Exam
An applicant for an adjuster's license can be issued a temporary license as an apprentice adjuster for how long?
12 Months
An applicant for an adjuster's license can be issued a temporary license as an apprentice adjuster for how long?
12 months
Which of the following disability income policies would have the highest premium?
15-day waiting period / 10-year benefit period
Prosthodontics
A patient is being fitted for dentures. Which type of dental treatment is this?
A tornado that destroys property would be an example of which of the following?
A peril
Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis?
Adult day care
Conditions.
Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT
An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?
Consideration
In order to minimize adverse selection, employer group dental plans may require employees who enroll after they were initially eligible to participate to do all of the following EXCEPT
Increase benefits for a period of one year.
The applicant must experience a financial loss due to an accident or sickness that befalls the insured.
Insurable interest can be best described by which of the following?
What type of group rating uses the actual experience of the group as a factor in developing the rates to be charged?
Experience rating
Sexual orientation
It would be considered unfair discrimination to ask an insurance applicant about which of the following and then use that information as a rating factor to determine insurability?
Medicare Part C.
Medicare Advantage is also known as
Which of the following statements pertaining to Medicare Part A is correct?
Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65.
Premium payments for personally-owned disability income policies are
Not tax deductible
Which of the following applies to partial disability benefits?
Payment is limited to a certain period of time.
Under which type of alternative group health plan funding arrangement would the employer pay premiums 90 days past the policy's grace period?
Premium delay arrangement
Regarding the taxation of Business Overhead policies,
Premiums are deductible, and benefits are taxed.
Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen?
Pro rata benefit reduction
All of the above are correct
Regarding a PPO, which of the following is correct when selecting a primary care physician?
The insurer will return a percentage of the premiums paid.
Regarding the return of premium option for LTC policies, what happens to the premium if the policy lapses?
Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?
Residual disability
An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?
Revocable
Which of the following is an example of a producer being involved in an unfair trade practice of rebating?
Telling a client that his first premium will be waived if he purchases the insurance policy today
Income tax free.
The benefits received by the business in a Disability Buy-Sell policy are
All credit life and credit health insurance must be evidenced by an individual policy, or in the case of group insurance, by a certificate of insurance. The policy or certificate must be delivered to
The debtor
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
They cover the cost of extended nursing home care.
When the expenses exceed a certain percentage of the insured's adjusted gross income
When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT
When the amount payable under Social Security is more than the amount payable under the rider.
Independent Practice Association
Which HMO model provides its members with the greatest choice of physicians?
Taft-Hartley
Which act amended the National Labor Relations Act?
Incontestability
Which clause states that a representation may NOT be contested after a 2-year period?
Exchange of unequal values
Which of the following best describes the aleatory nature of an insurance contract?
Making derogatory oral statements about another insurer's financial condition
Which of the following best describes the unfair trade practice of defamation?
Premiums are not elevated.
Which of the following do the Standard and Preferred risk categories share?
The aggregate amount of premiums due
Which of the following does NOT have to be disclosed in a long-term care (LTC) policy?
If paid by the individual, the premiums are tax deductible.
Which of the following is INCORRECT concerning taxation of disability income benefits?
Prosthodontics
Which type of dental treatment involves the replacement of natural teeth with artificial devices?
Which type of dental care services would cover the costs of the extraction of wisdom teeth?
oral Surgery
Any occupation disability typically means that an individual is unable to perform the duties of the occupation for which he/she is suited by all of these EXCEPT
preference
An agent offers his client free tickets to a sporting event in exchange for the purchase of an insurance policy. The agent is guilty of
rebating
An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?
revocable
The applicant for insurance agrees to be subject to the policy provisions, if the policy is issued, by
signing the application
A specialty credit insurance producer license
What license would permit a person to solicit applications and enroll groups on behalf of an authorized credit life
Open panel
What term is used to describe when a medical caregiver contracts with a health organization to provide services to its members or subscribers, but retains the right to treat patients who are not members or subscribers?
The insuring clause of a disability policy usually states all of the following EXCEPT
the method of premium payment
What is the duration of the free-look period for Medicare supplement policies?
30 days
Who can take a tax deduction for their share of the Social Security Tax?
Employers only
An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?
