North Carolina Health Insurance Exam
An agent has completed a total of 30 hours of continuing education (CE) during the license renewal period. How many of these hours made the agent apply towards the next CE compliance period? A. None B. No more then 3 C. 6 D. 12
C.
An insurance institution or agent that disclose his information in violation of the information privacy and disclosure statutes of North Carolina will be liable for A. The legal cost incurred by the client B. Only such damages as can be proven in a court of law C. Damages sustained by the individual to whom the information relates D. Any legal action brought by the client within five years
C.
A business wants to make sure that if a key employee becomes disabled, the business will be protected from any resulting loss. Which kind of insurance will protect the business? A. Business disability B. Individual disability C. Management loss D. Business loss
A.
A client has a new individual disability income policy with a 20 day probationary period and a 30 day elimination period. 10 days later, the client breaks their leg and is off work for 45 days. How many days of disability benefits will the policy pay? A. 10 day B. 15 days C. 25 days D. 45 days
B.
In all healthcare plans under the affordable care act, how many essential benefit categories are there? A. 5 B. 10 C. 12 D. 15
B.
Insurance policies are not drawn up through negotiations, and insured has little to say about its provisions. What contract characteristics does this describe A. Unilateral B. Adhesion C. Conditional D. Personal
B.
An insurer devises in intimidation strategy in order to corner a large portion of the insurance market. Which of the following best describes this practice? A. Unfair discrimination B. Defamation C. Illegal D. A legal advertising strategy
C.
The provision that provides for the sharing of expenses between the insured and the insurance company is A. Deductible B. Divided cost C. Coinsurance D. Stop loss
C.
A person who no knowingly obtains information about an Individual from an agent or the insurer under false pretenses has committed a(n) A. Trustworthy Act B. Unfair Trade Practice C. Felony D. Class 1 misdemeanor
D.
Premium payments for personally owned disability income policies are A. Eligible for tax credits B. Tax deductible C. Tax-deductible to the extent that they exceed 10% of the adjusted gross income of those itemizing deductions D. Not tax-deductible
D.
According to the future increase option rider, which of the following is NOT a qualifying event increase in insurance benefit level? A. Death of spouse B. Age 40 C. Marriage D. Birth of a child
A.
All of the following are correct about the required provision of health insurance policy EXCEPT A. A reinstated policy provides immediate coverage for an illness B. Proof of loss forms must be sent to the insured within 15 days of notice of claim C. A grace period of 31 days is found in an annual pay policy D. The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract
A.
All of the following are true regarding rebates EXCEPT A. Rebates are allowed if it is in the best interest of the client B. Rebates are only allowed if specifically stated in the policy C. Rebates can be anything of monetary value given as an inducement to purchase insurance D. Dividends are not considered to be rebates
A.
In a group policy, who is issued a certificate of insurance? A. The individual insured B. The healthcare provider C. The insurance company D. The employer
A.
In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party? A. Insurer to the insured B. Insured to the insurer C. Insurer to the dept of insurance D. Insured to the dept of insurance
A.
Under a Key Person disability income policy, premium payments A. Are made by the business and are not tax-deductible B. Are made by the employee and are not tax deductible C. Are made by the employee and are tax free D. Are made by the business and are tax deductible
A.
What is the initial period of time specified in a disability income policy that must pass, after the policies in force, before a loss can be covered? A. Probationary period B. Contestable period C. Elimination period D. Grace period
A.
What is the purpose of COBRA? A. To provide continuation of coverage for terminated employees B. To provide coverage for the dependents C. To provide health coverage for people with low income D. To protect the insured's against insolvent insurers
A.
Which of the following best describes an insurance company that has been formed under the laws of the state? A. Domestic B. Sovereign C. Alien D. Foreign
A.
Which of the following is NOT true of a major medical health insurance policy? A. It is designed to pay on a first dollar of expense basis B. It usually has a maximum benefit amount C. The benefits are subject to deductibles D. It is designed to cover hospital and medical expenses of a catastrophic nature
A.
Who pays the annual agent appointment fee? A. The insurer B. The commissioner C. The policy owner who hires the agent D. The agent
A.
