ExamFX, Michigan Health Only
# of house worked per week
A 55yo employee has worked PT for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employees eligibility
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?
NAIC
A long-term care insurance shopper's guide must be provided in the format developed by which of the following
Both group health and Medicare
A man is still employed at age 65 and is now eligible for Medicare. He wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him?
Notify the insurer within 31 days in order for coverage to continue without any evidence of insurability.
A married couple is covered under a group health insurance plan at the husband's place of employment. When the wife gave birth to their first child, what must the husband do in order to have coverage for the child?
By law, the new individual policy must provide the same benefits as the group policy
After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true?
18
Age to apply for license
Physician's and surgeon's services
All of the following are covered by Part A of Medicare EXCEPT
Premiums are tax deductible as a business expense
All of the following are true regarding key person disability income insurance EXCEPT
When the employer choose to renew the plan
All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT
Workers Compensation
An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance?
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?
Waiver
An insurance company receives an application with some information missing and issues the policy anyway. What is this called?
$2,800 - The insurer pays the expenses AFTER the 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
Concurrent review
An insured is admitted to the hospital for surgery on a herniated disk. The insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insurer's schedule. This is called
Full benefits - Presumptive Disability plans offer full benefits for specified conditions (loss of two limbs, total and permanent blindness, loss of hearing or speech).
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?
Benefits received are considered income tax free
An insured is the recipient of an accidental death and dismemberment (AD&D) policy purchased by his employer. The policy pays in case of accidental death. If the insured died as a result of an accidental stipulated in the policy, how will the benefits be taxed?
2 years
An insured was involved in an accident and could not perform her current job for 3 years. If the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan?
Authorized insurer
An insurer that holds a Certificate of Authority in the state in which it transacts business is considered an
14,000, all of which is taxable
Are made by the business and are not tax-deductible but are received income tax free by the business
Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense
As it pertains to group health insurance, COBRA stipulates that
None - general policies don't cover war, military service, self-inflicted injuries, overseas residence, or injuries obtained while committing a felony.
Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?
No, the group must be formed for a purpose other than obtaining group insurance
Can a group that is formed the sole purpose of obtaining group insurance qualify for group coverage?
24 hours
Continuing education required fevery 2 years
2 hours
Continuing education required in Ethics
Medicare coverage was not available until the month of his 65th birthday
Doug decided to retire at age 62. When he applied for SS Retirement Benefits, he discovered...
12 months (1 year)
File certificate of completion of the pre-licensing education
15 days
For insurer to file notice of producer appointment
2 or more
HIPAA applies to groups of
The primary care physician refers the member
How does a member of an HMO see a specialist?
A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area
How is emergency care covered for a member of an HMO?
The stop-loss amount The deductible The coins percentage Max amount of the benefit
How is the Major Medical policy premium amount determined?
$5 paid to the Commissioner
How much is an agent's appointment fee?
Conversion
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an ind policy, if requested within a specified period of time
66 and 2/3%
If an employer provides long-term group disability insurance for its employees, what percentage of monthly wages are lower-paid employees eligible to collect?
Unilateral
If only party to an insurance contract has made a legally enforceable promise, what kind of contract is it? In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe?
No tax - Disability income benefits are received income tax free by the individual
In an individual long-term care insurance plan, the insured is able to deduct the premiums from taxes. What income taxation will be imposed on the benefits received?
For the first 2 years of a disability
In disability income insurance, the own occupation definition of disability applies
Master policy
In group insurance, what is the policy called?
Handling insurer funds in a trust capacity
In insurance transactions, fiduciary responsibility means
Stop-loss
In major medical insurance policies, when the insured's share of coinsurance reaches a certain amount, the insured is no longer obligate to pay it. This feature is known as
Putting the client's best interests before their own
In what way can an agent demonstrate a high standard of ethics?
180 days
Length of temporary license
$5 life/$10 property & casualty
Maximum allowed value of articles of merchandise a producer may give to applicant or insured without violating unfair trade practice of rebating
Maximums
Maximum benefits for a major medical plan are usually lifetime
40 hours
Pre-licensing education requirement for combined license
20 hours
Pre-licensing education requirement for single line license
NOT tax deductible
Premium payments for personally-owned disability income policies are
Totally tax deductible
Premiums paid by self-employed sole proprietors or partners for medical expense insurance are
The insured may choose medical providers not found on the preferred list and still retain coverage; the insured is allowed to receive care from any provider, but if the insured selects a PPO provider, the insured will realize lower out-of pocket costs; If a non-network provider is used, the insured's out-of-pocket costs will be higher
Regarding a PPO, which of the following is correct when selecting primary care physician?
