life insurance test study set
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
November 1
C is the policy owner of a comprehensive individual major medical policy C pays an annual premium which is due September 1 if she forgets to pay the premium and is hospitalized September 10 how will insurer handle this claim
Pay the claim in full minus the premium due
With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period?
Gives the policyowner additional time to pay past due premiums
I am headed annual life insurance premium payment due January 1 she died January 10 without making the premium payment what actually they should take
pay face amount minus the past due premium
Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine
probability of making timely premium payments
what does the policy owner provide to the insurer for validation that loss has occurred
proof of loss
which of these terms accurately defines an underwriter assessment of information on a health insurance application
risk classification. underwriting is another term
why must an accident and health insurance applicant answer all questions on the application
statements and representations on the application are pRt of the consideration for issuing a policy
what should insured do if the insurer does not send claims forms within the time. Set forth in a health policy claims forms provision
submit the claim in any form
The policy provision that entitles the insurance establish conditions the insured must meet while a claim is pending is
time limit on certain conditions
which of the following is not included in the policy face
Exclusions
Which Federal law allows an insurer to obtain an inspection report on a potential insured?
Fair Credit Reporting Act
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
File written proof of loss
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?
$0
S buys a $50,000 whole life policy with the 50,000 accidental death and dismemberment rider. S does 1 year late of natural causes . how much will the insurer pay the beneficiary
$50,000
what is the maximum percentage of control business an agent may produce
50%
which of the following statements BEST describes what the legal actions provision of an accident and health policy requires
An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed
When does a Probationary Period provision become effective in a health insurance contract?
At the policy's inception
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's age as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?
The insurer will adjust the benefit to what the premiums paid would have purchased at the insured's actual age
It is covered by a term life policy and does not make the required premium payment which was due August 1 and I September 15 what action with her insurer take
claim will be denied
C is a policy owner of a comprehensive individual major medical policy C pays an annual premium which os die september 1 if C forgets to pay the premium and is hospitalized september 10 how will the insurer handle this claim
pay the claim in full minus the premium due
The provision that defines to whom the insured will pay benefits to is called
payment of claims
The notice of claims provision requires a policy owner to
notify an insurer of a claim within a specified time
according to the mandatory uniform policy provision 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
31 days
an insured pays premium on an annual basis for an individual health insurance policy what is the minimum number of days for the grace period provision
31 days
monthly premium individual health insurance policies must provide a grace period of at least
10 days
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss.
15 days
which of the following provisions is not required and HMO contracts or certificates
7 day grace period
what is the initial requirement for an insured to become eligible for benefits under the waiver of premium provision
Insured must be under a physician's care
Which health policy clause specifies the amount of benefits to be paid?
Insuring
which of these statements accurately describes the waiver of premium provision in an accident and health policy
The Waiver of Premium provision waives the payment of premiums after the insured has been totally disabled for a specified period of time.
what is the purpose of the grace period
additional time to pay past due premiums (31 days)
a disability income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability the original neck injuring occurred before the application was taken 5 years prior the next injury was never disclosed to the insurer at the time of application how will the insurer handle this claim
claim will be paid and coverage will remain in force
K failed to pay a renewalable premium within the time granted by the insurer k then sends in a payment which the insurer subsequently accepts which policy provision specified that the coverage may be restored in this situation
reinstatement
P is blinded in an industrial accident. Which provision of his life insurance policy will pay a stated benefit amount?
Accidental Death and Dismemberment provision
An insured must notify an insurer of a medical claim within how many days after an accident?
20
and insurer must not find it insured of a medical claim within how many days after an accident
20
agents that have been licensed for more than six years must complete ___ hours of continuing education every two years
24 hours
within how many days should a licensee notify department of financial services after a change of address
30 days
A group plan was recently terminated in Florida how many days are covered individuals guaranteed coverage after a group plans termination
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?
31 days
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... Without being appointed how long is this period of time
48 months
Florida requires an insurance agent must complete ___ hours of continuing education on the subject of law ethics every two years
5
The option that provides an additional death benefit for a limited amount of time at the lowest possible cost is called
Accidental Death and Dismemberment rider (AD&D)
all of the following Entries are classified under the four principal areas of Florida insurance law except
An agent's commission
"A producer does not have the authority to change a policy or waive any of its provisions". The health provision that best describes this statement is called the
Entire Contract
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?
Entire Contract
which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy
Entire Contract
The sections of an insurance contract which limit coverage are called
Exclusions
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
Guaranteed renewable
T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take?
Increase her policy's coverage amount
which of the following are NOT managed care organizations
Medical Information Bureau (MIB)
which of these is not considered to be a right given to a policy owner
Modify a provision in the insurance contract
which of these is considered a mandatory provision
Payment of Claims
what is the purpose of the time of payment of claims provision
Prevents delayed claim payments made by the insurer
what is the purpose of the time of payment of claims provision
Prevents delayed claim payments made by the insurer. The purpose of the Time of Payment of Claims provision is to prevent the insurance company from delaying claim payments.
