Health Insurance

Contributions to a traditional IRA in 2012 are limited to:

$5,000.

Business health insurance can be divided into two separate categories:

(1) employee benefit plans and (2) business continuation plans.

Medicare Part B includes all of the following EXCEPT: (A) hospitalization (B) Ambulance service. (C) x-rays. (D) medical equipment rental.

(A) Hospitalization

Which of the following statements about the Benefit Period in a disability income policy is correct? (A)The shorter the Benefit Period, the lower the premium. (B)The longer the Benefit Period, the lower the premium. (C)The Benefit Period will not begin until the first year after the Waiting Period is over. (D)The Benefit Period will not begin until the second year after the Waiting Period is over.

(A) The shorter the benefit period, the lower the premium.

All of the following statements about Medicare supplement (Medigap) policies are correct EXCEPT: (A) Medigap policies supplement Medicare benefits. (B) Medigap policies cover the cost of extended nursing home care. (C) Medigap policies pay most, if not all, Medicare deductibles and copayments. (D) Medigap policies pay for some health care services not covered by Medicare.

(B) Medigap policies cover the cost of extended nursing home care.

An HMO is required to provide for all of the following EXCEPT ______________ services. (A) emergency (B) preventive (C) prescription drug (D) physicians'

(C) Prescription drug

Which of the following services are provided under Medicare? (A) Inpatient hospital services, (B) Physicians' and surgeons' services in a hospital or clinic, (C) Hospice benefits (D) Home health care (E) Inpatient hospital services, physicians' and surgeons' services in a hospital or clinic, Hospice benefits, and home health care

(E) Inpatient hospital services, physicians' and surgeons' services in a hospital or clinic, Hospice benefits, and home health care

HMOs include all of the following EXCEPT: (A)copayments. (B)coverage for diagnostic surgery. (C)coverage for preventive care services. (D)subscribers can choose any doctor of their choice and full benefits will be payable.

(d)

A guaranteed insurability clause can be attached to which of the following types of health policies?

...

________ of the FICA tax is distributed to Medicare (2012).

1.45%

Agent Corrine accepts a premium for a lapsed disability policy. The reinstatement becomes effective for any illness after _______ from the date of acceptance.

10 Days

The HMO contract, certificate or member's handbook must be delivered within _____ working days after approval of the enrollment by the HMO.

10 Days

Florida law restricts an insurance company from charging a fixed rate higher than _____ annually on policy loans.

10%

Noncontributory group health plans generally require what percentage of participation by eligible members?

100%

Once an insured has paid a specified amount of his coverage (usually $1,000 to $2,000) under the stop-loss features of health insurance, the insurance company pays:

100%

According to the NAIC Model Law, health insurance contracts have how many mandatory provisions?

12

Under the health insurance Claims Forms provision, it is the company's responsibility to supply claim forms to an insured within how many days after receiving notice of a claim?

15 Days

Under the Notice of Claim provision in a health insurance policy, the insured must give written notice to the insurance company within a maximum of how many days after incurring a covered loss?

20 Days

Depending upon the policy, disability income elimination periods usually range from one week to one year or longer, but most are at least:

30 Days

The grace period allowed for long-term care policies in Florida is ______ days.

30 Days

In Florida, Medicare supplement policies require a free look period to last how long?

30 days

If one becomes totally disabled, Social Security disability benefits will begin after:

5 months

________ of the FICA tax is distributed to OASDI (2012).

6.20%

An insured must wait how many days after proof of loss before filing suit for payment against the insurance company if payment has not been received?

60 Days

Under Medicare Part A, a benefit period starts when a patient enters the hospital and ends when that patient has been out of the hospital for _______ days.

60 Days

If the participation rate in an annuity is 80% and the stock market moves up 10%, what amount is credited to the cash value?

8%

Once Medicare Part B participants have satisfied their annual deductible, Part B will pay ______ of covered expenses.

80%

With the exception of instances of legal incapacity, Proof of Loss for surgical expense benefits must be furnished to the insurance company within how many days after receiving the forms from the company?