To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters? A. 4 B. 6 C. 10 D. 40
B.
What is the continuing education requirement in ethics for agents in this state? A. 5 hours every year B. 3 hours every 2 years C. 5 hours every 2 years D 3 hours every year
B.
A group policy used to provide accident and health coverage on a group of persons being transported by a common carrier, without naming the insured's persons individually is called A. Limited benefit policy B. Blanket policy C. Universal policy D. Comprehensive policy
B.
A women's health insurance policy dictates which doctors she is allowed to see. Her health provider share an assumed risk for their patients and encourage preventative care. What best describes the health system that the woman is using? A. Group health B. Managed care C. Comprehensive health D. Major medical
B.
Concerning group medical and dental insurance, which of the following statements is INCORRECT? A. Employee paid premiums may be deducted if certain conditions are met B. Employee benefits are tax-deductible the year in which they were received C. Benefits received by the employee are free from federal income tax D. Premiums paid by the employer our deductible as a business expense
B.
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 A. Own occupation - less restrictive than other definitions B. Any occupation - more restrictive than other definitions C. Any occupation - less restrictive than other definitions D. Own occupation - More restrictive than other definitions
B.
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days? A. Renewable provision B. Conversion provision C. Reinstatement provision D. Grace period
B.
Regarding the taxation of business overhead policies, A. Premiums are not deductible, but expenses paid are deductible B. Premiums are deductible, and benefits are taxed C. Premiums are not deductible, and benefits are taxed D. Premiums are not deductible, but benefits are deductible
B.
The commissioner is empowered to examine the records of any person transacting insurance in the state as an agency, an agent or broker of record. If the commissioner does examine a person, the expense of that examination will be paid by A. The insurance companies B. The person examined C. The policyholders D. The insurance department
B.
The minimum number of credits required for partially insured status for Social Security disability benefits is A. 4 credits B. 6 credits C. 10 credits D. 40 credits
B.
When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees A. To renew the policy indefinitely B. To renew the policy until the insured has reached age 65 C. To charge a lower premium every year the policy is renewed D. Not to change the premium rate for any reason
B.
Which of the following best describes the unfair trade practice of defamation? A. Refusing to deal with other insurer's B. Making derogatory oral statements about another insures financial condition C. Assuming the name and identity of another person D. Issuing false advertising material
B.
Which of the following entities can legally bind coverage? A. Agent B. Insurer C. The insured D. Federal insurance board
B.
Which of the following is NOT a feature of a noncancelable policy? A. The insured has the right to renew the policy for the life of the contract B. The insurer may terminate the contract only at renewal for certain conditions C. The premiums cannot be increased beyond the amount stated in the policy D. The guaranteed to renew coverage usually applies until the insured reaches certain age
B.
Which of the following is NOT true about the conversion privilege under a group health insurance policy? A. The premium for an individual health insurance policy can be higher than that of the group policy B. An individual policy must provide the same benefits as the group insurance policy C. An employee does not need to prove evidence of insurability D. An employee can convert from group to individual insurance within 31 days of termination
B.
Which of the following is NOT true regarding basic surgical expense coverage? A. It is commonly written in conjunction with hospital expense policies B. Coverage is unlimited C. There is no deductible D. Contracts include a surgical schedule
B.
Which of the following is considered a presumptive disability under a disability income policy? A. Loss of one hand or one foot B. Loss of two limbs C. Loss of one eye D. Loss of hearing in one ear
B.
Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information? A. Consumer privacy act B. The fair credit reporting act C. Unfair trade practices law D. The guaranty association
B.
Which rider, when added to a disability income policy, provides for changes in the benefits payable based on changes in the consumer price index? A. Guaranteed insurability rider B. Cost of living adjustment rider C. Waiver of premium rider D. Social Security rider
B.
All of the following are included with the insurance commissioners duties EXCEPT A. Conducting investigation of all domestic insurers B. Reviewing the insurers annual report C. Writing North Carolina insurance laws D. Reporting any violations of insurance laws to the Attorney General
C.
