Texas LT care and partnership policies
Mr. Jones is concerned about his long-term care insurance policy keeping pace with increases in long-term care cost. What rider would you recommend he consider adding to his policy? a. spousal rider b. inflation rider c. reimbursement rider d. restoration rider
b
20. The premiums for Mr. Kazian's long-term care insurance policy Care based on all of the following EXCEPT a. his health status b. his education c. the design of his policy d. his age.
b.
5. Mr. Brighton's long-term insurance policy provides a 3-year benefit maximum, so benefits will be paid for how many days? a. 730 b. 1095 c. 900 d. 365
b. 1095
21. When providinga client with an outline of coverage, you can make all of the following comments and be correct EXCEPT. a. the outline of coverage and your premium payment comprise your contract with the insurer. b. this outline will make comparison shipping easier for you c. the state requires me to give you this outline of insurance coverage d. the outline describes many aspects of the policy including benefits and coverage, premium costs, exclusions and restrictions and much more.
c
10. Mr. Jackson received his long-term care policy on July 1. When does his free look period end? a. Sept 1 b. Oct 1 c. Aug 1 d. Nov 1
c. Aug 1
1. Because Rahul is impaired in one of the following activities of daily living, he requires on demand care. what is the activity? a. eating b. bathing c. dressing d. toleting
a
40. Mrs. Fuller asks you how her long-term care insurance premium may if she buys a longer elimination period. you be correct to tell her that her premium will be a. higher b. waived c. lower d. guaranteed
a
18. Your prospective client, Mr.s Benson asks why you are recommending she add an automatic increase rider to her long-term care insurance policy. The most accurate response is that a. her premiums will increase as she ages b. her benefits remain the same as her premiums increase. c. The premiums will increase when the cost of living increases. d. her benefits will increase when the cost of living increase.
d
19. A prospect asks you how he will qualify for benefits under the ADL trigger. Which of the following is the most accurate response to his question? a. Your insurance agent will complete an authorization form and submit it to the insurer's claims department. b. A licensed health care practitioner, using best judgement, must determine that you need 90 days of substantial assistance in performing at least two ADLs. c. A representative of the insurer will observe your activities for a few days and report the findings to the insurer. d. The insured will complete a comprehensive questionnaire and certify that his inability to perform at least two ADLs is expected to last 90 days.
d
22. On his way to work each day, Robert drops his dad off at the church social center where he gets to visit with other elderly people, have lunch, play checkers, and watch TV before Robert picks him up after work. This is an example of. a. a residential care facility b. ambulatory health care c. home health care d. an adult day care center
d
28. Mr. Benson's long-term care policy pays him $150 a day with a 3-year maximum. how much money is available for claims? a. $232,688 b. $148,232 c. $68,438 d. 164,250
d. 164,250
12. Gilbert's long-term care insurance policy includes a compound benefit increase option, so a. the daily benefit increase by %5 every 5 years on the policy's anniversary. b. the daily benefit increase by %5 each years on the policy's anniversary. c. the daily benefit increase by %2 every 6 months. d. the daily benefit increase by twice the inflation rate each year on the policy's anniversary.
a
29. When Mr. Wilson, an insurance agent, replaces Mrs. Fuller's long-term care insurance policy with one of lesser value to obtain additional commission, he is guilty of a. misrepresentation b. twisting c. rebating d. competition
a
31. Which of the following statements would you be wrong in listing as an advantage of long-term care policies? a. skilled, intermediate, and custodial care are covered. b. The cost of care is shifted to the insurance carrier c. home health care is normally an option d. most long-term care policies are conditionally renewable.
