Ad banker questions (incorrectly answered)
An insured may find it more difficult to qualify for benefits, but will enjoy a lower premium, when a more restrictive definition of _________ is found in a Disability Income policy.
Disability Explanation: Some policies require the insured to be unable to perform the duties of any occupation for which he/she is reasonably suited by education, training and experience.
Which of the following is false regarding an insurer's responsibility with cyber regulations in New York?
Each covered entity must maintain records for 3 years Explanation: Each covered entity must maintain records regarding the cybersecurity program, including schedules and date supporting their compliance, for a period of 5 years.
Beth has a contract stating she must be disabled for 3 months before benefits will begin to be paid. This 3-month period is known as the:
Elimination Period Explanation: Elimination Period
Home Health Care benefits under a LTC Policy may be limited or excluded by:
Excluding benefits for conditions caused by war or acts of war Explanation: Home Health Care benefits may be excluded when a condition results from war or acts of war.
Amy owns her own individual Medical Expense Policy and she itemizes deductions. Which of the following is true about the taxation of her premiums and medical expenses?
Expenses and premium costs in excess of 7.5% of AGI may be deductible Explanation: The AGI threshold for determining the deduction for unreimbursed medical expenses and premiums is 7.5%.
Deliberate deception with intent to gain is the definition of:
Fraud Explanation: Fraud is an intentional deception in order to induce another to part with something of value or surrender a legal right.
As long as the premium is paid, a Medigap policy is __________ renewable.
Guaranteed Explanation: As long as the premium is paid, a Medigap policy is guaranteed renewable.
Which statement is incorrect regarding HMOs?
HMOs must provide basic health care services including hospitalization, laboratory services, optical services, physical therapy, dental care, and preventive services Explanation: Usually optical services, physical therapy, and dental care are supplemental and offered as an option.
Ashley wanted to establish her company benefit plan so that it could cover her individual health insurance premiums and out-of-pocket expenses without group insurance or loss of unused benefits. After some research, she established a:
HRAs Explanation: A self-employed entrepreneur may establish an HRA without also establishing an HDHP.
Information about an applicant's work behavior or character gathered from neighbors or co-workers would be included on an?
Inspection Report Explanation: An Inspection Report is a general report of the applicant's finances, character, morals, work, hobbies and other habits. It is sometimes called a Consumer Investigative Report.
The purpose of the Healthy New York program is to:
Make standardized health insurance contracts available to small group and uninsured workers Explanation: Healthy New York requires all insurers in the state to provide a policy with standardized benefits to both small employers and employed individuals that have been unemployed for at least 12 months.
A policy that covers inpatient doctor visits and may be expanded to include payment for office visits, diagnostic x-rays, laboratory charges, ambulance and nurse's expenses when not hospitalized, and maternity benefits for an additional premium is considered which of the following?
Medical Expense Policy Explanation: The question describes a Medical Expense Policy, sometimes referred to as a Regular (Basic) Medical Expense Policy.
Which statement regarding Medicare is not true?
Medicare is the primary payor to any employer group health plan coverage Explanation: Group health plans with 20 or more employees are primary to Medicare and pay first.
Which Act was implemented in order to protect consumers from questionable Medicare Supplement Policy marketing practices?
NAIC Model Law Explanation: NAIC Model Law requires all Medicare Supplement policies to be standardized.
Group health plans usually cover:
Nonoccupational injury or disease Explanation: Group health plans usually only cover nonoccupational injury and disease. Workers' Compensation Insurance is designed to cover job-related injury or disease.
The __________ is the person applying for insurance coverage and is responsible for completing an application.
Policyowner Explanation: The policyowner is the person applying for insurance coverage and is responsible for completing an application.
A treatment approval procedure used by dental insurance carriers to determine the benefit to be paid is known as?
Precertification
Which event does not cause termination of continuing coverage by COBRA?
Premium payments are made in a timely manner Explanation: Making timely premium payments is a requirement for continuing coverage, not a cause to terminate it.
