Health Practice Test
An insurer must provide an insured with claim forms within ___days after receiving notice of loss
5, 10, 20, 15
P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?
$20,000, 14000, 6000, $0
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?
$2000, A lump sum of six , nothing, Earned but unpaid
A Hospital/Surgical Expense policy was purchased for a family a family of four in March of 2013. The policy was issued with $500 deductibles and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each excess of the deductible amount as well. What would be this family's out-of- pocket medical expenses for 2013?
$500. 1500, 2000, 1000
Qualified Long-Term Care policies may take into consideration an applicant's pre-existing conditions for a maximum of not more than __ month(s) prior to the effective date of coverage.
1, 12, 24, 6
B has a $100,000 Accidental Death and Dismemberment policy that pays triple indemnity for common carrier death. If B is killed from an accident on a commercial flight, what will the policy pay B's beneficiary?
100,000 , 200,000, 400,000 , 300,000
A licensed agent must be appointed by an insurance company to solicit insurance in Florida. The agents license will terminate ifa certain period of time elapses without being appointed, How long this period
12, 24, 36, 48 moths
A licensed agent must be appointed by an insurance company to solicit insurance in Florida. The agents license will terminate if a certain period of time elapses without being appointed. How long is this period of time?
12, 24,36, 48 months
A licensed agent must be appointed by an insurance company to solicit insurance in Florida. The agents license will terminate if a certain period of time elapses without being appointed, How long is this period of time
12,24,36,48 monthw
A group of Plan was recently terminated in Florida, how many days are covered individuals guaranteed coverage after a group plan's termination?
14 days, 31, 45, 60 Days
A group of plan has recently terminated, In Florida, how many days are covered individuals guranteed coverage after a . group plans termintation
14,45,60, 31 days
In what year was The Florida Office of Financial Regualtion (OFR) created?
1983, 1993, 2013, 2003
According to Florida Law, an additional lapse notice must be issued after the standard grace period has expired for policy owners age:
21 and under, 59 1/2 or older,69 and older, 64 years and older
Non occupational disability coverage is designed for :
24 hrs protection, those who are exempt from workers compensation coverage, sole proprio tors, employees who suffer non-work related disabilities are covered by Workers compensation
What is the required minimum percentage of employee participation for a non contributory group health insurance plan according to Florida Law?
25% ,75%,100%, 0%
What percentage of eligible persons must a policy cover in a non contributory group?
25, 50, 75 100
The XYZ Company has a committee whose members are appointed for three-year terms to review the company's hiring policies. This committee is an example of a __________ committee.
25, 75, 50, 100 % (Non contributory group health plans required 100% participation by eligible employees
Florida requires that an insurance agent must complete __ hours of continuing education on the subject of law and ethics every two years.
3,4,6,5
Within how many day must a licensee notify the Department Financial Services of a change in address
30 days
When does a Probationary Period provision become effective in a health insurance contract?
30 days after the policy's inception, when the claim was submitted, when covered loss, at the policy's inception
In Florida, what is the maximum percentage of controlled business an agent may produce
30, 40,60, 50%
Employees with less than __ employees are affected by Florida"s Health Insurance coverage Continuation Act
30,40, 10, 20
In Florida, what is the maximum of percentage of controlled business an agent may produce?
30,40,60,50%
Insures may request a hearing within ___ if their policy is rejected
30,60,90 20 days
Florida requires that coverage for newborns begins "from the moment of birth" and continues for
31 days, 6 months, 12 months, 18 months
Employers with less than __ employees are affected by Florida's Health Insurance Coverage Continuation Act (Mini COBRA).
40,30, 10, 30
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
5, 10, 20 ,15
What is the maximum Social Security Disability benefit amount an insured can receive?
50% of the insured's PIA, 75% , 100% of insured PIA minus any monies received, 100% of insured PIA
V is insured under an individual Disability Income policy with a 30-day Elimination period. On July 1, he is involved in an accident and temporarily disabled. He returns to work on December 1. How many months of benefit are payable?
6 months, 5 months, 41/2, 4 months
Within how many days must a licensee notify the Department of Financial Services be delivered
60, 90, 100, 30 days
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
7 days, 10, 80, 31 days
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
7, 10, 60, 31 days
In Florida, monhtly premium health insurance policies must provide a grace period of at least
7, 14,31, 10
C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?
720
In Florida, deceptive advertising is considered to be
A FORM OF MISREPRESENTATION
P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as?
A presumptive disability, an occupational disability, a residual disability, a recurrent disability
What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?
AD&D rider, disability income, guaranteed insuralbilty rider, waiver of premium rider
All of the following entries are classified under the four principal areas of Florida insurance law EXCEPT
AN AGENTS COMMISSION
Which of the following is the best description of "insurer"
ANY PERSON, CORPORATION, ASSOCIATION OR SOCIETY THAT WRITES INSURANCE CONTRACT
When is it acceptable to share commissions with another agent
AS LONG AS BOTH AGENTS ARE LICENSED FOR THE THE SAME LINES OF INSURANCE
Which of the following acts is an agent NOT authorized to do on behalf of an insurer
Accept premiums, complete insurance application, ask health related questions, Authorize claim payments.
Which of the following organization would make reinbursement payments directly to the insured individual covered medical expenditures?
