health first try
Which of the following is NOT true of basic medical expense plans?
coverage for catastrophic medical expenses they have no deductivles first dollar coverage low dollar limits
All of the following are considered unfair trade practices in the business of insurance EXCEPT
sharing commisions
What is a foreign insurer?
An insurer with a home office in another state
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?
18 months
An intermediary holding a Wisconsin insurance license in any major line of insurance must complete how many credit hours of continuing education every 2 years?
24
Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?
30 months
How long is an open enrollment period for Medicare supplement policies?
6 months
An insurer decides to renew a life policy but at a higher premium rate, starting on the renewal date. How many days in advance must the insured be notified?
60
An insurer plans to discontinue a specific type of group health insurance coverage. How much prior notice must the insurer give each employer and plan participant?
90 days
How is the amount of Social Security disability benefits calculated?
It is based upon the worker's Primary Insurance Amount (PIA), which is calculated from their Average Indexed Monthly Earnings over their highest 35 years.
If an insurer decides to stop providing all group health insurance coverage. It must send notice of the discontinuance to all of the following EXCEPT the
The NAIC
Which of the following is true regarding METs?
They allow several small employers purchase less expensive insurance together.
What is the purpose of the ADEA?
To prohibit age discrimination in employment
Underwriting for disability insurance is unique due to the type of risk involved. Which of the following situations illustrates this?
a construction worker pays a higher premium and receives a poorer classification of disability
A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called
a prepaid plan
Which of the following hospice expenses would NOT be covered in a cost-containment setting?
antibiotics
Because an agent is using stationery with the logo of an insurance company, applicants for insurance assume that the agent is authorized to transact on behalf of that insurer. What type of agent authority does this describe?
apparent
The provision that states that both the printed contract and a copy of the application form the contract between the policyowner and the insurer is called the
entire contract
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?
full benefits
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?
gold bronze pays 60 silver 70 gold 80 platiumn 90
Which of the following is an eligibility requirement for all Social Security Disability Income benefits?
have attained fully insured status
In long-term care (LTC) policies, as the benefit period lengthens, the premium
increases
Which of the following statements pertaining to Medicare Part A is correct?
individuals who have ALS automaticially qualify for medicare part A regardless of age
The type of dental plan which is incorporated into a major medical expense plan is a/an
integrated dental plan
In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost
is not covered
Which of the following statements is NOT true concerning Medicaid?
it consists of 3 parts part a part b part c
All of the following statements concerning Medicaid are correct EXCEPT
medicaid is a state funded program that provides health care to persons over age 65 only
Certain conditions, such as dismemberment or total and permanent blindness, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe?
presumptive disability
When an employee is still employed upon reaching age 65 and eligible for Medicare, which of the following is the employee's option?
remain on the group health insurance plan and defer eligibility for medicare until retirement
Which of the following is an example of a peril covered in an accident and health insurance policy?
sickness
An applicant is considered to be high-risk, but not so much that the insurer wants to deny coverage. Which of the following is NOT true?
the insurer will issue a conditional coverage
An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?
the pre-existing condition waiting period fufilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off
When an insurer is given an order of liquidation, which of the following will protect the insureds' unpaid claims?
the wi insurance security fund
Which of the following statements regarding conditional receipts is true?
they are temporary insuring agreements
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
they cover the cost of extended nursing home care
A health insurance policy may cover all of the following risks EXCEPT
war related injuries
Which of the following statements concerning Medicare Part B is correct?
it pays for physician services, diagnostic tests, and physical therapy
Untrue statements on the application unintentionally made by insureds that, if discovered, would alter the underwriting decision of the insurance company, are called
material misrepresentations
The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as
part A
An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?
$500
What percentage of individually-owned disability income benefits is taxable?
0% benefits are not income taxable
An agent who has had formal disciplinary action taken against them by a state regulatory agency must notify the Commissioner of this within
30 days
What is the duration of the free-look period for Medicare supplement policies?
30 days
All of the following are true regarding small group coverage in Wisconsin EXCEPT
Insurers are prohibited from ever increasing rates.
An underwriter may reject an application for health insurance if the rejection is based upon which of the following?
Prescription usage
an agent acting ethically in all of the following situations execpt
always representing the insured
Health-care policies that cover women 50 or older must provide coverage for mammograms
annually
Which of the following is not true of Disability Buy-Sell coverage?
benefits are considered taxable income to the business
All of the following apply to short-term disability plans EXCEPT
both group and individual plans are renewable
Which of the following would NOT be used in preventive care?
chemotheraphy
all of the following are covered by Part A of Medicare execpt
physicans and surgeons services
Tim and Tom are twins. When they applied for life insurance from Company A, the insurance company found that while neither of them smoked and both have a very similar lifestyle, Tim was in a much stronger financial position than Tom. Because of this, the company charged Tim a higher rate for his insurance. This practice would be
discrimination
When an applicant applies for Medicare supplement insurance, whose responsibility is it to confirm whether the applicant has an accident or sickness insurance policy in force?
the insurers
Which of the following is NOT a characteristic of an insurable risk?
the loss must be catastrophic
Under what condition are group disability income benefits received by an employee NOT taxable as income?
when the benefits received are equal or less than the employees percentage of the contribution
When does a person qualify to receive disability-related income?
when the insured is unable to perform his or her job duties
What provision may allow a small employer health benefit plan to exclude coverage for a pregnancy existing on the effective date of the coverage?
pre-existining condition
Which of the following is true regarding an advertisement that includes an invitation to apply for a specific individual policy?
the advertisement must include an outline of coverage
Once an agent has met the requirements to sell long-term care insurance, how often must he or she complete the 4 hours of ongoing training courses?
every 24 months
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?
the benefits will be coordinated
