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b) High premiums. Catastrophic plans usually have lower monthly premiums and high deductibles
All of the following are features of catastrophic plans EXCEPT al Essential benefits b) High premiums. c) Out-of-pocket costs d) High deductibles
a) A specified period of time that a person joining a group has to wait before becoming eligible for coverage A probationary period is a waiting period that new employee would normally have to satisfy before becoming eligible for benefits.
The Probationary period is a) A specified period of time that a person joining a group has to wait before becoming eligible for coverage b) The number of days the insured has to determine if he/she will accept the policy as received c) The stated amount of time when benefits may be reduced under certain conditions d) The period of days that must expire after the onset of an illness before benefits will be earned.
b) Employee paid group disability income. When the employer pays for group premlums, they are tax-deductible to the employer. When the employee pays for a portion of the group disability premiums, they are not tax-deductible to the emplovee
Regarding health insurance, all of the following are tax-deductible EXCEPT a) Employer pald group Accidental Death and Dismemberment. b) Employee paid group disability income. c) Employer paid grgup health insurance. d) Emplover paid group Long-Term Care.
b) The gatekeeper To access the services of a specialist, a Health Insuring Company (HIC) member must receive a referral from their gatekeeper, also known as their primary care physician.
11 a Health Insuring Company (HIC) member seeks the attention ot a specialist, who is responsible for referring the member? a) Referrals are not required for specialist appointments. b) The gatekeeper c) The producer d) The HIC
a) Part A deductible. Plan A is the core benefits only and does not include coverage for Part A deductibles.
A core Medicare supplement polley (Plan A) wil cover all of the following expenses EXCEPT a) Part A deductible. b) The first 3 pints of blood. c) 20% of Part B coinsurance amounts for Medicare-approved services. d) Part A colnsurance.
d) Business Overhead Insurance
A dentist is off work for 4 months due to a disability. His dental assistant's salary would be covered by a) Disability Income. b) Key Employee Disability. c) Partnership Disability. d) Business Overhead Insurance
d) Cancer Specified or dread disease policies protect only against the disease specified in the contract, such as cancer or heart disease.
A dread disease policy would cover which of the following? a) Broken leg b) illness caused by exposure to chemicals c) Infection due to liposuction d) Cancer
b) Atleast 2 A formulary must include at least 2 drugs in each treatment category, but it is not required to include all drugs.
A formulary must include how many drugs in each treatment category? al Atleast one b) Atleast 2 c) At least 3 d) Any number of drugs
a) A benefit for each day the insured is in a hospital. Hospital confinement indemnity policies pay specific amounts that depend on the amount of time the insured is confined to the hospital.
A hospital indemnity policy will pay a) A benefit for each day the insured is in a hospital. b) Income lost while the insured is in the hospital. C) All expenses incurred by the stay in the hospital. d) Any expenses incurred by the stay in the hospital, minus coinsurance payments and deductibles.
c) usual, customary and reasonable The usual, customary and reasonable approach for determining insurance is based upon the fees normally charged for specific procedures in the geographic location where the services are provided
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range or tees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as... a) benefit schedule b) gatekeepers c) usual, customary and reasonable d) relative-value schedule
c) Coverage for cosmetic treatment Elective treatment for the improvement of the insured's appearance is not covered under the plan.
All of the following are usually provided under an employer group dental insurance plan EXCEPT a) The dental plan is typically written in conjunction with group health insurance. b) The dental plan places limits on such procedures as braces and appliances. c) Coverage for cosmetic treatment d) Preventive care for up to 2 visits per year.
a) Employer-paid group disability. Employer-paid group disability benefits are income taxable
All of the following health insurance disability benefits are income tax free EXCEPT a) Employer-paid group disability. b)Emplovee-paid group disability c) Key-person disability benefits § Personallv-owned individual disability insurance
c) An applicant for a resident license who was previously licensed In another state and whose license lapsed 2years ago. an application for a resident insurance agent license in this state within 90 days after the cancellation of the previous license
All of the following individuals may be exempt from the prelicensing education requirement for agents EXCEPT a) An applicant for a temporary insurance agent license. b) A person applying for a limited lines agent license. c) An applicant for a resident license who was previously licensed In another state and whose license lapsed 2years ago. d) An agent who is currently licensed and in good standing in another state who is moving to this state.
c) Both a deductible and coinsurance payments will be required. Major medical plans have blanket coverage, and high maximum Ilmits but require both a deductible and coinsurance after the claim is submitted. Accidents are covered without an elimination or waiting period.