Administrative services , preffered provider organization, Hmo, commercial insurer
According to Florida law, which of the following statements accurately describes an admitted mail order insurance company
Admitted mail order insurance companies cannot solicit insurance business outside state of Florida, admitted mail order insurance companies are illegal in Florida, it may solicit insurance business by mail with the assistance of licensed agent, it may solicit insurance business by mail without the assistance of a licensed agent
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
Agents report, MIB Report, Attending doctor, Inspection Report
Which of the following statements about the classification of applicants is INCORRECT
An applicant can be classified as substatial risk because of a hazardous job, Preferred risk applicants typically have better premium rates than standard risk apllicant, substandard are always decline by the underwiter, substandard applicants are never declined by the underwriters
Which of the following statement BEST describes what the legal actions provisions of an Accident and health policy requires
An insured must wait atleast 60 days after Proof of loss is submitted
An applicant's medical information received from the Medical Information Bureau (MIB) may be furnished to the
Applicants physician
An incomplete health insurance application submitted to an insurer will result in which of these actions?
Application will be automatically declined, Application will be pending until a MIB report, application will be approved with restrictions, Application will be returned to the writing producer
N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as
Assignment of benefits, indemnity, co deductilbes, Coinsurance
When is a Group Health policy required to provide coverage for a newborn child?
At the moment of birth
According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant?
At the time of policy deliver, within 14 days of the application, 14 days of the policy deliver, at the time of application
Medicaid was designed to assist individuals who are
BELOW SPECIFIC INCOME
Who is NOT required to sign a life insurance application?
Beneficiary
Which of the following health insurance policy provisions specifies the health care services a policy will provide?
Benefit clause, consideration clause, usual, customary and renewable clause, insuring clause
T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable?
Benefits are tax free to T, Benefits are partially taxable, benefits are taxable to employer, Benefits are taxable to T
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?
CHANGE OF OCCUPATION PROVISION
The Bureau of Unclaimed Property is overseen by the :
Chief Financial Officer
P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?
Claim will be denied and policy terminated, claim will be partially paid, claim will be paid, claim will be denied
T was insured under an individual Disability Income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefit payments, but later discovered that the fire was set by T in what was described as arson. What actions will the insurer take?
Claim will be denied but the policy will remain in force without further premium payments due to the insured total disability, claim will be rejected because of the criminal act, due to the policy not being post-claim underwritten, bu the insurer must continue to pay this claim, the insurer will rescind the policy, deny the claim and recover all payments mode
Which of the following is considered an accurate statement of an unfair trade practice?
Coercion involves making a malicious statement, no more than 25% of an agents sales, rebating, twisting involves an agent using misrepresentation to convince a policy owner to cancel their current policy so that they can purchase a new life insurance policy with another company
J is an agent who has induced an insured through misrepresentation to surrender an existing insurance policy. What is J guilty of?
Coercion, Sliding, Rebating, Twisting
Which of these arrangements allows one to bypass insurable interest laws?
Concealment, Indemnity contract, contract of adhesion, Investor-Orginated Life Insurance
Which of the following involves analyzing case before admission to determine what type of treatment is necessary
Concurrent review, retrospective review, utilization review, prospective review
A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation the company will
Continue coverage but exclude the heart condition
A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart condition. The company issues the policy. Two-months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers pre-existing condition. In this situation the company will:
Continue coverage but exclude the heart condition
Which of the following statements does NOT accurately describe the tax treatment of premiums and benefits of individual Accident and Health Insurance
DISABILITY INCOME POLICY PREMIUMS ARE TAX DEDUCTIBLE
Under an Individual disability policy in Florida, what is the minimum schedule of time in which claims must be made to an insured
Daily, weekly, annually, monthly
M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt was left with the applicant. The insurance co.underwritting department request's M's medical records and determines that M has had asthma for many years. All of the following and probable underwriting outcomes , Except
Deny coverage, approve with a higher premium, attach a rider excluding specified coverage, changing the policy's provisions
M applies for a health insurance policy and pays the initial premium, When the agent completes the application, a conditional receipt is left with applicant. The insurance companys underwriting department request M's medical report and determines that M has had asthma for many years. all of the following are probable underwriting outcomes EXCEPT:
Deny coverage, approve with higher premium, attach a rider, Changing the policy provisions.
An example of unfair trade practice is
Denying payment of a claim within reasonable time, replacing an old life insurance with a new one, an agent writing less that 50% if their total sales from controlled business, and agent making a material misrepresentation to the insured
Which department oversees "Market Conduct Examinations in Florida
Department of Markets, Office of Financial Regulations, Department of Revenue, Office of the Insurance Regulations
Which department oversees "Market Conduct Examination in Florida?
Department of market, office of financial regulation, department of revenue, office of Insurance regulation
A disability elimination period is best described as a
Dollar deductible, eligibility period, probation period, time deductible
Non profit life insurance providers that are covered by a special section in the Florida insurance code are called
Domestic, mutual, unauthorized, fraternal life insurance company
Which of the following statements BEST describes how policy that uses the "accidental bodily injury definition of an accident differs form one that the "accidental means" define
Double indemnity, benefits are taxable, more restrictive, less restrictive
When must insurable interest exist for a life insurance contract to be valid?
