Health insurance

what the typical deductible for basic surgical expense insurance?

$0

an insured has a primary group health plan an an excess plan each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay

$5,000

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?

$900

in an all health care plans under the affordable care act how many essential benefit categories are there

10

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

10 days

a producer has competed of his continuing education hours, but his license has just lapses, within what timeframe must the producer reinstate his license if he wants to avoid taking an exam to regain his licensed status?

12 months

Which of the following disability income policies would have the highest premium?

15 day waiting period / 10 year benefit period

what is the maximum age requirement for Indiana residents to be eligible for a health Indiana plan?

64

how often must insurance producers in this state complete continuing education

every 2 years

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

How long can a person hold a consultants license before it expires

2 years

Under writing is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT

Premiums always stay the same

how is emergency care covered for a member of an HMO

a member of an HMO can receive in or out of the HMO service are but care is preferred in the service area

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 insurers correct age

An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery the agent collects the applicants 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

which do the following entities has the authority to make changes to insurance policy?

insurers executive officier

in a health insurance a doctor charges $50 more than what the insurance company considers usual, customary, and readable the extra cost

is not covered

which of the following is NOT a flexible spending account?

it does not have limits an contributions

which of the following is NOT true of a major medical health insurance policy

it is designed to pay on

COBRA applies to employers with at least

20 employees

what is the period of coverage for events such as death or divorce under COBRA

36 months

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within

90 days of a loss

Which of the following can remove the insurance commissioner from office?

Governor

Which of the following would best describe total disability

a personas ability to work is significantly reduced or eliminated for the rest of his/her life

a person was diagnosed with cancer five months before the effective date of their medicare supplement policy. When losses were reported by the insured to be covered by the medicare supplement policy, cover was denied. This is an example of excluding benefits based on

a pre existing condition

insurance policies are not drawn up through negotiations, and an insured has little to say about its provisions. What contract characteristic does this describe?

adhesion

which of the following would be considered an unfair claims settlement practice?

advising the insured would probably be receive less than what is currently being offered

all of the following would be consider rebating EXCEPT

agent misrepresents policy benefits to convince a policyowner to replace policies

the classification small employer means any person actively engaged in a business that on at least 50% of its working days during the preceding year employed

at least 2 and not more than 50 persons

the premium charged for exercising the guaranteed insurability rider is based upon the insureds?

attained age

A policy available to business owners that will provide payment for normal business expenses in the event that the owner is disabled, best describes?

business overhead expense

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 owners business partner to accomplish a buyout

in order for a Canadian insurance company to do business in this state, it must apply for an obtain

certificate of authority

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

representations are written or oral statements made by the applicant that are

considered true to the best of the applicants knowledge

which of the following reports will provide the underwriter with the information about an insurance applicants credit?

consumer report

contracts that are prepared by one party and submitted to the other party on a take it or leave it bases are classified as

contracts of adhesion

Which of the following terms describes a specific dollar amount of the cost of care that must be paid by the member?

copayment

what is the main difference between coinsurance and copayment

copayment is a set dollar amount

in a disability policy, the probationary periods refer to be time

during which illness - related disability are excluded from coverage

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

entire contract clause

if a person feels like he has become a victim of an unfair claims practice, which of the following would be the most effective action

file a complaint with the commissioner

which one of the following is an eligibility requirement for social security disability income benefits?

fully insured status

Which of the following is INCORRECT concerning taxation of disability income benefits?

if paid by the individual the premiums are tax deductible

A typical accidental death & dismemberment policy covers all of the following losses EXCEPT

income

which of the following statements is NOT correct concerning the Cobra Act of 1985?

it requires all employers regardless of the number of age of employees to provide extended group health coverage

the commissioners suitability for office is in part determined by the individuals

knowledge of and skill in insurance

under an individual disability policy, the MINIMUM schedule of time in 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 involved in a car accident. In addition to general, less serious injuries, 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

all of the following are qualifications of a resident producer EXCEPT

obtaining a sponsorship of an admitted insurance company

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

what is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered

probationary period

which of the following is legal representative of a specific insurance company?