If an insured changes his payment plan for monthly to annually, what happens to the total premium? A. Doubles B. Increases C. Decreases D. Stays the same
C.
If the commissioner denies an initial application for an agent, how long does the applicant have to request a review after receiving notification of the denial? A. 10 days B. 20 days C. 30 days D. 45 days
C.
L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustained a $2500 loss. What is the maximum amount that L will have to pay? A. $1000 (deductible + 20% of entire bill) B. $2500 (the entire bill) C. $900 (deductible + 20% of the bill after the deductible [20% of $2000]) D. $500 (amount of deductible)
C.
Representations are written or oral statements made by the applicant that are? A. Found to be false after further investigation B. Immaterial to the actual acceptability of the insurance contract C. Considered true to the best of the applicants knowledge D. Guaranteed to be true
C.
The medical information bureau was created to protect A. Insurance from unreasonable underwriting requirements by the insurance companies B. Medical examiners that perform insurance physical examinations C. Insurance companies from adverse selection by high risk persons D. Insurance department from lawsuits by policy owners
C.
The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as A. Payment of claims B. Proof of loss C. Legal actions D. Time limit on certain defenses
C.
What is a material misrepresentation? A. Any misstatement by the producer B. Concealment C. A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company D. Any misstatement made by an applicant for insurance
C.
What is the period of coverage for events such as death or divorce under cobra? A. 31 days B. 12 months C. 36 months D. 60 days
C.
When a licensee is accused of any act, omission, or misconduct that would subject the licensee to a license suspension or revocation, with the approval of the commissioner, the license may be surrendered for a period of A. 6 months B. 1 year C. Time to be set by the commissioner D. 90 days
C.
When an insurance agency published an advertising brochure, it emphasize the companies financial stability and sound business practices. In reality, its financial health is terrible, and the company will soon have to file for bankruptcy. Which of the following terms best describes the advertisement? A. Twisting B. Rebating C. False financial statement D. Defamation
C.
Which of the following is NOT a metal level of coverage offered under the patient protection and affordable care act A. Silver B. Bronze C. Iron D. Gold
C.
Which of the following will NOT be considered unfair discrimination by insurers A. Canceling individual coverage based on the insured's marital status B. Assigning different risk classifications to applicants based on gender identity C. Discriminating in benefits and coverages based on the insured's habits and lifestyle D. Charging applicants with similar health history's different premiums based on their ethnicity
C.
Which renewability provision allows an insured to terminate a policy for any reason, and to increase the premiums for any class of insureds? A. Cancellable B. Guaranteed renewable C. Optionally renewable D. Conditionally renewable
C.
Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insured's? A. Guaranteed renewable B. Optionally renewable C. Conditionally renewable D. Cancellable
C.
Which rider, when added to a disability income policy, provides for changes in the benefits payable based on changes in the consumer price index A. Social Security rider B. Guaranteed insurability rider C. Cost of living adjustment rider D. Waiver of premium rider
C.
All of the following are correct about the required provisions of a health insurance policy EXCEPT A. Proof of loss forms must be sent to the insured within 15 days of notice of claim B. A grace period of 31 days is found in a annual pay policy C. The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract D. A reinstated policy provides immediate coverage for an illness
D.
An agent represents the A. Insured B. Beneficiaries C. Contingent beneficiaries D. Insurer
D.
An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she has not met the condition specified in the A. Insuring clause B. Pre-existing conditions clause C. Eligibility clause D. Consideration clause
D.
An insurance contract must contain all of the following to be legally binding EXCEPT A. Offer and acceptance B. Consideration C. Competent parties D. Beneficiaries consent
D.
In a disability income policy, all of the following are considered presumptive disabilities EXCEPT A. Loss of hearing B. Loss of two limbs C. Loss of speech D. Loss of one eye
D.
In a disability policy, the elimination or waiting period refers to the period between A. The effective date of the policy and the date the first premium is due B. Coverage under a disability policy and coverage under Social Security C. During which any specific illness or accident is excluded from coverage D. The first day of disability and the day the insured starts receiving benefits
D.
In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe? A. Unidirectional B. Aleatory C. Conditional D. Unilateral
D.
