Health

An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply? a) Coverage will apply, but will be reduced by 50%. b) No coverage will apply, since the injury could have been foreseen. c) No coverage will apply, since disability income policies cover sickness only. d) Coverage will apply since the break was accidental.

b

No examination is required of a person licensed as an insurance producer in another state who moves to Tennessee as long as application is made within how many days of establishing legal residence? a) 60 days b) 90 days c) 120 days d) 30 days

b

Which of the following does the Insuring Clause NOT specify? a) The name of the insured b) A list of available doctors c) Covered perils d) The insurance company

b

Which of the following is NOT an exclusion in medical expense insurance policies? a) Routine dental care b) Coverage for dependents c) Military duty d) Self-inflicted injuries

b

f only one party to an insurance contract has made a legally enforceable promise, what kind of contract is it? a) A legal (but unethical) contract b) Unilateral c) Adhesion d) Conditional

b

Which of the following is an example of a producer being involved in an unfair trade practice of rebating? a) Inducing the insured to drop a policy in favor of another one when it's not in the insured's best interest b) Charging a client a higher premium for the same policy as another client in the same insuring class c) Making deceptive statements about a competitor d) Telling a client that his first premium will be waived if he purchased the insurance policy today

d

Which of the following provisions is mandatory for health insurance policies? a) Free-look b) Unpaid premiums c) Intoxicants and narcotics d) Physical examination and autopsy

d

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 a $100 per day. How much will the insurance company pay? a) $100 a day b) 80% of the total cost c) 20% of the total cost d) $120 a day

d

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, a) Both plans will pay the full amount of the claim. b) The insurance through his company is primary. c) The insurance through his wife's company is primary. d) The insurance plans will split the coverage evenly.

b

How many pints of blood will be paid for by Medicare Supplement core benefits? a) Everything after first 3 b) 1 pint c) First 3 d) None; Medicare pays for it all

c

If a producer continues to violate the Insurance Code, a new civil penalty will be assessed every a) Month. b) Year. c) Day. d) Week.

c

The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract? a) Adhesion b) Personal c) Unilateral d) Conditional

d

All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT a) Stocks, securities, or bonds. b) An offer to share in commissions generated by the sale. c) Dividends from a mutual insurer. d) An offer of employment.

c

Concerning Medicare Part B, which statement is INCORRECT? a) It offers limited prescription drug coverage. b) It provides partial coverage for medical expenses not fully covered by Part A. c) It is fully funded by Social Security taxes (FICA). d) It is known as medical insurance.

c

Which of the following may obtain a producer's license, but may NOT sell, solicit, or negotiate a contract of insurance in Tennessee? a) An applicant for an agency contract license b) An applicant for a limited lines license c) A business entity d) A nonresident producer

c

Which of the following provides coverage on a first-dollar basis? a) Supplementary major medical b) Limited major medical c) Basic expense d) Accident expense

c

Which of the following statements concerning Medicare Part B is correct? a) It pays on a first dollar basis. b) It pays 100% of Medicare's standards for reasonable charges. c) It pays for physician services, diagnostic tests, and physical therapy. d) It is provided automatically to anyone who qualifies for Part A.

c

An insurance producer may not act as an agent for an insurer unless he/she has become which of the following? a) Approved b) Commissioned c) Licensed d) Appointed

d

Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as a) Aleatory contracts. b) Binding contracts. c) Contracts of adhesion. d) Unilateral contracts.

c

If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that the insurer be notified of the child's birth and pay any required fee within how many days of the date of birth for coverage to continue? a) 180 b) 31 c) 60 d) 90

b

The premium charged for exercising the Guaranteed Insurability Rider is based upon the insured's a) Assumed age. b) Average age. c) Issue age. d) Attained age.

d

The regulation of the insurance industry primarily rests with a) The NAIC. b) Private insurers. c) The federal government. d) The State.

d

What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered? a) Contestable period b) Elimination period c) Grace period d) Probationary period

d

What is the main difference between coinsurance and copayments? a) With copayments, the insured pays all of the cost. b) With coinsurance, the insurer pays all of the cost. c) Coinsurance is a set dollar amount. d) Copayment is a set dollar amount.

