Ohio Health Insurance Exam (Attempt 1)
For group medical and dental expense insurance, what percentage of premium paid by the employer is deductible as a business expense?
twisting
For the purpose of insurance, risk is defined as
uncertainty or change of loss
If only one party to an insurance contract has made a legally enforceable promise, what kind of contract is it?
unilateral
What types of services may NOT be provided under the long-term care's assisted living care?
visits by a registered nurse
A health insurance policy may cover all of the following risks EXCEPT
war-related injuries
Which of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract?
warranty
Within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained?
3 days
An insured is covered by a partially contributory group disability income plan that pays benefits of $4,000 a month. If the insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable?
3000
What is the period of coverage for events such as death or divorce under COBRA?
36 months
What is the number of credits required for fully insured status for Social Security disability benefits?
40
The inflation protection feature in long-term care policies issued in this state must provide protection for inflation at what percent annually?
5
An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay?
5000
The sole proprietor of a business makes a total salary of $50,000 a year. This year, his medical expenses have reached a total of $75,000. What amount may the sole proprietor deduct in regards to his medical expenses?
50000
The minimum number of credits required for partially insured status for Social Security disability benefits is
6
Under the Affordable Care Act, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event?
60 days
How many eligible employees must be included in a contributory plan?
75
Which of the following is NOT covered under Part B of a Medicare policy?
Routine dental care
All of the following refer to specialty health care services EXCEPT
Services that are provided in combination with other health care services
When a group disability insurance policy is paid entirely by the employer, benefits paid to disabled employees are
Taxable income to employee
If an applicant intends to replace any existing accident and sickness policy with a Medicare supplement policy, what must the agent furnish to the applicant?
a notice regarding replacement
Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis?
adult day care
In which Medicare supplemental policies are the core benefits found?
all plans
Long-term care insurance policies must cover which of the following?
alzheimers
How often must health insuring corporations, other than specialty health care insurers, provide current company information, providers list, methods of operation and other reports to its insured?
annually
n insured purchased a policy to provide coverage on himself, his wife, and their 2 children. All of them would need to prove insurability EXCEPT
any children born after the inception of the contract
Which of the following types of agent authority is also called "perceived authority"?
apparent
The agent is known as the "Field Underwriter" because of the information he/she gathers for the insurer. This helps the insurer
avoid adverse selection
Which of the following has the authority to issue a cease and desist order?
superintendent
If an individual enrolls in a Medicare Advantage Plan on his 65th birthday, when would coverage begin?
the first day of the following month
A noncontributory group disability income plan has a 30-day waiting period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive
$12,000, all of which is taxable.
An insured's disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?
1
According to OBRA, what is the minimum number of employees required to constitute a large group?
100
In a noncontributory health insurance plan, what percentage of eligible employees must participate in the plan before the plan can become effective?
100%
In order to collect Social Security disability benefits, the claimant must be able to demonstrate that the disability will last at least
12 months
Which of the following are characteristics of a successful self-funded plan?
A group large enough to reasonably predict future loss experience. A stop-loss contract to assume losses beyond the insured's retention. A third party administrator who services claims
When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery?
A statement of good health
A group blanket health policy is best suited for which of the following?
A summer camp
Which of the following Medicare supplement plans would be available to a reasonably healthy 91-year-old female?
A-N
Which of the following produces evaluations of insurers' financial status often used by state departments of insurance?
AM best
Under which condition would an employee's group medical benefits be exempt from income taxes?
An employee's group medical benefits are generally exempt from taxation as income
While a claim is pending, an insurance company may require
An independent examination as often as reasonably required
Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?
An individual who was previously covered by group health insurance for 6 months is eligible.
Which of the following can be a reason for cancellation or non-renewal of a health policy by a health insuring corporation?
An intentional misrepresentation of material fact
What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided?
Application
At what point must an Outline of Coverage be delivered?
At the time of application or upon delivery of the policy
An insured owns a medical expense policy that he purchased for his family. The insured's employer purchased a Group Disability Income policy for the insured and all eligible employees. The insured subsequently suffered an accident on the job that left him unable to work for four months. If the insured receives benefits from his disability income policy, which of the following would be true?
Benefits received that are attributable to employer contributions are fully taxable to the employee as income.
A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability?
Business overhead expense policy
Which of the following is NOT true of basic medical expense plans?
