life insurance test study set

S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning

November 1

C is the policy owner of a comprehensive individual major medical policy C pays an annual premium which is due September 1 if she forgets to pay the premium and is hospitalized September 10 how will insurer handle this claim

Pay the claim in full minus the premium due

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period?

Gives the policyowner additional time to pay past due premiums

I am headed annual life insurance premium payment due January 1 she died January 10 without making the premium payment what actually they should take

pay face amount minus the past due premium

Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine

probability of making timely premium payments

what does the policy owner provide to the insurer for validation that loss has occurred

proof of loss

which of these terms accurately defines an underwriter assessment of information on a health insurance application

risk classification. underwriting is another term

why must an accident and health insurance applicant answer all questions on the application

statements and representations on the application are pRt of the consideration for issuing a policy

what should insured do if the insurer does not send claims forms within the time. Set forth in a health policy claims forms provision

submit the claim in any form

The policy provision that entitles the insurance establish conditions the insured must meet while a claim is pending is

time limit on certain conditions

which of the following is not included in the policy face

Exclusions

Which Federal law allows an insurer to obtain an inspection report on a potential insured?

Fair Credit Reporting Act

After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?

File written proof of loss

P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?

$0

S buys a $50,000 whole life policy with the 50,000 accidental death and dismemberment rider. S does 1 year late of natural causes . how much will the insurer pay the beneficiary

$50,000

what is the maximum percentage of control business an agent may produce

50%

which of the following statements BEST describes what the legal actions provision of an accident and health policy requires

An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed

When does a Probationary Period provision become effective in a health insurance contract?

At the policy's inception

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age

It is covered by a term life policy and does not make the required premium payment which was due August 1 and I September 15 what action with her insurer take

claim will be denied

C is a policy owner of a comprehensive individual major medical policy C pays an annual premium which os die september 1 if C forgets to pay the premium and is hospitalized september 10 how will the insurer handle this claim

pay the claim in full minus the premium due

The provision that defines to whom the insured will pay benefits to is called

payment of claims

The notice of claims provision requires a policy owner to

notify an insurer of a claim within a specified time

according to the mandatory uniform policy provision what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid

31 days

an insured pays premium on an annual basis for an individual health insurance policy what is the minimum number of days for the grace period provision

31 days

monthly premium individual health insurance policies must provide a grace period of at least

10 days

An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.

15 days

which of the following provisions is not required and HMO contracts or certificates

7 day grace period

what is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision

Insured must be under a physician's care

Which health policy clause specifies the amount of benefits to be paid?

Insuring

which of these statements accurately describes the waiver of premium provision in an accident and health policy

The Waiver of Premium provision waives the payment of premiums after the insured has been totally disabled for a specified period of time.

what is the purpose of the grace period

additional time to pay past due premiums (31 days)

a disability income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability the original neck injuring occurred before the application was taken 5 years prior the next injury was never disclosed to the insurer at the time of application how will the insurer handle this claim

claim will be paid and coverage will remain in force

K failed to pay a renewalable premium within the time granted by the insurer k then sends in a payment which the insurer subsequently accepts which policy provision specified that the coverage may be restored in this situation

reinstatement

P is blinded in an industrial accident. Which provision of his life insurance policy will pay a stated benefit amount?

Accidental Death and Dismemberment provision

An insured must notify an insurer of a medical claim within how many days after an accident?

20

and insurer must not find it insured of a medical claim within how many days after an accident

20

agents that have been licensed for more than six years must complete ___ hours of continuing education every two years

24 hours

within how many days should a licensee notify department of financial services after a change of address

30 days

A group plan was recently terminated in Florida how many days are covered individuals guaranteed coverage after a group plans termination

31 days

According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?

31 days

A licensed agent must be appointed by an insurance company to solicit insurance in Florida the agents license will terminate if a certain period of time... Without being appointed how long is this period of time

48 months

Florida requires an insurance agent must complete ___ hours of continuing education on the subject of law ethics every two years

5

The option that provides an additional death benefit for a limited amount of time at the lowest possible cost is called

Accidental Death and Dismemberment rider (AD&D)

all of the following Entries are classified under the four principal areas of Florida insurance law except

An agent's commission

"A producer does not have the authority to change a policy or waive any of its provisions". The health provision that best describes this statement is called the

Entire Contract

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

Entire Contract

which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy

Entire Contract

The sections of an insurance contract which limit coverage are called

Exclusions

K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered

Guaranteed renewable

T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take?

Increase her policy's coverage amount

which of the following are NOT managed care organizations

Medical Information Bureau (MIB)

which of these is not considered to be a right given to a policy owner

Modify a provision in the insurance contract

which of these is considered a mandatory provision

Payment of Claims

what is the purpose of the time of payment of claims provision

Prevents delayed claim payments made by the insurer

what is the purpose of the time of payment of claims provision

Prevents delayed claim payments made by the insurer. The purpose of the Time of Payment of Claims provision is to prevent the insurance company from delaying claim payments.

