Guaranteed exam health insurance

Which of the following statements is INCORRECT regarding group health insurance? A) to be eligible for group insurance, an employee must be considered a "full-time" employee B) costs are generally lower for group health insurance than individual health insurance C) in group insurance, the underwriter evaluates the group as a whole rather than each individual member D) each individual must be accepted into or rejected by a group policy

each individual must be accepted into or rejected by a group policy

Benefits for a Disability income policy are based on which of the following? A) miniumum wages B) typical wages for a similar profession C) earnings of the insured D) average US wages

earnings of the insured

What is the major difference between private and government insurance programs? A) there is no major difference between private and government insurance programs B) private insurance programs are funded with taxes C) government insurance programs are partially or totally funded by taxes D) government insurance programs are funded with premiums

government insurance programs are partially or totally funded by taxes

Regarding major medical plans A) higher stop-loss means higher premium B) lower stop-loss means level premium C) lower stop-loss means lower premium D) higher stop-loss means lower premium

higher stop-loss means lower premium

All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT A) an association of 35 people B) labor union C) multiple employer trust D) single employer with 14 employees

an association of 35 people

A retail shop owner is insured under a business overhead expense policy that pays a maximum monthly benefit of $2,500. His actual monthly expenses are $3,000. If the owner becomes disabled, the monthly benefit payable under his policy will be A) $3,000 B) $2,000 C) $2,100 D) $2,500

$2,500

Which of the following is an example of a physical hazard? A) carelessness B) lying C) bankruptcy D) diabetes

diabetes

Riley reads an agreement on the first page of her policy which includes a list of losses that will be covered by her insurer. What is the name of this agreement? A) insuring clause B) coverage provisions C) statement of loss coverage D) consideration clause

insuring clause

Guaranteeing future dividends is considered to be an unfair or deceptive act known as A) misrepresentation B) twisting C) false financial statements D) rebating

misrepresentation

If the insurance premiums were not tax deductible, what other taxation will this affect? A) federal income tax B) taxation of benefits C) taxation of interest D) taxation of the policy's cash value

taxation of benefits

In an employer group health insurance plan, the covered employee receives A) Nothing. B) Master contract. C) Facsimile contract. D) Certificate of insurance.

Certificate of insurance.

Which of the following time periods is the general enrollment period for Medicare Part B? A) March 1 through May 31 each year B) January 1 through January 31 each year C) March 1 through March 31 each year D) January 1 through March 31 each year

January 1 through March 31 each year

According to the law of agency, insurance producers represent A) insureds B) the public C) the state D) insurers

insurers

An insured purchased a health insurance policy with a renewability clause that states the policy is "Guaranteed Renewable." This means that as long as the required premiums are paid, the policy will continue until the insured A) reaches age 65 B) dies C) reaches age 100 D) becomes disabled

reaches age 65

For which of the following reasons may group coverage NOT be discontinued? A) the company's stock value lowers B) nonpayment of premium C) movement outside the service area D) fraud

the company's stock value lowers

Who determines if a particular group of employees can be excluded from group health coverage? A) the employee union B) the department of insurance C) the insurer D) the employer

the employer

An insured recently received his major medical insurance policy. Only 20 days after the policy issue, while recreational rock climbing, the insured suffered a fall that required hospitalization, surgery and physical therapy to repair his broken leg. Which of the following is true? A) Both a deductible and coinsurance payments will be required B) the plan will not cover the expenses due to the hazardous avocation C) the plan will not cover the expenses because the elimination period is not satisfied D) only the surgery is covered under the plan

Both a deductible and coinsurance payments will be required

When filling out an application for insurance, the applicant makes a mistake. If a fresh application were not available, what could the applicant do to properly correct the mistake? A) Either white out the answer or cross it out and write the new answer beside it. B) Nothing. A fresh application must be obtained. C) White out the incorrect answer and write the new one over D) Cross the incorrect answer out, write the correct one beside it, and initial the answer

Cross the incorrect answer out, write the correct one beside it, and initial the answer

Which act was introduced to reduce the cost of health care by utilizing preventive care? A) HMO Act of 1973 B) Employee Retirement Income Security Act (ERISA) C) Medical Freedom Act D) HIPAA

HMO Act of 1973

Medicare is a health insurance program for all of the following individuals EXCEPT A) Those with low income and low assets B) those 65 or over C) those with permanent kidney failure D) those who have been on Social security disability for 2 years