The commissioner must examine every domestic insurer at least once every A. Year B. 2 years C. 3 years D. 5 years
D.
What is the contract provision that allows the insured to non-renew health coverage if certain events occur? A. Optionally renewable B. Noncancellable C. Guaranteed renewable D. Conditionally renewable
D.
Which of the following best describes a misrepresentation? A. Making a deceptive or untrue statement about a person engaged in the insurance business B. Making a maliciously critical statement that is intended to injure another person C. Discriminating among individuals of the same insuring class D. Issuing sales material with exaggerate statements about policy benefits
D.
Which of the following describes taxation of individual disability income insurance premiums and benefits? A. Premiums are not tax-deductible, but benefits are taxable B. Premiums are tax deductible, but benefits are not taxable C. Premiums are tax deductible, and benefits are taxable D. Premiums are not tax-deductible, and benefits are not taxable
D.
When an insurer combines two periods of disability into one, the insured must have suffered a A. Recurrent disability B. Partial disability C. Residual disability D. Presumptive disability
A.
If a licensee is convicted of a criminal violation , the licensees insurance license is? A. Suspended after hearing B. Automatically suspended C. Automatically revoked D. Not affected
B.
What is the waiting period on a waiver of premium rider in life insurance policies? A. 30 days B. 3 months C. 5 months D. 6 months
D.
Which provision states that the insurance company must pay medical expense claims immediately? A. Time of payment of claims B. Payment of claims C. Legal actions D. Relation of earnings to insurance
A.
Which of the following is true regarding inpatient hospital care for HMO members? A. Inpatient hospital care is not part of HMO services B. Care can be provided outside of the service area C. Can can only be provided in the service area D. Services for treatment of mental disorders are unlimited
B.
Which of the following terms subscribes making false statements about the financial condition of any insure that are intended to injure any person engaged in the business of insurance? A. Slandering B. Defamation C. Undercutting D. Twisting
B.
All of the following applied to short-term disability plans except A. Individual plans can provide benefit periods of up to 2 years B. A benefit period of 26 weeks is most common for group plans C. Both group and individual plans are renewable D. Group plans can provide benefit periods of up to 52 weeks
C.
The patient protection and affordable care act mandates that ensures provide coverage for adult children of the insured up to the age of? A. 19 B. 21 C. 26 D. 30
C.
Which of the following is INCORRECT concerning taxation of disability income benefits A. If the insured paid the premiums, any disability income benefits are tax-free B. If the benefits are for a permanent loss, The benefit paid to employee are not taxable C. If paid by the individual, the premiums are tax deductible D. If the employer pay the premiums, income benefits are taxable to the insured as ordinary income
C.
Which of the following is NOT a feature of a guaranteed renewable provision A. Coverage is not renew it will be on the insured's age 65 B. The insureds benefits cannot be reduced C. The insured can increase the policy premium on an individual basis D. The insured has a unilateral right to renew the policy for the life of the contract
C.
Which of the following will vary the length of a grace period in health insurance policies? A. The length of time the insured has been insured B. The term of the policy C. The mode of the premium payment D. The length of any elimination period
C.
An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other 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.
Under the mandatory uniform provision notice of claim, the first notice of injury or sickness covered under an accident health policy must contain A. A statement from the insureds employer showing that the insured was unable to work B. An estimate of the total amount of medical and hospital expense for the loss C. A complete physician's statement D. A statement that is sufficiently clear to identify the insured and the nature of the claim
D.
What is a foreign insurer? A. An insurer was the home office in another country B. An insurer with licensed agents doing business and other countries C. An insurer with licensed agents doing business in other countries D. An insurer with a home office in another state
D.
Which of the following statements regarding business overhead expense policies is NOT true? A. Premiums paid for BOE are tax deductible B. Any benefits received are taxable to the business C. Leased equipment expenses are covered by the plan D. Benefits are usually limited to six months
D.
Which of the following is an example of a producer being involved in an unfair trade practice of rebating? A. Telling a client that his first premium will be waived if he purchases the insurance policy today B. Inducing the insured to drop a policy in favor of another one when it is not in the insured's best interest C. Charging a client a higher premium for the same policy as another client in the same insuring class D. Making deceptive statements about a competitor
A.
