Exam Questions (Part 2)

Pierre is covered by his employer's group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 benefit be taxable as income under this plan?

$0.

Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500?

$700.

The typical long-term care insurance policy is designed to provide a minimum of _________ years of coverage.

1.

An accident and health policy that provides reimbursement benefits makes them payable to the . . .

Insured.

An example of a primary care physician would be a(n):

Internist.

A common exclusion with Vision Plans is . . .

Lasik surgery.

The time limit for filing claim disputes is addressed in which provision of an accident and health policy?

Legal actions.

The IRS allows a taxpayer to deduct medical expenses that exceed 7.5% of their adjusted gross income. Which of the following is considered a tax deductible medical expense under this rule?

Long-Term care insurance premiums.

What kind of insurance provides coverage for one or more necessary or appropriate diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital?

Long-term care.

Which of these would NOT be considered a presumptive disbaility?

Loss of a leg or arm.

A viatical settlement broker may NOT

Make any transactions before being approved for a license.

Which of the following is considered to be a point of service (POS) plan?:

Managed-care plan.

Shirley has a Medigap policy, which is designed to pays costs associated with . . .

Medicare Parts A and B.

The purpose of Medicare Supplement Insurance is to address gaps in Medicare coverage, which can include . . .

Medicare in-hospital deductible.

Which type of plan would be most appropriate for an individual on Medicare and concerned that Medicare will NOT pay for charges exceeding the approved amount?

Medicare supplement Plan F.

An insurer producer who convinces a prospective insured to purchase a policy by exaggerating the benefits of the policy may be found guilty of

Misrepresentation.

Which of the following is a legal entity created for the sole purpose of providing affordable group health coverage to its participants?

Multiple Employer Welfare Arrangement (MEWA).

When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid?

No deductible payment is required.

What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?

No tax payment needed.

Which of the following is NOT an example of utilization review?

Ongoing inspection of accident-prone individuals.

The _______ of Coverage describes policy features, benefits, exclusions, and riders in a Long-Term Care policy.

Outline.

Which clause defines total disability as being unable to perform the major duties of the insured's regular occupation?

Own occupation clause.

An Arkansas resident producer who would like to solicit insurance in Louisiana MUST obtain a nonresident license in Louisiana. Which of these is NOT a requirement for obtaining a nonresident license?

Pass Louisiana's state licensing exam.

In what form do disability income policies typically pay benefits?

Periodic Income.

The Federal Employees Benefit Program consists of two types of health plans for federal civilian employees. The two plans are fee-for-service and . . .

Prepaid.

An insurance producer decides to conduct business under an assumed name. The Commissioner MUST be notified of this charge . . .

Prior to using the assumed name.

Who is the individual paid on a fee-for-service basis?

Provider.

An example of elective cosmetic surgery would be: - Reconstructive breast surgery after a mastectomy. - Removing excess fat from an insured's waistline. - Surgery to correct a birth defect. - Reconstructive surgery after suffering injuries from an automobile accident.

Removing excess fat from an insured's waistline.

Which of these is NOT an unfair Claims Settlement Practice?

Settling a claim by arbitration.

Health insurance involves two perils, accident and ________________.

Sickness.

Continuous 24-hour care provided by licensed medical professionals under the direct supervision of a physician is called

Skilled nursing care.

Typically, Long-Term Disability benefits are coordinated with which benefit plan?

Social Security.

Which entity regulates claim settlement practices?

State insurance departments

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?

Taxable income.

Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n)

deductible.

A pharmacy benefit covers prescription drugs derived from a list called a(n)

drug formulary.

Benefits provided by a Medicare Supplement policy must NOT

duplicate Medicare benefits.

A payment system for health care in which the provider is paid for each service given is called

fee-for-service.

A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment

indicates a preexisting condition.

A foreign insurance company doing business in Louisiana . . .

is a company that was formed under the laws of another state.

A person covered with an individual health plan . . .

is issued a policy.

The reinstatement provision in a health insurance policy is

mandatory.

The focus of major medical insurance is providing coverage for . . .

medical and hospitalization expenses

A health insurance policy will typically cover

preventative health services.

When comparing an HMO to a PPO, the PPO. . .

provides a greater choice of providers.

An indemnity plan . . .

provides the insured a specific dollar amount for services

"Maximum benefits" refers to the . . .

upper limit of the total lifetime benefits the insurance company will pay.

The Fair Credit Reporting Act protects consumers . . .

with guidelines regarding credit reporting and distribution.