$500
For how many days during a patient's lifetime will Medicare Part A cover mental health care in a psychiatrics facility?
190 days
How long is an open enrollment period for Medicare supplement policies?
6 months
Regarding Medicare Part A coverage of hospital charges, the plan will cover 100%of approved charges for____ days
60
If a mother delivers her baby through a C-section, the minimum hospital stay must be
96 Hours
If a mother delivers her baby through a C-section, the minimum hospital stay must be
96 hours
6 months (12 months for contracts of more than 3 years) after purchase of the policy.
A credit life insurance policy may include a provision excluding or denying a claim for death in the event of suicide within what time limit?
In underwriting a substandard risk, which of the following is INCORRECT?
A discounted premium would be charged.
150% of the single life rate
A husband and wife are insured under a credit life insurance policy. What is the highest premium rate that can be charged?
The benefits will be coordinated.
A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?
Insurable interest and consent
A life insurance policy has a legal purpose if both of which of the following elements exist?
Prior to the time of application
A long-term care shopper's guide must be presented at what point?
The insurance through his company is primary.
A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim,
$12,000, all of which is taxable.
A noncontributory group disability income plan has a 30-day waiting period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive
Cash to the owner's business partner to accomplish a buyout
A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?
Disability income
A waiver of premium provision may be included with which kind of health insurance policy?
Elective cosmetic procedures are covered.
All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT
A reinstated policy provides immediate coverage for an illness.
All of the following are correct about the required provisions of a health insurance policy EXCEPT
Benefits are considered taxable income to the business.
All of the following are true of the Key Person disability income policy EXCEPT
Dividends from a mutual insurer.
All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT
It is a compulsory program.
All of the following statements about Medicare Part B are correct EXCEPT
They cover the cost of extended nursing home care.
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
Preferred
An applicant for health insurance has not had a medical claim in 5 years. He exercises daily and does not smoke or drink. What classification do you assume the applicant would receive from his insurer?
$102
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
Benefits that are attributable to employer contributions are fully taxable to the employee as income.
An individual is insured under his employer's group Disability Income policy. The insured suffered an accident while on vacation that left him unable to work for 4 months. If the disability income policy pays the benefit, which of the following would be true?
Moral hazard.
An individual's tendency to be dishonest would be indicative of a
Beneficiary's consent.
An insurance contract must contain all of the following to be considered legally binding EXCEPT
$2,800 The insurer would pay 80% of covered expenses after the $500 deductible is satisfied.
An insured has a major medical policy with a $500 deductible and a coinsurance clause of 80/20. If he incurs medical expenses of $4,000, the insurer would pay
No benefits
An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits?
Full benefits
An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits?
10 days
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
$120 a day
An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay?
Rebating.
Any inducement offered to the insured in the sale of an insurance policy that is not specified in the policy is an unlawful practice known as
All of the following qualify for Medicare Part A EXCEPT
Anyone who is willing to pay a premium.
Spousal impoverishment rule
Bob is admitted into a nursing home, leaving his wife Sarah to pay the bills. The _________ will allow her to keep a portion of the couple's income and assets equal to a percentage of the federal poverty line.
False advertising
Circulating deceptive sales material to the public is what type of Unfair Trade Practice?
Maurice's health insurance plan covers practically all types of medical expenses. Maurice's insurer provides first-dollar coverage for basic benefits, but applies a deductible for major benefits and then pays 80/20 coinsurance. What type of coverage does Maurice have?
Comprehensive major medical
Employee benefits are tax deductible the year in which they were received.
Concerning group Medical and Dental insurance, which of the following statements is INCORRECT?
2 years.
Continuing education requirements must be met every
Contracts that are prepared by one party and submitted to the other party on a take it or leave it basis are classified as
Contracts of adhesion
Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as
Contracts of adhesion.
The gatekeeper of an HMO helps
Control specialist costs.
Jason's health insurance claim with his HMO was denied, but he feels it should have been covered. When Jason files a complaint, what complaint category would his complaint fall into?
Coverage complaints
Group disability income insurance premium paid by the employer are
Deductible by the employer as an ordinary business expense
The HMO Act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How has this plan since changed?
Employers are no longer forced to offer HMO plans.
