Most Missed Questions (Guarantee Exam)

What is the purpose of a benefit schedule? a) To provide the dates for the payment of benefits b) To list the insured's copayments and deductibles c) To state what and how much is covered in the plan d) To include the average charges for procedures

c) To state what and how much is covered in the plan

All of the following health insurance disability benefits are income tax free EXCEPT a) Employee-paid group disability b) Key-person disability benefits c) Personally-owned individual disability insurance d) Employer-paid group disability

d) Employer-paid group disability

Guaranteeing future dividends is considered to be unfair or deceptive act known as a) Twisting b) False financial statements c) Rebating d) Misrepresentation

d) Misrepresentation

Which of the following is NOT mandatory under the Uniform Provisions Law as applied to accident and health policies? a) Time Limit on Certain Defenses b) Physical Examination and Autopsy c) Entire Contract d) Probationary Period

d) Probationary period

What does the application of contract of adhesion mean? a) The holder of the contract has the ultimate power of promise b)The insurer may go to another for representation c)It makes sure the insured does not get more than the value of the loss d)Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured

d) Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured

Which of the following statements is NOT true regarding health insurance policy provisions? a) All additional provisions written by insurers are catalogued by their respective states b) All individual policies contain Universal Mandatory Provisions c) Insurers may only offer optional provisions that are allowed by the state where the policy is delivered d) Insurers may add provisions that are not in conflict with uniform standards

a) All additional provisions written by insurers are catalogued by their respective states

Which of the following scenarios would require than an insured is provided with a conversion option from group to individual LTC coverage? a)The insured had continuous coverage under the policy b) The insured employer was terminated c) The insured failed to pay premium payments on time d) The group policy was terminated

a) The insured had continuous coverage under the policy

Which of the following scenarios would require than an insured is provided with a conversion option from group to individual health insurance coverage? a) The insured had continuous coverage under the policy b) The insured employer was terminated c) The insured failed to pay premium payments on time d) The group policy was terminated

a) The insured had continuous coverage under the policy

A Major Medical Expense policy would exclude coverage for all of the following treatments EXCEPT a) Cosmetic Surgery b) Drug addiction c) Eye refractions d) Dental care

b) Drug addiction

All life and health policies must provide a clear and conspicuous disclaimer regarding the Insurance Guaranty Association on the face page of the policy. This disclaimer must do all of the following EXCEPT a) State that the insurer is prohibited by law from using the existence of the Guaranty Association for the purpose of solicitation or inducement of insurance b) Warn the policy holder that the Guaranty Association may not cover the policy c) State the name and address of the Life and Health Insurance Guaranty Association and insurance department d) State that the insurer and its agents are protected by the Guaranty Association in case of insolvency

d) State that the insurer and its agents are protected by the Guaranty Association in case of insolvency

Which of the following is true regarding copayment and coinsurance for services provided by a physical therapist under a health benefit plan? a) They can be higher than regular copayments under the policy b) They are a flat amount established by the insurer c) They are not allowed d) They must be the same as for the services of a primary care physician

d) They must be the same as for the services of a primary care physician

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA a)within 60 days b)Within 30 days c)Before termination is complete d)within 10 days

a) Within 60 days

All of the following are among the minimum maternity benefits required in health insurance policies in the state of Missouri EXCEPT a) 2 post-discharge visits by a registered nurse b) 3 post-discharge visits by a physician c) 48 hours of inpatient care after a vaginal delivery d) 96 hours of inpatient care after a C-section

b) 3 post-discharge visits by a physician

Outlines of coverage, delivered upon a Medicare supplement policy application, must include all of the following EXCEPT a) Statement identifying the outline as a summary of the policy b) Copy of the insurability clause c) Description of the benefits and coverage d) Statement of the renewal provisions

b) Copy of the insurability clause

All of the following are excluded from coverage in an individual health insurance policy EXCEPT a) Treatment received in a government hospital b) Mental illness c) Experimental procedures d) Purely cosmetic surgery

b) Mental Illness

When may HIV-related test results be provided to the MIB? a) Only when the test results are negative b) Only if the individual is not identified c) Under all circumstances d) When given authorization by the patient

b) only if the individual is not identified

If an insurer transacts insurance without first having received a Certificate of Authority, the insurer is guilty of a a) Misdemeanor b) Infraction c) Felony d) Capital Crime

c) Felony

Which of the following is NOT a required coverage in health insurance policies in Missouri? a) Bone marrow transplants b) Chemical dependency c) Mental retardation d) Immunization

c) Mental retardation

With respect to the entire contract clause in health 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

c) Only an executive officer of the company

What is the purpose of the impairment rider in a health insurance policy? a) To provide disability coverage b) To identify pre-existing conditions c) To exclude coverage for a specific impairment d) To cover impairments that otherwise could not be covered

c) To exclude coverage for a specific impairment

An insurance agent visits a potential client and explains various types of policies. The customer displays a lack of interest, so the agent guarantees higher dividends than he knows would be possible. Which term describes what the agent has done? a) Rebating b) Twisting c) Defamation d) Misrepresentation

d) Misrepresentation