An Insured recently received his major medical insurance policy. Only 20 days after the policy Issue, while recreational rock climbing, the insured suffered a fall that required hospitalization, surgery and physical therapy to repair his broken leg. Which of the following is true? a) The plan will not cover the expenses because the ellmination period is not satisfled. b) Only the surgery is covered under the plan. c) Both a deductible and coinsurance payments will be required. d) The plan will not cover the expenses due to the hazardous avocation.
d) 200% An agent's first-year commission is not allowed to exceed 200% of the renewal commission for servicing the policy in its second year.
An agent's first-year commission CANNOT exceed what percentage of the renewal commission for servicing a Medicare Supplement policy in its second year? a) 10% b) 50% c) 100% d) 200%
c) Offer the supplement policy on a guaranteed issue basis Once a person becomes eligible for Medicare supplement plans, and during the open enrollment period, coverage must be offered on a guaranteed Issue basis.
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do? a) Look at the applicant's medical history to decide what premium to charge b) Send the applicant to a doctor for a physical. Nothing can happen until they get the results. c) Offer the supplement policy on a guaranteed issue basis d) Exclude pre-existing conditions from coverage under the supplement policies
b) $5,000 FSAs are subject to "use-or-lose" rule; unused benefits do not carry over to the next year.
An emplovee has a Flexible Spending Account (FSA) with a $5.000 annual benefit. This year the employee used $3.000 available to the emplovee next vear? a) $7,000 b) $5,000 c) S3.000 d) $2,000
a) 23 employees Medical savings accounts (MSs) are only available to groups of 50 or fewer employees or a self-employed person.
An employee group with which of the following number of employees would qualify for a medical savings account? a) 23 employees b) 51 employees c) 101 employees d) Any number of employees
a) The annual open enrollment period. Group plans commonly have a 30-day open enrol Iment period once a year when employees can enroll without evidence of insurability. If enrolling at other time, the employee would find it necessary to provide evidence of insurability and could be declined.
An employee may enroll in an employer's group health plan when he/she Initially becomes eligible without proof of insurability. Should he/she enroll at another evidence of insurability is required EXCEPT at a) The annual open enrollment period. b) The first year anniversary of higher employment. c) The request of the employer. d) The anniversary of the policy
a) Within 60 days. The terminated emplovee must exercise extension of benefits under COBRA within 60 days of separation from employment
An employee that becomes ineligible for group coverage because of termination ot employment extension of benefits under COBRA a) Within 60 days. b) Within 30 days. c) Before termination is complete. d) Within 10 days.
b) June 1 The waiver of premlum provision is retroactive to the date of disability once the watting period has been satisfiled. Since the Insured is determined to be permanently totally disabled the waiting period will be met, regardless of the length, and therefore, the waiver of premium would start June 1, the date of disability.
An individual buys a disability policy May 1 with a waiver of premium rider. The insured becomes disabled June 1. it is determined the Insured is permanently totally disabled on July 1; and he receives his first benefit payment on July 15. When does the waiver of premium provision start? a) May 1 b) June 1 c) July 1 d) July 15
b) Captive agent. A captive/exclusive agent has agreed, by contract, to produce insurance business only for the insurer they are contracted with.
An insurance producer who by contract is bound to write insurance for only one company is classified as a/an a) Independent producer. b) Captive agent. c) Solicitor. d) Broker.
d) His lost income DIsability Income Insurance is designed to provide periodic payments when an insured is unable to work because of sickness or injury
An insured driver is involved in an accident in which he is disabled and his passenger and the other driver are disability income policy? a) The other driver's injuries b) His medical exenses c The passenger's d) His lost income
b) Fee for service in fee-for-service plans, providers receive payments for each service provided
An insured has a routine exam, blood work, and a follow-up appointment with a speclalist. The insured receives a bill for each service provided. What type of plan does the Insured have? a) Prepaid b) Fee for service c) indemnity d) Comprehensive
a) Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.