All of these are considered sources of underwriting information about an applicant EXCEPT
Rating Services
P is a producer who notices 5 questions on a life application were not answered. What actions should P take?
Schedule another appointment with the applicant to complete the unanswered questions
A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?
Send a notice to the MIB that the applicant was declined
the insuring clause
States the scope and limits of the coverage
Which of the following statements about the classification of applicants is INCORRECT
Substandard applicants are never declined by underwriters
which of the following BEST describes a short term medical expense policy
nonrenewable
which of the following factors is not considered when the Department of financial services determines if an agents home is an insurance agency
The amount of premium collected at this location.
in health insurance policies a waiver of premium provision keeps the coverage in force without premium payments
The waiver of premium provision keeps the coverage in force without premium payments if the insured has become totally disabled as defined in the policy.
T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called
Time Limit on Certain Defenses
The notice of claim provision requires a policy owner to
notify an insurer of a claim within a specified time
Ty found the claim on his accident and health policy after being treated for an illness then Sherance company believes that she misrepresented his actual health on the initial insurance application and is therefore the speed in the claims Vallidity The provision that now is the time. During the company may dispute a claim validity it's called
Time limit of certain defendent
what type of rider would be added to an accident and health policy if the policy owner wants to ensure the policy will continue if he she ever becomes totally disabled
Waiver of premium rider
which of the following statements describe what an accident and health policy owner may not do
adjust the premium payments
which of the following statements best describes what the legal action provision of an accident and health policy requires
an insurer must wait 60 days after proof of loss has been submitted before a law suit can be filed
Before a Health Policy is issued which of these components of the contract is required
applicants signature on application
A(n) __ of benefits of a health policy transfers payments to someone other than the policyowner
assignment
when does a probationary period provision become affective in the health insurance contract
at policy inception
s is the policyowner of a major medical policy the premiums are paid monthly and due on the 1st of each month . S fails to make september payment and is hospitalized october 15 when S files the claim for this hospitalization the insurer will likely
deny the claim
An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to
determine if the applicant is an acceptable risk by completing standard underwriting procedures
In Florida, an insurer domiciled and incorporated in this state is called a(n)
domestic company
Health insurance benefits not covered due to an act of war are
excluded by the insurer in the contract provision
health insurance benefits NOT covered due to an act of war are
excluded by the insurer in the contract provisions
An underwriter determines that an applicant's risk should be recategorized due to a health issue. This policy may be issued with a(n)
exclusion for the medical condition
after an insured gives a notice of loss what should he or she do it if the insured does not furnish forms
file written proof of loss
The financial services commission may hold hearings
for any reason deemed necessary
under an individual health insurance policy the time limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two years
from the date that the policy was issued
and insured is past due on his life insurance premium but it's still within the grace. What were the beneficiary receive the should die during the grace period
full face amount minus past due payment
which of the following provision specifies have a long term policy owners insurance coverage will remain in effect if the policy owner is not paid by the due date
grace period
which of the following provisions specifies how long a policies health coverage will remain in effect if the policy owner does not pay the premium when it is due
grace period
X is insured with a disability income policy that provides the coverage until the age of 65 this policy allows the insurer to change the premium rate for the overall risk class assigned which of these renewability features does this policy contain
guaranteed renewable
T applied for disability income policy and has a history of back injuries the insurer and issued the policy with a statement that excludes coverage for back injuries this statement is called
impairment rider
t applied for a disability income policy and has a history of back injuries the insurer issued the policy with a statement that excluded coverage for back injuries this statement is called
impairment rider
He owns an accident and health policy and notified her insurance she has chosen a less hazardous occupation under the change of occupation provision which of the following actions may her insurance company take
increase her policy coverage
the ____ clause indentified which losses resulting from an accident or sickness are insured by the policy
insuring
the ____ clause indentifies which losses resulting from an accident or sickness are insured by the policy
insuring
Did the beneficiary under her husbands ADND policy submits an accidental death claim on May 1, 2010 following his death however the company denied They claim to the basis that the death was due to natural causes she decides to talk to her parents honey what is the earliest date for taking legal action against ensure
july 1st 2010
Which type of plan normally includes hospice benefits?
managed care plans
which of these factors do NOT play a role in the underwriting of a health insurance policy
marital status
according to the time payment of claims provision the insured must pay disability income benefits no less frequently than which of the following options
monthly
A disability income policy that only the policy owner can terminate and which the rates would never go up as considered to be
noncancellable
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
noncancellable
What type of renewability guarantees premium rates and renewability?
noncancellable