During contestable, when the insured dies, throughout the entire length of the contract, inception of the contract
The federal income tax treatment of employer- provided group Medical Expense insurance can be accurately describe as
EMPLOYEES PREMIUM PAID BY THE EMPLOYER IS TAX DEDUCTIBLE TO THE EMPLOYER AS A BUSINESS EXPENDITURE
An underwriter determines that an applicants risk shld be recategorized due to health issue . The policy may be issued with an
EXCLUSION FOR THE MEDICAL CONDITION
The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately describe as:
Employees premium paid by the employer is tax deductible to the employer as a business expenditure
Which of these is NOT characteristic of a HRA
Employers funds the HRA entirely, HRA can be offered with other health plans, HRA's allows reimbursement for eligile medical expense, Employee fund the HRA entirely
What is the purpose of the Life and Health Insurance Guaranty Association?
Enforces Florida's insurance regulations, Underwriter high risk insurance applications, establishes underwriting guidelines, protects policy owners against insolvent insurance companies
The provisions that defines to whom the insurer will pay benefits to is called
Entire clause, proof of loss, claim forms, payment of claims
When the insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and insurer?
Entire contract
An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?
Entire contract clause, MIB Clause, Insuring clause, Consideration clause
The clause identifying which losses resulting form an accident or sickness are insured by the policy is called the
Entire contract provision, benefit, consideration, Insuring clause
The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the :
Entire contract, Consideration, Benefit, Insuring clause
The provisions that defines to whom the insurer will pay benefit to is called
Entire contract, Proof of loss, Claim of forms, payment of claims
The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the
Entire contract, consideration clause, benefit clause, insuring clause
The provision that defines to whom the insurer will pay benefits to is called:
Entire contract, proof of loss, claim forms, payment of claims
Which of these is considered a statement that is assured to be true in every respect?
Estopel, Representation, Guarantee, Warranty
The sections of an insurance contract which limit coverage are called
Exclusions
Which of the following is NOT included in the policy face
Exclusions
Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?
Extended insurability rider, paid-up option rider, additional coverage rider, Guaranteed insurability rider
A physician opens up a new practice and qualifies for a $7000 Disability income policy. what rider would the physician add if he wants the ability to increase his policy as his practice and income grow
Extended term rider, cost of living adj, waiver premium, Guaranteed Insurability Option rider
The act of an insurance company publishing misleading information about tis policy
FALSE ADVERTISING
This type of deductibles provision waives the deductible for all family members after some have satisfied individual deductilbes within the same year
FAMILY MAXIMUM DEDUCTIBLES
In Florida, when agents recommend changes be made for existing coverage, the agent must follow established procedures. The name of this rule is called the
FLORDA REPLACEMENT RULE
Non profit life insurance providers that are covered by a special section in the Florida insurance are called
FRATERNAL LIFE INSURANCE ORGANIZATIONS
The life and Health Insurance Guaranty Association is
FUNDED BY THE ADMITTED INSURANCE COMPANIES THROUGH ASSESSMENT
Which of the following is NOT an unfair claim settlement practice
Failing to acknowldege and act promptly with respect to an insurance claim, compelling an insrured to initiate a lawsuit, failing to accept or deny , Needing written documentation of calim details
Taking receipt of premiums and holding them for the insurance company is an example of
Fiduciary responsibility
Which of the following professional organization has its code to ethics incorporated into Florida law?
Financial Industry Regulator Agency, National Association of Insurance and Commission, the American college of life insurance, National Association of Insurance and Financial Services Advisors (NAIFA)
Which organization was established to provide funds to protect an insured in the event of an insurers insolvency>
Florida Life and Health Insurance Guaranty Association
K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?
Free-look, grace period, consideration, reinstatement
All of these are pre-requisite for becoming a licensed agent EXCPT
GRADUATE FROM HIGHSCHOOL
Insurers/agents must, in Florida, offer and issues all small employer health plans
GUARANTEED-ISSUE
Which of the following provisions specifies how long a policy owners health coverage will remain in effect if the policy owner does not pay the premium when it is due
Grace perid
The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy effective date is referred to as the
Grace period, postpone period, elimination, waiting period
Which contract permits the remaining partners to buy-out the interest of a disabled business partner?
Group Disability, Business Continuation, Key person disability, Disability Buy and Sell
All of the following are eigible requrirements for an association group EXCEPT
Group must have been in existence for 2 years, Group must hold regular meeting at least on an annual basis, must have been orgaized for some reasons other than to obtain group insurance, Contributory plans require a minimum of 25 participants
J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase?
Guaranteed Renewable, optionally renewable, conditional, Non cancellablle
If insurance company issues a Disability income policy that it cannot cancel or for which it cannot increase premium, the type of renewability that best describes this policy is called
Guaranteed renewable, cancelable, conditional, noncancelable
S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a
HIGH DEDUCTIBLE HEALTH PLAN
Which of the following reimburses its insureds for covered medical expenses?
HMO, PPO, Service provider, commercial insurers
The Florida Employee Health Care Access Act was established to make
Health insurance affordable, individual health plan, health insurance affordable, group health insurance available to employer with up to 50 employees
K has an Accidental Death and Dismemberment (AD&D) insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. Under the Common Disaster clause, if K and her husband are both killed in an automobile accident, where would the death proceeds be directed?
