health exam study guide

#62. An underwriter is reviewing an applicant with an extensive medical history. Which of the following would give the underwriter a better understanding of how the applicant has been treated for various illnesses?

Attending Physician's Statement

An underwriter is reviewing an applicant with an extensive medical history. Which of the following would give the underwriter a better understanding of how the applicant has been treated for various illnesses?

Attending Physician's Statement

All of the following statements about mutual insurance companies are correct EXCEPT

Policy dividends issued by mutual companies are guaranteed and not taxable

#86. All of the following statements about mutual insurance companies are correct EXCEPT

Policy dividends issued by mutual companies are guaranteed and not taxable.

#30. 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

Preferred Provider Plan

#60. Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time parameters?

Within 20 days

Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time parameters?

Within 20 days

Which of the following best defines the Probationary Period in group health policies?

a specific period of time that a person joining the group has to wait before becoming eligible for coverage

An individual is approaching retirement age and is concerned about having proper coverage should he have to be placed in a Long-Term Care (LTC) facility. His agent told him that LTC policies would provide necessary coverage at all of the following levels EXCEPT

acute

All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT

an association of 35 people.

A producer advises a policyholder that he should replace his life insurance policy with another, similar policy. The agent is advising this, however, for the sole purpose of earning a commission. What violation has the agent committed?

churning

Utilization management consists of an evaluation of the appropriateness, necessity and quality of health care, and may include

prospective and concurrent review

What type of insurer uses a formal sharing agreement?

reciprocal insurers

Which of the following is NOT a characteristic of a Managed Care Plan? aControlled access of providers c) Comprehensive case management preventive care

risk retention

HMOs are known as what type of plans? b) Health savings © Consumer driven d) Reimbursement

service

#92. Among the applicants in the same class and life expectancy, which of the following factors can be used to determine premium rates?

Occupation

#58. An individual is approaching retirement age and is concerned about having proper coverage should he have to be placed in a Long-Term Care (LTC) facility. His agent told him that LTC policies would provide necessary coverage at all of the following levels EXCEPT

Acute

#73. Which rider, when added to a disability policy, pays income during the six-month waiting period before Social Security benefits can begin?

Additional Monthly Benefit

Which rider, when added to a disability policy, pays income during the six-month waiting period before Social Security benefits can begin?

Additional Monthly Benefit

#56. All of the following could qualify as a group for the purpose of purchasing group health insurance EXCEPT

An association of 35 people.

Among the applicants in the same class and life expectancy, which of the following factors can be used to determine premium rates?

Occupation

#80. How many members must a group have to be eligible for blanket coverage?

100

How many members must a group have to be eligible for blanket coverage?

100

#94. If an insurer decides to nonrenew all of its health benefits plans, the insurer must provide a notice of its decisions to all affected insureds at least how many days prior to nonrenewal?

180 days

If an insurer decides to nonrenew all of its health benefits plans, the insurer must provide a notice of its decisions to all affected insureds at least how many days prior to nonrenewal?

180 days

#12. A MEWA may be formed with what minimum number of employers participating?

2

A MEWA may be formed with what minimum number of employers participating?

2

#108. Within how many days of the termination of the insured's group coverage must the insured notify the insurer of the decision to convert to individual coverage?

30 days

Within how many days of the termination of the insured's group coverage must the insured notify the insurer of the decision to convert to individual coverage?

30 days

#103. Insurers are required to complete investigation of a claim within what time period?

45 calendar days

Insurers are required to complete investigation of a claim within what time period?

45 calendar days

A newborn infant must be covered under a policy for routine nursery care and pediatric costs until either the mother is discharged from the hospital or a period of

5 days

#95. A newborn infant must be covered under a policy for routine nursery care and pediatric costs until either the mother is discharged from the hospital or a period of

5 days.

#26. Partial disability usually pays what percent of the total disability benefit?

50%

Partial disability usually pays what percent of the total disability benefit?

50%

#33. 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

60 days after written proof of loss has been submitted

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

60 days after written proof of loss has been submitted.

#76. Which of the following best defines the Probationary Period in group health policies?

A specified period of time that a person joining a group has to wait before becoming eligible for coverage

#91. Guaranteeing future dividends is considered to be an unfair or deceptive act known as

Misrepresentation

#85. A producer advises a policyholder that he should replace his life insurance policy with another, similar policy. The agent is advising this, however, for the sole purpose of earning a commission. What violation has the agent committed?

Churning

#3. Which of the following elements of an insurance contract requires payment of premium?

Consideration

Which of the following elements of an insurance contract requires payment of premium?

Consideration

#32. Regarding the consideration clause, which of the following is NOT correct?

Consideration of the insurer and insured must be equal

Regarding the consideration clause, which of the following is NOT correct?

Consideration of the insurer and insured must be equal.

#43. Which of the following is NOT correct concerning taxation of disability income benefits?

If paid by the individual, the premiums are tax deductible

Which of the following is NOT correct concerning taxation of disability income benefits?

If paid by the individual, the premiums are tax deductible.

#44. Who makes up the Medical Information Bureau?

Insurance companies

Who makes up the Medical Information Bureau?

Insurance companies

#6. Medicare Part B covers all of the following EXCEPT

Long-term care services

Medicare Part B covers all of the following EXCEPT

Long-term care services.

#59 What is the primary difference between Medigap and Medicare SELECT policies?

Medicare SELECT policies contain restricted network provisions

What is the primary difference between Medigap and Medicare SELECT policies?

Medicare SELECT policies contain restricted network provisions

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 HMO group plan.

Preferred Provider Plan

#45. Utilization management consists of an evaluation of the appropriateness, necessity and quality of health care, and may include

Prospective and concurrent review

#19. What type of insurer uses a formal sharing agreement?

Reciprocal insurers

#15. An applicant for a disability insurance policy has a heart condition of which they are unaware and therefore they answer no to the question pertaining to heart problems on their application. Their answer is considered to be a

Representation

An applicant for a disability insurance policy has a heart condition of which they are unaware and therefore they answer no to the question pertaining to heart problems on their application. Their answer is considered to be a

Representation

#21. Which of the following is NOT a characteristic of a Managed Care Plan?

Risk retention

#57. An insured's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. That means the policy provides benefits on what basis?

Scheduled

An insured's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure.That means the policy provides benefits on what basis?

Scheduled

#40. HMOs are known as what type of plans?

Service

All of the following are included as duties and powers of the Insurance Commissioner EXCEPT

Setting premium rates

#105. All of the following are included as duties and powers of the Insurance Commissioner EXCEPT

Setting premium rates.

Jane was granted a temporary license for her deceased's husband's agency on March 1. On May 1 she processed an application for life insurance on a new applicant. Which of the following is TRUE?

The application was processed without a valid license

#90. Jane was granted a temporary license for her deceased's husband's agency on March 1. On May 1 she processed an application for life insurance on a new applicant. Which of the following is TRUE?

The application was processed without a valid license.

#98. A producer represents

Their appointing insurer

A producer represents.

Their appointing insurer

#1. What is the purpose of the impairment rider in a health insurance policy?

To exclude coverage for a specific impairment

What is the purpose of the impairment rider in a health insurance policy?

To exclude coverage for a specific impairment