a
34. David has a room in a facility that provides attendants who help him get in and out of bed, eat, bathe, and get dressed, one of which he can do by himself. David is living in a(n) a. continuing care retirement community b. fraternal or religious home c. independent living facility d. residential care facility
a
4. The long-term care insurance partnership program is a joint effort between a. state governments and insurance companies b. the state and long-term care facilities c. the state and social security d. the state and the U.S department of Labor
a
2. During an annual review meeting with a client who is 53 years old, the client tells you she is beginning to worry about relying on family or friends when she begins to lose her independence. She also tells you she dislikes the very idea of becoming impoverished to qualify for medicaid. Which of the following products would best meet her needs? a. medicare supplement insurance b. long term care insurance c. disability income insurance d. medicare program
a. medicare supplement insurance
13. Which of the following providers of care to Mr. Wilson is not commonly covered by long-term care policies? a. The St. Benedict nursing home b. Mr. Wilson's son and daughter c. Blazon's adult day care center d. Barron's home heath care agency
b
32. John has a tax-qualified indemnity long-term care insurance policy. The annual cost of his care in a long-term care facility is $102,200. The annual benefits form his long-term care insurance policy amount to $104,400. How will his benefits be taxed? a. A total of $2,200 will be taxed b. ten percent of his benefits will be taxed c. his benefits will be free from income taxation d. the amount divided by the IRS's daily benefit limit for an indemnity policy will be taxed
b
43. Carolyn has long-term care policy that pays her $150 a day once she is determined to be eligible for benefits, regardless of her actual long-term care expenses. What type of policy does Carolyn have? a. non-qualified b. expense incurred c. reimbursement d. per diem (or indemnity)
b
45.Your client George asks you to describe the benefit triggers of tax-qualified long-term care insurance policies. Which of the following would be the most accurate initial response? a. benefits are triggered when an insured formally requests benefits. b. benefits are triggered when a registered nurse certifies that the insured needs benefits c. Benefits are triggered by a physical impairment or a severe cognitive impairment d. Benefits are triggered when an insured needs the services of both informal and formal caregivers.
b
14. An insured has a $100,000 universal life policy with an LTC rider that provides an LTC monthly benefit equal to %2 of the face amount, up to a maximum benefit of $50,000. If the insured is confined to a nursing home, how long will benefits be paid? a. 10 months b. 25 months c. 20 months d. 15 months
b. 25 months
6. Which of the following would be the most accurate way for you to explain a benefit trigger to a prospect? a. A benefit trigger is an evaluation made by a health care professional to justify payment of a claim. b. A benefit trigger is an event or a condition that must occur before benefits are paid. c. A benefit trigger is the phone call you make to your agent to initiate a claim. d. A benefit trigger is an administrative act that initiates the benefit payment process at an insurance company.
b. A benefit trigger is an event or a condition that must occur before benefits are paid.
30. Mr. Jackson, an insurance agent, is working with Mrs. Timson to tailor an LTC insurance policy to her needs. Which of the following would NOT be appropriate for Mr. Jackson to do in this process? a. ask Mrs Timson questions about her situation b. make policy design decisions for Mrs. Timson c. make recommendations about what options he thinks are bet for Mrs. Timson d. Explain the various policy choices and options.
b. make policy design decisions for Mrs. Timson
33. Which of the following is an example twisting? a. Johanna selling LTC policies that have loss ratios higher than those allowed by law. b. Andre selling LTC insurance to applicants who are already eligible for Medicaid c. Alecia making misrepresentations to convince an LTC policyholder to replace his policy. d. Marcus failing to statein an advertisement that "an insurance agent will contact you" if that is the case.
c
36. you are explaining Medicaid eligibility to your client. Which phrase should you use to describe eligibility to receive Medicaid long-term care benefits? a. an individual who satisfies state-imposed asset and income requirements b. an individual who pays the required monthly Medicaid premium c. an individual who reaches age 65 d. an individual who purchases a private long-term care insurance coverage.
c
37. An insured had paid $34,000 in long term care insurance premiums and has had one claim totaling $34,000. The policy contains a return-of-premium non-forfeiture provision. If the insured dies at this point, the non-forfeiture provision will provide a benefit of: a. 22,000 b. $14,000 c. $0 d. $18,000
c
42. If Ann Ralston is the assessor of a claimant's functional abilities under a tax-qualified, long-term care insurance policy, Ann must be a a. member of the insured's immediate family b. representative of the insurance company c. member of the clergy c. licensed health care practitioner
c
Which explanation would be the most accurate way for you to explain the free-look period to a prospect? a. If you are not satisfied with your first claim experience, a significant percentage of the premiums paid will be returned to you. b. If you are not satisfied with the policy, you can return it during the free-look period for a portion of the premium. c. If, for any reason, you are not satisfied with the policy, you can return it during the free-look period for a full refund of premium. d. The free-look period lets you examine the policy for as long as you want. If you're ready and satisfied with the policy, just inform the insurance company in writing to initiate the contract.
c. If, for any reason, you are not satisfied with the policy, you can return it during the free-look period for a full refund of premium
7. Which of the following is NOT an activity of daily living (ADL)? a. bathing b. Toileting c. Writing letter d. Transferring
c. Writing letter
8. When using the functional model to trigger long-term care benefits, an insurance company should measure the insured's a. ability to pay for long-term care b. cognitive impairments only c. cognitive and physical ability to complete activities of daily of living. d. need for medically necessary care.
