Insurance

Disability (A&H) policies are incontestable once they have been in force for

2 years.

If a consumer requests additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply?

5 days

How long is an open enrollment period for Medicare supplement policies?

6 months

In order for costs to be covered under a dental plan, what is the minimum interval that must pass between routine dental exams?

6 months

The free-look period does NOT apply to single premium, short-term policies if the period of coverage is less than

6 months.

In order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits?

60 days

an insurance policy is considered a new policy if it has been in effect for what maximum time period?

60 days

If an employer provides long-term group disability insurance for its employees, what percentage of monthly wages are lower-paid employees eligible to collect?

66 and 2/3%

Every disability insurance policy with weekly premiums must contain a provision for a grace period lasting at least

7 days

In a non-scheduled plan, the insurer will be expected to pay what portion of the fees for basic services?

80%

Which of the following does NOT qualify as a long-term care policy?

A disability policy that provides hospital coverage onlyb)

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.

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

An agent accepts the premium payment 35 days after it is due, telling the insured that the pokicy will continue to remain in force. This is an example of what type of agent authority?

Apparent.

Under a Key Person disability income policy, premium payments

Are made by the business and are not tax-deductible.

Which of the following is not true of Disability Buy-Sell coverage?

Benefits are considered taxable income to the business.

All of the following features of a medical plan are expressed as a set dollar amount except

Coinsurance

Most scheduled plans provide first-dollar benefits without

Coinsurance and deductibles.

All of the following are differences between individual and group health insurance EXCEPT

Individual insurance does not require medical examinations, while group insurance does require medical examinations.c)

Which of the following entities must approve all Medicare supplement advertisements?

Insurance Commissioner or Director

Which of the following is NOT true regarding a flexible spending account?a)

It does not have limits on contributions.

An insured has a Social Insurance Supplement rider in her disability income plan. Following a disability, she begins receiving benefit payments from the insurer. She then begins receiving Social Security benefits that are smaller than the SIS benefit payments. At that point, her insurer ends the SIS benefit payments. Which of the following best describes the situation?

The insured should contact the insurer to confirm her actual Social Security benefit amount. The SIS rider should pay the difference between the rider amount and the actual benefit.

Which of the following is a requirement for medicare supplement policies?

They may not duplicate medicare benefits

A warranty under which certain things will be done or not be done after the policy takes effect is an

conditional warranty

In a group policy, the contract is between the insurance company and the

employer

An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?

$500

Policies with monthly premiums must provide for a grace period of at least

10 days.

An intermediary has just placed insurance on himself. He can receive compensation for this transaction only if he has placed insurance on other individuals with the same insurer within the last

12 months

The commissioner may issue a temporary license for an intermediary for a period up to

12 months

If an insurer decides to discontinue providing group health insurance in general, how many days before the date of discontinuance must a notice be sent to the Commissioner and to each employer?

180

If a person has a Medigap policy, and later becomes eligible for Medicaid, benefits and premiums may be suspended for up to how many years while Medicaid coverage is in force?

2 years

If an insurer pays compensation to an agent for the sale of medicare supplement policy, the first-year commission CANNOT exceed what percentage of the renewal commission for servicing the policy in the second policy year?

200%

A disability insurance policy other than a Medicare supplement or Medicare replacement policy may require patients to enter a licensed skilled nursing care facility within what period of time after discharge from a hospital in order to receive continued care for the same condition?

24 hours

Within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained?

3 days

If group coverage ends, coverage may be continued or converted to an individual policy if a person has been insured under that contract for at least

3 months

An aggrieved person's petition for a re-hearing will be considered denied if the commissioner does not act on it within

30 days

Policies other than weekly and monthly-pay require a grace period that last for how many days?

31

What is the maximum number of insurance risks an agent can place with a single insurer in one calendar year if the agent is not listed with that insurer?

5

How can a new physician be added to the PPO's approved list?

Agree to follow the PPO standards and charge the appropriate fees.

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 has not met the conditions specified in the

Consideration Clause.

Which of the following is NOT a characteristic or a service of an HMO plan?

Contracting with insurance companies

Prior to issuance of a Long-Term Care policy to an applicant age 80 or older, the insurer must obtain all of the following EXCEPT

Date of previous doctor visit.

Which of the following is NOT considered to be a basic service, under a nonscheduled plan?

Dentures

Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer?

Disability Income

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.

Once an agent has met the requirements to sell long-term care insurance, how often must he or she complete the 4 hours of ongoing training courses?

Every 24 months

In disability income insurance, the own occupation definition of disability applies

For the first 2 years of a disability.

Which of the following coverages is NOT monitored by the Employee Retirement Income Security Act (ERISA)?

Golden parachutes

Which type of care is NOT covered by Medicare?

Long-term care

Which of the following types of health policies cover medical and hospital expenses, and have deductibles, coinsurance and high maximum limits?

Major medical policies

In health underwriting, it would be inappropriate to decline a risk using any of the following factors EXCEPT

Mental illness.

The law of large numbers is best defined as a large number of people with similar exposures to loss resulting in actual losses being

More predictable

Which of the following types of policies are issued by stock companies?

Nonparticipating

Medicare Part A services do NOT include which of the following?

Outpatient Hospital Treatment

Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?

Parts A and B of Medicare

Which of the following is correct regarding the taxation of group medical expense premiums and benefits?

Premiums are tax deductible and benefits are not taxed.

All of the following are considered to be supplemental benefits under an HMO plan EXCEPT

Preventive services.

Which of the following is NOT covered under Plan A in Medigap insurance?

The Medicare Part A deductible

what authority must an agent's sales presentation?

The agent's insurer

In a defined contribution plan,

The contribution is known and the benefit is unknown.

Which of the following acts protects consumers against the distribution of incorrect and obsolete personal or financial information?

The fair credit reporting act

For group medical and dental expense insurance, any premium paid by the employer

is deductible as a business expense

When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is

lower

Unilateral

one-sided, one party makes a promise

Adhesion

only one party (insurer) prepares a contract, and the other party (insured) accepts it as is.

According to the fair credit reporting act, consumer reports are prohibited from reporting negative information about a customer after how many years?

seven years

Which of the following entities is responsible for paying the producers appointment renewal fee?

the appointing insurer

Aleatory

unequal exchange of value