Health Insurance Certification Exam
Recurrent disability
:When an insured combines two periods of disability in one, the insured must've suffered a
Authorized
If an insurer meets the states financial requirements and is approved to transact business in the state, it is considered what type of insurer?
the frequency and amount of a premium payment
The mode of a premium payment is:
Free look
This policy provision gives an insured a certain number of days to go over the policy and make sure that it covers what is expected
Medical Information Bureau
What does MIB stand for?
Illegal occupation
Which of the following is not a mandatory provision in health insurance policies?
The same bases as hospital and medical benefits
all health insurance plans that reimburse inpatient hospital and medical expenses must provide health service benefits for the treatment of emotionally handicapped children on:
Age 65, regardless of employment status
A 63-year-old man is planning to be employed until age 68, when will he be eligible for Medicare?
Nonprofit health service plan corporation
A corporation that contracts for health services for subscribers in exchange for the periodic payment by or on behalf of the subscribers, and that does not bill the subscriber directly, but as a service plan, classified as a
Platinum
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?
60%
According to the PPACA rules, what percentage of healthcare cost will be covered under a bronze plan?
Physician and surgeon services
All of the following are covered by part A of Medicare except
18 months
An individual lost his job. Under cobra, for how many months is the individual entitled to keep his health insurance coverage?
Justifying denial of a policy
An insured may use Medical Information Bureau (mib) reports for all of the following except:
10 days
An insured pays a monthly premium of $100 for health insurance. What would be the duration of the grace period under her policy?
Pay the claim
An insured pays her major medical insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19 she had an accident and broke her leg. The insurance company would:
Scheduled
And insured has a cavity filled. His insurance covers his claim up to a predetermined amount which is indicated by a fee schedule. Which type of dental plan does the insured have?
DEMOGRAPHICS
CAFETERIA PLANS MUST PASS ALL OF THE FOLLOWING DISCRIMINATION TESTS EXCEPT:
Free look period
During this policy period, the insured can return the policy for a full refund of premium if the insured is dissatisfied with the policy for any reason
Appointed by the governor
How is the commissioner of commerce chosen?
30 days
How long is a typical free look period for long term care insurance policies?
0%
How much of the premium is paid by employees participating in a non-contributory plan?
12 months, or 1 year
If a producer's license lapses, how much time does he/she have to apply for reinstatement without having to take the exam?
100% of the premium paid the employer and 2% processing fees
If insured employees elect COBRA coverage after the employment is terminated, how much premium will the insured have to pay?
$25,000
In Minnesota under a long term care policy, there is a minimum lifetime benefit limit of at least:
Nonresident producers only need to fill the CE requirements in their home state
In Minnesota, what are the continuing education requirements for nonresident producers?
Elimination period
In a disability income policy, which of these clauses acts as a deductible?
Maximum amount the insurer will pay per day for care
In long-term care insurance, what is a maximum daily benefit?
Contributory
In which type of group life insurance plan, the employee pays part of the premium?
The individual son gets a part-time job to help support the family
In which type of situation with Social Security disability benefits not cease?
Income assistance for work related injury
Medicaid provides all of the following benefits except
C0-insurance
Money that an individual pays for healthcare services after deductible has been paid for is called:
Not taxable since the IRS treats them as a return of a portion of the premium paid
On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are:
3 years
Once an individual has successfully passed the licensing exam, how many years are the results valid?
Two years
Producer license must be renewed every
Coinsurance a policyholder must pay
Stop Loss Limit provision put a cap on which of the following?
The deductible
The amount an individual must pay for health care services before insurance covers any of the cost is called
It is only available on individual policies (NOT TRUE)
The following is not true regarding coverage for chemical dependency and health policies in the state?
24 months
The relation of earnings to insurance provision allows the insurance company to limit the insurance benefits to his/her advantage income over the last:
Elimination period
The time between the date that the disability commences and the beginning of the benefit payment period Is called:
Cancellation
Voluntarily giving up insurance by the insured is called:
The chief administrator of the insurer is called the "attorney in fact"
What is a characteristic of a reciprocal insurance exchange?
Limited benefit plan
What is not a type of managed care plan?
18 years old
What is the minimum age requirement for a person applying for a resident product license in Minnesota?
The plan is completely paid for by the employer
What is true regarding noncontributory life insurance plans?
Excessive benefits may be taxable
What is true regarding taxation of long term care insurance?
Corridor deductible
What kind of deductible is applied between basic coverage and major medical coverage?
Alien Insurer- an insurer formed under the laws of another country
When transacting business in this state, an insurer formed under the laws of another country is known as a/and
Present earnings and earnings prior to disability
Which of the following are the main factors taken into account when calculating residual disability benefits?
Domestic
Which of the following best describes an insurance company that has been formed under the laws of this state?
Deductible
Which of the following is a specified dollar amount if the insured must pay before the policy benefits begin?
Monthly- there will be additional expenses and billing the premium
Which of the following premium modes would result in the highest annual cost for a life insurance policy?
Notice of claim
Which of the following provision states that it is the insured's responsibility to notify the insurer of a loss within a specified number of days?
An employee is absent from work for an extended period because total disability
Which of the following would not be an allowable reason for the cancellation of health coverage for an insured under a group policy?
