Accident and Health Insurance
Dental care coverage is designed to cover the costs of all of the following except ?
Loss of income
Which of the following types of health coverage frequently uses a deductible?
Major Medical policy
Which of these is not considered to be an element of an insurance contract?
Negotiating
Which of the following characteristics is associated with a large group of disability income policy
No medical underwriting
which statement is true regarding a minor beneficiary
Normally, a guardian is required to be appointed in the Beneficiary clause of the contract
S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning
November 1
Group/voluntary long-term care policy premiums are typically deducted from the employee's income and
are less costly as compared to individual long term care coverage
Medicaid was designed to assist individuals who are
below a specific income limit
The coordination of benefits provision
prevents an insured covered by two health plans from making a profit on a covered loss
Statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called
representations
The consideration clause of an insurance contract includes
the schedule and amount of premium payments
A Business Disability Buyout plan policy is designed
to pay benefits to the Corporation or other shareholders
Which type of policy would pay an employees salary if the employer was injured in a bicycles accident and out of work for six weeks?
Business Overhead Expense
A disability income policyowner recently submitted a claim for a chronic neck that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of the application. How will the insurer handle the claim?
Claim will be paid and coverage will remain in force.
Which of the following reimburses it's insured for covered medical expense?
Commercial Insurers
Which of the following would be a likely candidate for disability income insurance on a key employee
Company executive
The Consolidated Omnibus Budget Reconciliation Act(CORBA) gives workers( and their families) whose employment has been terminated the right to
Continue group health benefits
Which of the following consists of offer, acceptance, and consideration?
Contract
Common exclusions to continuation of group coverage include?
Dental care, other prescription drugs
Which contract permits the remaining partners to buy-out the interest of a disabled business partner?
Disability Buy-Sell
B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have?
Disability Income
In the event of an illness, an _____ _____ policy would reimburse an insured for loss of earnings.
Disability Income
K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?
Disability Income
What kind of Accidental Death and Dismemberment (AD&D) insurance beneficiary requires his/her consent when a change of beneficiary is made?
Irrevocable beneficiary
Stranger Originated Life Insurance (STOLI) has been found to be in violation of which of the following contractual elements?
Legal Purpose(Insurable Interest)
In major medical expense policies what is the objective of a stop loss provision?
Limits an insured's out-of-pocket medical expenses
An insurance company would most likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses?
Loss of eyesight due to an accidental injury
Generally, how long is a benefit period for a Major Medical Expense Plan?
one year
A "reimbursement policy" pays what amount of covered long-term coverage?
Actual covered expenses up to the daily maximum
Which of the following claims are typically excluded from medical expense policies
Intentionally self-inflicted injuries
A life insurance arrangement which circumvents insurable interest statues is called
Investor-Originated Life Insurance
B has a $100,000 Accidental Death and Dismemberment policy that pays triple indemnity for common carrier death. If B is killed from an accident on a commercial flight, what will the policy pay B's beneficiary?
$300,000
An individual has a major medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the insured have to pay if a total of $15,000 in covered medical expenses are incurred?
$7,000". In this situation, $5,000 + 20% of the remaining bill = $7,000
XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is
100%
Which of the following statements describes what an accident and health policyowner may not do?
Adjust the premium payments
Under a Long Term Care policy, which benefit would be typically excluded or limited?
Alcohol rehabilitation
All of the followings statements regarding group health insurance are true, EXCEPT
An individual policy is given to each member
Which of the following is the most important factor when deciding how much disability income coverage an applicant should purchase?
Applicant's monthly income
Accidental death coverage is provided to commercial airline passengers in which of the following types of policies
Blanket Accident policy
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is
Business Overhead Expense
Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is
Business Overhead Expense
Which of these arrangements allows one to bypass insurable interest laws?
Investor-Originated Life Insurance
Which of the following statements best describes the intent of a Coinsurance clause in a major medical policy?
Discourages overutilization of the insurance coverage
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the
Entire Contract provision
A comprehensive major medical health insurance policy contains an eligible medical expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered expect for
Experimental and investigative services
This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year
Family maximum deductible
Which of these is considered a true statement regarding Medicaid
Funded by both state and federal governments
A physician opens up a new practice and qualifies for a $7,000/month Disability Income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow?