Those with low income and low assets

A subscriber has been treated for a medical condition by his primary care physician for 3 months with experimental remedies without a significant health improvement before being referred to a specialist. Which of the following types of plans does the subscriber have? A) a gatekeeper HMO plan to control the costs B) a limited benefit plan C) a fully-paid indemnity plan that covers his condition only at a specified provider D) major medical insurance with a low deductible and low coinsurance

a gatekeeper HMO plan to control the costs

If an insured decides to reduce the coinsurance amount on her major medical insurance, what can the insured expect? A) a higher monthly premium B) a higher deductible C) a lower lifetime benefit payout D) stop-loss increase

a higher monthly premium

Which of the following is a limited lines license? A) a business entity license B) a portable electronics insurance license C) a temporary insurance producer license D) a nonresident producer license

a portable electronics insurance license

An insured undergoes a minor surgical procedure. The insurer owes the insured $500 in medical claims. However, the last premium of $200 due on the policy was never paid. How much should the insured receive in claims? A) the claim will not be processed until the premium is paid B) $500 C) $300 D) $200

$300

The Omnibus Budget Reconciliation Act of 1990 (OBRA) requires that large group health plans with 100 employees or more must provide primary coverage for non retired, disabled individuals under what maximum age? A) 50 B) 55 C) 60 D) 65

65

To be acceptable to insurance companies, what percentage of eligible employees must be enrolled under a contributory group health insurance plan? A) 100% B) 50% C) 65% D) 75%

75%

Which of the following is NOT a typical type of Long-term care coverage? A) skilled nursing care B) residential care C) home health care D) child day care

child day care

Regarding the consideration clause, which of the following is NOT correct? A) consideration of the insurer and insured must be equal B) consideration is defined as the exchange of values C) the insurer's consideration consists of providing coverage D) the insured's consideration consists of providing information on the application, as well as agreeing to pay the premium

consideration of the insurer and insured must be equal

HMOs are known as what type of plans? A) consumer driven B) reimbursement C) service D) health savings

service

The license that allows a serving spouse to enter into a contract to maintain the business of a producer who has died or is unable to perform his duties is called a A) Special broker license B) business entity license C) temporary insurance producer license D) public insurance producer license

temporary insurance producer license

In a group policy, all of the following can be the policyowner EXCEPT A) a union B) the employer C) an association D) the insurance company

the insurance company

Which of the following best depicts the law of large numbers? A) large groups offer less opportunity for loss B) the larger the group is, the more likely it will be to get a good choice C) the larger the pool of risks under study, the more accurate the predictions will be D) larger groups produce healthier applicants

the larger the pool of risks under study, the more accurate the predictions will be

Insurance provides a means to A) retain a loss B) avoid a loss C) eliminate a loss D) transfer a loss

transfer a loss

All of the following are features of a health insurance plan purchased on the health insurance marketplace EXCEPT A) coverage for emergency services B) coverage for pre-existing conditions C) dollar limits on essential benefits D) guaranteed renewability

dollar limits on essential benefits

With respect to the entire contract clause in health policies, who has the authority to make changes to an existing policy? A) solely the producer B) solely the policyowner C) changes cannot be made on the policy D) only an executive officer of the company

only an executive officer of the company

Which of the following Medicare parts provides prescription drugs benefit? A) part B B) part C C) part D D) part A

part D

What is another term for a health insurance policy subscriber? A) dependent B) beneficiary C) participant D) underwriter

participant

Which of the following is consideration on the part of an insurer? A) Decreasing premium amounts B) Paying the premium C) Underwriting D) Paying a claim

paying a claim

Ed is covered under a health plan provided by his employer. He was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plan's list. If Ed chose to be treated by a provider who was not on the list, his portion of the bill would be greater. Ed is covered under a/an A) coordinated plan B) HMO group plan C) limited health plan D) preferred provider plan

preferred provider plan

In group insurance, the primary purpose of the Coordination of Benefits provision is to A) prevent lawsuits between insurance companies involved in the claim B) ensure the payment of claims by all policies that are in effect at the time of the claim C) encourage hospitals to keep their charges reasonable D) prevent overinsurance

prevent overinsurance

New individual members of an HMO must choose a A) referral physician B) specialty physician C) surgeon D) primary care physician

