NEW L&H Questions

An insured is covered by a partially contributory group disability income plan that pays benefits of $4000 a month. If the insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable?

$3000 -on partially contributory group disability income insurance, only that portion of the benefits that are related to the premium paid by the employer is taxable to the employee. In this case, because the employer pays 75% of the premium, the employee will be taxed on 75% of the benefits

L has a mjor medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2500 loss. What is the maximum amount that L will have to pay?

$900 (deductible + 20% of the bill after the deductible [20% of $2000])

A disability income policy is written with a 10 month benefit period, a 30 day elimination period, and a 30 day probationary period. if te insured becomes disabled due to illness 9 days after the effective date, the policy will pay benefits for a maximum of

10 months

To qualify for group health insurance coverage with a small employer, the employee must work how many hours a week?

30

What is the maximum age for qualifying for a catastrophic plan?

30

Insurers marketing long term care products must complete

5 hours continuing education should be completed every 2 years

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?

50/50

How long is an open enrollment period for Medicare supplement policies

6 months

Adult day care is a program for....

6 or more individuals, consisting of social and health-related services provided during the day in a community setting for the purpose of supporting frail, impaired, elderly, or other adults with disabilities who can benefit from care in a group setting outside the home

The rider that may be added to a Disability Income policy that allows for an increase in the benefit amount under certain conditions is called

Cost of Living (COLA)

An applicant is denied insurance because of information found on a consumer report. Which of the following requires that the insurance company supply the applicant with the name and address of the consumer reporting company?

Fair Credit Reporting Act -The Fair Credit Reporting Act governs what info can be collected and how the info can be used

Rule 38.1 is also known as

Group Coordination of Benefits

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 insurer purchase the policy?

Mutual -funds not paid out after paying claims and other operating costs are returned to the policyowners in the form of a dividend. If all funds are paid out, no dividends are paid

Which of the following must be present in all Medicare supplement plans?

Plan A -the NAIC developed standard Medicare Supplement benefit plans which are identified with the letters A through N. The benefits in Plan A are considered to be core benefits and must be included in the other types

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

a permanent resident lawfully present in the US -to be eligible for health coverage on the Marketplace, the individual must be a US citizen or national or be lawfully present in the US, must live in the US, and cannot be currently incarcerated. Medicare recipients are not eligible for coverage in the Marketplace.

Which of the following would NOT be eligible for a health insurance policy from the Indiana Comprehensive Health Insurance Association?

a person who applied for Medicaid 90 days prior to applying for the Association policy

Which of the following is NOT covered under a long-term care policy

acute care in a hospital -LTC policy may provide coverage for home health care, adult day care, hospice care, or respite care. Acute care isn't covered

In which Medicare supplemental policies are the core benefits found

all plans

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?

all providers will have the same coverage options and conditions for each plan

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care

attending physician

Which of the following is NOT required to be stated in te outline of coverage provided with a long-term care policy?

basic info about supplementary policies -the outline of coverage must follow the standard format inclued in the insurance regulations. it must provide info about the insurance company, the policy number, important features of the policy, and explain the right to return the policy for a refund

Which of the following statements regarding Business Overhead Expense policies is NOT true?

benefits are usually limited to six months -BOE insurance is sold to small business owners for the purpose of reimbursing the policyholder for BOE during a period of total disability. Premiums are tax-deductible for a business, but any benefits received are taxable as income. Overhead expenses, including equipment and employee salaries, are covered by the plan. Salaries and profits of the employer are not protected

To be eligible for tax credits under the ACA, individuals must have income that is what percent of the Federal Poverty Level?

between 100% and 400%

According to the provisions of the Patient Protection and ACA, all of the following are required preventive care services EXCEPT

cervical cancer exams for all women starting at age 40 -cervical cancer exams as a preventive service will only be availiable for women at higher risk. All the other services are required preventive care services

In any case where there is a controversy or dispute between the insurance company and the insured, the soliciting agent is the agent of the...

company -An agent's license authorizes them to represent an insurance company, not the insured

