Health Insurance
A guaranteed renewable disability insurance policy
Is renewable at the insured's option to a specified age.
Which of the following is correct about a group health insurance policy?
It cannot exclude newborn children from coverage
All of the following statements about Medicare Part B are correct:
It covers services & supplies not covered by Part A, it is financed by monthly premium, it is financed by tax revenues (Part B is elective)
With respect to the consideration clause, which of the following would be considered consideration on the part of the applicant for insurance?
Payment of premium
Which of the following provisions is mandatory for health insurance policies?
Physical examination and autopsy
All of the following are covered by Part A of Medicare EXCEPT?
Physician's and surgeon's services
Which of the following statements is true regarding coinsurance?
The larger the percentage that is paid by the insured, the lower the required premium will be
Which of the following statements is true regarding coinsurance?
The larger the percentage that is paid by the insured, the lower the required premium will be.
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT?
Unearned premiums are retained by the insurance company
A policy owner has a health insurance policy with his wife listed as the primary beneficiary. He roils like to change the primary beneficiary to his sister which of the following is true?
Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at any time
Under the physical exam and autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?
Unlimited
Which characteristic does NOT describe managed care?
Unlimited access to providers
Long-term care offers coverage for a set of losses that occur for a minimum of how many months?
12 months
Many health insurance policies are required to provide chlamydia screenings. At what age does this coverage end?
29
How many hours of continuing education must be completed in ethics each licensing period?
3
All of the following are the most common variations in a Long-Term Care policy EXCEPT
Number of family dependents
Benefit periods for individual short-term disability policies will usually continue from?
Six months to 2 years
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the
Insuring clause
All of the following long-term coverages would allow an insured to receive care at home EXCEPT..
Skilled care
The type of dental plan which is incorporated into a major medical expense plan is a/an..
Integrated dental plan
The type of dental plan which is incorporated into a major medical expense plan is a/an?
Integrated dental plan
A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for all losses?
"Own occupation"- less restrictive than other definitions
Any licensed person in this state may be assessed a civil penalty for an unintentional violation of a state insurance statue up to
$1,000
A Noncontributory group disability income plan has a 30-day waiting period and offers benefits of $2000 a month. If an employee is unable to work for seven months due to a covered the stability, the employee will receive
$12,000, all of which is taxable
An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged a $100 per day. How much will the insurance company pay?
$120 a day
The sole proprietor of a business makes s total salary of $50,000 a year. This year, his medical expense have reached a total of $75,000. What amount may the sole proprietor deduct in regards to his medical expenses?
$50,000
What percentage of individually-owned disability income benefits is taxable?
0%
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? Grace period is 7 days if paid weekly, but 10 days if paid monthly, and 31 for all other modes
10 days
What is the maximum age for qualifying for a catastrophic plan?
30
How long is the free-look period with a Medicare supplement policy?
30 days
If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits?
12 credits
How many credit hours of excess continuing education are producers allowed to carry over to the next renewal cycle?
12 hours
a disability income policy is written with a 10-month benefit period, a 30-day elimination period, and a 30-day probationary period. If the insured becomes disabled due to illness 9 days after the effective date, the policy will pay benefits for a maximum of
10 months
How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state?
12 months
For how many days of skilled nursing facility care will Medicare pay benefits?
100 days
Which of the following disability income policies would have the highest premium?
15-day waiting period/10-year benefit period
Minimum required age for an insurance producer in this state?
18 years old
A temporary license may be issued by the commissioner for a period not to exceed how many days?
180
A candidate for an Accident and Health producer's license must complete how many hours of prelicensing education?
20
Candidates for either a property license or a casualty license must complete how many hours of prelicensing education?
20
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days?
20
COBRA applies to employers with at least
20 employees
Which of the following must the patient pay under Medicare Part B?
20% of covered charges above the deductible
The patient protection and affordable care act mandates that insurers provide coverage for adult children of the insured up to the age of
26
If payments of a specific premium or subscription fee is required to provide coverage for a child, the policy or contact may require that the insurer be notified of the child's birth and pay any required fee within how many days of the date of birth coverage to continue?