producer

which of the following answers does NOT describe the principal goal of preferred provider organization

provide medical services only from physician in the network

a producer licensed in another state wants to become a non resident producer in Indiana. The other state gives the same privileges to Indiana producers as it does to its own producer, Indiana, therefore, extend the licensing privileges to the prospective producer of the other state. What is this called?

reciprocity

which of the following is not provided by an HMO?

reimbursement

which health insurance provision describes the insureds right to cancel coverage?

renewal provision

an insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain if the right of ownership. the insured should have her husband named as what type of beneficiary?

revocable

Which of the following basic medical expense coverage NOT cover?

surgeons services

Which of the following may NOT be included in an insurance company's advertisement

that its policies are coverage by a state guaranty association

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

which of the following would qualify as a competent party in an insurance contract?

the applicant has a prior felony conviction

Insurance 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

What happens if a non member physician is utilized under the point of service plan?

the attending physician will be paid a few for service, but the member patient will have to pay a higher coinsurance amount

an insured was pregnant when she applied for an individual accident and health sickness insurance policy. When will her insurance benefits extend to the newborn?

the child may not be covered

Which of the following true able the commissioner of insurance?

the commissioner is authorized to participate in the NAIC

What entity decides whether a persons license will be suspended or revoked

the commissioner of insurance

if a business wants to by a disability income policy on a key employee, which of the following is considered the beneficiary?

the employer

Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial situation?

the fair credit reporting act

an insured purchase a noncancelable 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

which of the following is NOT covered under plan a in medigap insurance

the medicare part A deductible

Which of the following definitions woul dmake it easier to quialify for total disability benefits

the more liberal "own occupation"

which of the following statements regarding the change of beneficiary provision is false?

the policy owner has the right to change beneficiaries in any case

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

When a producer is trying to reinstate a lapses license what kind of fees would he be required to pay

the producer will have to pay a penalty 3 times the unpaid renewal fees

How long does the commissioner serve in office

there is no specified length of term, the commissioner serves at the pleasure of the governor

An insured is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true? A There is nothing wrong with this form of policy delivery. B The insured should complain to the insurer. C The insured should ask for a new policy to be delivered. D The policy will not be legal until it is delivered by an agent.

there is nothing wrong with this form of policy delivery

which do the following is true regarding optional benefits with long term care policies?

they are available for an addition premium

What do long term care policies offer to policyholders to account for inflation?

they offer the option of purchasing coverage that raises benefit levels accordingly

An insured offers a policy very similar to Medicare, although it differs slightly. An agent tells an applicant that the policy is Medicare, since the policies are so similar anyway. Which of the following is true?

this practice is illegal

which provision states that the insurance company must pay medical expense claims immediately?

time of payment of claims

Agents who persuaded insurance to ax axle a policy in favor of another one when it might not be in the insured's best interest are guilty of

twisting

under the physical exam and autopsy provision, how many times can an insurer have the insured examined, at its own expense, which claim is pending?

unlimited

A medical expense policy that establishes the amount of the 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 that geographic area is known as

usual, customary, and reasonable

Manny has been insured in an accident. Although she is still receiving benefits form her policy, she does not have to pay premiums. Her policy includes

waiver of premium rider

Rule 18 governing accident and sickness insurance advertising includes all of the following EXCEPT

want add soliciting new agents

all of the following cases show when a small employer medical plan cannot be renewable EXCEPT

when the employer choose to renew the plan

Which of the following would be considered a class A misdemeanor

willingfully violating the Indiana insurance code

Once a complain has been filed with the commissioner regarding an unfair claims practice, the commissioner

within 10 business days will send a copy of the final min to the company involved

which is NOT a characteristic of group health insurance?

a policy is issued to each insured individual

long term care coverage may be available as any of the following options EXCEPT

Endorsement to a health policy

medicare advantage is also known as

Medicare part c

A long term care insurance shoppers guide must be provided in the format developed by which of the following?

NAIC

An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply?

no coverage will apply since the injury could have been forseen

which provision concerns the insured duty to provide the insurer with reasonable notice in the even of a loss?

notice of claim