Missed final insurance questions
Karen is a producer who has obtained personal information about a client without having a legitimate reason to do so. Under the McCarran-Ferguson Act, what is the minimum penalty for this? 1. $0 2. $5,000 3. $10,000 4. $15,000
"$10,000". A fine of $10,000 or up to one year in jail is the penalty for any person who obtains information about a client without having a legitimate reason to receive it.
A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay? 1. $35 2. $75 3. $100 4. $140
"$140". Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140.
After a hearing, if the Commissioner determines that a person has willfully engaged in an unfair trade practice, the Commissioner may impose a fine of which of the following? 1. $5,000 for each violation 2. $10,000 for each violation 3. $15,000 for each violation 4. $20,000 for each violation
"$5,000 for each violation". A fine of up to $1,000 can be administered for each violation, $5,000 if the violator knew the act was illegal.
The typical long-term care insurance policy is designed to provide a minimum of __ year(s) of coverage. 1. 1 2. 3 3. 5 4. 7
"1". Long-term care insurance in any insurance policy is designed to provide coverage for a minimum benefit period of 1 year.
Which of the following is the number of days required in a notice of hearing? 1. 10 days 2. 15 days 3. 30 days 4. 90 days
"10 days". Hearings are held 10 days after a notice of hearing notification.
The licensee shall advise the Department of Banking and Insurance of the closing of a branch office within how many days? 1. 20 days in writing 2. 20 days 3. 30 days in writing 4. 30 days
"30 days in writing". The licensee shall advise the Department of Banking and Insurance of the closing of a branch office within 30 days in writing.
What is the free-look period of a Medicare Supplement policy? 1. 10 days 2. 20 days 3. 30 days 4. 40 days
"30 days". The free-look period of a Medicare Supplement policy is 30 days.
Additional premiums or contributions are required to make coverage effective for a newborn infant from the moment of birth to how many days after the birth? 1. 30 2. 45 3. 60 4. 75
"30". Additional premiums or contributions are required to make coverage effective for a newborn infant from the moment of birth to 30 days after the birth.
In New Jersey, an insurer is required to maintain files of all published and printed advertisements for 1. 5 years from the date of first use 2. 3 years from the date of first use 3. 5 years from the date of last use 4. 3 years from the date of last use
"5 years from the date of last use". In New Jersey, an insurer is required to maintain files of all published and printed advertisements for 5 years from the date of last use.
The legal action provision in a health contract is limited to no more than ___ years. 1. 2 2. 3 3. 4 4. 5
"5". The time limit for a legal action provision in a contract is limited to no more than 5 years.
The legal action provision in a health contract is limited to no more than ___ years. 1. 2 2. 3 3. 4 4. 5
"5". The time limit for a legal action provision in a contract is limited to no more than 5 years.
What percentage of a participant's income are group long-term disability benefit amounts typically limited to? 1. 30% 2. 40% 3. 50% 4. 60%
"60%". Group long-term disability benefit amounts are usually limited to 60% of the participant's income.
Maternity care must be provided to mother and newborn in a licensed facility for at least how many hours following a cesarean section? 1. 24 hours 2. 36 hours 3. 48 hours 4. 96 hours
"96 hours". Maternity care must be provided to mother and newborn in a licensed health facility for at least 96 hours following cesarean section.
Part A Hospital expense coverage provided under Medicare is automatically made available to each of the following EXCEPT 1.A 50-year old individual who has qualified for SSDI in the last 24 months 2. A 70-year old NOT eligible for Social Security 3. A 55-year old suffering from kidney failure 4. A 65-year old retiree
"A 70-year old NOT eligible for Social Security". You are eligible to receive Medicare Part A benefits at age 65 or older if you are eligible to receive Social Security benefits.
Under a disability income policy, which provision would be payable if the cause of an injury is unexpected and accidental? 1. Presumptive disability provision 2. Absolute accidental provision 3. Accidental death benefit provision 4. Accidental bodily injury provision
"Accidental bodily injury provision". Under the accidental bodily injury provision, benefits would be payable if the cause of an injury is unexpected and accidental.
