practice test A
Jane has a Major Medical plan with an 80%/20% coinsurance and a deductible of $75. If she has already met her deductible and received her bill of $175, how much will her insurer pay?
$140
What is the maximum limit for a Flexible Spending Account?
$2,500
Paul's LTC policy will pay a specific fixed dollar of $250 per day. The actual cost of his care is $225. What will his policy pay?
$250
An insured has an Accidental Death & Dismemberment policy with a principal value of $50,000. He looses sight in both eyes in a hunting accident. How much will he receive?
$50,000
When an insured has a policy that only covers Medical costs associated with accidents, what is it called?
Accident only
A group of more than 20 employees would have _____ available in any state.
COBRA
What is the purpose of the PPACA insurance exchange?
To administer Health insurance subsidies and to help with the enrollment in private Health insurance
Why is a disability benefit payment less than an insured's income?
To prevent over insurance and malingering
57. Which of the following is a LTC policy exclusion?
alc. dependency
Which of the following best represents an eligibility factor for an employee to be covered under a group policy?
conditions of employment
Which of the following is a payment system for Health Care when the provider is paid for each of their services?
fee for service
What risk reflects the average exposure to a loss?
standard
Carl is covered under two group Health insurance plans, his own and his wife's plan. Carl suffered a loss of $3,000. After he paid $500 in deductible and coinsurance amounts, his primary insurance company paid $2,500 of his expenses. What amount would be paid by his secondary insurer, if any?
$500
Wanda pays $357.92 a month for her insurance. What is the duration of her grace period?
10 days
N&J insurer received a notice regarding a claim. When must N&J supply claim forms to their insured?
15 days
What is the usual grace period for a semiannual policy?
31 days
Bob has a primary group Health plan and an excess plan that covers losses up to $20,000. Bob suffered a loss of $25,000. How much will Bob's excess plan cover?
5,000
A pre-existing condition, is a condition for which an employee has sought Medical advice, diagnosis, or treatment within the previous __ months.
6
Under HIPAA, Group Health plans CANNOT impose more than a 12 month pre-existing conditions exclusion for a person who sought medical advice, treatment, or diagnosis within the last:
6 months
In regard to a Short Term Disability employer plan, what percentage of an employee's income would generally be covered?
70%
Medicare Part B covers what percentage of approved charges after a yearly deductible has been satisfied?
80%
When do individuals under a Blanket policy receive their Certificate of Insurance?
A Certificate of Insurance is not issued to an individual under a Blanket policy.
When can a group be formed to obtain insurance?
A group is never allowed to be formed to obtain insurance
Which statement best describes the primary difference between a mutual insurance company and a stock insurance company?
A stock company is owned by shareholders and a mutual company is owned by policyholders
Which of the following would be covered under a blanket insurance policy?
A university's soccer team
Injuries are classified as accidental injury or as accidental bodily injury. Which injury generally has broader coverage?
Accidental bodily injury
How is emergency care under an HMO covered for its members?
An HMO member can receive emergency care in and out of their service area, but it is preferred in their service area whenever possible
What is the most required question that must be in each Medigap application?
Are you eligible for Medicaid?
Which of the following does not describe a MET?
At least 3 or more employers must join together to form a MET
What is the best time for an agent to present a Medicare Supplement Buyer's Guide to an applicant?
At the time of their application
Which of the following is false in relationship to policy provisions?
Claims must be submitted on claim forms provided by an insurer
What kind of clause relates to this statement: E&N company issued a policy in consideration of the representations on an application and the payment of the first premium?
Consideration
One party submitting a "take-it-or-leave-it" contract to another party is a characteristic of what type of contract?
Contract of Adhesion
Which of the following riders provides for changes in benefits based on the Consumer Price Index?
Cost of Living Adjustment Rider
To avoid being taxed annually what must a corporation that owns an annuity do?
Designate a human annuitant
Due to Karen's family history of heart disease, she purchased a policy that specifically covers the expense of treating heart disease. What kind of policy did Karen purchase?
Dread Disease Policy
When a client is considering replacing an existing Health insurance policy, all of the following should be areas of concern EXCEPT:
Duration of time on the existing Health Insurance policy
Which Act makes it a necessity for insurers to disclose when their applicant's consumer or credit background information is being investigated?
Fair Credit Reporting Act
An insurance company incorporated in one state and licensed to conduct business within another state is called?
Foreign
What provision will allow Sam to inspect his policy and if dissatisfied, be able to return it for a full refund?
Free look
Which of the following is a health plan that generally covers only services from approved providers in their network?
HMO
Which of the following provides a range of comprehensive health care services for its members that generally are enrolled on a group basis and pay a fixed contribution for their services from participating physicians?
HMO
Concerning insurance, the definition of a fiduciary responsibility is:
Handling insurer funds in a trust capacity
What is most correct about a revocable beneficiary?
It may be changed by the policyowner's will
Dan is a small business owner that just became disabled. Two years ago he bought a Business Overhead Expense policy. How can the policy help Dan?
It will reimburse Dan for his overhead business costs while he is disabled
Manny has a Major Medical policy. He lost his job and didn't have money for groceries. So last week he stole some food from his local grocery store. As he was attempting to run out of the store he injured himself. To what extent would his policy pay his claim?
Manny's claim will be denied if his policy has the Illegal Occupation provision
Jill was in a boating accident and she severely damaged her left hand. She went to the doctor and her injury was not classified as disabled. Which of the following would cover part of Jill's Medical expenses?