An applicant for an individual health policy failed to complete the app properly. before being able to complete te application and pa the initial premium, she is confined to a hospital. This will not be covered by insurance because she has not met he conditions specified in the

consideration clause

Which of the following provisions must be included on the first page of a Medicare supplement policy, which states the insurer's right to change premium amounts?

continuation provision

Which of the following would be considered a time deductible in a health insurance polic

elimination period

Concerning group Medical and Dental insurance, which of the following statements is INCORRECT

employee benefits are tax deductible the year in which they were received

In disability income insurance, the own occupaton definition of disability applies

for the first 2 years of a disability

Regarding long-term care coverage, as the elimination period gets shorter, the premium

gets higher

In insurance transactions, fiduciary responsibilty means...

handling insurer funds in a trust capacity -an agent's fiduciary responsibility includes handling insurer funds in a trust capacity

The Patient Protection and ACA includes all of the following provisions EXCEPT

individual tax deduction for premiums paid -the Act doesn't offer tax deductions for health insurance premiums. the Act does offer a tax credit, which is different from a tax deduction. All the other provisions are included in the Act.

When a person applies for Medicare supplement insurance, whose responsibility is it to confirm that the applicant doesn't already have accident or sickness insurance in force?

insurer

Who is responsible for making sure tha agents are prperly trained in the use of the suitability standards for LTC policies?

insurer

Under the Fair Credit Reporting Act, ind. rejected for insurance due to info concatined in a consumer report

must be informed of the source of the report -under the FCRA, if an insurance policy is declined or modified cuz, of info contained in a consumer report, the consumer must be advised and provided with the name and address of the reporting agency

An insured is involved in a car accident. in addition to general, less serious injuries, he permanently loses the use of this leg and is rendered completely blind. he blindness improves a month later. To what extent will he receive Presumptive Disability benefits?

no benefits

After the elimination period, a totally disabled insured qualified and started receiving benefits from his disability income policy that has a waiver of premium rider. what will most likely happen to the premiums paid into the policy during the elimination period?

premiums will be refunded -premiums that were paid by the insured during the elimination period are usually refunded once the insured qualifies to begin receiving benefits

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

present earnings and earnings prior to disability

Under a disability income policy, the insurer doesn't pay a monthly benefit that is equal to the insured's previous income. The reason for paying a benefit amount hat is less than the insured income is to

prevent overutilization and malingering

Which of the following statements is an accurate comparison between private and government insurers?

private insurers may be authorized to transact insurance by state insurance departments

Workers Compensation benefits are regulated by which entity?

state government

Which of the following is an example of apparant authority of an agent appointed by an insurer?

the agent accepts a premium payment after the ened of the grace period -an agent who accepts a premium after the end of the grace period appears to the client to have the authority to prevent the policy from lapsing. In fact, the agent has no such power. The power to use business cards, stationery and signage may be either express (written) or implied (not written), but in either case it is allowed

What is necessary in order to be eligible to receive benefits from a long-term care policy

the insured must be unable to perform some activities of daily living

All of the following statements about Medicare supplement insurance policies are correct EXCEPT

they cover the cost of extended nursing home care

Which of the following is true regarding benefits paid to disabled employees

they may be subject to taxation if the premium was paid by the employer

What is the purpose of the rehabilitation benefit in disability insurance?

to cover the expenses of retaining the insured to return to work -rehab benefit will cover a portion of the cost for the insured to enroll in a retraining program that will help the insured o return to work after a disability

A single mother wants to make sure that if she is unable to work for healh reasons, she and her child would be protected financially. Which of the following insurance plans would best suit her needs?

total disability plan -this plan protects a family or individual against the economic loss that would occur if te wag earner were totally disabled

An agent is completing an application for a long-term care policy. The agnt is required to do all of the following EXCEPT

warn the applicant about the 10 day free look period -LTC policies must have a 30 day free look period

All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT

when the employer chooses to renew the plan -as well as noncompliance with the carrier's minimum participation requirements, noncompliance with the carrier's employer contribution requirements, repeated misuse of a provider network provision, all of te above are exceptions t replacement

Workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from

work-related disabilities