primary care physician

On an Accidental Death and Dismemberment (AD&D) policy, the death benefit payable is known as the A) face amount B) capital sum C) policy limit D) principal sum

principal sum

Medicare Part A services do NOT include which of the following? A) hospitalization B) hospice care C) private duty nursing D) post hospital skilled nursing facility care

private duty nursing

Utilization management consists of an evaluation of the appropriateness, necessity and quality of health care, and may include A) cost-saving services B) coordination of benefits C) preventative care D) prospective and concurrent review

prospective and concurrent review

Your client is sole proprietor and wishes to include his family on a medical expense plan. How much of the cost of the medical expense plan can be deducted (since he is considered self-employed) ? A) 0% B) 85% C) 90% D) 100%

100%

Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss? A) 60 days B) 90 days C) two years D) 30 days

90 days

Under the Affordable Care Act, maternity, pregnancy, and preventive care services are considered A) Limited. B) Optional. C) Essential. D) Elective.

Essential

An employee is covered under COBRA. His previous premium payment was $100 per month. His employer now collects $102 each month. Why does the employer collect an extra $2? A) to cover the employer's administration costs B) penalty for termination C) premiums go up every year regardless of health conditions D) to cover other employees who qualify to bypass premium payment

to cover the employer's administration costs

What is the purpose of a benefit schedule? A) to list the insured's coypayments and deductibles B) to state what and how much is covered in the plan C) to include the average charges for procedures D) to provide the dates for the payment of benefits

to state what and how much is covered in the plan

In group health insurance, what is experience rating? A) the larger the group, the more experienced the agent assigned to the policy B) when a larger group gets higher premiums due to its relatively higher health costs C) when a larger group gets lower rates because its median age is fairly low D) when an insurer uses the experience of the group as a whole to determine the premiums

when an insurer uses the experience of the group as a whole to determine the premiums

Which of the following elements of an insurance contract requires payment of premium? A) consideration B) legal purpose C) competent parties D) offer and acceptance

consideration

Health insurance rates may be based upon all of the following EXCEPT A) religion B) gender C) age D) medical history

religion

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA A) within 10 days B) within 60 days C) within 30 days D) before termination is complete

within 60 days

All of the following are ways to handle risk EXCEPT A) elimination B) avoidance C) reduction D) transfer

elimination

Which of the following is NOT a crucial factor in health insurance underwriting? A) occupation B) income C) physical condition D) morale hazards

income

An employee is on an extended leave of absence when the employer group health plan changes from one carrier to another. Before the employee returns to work, what might the employee most likely notice? A) increased benefits B) no change in coverage C) suspended coverage D) limited coverage

limited coverage

Which statement is required to be printed on the first page of a health insurance policy, which signals to the insured that the policy's benefits are limited? A) statue of limitations B) limited benefit statement C) limited policy notice D) benefit notice

limited policy notice

Medicare part B covers all of the following EXCEPT A) long-term care services B) doctor's services C) home health visits D) outpatient hospital services

long-term care services

Compared to the cost of individual insurance, the cost of group insurance is generally A) more variable B) higher C) lower D) the same

lower

An insurance adviser's license may be issued to a corporation if the majority of the officers of the corporation A) have completed, or are currently in a formal pre-licensing course for insurance producers B) are currently licensed as insurance producers and have completed the individual CE requirements C) are found by the Commissioner to be competent in all respects as insurance solicitors D) are found by the commissioner to be in all respects qualified for licenses as advisers

are found by the commissioner to be in all respects qualified for licenses as advisers

Policy delivery refers to the delivery of the A) completed insurance policy to the policyowner B) completed application for the insurance policy to the general agent C) first premium and receipt for the insurance policy to the agency D) insurance policy cost disclosure materials to the applicant

completed insurance policy to the policyowner

Which of the following is NOT a type of hazard? A) exposure B) physical C) moral D) morale

exposure

The commissioner may order that an insurer or its producer make restitution to any claimant who has suffered actual economic damage as a result of A) failure by the insured to avoid a risk for which the insurer had no recourse B) inadequate levels of coverage written on an insured based on levels of risk to be covered C) a violation of any cease and desist order committed by the insurer or its producer D) a slow claims processing unit for which such producer or insurer has responsibility

a violation of any cease and desist order committed by the insurer or its producer