31 days
When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy?
31 days
Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?
5 months
Which of the following is NOT true regarding prelicensing education requirements for insurance producers in this state?
50% of prelicensing education must be completed in a classroom
A Medicare supplement contract cannot define a "pre-existing condition" more restrictively than a condition for which medical advice was given or treatment recommended within how many months of the effective date of coverage?
6 months
When can an insured initiate legal action against the insurer?
60 days after submitting proof of loss
According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?
60%
Eligible persons for Medicare supplement insurance must apply to enroll under the policy no later than __ days after the date of the termination of enrollment in another plan
63
The term "continuous period of creditable coverage" only applies if the individual had no breaks in coverage greater than
63 days
At what age may an individual make withdrawals from an HSA for nonhealth purposes without being penalized?
65
A specified dollar amount that the insured must pay first before the insurance company will pay the policy
A deductible is
Which of the following does the insuring clause NOT specify?
A list of available doctors
Which of the following would be required to complete pre-licensing education?
A nonresident life insurance producer who is planning to transact property insurance
Disability income coverage specifies that the policy covers the insurance if he is unable to perform any job for which he is qualified. In this case, total disability is defined as
Any occupation- more restrictive than other definitions
Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace?
A permanent resident lawfully present in the U.S.
Social Security Disability definition includes all of the following:
A physical impairment expected to result in death, the inability to engage in any gainful work, disability resulting from a medically determinable mental impairment
Which is NOT a characteristic of group health insurance?
A policy is issued to each insured individual
All of the following are correct about the required provisions of a health insurance policy EXCEPT?
A reinstated policy provides immediate coverage for an illness
All of the following individuals may qualify for Medicare health insurance benefits EXCEPT?
A retired person age 50
All of the following statements concerning workers compensation are correct EXCEPT?
A worker receives benefits only if the work related injury was not his/her fault
An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?
Adjust the claim benefit to reflect the insured's true age
Which of the following long-term are benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis?
Adult day care
A 63-year-old man is planning to be employed until age 68. When will he be eligible for Medicare?
Age 65, regardless of his employment status
How can a new physician be added to the PPO's approved list?
Agree to follow the PPO standards and charge the appropriate fees
In which Medicare supplement policies are the core benefits found?
All plans
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
All providers will have the same coverage options and conditions for each plan
Assuming that all of the following people are covered by a High Deductible Health Plan and are not claimed as dependents on anyone's tax returns, which would NOT be eligible for a Health Savings Account?
Amanda is 67 and is covered by a basic medical expense policy
When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision?
Amounts payable under the policy will reflect the insured's correct age
Which statement accurately describes the Change of Beneficiary provision?
Any policy that has a death benefit must also have a Change of beneficiary provision
All of the following individuals may qualify for Medicare health insurance benefits EXCEPT
Anyone who is willing to pay a premium
All of the following statements regarding Business Overhead Expense policies is true:
Any benefits receives are taxable to the business, leased equipment expenses are covered by the plan, premiums paid for BOE are tax-deductible
Under a key person disability income policy, premium payments
Are made by the business and are not tax-deductible
What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?
As long as the policy is in force
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?
Attending Physician
Which of the following is NOT an enrollment period for Medicare Part A applicants?
Automatic enrollment
All the following are true of the key person disability income policy except
Benefits are considered taxable income to the business
To be eligible for tax credits under the ACA, individuals must have income that is what percent of the Federal Poverty Level?
Between 100% and 400%
In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is
Broader in general
Policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called
Business overhead expense
What type of policy allows the insurance company to cancel a policy at any time?
Cancellable
A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?
Cash out to the owner's business partner to accomplish a buyout
A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?
Cash to the owner's business partner to accomplish a buyout
According to the provisions of the patient protection and affordable care act, all of the following are required preventive care services EXCEPT
Cervical cancer exams for all women starting at age 40
The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract?