If an insured dies under the AD&D policy, which of the following will provide benefit payouts to the beneficiary:
Principal sum Explanation: Death benefits payable under an AD&D policy are referred to as the principal sum.
The purpose of the Social Insurance Supplement rider is to:
Provide benefits in case an insured is declined Social Security disability benefits Explanation: Pays in addition to regular disability policies until Workers' Compensation or Social Security payments begin. If either benefit stops or is declined, the SIS will pay benefits.
If a disability insurance applicant is insurable, but not at a standard rate, all of the following are actions an underwriter can take, except:
Reduce the dividends the policy is eligible for Explanation: If an applicant is substandard, the insurer may want to reduce the risk. This may be accomplished by charging an extra premium, increasing the elimination period, shortening the benefit period, reducing the amount of benefit and/or utilizing an exclusion rider when a condition appears certain to result in recurrent disabilities.
What type of disability income insurance is designed help a small business continue to make regular monthly payments on its long-term financial commitments in the event of the owner's disability?
Reducing term Explanation: Disability Reducing Term helps a small business that has long-term financial commitments requiring regular monthly payments to meet its obligations. The amount of the benefit remains the same monthly, but the benefit period reduces.
When an insurance company sells part of their risk to another insurance company, this is called:
Reinsurance Explanation: Reinsurance is how insurance companies spread out their risk. Particularly larger risks. This is referred to as Risk Sharing or Reinsurance. An insurer retains part of the risk and cedes the remaining risk to one or more insurers with a reinsurance agreement.
A firm with 50 employees replaces its existing group health plan. With regard to ongoing existing claims, the replacing insurer will be:
Required to continue paying them under the No Loss-No Gain law Explanation: The No Loss-No Gain law (a.k.a. the Hold Harmless Agreement) establishes mandatory risk transfer.
Under the New York Dependent Requirements for individual health insurance, newborn child coverage is not required in the case of __________ insurance.
Student Explanation: Under the New York Dependent Requirements for individual health insurance, newborn child coverage is not required in the case of student insurance.
Individuals covered under a Blue Cross/Blue Shield HMO plan are typically referred to as:
Subscribers
Which policy utilizes a Corridor Deductible after Basic Medical Expense Coverage benefits have been exhausted and before Major Medical benefits begin?
Supplementary Major Medical Explanation: The question describes the characteristics of a Supplemental Major Medical Policy.
_____________ insurance allows for insurance coverage to be obtained when not available from admitted carriers.
Surplus lines
What is the primary source of underwriting information for an individual health insurance policy?
The application Explanation: The application is the primary source of underwriting information. All other sources are supplementary.
Who among the following is required to display their license?
The broker or agent who is the supervising person responsible for that place of business Explanation: An agent or broker, if they are the supervising person responsible for that place of business, is required to prominently display their license.
Which statement is false concerning Social Security disability benefits?
The employee must only be unable to engage in his/her own occupation to be considered disabled Explanation: The employee must be unable to engage in any kind of gainful employment, not just his/her own occupation.
When an accident and health policy is terminated, how are covered expenses that were incurred while the policy was still in force handled?
The insurer must pay for those expenses Explanation: If the covered medical services were provided while the policy was in force, the insurance company must pay the claim.
When a group is covered by a MET, who is issued the Master Policy?
The trust Explanation: The sponsor develops the plan, sets the underwriting rules, and administers the plan, but the trust is the Master Policyowner.
Which of the following statements is incorrect regarding New York's required benefits?
There is no required coverages for cancer Explanation: New York has required coverages regarding preventative care and screening for cancer, cancer drugs, and chemotherapy services.
Residual Disability Income pays funds to the insured, to make up for what the insured would have earned after returning to work, and while recovering from ___________.
Total disability Explanation: Residual Disability provides benefits for loss of income after the insured returns to work usually following a total disability.
