Health
For which of the following losses would an insurance company MOST likely pay benefits under an Accidental Death and Dismemberment policy?
Loss of eyesight due to an accidental injury
An insured is covered by Workers' Compensation and a group Major Medical plan. Which of the following statements BEST describes how a claim would be handled if the insured were injured on the job?
Major Medical would be applied first, less any deductible and the coinsurance amount, and workers' Compensation would cover the balance of the medical expenses
An insured is covered by Wokers' Compensation and a group Major Medical plan. Which of the following statements BEST describes how a claim would be handled if the insured were injured on the job?
Major Medical would be applied first, less any deductibles and the coinsurance amount, and Workers' Compensation would cover the balance of the medical expenses
A full-time employee who is suffering from chronic kidney failure and requires dialysis is eligible for medical coverage under which of the following plans?
Medicare
An insurance company MUST do which of the following to properly terminate a producer's appointment?
Notify the producer of the termination at least 30 days before the effective date of termination
The legal term that permits an insurance company to transact business in Mississippi is called a certificate of
authority
Dental care indemnity plans
reimburse services only after the carrier receives a bill
Most insurance companies use the usual, customary, and reasonable (UCR) charges to
reimburse the employee for expenses charged by the medical facilities
If a producer allegedly committed an unfair marketing practice the Commissioner of Insurance MUST
schedule a hearing before imposing any penalties
Under a Disability policy the Elimination period is
similar to a deductible but expressed in terms of time rather than dollars
Insurance company employees MUST be licensed if they
solicit potential clients for producers
The Commissioner of insurance MAY examine the records of an insurance company in order to determine the
solvency of the company
The purpose of the Insuring clause in an Accident and Health policy is to
specify the conditions under which benefits are payable
Failing to complete the maximum continuation education requirements established by regulations can result in
suspension of license
P received a $2,000 benefit from an employer-paid Disability Income policy. The tax status of this benefit makes the $2,000
taxable to the employer
Under an individual Major Medical policy, a married policyowner has the right to take which of the following actions?
Add a newborn child to the policy without providing proof of insurability
Which of the following Long-Term Care insurance plan designs allows only days on which the insured receives paid care to count toward the Elimination Period?
Calander day design
A type of health contact that allows the remaining partners in a business to buy in a business to buy out the interest of a disabled business partner is known as
Disability Buy-Sell
Which of the following conditions is typical of a Major Medical policy?
It contains a deductible and coinsurance
Which of the following is CORRECT about Medicare?
It is a hospital and medical expense insurance program
Which of the following statements is generally CORRECT about a major medical policy?
It provides benefits for reasonable and necessary medical expenses, subject to policy limits
Which of the following statements about a Dismemberment provision in a health insurance policy is CORRECT?
It provides benefits for the loss of specific part of the body
Which of the following statements is CORRECT about the Medicaid program?
It provides medical assistance for participants who are blind
The Time of Payment of Claims provisions states that the intervals between Disability Income Benefit payments may NOT exceed
one month
The primary purpose of the Life and Health Insurance Guaranty Association is to
pay legitimate claims filed against liquidated insurance companies
An insured who owns a Disability Income policy forgot to pay the premium due on July 1. If the insured files a disability claim on July 31, the insurance company will MOST likely:
pay the claim but deduct the unpaid premium
Basic cancer plans pay for all of the following EXCEPT
physical therapy
To enroll in Medicare Part C, an individual must
already be enrolled in Medicare Parts A and B
An insurance company formed under the laws of Cananda would be known in Mississippi as
an alien company
The Fair Credit Reporting Act requires that
applicants be advised that a consumer report may be requested
The Commissioner of insurance has the authority to impose which of the following penalties on a producer who has violated insurance law?
A monetary fine
Which of the following situations describes a representation?
A prospect's statement on an application that is held to be substantially true
As defined for Social Security benefit purposes, disability is the inability of an insured to be gainfully employed because of a medically determined physical or mental impairment that has lasted or may be expected to last at LEAST how long?
6 months
A doctor who is receiving Disability Income benefits is not able to return to work full-time but continues practing
A Residual Benefit clause
A $100,000 group Accidental Death and Dismemberment policy will pay double indemnity if the insured dies in a commercial airplane crash. If the insured is killed when flying to a business meeting on a commercial flight, the policy will pay a MAXIMUN of
$200,000
An insured is hospitalized for 2 weeks and receives a bill for $2,100. The insured has a Major Medical Policy with a $100 deductible. The Coinsurance is 80/20, figured after reducing the bill by the deductible amount. The insured is expected to pay a total of
$500
If a person whose application for a license was denied request a hearing, the Commissioner of Insurance must hold the hearing within a MAXIMUM of how many days after receipt of the request?