Conditional
An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she had not met the conditions specified in the
Consideration clause
Representations are written or oral statements made by the applicant that are..
Considered true to the best of the applicant's knowledge
Which of the following reports will provide the underwriter with the information about an insurance applicant's credit?
Consumer report
Which of the following is NOT a characteristic or a service of an HMO plan?
Contracting with insurance companies
The purpose of managed care health insurance plans is to
Control health insurance claims expenses
In a relative value system of determining coverage for a given procedure, what term describes the total amount payable per point?
Conversion factor
A small company offers group health insurance to its employees, but recently has decided to terminate the health insurance contract, leaving the workers without insurance. What can the employees do regarding their insurance?
Convert to an individual health policy
Which of the following terms describes a specific dollar amount of the cost of care that must be paid by the member?
Copayment
In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible?
Corridor
Which of the following is NOT true regarding Basic Surgical Expense coverage?
Coverage is unlimited
A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as
Critical illness
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that we will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day..
Elimination period (time immediately following the start of a disability when benefits are not payable. This is used to reduce the cost of providing coverage and eliminates the filing of many claims.)
All of the following statements concerning Accidental Death and Dismemberment coverage are correct EXCEPT?
Death benefits are paid only if death occurs within 24 hours of an accident
Group disability income insurance premiums paid by the employer are
Deductible by the employer as an ordinary business expense
Which agreement specifies how a business will transfer hands when one of the owners dies or becomes disabled?
Disability buy-sell
A waiver of premium provision may be included with which kind of health insurance policy?
Disability income
Which of the following will NOT be considered unfair discrimination by insurers?
Discriminating in benefits and coverages based on the insured's habits and lifestyle
All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT?
Dividends from a mutual insurer
Who can provide skilled nursing care?
Doctor
An insured has Medicare Part D coverage. He has reached his initial benefit limit and must now pay 50% of his prescription drug costs. What is the term for this gap in coverage?
Donut hole
Other than for a qualified event, when can a change be made in benefits for a Flexible Spending Account (FSA)?
During the open enrollment period
All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT
Elective cosmetic procedures are covered
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This would indicate that his policy was probably written with a 30-day
Elimination period
Concerning group Medical and Dental insurance, which of the following is INCORRECT?
Employee benefits are tax deductible the year in which they were received
The HMO act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How had this plan since changed?
Employees are no longer forced to offer HMO plans
The HMO act of 1973 required employers to offer an HMO plan as an alternative to regular health plans if the company had more than 25 employees. How has this plan since changed?
Employers are no longer forced to offer HMO plans
Long-term care coverage may be available as any of the following options EXCEPT..
Endorsement to a health policy
The insurance policy, together with the policy application and any added riders form what is know as?
Entire Contract
Which of the following statements is correct concerning taxation of long-term care insurance?
Excessive benefits may be taxable
Items stipulated in the contract that the insurer will not provide coverage for are found in the
Exclusions
Medicaid provides all of the following benefits:
Family planning services, home health care services, and eyeglasses
How many pints of blood will be paid for by Medicare Supplement Core benefits?
First 3
If an insured is not required to pay a deductible, what kind of coverage does he/she have?
First dollar
Which of the following would NOT increase the premium for a policyowner?
Impairment rider
Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it?
Free look period
The provision that allows a policyholder to return a new policyholder to return a new policy within a given time if not satisfied is called the
Free look provision
Which one of the following is an eligibility requirement for Social Security disability income benefits?
Fully insured status
Which of the following policies us required to provide coverage for hearing conditions and speech disorders?
Group health
A Medicare supplement plan must have at least which of the following renewal provisions?
Guaranteed renewable
Which of the following statements is CORRECT?
HMO's may pay for services not covered by Medicare
Which of the following statements is CORRECT?
HMO's may pay for services not covered by Medicare.
Concerning insurance, the definition of a fiduciary responsibility is
Handling insurer funds in a trust capacity.