Which of the following is not a feature of a noncancelable policy? A. The insurer may terminate the contract only at renewal for certain conditions B. The premiums cannot be increased beyond the amount stated in the policy C. The guarantee to renew coverage usually applies until the insured reaches certain age D. The insured has the right to renew the policy for the life of the contract
A.
Which of the following must an insurer obtain in order to transact insurance within a given state? A. Certificate of authority B. Producer certificate C. Business entity license D. Insurers license
A.
Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policy owner? A. Payment of claims B. Change of beneficiary C. Entire contract clause D. Proof of loss
A.
All of the following actions can be described as twisting EXCEPT A. Making an incomplete comparison between the existing and proposed policies B. Explaining to the client the advantages of permanent insurance over term and suggesting changing policies C. Misrepresenting the terms and conditions of the existing policy to make the new one more attractive D. Embellishing the terms of the proposed policy in order to convince the insured to switch
B.
And insured purchased a disability income policy with a 10 year benefit period. The policy stated a 20 day probationary period for illness. If the insured is hospitalized with an illness two weeks after the policy was issued, how much will the policy pay? A. It will pay until the insured is released from the hospital B. Nothing, illness is not covered during the first 20 days of the contract C. The insured will receive a return of premium D. It will pay up to 10 years of benefits
B.
Any agent, broker or limited representative who acts for a person other than himself negotiating a contract of insurance, for the purpose of receiving the premium, is deemed to be A. In violation of the free credit act B. An agent of the company C. A designated representative of the agent D. A managing partner of the insured
B.
Certain conditions, such as dismemberment or total and permanent blindness, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe? A. Residual disability B. Presumptive disability C. Dismemberment disability D. Partial disability
B.
How long does a North Carolina agent have to notify the department of insurance in the event of a change in residence address? A. A change of residence address does not require notification B. 10 business days C. 30 business days D. 60 business days
B.
How soon before the child's attainment of limiting age must proof of intellectual or physical disability be provided to an insurer, in order for coverage to continue on the child? A. 15 days B. 31 days C. 45 days D. 60 days
B.
If an insurer accepts premium payments by credit card, who is responsible for paying the fees charged by a credit card company? A. Credit card company B. Insurer accepting payment C. Policy owners, as part of premium D. Insured
B.
Insurers may change which of the following on a guaranteed renewable health insurance policy? A. No changes are permitted B. Rates by class C. Coverage D. Individual rates
B.
Intimidating or discouraging a claimant from seeking legal advice would be a violation of which of the following? A. Attorney client privilege B. Ethical standards C. The fair credit reporting act D. Human rights
B.
When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy? A. 15 days B. 31 days C. 60 days D. 10 days
B.
When an insurer requires a written proof of loss after notice of such loss has been given by the insured or beneficiary, the company must A. Request a police report from the Department of Motor Vehicles B. Furnish a blank form to be used for that purpose C. Document the request for further investigation D. Submit the loss claim to underwriting for premium review and resolution
B.
When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles? A. Deductibles carryover, but coinsurance is generally higher B. They carryover from the old plan to the new plan C. They have to be reevaluated D. Coinsurance carries over, but deductibles are generally higher
B.
Which describes the features of a comprehensive major medical policy? A. There is no coinsurance B. Basic medical expense benefits are provided in single package C. The deductible is always expressed as a deferred amount D. It is the same as major medical insurance
B.
Which of the following best describes the first dollar coverage Principal in Basic Medical insurance? A. Deductibles and coinsurance are taxed first B. The insured is not required to pay a deductible C. The insured must first pay a deductible D. The insurer covers the first claim on the policy
B.
Which of the following is correct regarding selecting a primary care physician and a PPO plan? A. Out of network providers maybe used for an additional premium B. The insured may choose medical providers not found on the preferred list C. And insured must receive precertification prior to visiting a preferred provider D. Insurance typically pay lower out of pocket cost for out of network providers
B.