$120 ($90 which is 30% of $300 + any amount above usual/customary costs: $30(Usual cost is :300 but this one is $330 so 330-300=30)
A policy owner has an indemnity policy which is responsible for 30% of usual and customary cost and the insured is responsible for the remaining 70%. After the insured's visit to a doctor the insurance company in sent a bill for $330. The customary cost of services in this case is $300. How much will the insured need to pay
Dividends from a mutual insurer
All of the following could be considered rebates if offered to an insured in the sale of insurance except
Anyone who is willing to pay a premium. Medicare was not designed for a specific class of society but primarily for citizens age 65 and over.
All of the following qualify for Medicare part A, except:
Foreign - a foreign insurer is domiciled in one state and transaction another state
An insurance company is domiciled in Montana and transacts insurance in Wyoming. Which term best describes the insurance classification in Wyoming?
Guilty of an unfair claims settlement practice
An insurance company that routinely ignores all letters and phone calls from insured's that have filed claims is
18 months
Employees covered under a group plan who's employment is terminated or hours reduced so that they no longer qualify for coverage, must be allowed to continue coverage under the group plan for a period of:
20% of cover charges above the deductible
Following an injury, a policy owner covered under Medicare part A and B was treated by her physician on an outpatient basis. How much of her doctors bill will she be required to pay out-of-pocket?
180 days
Health insurance carriers who wish to stop doing business in the small employers market must notify the commissioner and each small employer how many days in advance?
No tax
In an individual long-term care insurance plan the insured is able to deduct the premiums from taxes. What income taxation was imposed on benefits received?
63 days
To qualify as an eligible insured under HIPPA, a person must not have had a gap in coverage lasting more than how many days?
Are made by the business and are not tax-deductible
Under the Key Person Disability Income Policy, premium payments:
When the benefits received are equal or less than the employees contribution
Under what condition are group disability income benefits received by an employee not taxable as income?
Living behaviors that tend to put an individual at greater risk of injury
What is a moral hazard?
Premium/benefits are tax deductible as a business expense
What is false regarding Key Person Disability Income Insurance?
Benefits are considered taxable income to the business
What is false regarding the Key Person Disability Income Policy?
Terminated employment for gross misconduct
What is not a qualifying event under cobra?
Builders risk disability
What is not a type of disability income insurance?
Premiums are not tax-deductible and benefits are not taxable
Which of the following describes taxation of individual disability income insurance premium and benefits?
A permanent resident lawfully present in the US
Which of the following individuals will be eligible for coverage on the health insurance marketplace?
Fully insured status
Which of the following is an eligibility requirement for Social Security disability income benefits?
Premiums are tax deductible and benefits are not taxed
Which of the following is correct regarding the taxation of group medical expense premium/benefits?
Iron- only includes silver, bronze, platinum, and gold
Which of the following is not a metal level of coverage offered under the patient protection and affordable care act?
Grace period
Which policy provision stipulates for what period of time the policy will remain in effect after the premium payment has been missed?
Unless the policy designated the current beneficiary is irrevocable the policy owner can make the change anytime
A policy owner has health insurance policy with his wife listed as the primary beneficiary. He would like to change the primary beneficiary to a sister. Which of the following is true?
60 days
After an insurance company examination, commissioner or an examiner appointed by the commissioner must file a written report of the examination within:
Commissioner of human services
Health service benefits for the treatment of emotionally handicapped children must be provided in a residential treatment facility that is licensed by:
10
In all healthcare plans under the Affordable Care Act, how many essential benefit categories are there?
Every 24 months, or two years
Once an agent has met the requirements for long term care insurance, how often must he/she complete the 4 hours of ongoing training courses?
8 hours
Once an individual is licensed as an insurance producer for life or accident and health insurance, how many training hours must they initially complete to sell long-term care insurance?
5 months
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?
75%
To be entitled to have small employers health coverage issued on a guaranteed basis, how many eligible employees must participate in a health benefit plan?
Non-occupational coverage
The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the injured's employment is called:
A retired individual at age 50
All of the following are eligible for Medicare except:
Placement
All individual or group accident and health policies that provide coverage to a Minnesota resident must cover the insured's adopted children on the same basis as other dependence coverage begins on the adopted child's date of:
The proportionate amount
An insured carries health insurance with two different providers and is covered on an expense incurred basis. He has an appendectomy and files the claims to both insurers. Neither company is notified in advance that the insured has other coverage. What should each insurer pay?
$1800 ($5000-$1000=$4000, 20% of %4000 is 800, therefor the insured would pay the $1000 deductible+$800 for the 20%)
An insured has a major medical policy that calls for a $1000 deductible and 80/20 participation. If this insured incurs covered medical Spences of $5000, the insured would pay:
Surplus lines insurers
The comprehensive health association contracts with all the following entities to provide coverage for their subscribers except:
The entire contract
Which of the following provisions states what must be included for an insurance contract to be considered complete?
Provide an insured individual with evidence of insurance
What is the purpose of a certificate of insurance?
HMOs may pay for services not covered by Medicare
Which of the following statements is correct concerning the relationship between Medicare and HMOs?
Defamation
When a producer was reviewing a potential customers coverage written by another company, the producer made several marks that were maliciously critical of the other insure. The producer could be found guilty of:
Deductible
Which of the following provisions specifies the dollar amount that the insured must pay before the insurance will start to pay policy benefits?
Notice of claim
Which of the following provisions states that it is the insured's responsibility to notify the insurer of a loss within a specific number of days?
Custodial care
Which of the following types of long-term care is provided mainly for the purposes of meeting the insured's need for activities of daily living?
respite care
Which of the following types of long-term care services provides temporary relief from caregiving to a member of the insured's immediate family?
Long term care
Which type of care is not covered by Medicare?