An association could buy group insurance for its members if it meets all of the following requirements:
Has a constitution and by-laws, holds annual meetings, is contributory
An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What the other requirement must the insured have met to receive Social Security Disability benefits?
Have accumulated 6 work credits in the past 3 years
In terms of Medicare supplement insurance, which of the following means expenses of health maintenance organizations associated with the delivery of health care service which expenses are analogous to incurred losses of insurers?
Health care expenses
Health Savings Accounts (HSAs) are designed to
Help individuals save for qualified health expenses
Which of the following is INCORRECt concerning taxation of disability income benefits?
If paid by the individual, the premiums area tax deductible.
An insurer devised an intimidation strategy in order to corner a large portion of the insurance market. Which of the following best describes this practice?
Illegal
A health insurance policy lapses but its reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective?
Immediately
Which of the following riders would NOT increase the premium for a policyowner?
Impairment rider
In which of the following locations would skilled care most likely be provided?
In an institutional setting
The patient protection and affordable care act includes all of the following provisions EXCEPT
Individual tax deduction for premiums paid
In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?
Insurer to the insured
Which of the following entities has the authority to make changes to an insurance policy?
Insurer's executive officer
Which of the following is NOT true of a major-medical health insurance policy?
It is designed to pay on a first dollar of expense basis
Which is true regarding HMO coverage?
It is divided into geographic territories
Concerning Medicare Part B, statement is incorrect?
It is full funded by Social Security taxes (FICA)
Concerning Medicare Part B, which statement is INCORRECT?
It is fully funded by Social Security taxes (FICA)
All of the following is true concerning Medicaid:
It is funded by state and federal taxes, it is intended to provide lexical assistance for certain categories of people who are needy, and it is a state program
In which of the following situations is it legal to limit coverage based on marital status?
It is never legal to limit coverage based on marital status
Which of the following is INCORRECT concerning Medicaid?
It is solely a federally administered program
Which of the following statements concerning Medicare Part B is correct?
It pays for physician services, diagnostic tests, and physical therapy
All of the following would be qualified as a Dependent Care Flexible Spending Account, EXCEPT?
Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair
All of the following would be qualified as a dependent under a Dependent Cre Flexivlr Spending account, EXCEPT?
Jeremy had to have both legs amputated, but has learned how to take care of himself and to get around in a wheelchair
Under the affordable care act, which classification applies to health plans based on the amount of covered costs?
Metal level classification
What type of health insurance policy provides an employer with funds to train a replacement if a valued employee becomes disabled?
Key person disability
Under Worker's Compensation, which of the following benefits are not included?
Legal Benefits
Which type of care is NOT covered by Medicare?
Long-term care
In a Disability Income Policy, all of the following are considered presumptive disabilities
Loss of hearing, loss of two limbs, loss of speech
The corridor deductible derives its name from that it is applied between the basic coverage and the
Major medical coverage
For the purpose of making an investigation, the Commissioner does NOT have the power to do which of the following?
Make testimony and documents available to the public
Which of the following programs expands individual public assistance programs for people with insufficient income and resources?
Medicaid
All of the following statements concerning Medicaid are correct EXCEPT?
Medicaid is a state funded program that provides health care to persons over age 65
Which of the following statements is NOT correct?
Medicare Advantage must be provided through HMO's
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in
Medicare Part A
Which of the following statements pertaining to Medicare Part A is correct?
Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age
Which of the following statements pertaining to Medicare Part A is correct?
Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65.
Medicare advantage is also known as..
Medicare Part C
An insured is covered under a Medicare policy that provides a list of network health care providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own?
Medicare SELECT
An insurance producer is selling a Medicare supplement policy to an applicant. The applicant is worried that if his health changes, his policy will not be renewed. What should the producer tell him?
Medicare supplement policies are guaranteed renewable
Which of the following is true regarding duplication of Medicare benefits?
Medicare supplement policies cannot duplicate any Medicare benefits
Under an individual disability policy, the MINIMUM schedule of time which claim payments must be made to an insured is?