c. cognitive and physical ability to complete activities of daily of living
11. An insured has paid $18,000 in LTC insurance premiums and has had one paid claim totaling $4,000. The policy contains a return-of-premium nonforfeiture provision. If the insured dies at this point, the nonforfeiture provision will provide a benefit of a. $18,000 b. $14,000 c. $22,000 d. $0
d
15. In which of these situations might adult day care be suitable? a. Jonathon, who can no longer care for himself, has no one to look after him other than his son whose business takes him to South America twice a month. b. Bernie sometimes has trouble remembering to eat regular meals and wanders off of not carefully watched. He lives with his nephew, who is a bank clerk and works a normal business day five days a week. c. Carolyn lives in her won home and can look after herself, but needs speech therapy after her stroke. d. Marvin needs 24 hour care delivered by a nurse.
d
16. Medicare will provide long-term care benefits in a nursing facility for a. adult day care only b. respite care only c. skilled nursing care only d. custodial care only
d
17. A prospect asks you how he will qualify for benefits under the ADL trigger. Which of the following is the most accurate response to his question? a. Your insurance agent will complete an authorization form and submit it to the insurer's claims department. b. A licensed health care practitioner, using best judgement, must determine that you need 90 days of substantial assistance in performing at least two ADLs. c. A representative of the insurer will observe your activities for a few days and report the findings to the insurer. d. The insured will complete a comprehensive questionnaire and certify that his inability to perform at least two ADLs is expected to last 90 days.
d
24. During an annual review meeting with a client who is 56 years old, she tells you she is beginning to worry about relying on family or friends when she begins to lose her independence. She also tells you she has very few assets and little income. Which of the following products would best meet her needs? a. disability income insurance b. long-term care insurance c. medicaid programs d. medicare supplement insurance
d
25. Generally, eligibility to receive Medicaid long-term care benefits is attained by a. reaching age 65 b. purchasing private long-term care insurance coverage c. paying the required monthly Medicaid premium d. satisfying state-imposed asset and income rquirements
d
26. Under the restoration of benefits clause in Mr. Bronson's long-term care insurance policy, if he receives care in a nursing facility and recovers, the policy benefit is restored to its original benefit level as soon as he a. is certified "treatment free" for a period of at least six month. b. pays the higher attained age premium c. is discharged from the facility d. is certified "chronically ill"
d
3. Which of the following is NOT considered by an insurance company in determining the premium for a long-term care policy? a. the prospect's health status b. the prospect's age c. the prospect's annual income d. the long-term care product design
d
38. Alan Cook, MD certifies that Mrs. Brown needs nursing home care because she is suffering from a severe cognitive impairment. To Mrs. Brown's HIPAA tax-qualified long-term care insurance policy, Dr. Cook certifications is a. preexisting condition limitation b. a benefit trigger c. an NAIC exclusion d. an ADL
d
39. Which of the following statements about Medicare is FALSE? a. eligibility for Medicare is based on financial need b. medicare does not cover all expenses c. medicare was signed into law in 1965 d. medicare is an entitlement program
d
44. John has a tax-qualified indemnity long-term care insurance policy. The annual cost of his care in a long-term care facility is $104,400. The annual benefits from his long-term care insurance policy amount to $102,200. How will his benefits be taxed? a. A total of $2,200 will be taxed b. his benefits will be free from income taxation c. Ten percent of his benefits will be taxed d. the amount divided by the IRS's daily benefit limit for an indemnity policy will be taxed.
d
9. All of the following would decrease the premium for a long-term care policy EXCEPT a. decreasing the benefit period b. increasing the elimination period c. decreasing the daily benefit d. adding the inflation option
d.
23. In describing a long-term care insurance policy to a client, he asks you to explain how the standard free-free look provision in his policy works. Which one of the following comments can you correctly make to your client? a. Client has 15 days to review the policy and return it for a full return of premium. b. client has 45 days to review the policy and return it for a 50% return of the premium. c. Client has 65 days to review the policy and return it for a 75% return of the premium. d. Client has 30 days to review the policy and return it for a full return of premium.
d. Client has 30 days to review the policy and return it for a full return of premium.
35. Jacob needs around-the clock are provided by a licensed health care professional under a physician's supervision that is designed to rehabilitate Jacob. What level of care does Jacob need. a. personal care b. custodial care c. intermediate care d. skilled care
d. skilled care