30
A licensee MUST notify the Commissioner of insurance by any means acceptable of an address change within
30 days
The Misstatement of Age provision in an Accident and Health policy allows an insurance company to take which of the following actions if an insured has understated the insured's age on the policy application?
Adjust the benefits
A producer receives a phone call from an insured who already has health insurance and now wants to buy an Accidental Death and Dismemberment (AD&D) policy. In this situation, the producer should take which of the following actions?
Answer the routine application questions, meet with the prospect to obtain any additional information, and have the prospect sign the application
Which of the following kinds of policies typically contain a limited daily room and board benefit and provides coverage on an in-hospital basis only?
Basic Hospital
Social Security provides all of the following types of benefits EXCEPT
Dismemberment
A benefit that is NOT included as one of the ten Essential Health Benefits is
Elective Surgery
The policy provision that prevents an insurance company from altering its agreements with a policyowner by referring to documents or other items not contained in the policy is called the
Entire Contract provision
An insured who wants to guarantee that an Accident and Health policy will remain in force even in the event of being disabled should purchase which of the following riders?
Guaranteed Insurability
Benefits for treatment of which of the following conditions would commonly be EXCLUDED in a Major Medical policy?
Intentionally self-inflicted injuries
A Major Medical policy insured is injured in an auto collision during a police chase. The occupants in the police car are killed. The insured is convicted of reckless driving and manslaughter. If the insured files a claim, the insurance company will MOST likely take which of the following actions?
Pay full benefits
The statement that an insured MUST give an insurance company to show that a loss actually occurred is a
Proof of Loss
Which of the following provisions establishes a procedure for restoring a policy after it has lapsed because of nonpayment of premium?
Reinstatement
Which of the following information is included in the Consideration clause in an Accident and Health policy?
Schedule an amount of premium payments
A producer has taken an application for an individual Disability Income policy, collected a premium, and given the applicant a conditional receipt. Which of the following statements is CORRECT about this situation?
Since the producer collected a premium when taking the application, the insured is guaranteed coverage as of the date of the application
After the expiration of COBRA or State Continuation laws, which of the following statements is CORRECT about an employee who quits the job and wants to convert the group accidental and health coverage to an individual policy?
The employee has a maximum of six months to convert
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?
The insured may periodically increase the amount of benefits payable under the policy
A prospect submits an Accident and Health application with the premium and receives a conditional receipt. The insurance company issues a policy and mails it to the insured, but the insured never receives it. Which of the following statements is CORRECT about this situation?
The policy is in force
Which of the following statements about a policy delivery is CORRECT?
The producer should explain the policy to the insured to increase the chance that the insured will understand the policy's benefits and keep it
A producer submits an application to an insurance company without the initial premium. If the company issues the policy, the producer should promptly deliver the policy and collect the initial premium for which of the following reasons?
The prospect does not have coverage until the policy is delivered and the premium is paid
Which of the following statements is CORRECT about the benefits of a group Short-term Disability Income policy?
They are payable when expenses exceed Workers' Compensation benefits
Under an Accidental Death and Dismemberment policy, in which of the following circumstances will an autopsy NOT be performed?
When it is prohibited by law
A producer must deliver an Outline of Coverage to a prospective insured who is eligible for Medicare at which of the following times?
When the policy is delivered
Under the Guaranteed Renewable provision in a policy issued to a group of persons having a common occupation, an insurance company may NOT terminate coverage on a group member if the member
ceases to fall within the eligible classifications
Under federal law, a tax except Health Savings Account can only be opened for an individual who is
covered by a qualified High Deductible Health Plan
Benefits produced under Long Term Care policies must be related to long-term treatment of or expenses incurred by all of the following conditions EXCEPT
death
Group vision insurance plans typically provide insurance benefits that cover the cost of
eye exams, lenses, frames, and contact lenses
The term that allows the type of responsibility expected of any producer toward funds entrusted to that producer's care in connection with the transaction of insurance is
fiduciary
An individual health insurance policy contains a Change of Occupation provision. If the insured experiences a loss in a more hazardous occupation than when the policy was issued, the insurance company may
increase the deductible to adjust for the occupational difference
The coinsurance clause is an individual Medical Expense policy refers to the
insurance company's right to require the insured to share a certain percentage of the cost of each claim
An employee who owns an individual Disability Income policy is injured in an automobile accident and files Proof of Loss with the insurance company. Under the Payment of Claims provision in the policy, the company will likely pay the policy benefits to the
insured
The commissioner of insurance must revoke the license of any producer who
is convicted by final judgement of a misdemeanor
An application for an individual Disability Income policy may require all of the following information about the proposed insured EXCEPT for
martial status and occupation
In determining how much Disability Income insurance a prospective insured could purchase, the MOST important factor to be considered is the insured's
monthly income