Which of the following riders would NOT cause the death benefit to increase A. Accidental death rider B. Payer benefit rider C. Guaranteed insurability rider D. Cost of living Rider
B.
Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date? A. Non-Cancellable B. Optional renewable C. Conditionally renewable D. Guaranteed renewable
B.
Which statement best defines a multiple employer welfare arrangement (MEWA) A. A group health plan that covers medical expenses arising from work related injuries B. A joining together by employers to provide health benefits for employee C. A plan that provides hospice care for terminally ill employees D. A government health plan that provides healthcare for the unemployed
B.
While repairing the roof of his house an insured accidentally falls off and breaks his arm and sustains a head injury that results in total blindness of both eyes. His policy contains an Accidental Death & Dismemberment Rider. What is the extent of benefits that he will receive? A. Reciprocal Amount B. Principal Sum C. Capital Sum D. 50% of the Principal
B.
All of the following apply to short term disability plans EXCEPT A. Individual plans can provide benefit periods of up to 2 years B. A benefit period of 26 weeks is most common for group plans C. Both group and individual plans are renewable D. Group plans can provide benefit periods of up to 52 weeks
C.
All of the following are requirements of eligibility for Social Security disability income benefits EXCEPT A. Fully insured status B. Waiting period of five months C. Being age 65 D. Inability to perform any gainful work
C.
All of the following could be considered rebates if offered to an insured in the sale of insurance except A. Stocks, securities, or bonds B. An offer to share in commissions generated by the sale C. Dividends from a mutual insurer D. An offer of employment
C.
An employer responsible for paying part or all of the premium for a group life or group health plan cannot willfully fail to pay the premium without first giving the employees how many days advance notice? A. 15 B. 30 C. 45 D. 60
C.
As it pertains to group health insurance, the continuation provision stipulates that A. Terminated employees may convert to an individual policy only upon proof of insurability B. Group coverage must be extended for terminated employees up to a certain period of time at the employers expense C. Group coverage must be extended for terminated employees up to a certain period of time at the employees expense D. Retiring employees must be allowed to convert their group coverage to individual policies
C.
In disability income insurance, the time between the onset of an injury or sickness and benefits begin is known as the A. Enrollment period B. Probationary period C. Elimination period D. Qualification period
C.
The purpose of managed care health insurance plans is to.. A. Give the insured an unlimited choice of providers B. Coordinate benefits C. Control health insurance claims expenses D. Provide for the continuation of coverage when an employee leaves the plan
C.
The regulation of the insurance industry primarily rests with A. Private insurers B. The federal government C. The state D. The NAIC
C.
Under workers compensation, which of the following benefits are NOT included A. Income benefits B. Death benefits C. Legal benefits D. Medical and rehabilitation benefits
C.
What are the requirements for an agent asking a client questions designed to obtain information solely for marketing or research purposes? A. That agent and a witness must record the clients answers B. The agent must give the client a written list of all the questions C. The agent must clearly specify the purpose of the questions D. The agent must allow the client to answer the questions later
C.
Which characteristic does NOT describe managed care? A. Shared risk B. Preventative care C. Unlimited access to providers D. High quality care
C.
Which of the following is NOT a feature of a guaranteed renewable provision A. Coverage is not renewable beyond the insured's age 65 B. The insured's benefits cannot be reduced C. The insurer can increase the policy premium on an individual basis D. The insured has a unilateral right to renew the policy for the life of the contract
C.
Which of the following is NOT a feature of a noncancelable policy? A. The guarantee to renew coverage usually applies until the insured reaches certain age B. The insured has the right to renew the policy for the life of the contract C. The insurer may terminate the contract only at renewal for certain conditions D. The premiums cannot be increased beyond the amount stated in the policy
C.
Which of the following is NOT considered a misrepresentation as a pertains to unfair trade practices? A. Exaggerating the benefits provided in the policy B. Stating that the competitors will arbitrarily increase their premiums each year C. Making comparisons between different policies D. Stating that the insurance policy is a share risk of stock
C.
Which of the following special policies covers unusual risks that are Not normally covered under an accidental death and dismemberment coverage? A. Specified disability policy B. Credit disability C. Special risk policy D. Limited risk policy
C.
