Life and Health
stop-loss limit
Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?
Health insurance solicitation
All of the following wold be legal activities for an HMO to engage in except
A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits
A deductible is
Guaranteed insurability option
An individual is purchasing a permanent life insurance policy with a face value of $25,000. While this is all the insurance that he can afford at this time he wants to be sure that additional coverage will be available in the future. Which of the following options should be included in the policy?
The company will continue to renew the policy until the insured has reached age 65
An insurance agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts the policy the insurer agrees that
LTC policies are marketed effectively to prospective insureds
Every insurer marketing Long term care insurance must establish marketing procedures to ensure all of the following except
By the member's- authorize insurers
How are state insurance Guaranty Associations funded?
A member of an HMO can receive care in or out of the HMO service area but care is preferred in the service area
How is emergency care covered for a member of an HMO?
Misrepresentation
On it's advertisement a company claims that it has funds in it's possession that are in fact not available for the payment of losses or claims. The company is guilty of
50/50
Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?
Must allow the policyowner to return the policy for a full refund
Regarding the free-lock provision, the insurance company
consideration
Something of value exchanged between the insurer and the insured is considered an
The insurer
The expense for an autopsy covered under the physical exam and autopsy provision is paid by
The policy contains sufficient cash value to cover the cost of insurance
The policyowner of a universal life policy may skip paying the premium and the policy will not lapse as long as
The original age is used for premium determination
What is the advantage of reinstating a policy instead of applying for a new one
Whole life
Which of the following types of insurance policies would perform the function cash accumulation
Face amount
Which policy component decreases term insurance?
At least every 5 years
How often must domestic insurance companies be examined by the chief financial officer in Florida
5 days
If a consumer requests additional info concerning an investigation consumer report how long does the insurer or reporting agency have to comply?
Conversion
If an employee terminates her employment which of the following provisions would allow her to continue health coverage under individual policy if requested within 31 days
90 days of loss
Under the uniform, required provisions proof of loss under a health insurance policy normally should be filed within
The attending physician will be paid a fee of 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
An agreement between a ceding insurer an assuming insurer
What is reinsurance
Send a written notification to the department of insurance
An insurance agent x has been found guilty of felony and was sentenced to 3 years in prison. What would be appropriate plan of action?
Exchange of unequal values
Which of the following best describes the aleatory nature of an insurance contract?
declare a pre existing condition
A 70 year old individual who bought a Part B Medicare policy 2 months ago just began kidney dialysis treatments this week. The individual is now applying for a medicare supplement policy which would begin in 8 months.which of the following could the insurer do to avoid paying for the dialysis
Controlled
An insurance producer just served an insurance policy to his sister, What kind of business is this?
The surviving beneficiary will continue receiving 2/3 of the benefit paid when both beneficiaries were alive
An insured has chosen joint and 2/3 survivor as the settlement option. What does this mean to the beneficiaries
Stop-loss limit
An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her for medical expenses. What term best describes the condition she has met?
who joined the group after the effective date
In a group health policy a probationary period is intended for people
It determines if the insurance policy is an MEC
What is the main purpose of the seven pay test
5 years
When a group policy terminates every individual insured under the policy will be entitled to have an individual policy if the insured has been insured by the group policy for at least how many years prior to policy termination
The medicare Part A deductible
Which of the following is not covered under Plan A in Mediagap insurance?
Family
A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of policy do they have?
5
A licensed agent must complete how many hours of continuing education in the agents line of authority every licensing period?
The full death benefit
A life insurance policy does not have a war clause. If the insured is killed during a time of war, what will the beneficiary receive from the policy ?
The policyholder
A person insured under a grou life insurance policy can make an assignment of all or any part of the incidents of ownership conferred on the insured by the policy or by law, to any of the following except
The cost of coverage is a deductible expense by the employer
An employer offers group life insurance to its employees for the amount of $10,000. Which of the following is true?
Decreasing term
An individual has just borrowed $10,000 from his bank on a 5 year installment loan requiring monthly payments. What type of life insurance policy would be best suited to this situation?
The pre existing condition waiting period fulfilled in the old policy will be transferred to the new policy the new one picking up where the old one left off
An individual purchased a Medicare supplement policy in march and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?