Coverage for catastrophic medical expenses
Which of the following dental insurance categories would cover the filling of cavities?
Routine and major restorative care
All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT
Death benefits are paid only if death occurs within 24 hours of an accident.
Who assumes control over an insurance company's funds and management if they become insolvent?
Department of Insurance
Most LTC plans have which of the following features?
Guaranteed renewability
Under the Privacy Rule for HIPAA, protected information includes all individually identifiable health information
Held or transmitted in any form.
Which authority is NOT stated in an agent's contract but is required for the agent to conduct business?
Implied
In order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to participate to do all of the following EXCEPT
Increase benefits for a period of one year.
Which type of a hospital policy pays a fixed amount each day that the insured is in a hospital?
Indemnity
Which of the following entities protects policyowners, insureds, and beneficiaries under insurance contracts when insurers fail to perform contractual obligations due to financial impairment?
Insurance Guaranty Association
Which of the following refers to "own occupation" disability?
Insured is unable to perform duties of the occupation for which he/she was educated and trained.
Which of the following best describes a misrepresentation?
Issuing sales material with exaggerated statements about policy benefits
Which of the following statements is NOT correct concerning the COBRA Act of 1985?
It requires all employers, regardless of the number or age of employees, to privde extended group health care coverage
Which of the following is NOT true regarding a temporary license in this state?
It will continue for 180 days even if the owner disposes of the business.
Which of the following is true of a PPO?
Its goal is to channel patients to providers that discount services.
All of the following would be qualified as a dependent under a Dependent Care Flexible Spending Account, EXCEPT
Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair
In group insurance, what is the policy called?
Master policy
Which of the following may be used when determining Medicare Advantage out-of-pocket costs?
Medicare Part B premiums paid by the plan
In order to be eligible for group health insurance, all of these are conditions an employee must meet EXCEPT
Must have dependents.
Under most dental plans, what limitations are posed for denture replacement?
Once every 5 years
Who is involved in completing the agent's report?
Only the agent
Which of the following factors would be an underwriting consideration for a small employer carrier?
Percentage of participation
Which renewability provision are you most likely to see on a travel accident policy?
Period of time
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to a stated age with the company having the right to increase premiums on the entire class
Which of the following do the Standard and Preferred risk categories share?
Premiums are not evaluated
Pertaining to insurance, what is the definition of a fiduciary responsibility?
Promptly forwarding premiums to the insurance company
Insurers may change which of the following on a guaranteed renewable health insurance policy?
Rates by class
Which services are associated with Standard & Poor's and AM Best?
Rating the financial strength of insurance companies
The Superintendent may examine books and records of all authorized insurers in Ohio. Who is responsible for paying for the examination?
The Department of Insurer
Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information?
The fair credit reporting act
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?
The insured is in an accident and incurs a large claim.
Which is NOT true regarding an insured who is considered to be a standard risk?
The insured may have to pay slightly higher premiums
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?
The insured must have first been hospitalized for 3 consecutive days.
How does a member of an HIC see a specialist?
The primary care physician refers the member.
In insurance policies, contract ambiguities are automatically ruled in the favor of the insured. What privilege does the insurer have in order to balance this?
The right to determine the wording of a policy
The free-look provision allows for which of the following?
The right to return policy for a full premium refund
An insurer suspects an agent of fraud and cancels his appointment. Which authority, if any, should be notified?
The superintendent
Regarding Medicare SELECT policies, what are restricted network provisions?
They condition the payments of benefits
What are the requirements for Health Insurance Marketplace coverage of specific vaccines administered by an in-network provider?
They must be covered without a copayment or coinsurance
When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?
consideration
What is the purpose of the gatekeeper in an HIC
controlling costs
Who is entitled to an evidence of coverage for a health care plan provided by a health insuring corporation?
every subscriber
As it pertains to group health insurance, COBRA stipulates that
group coverage must be extended for terminated employees up to a certain period of time at the former employees expense
A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?
immediately
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?
insurer to the insured
Which of the following is true regarding health insurance?
it could provide payments for loss of income
Which of the following programs expands individual public assistance programs for people with insufficient income and resources?
medicaid
Premium payments for personally-owned disability income policies are
not Tax deductible
When an individual is covered under two health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called
overinsurance
Which clause allows both the insured and dentist to know in advance which benefits will be paid?
precertification
Any inducement offered to the insured in the sale of an insurance policy that is not specified in the policy is an unlawful practice known as
rebating