Husband estate, K estate, trust fund, daughter
During the application process the agents primary responsibility is to
INSURANCE COMPANY
If a contract of adhesion contains complicated language, to whom would the interpretation be in favor of
INSURED
Which of the following health insurance policy provisions specifies the health care services a polilcy will provide
INSURING CLAUSE
The phrase "This policy will only pay for a semi-private room" is an example of a(n)
INTERNAL LIMIT
How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy?
If the primary beneficiary is a minor at the time of the insured's death, if the insured died of accidental causes, if the insured died of natural causes, if the primary benificiary dies before the insured
Which of the following is the reimbursement of benefits for the treatment of a beneficiary's caused by a third party?
Indemnity, Legal actions, Consideration, Subrogation
Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?
Indemnity, legal actions, consolidation Subrogations
Which of these is NOT a legal entity for selling life insurance in Florida?
Independent agency, career agency, personal, risk management advisers
This type of deductible provision states that should more than one family member be involved isn a common accident or suffer the same illness, only one individual deductible amount shall be applied
IndivIdual deductible, corridor deductible, family maximum, common accident deductible
This type of deductible provision waives the deductible for all the family members after some of the have satisfied individual deductible within the same year:
Individual , corridor, common, family maximum deductible
Which Long Term Care insurance statement is true?
Inflation protection is usually offered, benefits are usually payable, can be offered to ind., Pre-existing conditions must be covered after the coverage has been in force for six months
Which of the following areas of state regulation is NOT protected by the savings clause os ERISA
Insurable, Banking, Securties, Commerce
What would be an accurate definition of "controlled business"
Insurance business that is obtained by replacing and existing policy through misrepresentation, insurance business that is obtained through false advertising, insurance business obtained by an agent through coercion, intimidation, insurance business that is written on the agents own life, property or interest
If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act?
Insured contingent beneficiary
What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provisions?
Insured must be unemployed, insured must be hospitalized, insured must demonstrate financial need, insured must be under a physician's care
What kind of AD&D insurance beneficiary requires his consent change of beneficiary is made
Irrevocable
Which if the following actions an insurance company most likely NOT take an application who has diabetes, applies for a Disability Income policy
Issue the policy with a diabetes of claims provisions, issue policy with rating, decline the applicant, issue the policy with an altered Time of Payment of Claims provisions
According to Florida law, which of the following statements accurately describes an admitted mail order insurance company?
It may solicit insurance business by mail only with the assistance of license in Florida agent, Admitted mail order insurance companies are illegal in Florida, admitted mail order insurance companies cannot solicit insurance business outside the state of Florida, it may solicit insurance business by mail w/out assistance of a license agent.
When an employee is required to pay a portion of the the premium for an employer/emplyee group health plan, the employee is covered under which of the following plans?
Joint, non contributory, participating, contributory
What actions should the producer take if the initial premium is NOT submitted with the application?
Keep the application until premium is paid, forward the application with binding receipt, forward application to the insurer after giving the applicant a conditional receipt, forward the application to the insurer without the initial premium
Which type of policy would pay an employees salary if the employer was injured in a biycle accident and out of work for six weeks?
Key employee disability, work comps, disability income, Business overhead expense
Which type of policy would pay an employee's salary, if the employer was injured in a bicycle accident and out of work for six weeks
Key employer disability, disability income, workers compensation, business overhead expense
Nursing home benefits must be provided for at least 12 consecutive months in which of the following types of policies?
LONG TERM CARE
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the
Legal contract clause, time limit on certain defenses provision, insuring clause, entire contract provision
T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect?
Less that $5000
In Major Medical Expense policies, What is the intent of a stop loss provision
Limit the an insured's out of pocket medical expenses
J has a Disability Income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this?
Limited coverage, workers compensation, occupational coverage, nonoccupational coverage
Which type of provider is known for stressing preventative medical care?
MEWA, Major medical, PPO, HMO
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to?
MEWA,MET,Coop, HMO
From what authority derives the requirement that an insurance application contains a disclosure stating that an investigative consumer report may be obtained on an applicant?
MIB, Part 11, Life Insurance, Fair Credit Union
Which Federal law allows an insurer to obtain an inspection report on a potential insured?
MIB, medical information, freedom information, Fair credit reporting act
A Ceo's personal assistant suffered injuries at home and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal information
Major medical , key employee, business overhead, disability Income
Which of the following statements does NOT accurately describe the tax treatment of premiums and benefits of individual accident and health insurance?
Major medical policy benefits are normally not taxed, disability income policy benefits are normally taxed. disability income policy is NOT taxable, disability income policy premium is tax-deductible.