Monthly
The primary eligibility requirement for Medicaid benefits is based upon
Need
An insured is covered by s disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and brake an ankle. What coverage will apply?
No coverage will apply, since the injury could have been foreseen
Can a group that is formed for the sole purpose of obtaining group insurance qualify for group coverage?
No, the group must be formed for a purpose other than obtaining group insurance
Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?
None
Medicare supplement policies may use waivers to do what to pre-existing conditions?
None of the above
An insurer can alter the pricing of a Medicare supplement policy because of all of the following EXCEPT
None of the above. All are not valid reasons to alter pricing.
Premium payments for personally-owned disability income policies are
Not tax deductible
An insured purchased a disability income policy with a 10-year benefit period. The policy stated a 20 day probationary period for illness. If the insured is hospitalized with an illness 2 weeks after the policy was issued, how much will the policy pay?
Nothing; illness is not covered during the first 30 days of the contract
Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?
Notice of claim
In a long-term care insurance, what type of care is provided with intermediate care?
Occasional nursing or rehabilitative care
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?
Offer the supplement policy on a guaranteed issue basis
Chuck is issued an insurance policy in which his insurance agency holds the right to cancel. By state law, Chuck's insurer must notify him of their right to cancel through which method?
On the face of the policy
Am insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles
Once the primary plan has paid its full promised benefit, the insured submits the claim to the secondary, or excess, provider for any additional benefits payable. (5,000)
The Part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as
Part A
Which of the following statements is INCORRECT concerning Medicare Part B coverage?
Part B coverage is provided free of charge when an individual turns age 65
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?
Parts A and B of Medicare
An insured pays her Major Medical Insurance premium annually on March 1st. Last March she forgot to mail her premium to the company. On March 19th, she had an accident and broke her leg. The insurance company would
Pay the claim
Which of the following applies to partial disability benefits?
Payment is limited to a certain period of time
Which of the following must be present in all Medicare supplement plans?
Plan A (in order to standardize the coverage provided under Medicare supplement policies, the NAIC has developed standard Medicare supplement benefit plans which are identified with the letters A through N. The benefits and plan A are considered to be core benefits and must be included and other types.)
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to a stated age with the company having the right to increase premiums on the entire class
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class
A woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnancy. Which of the following is true about coverage for pregnancy?
Pregnancy will be covered immediately
Regarding the taxation of Business Overhead policies,
Premiums are deductible and benefits are taxed
Which of the following describes taxation of individual disability income insurance premiums and benefits?
Premiums are not tax deductible, and benefits are not taxable
All of the following are true statements regarding Business Overhead Expense policies:
Premiums paid to BOE are tax-deductible, any benefits received are taxable to the business, leased equipment expenses are covered by the plan.
Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's death?
Principal sum
Under the accidental death and Dismemberment coverage, what type of benefit will be paid to the beneficiary in the event of fever insured's accidental death
Principal sum
What is the initial period of time specified in a disability income policy that must pass, after a policy is in force, before a loss can be covered?
Probationary period
A Medicare SELECT policy does all of the following EXCEPT
Prohibit payment for regularly covered services if provided by non-network providers
Insurers may change which of the following on a guaranteed renewable health insurance policy?
Rates by classes
Giving a client an inducement to a sale not stated in the policy is an unlawful practice known as
Rebating
When an insurer combines two periods of disability into one, the insured must have suffered a
Recurrent disability
The Federal Fair Credit Reporting Act
Regulates consumer reports
Which of the following is NOT provided by an HMO
Reimbursement
What type of care is Respite care?
Relief for a major care giver
The primary purpose of disability income insurance is to
Replace income lost due to a disability
Disability income policies cover provide coverage for loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?
Residual disability
An insured wants to name her husband as the beneficiary of her health policy. She also wished to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary?
Revocable
The free-look provision allows for which of the following?