Guaranteed Insurability Option rider
Which type of provider is known for stressing preventative medical care?
Health Maintenance Organizations (HMO's)
The health insurance portability and accountability act(HIPPA) gives privacy protection for?
Health information
A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
Her group health plan
Which of the following statements about health reimbursement arrangements(HRA) is correct?
If the employee paid for the qualified medical expenses, the reimbursements may be tax-free
When must insurable interest exist for a life insurance contract to be valid?
Inception of the contract
T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take?
Increase her policy's coverage amount
Who makes the legally enforceable promises in a unilateral insurance policy?
Insurance Company
If a contract of adhesion contains questionable language, to whom would the interpretation be in favor of?
Insured
If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act?
Insured's contingent beneficiary
Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured?
PPO
On an Accidental Death and Dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation?
Policyowner
how does group insurance differ from individual insurance
Premiums are lower
An insured covered by Accidental Death and Dismemberment (AD&D) insurance has just died. What will happen if the primary beneficiary had already died before the insured and contingent beneficiary?
Proceeds will go to the contingent beneficiary
What is the consideration given by an insurer in the Consideration clause of life policy
Promise to pay a death benefit to a named beneficiary
P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as?
Recurrent Disability
D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits?
Residual Benefit clause
When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following?
Residual disability
Which mode of payment is NOT used by health insurance policies?
Single Premium
Which type of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?
Subrogation
An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?
The correct answer is "$3,000". In this situation, the insured is responsible for $1,000 deductible + 20% of the remaining bill = $3,000.
Which of the following statements is correct regarding an employer/employee group health insurance?
The employer receives a master policy and the employees receive certificates.
A policy of adhesion can only be modified by whom?
The insurance company
Which of the following statements is true about Blue Cross/ Blue Shield organizations?
They are nonprofit organizations
What is the elimination period of an individual disability policy?
Time period a disabled person must wait before benefits are paid
What is the minimum number of activities of daily living(ADL) an insured must be unable to perform to qualify for long term care benefits?
Two
The provision in a health insurance that suspends premiums being paid to the insurer while the insured is disabled is called the
Waiver of premium
The part of life insurance policy guaranteed to be true is called an
Warranty
Which of the these is considered a statement that is assured to be true in every aspect
Warranty
All students attending a large university could be covered by
a blanket policy
What is issued to each employee of an employer health plan?
certificate
A major medical policy typically contains a provision that requires the insurer to pay only part of a loss while the balance is paid by the insured. This provision is called
coinsurance
Major Medical policies typically
contain a deductible and coincide
K has an Accidental Death and Dismemberment (AD&D) insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. Under the Common Disaster clause, if K and her husband are both killed in an automobile accident, where would the death proceeds be directed?
daughter
Medicare Part A and Part B do NOT pay for
dental work
Which of the following does social security not provide benefits for ?
dismemberment
Health insurance benefits not covered due to an act of war are
excluded by the insurer in the contract provisions
The reason for a business having a business overhead expense disability plan is to cover?
fixed business expenses
A medical care provider which typically delivers health services at its own local medical facility is known as a
health maintenance organization
Which of the following will a long term care plan typically provide benefits for?
home health care
T sends proof of loss to her insurer for an acceptable medical expense claim under her individual Health Insurance policy. Upon receipt, the insurer must pay the benefits
immediately
The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the
initial deductible
A life insurance policy would be considered a wagering contract without
insurable interest
A policy owner's rights are limited under which beneficiary designation?
irrevocable
A policyowner would like to change the beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy and make the change permanent. Which type of designation would fulfill this need?
irrevocable
A policyowner's rights are limited under which beneficiary designation?
irrevocable
Which of the following situations does a critical illness plan cover?
leukemia
Which of the following is not a limited benefit plan?
life insurance policy
Nursing home benefits must be provided for at least 12 consecutive months in which of the following types of policies?
long term care
Dental care coverage is designed to cover the costs of all of the following EXCEPT:
loss of income
Basic Hospital and Surgical policy benefits are
lower than the actual expenses incurred
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called
noncancellable
Which of the following best describes a short-term medical expense policy?
nonrenewable