90 Days

According to the NAIC Uniform Health Insurance Policy Provision Law, an individual has how many days in which to file Proof of Loss, if reasonably possible?

90 days

In _____________, employee compensation is deferred to some future age or date.

A Section 457 Plan

Individuals covered by a group plan receive

A certificate of insurance

What is considered a cancellable policy?

A policy the insurer may cancel at any time by returning the unearned premiums

Which of the following most accurately and completely describes an application?

A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information contained in the application

In order for an HMO to conduct business in Florida, it must obtain a valid Health Care Provider Certificate from the:

Agency for Health Care Administration of Florida.

If the insurer opts to terminate an Optionally Renewable health policy, the cancelation usually takes place on:

Anniversary Dates or Premium Due Dates

The term "first dollar" is often used to describe benefits payable by which type of policy?

Basic Medical Expense plan

A disability income policy's COLA rider provides for indexing the monthly or weekly benefit payable to changes in the:

CPI

Section 125 plans are also called ______________ plans.

Cafeteria

The HMO concept that service providers are paid a fixed monthly fee for each member is called:

Capitation

Agents must secure ____________________ prior to the use of any advertisement not furnished by the insurer.

Company Approval

Rachel is hospitalized with a back injury and, upon checking her disability income policy, learns that she will not be eligible for benefits for at least 60 days. This would indicate that her policy probably has a 60-day:

Elimination Period

Voluntary cosmetic surgery under the typical health insurance policy is generally:

Excluded

Which of the following limits coverage under an insurance contract?

Exclusions

Which of the following statements about agent authority is INCORRECT? (A) Express authority is granted by means of the agent's contract. (B) Express authority is determined by a principal's conduct. (C) Implied authority is not overtly extended in the agent's contract, but does permit many of the agent's operations. (D) Apparent authority can be assumed from the actions of the principal.

Express authority is determined by a principal's conduct.

All health policies are required to contain a Change of Occupation clause by law.

False

Both HMOs & PPOs rarely have deductibles. (T/F)

False

Health insurance renewability provisions, reserves, and claims are the same as with life insurance.

False

Medicare Part A is optional once an individual applies for Social Security benefits, has an annual deductible and coinsurance.

False

Prepaid health clinics are nearly identical to HMOs. (T/F)

False

An agent engaged in churning is guilty of a _______________ if he or she is proven to have exhibited fraudulent conduct.

First Degree Misdemeanor

In 2004, the _________________ was created to replace the Florida Comprehensive Health Association (FCHA).

Florida Health Insurance Plan

The ______________________ gives the Chief Financial Officer power to regulate financial planners.

Florida Insurance Code

The _______________ is the law that spells out the information and procedures required of agents and insurers when proposing life insurance to a prospective buyer.

Florida Life Insurance Solicitation Law

The coordination of benefits clause is found in what kind of health policy?

Group

According to Florida law, _______________ plans must provide maternity benefits.

Group Medical Expense

Which of the following is NOT a typical type of long-term care coverage?

Hospice Care

In disability income underwriting, __________ is the most important factor.

Income

The categories of health policies include all EXCEPT:medical (A) expenses. (B) disability income. (C) Accidental Death and Dismemberment (AD&D). (D)indemnity.

Indemnity

A Hospital Expense policy that pays a flat amount per day for hospital room and board pays benefits on what basis?

Indemnity plan

Health insurance renewability provisions define the ___________ rights.

Insured's

With Medicare coverage, the part that is compulsory and provides coverage for hospitalization is known as:

Medicare Part A

Grouping small businesses together to obtain group insurance as one group is characteristic of which of the following?

Multiple Employer Trust

Can an insurer refuse coverage solely because the proposed insured has been diagnosed as having a fibrocystic condition?

NO - unless the condition is diagnosed through a breast biopsy that demonstrates an increased disposition to developing breast cancer.

If an employer pays the premiums for an insurance plan that automatically covers all eligible employees, the plan is known as ______________ group insurance.