d

What type of health insurance policy provides an employer with funds to train a replacement if a valued employee becomes disabled? a) Group Disability b) Disability Buy-Sell c) Business Overhead d) Key Person Disability

d

Which of the following is true about the requirements regarding HIV exams? a) Results may be disclosed to the agent and the underwriter. b) Prior informed oral consent is required from the applicant. c) HIV exams may not be used as a basis for underwriting. d) The applicant must give prior informed written consent.

d

Which of the following riders would NOT increase the premium for a policyowner? a) Payor benefit rider b) Waiver of premium rider c) Multiple indemnity rider d) Impairment rider

d

Which of the following persons is required to hold a producer license? a) A person who administers employee benefits b) A person who negotiates insurance contracts c) A person who only takes messages related to claims d) A person who creates insurance advertisements

b

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? a) Full b) 50% c) 25% d) None

d

Which of the following statements is INCORRECT concerning Medicare Part B coverage? a) Participants under Part B are responsible for an annual deductible. b) Part B will pay 80% of covered expenses, subject to Medicare's standards for reasonable charges. c) It is a voluntary program designed to provide supplementary medical insurance to cover physician services, medical services and supplies not covered under Part A. d) Part B coverage is provided free of charge when an individual turns age 65.

d

A client has a new individual disability income policy with a 20-day probationary period and a 30-day elimination period. Ten days later, the client breaks their leg and is off work for 45 days. How many days of disability benefits will the policy pay? a) 10 days b) 15 days c) 25 days d) 45 days

b

Which of the following is NOT covered under Basic Hospital Expense Coverage? a) X-ray charges b) Surgeons' fees c) Hospital room and board d) Lab charges

b

Which of the following must be present in all Medicare supplement plans? a) Plan C coinsurance b) Plan A c) Foreign travel provisions d) Outpatient drugs

b

How long is the free-look period with a Medicare supplement policy? a) 10 days b) 20 days c) 30 days d) 60 days

c

Which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage? a) Specified Disease Policy b) Credit Disability c) Special Risk Policy d) Limited Risk Policy

c

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company? a) As soon as possible b) Within 20 days c) Within 60 days d) Within 90 days or as soon as reasonably possible, but not to exceed 1 year

d

Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid? a) 5 months b) 12 months c) Benefits will be paid immediately. d) 90 days

a

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the a) Entire contract clause. b) Time limit on certain defenses clause. c) Incontestability clause. d) Legal action against us clause.

a

Which of the following is considered a presumptive disability under a disability income policy? a) Loss of hearing in one ear b) Loss of one hand or one foot c) Loss of two limbs d) Loss of one eye

c

Which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage? a) Limited Risk Policy b) Specified Disease Policy c) Credit Disability d) Special Risk Policy

d

In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible? a) Corridor b) Full c) Half d) None

a

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within a) 90 days of a loss. b) 20 days of a loss. c) 30 days of a loss. d) 60 days of a loss.

a

The provision that provides for the sharing of expenses between the insured and the insurance company is a) Deductible. b) Divided cost. c) Coinsurance. d) Stop-loss.

c

Which of the following entities can legally bind coverage? a) Federal Insurance Board b) Agent c) Insurer d) The insured

c

Which of the following will NOT be considered unfair discrimination by insurers? a) Discriminating in benefits and coverages based on the insured's habits and lifestyle b) Charging applicants with similar health histories different premiums based on their ethnicity c) Cancelling individual coverage based on the insured's marital status d) Assigning different risk classifications to applicants based on gender identity

a

A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of policy do they have? a) Mutual b) Family c) Combined d) Joint

b

Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to a) The spouse of the insured. b) The insured. c) Creditors. d) Beneficiary of the death benefit.

b

What is the minimum required age for an insurance producer in this state? a) 17 years old b) 18 years old c) 21 years old d) 23 years old

b

Which of the following best describes the MIB? a) It is a rating organization for health insurance. b) It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance. c) It is a government agency that collects medical information on the insured from the insurance companies. d) It is a member organization that protects insured against insolvent insurers.

b

The insurance policy, together with the policy application and any added riders form what is known as a) Contract of adhesion. b) Whole life policy. c) Entire contract. d) Certificate of coverage.