Right to return the policy for a full premium refund
Which of the following is NOT covered under Part B of a Medicare policy?
Routine dental care
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations?
SELECT
Under the mandatory uniform provision Notice of Claim,the first notice of injury or sickness covered under an accidents and health policy must contain
Statement that is sufficiently clear to identify the insured and the nature of the claim.
An insured had 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?
Stop-loss limit
A provision found in insurance policies which prevents the insured from collecting twice for the same loss is called?
Subrogation
The transfer of an insured's right to seek damages from a negligent party to the insurer is found in which of the following clauses?
Subrogation
The legal process that gives the insurer, after payment of a loss, the right to seek recovery from a third party that was responsible for the loss is known as
Subrograion
Which of the following would be a qualifying event as it relates to COBRA?
Termination of employment due to downsizing
Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial information?
The Fair Credit Reporting Act
Who chooses a primary care physician in an HMO?
The Individual member
Which of the following is NOT covered under Plan A in Medigap insurance?
The Medicare Part A deductible
An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider, which of the following will happen?
The PPO will pay reduced benefits
What happens if a non-member physician is utilized under the Point-of-Service plan?
The attending physician will be paid a fee for service, but the member patient will have to pay a higher coinsurance amount.
A husband and wife are insured under group health insurance plans at their own places of employment, and as dependent under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?
The benefits will be coordinated
All of the following are true regarding key person disability income insurance:
The employee is the insured, the employer receives the benefits if they key person is disabled, and the employer pays the premiums
The employer contributions to a Health Savings Account affect the insured's taxes?
The employer contributions are not included in the individual insured's taxable income
Which statement accurately describes group disability income insurance?
The extent of benefits is determined by the insured's income
An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true?
The group plan will not pay because the employee was injured at work
The affordable care act requires all U.S. citizens and legal residents to have qualifying health care coverage. This is known as
The individual mandate
Which statement regarding qualifications for Social Security Disability benefits is NOT true?
The individual must be at least 65 years old
In which of the following situations would Social Security Disability benefits NOT cease?
The individual's song gets a part-time job to help support the family
A man works for Company A and his wife works for Company B. The spouses are covered by health plans through the respective companies that also cover the other spouse. If the husband files a claim, 😂😂😂😂😂😂😂😂
The insurance through his company is primary
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?
The insured is in an accident and incurs a large claim
Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?
The insured may carry over the amount of this year's expenses to next year, which will help satisfy next year's deductible
Which of the following is NOT a feature of a guaranteed renewable provision?
The insurer can increase the policy premium on an individual basis
When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her gent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled?
The insurer is considered to be notified since the notification to agent equals notification to the insurer
Which of the following is NOT a feature of a noncancellable policy?
The insurer may terminate the contract only at renewal for certain conditions
Which of the following would provide an underwrite with information concerning an applicant's health history?
The medical information bureau
Which of the following will vary the length of the grace period in health insurance policies?
The mode of the premium payment
Which of the following definitions would make it easier to qualify for total disability benefits?
The more strict "own occupation"
Hospital indemnity/hospital confinement indemnity policy will provide payment based on
The number of days confined in a hospital
An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?
The old policy should stay in force until the new policy is issued
A policy with a 31-day grace period implies
The policy will not lapse for 31 days if the premium is not paid when due
Premiums paid by self-employed sole proprietors or partners for medical expense insurance are
Totally tax deductible
Hospice care is intended for
The terminally ill
None of the following would be covered by long-term care EXCEPT
Therapeutic care for 13 months
Which of the following is true regarding optional benefits with long-term care policies?
They are available for an additional premium
An insured makes a regular contributions to his Health Savings Account. How are those contributions treated in regards to taxation?
They are tax deductible
Regarding Medicare SELECT policies, what are restricted network provisions?
They condition the payment of benefits
All of the following statements about Medicare supplement insurance policies are correct:
They cover Medicare deductibles and copayments, they supplement Medicare benefits, they are issued by private insurers
All of the following statements about Medicare supplement insurance policies are CORRECT except?