When an insurance agency published an advertising brochure, it emphasized the company's financial stability and sound business practices. In reality, its financial health is terrible, and the company will soon have to file for bankruptcy. Which of the following terms best describes the advertisement?
False financial statement
Medicare is funded mostly by
Federal Taxes
3
Following a hospital confinement lasting _____ days, Medicare Part A will pay for up to 100 days in a skilled nursing facility for each benefit period.
In disability income insurance, the own occupation definition of disability applies
For the first 2 years of the disability
What option allows the insured to periodically increase benefit levels without providing evidence of insurability?
Guarantee of insurability
Nonprofit.
HMOs that are consumers' cooperatives are typically
Medical personnel
Hedwig, who is covered by a HMO, feels that her physician has not been doing all he can to treat her symptoms. She wishes to file a complaint, but wants to know who would initially review the complaint once she files it. Since Hedwig's complaint would be a care complaint, who would initially review it?
The primary care physician refers the member.
How does a member of an HMO see a specialist?
10%
If a disability income policy covers nondisabling injuries, benefits will probably be limited to ___ of the regular weekly benefit.
Charge an extra premium.
If an applicant for a health insurance policy is found to be a substandard risk, the insurance company is most likely to
Where are the execution agreements found in a health insurance application?
Immediately preceding the applicant's signature
Which of the following riders would NOT increase the premium for a policyowner
Impairment Rider
The first day of disability and the day the insured starts receiving benefits
In a disability policy, the elimination (or waiting) period refers to the period between
During which illness-related disabilities are excluded from coverage.
In a disability policy, the probationary period refers to the time
Mental illness.
In health underwriting, it would be inappropriate to decline a risk using any of the following factors EXCEPT
All providers will have the same coverage options and conditions for each plan.
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
The Medical Information Bureau (MIB) was created to protect
Insurance companies from adverse selection by high risk persons.
Increased benefits
Issue age policy premiums increase in response to which of the following factors?
What is the benefit of experience rating?
It allows employers with low claims experience to get lower premiums.
What is NOT a benefit of a POS plan?
It allows guaranteed acceptance of all applicants.
Which of the following is NOT true of a major-medical health insurance policy?
It is designed to pay on a first dollar of expense basis.
Which is true regarding HMO coverage?
It is divided into geographic territories.
In franchise insurance, premiums are usually
Lower than individual policies, but higher than group policies
In group insurance, what is the policy called?
Master Policy
On its advertisement, a company claims that it has funds in its possession that are, in fact, not available for the payment of losses or claims. The company is guilty of
Misrepresentation.
Guaranteed renewability
Most LTC plans have which of the following features?
An insurance license issued by the Kentucky Department of Insurance shall include all of the following, EXCEPT:
Name and address of the appointing insurer.
HMO's that are patients' cooperatives are___ while those owned by physicians are typically ___
Nonprofit; for-profit
Which type of dental care would cover operative treatment of the mouth?
Oral Surgery
The cause of loss insured against.
Peril is most easily defined as
Which type of dental treatment address the supporting tissue of teeth
Periodontics
Which of the following is a comprehensive list of all Medicare supplement policies available?
Plans A-J
Certain conditions, such as dismemberment or total and permanent blindness, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe?
Presumptive Disability
If a domestic insurer is identified as impaired or insolvent, the Kentucky Life and Health Guaranty Association may do all of the following EXCEPT
Provide for unlimited coverage for individual insureds.
Notice Regarding Replacement.
Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the
Part A of Social Security is funded primarily through
Social Security payroll taxes.
Workers Compensation benefits are regulated by which entity?
State Government
Military retirees
TRICARE is geared toward which of the following?
Which of the following is NOT covered under Plan A in Medigap Insurance?
The Medicare Part A deductible
Age 65 who are not retired.
The Omnibus Budget Reconciliation Act of 1990 (OBRA) requires that large group health plans must provide primary coverage for disabled individuals under
Second injury fund
The ________ is designed to encourage employers to hire people who are partially disabled.
An insurer is attempting to determine the insurability of an applicant and decides to obtain medical information from several different sources. Which entity must be notified of the investigation?