The spouse of a deceased producer may take which of the following actions to continue the producer's insurance business? 1. Apply for a temporary appointment with the producer's insurance company 2. Apply for a temporary license with the Department of Banking and Insurance 3. Pass a special insurance exam and apply for a temporary license 4. Demonstrate competence and insurance knowledge to the Department of Banking and Insurance
"Apply for a temporary license with the Department of Banking and Insurance". The spouse of a deceased producer may apply for a temporary license with the Department of Banking and Insurance to continue the producer's insurance business.
The spouse of a deceased producer may take which of the following actions to continue the producer's insurance business? 1.Apply for a temporary appointment with the producer's insurance company 2.Apply for a temporary license with the Department of Banking and Insurance 3.Pass a special insurance exam and apply for a temporary license 4.Demonstrate competence and insurance knowledge to the Department of Banking and Insurance
"Apply for a temporary license with the Department of Banking and Insurance". The spouse of a deceased producer may apply for a temporary license with the Department of Banking and Insurance to continue the producer's insurance business.
The difference between a Long Term Care Partnership Plan and a Non-Partnership Plan is which of the following? 1. Pre-existing conditions 2. Level of benefits 3. Asset Protection 4. Elimination period
"Asset Protection". Assets are protected from Medicaid Recovery under a Long-Term Care Partnership plan. Non-partnership plans do not protect assets from Medicaid Recovery.
Which of the following nursing home options would BEST suit an individual who needs some nursing care and supervision but NOT full-time care? 1. Custodial care homes 2. Assisted living facilities 3. Skilled nursing facilities 4. Congregate housing
"Assisted living facilities". An assisted living facility would best suit an individual who needs some nursing care and supervision but not full-time care.
XYZ Corp pays the tax-deductible insurance premiums for a key employee disability policy. Which of the following would be the appropriate tax consequence? 1. Premiums are paid with tax credits 2. Benefits are partially taxable 3. Benefits are fully taxable 4. Premiums are paid with after-tax dollars
"Benefits are fully taxable". If the business pays premium as a tax-deductible expense, any benefits paid will be fully taxable.
A voluntarily terminated producer license may be reinstated during the same license period if the producer takes which of the following actions? 1. Completes a new license application 2 Pays a quarterly renewal fee 3. Completes an approved continuing education course 4. Posts a $500 reinstatement bond
"Completes a new license application". A voluntarily terminated producer license may be reinstated during the same license period if the producer completes a new license application.
Which disability policy provision would address any concerns of the value of the benefits decreasing over time? 1. Cost of living benefit 2. Inflation rider benefit 3. Policy enhancement benefit 4. Interest sensitive benefit
"Cost of living benefit". A cost of living benefit will address any concerns that the value of the benefits may decrease over time.
Which of the following coverages is a mandatory provision of Medicare Supplement policies? 1.Foot care in connection with chronic foot strain 2. Alcoholism and drug addiction 3. Coverage for pre-existing conditions after six months from the effective date of coverage 4. Custodial care
"Coverage for pre-existing conditions after six months from the effective date of coverage". Pre-existing conditions must be covered after six months from the effective date of coverage.
Which of the following coverages is a mandatory provision of Medicare Supplement policies? 1. Foot care in connection with chronic foot strain 2. Alcoholism and drug addiction 3. Coverage for pre-existing conditions after six months from the effective date of coverage 4. Custodial care
"Coverage for pre-existing conditions after six months from the effective date of coverage". Pre-existing conditions must be covered after six months from the effective date of coverage.
Which of the following statements is NOT true regarding a Critical Illness Plan? 1. Pays a lump sum to the insured upon the diagnosis of a critical illness 2.The insurer may have a list of critical illnesses they will cover 3. Coverage is limited to a single devastating disease 4. Also known as Specified Disease Plans
"Coverage is limited to a single devastating disease". This is incorrect. There are normally a number of "critical illnesses" that a Critical Illness Plan will cover.
