by utilizing preventive care?
HMO Act of 1973
An insured's hospital policy states tht it will pay him a flat fee of $75 per day for each day he is hospitalized. The policy pays benefits on what basis
Imdenity
Which of the following is NOT a Medicaid qualifier?
Insurability
Which of the following indicates how much of the health coverage premium must go toward actual medical care?
Medical Loss Ratio
Ed is covered under a health plan provided by his employer. He was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plan's list. If Ed chose to be treated by a provider who was not on thie list, his portion o f the bill would be greater. Ed is covered under a
PPO
What must states do after of a person who received medicaid benefits, according to the Medicaid Estate Recovery Act?
Seek repayment of funds that were paid
which of the following define "own occupation disability" with respect to disability income insurance?
a occupation that insured can work another job when they're unable to do regular job
an insurer who transacts insurance in this state but whose articls of incorportaion are registered in canadada is considered
alien
What is the latest point at which an Outline coverage may be presented
at the time of policy delivery
which of the following is not an example of the company's location of incorporation
authorized
which of the following is not normallu an excluded cause of disability in an individual disability income policy
complications from pregnancy
carlos's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. Carlo's policy provides benefits on a
scheduled
An employee may enroll in an employer's group health plan when he/she initially becomes eligible without proof of insurability. She he/ She enrolll at another time, evidence of insurability is required except
the annual open enrollment period
whose resonsibility is it to ensure that the application for health insurance is complete and accurate
underwriter
among people in the same class and life expectancy which of the following factos can be used to influence premium rates
occupations
which of the following best describes a presumptive disability?
one that is severe enough that the insured automatically qualifies for full disability benefits
which of the following is not a format for marketing long term care insurance
individual policies
What is another name for a health insurance policy subscriber?
insured
which of the following statements is trye regarding advertising that the insrance guaranty association would ensure payment of benefits in the event of insurer insolvency
it is unfair treade practive
if a business wants to make sure it will be able to coer losses due to the disability of its top employee, the business should get which type of insureance
key person
Which statement is required to be printed on the first page of a health insurance policy, which signals to the insued that the policy's benefits are limited?
limited policy notice
An individual was denied coverage under Social Security because his disability did not meet the strict definition of total disability used by Social Security. WHich of the following would provide disability income coverage?
sis
Two individuals of the same age, health status, and life expectany apply for coverage, when polices are issued by the same insurer, the premium rates are different based on race
unfair discrimination
In a group health insurance, what is experience rating?
when an insurer uses the experience of the group as a whole to determine the premiums
Which of the following is a requirement for replacement of health policies
the old policy must stay in force until the new policy is issued
every medicare supplement policy must have a notice to buyer on the fromt page that states which of the following
the premium may increase
In insurance, what is the term used for the cause of a loss
Peril
A subscriber has been treated for a medical condition by his promary care physician for 3 months with experimentalremedies without significant health improvement before being referred to a specialist. Which of the following types of plans does the subscriber have
a gatekeeper HMO plan to control the costs
The annual open enrollment period for stae insurance exchanges runs from novemebr through
december
Medicare Part B covers all of the following except
//long term care services
according to the time limit on certain defenses provision, statements or misstatements made in the appl
2 years
An employee has a Flexible Spending Account with a $5,00 annual benefit. This year the employee used $3,000. What would be the amount of the benefit availabel to the employee next year
5,000
As required by the Affordable Care Act, employers must provide a minimum value plan that cover what minimum percentage of the participant's expected health care costs?
60
Medicare is a health insurance program for all the following individuals except
65 and older
Under normal circumstances, how long is a temporary license in this state valid
90 days
If any authorized entity fails to file an annual financial solvency statement, or does not reply to a written inquiry with 30 days, they are subject to a penalty of up to
??$100 per day of delay, not to exceed an aggregate of $5,000 for each failure
What was enacted to ensure that employees receive the pension and other benefits promised by their employers?
EIRSA ( Employee Retirement Income Security Act)
When filing out an application for insurance, the applicant makes a mistake. If a fresh aoolication were not avaiable. What could the applicant do to properlu correct the mistake
cross out, write correct and initial it
All of the following are places where care can be administered for a medical plan except
eye centers
Daryl is involved in an automobile accident with another motorist. Darul was at fault. Daryl ws injured and hospitalized for 2 moths. the other motorist suffered $15,000 of medical expenses as a result of the accident. Daryl's disability income will pay
daryl's loss of income
the presumptive disability provision assumes that the insured is totally disabled upos loss of all of the following except
feeling
an insured driver is incolved in accident in which he is disable and his passenger the other driver are injured. Which of the following will be covered by his disability income
his lost income
Which of the following is not true regarding a noncancellable policy?
insurer can increase the premium above what is stated in the policy if claims experience is greater than expected
Riley reads an agreement on the first page of her policy which includes a list of losses that will be coverred by her insurer. What is the name of this agreement?
insuring clause