The applicant
Which of the following is NOT the consideration in a policy
The application given to a prospective insured
An insured who has an accidental Death and Dismemberment Policy losses her left arm in an accident. What type of benefit will she most likely receive from this policy.
The capital amount in a lump sum
Nonoccupational coverage.
The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called
An individual applied for an insurance policy and paid the initial premium. The insurer issued a conditional receipt. Five days later the applicant had to submit to a medical exam. If the policy is issued, what would be the policy's effective date?
The date of the medical exam
In a group policy, the contract is between
The employer and the insurance company.
As of the application date
The full premium was submitted with the application for life insurance, and the policy was issued two weeks later as requested. When does the policy coverage become effective?
How are excess funds in an employee's HSA handled
The funds can be carried forward to the next year
Who chooses a primary care physician in an HMO?
The individual member
A policy with a 31-day grace period implies
The policy will not lapse for 31 days if the premium is not paid when due.
Which provision states that the insurance company must pay Medical Expense claims immediately?
Time of Payment of Claims
What is the purpose of COBRA?
To provide continuation of coverage for terminated employees
Principal sum
Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?
Metal level classification
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?
Conventional fully-insured
Under what type of group health plan does the insurer issue the plan on a one-year, renewable term basis, and the premium for each year only pays for that year's coverage?
An employee's group medical benefits are generally exempt from taxation as income.
Under which condition would an employee's group medical benefits be exempt from income taxes?
Signed waiver of premium.
Upon policy delivery, the producer may be required to obtain any of the following EXCEPT
Attending Physician's Statement
What document describes an insured's medical history, including diagnoses and treatments?
Third-party administrator
What is another name for an Administrative-Services Only arrangement?
Old Age, Survivors, and Disability Insurance
What is another name for social security benefits?
It is health coverage for small groups whose numbers are too small to qualify for true group insurance
What is franchise insurance?
30
What is the maximum age for qualifying for a catastrophic plan?
To cover the expenses of retraining the insured to return to work
What is the purpose of the rehabilitation benefit in disability insurance?
Defamation.
When a producer was reviewing a potential customer's coverage written by another company, the producer made several remarks that were maliciously critical of that other insurer. The producer could be found guilty of
Suspend or revoke that company's certificate of authority.
When an admitted life insurer becomes insolvent, after notice and a hearing, the Commissioner will assess member insurers in order to pay insured, claimants, and beneficiaries of the insolvent insurer. Should a member fail to pay their assessment, the Commissioner will
Case management provision
When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply?
Reimbursement
When benefits are paid directly to the insured under a health insurance policy, the policy provides benefits on what type of basis?
Within 6 months of the effective date of coverage
When can a Long-Term Care policy deny a claim for losses incurred because of a pre-existing condition?
Worker's occupation
Which of the following is NOT a factor in determining qualifications for Social Security disability benefits?
The insurer can increase the policy premium on an individual basis.
Which of the following is NOT a feature of a guaranteed renewable provision?
Coverage is unlimited.
Which of the following is NOT true regarding Basic Surgical Expense coverage?
Warranty
Which of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract?
It can provide coverage for handicapped children.
Which of the following is correct about a group health insurance policy?
Premiums are tax deductible and benefits are not taxed.
Which of the following is correct regarding the taxation of group medical expense premiums and benefits?
Benefits are considered taxable income to the business.
Which of the following is not true of Disability Buy-Sell coverage?
Copayment
Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service?
it requires all employers, regardless of the number or age of employees, to provide extended group health coverage.
Which of the following statements is NOT correct concerning the COBRA Act of 1985?
Home health care
Which of the following types of LTC is NOT provided in an institutional setting?
Insurers
Who makes up the Medical Information Bureau?
Insurer
Who must pay for the cost of a medical examination required in the process of underwriting?
Full coverage
______ policies cover injuries and illnesses that occur on-the-job or off-the-job.
In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?
insurer to the insured
The act of voluntarily giving up insurance by the insured is called
cancellation
When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?
consideration
Which of the following is NOT an essential element of an insurance contract?
counteroffer
When Y applied for insurance and paid......
issue the policy anyway and pay the face value to the beneficiary
Which of the following is true regarding a term health policy?
it is nonrenewable