As it pertains to group health insurance, COBRA stipulates that a) Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense. b) Retiring employees must be allowed to convert their group coverage to individual policies. c) Terminated employees must be allowed to convert their group coverage to individual policies,
c) By the last day of their birth month After initial requirements, agents must continue to renew their licenses biennially, on the last day of their birth month.
By what date in each licensing period are agents required to renew their license? a) By the date CE courses are completed b) By the license issue anniversary date c) By the last day of their birth month d) By December 31
b) The applicant's earned income. The amount of benefit that the insurance company will issue is based upon the applicant's net earned income. In order to prevent over-insurance, most companies do not pay benefits that exceed a percentage of the Insured's net earned income.
Disability benefits are calculated based on a) An amount agreed upon by the insurer and insured. b) The applicant's earned income. c) The applicant's net worth. d) The average salary for the applicant's occupation.
d) 100 Treatment in a skilled nursing facility is covered in full for the first 20 days. From days 21 to 100, the patient must pay the dally copayment. There are no Medicare benefits provided for treatment in a skilled nursing facility beyond 100 days.
For how many days of skilled nursing facility care will Medicare pay benefits? a) 30 b) 60 c) 90 d) 100
a) Service The HIC provides benefits in the form of services rather than in the form of reimbursement for the services of the physician or hospital
HICs are known as what type of plans? a) Service b) Health savings c) Consumer driven d) Reimbursement
d) The number of days confined in a hospital. Hospital indemnity/hospital confinement indemnity policy provides payment based only on the number of days confined in a hospital.
Hospital indemnity/hospital confinement indemnity policy will provide payment based on a) The type of illness. b) The premiums paid into the policy. c) The medical expense incurred. d) The number of days confined in a hospital.
b) Within 10 days of when the policy was delivered The free look period begins at the time the policy is delivered.
If an Insured is not entirely satisfled with a policy issued, the insured may return it to the insurance company and receive a refund of the entire premium paid, at which of the following times? a) Within 10 days of when the Insurer received the first premium b) Within 10 days of when the policy was delivered c) Before any claim has been filed on the policy d) Within 10 days of when the policy was issued
d) Express authority. Express authority is legitimate authority written into an agent contract.
If an agent follows the rules and terms of his agent contract, he is exercising his a) Apparent authority. b) Contractual authority. c) Implied authority. d) Express authority.
c) Charge an extra premium. The premium rate will be adjusted to reflect the insurer's increased risk.
If an applicant for a health insurance policy is found to be a substandard risk, the insurance company is most likely to a) Lower its insurability standards. b) Refuse to Issue the policy. c) Charge an extra premium. d) Require a yearly medical examination.
b) 48 hours Insurers must respond to prior authorization requests for urgent care services no later than 48 hours from the request submission. All other requests must be responded to within 10 days.
If prior authorization for urgent care health services is required, how soon from a request must an insurer approve or deny the appeal a 24 hours b) 48 hours c) 72 hours d) 10 days
d) Taxation of benefits The taxation status of benefits Is often determined by whether the premlums had been taxed.
If the Insurance premlums were not tax deductible, what other taxation will this affect al Taxation of interest b) Taxation of the policy's cash value c) Federal income tax d) Taxation of benefits
b) Prevent overinsurance. Coordination of Benefits provision is used to prevent or minimize over-Insurance. Usually, under Coordination of Benefits provisions, one Insurance policy is primary and the other is secondary. The primary policy pays first. Expenses not covered by the primary, but covered under the secondary may be collected, but only after the primary has paid its Ilmit.
In group insurance, the primary purpose of the Coordination of Benefits provision is to a) Encourage hospitals to keep their charges reasonable. b) Prevent overinsurance. c) Prevent lawsuits between insurance companies Involved in the claim. d) Ensure the payment of claims by all policies that are in effect at the time of the claim.
a) Has been active for five years minimum.