Single premium whole life
An insurance policy that only requires a payment of premium at it's inception provides insurance protection for the life of the insurer and matures of the insured's age 100 is called
The owner
In a life settlement contract whom does the life settlement broker represent
The method of premium payment
The insuring clause of a disability policy usually states all of the following except
12 months
Under special circumstances continuing education requirements may be extended beyond the 2 year period for a maximum period of
115 % of the regular group rate
The Florida health insurance coverage act requires insurers that sell health plans to small employees to offer in those plans a right to elect to continue coverage without providing evidence of insurability to employees who lose their coverage and are unable to replace it the premium rate for this coverage may not exceed
Subrogation
The legal process that gives the insurer after payment of loss the right to seek recovery from a third party that was responsible for the loss is known as
Issue of securities
The office of insurance regulation is responsible for all of the following insurer activities except
Copayment is a set dollar amount
What is the main difference between coinsurance and copayments
To help the insurance company to prevent overutilization of the policy
What is the purpose of coinsurance provisions
Absolute
What level of authority is given to the office of insurance regulation with respect to examination of insurers activities to determine compliance unfair trade practice laws
100 %
What percentage of a company employees must take part in a noncontributory group life plan?
Within 6 months of the effective date of coverage
When can a long term care policy deny a claim for losses incurred because of a pre existing condition
Discrimination
When twin brothers applied for life insurance from Company A, the company found that while neither of them smoked and a very similar life style one of the , 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
That it's policies are covered by the state Guaranty Association
Which of the following may not be included in an insurance company's advertisement?
Life expectancy
Which of the following terms means a result of calculation based on the average number of months the insured is projected to live due to medical history and mortality
Elderly insureds
Who does the secondary notice provision protect
The agent
Whose responsibility is it to determine if all questions on an application have been answered
Pay the policy proceeds only if it would have issued the policy
A prospective insured receives a conditional receipt but dies before the policy is issued. The insurer will
Unless the policy designated the current beneficiary as irrevocable the policyowner can make the change any time
A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would like to change the primary benefit to his sister. Which of the following is true?
$500
An insured is covered under 2 group health plans - under is own and his spouse's. He had suffered a loss of $20,000. After the insured paid the total of $500 in deductibles and coinsurance the primary insurer covered $1,500 of medical expenses. what amount if any would be paid by the secondary insurer?
Pay a special deductible on his major medical policy
Don has both a basic expense and major medical policy. He is inured in an accident which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?
Blanket
The First Street Church plans to sponsor a summer camp for the youth of their congregation. They would like to purchase insurance that would pay benefits should one of the youth get injured while participating in the camp activities. The type of policy they would likely need is a/an
Twisting
When an HMO knowingly makes any misleading representations incomplete or fraudulent comparison for the purpose of inducing any person to lapse, forfeit, terminate, surrender or convert any insurance policy or contract with another insurance company or HMO they are in violation of the unfair trade practice of
Life insurance with period certain
Which life insurance settlement option guarantees payments for the lifetime of the recipient but also specifies a guaranteed period during which if the original recipient dies the payment will continue to a designated beneficiary?
Notice regarding replacement
Which of the following documents must be provided to the policyowner or applicant during policy replacement?
Policyowner
Which of the following individuals must have insurable interest in the insured?
Providing a written comparison and summary statement
Which of the following is among the regulations set forth by the Florida Replacement Rule?
Fully insured status
Which of the following is an eligibility requirement for social security disability income benefits
It is solely a federally administered program
Which of the following is incorrect concerning Medicaid?
Agent C uses her license to write only business other than controlled
Which of the following would not be a violation of state insurance regulations
Certain groups of employees only
A taxed sheltered annuity is a special tax favored retirement plan available to
Unearned premiums are retained by the insurance company
According the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy except
Variable annuity
Which of the following products requires a securities license?
Annuitization period
In an annuity the accumulated money is converted into a stream of income during which time period?
Replacement rule
Which rule would apply if an agent knows an applicant is going to cash in an old policy and use the funds to purchase new insurance?
The insured over the age 64
Who does the secondary addressee provision protect