They cover the cost of extended nursing home care
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
They cover the cost of extended nursing home care
Which of the following is NOT true regarding partial disability?
This is a form of insurance that covers part-time workers
An insured notifies the insurance company that he had become disabled. What provision states that claims must be paid immediately upon written proof of loss?
Time of payment claims
An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?
Time of payment of claims
Which provision states that the insurance company must pay Medical Expense claims immediately?
Time of payment of claims
Which of the following statements is CORRECT about Social Security?
To be eligible, one must meet certain requirements.
What is the purpose of coinsurance provisions?
To help the insurance company to prevent over-utilization of the policy
What is the purpose of COBRA?
To provide continuation of coverage for terminated employees
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in they geographic area is known as
Usual, customary, and reasonable
Manny had been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. He policy includes?
Waiver of premium rider
Social security supplement (SIS) or Social Security riders would provide for the payments of income benefits in each of the situations below EXCEPT?
When the amount payable under a Social Security is more than the amount payable under the rider
Under what condition are group disability income benefits received by an employee NOT taxable as income
When the benefits received are equal or less than the employee's percentage of the contribution.
In a group health policy, a probationary period is intended for people
Who joined the group after the effective date
How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?
Within 90 days or as soon as reasonably possible, but not to exceed 1 year
Workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from?
Work-related disabilities
Can an individual who belongs to a POS plan use an out-of-network physician?
Yes , and they may use any preferred physician, even if not part of the HMO
Can an individual who belongs to a POS plan use an out-of-network physician?
Yes, and they may use any preferred physician, even if not part of the HMO
If an insurance company wishes to order a consumer report on an applicant to assist in the underwriting process, and if a notice of insurance information practices has been provided, the report may contain all of the following information EXCEPT the applicant's..
ancestry
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would his maximum monthly premium for COBRA coverage?
$102 (The employer is permitted to collect a premium from the terminated employee at a rate of no more than 102% of the individual's group premium rate (in this scenario , 102% of $100 total premium is $102). The 2% charge is to cove the employer's administrative costs.
A client has a new individual disability income policy with a 20-day probationary period and a 30-day elimination period. Ten days later, the client breaks their leg and is off work for 45 days. How many days of disability benefits for the policy pay?
15 days
What is a penalty tax for nonqualified distributions from a health savings account?
20%
What is the period of coverage for events such as death or divorce under COBRA?
36 months
If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?
5 days
Most policies will pay the accident death benefits as long as the death is caused by the accident and occurs within
90 days
A hospital indemnity policy will pay?
A benefit for each day if the insured is in a hospital
Which of the following would be an example of a limited accident and health insurance policy?
A dread disease policy
The insured's health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have?
Accident-Only
And insured has made all the decisions regarding the provisions included in the insured's policy. The insured finds an objectionable provision and wants to negotiate it with the insurer but is not allowed to do so. Our only options are to reject the policy or except it as is. Which contract feature does this describe?
Adhesion
Which of the following individuals is eligible for a Health Savings Account?
Allison is insured by a High Deductible Health Plan (HDHP)
Long-term care insurance policies must cover which of the following?
Alzheimer's disease
An agent makes a mistake on the application and then corrects his mistake by physically entering the necessary information. Who must then initial that change?
Applicant
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care
Attending Physician
What document describes an insured's medical history, including diagnoses and treatments?
Attending physician's statement
What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan?
Diagnostic and preventive care
This arrangement specifies who will purchase a disabled partner's interest in the event he or she becomes disabled
Disability buyout
Which of the following is considered a qualifying event under COBRA?
Divorce
In disability income insurance, another name for the waiting period is the
Elimination period
In disability income insurance, another name for the waiting period is the..
Elimination period
Which of the following is another name for a primary care physician in an HMO?
Gatekeeper
How are HMO territories typically divided?
Geographic areas
Regarding long-term care coverage, as the elimination period gets shorter, the premium...