Z owns a Disability Income policy with a 30-day Elimination period. Z contracts pneumonia that leaves him unable to work from January 1 until January 15. Z then becomes disabled from an accident on February 1 and the disability lasts until July 1 the same year. Z will become eligible to receive benefits starting on
March 1
The percentage of an individual's Primary Insurance Amount determined the benefits paid in which of the following programs
Medicare, Medicaid, Cobra, Social Security Disability Income
Which of the following statements BEST describes the intent of a Coinsurance Clause in a Major Medical policy
Minimizes the waiting period, Discourages adverse selection, Minimizes the need for deductibles, Discourages overtilization of the insurance coverage
Convincing a prospective insured to buy an insurance policy based on exaggerations is called
Misreperesentation
According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
Monthly
With Disability Income insurance, an insurance company may limit the monthly benefit amount a prospective policy holder may obtain because the insureds
Monthly expenditure at the time of disability, occupation at the time of purchase, gross income at the time of disability, gross income a the time of purchase
Non profit life insurance providers that are covered by a special sections in the Florida Insurance code are called:
Mutual life insurance, Unauthorized insurers, domestic life, Fraternal life insurance organizations
In order for a domestic, foreign, or alien insurance company to conduct business, it must be authorized by whom
NAIC, Homeland Security, Attorney general, That state where they are conduction business
In Florida, agents are allowed to engage in rebating if
OFFERED TO ALL INSUREDS IN THE SAME ACTUALRIAL CLASS
In Florida, agents are allowed to engage in rebating if
OFFERED TO AN ALL INSUREDS IN THE SAME ACTUALRIAL CLASS
Which entity approves the insurance policy forms used in Florida?
OFFICE OF INSURANCE REGULATION (OIR)
What type of renewability guarantees premium rates and renewability?
Optional renewable, conditional renewable, guranteed renewable, noncancellable
K is the insured and P is the sole beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy. Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision, which of these statements is true?
P estate
Which of the these statements is INCORRECT regarding PPO
PPO is not a managed care
Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements
PPO, MEWA, POS, HMO
Which of the following types of organization are prepaid group, where members pay in advance for the services of participating physicians and hospitals that have agreements
PPO, MEWA,POS ,HMO
An insured covered by Accidental Death and Dismemberment insurance has died. What will happen if the primary beneficiary had already died before the insured and contingent beneficiary?
PROCEEDS WILL GO TO THE CONTINGENT BENEFICIARY
What does Medicare Part A and Part B covers:
Part A covers hospitalization Part B covers long term care, Part A covers doctors services and Part B covers hospitalization, Part A covers hospitalization Part B covers doctors services.
A disability Income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a 5 month period. The insurer may cover second disability w/out a new elimination period under the
Partial disability provision, residual disability provision, presumptive disability , recurrent disability
Which of these statements accurately describes the Waiver premium provisions in an Accident and Health policy
Past due premium on a lapsed policy are waived and coverage is restored, the insured is paid monthly benefit to keep insurance premiums current in the event of disabililty, Premiums are waived after the insured has been totally disabled for a specified time period
Which required disclosure helps a buyer choose the amount and type of insurance to buy and how to save money by comparing the cost of similar policies?
Policy summary, outline of coverage, certificate of coverage, Buyers Guide
Which of these is considered a mandatory provision
Payment of Claims is considered a mandatory provision and directs where the claim benefits will go. The others are considered optional provisions.
Which of the following are NOT managed care organizations
Point of service, PPO, HMO, MIB
M completes an application for life insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT
Policy is delivered, insurance company issues policy, initial premium is collected, free look period has expired
Which of these do NOT constitute policy delivery?
Policy mailed to the applicant, policy mailed to producer, policy delivered to the applicant by the producer, Policy issued with a rating
All of the following statements regarding group health insurance is true, EXCEPT:
Premiums are determined by the claims experience, mast contract is issued for the group, group health insurance are typically lower than ind health insurance premium, an individual policy is given to each member
Which of these statements concerning an individual Disability policy is TRUE:
Premiums are normally tax deductible, age of the insured determines the amount of the benefits, benefits are normally norma, normally includes an Elimination period
Which of the following statements about Guaranteed Renewable Health Insurance policy is CORRECT
Premiums normally decrease at time of renewable, policy can be renewed at any time of renewal, Policy can be cancelled at any time, Premiums normally increase at time of renewal
For which of the following expenses does a Basic Hospital policy pay
Prescription drug, surgical fees, physicians fees, hospital room and board
For which of the following expenses does a Basic Hospital pay
Prescription, surgical, physician fees, hospital room and board
What would the Medical Information Bureau (MIB) identify?
Primary physician, credit scores, existing life insurance coverabe, testing positive for marijuana from the previous screening
A disability elimination period is best described as a :
Probation period, eligibility period, dollar, time deductible
The provision in a health insurance policy that interrupts premiums being paid to the insurer while the insured is disabled is called the
Probation period, grace period, elimination period, waiver premium
What is issued to each employee of an employer health plan?
Provision, receipt, policy, certificate
P and Q are married and have three children. P is the primary beneficiary on Q's Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are killed instantly. The Accidental Death benefits will be paid to
R estate, Q estate, P and Q estate, P only
All of these are considered sources of underwriting information about an applicant EXCEPT
RATING SERVICES
With Optionally Renewable Health policies, the insurer may
REVIEW THE POLICY ANNUALLY AND DETERMINE WHETHER OR NOT TO RENEW IT
R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?
Recurrent Disability, Presumptive Disability, Occupational Disability, Residual Disability (It is usually percentage of the total disability benefit for periods when the insured is unable to perform some of the duties of his occupation)
R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily work load. Which provision pays reduced benefits to R while he is not working at full capacity
Recurrent disability, presumptive, occupational, residual disability
Which provisions allows portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time
Reimbursement benefit, restoration unused benefit, medical offset benefit, restoration of used benefit
Statements made an insurance application that are believed to be true to the best of the applicants knowledge are called:
Representations
T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary?