In order for an alumni assoclation to be ellgible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the association a) Has been active for five years minimum. b) Has a constitution, by-laws, and must hoid at least annual meetings. c) Is organized for reasons other than buying insurance. d) Has at least 100 members.
b) If an individual is in debt to a specific creditor, payments will be made for him/her until the return to work. A credit disability policy is issued only to those in debt to a specific creditor. In case of disability, payments to the creditor will be made for them until able to return to work by the definition in the policy.
In which of the following cases would a credit disability policy be issued? a) If an insured has filed bankruptcy and his premiums are waived, he can be issued a credit disability policy. b) If an individual is in debt to a specific creditor, payments will be made for him/her until the return to work. c) If a person receives disability benefits, he or she is eligible for credits on their group policies for future disabilites d) A person receiving disability benefits cannot receive a credit disability policy.
a) High deductible health insurance Participants in a medical savings account cannot have Medicare or any other health coverage that is not a high deductible health plan.
Medical Savings Accounts (MSAs) are available to small business employees and self-employed individuals who have a) High deductible health insurance b) Medicaid c) No health insurance. d) Medicare.
a) Private Duty Nursing Private duty nursing is not covered under Medicare Part A.
Medicare Part A services do NOT Include which of the following? a) Private Duty Nursing b) Post hospital Skilled Nursing Facility Care c) Hospitallzation d) Hospice Care
c) Long-term care services. Medicare does not cover long-term care services.
Medicare Part B covers all of the following EXCEPT al Home health visits b) Outpatient hospital services c) Long-term care services. d) Doctor's services
c) Those with low income and low assets. Medicare is a federal program for those over 65, those that have been on Social Security for 2 years, and those with permanent kidney failure. Assets and income have nothing to do with Medicare eligibility.
Medicare is a health insurance program for all the following individuals EXCEPT a) Those with permanent kidney failure b) Those who have been on Social Security Disability for 2 years. c) Those with low income and low assets. d) Those 65 or over.
b) Attending physician Home health care is care provided in one's home and could include occasional visits to the person's home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice. Home health care might include physical therapy and some custodial care such as meal preparations.
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? a) Community-based organization professionals b) Attending physician c) Registered nurses d) Licensed practical nurses
c) The spouse of the policyowner
On a health insurance application, a signature is required from all of the following individuals EXCEPT a) The policyowner. b) The agent. c) The spouse of the policyowner d) The proposed insured.
d) The beneficiary Is then responsible for a portion of prescription drug costs. Once the initial benefit limit is reached, the beneficlary is responsible for paying 25% of prescription drug costs.
Once the initial benefit limit in Medicare Part D is reached, how is the beneficiary affected? a) The beneficiary is then responsible for 75% of prescription drug costs. b) The beneficiary is no longer responsible for prescription drug costs. c) Medicare Part A will cover all costs d) The beneficiary Is then responsible for a portion of prescription drug costs.
b) Not included in the "entire contract" The agent's statement is not included in the "entire contract
Only the agent is involved in completing the agent's report. The agent's statement is a) Included in the "entire contract" b) Not included in the "entire contract" c) Only Included in the "entire contract" if it provides information upon which the underwriting decision was made. d) Usually included in the "entire contract
a) A flat amount. Group disability plans usually specify the benefits based on a percentage of the worker's income, while individual policies usually specify a flat amount.
The benefits for individual disability plans are based on a) A flat amount. b) The employer's net worth. c) The number of employees of the company. d) A percentage of the worker's income.
b) 6 credits. To be considered partially insured, an individual must have earned 6 credits during the last 13-quarter period.
The minimum number of credits required for partially insured status for Social Security disability benefits is 4 credits. b) 6 credits. c) 10 credits. d) 40 credits.
d) Protect consumers against the circulation of inaccurate or obsolete personal or financial information The Fair Credit Reporting Act is administered by the Federal Trade Commission. The purpose of the law is to protect consumers against the circulation of inaccurate or obsolete information and to ensure that consumer reporting agencies are fair and equitable in their treatment of consumer
The purpose of the Fair Credit Reporting Act is to a) Protect the insurer from adverse selection b) Ensure the consumers recelve a copy of investigative consumer reports. c) Ensure coverage for all applicants. d) Protect consumers against the circulation of inaccurate or obsolete personal or financial information
c) Integrated dental plan, When dental coverage is covered under the benefits of a major medical plan, the dental coverage and medical coverage would be an integrated plan. Any deductible amount can be met by either dental or medical expenses.