Which of the following would best describe total disability? A. A persons total loss of income B. A person's inability to qualify for insurance coverage C. A persons ability to work is significantly reduced or eliminated for the rest of his/her life D. A persons inability to perform one of the regular duties of his/her occupation
C.
Which of the following would qualify as a competent party in an insurance contract? A. The applicant is a 12 year old student B. The applicant is under the influence of a mind impairing medication at the time of the application C. The applicant has a prior felony conviction D. The applicant is intoxicated at the time of the application
C.
A father owns a life insurance policy on his 15-year-old daughter. The policy contains the optional Payor Benefit rider. If the father becomes disabled, what will happen to the life insurance premiums? A. The premiums would become tax-deductible until the insured's 18th birthday B. Since it is the policy owner, and not the insured, who has become disabled, the life insurance policy will not be affected C. The insured will have to pay premiums for six months. If at the end of this. The father is still disabled, the insured will be refunded the premiums D. The insureds premiums will be waived until she is 21
D.
All of the following are differences between Individual and group health insurance EXCEPT A. In individual policies, the individual selects coverage options, while in a group plan all employees are covered for the same coverage which is chosen by employer B. Individual coverage can be written on an occupation or no occupational basis C. Individual policies are renewable, while group terminates when the individual leaves D. Individual insurance does not require medical examinations, while group insurance does not require medical examinations
D.
Todd has been informed that he has a hernia which requires repair. When Todd researches the cost, he learns that his insurance plan will cover 200 points worth of surgical expenses. Each point represents $10, which means that $2000 of his surgery will be covered by his insurance plan. What system is Todd's insurance company using? A. Relative value B. Basic surgical C. Point based medical D. Conversion factor
A.
When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled? A. The insurer is considered to be notified since the notification to agent equals notification to the insurer B. The insurer may delay the payment of this claim for up to 6 months C. The insurer may settle this claim for less than it otherwise would have had the notification been provided in a timely manner D. The insurer may deny the claim since it was not notified within the required 20 day time frame
A.
Which characteristic does NOT describe managed care? A. Shared risk B. Preventive care C. Unlimited access to providers D. High quality care
C.
Which of the following are the main factors taken into account when calculating residual disability benefits? A. Employees full-time status and length of disability B. Present earnings and standard cost of living C. Present earnings and earnings prior to disability D. Earnings prior to disability and the length of disability
C.
Which of the following definitions would make it easier to qualify for total disability benefits? A. The more liberal "any occupation" B. The more strict "own occupation" C. The more liberal "own occupation" D. The more strict "any occupation"
C.
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. A statement from the insured's employer showing that the insured was unable to work B. An estimate of the total amount of medical in hospital expense for the loss C. A complete physicians statement D. A statement that is officially cleared to identify the insured and the nature of the claim
D.
And a disability income policy, all the following are considered presumptive disabilities EXCEPT A. Loss of two limbs B. A loss of speech C. Loss of one eye D. Loss of hearing
C.
Group health insurance is characterized by all of the following except A. A master contract B. Lower administrative costs C. Conversion privilege D. Adverse selection
D.
Which describes the features of a comprehensive major medical policy? A. The deductible is always expressed as deferred amount B. It is the same as major medical insurance C. There is no coinsurance D. Basic medical expense benefits are provided in a single package
D.
Which of the following describes taxation of individual disability income insurance premiums benefits? A. Premiums are not tax deductible title, but benefits are taxable B. Premiums are tax deductible, but benefits are not taxable C. Premiums are tax deductible, and benefits are taxable D. Premiums are not tax deductible, and benefits are not taxable
D.
Agents who persuade insured's to cancel a policy in favor of another one when it might not be in the insured's best interest are guilty of A. Twisting B. Defamation C. Misrepresentation D. Rebating
A.
A friend helped an insurance producer so an insurance policy. The producer can share the commission with the friend if A. The producer applies for a shared commission form for that fiscal year B. The friend is licensed in the same line of insurance C. The friend is licensed in any type of insurance D. The commissioner gives producer verbal permission to share
B.
