Life & Health Exam

Aleatory

exchange of unequal amounts

6 years old

A child with phenylketonuria (PKU) will have its physician-recommended foods covered by a health insurance policy, provided the child is under what maximum age?

A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.

A deductible is

Critical illness

A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as

The dependent's incapacity for self-sustaining employment and the dependent's reliance on the policyholder for support and maintenance

A health policy will not terminate for a physically or mentally handicapped dependent upon that dependent's attainment of the limiting age only if which two conditions are demonstrated to the insurer?

The benefits will be coordinated.

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?

12

A licensed life insurance producer in Missouri completed 20 hours of continuing education credits in order to renew her license. How many hours of continuing education credit will this producer need to complete in order to renew her license the next term?

NAICS (North American Industry Classification System)

A long-term care insurance shopper's guide must be provided in the format developed by which of the following?

The insurance through his company is primary.

A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim,

6

Albert Jones, CPCU, has prepared an insurance course and obtained approval for the course for 6 hours of continuing education credits. Al presented this course to various agent groups during the continuing education term on four different occasions. How many continuing education credit hours may Al claim for his own license renewal?

At the moment of birth

All individual and group health insurance policies issued in this state that cover dependents of the insured must provide coverage for newborn children of the insured starting

Ask her to sign a statement of good health

An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery, the agent collects the applicant's premium check, answers any questions the applicant may have, and then leaves. What did he forget to do?

Workers Compensation

An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance?

Full benefits

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?

There is nothing wrong with this form of policy delivery.

An insured is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true?

10 days

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

Revocable

An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?

Consideration

An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?

First-dollar basis

Another term used to describe "no deductible" is

Rebating

Any inducement offered to the insured in the sale of an insurance policy that is not specified in the policy is an unlawful practice known as

Be appointed to represent at least one authorized insurance company.

Before the Director will issue a license, a person must meet all of the following qualifications EXCEPT - Be at least 18 years of age - File an application with the Director - Pass an examination for each line for which a license is sought - Be appointed to represent at least one authorized insurance company.

False advertising

Circulating deceptive sales material to the public is what type of Unfair Trade Practice?

American Cancer Society

Colorectal screenings performed under individual and group health policies are required to be in compliance with the standards set by which of the following organizations?

Employer-sponsored plan

Employer-provided group coverage; employees must meet service requirements and work full-time

30 days and the notice must be in writing.

Every producer licensed in Missouri must notify the Director of a change in his/her residence address within

Notify the insurer within 31 days in order for coverage to continue without any evidence of insurability

Fred and Jody are covered under a group health insurance plan at his place of employment. When Jody gave birth to their first child, what must he do in order to have coverage for their child?

Senior citizens above age 65

Health insurance policies are required to provide coverage for general anesthesia for dental care provided to all of the following EXCEPT - A severely disabled person - A person with a behavioral condition requiring hospitalization when dental care is provided - Senior citizens above age 65 - Children under age 5

From birth to age 5

Health policies issued in Missouri must provide coverage for the immunization of children of what age?

3 years

How long must an insurer retain an advertisement for its long-term care policies?

Within 90 days or as soon as reasonably possible, but not to exceed 1 year

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

The company can still be liable for its policies in any court of this state.

If a company has transacted insurance in this state without a Certificate of Authority, which of the following is true of its obligations for the policies sold?

Producer

If a person wants to sell, solicit, or negotiate insurance, which license must be obtained?

$100,000

If an insurer imposes a maximum lifetime benefit for breast cancer treatment using stem cell transplants, this limit must be at least

10

In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there?

The individual's employment was terminated.

In which of the following situations would an individual be permitted to exercise conversion privileges in a group health insurance policy?

A mammogram every year for women age 50 and over

Individual and group health policies in this state will cover which of the following procedures for women?

HSA (health savings account)

Individuals covered by a high deductible health plan can make a tax-deductible contribution to HSA, and use it to pay for out-of-pocket medical expenses

The applicant must experience a financial loss due to an accident or sickness that befalls the insured.

Insurable interest can be best described by which of the following?

Adhesion

Insurance policies are not drawn up through negotiations, and an insured has little to say about its provisions. What contract characteristic does this describe?

Benefit period

Length of time monthly disability benefit payments last

Alzheimer's disease

Long-term care insurance policies must cover which of the following? - All mental disorders - Treatment of alcoholism - Injuries caused by an act of war - Alzheimer's Disease

Benefit Limitations

Maximum benefits an insurer is willing to accept for an individual risk; based on percentage of insured's past earnings

Obtains from the Director a Certificate of Authority.

No insurance company may transact insurance business in Missouri unless it first

Intermediate care

Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care

Misrepresentation

On its advertisement, a company claims that it has funds in its possession that are, in fact, not available for the payment of losses or claims. The company is guilty of

Reciprocity

Paul is a producer in Kansas and wants to become a producer in Missouri. The Department will waive certain examination requirements, provided that Kansas would waive these same requirements if a Missouri producer sought licensure in Kansas. What term is used to describe this phenomenon?