c

Two individuals are in the same risk and age class; yet, they are charged different rates for their insurance policies due to an insignificant factor. What is this called? a) Misrepresentation b) Adverse selection c) Discrimination d) Law of large numbers

c

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within a) 30 days of a loss. b) 60 days of a loss. c) 90 days of a loss. d) 20 days of a loss.

c

What is the best way to change an application? a) White-out the previous answer b) Draw a line through the incorrect answer and insert the correct one. c) Start over with a fresh application d) Erase the previous answer and replace it with the new answer

c

A woman's health insurance policy dictates which doctors she is allowed to see. Her health providers share an assumed risk for their patients and encourage preventative care. What best describes the health system that the woman is using? a) Managed Care b) Comprehensive health c) Major medical d) Group health

a

Unless revoked or suspended, how long does a producer's license remain in effect in Tennessee? a) 24 months b) 48 months c) 6 months d) 12 months

a

Which of the following statements is true regarding coinsurance? a) The smaller the percentage that is paid by the insured, the lower the required premium will be. b) The smaller the percentage that is paid by the insured, the more consistent the required premium will be. c) The larger the percentage that is paid by the insured, the lower the required premium will be. d) The larger the percentage that is paid by the insured, the higher the required premium will be.

c

Which of the following would best describe total disability? a) A person's total loss of income. b) A person's inability to qualify for insurance coverage. c) A person's ability to work is significantly reduced or eliminated for the rest of his/her life. d) A person's inability to perform one of the regular duties of his/her occupation

c

With respect to the Consideration Clause, which of the following would be considered consideration on the part of the applicant for insurance? a) Providing warranties on the application b) Notice of policy cancellation c) Payment of premium d) Promise to renew the policy at the end of the policy period

c

Which of the following is INCORRECT concerning Medicaid? a) It provides medical assistance to low-income people who cannot otherwise provide for themselves. b) It pays for hospital care, outpatient care, and laboratory and X-ray services. c) The federal government provides about 56 cents for every Medicaid dollar spent. d) It is solely a federally administered program.

d

Which of the following is NOT covered under a long-term care policy? a) Adult day care b) Hospice care c) Home health care d) Acute care in a hospital

d

A waiver of premium provision may be included with which kind of health insurance policy? a) Dread disease b) Disability income c) Basic medical d) Hospital indemnity

b

According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that? a) Gold b) Platinum c) Bronze d) Silver

b

All of the following long-term care coverages would allow an insured to receive care at home EXCEPT a) Home health care. b) Skilled care. c) Custodial care in insured's house. d) Respite care.

b

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? a) 7 days b) 10 days c) 31 days d) 60 days

b

A guaranteed renewable health insurance policy allows the a) Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. b) Policyholder to renew the policy to a stated age and guarantees the premium for the same period. c) Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term. d) Insurer to renew the policy to a specified age.

a

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? a) Insurer to the insured b) Insured to the insurer c) Insurer to the Department of Insurance d) Insured to the Department of Insurance

a

All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT a) Accidental death and dismemberment insurance is considered to be limited coverage. b) Death benefits are paid only if death occurs within 24 hours of an accident. c) Accidental death benefits are paid only if death results from accidental bodily injury as defined in the policy. d) Dismemberment benefits are paid for certain disabilities that are presumed to be total and permanent.

b

An insurer devises an intimidation strategy in order to corner a large portion of the insurance market. Which of the following best describes this practice? a) Defamation b) Illegal c) A legal advertising strategy d) Unfair Discrimination

b

Another term used to describe "no deductible" is a) Immediate cooperative b) First-dollar basis. c) Comprehensive. d) Total coverage.

b

Candidates for either a Property license or a Casualty license must complete how many hours of prelicensing education? a) 15 b) 20 c) 5 d) 10

b

If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits? a) 40 credits b) 12 credits c) 20 credits d) 6 credits

b

In a group health policy, a probationary period is intended for people a) Who want lower premiums. b) Who joined the group after the effective date. c) Who had a pre-existing condition at the time they joined the group. d) Who have additional coverage through a spouse.

b

Items stipulated in the contract that the insurer will not provide coverage for are found in the a) Consideration clause. b) Exclusions. c) Insuring clause. d) Benefit Payment clause.