The type of dental plan which Is incorporated into a major medical expense plan is a/an a) Stand-alone dental plan. b) Blanket dental plan. c) Integrated dental plan, d) Supplemental dental plan.
c) Groups of one or more Legislation that took effect in July 1997 ensures portability of group insurance coverage and includes various required benefits that affect small employers, the self-employed, pregnant women, and the mentally ill. HIPAA applies to groups of two or more.
Under HIPAA portability, which of the following are NOT protected under required benefits? a) Pregnant women b) Mentally ill c) Groups of one or more d) Self-employed
c) 60 days Unless specifically stated otherwise, individuals or enrollees have 60 days from the date of a triggering event to select a qualified health plan.
Under the Affordable Care Act, a speclal enrollment period allows an individual to enroll in a qualifled health plan within how many days of a qualifying event? a) 10 days b) 30 days c) 60 days d) 90 days
c) Metal level classification Plans other than self-insured plans will be classified into four levels determined by how much of one's expected health care costs are covered. The four plans are bronze, silver, gold, and platinum. This is called metal level classification.
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs? a) Grandfathered and nongrandfathered b) Risk classification c) Metal level classification d) Guaranteed and nonguaranteed
a) Respond to the consumer's complaint. The consumer has the right to request the information on the report, the reasons for turn down and any adverse underwriting decisions. The reporting agency Is required to responchoine consumers compancancinecessanoreinvestigare the report
Under the Fair Credit Reporting Act. If a consumer challenges the accuracy of the information contained in a consumer or investigative report, the reporting agency must a) Respond to the consumer's complaint. b) Defend the report If the agency feels it is accurate c) Change the report. d) Send an actual certified copy of the entire report to the consumer.
c) How much are you able to pay in premiums? Every insurer marketing long-term care insurance coverage must establish marketing procedures to ensure that any comparison of policies will be fair and accurate, excessive insurance will not be sold, and every reasonable effort is made to identify whether a prospective applicant for long-term care insurance already has accident and health or long-term care insurance, and the types and amounts of any such insurance.
Under the long-term care marketing regulations, which of the following questions would a producer NOT have to ask the applicant in order to determine if the purchase is suitable? a) Are you planning to replace an existing health insurance? b) What is the amount of your existing health or long-term care insurance? c) How much are you able to pay in premiums? d) Do you currently have any Medicare supplement policies?
a) Assignment Pairing Token: dd6e-27cd
What is it called when a doctor accepts the Medicare approved amount? a) Assignment b) Consent c) Verification d) Acceptance
b) Conditionally renewable
What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur? a) Guaranteed renewable b) Conditionally renewable c) Optionally renewable d) Noncancellable
c) In franchise Insurance underwriting Is done for each person. Franchise Insurance provides health coverage for small groups that do not qualify for true group coverage. in franchise insurance Individual policies are issued for each participant, Individual underwriting is done for each person, and each participant submits his or her own application and medical history.
What is the main difference between franchise and group insurance? a) Franchise Insurance charges smaller premiums than group insurance. b) In franchise Insurance participants do not need to submit their applications. c) In franchise Insurance underwriting Is done for each person. d) Franchise Insurance provides coverage for large groups.
c) $300,000
What is the maximum amount the Insurance Guaranty Assoclation will pay in benefits to any one individual (unless the benefits are for basic hospital, medical, and surgical insurance and major medical insurance)? a) $100,000 b) $250,000 c) $300,000 d) $500.000
a) Medicare SELECT policies contain restricted network provisions! Unlike Medigap policies, Medicare SELECT policies contain restrictive network provisions. In exchange for using network providers, insureds are able to pay lower premiums
What is the primary difference between Medigap and Medicare SELECT policles? a) Medicare SELECT policies contain restricted network provisions! b) Medigan policy premiums are lower. c) Medicare SELEC Agolicies cover the first 3 pints of blood. d) Medigap policies provide coverage for core benefits.
d) Reciprocal insurers Sharing is a method of dealing with risk for a group of individual persons or businesses with the same or similar exposure to loss to share the losses that occur within that group. A reciprocal insurance exchange is a formal risk-sharing arrangement. When insurance is obtained through a reciprocal insurer, the insureds are sharing the risk of loss with other subscribers of that reciorocal.