Josh is a concert pianist and earns a very good living with his talent. He was in a car accident and broke his arm. His disability is considered:
Total, temporary Explanation: Temporary Disability occurs when the insured suffers a disability and is expected to recover fully. Temporary disability may be total or partial, depending on the person's ability to work or not. A professional pianist with a broken arm would not be able to perform, and would be considered totally disabled for a temporary period of time.
Which of the following would be eligible for benefits provided under the New York State Disability Benefits Law?
Unemployed individuals Explanation: An unemployed individual may be eligible for benefits if they become disabled during unemployment and the disability prevents them from performing duties they are qualified for.
Many insurers pay benefits based on the average fee charged in a geographical area. This is referred to as which of the following?
Usual Customary and Reasonable Explanation: UCR is not scheduled, but is based on the average fee charged by all doctors in a given geographical area.
_______________ is insurance provided by an employer to cover injuries that occur on the job only.
Workers' Compensation Explanation: Workers' Compensation is insurance provided by an employer to cover injuries that occur on the job only.
After Robert signed up for Medicare, he withdrew $2,000 from his HSA. He used $600 for his Medicare Supplement premium, $200 for out-of-pocket medical expenses, and the remaining $1,200 on a trip to celebrate his retirement. Later on, when he paid his taxes for the year, he discovered that:
$1,200 was subject to income tax Explanation: Robert paid income tax on the $1,200, but not the 20% penalty, because he was at least 65 years of age, as indicated by the fact that he was on Medicare and retired.
Medical Expense Insurance is usually written with a policy period of __________.
1 year Explanation: Medical Expense policies are usually written with a benefit period of one year, such as January 1 through December 31.
Insurance producers are required to complete how many hours of approved continuing education during each 2-year license period?
15 Explanation: Producers must complete 15 hours of approved continuing education during each 2-year license period.
After notifying the Superintendent of the termination of a producer's appointment, within how many days must an insurer in New York notify the producer?
15 Explanation: The insurer must notify the producer of their termination within 15 days after notifying the Superintendent. The producer must be notified via overnight delivery or certified mail at their last known address with return receipt requested.
The pregnancy discrimination act applies to groups with ______ or more employees.
15 Explanation: The pregnancy discrimination act applies to groups with 15 or more employees.
Up to what age is a dependent child covered for preventative care services in New York, such as check-ups and physicals?
19 Explanation: Preventive and primary care services are provided to a covered child of the insured from birth to age 19.
For an employee to be eligible to participate in an employer's group health insurance plan, he/she must be considered full-time and work a minimum of _____ hours as established by the Affordable Care Act.
30 Explanation: To be eligible, an employee must be considered full-time and work a minimum of 30 hours as established by the Affordable Care Act.
Applicants seeking a life, accident, and health insurance license are required to complete how many hours of prelicensing education
40 Explanation: Individual lines require 20 hours. A combined life and health license requires 40.
If notice under an employer group health insurance conversion privilege is provided more than 15 days, but less than 90 days after termination, the conversion privilege must be extended to ______days.
45 days Explanation: If notice under an employer group health insurance conversion privilege is provided more than 15 days but less than 90 days after termination, the conversion privilege must be extended to 45 days.
How many employees would an employer require in order to be considered a small employer:
50 or less Explanation: A Small Employer is any person, firm, corporation, partnership, or association that is actively engaged in business and has 50 employees or less.
How many years must insurers typically maintain books and records, producer licensing records, complaints and claims, financial, or any other or licensee doing business in the state of New York?
6 Explanation: The Superintendent may examine the books and records, including policy, claim, complaint, financial, and producer licensing records, of any insurer or licensee doing business in this state. Typically, insurers must maintain records for 6 calendar years, or until after the filing of an examination report or the conclusion of an investigation in which the record was subject to review.
What percentage of employee participation is required for a contributory employer group plan?
75% Explanation: Contributory plans require 75% participation.
Until yesterday, J. J. worked for his father's company and was covered by the company's large group health plan. He stopped working to go to college. He is 26 years of age and wants to keep the same coverage until he earns his degree in approximately 24 months. Which of the following statements is true?