If a consumer request additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply A. 7 days B. 10 days C. 3 days D. 5 days
D.
A guaranteed renewable health insurance policy allows the A. Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class B. Policy holder to renew the policy to a state age and guarantee the premium for the same period C. Policy to be renewed at the time of expiration, but the policy can be canceled for cause during the policy term D. Insurer to renew the policy to a specified age
A.
A guaranteed renewable health insurance policy allows the A. Policyholder to renew the policy to stated age, with the company having the right to increase premiums on the entire class B. Policyholder to renew the policy to a state age and guarantees the premium for the same period C. Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term D. Insurer to renew policy to specified age
A.
A hospital indemnity policy will pay A. A benefit for each day the insured is in the 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 licensee decides to terminate his residency in the state. Which of the following would be an appropriate action? A. Delivering the license to the commissioner within 30 days B. Allowing the license to expire C. Notifying the NAIC D. Notifying the commissioner within 10 days
A.
Agents who persuade insured's to cancel a policy in favor of another one when it might not be in the insured's best interest or guilty of A. Twisting B. Defamation C. Misrepresentation D. Rebating
A.
All of the following statements concerning workers compensation are correct EXCEPT A. A worker receives benefits only if the work related injury was not his/her fault B. Worker's Compensation laws are established by each state C. All states have workers compensation D. Benefits include medical, disability income, and rehabilitation coverage
A.
An individual is insured under his employer's group disability income policy. The insured suffered in accident while on vacation that left him unable to work for four months. If the disability income policy pays the benefit, which of the following would be true? A. Benefits that are attributed to employer contributions are fully taxable to the employee as income B. The insured has to wait two more months to start receiving the benefits C. For the business, payments are not considered tax deductible as an ordinary business expense D. The insured can deduct his medical expense benefits from his income tax
A.
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 would indicate that his policy was written with a 30 day A. Elimination period B. Blackout period C. Probationary period D. Disability period
A.
If an insurance company wishes to order a consumer report on an applicant to assist in the underwriting process, and if a notice of insurance information practices has been provided, the report may contain off the following information EXCEPT the applicants A. Ancestry B. Credit history C. Habits D. Prior insurance
A.
The commissioner reports any violations of insurance laws and regulations to the A. Attorney general B. Guaranty association C. Governor D. NAIC
A.
All of the following are differences between individual and group health insurance EXCEPT A. In individual policies, the individual selects coverage options, while in a group plan all employees are covered for the same coverage which is chosen by the employer B. Individual coverage can be written on an occupational or non-occupational basis, group plans cover only non-occupational C. Individual policies are renewable at the option of the insured, well group usually terminates with the individual leaves the group D. Individual insurance does not require medical examinations, while group insurance does require medical examinations
D.
An insurer or authorized representative of the insurer that terminates the appointment, employment, contract, or other insurance business relationship with an agent shall notify the commissioner A. Within 60 days after the effective date of termination B. Within 45 days after the effective date of termination C. 30 days prior to the effective date of termination D. Within 30 days after the effective date of termination
D.
In the event apology lapse is due to non-payment of premium, within how many days would the policy be automatically reinstate once the outstanding premium is paid? A. 10 days B. 25 days C. 30 days D. 45 days
D.
In the event of policy lapses due to nonpayment of premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid? A. 10 days B. 25 days C. 30 days D. 45 days
D.
Insurers may change which of the following on a guaranteed renewable health insurance policy? A. Coverage B. Individual rates C. No changes are permitted D. Rates by class
D.
Stating that an insurance policies are guaranteed by the existence of the life and health guarantee association is A. Mandatory B. Only required of some lines of insurance C. Permitted D. An unfair trade practice
D.
To maintain their Insurance license, agents are required to complete how many hours of continuing education every two years A. 12 hours B. 15 hours C. 18 hours D. 24 hours
D.
Which of the following entities protects policy owners, insured's, and beneficiaries under insurance contracts when insurers failed to perform contractual obligation's due to financial impairment A. Insurance consumer protectorate B. Insurance Solvency Association C. Consumer protection agency D. Insurance guaranty association
D.