What type of insurer uses a formal sharing agreement a) Stock insurers b)Mutualinsurers c) Fraternal Benefit Societies d) Reciprocal insurers
c) Visits by a registered nurse The following services may be provided: linens and personal laundry service, assistance with dressing and bathing, reminders regarding medication, assistance with eating. Assisted living offers nonmedical assistance
What types of services may NOT be provided under the long-term care's assisted living care? a) Assistance with dressing and bathing b) Reminders regarding medication c) Visits by a registered nurse d) linens and personal laundry service
d) The new document must be filed with the Director for approval. Any changes in a health insuring corporation's solicitation document must be filed with the Director. The Di document or amendment to it on any grounds
When a health insuring corporation makes changes to its solicitation document, which of the following requirements must be met? a) The new document must be filed with the Director. b) The old document must be discarded and the new one put in circulation. c) The new document must be approved by all participating physicians. d) The new document must be filed with the Director for approval.
b) The Insurer's It is ultimately the insurer's responsibility to determine if an applicant already has an accident or sickness policy in force.
When an applicant applies for Medicare supplement insurance, whose responsibi is it to confirm whether the applicant has an accident or sickness insurance policy in force? a) The soliciting agent's b) The Insurer's c) The applicant's d) A primary care physician's
c) Only if the Individual is not Identified Insurance companies must maintain strict confidentiality regarding HIV-related test results or dlagnoses. Test results may not be provided to the MIB If the individual is identified.
When may HIV-related test results be provided to the MIB? a) When given authorization by the patient b) Only when the test results are negative c) Only if the Individual is not Identified d) Under all circumstances
b) Income lost by the insured's inability to work Disability benefits are paid to those who are unable to work as they normally would, due to an accident or illness. Benefits are designed to help the insured recover income lost as a result of the disability. The amount of benefits that an insured receives is determined by the insured's earned income and is usually limited to a certain percentage of that amount.
Which benefits would a disability plan most likely pay? a) medical expenses associated with a disability b) Income lost by the insured's inability to work c) Rehabilitation costs d) Copayments
c) Insurability Medicald Is a program operated by the State, with some Federal funding, to provide medical care for those in need. To quality for Medicald, a person must be poor or become poor, be a U.S. citizen or permanent resident allen, and must meet other quallflers, some of which are blind, disabled, pregnant, over 65, or caring for children receiving welfare benefits.
Which of the following Is NOT a Medicald quallfler? a) Age b) Residency c) Insurability d) Income level
d) Offering an inducement of something of value not specified in the policy Rebating is offering anything of value that is not specifled in the policy as an inducement to purchase insurance.
Which of the following best defines the unfair trade practice of rebating? a) Making statements that misrepresent an Insurance policy in order to induce an insured to replace the policy b) Charging premium amounts in excess of the amount stated in the pollcy c) Making false statements that are maliciously critical and intended to injury another person in the business of insurance d) Offering an inducement of something of value not specified in the policy
a) A disability that results in the insured being unable to work at their regular job even though they may be able to perform the dutles of another occupation, The definition of "own" occupation means the insured is unable to perform their regular job, but could work or be retrained to perform other jobs.
Which of the following defines "own occupation disablilty with respect to disability income insurance? a) A disability that results in the insured being unable to work at their regular job even though they may be able to perform the dutles of another occupation, b) Any disability that requires home confinement c) A disability caused by an infectious disease that, should the insured return to work, would cause the disease to spread d) A disability resulting from an accident while on the job
b) Students at a public school Blanket insurance is issued on those groups that have members that are constantly changing
Which of the following groups would most likely be covered under a blanket accident policy? a) Independent contractors who work for a general contractor b) Students at a public school c) Office workers for a retail business d) Factory workers at the automobile assembly plant
d) Income Unlike life insurance, which works with a very limited number of claims, health Insurance can process a large number underwriting is so important. The three major categories that an underwriter considers in health insurance are the hazards, and the risk level associated with the potential insured's occupation.