Request will be accepted only if in writing, change will be made only if premium are paid, change will be made immediately, request of the change will be refused
D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits?
Residual Benefit Clause
A disability income policy owner suffers s disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insured may cover the second disability without a new elimination period under the
Residual disability provision, Presumptive, partial, recurrent disability provision
A disability Income policyowner suffers a disability which was due to the same cause as a previous disabilty. Both disabilities occured within a five-month period. The insurer may cover the second disability wihthout a new elimination period under the
Residual disability provision, presumptive disability provision, partial , recurrent disability provision
When an insured has the same disability within a specified time period and the insurance company provides the same benefits without a new waiting period, the second disability is covered under which of the following benefits?
Residual disability, presumptive, repeat disability, recurrent disability
Which of the following provisions is NOT requires in HMO contracts/certificates
SEVEN DAY GRAC PERIOD
S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning
Sept 21, October 16, December 1, November 1
P is a producer who notices 5 questions on a health application were not answered. What actions should P take?
Set up a meeting with the applicant to answer remaining questions
Which of the following provisions is NOT required in HMO contracts/certificates
Seven day grace period
P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA laws, which of the following statements is TRUE?
She does need to provide evidence of insurability, she will have to wait 6 months to convert, she will be paying exactly the same premium for the individual plan, She does Not need to provide evidence of insurability
What is required in the Florida Health Care Access Act
Small group benefit plans are to be issued on a "contributory - issue basis", all small group benefit have 60 days grace period, all small group benefit plans have no lifetime benefit , small group plans are to be issued on a guaranteed-issue" basis
Under Florida law, which of the following provisions is NOT required in a Medicare Supplement policy?
Suitability form, Guranteed issue, free look period for 30 days, limitations on pre-existing conditions for up tp 12 months
G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills?
THE INSURED
Which of the following statement BEST defines usual, customary and reasonable charges
THE MAXIMUM AMOUNT CONSIDERED ELIGIBLE FOR REIMBURSEMENT BY AN INSURANCE COMPANY INDER A HEALTH PLAN
According to Florida law, in which of the following situations would be a dependent handicapped child not be covered under a Family health policy
THE PREMIUMS FOR THE HANDICAPPED CHILD MOT PAID
What is the elimination period of an individual disability policy?
TIME PERIOD A DISABLED PERSON MUST WAIT BEFORE BENEFITS ARE PAID
A Business Disabilty Buyout plan policy id designed
TO PAY BENEFITS TOT HE CORPORATION OF OTHER SHAREHOLDERS
Which of the following is considered an accurate statement of an unfair trade practice
TWISTING INVOLVES AN AGENT UUNG MISREPRESENTATION TO CONVINCE A POLICY OWNER TO CANCEL THERI CURRENT POLICY SO THAT THEY CAN PURCHASE A NEW LIFE INSURANCE POLICY WITH ANOTHER COMPANY
What kind of Accidental Death and Dismemberment (AD&D) insurance beneficiary requires his/her consent when a change of beneficiary is made?
Tertiary, primary, revocable, irrevocale
A policyowner's rights are limited under which beneficiary designation?
Tertiary, revocable, contigent, irrevocable
In Florida, agents are allowed to engaged in rebating if
The amount rebated stays below a maximum percentage an annual premium, transaction is reported to the IRS purpose, the insured gives written consent, offered to all insureds in the same actualrial class
The reason for a business having a Business Overhead Expense Disability Plan is to cover:
The cost of providing grp disability insurance, the owner's lost of income, all business related expenses and salaries, fixed business expenses
What does a Guaranteed Insurability rider provide a Disability Income policyowner?
The guarantee that the premium will never increase, The guarantee that policy will never be cancelled, the ability to periodically increase amount of coverage only with evidence of insurability, the ability to periodically increase the amount w/out evidence of insurability
What does a Guaranteed Insurabilty rider provide a Disabilty Income policyowner
The guarantee that the premiums will never increase,The guarantee that the policy will never be cancelled, the ability will perioddically increase the amount of coverage w/out evidence of insurability,
According to Florida Law, in which of the following situations would be a dependent handicapped child NOT be covered under the Family Health policy>
The handicapped child becomes a full time student
How would a contingent beneficiary receive the policy proceeds in Accidental Death and Dismemberment policy
The primary benefiary is a minor at the time of the insured's death, if the insured died of natural causes, the insured died of accidental causes, if the primary benefciary dies before the insured
Association Plans that are designed to provide health benefits to their members are regulated by the state because *they are insured by an authorized insurer *they conduct business in Florida *they provide a service to their members *they require a certain level of member participation
They are insured by the authorized insurer
Which if the following is NOT a consequence for placing business with an unauthorized insurer
Third degree felony, insurance license revoked, responsible for unpaid claims, first degree felony
Which of the following is NOT a consequence for placing business with an unauthorized insurer
Third degree, insurance licensed revoked, responsible for unpaid claims, first degree
Which of the following claims are typically excluded from Medical expense policies?
Treatment for alcohol addiction, treatment for mental illness, injuries sustained from automobile accident, intentionally self-inficted injuries
Life and Health Insurance policy are :
Unilateral contract: because one party makes a promise and the other party accept it
Which of these options can an individual use their medical flexible spending account to pay for?
