Random Health Insurance Questions

B

According to the Time Limit on Certain Defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years? A) 1 year B) 2 years C) 3 years D) 5 years

A

For which of the following reasons may group coverage NOT be discontinued? A) The company's stock value lowers B) Nonpayment of premium C) Movement outside the service area D) Fraud

A

What is the maximum age that a disabled insured worker may receive Social Security disability benefits? A) 65 B) Life: no max age limit C) 54 D) 62

B

What is the purpose of the gatekeeper in an HMO? A) Making sure that services are properly prepaid. B) Controlling costs C) Making sure that patients do not go to physicians outside of the HMO's region D) Establishing strong preventive care

A

When may HIV-related test results be provided to the MIB? A) If the individual is not identified B) Under all circumstances C) When given authorization by the patient D) Only when the results are negative

C

A Major Medical Expense policy would exclude coverage for all of the following treatments EXCEPT A) dental care B) cosmetic surgery C) drug addiction D) eye refraction

C

An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits? A) Have accumulated 40 work credits B) She does not need any work credits because she is under the age of 24 C) Have accumulated 6 work credits in the past 3 years D) Have accumulated 20 work credits in the past 10 years

A

An insured had a heart attack while jogging but is expected to return to work in about 6 weeks. The insured's Disability Income policy will A) replace a percentage of his lost income. B) cover injuries only. C) not pay. D) pay a lump-sum beneffit.

B

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? A) 7 days B) 10 days C) 31 days D) 60 days

D

If an applicant submits the initial premium with an application, which action constitutes acceptance? A) The applicant submits a statement of good health. B) The producer delivers the policy. C) The insurance company receives the application and initial premium. D) The underwriters approve the application.

A

Medicare is a health insurance program for all the following individuals except A) those with low income and low assets. B) those 65 or over. C) those with permanent kidney failure. D) those who have been on Social Security Disability for 2 years.

B

Only the agent is involved in completing the agent's report which is A) included in the entire contract. B) not included in the entire contract. C) only included if it provides information upon which the underwriting decision was made. D) usually included in the entire contract.

B

The guaranteed purchase option is also referred to as the A) evidence of insurability rider B) future increase option C) multiple indemnity rider D) impairment rider

D

Which of the following is NOT true regarding uniform mandatory provisions concerning claims? A) If the insured is several days late in filing proof of loss form, the claim cannot be denied if the insured can show good cause. B) The insured is customarily required to give notice of claim within 20 days. C) If the insured is 2 years late in filing a proof of loss, the claim can be denied. D) An insured must notify the insurer of a claim on forms prescribed by the insurer.

C

Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care? A) home health care B) skilled care C) intermediate care D) custodial care

A

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT A) Unearned premiums are retained by the insurance company. B) The insurer must provide the insured a written notice of the cancellation. C) Claims incurred before cancellation must be honored. D) An insurance company may cancel the policy at any time.

A

All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT A) an association of 35 people B) labor union C) multiple employer trust D) single employer with 14 employees

A

An insured wants to cancel her health insurance policy. Which portion of the contract would explain cancellation rights? A) Renewability provision B) Exclusions C) Insuring clause D) Consideration clause

B

An insured's cancelable health insurance policy is being cancelled. One day before the policy is scheduled to end, he is involved in a major accident and is hospitalized for a week. What is his coverage? A) No benefits at all. B) Full benefits as if the policy were still completely in effect C) One day of full benefits D) Minimal benefits for the duration of the hospital stay

C

Following a covered loss, the Time Payment of Claims Provision requires that an insurance company pay disability income benefits no less frequently than A) annually B) weekly C) monthly D) semi-annually

C

How many pints of blood will be paid for by Medicare Supplement core benefits? A) Everything after first 3 B) 1 pint C) First 3 D) None; Medicare pays for it all

D

Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss? A) 2 years B) 30 days C) 60 days D) 90 days

A

What happens to an insurance application after a policy is issued? A) It becomes part of the contract B) It is discarded C) It is kept on file until the next examination of the insurer D) It is forwarded to the MIB

B

When an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. When would this accident be covered upon reinstatement of the policy? A) It would not be covered. B) Immediately C) After 10 days D) After 31 days

D

When is the company responsible for actions of its agents? A) Whenever the agent is licensed. B) Always; the agent's actions are presumed to be those of the company. C) Never; agents represent clients not companies. D) Whenever the agent is acting within the conditions of the contract

C

A Medicare SELECT policy does all of the following EXCEPT A) Provide payment for full coverage under the policy for covered services not available through network providers. B) Provide for continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program. C) Prohibit payment for regularly covered services if provided by non-network providers. D) Make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare SELECT policy to each applicant.

A

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) Policyholder to renew the policy to a stated 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 the policy to a specified age.

B

Which entity has the option of including optional provisions in a health insurance policy? A) the federal government B) the insurer C) the state D) the policyholder

A

Which of the following describes the relationship between a capital sum and a principal sum? A) Capital sums are percentages of principal sums. B) Principal sums vary; capital sums do not. C) Capital sums vary; principal sums do not. D) Principal sums are percentages of capital sums.

C

Which of the following does the Insuring Clause NOT specify? A) The insurance company B) The name of the insured C) A list of available doctors D) Covered perils

C

Which of the following is NOT mandatory under the Uniform Provision Law as applied to accident and health policies? A) Physical Examination and Autopsy B) Entire Contract C) Change of Occupation D) Time Limit on Certain Defenses

C

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? A) Entire Contract Clause B) Proof of Loss C) Payment of Claims D) Change of beneficiary

D

Which of the following statements is INCORRECT regarding the definition of total disability? A) Disability is defined differently under certain disability income policies B) Total disability can be the inability to perform any occupation for which a person is reasonably suited by reason of education, training, or experience. C) Total disability can be the inability to perform the duties of one's own occupation. D) Total disability is the inability to perform partial duties of any occupation for which a person is suited by reason of education, training, or experience.

C

Which statement best describes agreement as it relates to insurance contracts? A) All parties must be capable of entering into a contract. B) Each party must offer something of value. C) One party accepts the exact terms of the other party's offer. D) The intent of the contract must be legally acceptable to both parties.