Express authority
The authority granted to an agent through the agent's contract is referred to as
Fiduciary responsibility
The requirement that agents not commingle insurance monies with their own funds is known as
$50,000
The sole proprietor of a business makes a total salary of 50,000 a year. This year, his medical expenses have reached a total of 75,000. What amount may the sole proprietor deduct in regards to his medical expenses?
18 months
To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?
30 days
To notify commissioner of appointment termination
12 months
To reinstate lapsed license without having to take written examination
30 days
To report administrative action or criminal prosecution
30 days
To report change of name or address
An individual who was previously covered by group health insurance for 6 months is eligible
Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?
Are made by the business and are not tax-deductible but are received income tax free by the business
Under a Key Person disability income policy, premium payments
Legal benefits Included: medical and rehab, income, and death benefits
Under workers compensation, which of the following benefits are NOT included?
A construction worker pays a higher premium and receives a poorer classification of disability.
Underwriting for disability insurance is unique due to the type of risk involved. Which of the following situations illustrates this?
Taft-Hartley
What act amended the National Labor Relations Act?
The attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount.
What happens if a non-member physician is utilized under the Point-Of-Service plan?
It allows guaranteed acceptance of all applicants
What is NOT a benefit of a POS plan?
A Certificate of Completion for an insurance license in Michigan The passing a written examination Applicant must be 18 years old
What is required for an insurance license in Michigan?
Early detection through regular checkups?
What is the goal of the HMO?
To protect individuals or families against the economic loss after a total disability of the wage earner
What is the main purpose of the total disability plan?
To provide a continuation of coverage for terminated employees
What is the purpose of COBRA?
O%, the premiums are paid with after tax dollars.
What percentage of individually-owned disability income benefits is taxable?
Prospective review
What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid? Under which provision can a physician submit claim information prior to providing treatment?
Taxable income to the employee
When a group disability insurance policy is paid entirely by the employer, benefits paid to disabled employees are
Transfer
When an individual purchases insurance, what risk management technique is he or she practicing?
When the expenses exceed a certain percentage of the insured's adjusted gross income
When may an insured deduct unreimbursed medical expenses paid under long term care policy?
If it is intentional and material
When would a misrepresentation on the insurance application be considered fraud?
It is divided into geographic locations
Which is true regarding HMO coverage?
Business Entity
Which of the following could be used when a corporation, association, partnership, or limited liability partnership acts as a producer?
Premiums are not tax deductible, and benefits are not taxable
Which of the following describes taxation of individual disability income insurance premiums and benefits?
The insured's income
Which of the following factors does an insurer use the most to determine the extent of disability benefits that it will promise in a contract?
A group that changes insurance annually
Which of the following groups seeking group health insurance would represent a bad risk for underwriters?
The benefit can be up to 50% of one's yearly income True statements: the benefit can be up to 66 and 2/3% of one's monthly income The elimination period is the same as in the short-term plan's benefit period The benefit period may be to age 65
Which of the following is NOT a characteristic of a group long-term disability plan?
To minimize the insured's level of liability in the event of loss
Which of the following is NOT a goal of risk retention?
FDIC
Which of the following is NOT a government insurance program?
Elective services
Which of the following is NOT covered by HMOs (Health Maintenance Organizations)
The application give to a prospective insured
Which of the following is NOT the consideration in a policy?
It consists of 3 parts (True answers include: it is a state program, it is funded by state and federal taxes, it is intended to provide medical assistance for certain categories of people who are needy)
Which of the following is NOT true concerning Medicaid?
They may be subject to taxation if the premium was paid by the employer
Which of the following is true regarding benefits paid to disabled employees?
It is deductible as an ordinary business expense
Which of the following is true regarding the taxation of the premium in group accidental death and dismemberment policies?
A person who has been entitled to SS disability benefits for the last 6 months
Which of the following persons is NOT eligible for Medicare?
Medicare A - Hospital Insurance, paid by FICA B - Medical Insurance, monthly premiums paid by insureds C - D - prescription drugs
Which of the following programs is made up of 4 parts, where the first part is paid for by FICA, and the second part is financed by premiums and payroll taxes?
Disability insurance can be written as occupational or non-occupational
Which of the following statements about occupational vs. non-occupational coverage is TRUE?
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?
Medicare Advantage must be provided through HMOs
Which of the following statements is NOT correct?
Home Health Care
Which of the following types of LTC is not provided in an institutional setting?
Implying that the agent is the insurer
Which of the following would be considered false advertising?
Rating the financial strength of insurance companies
Which services are associated with Standard & Poor's and AM Best
A joining together by employers to provide health benefits for employee
Which statements best defines a MEWA?
The individual member
Who chooses a primary care physician in an HMO?
The insurer will return a percentage of the premium paid
regarding the return of premium option for LTC policies, what happens to the premium if the policy lapses?
Medicaid
which of the following programs expands individual public assistance programs for people with insufficient income and resources