According to the Fair Credit Reporting Act, all of the following statements are true EXCEPT A) if an applicant is declined for an insurance policy, he or she has no right to know what was in the report B) it protects consumers against the circulation of inaccurate information C) it ensures that consumer reporting agencies are fair in their treatment of consumers D) investigative consumer reports can be used to obtain information on the applicant's character and reputation

if an applicant is declined for an insurance policy, he or she has no right to know what was in the report

Who makes up the Medical Information Bureau? A) hospitals B) insurance companies C) physicians and paramedics D) former insureds

insurance companies

Which of the following would be eligible to become a life settlement broker? A) a licensed health insurance producer who does not receive compensation from a settlement purchaser B) a newly licensed nonresident life insurance producer who does not receive compensation from a life settlement provider C) a licensed attorney who receives compensation by a life settlement provider D) a licensed resident life insurance producer

a licensed resident life insurance producer

Which of the following are considered activities of daily living in most long-term care policies? A) hearing and seeing B) eating and dressing C) bathing and sleeping D) walking and running

eating and dressing

All of the following are places where care can be administered for a medical plan EXCEPT A) eye centers B) doctor's office C) surgicenters D) urgent care centers

eye centers

An insured driver is involved in an accident in which he is disabled and his passenger and the other driver are injured. Which of the following will be covered by his disability income policy? A) the passenger's B) his lost income C) the other drivers injuries D) his medical expenses

his lost income

Which source of underwriting information includes information on an applicant's character, general reputation, personal habits, and mode of living? A) physician's statement B) agent's report C) investigative consumer report D) MIB report

investigative consumer report

Which of the following statements is INCORRECT? A) medicaid does not pay for nursing home care in any case B) medicare and medigap policies do not provide coverage for long-term custodial or nursing home care C) medicare and medigap policies provide coverage for long-term custodial or nursing home care D) medicare and medicare supplements does not cover skilled nursing care

medicare and medigap policies provide coverage for long-term custodial or nursing home care

An insurance agent visits a potential client and explains various types of policies. The customer displays a lack of interest, so the agent guarantees higher dividends that he knows would be possible. Which term describes what the agent has done? A) twisting B) defamation C) misrepresentation D) rebating

misrepresentation

In health insurance, the length of the grace period varies according to the A) mode of premium payment B) length of the waiting period C) length of the benefit period D) age of the insured

mode of premium payment

All of the following are reasons for group insurance termination for dependents EXCEPT A) the dependent reaches age 21 B) the dependent fails to meet the definition of a dependent C) the end of the last period for which the employee has made the required premium for dependent coverage passes D) the overall maximum benefit for major medical benefits is received

the dependent reaches age 21

A licensed producer has moved his office across town. He must inform the Commissioner of his change of address A) prior to his next license renewal B) within 30 days C) within 10 days D) immediately

within 30 days

How long is the free-look period of a Medicare supplement policy? A) 60 days B) 10 days C) 20 days D) 30 days

30 days

Under the mandatory uniform provision Legal Actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to A) one year after the occurrence of a disability B) 30 days after the loss C) 60 days after written proof of loss has been submitted D) 90 days after written proof of loss has been submitted

60 days after written proof of loss has been submitted

Which of the following types of care could be provided at a community center? A) respite care B) intermediate care C) skilled care D) adult day care

adult day care

What is it called when a doctor accepts the Medicare approved amount? A) verification B) acceptance C) assignment D) consent

assignment

Conrad receives $50,000 from a $100,000 Accidental Death and Dismemberment policy as a result of the loss of his left arm in an accident. Conrad has received the A) contributory amount B) primary amount C) principal amount D) capital amount

capital amount

Which of the following is true regarding health coverage for mentally disabled children of the insured? A) coverage will terminate when the child reaches age 30 B) coverage is mandatory only until the age of 26 C) coverage must continue after the child reaches the limiting age with proof of incapacity D) coverage is only available if purchased from a government plan

coverage must continue after the child reaches the limiting age with proof of incapacity