A good option for J.J. is to exercise the COBRA option under his father's group plan Explanation: Since J.J has lost his dependent status, but still wants the same group coverage, he can continue that coverage under COBRA for up to 36 months.
Which of the following is not correct with respect to the definition of a producer?
A producer includes an agent of a title insurance company Explanation: The term producer does not include an agent or representative of any title insurance company.
Which of the following is not an eligible group for group health or blanket insurance in New York?
A professional employer organization with 75 persons Explanation: A professional employer organization must have at least 100 persons insured on the date of issue to be eligible.
Timothy owns an individual A&H policy, and in the event of an accident, he is required to prove only that the injury itself is unforeseen and unintended. Tim's policy is based on which of the following definitions of accident?
Accidental Bodily Injury Explanation: Tim's policy is based on Accidental Bodily Injury (or, Accidental Injury) as opposed to Accidental Means. Under the Accidental Means definition, both the cause and the result must be unintended and not under the control of the insured.
All of the following practices may never be used when advertising health insurance, except:
Advertising a group's product endorsement, if the insurer has any control over the group Explanation: An insurer may use the endorsement of a group over which it has some control, as long as it discloses that control in its advertising.
A long-term care policy can exclude from coverage all of the following, except:
Alzheimer's disease Explanation: Alzheimer's disease cannot be excluded from long-term care coverage.
When Harry completed his insurance application, the agent discovered that he was under treatment for a chronic condition. In order to gather the necessary information, Harry's agent ordered a/an:
An attending physician statement Explanation: An attending physician's statement is ordered when the application reveals the presence of a chronic or other condition for which additional information regarding treatment and prognosis is required. A medical exam is ordered based on a variety of factors including the age, and condition of the applicant as well as the amount of coverage requested. A Medical Information Bureau report will be ordered on all applicants as a matter of course.
Which of the following statements about the Insurance Frauds Prevention Act is TRUE?
An innocent person who cooperates with a fraud investigation is immune from civil liability Explanation: Insurers are required to formulate a fraud prevention plan. The Superintendent can impose a civil penalty up to $5,000, in addition to the amount of claim. A person is not subject to civil liability for providing information relating to suspected fraudulent insurance transactions in the absence of fraud or bad faith.
Which of the following is incorrect with regard to commissions and compensation?
An insurer may not pay a commission to anyone other than a currently licensed and appointed agent, but may pay a commission to an agency that is not licensed Explanation: An agency must be licensed and appointed before an insurer may pay commissions to an agency.
Which of the following is true about the open enrollment period for a Medicare Supplement policy?
Applicants must be accepted at all times throughout the year for any Medicare Supplement plan available Explanation: Applicants must be accepted at all times throughout the year; there is not a specified open enrollment period. Pre-existing conditions may not be excluded from coverage if the insured had coverage within 63 days before the enrollment date of the new coverage. Insurers may not deny coverage for the health status, claims experience, receipt of health care, or medical condition of the applicant.
New York State Disability Benefits Law provides coverage for injuries that:
Are nonoccupational and prevent an individual from earning an income Explanation: New York State Disability Benefits provides coverage for injuries that occur outside of an individual's occupation and occupational duties that prevent them from earning an income.
Which of the following terms and definitions do not match?
Cancellable -- An effective period for the policy is expressed in its provisions and it cannot be renewed Explanation: This is the definition of Nonrenewable, not Cancellable.
In a legal sense, an insurance premium is the insured's
Consideration Explanation: The premium paid by the insured represents their consideration. Consideration is something of value exchanged under the terms of a contract and is a required element of a legal contract.
If questions are incomplete on an application and the insurer issues the policy, a claim is:
Covered since the insurer issued the contract based on an incomplete application Explanation: If a policy is issued with questions unanswered, the contract will be interpreted as if the question had not been asked, and is therefore waived by the insurer and covered.