Medical Reimbursement Benefit
If a group has 50 members, which of the following is not required from their participants?
Medical information
Medicare Supplement policies do not...
Medigap does not covers the cost of extended Nursing Care
An insurance company that is owned by its policyholders and can pay annual dividends to them is considered :
Mutual Company
What kind of policy is for a short term?
Non - renewable
LTC benefits can be received tax free if which of the following occurs?
Nothing needs to occur because the benefits are tax free
What provision prohibits an insurer from paying a reimbursement to someone other than a policyowner?
Payment of Claims
A Medical Insurance plan in which the Health Care provider is paid a regular fixed amount for providing care to an insured and does not receive additional amounts of compensation dependent upon the procedure performed, is called ?
Prepaid plan
All medical health insurance plans since 2014 must cover which of the following?
Preventive health services
An HMO plan with the gatekeeper system, allows members to see a specialist by obtaining a referral from the:
Primary Care Physician
Carl was repairing his neighbor's roof and he fell off the ladder and received severe injuries. He broke his leg and a head trauma caused total blindness in both of his eyes. Carl's policy has an Accidental Death & Dismemberment Rider. What benefits will Carl receive?
Principal
Accidental Death and Dismemberment benefits cover ____and ____ amounts.
Principal and Capital
Which of the following is an advance utilization management tool to determine if a procedure is covered under a Health Plan?
Prospective Review
Which of the following groups would most likely be covered under a Blanket Accident Policy?
Students at a public school
Federal government _____ assist in the cost of health insurance coverage in several different ways.
Subsidies
There are several different kinds of health care plans. Which of the following would help consumers compare the benefits and costs of the plans?
Summary of Benefits and Coverage
Which of the following is true regarding the excess funds in an employee's HSA?
The excess funds may be carried over into the next year
Not all losses are insurable, and there are certain requirements that must be met before a risk is a proper subject for insurance. These requirements include all of the following EXCEPT:
The loss may be intentional
When would an Accidental Death and Dismemberment policy pay the principal amount, other than for an accidental death?
The loss of 2 or more limbs
There are times when group insurance is provided to employees in more than one state. If this occurs, which state would have the jurisdiction?
The state where the coverage was delivered
Barb is very upset that her agent didn't hand deliver her insurance policy. Which of the following is true in regard to the matter that she received it in the mail?
There is nothing wrong with the way Barb's agent handled the delivery of her policy
What is the reason dividends from a mutual insurer are not subject to taxation?
They are equivalent to returning a premium
In regard to Medicare Select policies, what are restricted network provisions?
They condition the payment of benefits
A disability elimination period is best known as which of the following?
Time deductible
A consumer report was requested by an underwriter during Joe's application process. What would the report be used for?
To determine the probability of him making his timely premium payments
A Total Disability Plan is useful in many ways. What is the main purpose of the plan?
To protect individuals and families against the economic loss of a prime wage earner
Which of the following describes the purpose for a Certificate of Coverage?
To reduce the 1 year waiting period for pre-existing conditions
A probationary period refers to
Waiting period
Jim forgot to pay his $300 premium last month. He is due a claim of $900. Will his insurer pay his claim
Yes, but the $300 will be deducted from the amount and Jim will receive the balance
Contract law requires each party to give something of value for it to be a legal contract. This value is called?
a consideration
There is a correlation between an insured's disability and the amount of the disability premium. Which of the following would pay the lowest disability insurance premium?
a personal trainer
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 persons individually is called:
blanket policy
What term relates to giving up an insurance policy voluntarily?
cancellation
A Dread Disease policy would be best used for which of the following:
cancer
E.R.I.S.A., the Employee Retirement Income Security Act of 1974, was passed by:
congress
What provision in a disability policy would be in regard to the value of benefits decreasing over time?
cost of living
Which of the following is covered in a LTC policy?
dementia
A Preferred Risk would pay a:
discounted premium
Disability benefits are not paid during which period?
elimination period
Gill is an employee that was just taxed on the cost of his employer's Group Life policy. What amount did their coverage exceed in order for this to take place?
exceeds $50,000
Ken applied for a Medicare Supplement. Who must make sure he does not already have a Health policy in force?
his insurer
What is used the most to determine the extent of disability benefits?
income
Which of the following regarding Disability Income benefits taxation is false?
individual premiums are tax deductible
An underwriter's attitude toward group risks can be ____ restrictive than with individual policies, because the group policies are subject to annual reevaluations
less
Mr. Jones is terminally ill. What kind of Part A care does he most likely receive?
medicare hospice care
What kind of plan is a Stock Life insurance company conducting when it issues both participating and non-participating policies?
mixed
What term best describes the provider network?
narrow
What is defined as a health plan's manner to deliver promised benefits to consumers, by providing them with primary care and specialty physicians' access, without any unreasonable delay?
network adequacy
The removal of a wisdom tooth would be performed by which dental treatment?
oral surgery
Harry is 82 years old and he wants a Long Term Care policy. Which of the following would not be a requirement for his insurer?
previous date that he visited his doctors
Relief for a primary caregiver relates to which type of Long Term Care?
respite
What metal level plan under the PPACA, will cover 70% of the costs?
silver
Billy is covered under Blue Cross Blue Shield plan. What is he called?
subscriber
Which of the following HMO entities are responsible for making premium payments?
subscribers