Which of the following is NOT a crucial factor in health insurance underwriting? a) Physical condition b) Morale hazards c) Occupation d) Income
c) Child day care
Which of the following is NOT a typical type of Long-Term Care coverage? a) Residential care b) home health care c) Child day care d) skilled nursing care
a) Experimental infertility services Basic services provided under a Health insuring Corporation (HIC) does not include experimental procedures or services
Which of the following is NOT considered a basic service under a Health Insuring Corporation (HIC)? a) Experimental infertility services b) Well-child care c) Therapeutic radiologic services d) Periodic physical examinations
a) If paid by the individual, the premiums are tax deductible. Premlum payments on personally owned disablty Income policles are non-deductible by the individual However, disablty income benefits are received income tax free by the individual.
Which of the following is NOT correct concerning taxation of disability income benefits? a) If paid by the individual, the premiums are tax deductible. b) If the employer paid the premiums, income benefits are taxable to the insured as ordinary income. c) If the insured pald the premiums, any disablity income benefts are tax free. d) If the benefits are for a permanent loss, they are not subject to income taxation no matter who paid the premium.
d) The chief administrator of the insurer is called an "attorney-in-fact". A "reciprocal" is an unincorporated aggregation of individuals, called subscribers, who exchange insurance risks. If the premiums charged for coverage are not sufficient to pay the losses of the group, subscribers may be assessed an additional premium. A reciprocal is administered by an attorney-in-fact who is empowered to bind each subscriber to assume a share of the losses of the group.
Which of the following is a characteristic of a Reciprocal Insurance Exchange? a) Normally write all lines of insurance b) Stock holders share in any profits c) issues nonassessable policies d) The chief administrator of the insurer is called an "attorney-in-fact".
c) Its goal is to channel patients to providers that discount services. Insureds are treated by providers who have agreed to discount their charges.
Which of the following is true of a PPO? a) Claim forms are completed by members on each claim. b) No copayment fees are involved. c) Its goal is to channel patients to providers that discount services. d) The most common type of PPO is the staff model.
b) Custodial care Custodial care is care for meeting personal needs such as assistance in eating, dressing,
Which of the following meets the insured's personal needs, and is provided by nonmedical personnel? a) Intermedlate care b) Custodial care c) Skilled care d) assisted living
c) Medicaid Medicald is a "needs" tested program administered by the states to provide assistance to persons who are not able to provide for themselves.
Which of the following programs expands individual public assistance programs for people with insufficient income and resources? a) Social Security b) Unemployment compensation c) Medicaid d) Medicare
b) Root canal Endodontics involves the treatment of dental pulp within natural teeth, such as root canal.
Which of the following services would be covered by endodontics? a) Replacement of missing teeth b) Root canal c) Tooth extraction d) Treatment of gum disease
a) It is an unfair trade practice to mention the Association in advertisements. It is an unfair trade pl ractice to make any statement that an insurer's policies are guaranteed by the existence of the Insurance Guaranty Association.
Which of the following statements Is TRUE regarding advertising that the Insurance Guaranty Association would ensure payment of benefits in the event of insurer insolvency? a) It is an unfair trade practice to mention the Association in advertisements. b) Insurers may choose whether to mention the Association in advertisements, but if they choose to do so, they must first pay a fee to the Association. c) If insureds join the Association, they will be protected financially if their insurers become insolvent. d) All advertisements of an insurer must mention coverage oy the Association.
b) Each individual must be accepted into or rejected by a group policy. the group's risk profile determines whether the group will be accepred or rejected. As with any type of underwriting, the underwriter tries to avoid adverse selection.
Which of the following statements is INCORRECT regarding group health insurance? a) in group insurance, the underwriter evaluates the group as a whole rather than each individual member b) Each individual must be accepted into or rejected by a group policy. c) To be eligible for group insurance, an employee must be considered a "full-time" emplovee d) costs are generally lower for group health insurance than individual health insurance.
c) It requires all employers, regardiess of the number or age of employees, to provide extended group health coverage COBRA Act applies to only employers with 20 or more employees.