Which of the following is NOT taken into consideration when determining eligibility for Medicare benefits?

Income

Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental?

Accident bodily injury provision.

A long-term care policy typically provides all of the following levels of care EXCEPT:

Acute care.

The waiver of premium does NOT include which provision?

All future premiums are waived if the insured recovers from the disability.

Which of the following actions may an insurance company NOT do in a healthy policy that contains guaranteed renewable premium benefit?

Increase the premiums on an individual basis.

Health insurance will typically cover which of the following perils?

Injury due to accident.

Which of the following statements is NOT true regarding a Critical Illness Plan?

Coverage is limited to a single devastating disease.

Which of the following does restorative dental treatment cover?

Crowns.

Medicare provides coverage for each of the following EXCEPT: - Hospital room and board. - Doctor and surgeon services. - Prescription drugs. - Custodial care.

Custodial care.

A Medicare Supplement Policy is . . .

Designed to fill in gaps of Part A & Part B Medicare.

In group health care, what is the purpose of the coordination of benefits provision?

Determines what is paid by the primary and secondary insurers in the event of a claim.

Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the

Employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan.

How often must an Insurance producer's license in Louisiana be renewed?

Every 2 years.

The waiting period for a disability insurance policy . . .

Excludes payments for a short-term illness or injury.

A health care provider claim may be settled using which of the following payment methods?

Fee-for-service.

A medicare supplement plan can be cancelled by the insurer . . .

For nonpayment of premiums.

Premium mode is a term used to describe the:

Frequency of the premium payment.

Which of these statements about Medicaid is CORRECT?

Funded by federal, state, and local taxes

Which of these will typically authorize treatment from a specialist?

Gatekeeper.

How is Medicare Part B funded?

General tax revenue and user premiums.

An HMO that involves a partnership of physicians and other providers who practice out of a central facility is called a(n)

Group HMO.

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?

Guaranteed insurability rider.

Medicare Part A covers . . .

Impatient hospital stay.

Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation?

Unpaid Premiums.

What is the primary factor that determines the benefits paid under a disability income policy?

Wages.

An individual can enroll in a Part C Medicare Advantage Plan at what time?

When becoming eligible for Medicare.

A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation?

Will be the secondary insurer and pay for claims not fully covered by the group plan.

Major Medical expense plans provide coverage for each of the following EXCEPT

Work-related injuries.

Long-term care policies or certificates issued in Louisiana are required to have . . .

a nonforfeiture value.

The entire contract includes the actual policy and the . . .

application.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must . . .

be the same and the premium cannot exceed 102%.

An accident and health insurer has just received written proof of loss from one of its insureds. The insured must now wait 60 days before

bringing legal action against the insurer.

How long is the free-look period for a life insurance policy sold in Louisiana?

10 days.

Kathy pays a monthly premium on her health insurance policy. How long is her grace period?

10 days.

Medicare Part A does not pay for medical benefits provided for treatment in a skilled nursing facility beyond

100 days.

Lorenzo is self employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year?

100% of his health insurance costs can be deducted from his gross income.

An insurer has _______ days to file a notice of appointment to the Commissioner.

15.

Within how many days must a producer submit a change in address?

30.

The open enrollment period for Medicare Supplements begins at age . . .

65.

How much does Medicare Part B pay for physician fees?

80%.

proof of loss on a health insurance claim must be submitted to an insurer within ___ days after the insured's date of loss.

90.

What amount will be paid under a policy where the insured misstated his/her age?

An amount the premium would have purchased at the correct age.

The difference between a Long-term care partnership plan and a non-partnership plan is which of the following?

Asset Protection.

Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him?

Assisted living.

Which situation would qualify an individual for receiving benefits from a qualified long-term care policy?

Becoming cognitively impaired (mentally ill).

A disability income policy can prevent an insured from earning a higher income than if he/she were working by utilizing . . .

Benefit limits.

Which of the following is a requirement for ANY change in an insurance application? - Change must be initialed by the agent. - Change must be initialed by the applicant. - Change must be approved by the insurer. - Change must be notorized

Change must be initialed by the applicant.

When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?

Change of occupation provision.

In which of the following processes will the insurer oversee the insured's hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?

Concurrent review.

Which disability policy provision would address any concerns of the value of the benefits decreasing over time?

Cost of living benefit.

A medicare Supplement basic benefit is . . .

The first 3 pints of blood per year.

What happens when an insurance policy is backdated?

The policy's effective date is earlier than the present.