All of these are considered sources of underwriting information about an applicant EXCEPT

Rating Services

P is a producer who notices 5 questions on a life application were not answered. What actions should P take?

Schedule another appointment with the applicant to complete the unanswered questions

A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?

Send a notice to the MIB that the applicant was declined

the insuring clause

States the scope and limits of the coverage

Which of the following statements about the classification of applicants is INCORRECT

Substandard applicants are never declined by underwriters

which of the following BEST describes a short term medical expense policy

nonrenewable

which of the following factors is not considered when the Department of financial services determines if an agents home is an insurance agency

The amount of premium collected at this location.

in health insurance policies a waiver of premium provision keeps the coverage in force without premium payments

The waiver of premium provision keeps the coverage in force without premium payments if the insured has become totally disabled as defined in the policy.

T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called

Time Limit on Certain Defenses

The notice of claim provision requires a policy owner to

notify an insurer of a claim within a specified time

Ty found the claim on his accident and health policy after being treated for an illness then Sherance company believes that she misrepresented his actual health on the initial insurance application and is therefore the speed in the claims Vallidity The provision that now is the time. During the company may dispute a claim validity it's called

Time limit of certain defendent

what type of rider would be added to an accident and health policy if the policy owner wants to ensure the policy will continue if he she ever becomes totally disabled

Waiver of premium rider

which of the following statements describe what an accident and health policy owner may not do

adjust the premium payments

which of the following statements best describes what the legal action provision of an accident and health policy requires

an insurer must wait 60 days after proof of loss has been submitted before a law suit can be filed

Before a Health Policy is issued which of these components of the contract is required

applicants signature on application

A(n) __ of benefits of a health policy transfers payments to someone other than the policyowner

assignment

when does a probationary period provision become affective in the health insurance contract

at policy inception

s is the policyowner of a major medical policy the premiums are paid monthly and due on the 1st of each month . S fails to make september payment and is hospitalized october 15 when S files the claim for this hospitalization the insurer will likely

deny the claim

An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to

determine if the applicant is an acceptable risk by completing standard underwriting procedures

In Florida, an insurer domiciled and incorporated in this state is called a(n)

domestic company

Health insurance benefits not covered due to an act of war are

excluded by the insurer in the contract provision

health insurance benefits NOT covered due to an act of war are

excluded by the insurer in the contract provisions

An underwriter determines that an applicant's risk should be recategorized due to a health issue. This policy may be issued with a(n)

exclusion for the medical condition

after an insured gives a notice of loss what should he or she do it if the insured does not furnish forms

file written proof of loss

The financial services commission may hold hearings

for any reason deemed necessary

under an individual health insurance policy the time limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two years

from the date that the policy was issued

and insured is past due on his life insurance premium but it's still within the grace. What were the beneficiary receive the should die during the grace period

full face amount minus past due payment

which of the following provision specifies have a long term policy owners insurance coverage will remain in effect if the policy owner is not paid by the due date

grace period

which of the following provisions specifies how long a policies health coverage will remain in effect if the policy owner does not pay the premium when it is due

grace period

X is insured with a disability income policy that provides the coverage until the age of 65 this policy allows the insurer to change the premium rate for the overall risk class assigned which of these renewability features does this policy contain

guaranteed renewable

T applied for disability income policy and has a history of back injuries the insurer and issued the policy with a statement that excludes coverage for back injuries this statement is called

impairment rider

t applied for a disability income policy and has a history of back injuries the insurer issued the policy with a statement that excluded coverage for back injuries this statement is called

impairment rider

He owns an accident and health policy and notified her insurance she has chosen a less hazardous occupation under the change of occupation provision which of the following actions may her insurance company take

increase her policy coverage

the ____ clause indentified which losses resulting from an accident or sickness are insured by the policy

insuring

the ____ clause indentifies which losses resulting from an accident or sickness are insured by the policy

insuring

Did the beneficiary under her husbands ADND policy submits an accidental death claim on May 1, 2010 following his death however the company denied They claim to the basis that the death was due to natural causes she decides to talk to her parents honey what is the earliest date for taking legal action against ensure

july 1st 2010

Which type of plan normally includes hospice benefits?

managed care plans

which of these factors do NOT play a role in the underwriting of a health insurance policy

marital status

according to the time payment of claims provision the insured must pay disability income benefits no less frequently than which of the following options

monthly

A disability income policy that only the policy owner can terminate and which the rates would never go up as considered to be

noncancellable

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called

noncancellable

What type of renewability guarantees premium rates and renewability?

noncancellable