Which of the following statements is NOT correct concerning the COBRA Act of 19857 a) It applies onlv to employers with 20 or more employees that maintain group health Insurance plans for employees. b) COBRA stands for Consolidated Omnibus Budget Reconciliation Act. c) It requires all employers, regardiess of the number or age of employees, to provide extended group health coverage d) It covers terminated employees and/or their dependents for up to 36 months after a qualifying event.
a) Excessive benefits may be taxable. Regardless of whether or not the insured can deduct individual long term care premiums, the benefits are received Income tax free by the Individual. Excessive benefits as determined by statute are taxable as ordinary income.
Which of the following statements is correct concerning taxation of long-term care insurance? a) Excessive benefits may be taxable. b) Benefits may be taxable as ordinary income. c) Premiums may be taxable as income. d) Premiums are not deductible in any case.
b) The mode of the premium payment The grace period is 7 days on a policy with a weekly premium mode: 10 days if a monthly premium mode; 31 days on other premium modes.
Which of the following will vary the length of the grace period in health insurance policies? a) The term of the policy b) The mode of the premium payment c) The length of any elimination period d) The length of time the insured has been insured
c) Massage therapy Massage therapy Is not a supplemental benefit of Medicare Advantages plans. Other exclusions include, but are not limited to, smoke detectors, cosmetic ser electronic medical records, stand-alone memory fitness benefits, and case management services.
Which of the following would be EXCLUDED from supplementary benefits under a Medicare Advantage Plan? a) Meals b) Health education c) Massage therapy d) Physical exams
b) A member received multiple small lacerations from falling debris. Urgent care services provide for unforeseen conditions that require immediate medical attention but do not threaten life, limb, or permanent health of the inured or ill
Which of the following would be an appropriate reason to use urgent care services when seeking medical attention under Health Insuring Corporation coverage? a) A member fell and received a malor concussion. b) A member received multiple small lacerations from falling debris. C) A member was bitten by a poisonous animal d) A member went into anaphylactic shock as a result of an allergic reaction.
b) The applicant has a prior felony conviction. When an insurer and insured enter into a contract, both parties must be of legal age and mentally competent. It is legal for a person convicted of a felony to buy an Insurance contract. An Intoxicated person, however, may not be mentally competent, a 12-year-old student is considered to be underage in most states and a person under mind-impairing medication most likely would not be mentally competent.
Which of the following would qualify as a competent party in an insurance contract? a) The applicant Is under the Influence of a mind-impairing medication at the time of application. b) The applicant has a prior felony conviction. c) The applicant Is intoxicated at the time of application. d) The applicant is a 12-year-old student
b) Additional Monthly Benefit This rider pays income benefits during the six-month waiting period before Social Security disability benefits begin
Which rider, when added to a disability policy, pays income during the six month waiting period before Social Security benefits can begin? a) Coordination of Benefits b) Additional Monthly Benefit c) Cost of Living d) Waiver of Premium
b) Medicare SELECT Medicare SELECT policies require insureds to use specific healthcare providers and hospitals, except in emergency situations. In return, the insured pays lower premium amounts.
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations? a) Preferred b) Medicare SELECT c) Medicare Advantage d) Medicare Part A
c) Reciprocal insurance Reciprocals are insurance companies made up of subscribers, who are collectively known as a Reciprocal Insurance Company or Exchange. These types of companies are administered by an appointed Attorney in Fact.
Which type of insurance is based on mutual agreements among subscribers? a) Limited liability b) Reinsurance c) Reciprocal insurance d) Mutual insurance
c) Only an executive officer of the company No changes may be made to the policy without the express written agreement of both parties, and any changes must also be made a part of the contract. Only an executive officer of the company, not an agent, has authority to make any changes to the policy.
With respect to the entire contract clause in heath policies, who has the authority to make changes to an existing policy? a) Solely the policyowner b) Changes cannot be made on the policy. c) Only an executive officer of the company d) Solely the producer
d) increased With a conditionally renewable policy, the insurer may terminate the contract only for certain conditions that ar re stipulated in the contract. in addition, the policy premiums may be increased
with a conditionally renewable policy, the premlums are more likely to be a) Decreased b) variable c) flexible d) increased