b

Which of the following is true regarding elimination periods and the cost of coverage? a) Elimination periods have no effect on the cost of coverage. b) The longer the elimination period, the lower the cost of coverage c) The shorter the elimination period, the lower the cost of coverage d) The longer the elimination period, the higher the cost of coverage

b

All of the following statements about Medicare supplement insurance policies are correct EXCEPT a) They are issued by private insurers. b) They cover the cost of extended nursing home care. c) They cover Medicare deductibles and copayments. d) They supplement Medicare benefits.

b

Before a customer's agent delivers his policy, the insurer makes a last-minute change to the policy. The agent informs the customer of this change, and he accepts it. What must the agent do now? a) The agent must notify the beneficiary of the change in policy. b) If the change would affect the premium, the agent must have the customer sign a statement acknowledging the change. c) The agent should ask the customer to sign a statement acknowledging that he is aware of the change. d) Nothing. After the explanation, the agent is not legally bound to do anything else.

c

Which of the following statements is NOT correct concerning the COBRA Act of 1985? a) It applies only to employers with 20 or more employees that maintain group health insurance plans for employees. b) COBRA stands for Consolidated Omnibus Budget Reconciliation Act. c) It requires all employers, regardless of the number or age of employees, to provide extended group health coverage. d) It covers terminated employees and/or their dependents for up to 36 months after a qualifying event.

c

An insured has Medicare Part D coverage. He has reached his initial benefit limit and must now pay 50% of his prescription drug costs. What is the term for this gap in coverage? a) Bridge b) Blackout period c) Latency period d) Donut hole

d

In insurance, an offer is usually made when a) The insurer approves the application and receives the initial premium. b) The agent hands the policy to the policyholder. c) An agent explains a policy to a potential applicant. d) The completed application is submitted.

d

In order to enforce the Insurance Code the Commissioner has the power to conduct which of the following? a) Solicitations b) Business c) Civil proceedings d) Investigations

d

Medicaid provides all of the following benefits EXCEPT a) Home health care services. b) Eyeglasses. c) Family planning services. d) Income assistance for work-related injury.

d

S is a sole business proprietor who owns a medical expense plan. What percentage of the cost of the plan may he deduct? a) 25% b) 50% c) 75% d) 100%

d

The annual contribution limit of a Dependent Care Flexible Spending Account is set by a) The employer. b) The insurer. c) The insured. d) The IRS.

d

The free-look provision allows for which of the following? a) Immediate coverage when the application is submitted b) A guarantee that the policy will not lapse if the premium is overdue c) A guarantee that the policy will be issued d) A right to return the policy for a full premium refund

d

Which entity must approve a new group policy? a) Federal Insurance Regulation Board b) MIB c) NAIC d) Commissioner

d

Which of the following best describes an insurance company that has been formed under the laws of this state? a) Sovereign b) Alien c) Foreign d) Domestic

d

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as a) Relative-value schedule. b) Benefit schedule. c) Gatekeepers. d) Usual, customary and reasonable.

d

All of the following would be qualified as a dependent under a Dependent Care Flexible Spending Account, EXCEPT a) Joe was paralyzed from the neck down in a car accident and is cared for by his wife b) Matt must be constantly watched due to his violent muscle spasms which often lead to Matt injuring himself c) Pete is severely autistic and refuses to take care of his own personal needs, which are taken care of by his father d) Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair

d

An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? a) Medicare Part A b) Medicare Supplement c) Medicare Advantage d) Medicare SELECT

d

A small company offers group health insurance to its employees, but recently has decided to terminate the health insurance contract, leaving the workers without insurance. What can the employees do regarding their insurance? a) Apply for another group health insurance b) Request a refund of unearned premium c) Convert to an individual health policy d) Sue the employer

c

According to the provisions of the Patient Protection and Affordable Care Act, all of the following are required preventive care services EXCEPT a) Well-woman visits and counseling. b) Screenings for autism and behavioral disorders in children. c) Cervical cancer exams for all women starting at age 40. d) Diet counseling for adults.

c

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT a) Claims incurred before cancellation must be honored. b) An insurance company may cancel the policy at any time. c) Unearned premiums are retained by the insurance company. d) The insurer must provide the insured a written notice of the cancellation.

c

An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point? a) Approved the application b) Issued the policy c) Neither approved the application nor issued the policy d) Both approved the application and issued the policy

c