Vitamins, household expenditures, cosmetic, prescription drugs
In a Disabilty Income policy, which of these clauses acts as deductible?
Waiver period, Deduction period ,Probationary, Elimination Period
Which of the following policy provisions prohibits an insurance company from incorporating external documents info an insurance policy?
Waiver, Exceptions and reductions, incontestable, entire contract
In regards to representation or warranties, which of these statements is TRUE?
Warranties are statements considered to be true to the best of the applicants belief, representation are statements guaranteed to be true in every respect, If material to the risk , false representation will NOT void a policy, If material to the risk, false representation will void a policy
At what point does an informal contract become binding>
When one party makes an invitation and the offer makes an offer, when an offer is made by one party and the other party rejects the other party, when one party requires payment. when one party makes an offer and the other party accepts that offer.
At what point does an informal contract become binding
When one party makes an offer and the other party accepts that offer
When must insurable interest be present in order for a life insurance policy to be valid?
When the insured dies, within the incontestabllity period, before the insured dies, when the application was made
An example or rebating would be
a mutual insurance company paying dividends, reducing the premiums, using intimidation, offering a client something of value not stated int the contract in exchange for their business
Information obtained from a phone conversation to proposed insured can be found in which of these reports
agents report, MIB report, attending physician, Inspection report
An example of an unfair trade practice is
an agent making a material misrepresentation to the insured
An example of an unfair trade practice
an agent writing less than 50% of their total sales from controlled business, replacing an old life insurance policy with a new one, denying payment of a claim w/in reasonable time, an agent making a material misrepresentation to the insured
An example of an unfair trade practice is :
an agent writing less than 50% of their total sales from controlled business, replacing an old life insurance policy with a new one, denying payment, an agent making a material misrepresentation to the insured
A Business Disability Buy out plan policy is designed
as incurred expense plan, with a very short elimination period, to pay benefits to the insureds spouse, the pay benefits to the Corporation or other shareholders
Which of these factors do NOT play a role in the underwriting of a health insurance policy
avocations, occupations, credit status, marital status
The Department of Financial Services serves as the receiver of any insurer placed into
bankruptcy, foreclosure, indeptness, receivership
In order to establish a Health Reimbursement Arrangenet (HRA), it must:
be offered in conjunction with other employer, limit the benefits, limit the amount of money , be established by the employer.
K applies for a life insurance policy on herself and submits the initial premium with the application. She is given a receipt by the agent stating that coverage begins immediately if the application is approved. What kind of receipt was used?
binding, initial premium, contigent, conditional
All of the following are limited benefits plans, Except:
cancer policies, dental , critical, life insurance policies
Which of the following is NOT limited benefit plan?
cancer policies, dental, critical, life insurance policy
Health Insurance benefits NOT covered due to act of war are
charged higher premium, given a longer probationary period, assigned to a reinsurer, excluded by the insurer in the contract provisions
An example of sliding would be
charging for an additional product without the applicant's consent
The percentage of an individuals PIA determines the benefits paid in which of the following programs
cobra, medicaid, medicare supplement, Social Security Disability Income
An agent who makes misleading statements that lead to the termination of an existing insurance policy so that a new policy with another insurer can be taken out has committed
coercion, rebating, defamation, twisting
Which health policy clauses specifies the amount of benefits to be paid
consideration, payment, free look, insuring
Insurance contract are known as ____ because certain future conditions or acts must occur before any claims can be paid:
consideration, unilateral, aleatory, conditional
A life insurance arrangement which circunvents insurable interest statutes is called
contract of adhesion, an indemnity contract, key person, Investor-Originated Life Insurance
A Business Overhead Expense policy
covers business expenses such as rent and utilities
Which of the following services is NOT covered under a hospitalization expense policy?
daily room, intensive care, miscellaneous, surgeons fees
Periodic health claim payments MUST be made at least
daily, weekly, annually, monthly
An example of unfair discrimination would be
declining an insurance application because of involvment of hazardous occupation, offering the same terns of coverage for different polcy owner issuing a policy bacuse for poor health, offering different terms of coverage for different policyowners having the same risk classification
Which of the following phrases refers to the fees charged a healthcare professional
deductible, coinsurance, hospital expenses, usual, customary and reasonable expenses
An underwriter determines that an applicant's risk should be recategorized due to a health issue. This policy may be issued with a(n)
delayed effective date, extended Contestable period, concealment clause, exclusions for the medical condition
Common exclusions to continuations of group coverage include
dental care, other prescription drugs, All of the above
Which of the following will a Long Term Care plan typically provide benefits for
disability income, death, unemployment, home health care
Which of the following will a Long Term Care plan typically provide benefits
disability income, death, unemplyment, home health care
Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine
driving history, if applicant is a tobacco user, overall health of the applicant, probability of making timely premium payment
A physician opens up a new practice and qualifies for a $7000. monthly Disability Income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow
extended term, cost of living , waiver premium, guaranteed Insurabilty option rider
Insurers/agents must, in Florida, offer and issue all small employee health plans on a basis
fair, non renewable, discounted, guaranteed issue
Insurers/agents must, in Florida, offer and issue all small employer health plans on
fair, nonrenewable, discounted, guranteed-issue
Insurers/Agents must, in Florida offer and issues all small employer health plans on a basis:
fair, renewable, discounted, guaranteed-issue
The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the
grace period, postponed period, elimination , waiting period
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called
guaranteed renewable, cancelable, conditionally renewable, noncancellable
How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment policy?