What is the advantage of an open enrollment period to the insured? A) it occurs several times a year for the benefit of the insured B) the premiums for coverage are lower during this period C) coverage will be provided regardless of the insured's health status D) the insured may change providers as frequently as deemed necessary

coverage will be provided regardless of the insured's health status

What is the main difference between franchise and group insurance? A) franchise insurance provides coverage for large groups B) franchise insurance charges smaller premiums than group insurance C) in franchise insurance participants do not need to submit their applications D) in franchise insurance underwriting is done for each person

in franchise insurance underwriting is done for each person

All of the following are used to keep costs down for dental insurance EXCEPT A) limitation to full mouth x-rays to once every two to three years B) calendar year maximums C) lifetime maximums D) limitation on the number of teeth that may be treated in a given year

limitation on the number of teeth that may be treated in a given year

A self-employed mechanic operates his own shop. He is considering purchasing health insurance that would protect him financially in the event of a serious sickness or accident. He feels that he can handle any small health care expenses. What type of policy would likely meet this person's needs? A) comprehensive major medical B) basic hospital C) dread disease D) major medical

major medical

Which of the following statements is true regarding Blue Cross/Blue Shield? A) the company only makes payments to those medical providers who are contracted with the Blue Cross/Blue Shield B) it is a traditional, fee-for-service type insurance company C) it is a for-profit company, whose profits go back to the policyholders D) medical providers bill the company directly for services provided to the subscribers

medical providers bill the company directly for services provided to the subscribers

Which of the following used to be called Medicare + Choice Plans? A) original medicare plan B) medicare advantage plans C) medical insurance D) medicare supplement plans

medicare advantage plans

Under the Affordable Care Act, when would pregnancy be considered a pre-existing condition? A) only if specifically excluded by the insurer B) if it begins before the coverage takes effect C) always D) never

never

Which of the following best describes a presumptive disability? A) one that is severe enough that the insured automatically qualifies for full disability benefits B) one that requires the insured to submit to physical exams periodically C) one that a doctor predicts may reoccur in the future D) one that the insured will fully recover from in the future

one that is severe enough that the insured automatically qualifies for full disability benefits

The premiums paid by an employer for group health insurance are A) may be different amount for different employees B) tax deductible to employer C) tax deductible to employee D) included in the employee's taxable income

tax deductible to employer

An employee may enroll in an employer's group health plan when he/she initially becomes eligible without proof of insurability. Should he/she enroll at another time, evidence of insurability is required EXCEPT at A) the request of the employer B) the anniversary of the policy C) the annual open enrollment period D) the first year anniversary of higher employment

the annual open enrollment period

All of the following are characteristics of group health insurance plans EXCEPT A) the parties that hold a group health insurance contract are the employees and the employer B) the cost of insuring an individual is less than what would be charged comparable benefits under an individual plan C) employers may require the employees to contribute to the premium payments D) the benefits under a group plan are more extensive than those under individual plans

the parties that hold a group health insurance contract are the employees and the employer

All of the following are true regarding a producer's fiduciary responsibilities EXCEPT A) All monies must be accounted for and paid to the proper party. B) A producer who fails to pay trust funds to the company represented is guilty of theft. C) Producers may commingle personal funds with company funds. D) A producer who receives money for the sale or negotiation of an insurance contract must keep the funds in a separate trust account.

Producers may commingle personal funds with company funds.

The benefits in Medical Expense insurance are A) taxed when they reach $25,000 per year B) received income tax free by the individual C) taxable D) nonexistent

received income tax free by the individual

An insured had a heart attack while jogging, but is expected to return to work in approximately 6 weeks. The insured's Disability Income policy will A) replace a percentage of his lost income B) cover injuries only C) not pay D) pay a lump-sum benefit

replace a percentage of his lost income

MassHealth is a health insurance program available to A) any residents of Massachusetts who are over the age of 65 B) any person who becomes sick or injured in the Commonwealth C) all residents of massachusetts D) residents of Massachusetts who meet certain income level requirements

residents of Massachusetts who meet certain income level requirements

Which of the following is NOT a characteristic of a Managed Care Plan? A) comprehensive case management B) preventive care C) controlled access of providers D) risk retention

risk retention

An employer is no longer able to afford the group health insurance plan and the plan terminates. However, one of the employees continues to receive coverage under the plan. Which of the following explains the reason for the continued coverage? A) the employee is an executive covered under the plan B) the employee's health savings account pays for the coverage C) a nonforfeiture value is in place D) the employee is totally disabled

the employee is totally disabled

What is the purpose of a disability buy-sell agreement? A) to protect individuals against loss of income due to a disability B) to allow the business buyout in case of the owner's disability C) to reimburse the business in case of a key employee's disability D) to help the business meet overhead expenses in case of the owner's disability

to allow the business buyout in case of the owner's disability