Non Contributory

Any profits derived with Fraternal Benefit Societies are considered:

Non Taxable

A person who has a disability income policy and suffers from a disability that is not serious enough to qualify them for disability income benefits may receive the actual cost of medical treatment for accident-related injuries under the:

Nondisabling Injury Provision

Individual health insurance policies are typically issued on a _______________ basis.

Nonparticipating

Health insurance ______________ Reserve funds represent the insurer's liability for losses that have not occurred but for which premiums have been paid.

Premium

In what phase of the selling process are serious problems of misrepresentation likely to occur?

Presentation of recomendations

The "one time only" period in a health policy when the policy first starts is called the _______________ Period.

Probationary

The _____________ period specified in a disability insurance policy is the period of time that must elapse following the effective date of the policy before benefits are payable.

Probationary

Representing to the applicant that a specific ancillary coverage or product is included in the policy applied for without an additional charge when such charge is required is called:

Sliding

The state government agency(ies) involved in the regulation of the insurance industry in the State of Florida is/are the:

State Legislature, the Department of Financial Services, the Office of Insurance Regulation, and the State Court System.

When using a policy illustration, producers must obtain a signed and dated statement from the applicant attesting to the fact that the applicant received a copy of the illustration and understands nonguaranteed elements illustrated are subject to change.

TRUE

In an AD&D policy, the amount payable for a double dismemberment is referred to as:

The Capital Sum

Which of the following CORRECTLY describes the original purpose of Medicaid?

To improve the health of people who might otherwise go without medical care for themselves and their children

Basic Hospital, Medical, and Surgical Expense policies usually have a stated limit for specific expenses. (T/F)

True

Benefit periods for group short-term disability plans are typically short in duration, such as 13 or 26 weeks. (T/F)

True

Business Overhead Expense insurance is considered a valued policy. (T/F)

True

Cafeteria Plans allow employees to pick and choose benefits to custom tailor their own benefits package. (T/F)

True

HMOs operate on a prepaid basis. PPOs operate on a fee-for-services-rendered basis. (T/F)

True

HSA assets can accumulate over the years and ownership can be transferred to a spouse tax free upon the death of the HSA owner.

True

Hearing screening for all newborns provided prior to hospital discharge is a mandatory covered benefit under all health insurance policies in Florida. (T/F)

True

Unlike physicians in HMOs, PPO healthcare providers are normally in private practice. (T/F)

True

An insured submits a valid documented claim for medical expenses covered by his major medical policy. According to the Time Payment of Claims provision, how soon must the company pay the claim?

Within 45 Days

Mrs. Glenridge lapsed her disability policy May 29th. She reinstated it on June 1st. She claimed coverage for an accident that occurred on June 3rd. Is the claim valid?

YES - In case of an accident, coverage is effective immediately upon reinstatement.

A stop-loss feature in a major medical policy specifies the maximum:

amount the insured must pay toward covered expenses

In Florida, the Legal Action provision of a health policy requires that:

an insured must wait at least 60 days after the submission of proof before initiating a lawsuit.

Rachel is hospitalized with a back injury and, upon checking her disability income policy, learns that she will not be eligible for benefits for at least 60 days. This would indicate that her policy probably has a 60-day:

elimination period.

The three basic kinds of deductibles in major medical policies are:

flat, corridor, and integrated.

An annual premium at 3% reserve interest assumption will be _________ than at a 3 1/2% reserve interest assumption.

greater

The purpose behind full disclosure requirements is to:

help a client make an informed decision.

Eligible tax deductions on the insured's IRS 1040 Form for medical expenses include all of the following EXCEPT:

individual personal disability premium payments.

Under a disability income plan, disability benefit payments that are attributed to employee contributions are:

not taxable.

Hospital indemnity policies are designed to:

pay a benefit based on the number of days an insured is hospitalized.

The probationary period in disability income policies applies to:

sickness only, not accidents.

Coinsurance may be defined as:

the sharing of expenses by the insured and the insurer - a form of risk retention.