if the primary beneficiary is a minor at the time of the insureds death, the insured died of accidental causes, the insured died of natural causes, primary beneficiary dies before the insured
All of the following will result in the suspension of an agents license EXCEPT
intentionally misrepresenting the provisions of a policy, forging name of an insurance application, being convicted of a felony, acting with fiduciary responsibility
What is Medicare
is a hospital and medical expense insurance program
Which of these actions should a producer take when submitting an insurance application to an insurer?
issue a binding receipt to applicant if no initial premium submitted, disclose to the applicant the amount of commisions to be earned on transaction, arrange for a copy of the atteding physician statement to be sent to the producer, inform insurer of relevant information not included on the application
One definition of replacement is "the act of replacing an existing insurance policy with another Replacement is:
legal and requires no disclosure, not legal in florida, allowed only if the policy originated the state of Florida, closely regulated and requires full disclosure
One definition of replacement is "the act of replacing an existing insurance policy with another"
legal and requires no disclosure, not legal in the state for Florida, allowed only if the policy originated outside the state of Florida, closely regulated and requires full disclosure
Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?
limited, special risk , blanket, reinbursement
The phrase "This policy will only pay for a semi-private room" is an example of an
maximum policy limit, stop loss, participation percentage, internal limit
An insurance company normally has 2 years to contrast information provided on an accident and have an application. This 2 year period begins on the date that the
medical examination is given, producer completes the application, the firs premium was paid, insurer dates the policy
An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the
medical examination is given, producer completes the application, the first premium paid, insurers dates the policy
Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been issued, or after the policy has been in effect for a particular period of time
medical offset benefit, restoration of used benefit, reimbursement benefit, restoration of unused benefit
The benefits under a DisabilityBuy-Out policy are:
normally paid in installments, taxable to the beneficiary, normally paid after the elimination , payable to the company or another shareholder
An agent's license can be suspended or revoked by
not meeting annual sales, issuing a binding receipts, replacing an existing insurance policy with a new one, writing a controlled business
With Disability Income insurance, an insurance company may limit the monthly benefit amount a prospective policy holder may obtain because of the insured's
occupation at the time of purchase, gross income at the time of disability, monthly expidentures, gross income at the time of purchase
Medicare Part B does NOT cover
occupational therapy, physician and surgeons services, medical equipment, inpatient hospital services
An example of rebating would be
offering a client something of value not stated in the contract in exchange for their business
K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered
optionally renewable, conditionally renewable, noncanceble, guaranteed renewable
Consumer Reports requested by underwriter during the application process of a health insurance policy can be used to determined
overall health of the applicant, if applicant is a tobacco user, driving history, probability of making timely premium payments
Deductibles are used in health policies to lower
overuse of medical services
The Benefits under a Disability-buy-out policy are:
payable to the company or another share holder
The benefits under a Disability Buy-out policy are
payable to the company or another shareholder
Which of the following types of insured are life insurance companies allowed to make policy rate discrimination against
people with different religion, people that are married, people of different races, people that smoke
M completed an application for health insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect, Except
policy deilvered, insurance company issues policy, initial premium is collected, free look has expired
M completes an application for health insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT
policy is delivered, insurance company issues policy, initial premium is collected, free look has expired
A life insurance policy would be considered wagering contract WITHOUT
premium payment, agent solicitation, constructive delivery, insurable interest
Which of these statements concerning an individual Disability income policy is TRUE
premiums are normally tax deductible, age of the insurred determines the amount of benefits, benefits are normally taxable, normally includes elimination period
What is considered to be characteristic of a Conditionally Renewable Health Insurance policy
premiums may increase at a time of renewal
An accident policy will most likely pay a benefit for an :
self-inflicted injury, critical, on the job accident, off-the-job accident
Insurance policies are considered aleatory contracts because
they are take it or leave it, both parties consent on the contract, the contract is voidable upon proof of fraud, performance is conditioned upon a future occurence
An assignment of benefits of a Health Policy
transfers payments to someone other than the policyowner
Omitting information that affects the issuance or the rate of an insurance contract is called
twisting, coercion, sliding concealment
According to the Time Limit of Certain Defenses provision in an individual Health Insurance policy, nonfraudulent misstatements first become incontestable
two years from the date the policies was delivered, two years from the date of the first claim. two years after the collection of the initial premium, two years from the date of the policy was issued
Generally, how long is a benefit period for a Major Medical Expense plan
two, three, four, one year
Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy?
waiver, exceptions and reductions, inconstestable , entire contract
Which of these terms accurately defines an underwitters assessment of information of a health insurance application
warranty, insurabe, insepection, risk classification
In health insurance policies, waiver of premium provisions keeps the coverage in force w/out premium payment:
whenever an insured is unable to work, during the time an insured is confined in a hospital, following an accidental injury, after an insured has become totally disables as define in the policy
In health insurance policies , a waiver of premium keeps the coverage in force w/out premium payment
whenever the insured is unable to work, during the time an insured a confirmed in a hospital , following an accidental injury but not during sickness, after an insured has become totally disabled as defined in policy