Hospital indemnity

Provides a specific amount on a daily, weekly, or monthly basis while the insured is confined to a hospital

Coordination of Benefits (COB) provision

Purpose - avoid duplication of benefit payments and overinsurance when an individual is covered under multiple group health insurance plans establishes primary plan (responsible for providing full specified benefit amounts and secondary, or excess, provider (responsible for any additional benefits payable)

Change of beneficiary

Revocable: can be changed at any time Irrevocable: can only be changed with the beneficiary's consent

Recurrent disability

Specifies period of time during with the recurrence of an injury or illness will be considered a continuation of a prior disability

No later than 5 years from now

The Director has just finished examining a domestic insurer. When is the Director next required to examine that insurer?

A licensee age 65 or older.

The Director may waive the continuing education reporting requirements for any of the following, EXCEPT

The method of premium payment.

The insuring clause of a disability policy usually states all of the following EXCEPT

Entire contract clause

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

2 years

The time limit of certain defenses provision prohibits insurers from denying a claim due to misrepresentation, as long as the policy has been in force for at least

Monthly

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

Individual members of the group may select the level of benefits for their own coverage.

Underwriting a group health insurance plan that is paid for by the employer requires all of the following EXCEPT

The attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount.

What happens if a non-member physician is utilized under the Point-Of-Service plan?

It allows guaranteed acceptance of all applicants.

What is NOT a benefit of a POS plan?

A statement by the applicant that, upon discovery, would affect the underwriting decision of the insurance company

What is a material misrepresentation?

$100,000

What is the maximum amount a person guilty of an unfair method of competition or an unfair or deceptive act or a prohibited practice may be fined in any 12 month period?

200% of the commission paid for the servicing of the policy in the second year 30 day free look period

What is the maximum first-year commission that a producer may receive for the sale of a Medicare supplement policy?

Notify the requesting enrollee of the carrier's determination

What must a health carrier do within 72 hours of receiving a request for an expedited review?

Free-look period

What phase begins after a new policy is delivered?

The insurer is considered to be notified since the notification to agent equals notification to the insurer.

When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled?

Amounts payable under the policy will reflect the insured's correct age.

When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision

Adjust the benefit in accordance with the decreased risk.

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should

Discrimination

When twin brothers applied for life insurance from Company A, the company found that while neither of them smoked and both had a very similar lifestyle, one of the twins was in a much stronger financial position than the other. Because of this, the company charged him a higher rate for his insurance. This practice is considered

It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance.

Which of the following best describes the MIB?

Soliciting, negotiating or delivering insurance policies

Which of the following describes the duties of an insurance producer?

A list of available doctors

Which of the following does the Insuring Clause NOT specify?

Insurer

Which of the following entities can legally bind coverage?

Void any applicable policies

Which of the following is NOT among the actions that the Director could take after determining that an insurer has engaged in an unfair trade practice?

Group health insurance

Which of the following is NOT among the lines of authority for which an insurance producer may qualify in the state of Missouri?

Coverage for dependents

Which of the following is NOT an exclusion in medical expense insurance policies?

A lump-sum benefit payment option

Which of the following is a feature of a disability buyout plan?

They are available for an additional premium.

Which of the following is true regarding optional benefits with long-term care policies?

Plan A - Hospital Insurance, financed through payroll tax (FICA)

Which of the following must be present in all Medicare supplement plans? - Plan A - Foreign travel provisions - Outpatient drugs - Plan C coinsurance

The larger the percentage that is paid by the insured, the lower the required premium will be.

Which of the following statements is true regarding coinsurance?

The policy owner has the right to change beneficiaries in any case.

Which of the following statements regarding the Change of Beneficiaries Provision is false?

Termination of employment due to downsizing Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.

Which of the following would be a qualifying event as it relates to COBRA?

The group is assessed individually for insurability.

Which statement is NOT true regarding underwriting group health insurance?

All companies: authorized and unauthorized

Which type of insurers will be held liable for their actions in court?

Every company is required to establish marketing procedures.

Which types of insurance companies marketing long-term care insurance coverage must establish procedures to assure that any comparison of policies by its agents will be fair and accurate?

6 months

Within what time frame after the effective date of coverage of an individual long-term care policy may an insurer exclude coverage of a loss related to a pre-existing condition?

Dread disease policy

a variety of benefits for a specific disease such as cancer policy or heart disease policy

Occupational Coverage

benefits for illness, injury or disability resulting from accidents or sicknesses that occur on or off the job

Custodial care

care for a person's activities of daily living provided in an institutional setting or in the patient's home

Accident

coverage for disability, medical care, death or dismemberment resulting from an accident

Basic hospital expense coverage

covers hospital room and board, and miscellaneous expenses, such as lab and X-ray charges and medicines while insured is confined to a hospital

Skilled care

daily nursing and rehabilitative care provided by medical personnel

Notice of claim

insured must provide insurer with reasonable notice after loss. Notice is required within 20 days of loss, or as soon as possible

Adhesion (definition)

one party prepares the contract; the other party must accept it as is

Nonoccupational Coverage

only covers claims that result from accidents or sicknesses occurring off the job

Probationary period

period after the policy starts during which benefits won't be paid for illness-related disabilities

Consideration (definition)

premiums and representations on the part of the insured; payment of claims on the part of the insurer

Residual disabiliy

provides benefits for loss of income when person returns to work after total disability, but cannot yet work at a pre-disability level

Presumptive disability

specifies condition that qualify insured for full disability benefits

Mode

the more frequently premium is paid, the higher the premium

Elimination period

waiting period lasts from the onset of disability until benefit payments start