Gets higher
As it pertains to group health insurance, COBRA stipulates that?
Group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense.
Moet LTC plans have which of the following features?
Guaranteed renewability
Under the Privacy Rule for HIPAA, protected information includes all individually identifiable health information
Held or transmitted in any form
MIB (Medical Information Bureau)
It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance
Which of the following is NOT correct concerning the COBRA Act of 1985
It requires all employers, regardless of the number or age of employees, to provide extended group health coverage
Which of the following is true of a PPO?
Its goal is to channel patients to providers that discount services
Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called?
Key employee disability insurance
Which of the following is considered a presumptive disability under a disability income policy?
Loss of two limbs
And insured stated on her application for life insurance that she had never had a heart attack, when in fact she had a series of minor heart attacks last year for what she sought medical attention. Which of the following will explain the reason a death benefit claim is denied?
Material misrepresentation
In long-term care insurance, what type of care is provided with intermediate care?
Occasional nursing or rehabilitative care
In the event of a loss, business overhead insurance will pay for..
Rent
Benefit periods for individual short-term disability policies will usually continue from
Six months to 2 years
Before a customer's agent delivers his policy, the insurer makes last-minutes change to the policy. The agent informs the customer of this change, and he accepts it. What must the agent do now?
The agent should ask the customer to sign a statement acknowledging that he is aware of the change.
Which statement is NOT true regarding underwriting group health insurance?
The group is assessed individually for insurability
Who chooses a primary care physician in an HMO?
The individual member
Which of the following is true regarding health insurance underwriting for a person with HIV?
The person may not be declined for medical coverage solely based on HIV status.
What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided?
Application
An agent is ready to deliver a policy to an applicany but had not yet received payment. Upon delivery, the agent collects the applicant's premium check, answers any questions the applicant may have, and then leaves. What did he forget to do?
Ask her to sign a statement of good health
In a replacement situation, all of the following must be considered EXCEPT
Assets
To comply with Fair Credit Reportinh Act, when must a producer notify an applicant that s credit report may be requested?
At the time of application
Which of the following is covered under a long-term care policy?
Home health care, adult say care, and hospice care
What are the three basic coverages for medical expense insurance?
Hospital, Surgical, Medical
In long-term care (LTC) policies, as the benefit period lengthens, the premium..
Increases
Which type of a hospital policy pays a fixed amount each day that the insured is in a hospital?
Indemnity
A life insurance policy has a legal purpose if both of which of the following elements exist?
Insurable interest and consent
An applicant for a health insurance policy returns a completed application to her agent, along with a check for the premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point?
Neither approved the application nor issued the policy
An insured is involved in a car accident. In addition to general, less serious inquiries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits?
No benefits
If your health care plan had characteristics of an HMO and PPO, what type of plan do you have?
POS
Under which of the following organizations are the practicing providers compensated on a fee-for-service basis?
PPO
Don has both a basic expense and a major medical policy. He is injured 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?
Pay a special deductible on his major medical policy
Todd has been informed that he's had a hernia which requires repair. When Todd researches the cost, he learns that his insurance plan will cover 200 points worth of surgical expenses. Each point represents $10, which means that $2000 of his surgery will be covered by his insurance plan. What system is Todd's insurance company using?
Relative value
All of the following types of LTC is provided in an institutional setting:
Skilled nursing care, custodial care, and intermediate care
Which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage?
Special Risk Policy
Insurable interest can be best described by which of the following?
The applicant must experience a financial loss due to an accident or sickness that befalls the insured
Which of the following is true about the requirements regarding HIV exams?
The applicant must give prior informed written consent.
Which of the following is NOT the consideration in a policy?
The application given to a prospective insured
An insured loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will she most likely receive from this policy?
The capital amount in a lump sum
The period of time immediately following a disability during which benefits are not payable is
The elimination period
Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT
When the amount payable under SoCal Security is more than the amount payable under the rider
Social security supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT
When the amount payable under Social Security is more than the amount payable under the rider