An individual must be a licensed producer in order to take which of the following actions? 1. Compile the names and addresses of perspective insurers for marketing purposes 2. Accept premiums from insureds at a recorded place of business 3. Discuss the effects of age or health on premiums with a perspective insured 4. Type binders or certificates
"Discuss the effects of age or health on premiums with a perspective insured". An individual must be a licensed producer in order to discuss the effects of age or health on premiums with a perspective insured.
One of the most important considerations when replacing health insurance would be the 1. Age of the insured 2. Exclusions on a new policy 3. Occupation of the insured 4. Cost
"Exclusions on a new policy". One of the most important considerations in replacing medical insurance is the exclusions or limitations on a new policy.
XYZ Company has applied for group health insurance for its employees. What information would the insurer's underwriters likely use to determine the appropriate coverage and final premium rate given to the group? 1. Experience rating 2. Credit reports 3. Arrest reports 4. AM Best rating
"Experience rating". When determining the appropriate coverage and final premium rate for group health insurance, the insurer's underwriters will use the group's experience rating. An experience rating system is used to estimate how much a specific group will have to spend on medical care.
An insurance company needs to obtain personal information from a third party concerning an applicant. Which law do all insurers and their producers need to comply with? (1)USA Patriot Act (2)Personal Information Act (3)Fair Credit Reporting Act (4)McCarran-Ferguson Act
"Fair Credit Reporting Act". To protect the rights of consumers for whom an inspection or credit report has been requested, Congress enacted the Fair Credit Reporting Act in 1970.
Which of these is NOT a qualifying event for Medicare? 1. On Social Security disability for over 2 years 2. Kidney failure 3. Age 65 or older 4. Falling below the federal poverty level
"Falling below the federal poverty level". All of these are qualifying events for Medicare EXCEPT being poverty stricken.
Which of these will typically authorize treatment from a specialist? 1. Administrator 2. Policyowner 3. Insurance company 4. Gatekeeper
"Gatekeeper". A gatekeeper must authorize treatment from a specialist.
All of the following are primary risk factors in underwriting individual health insurance policies EXCEPT 1. Geographical location 2. Moral hazard 3. Occupation 4. Physical condition
"Geographical location". Geographical location is not a factor when determining risk in individual health insurance policies.
All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT 1. Section 125 Plan 2. Premium Only Plan 3. Cafeteria Plan 4. Health Reimbursement Arrangement Plan
"Health Reimbursement Arrangement Plan". Employers contribute to Health Reimbursement Arrangement Plans (HRA's), not employees.
Which of the following is NOT taken into consideration when determining eligibility for Medicare benefits? 1. Chronic kidney disease 2. Income 3. Age 4. Social Security disability
"Income". All of the following are eligibility considerations for Medicare benefits EXCEPT "income".
Which of the following is present when an applicant stands to lose value if the insured dies? (1) Insurability (2) Offer and acceptance (3) Insurable interest (4) Consideration
"Insurable interest". Insurable interest means that the person acquiring the contract (the applicant) must be subject to loss upon the death, illness, or disability of the person being insured.
Which of the following is present when an applicant stands to lose value if the insured dies? 1. Insurability 2. Offer and acceptance 3. Insurable interest 4. Consideration
"Insurable interest". Insurable interest means that the person acquiring the contract (the applicant) must be subject to loss upon the death, illness, or disability of the person being insured.
Which of the following statements is CORRECT about a Buyer's Guide? 1. It must explain specific policy values 2. It's content must be approved by the Insurance Commissioner 3. It must include the amount of the equivalent level annual dividend 4. It must give the name and address of the producer making the sales presentation
"It's content must be approved by the Insurance Commissioner". The content of a Buyer's Guide must be approved by the Insurance Commissioner.
The authority granted to a licensed producer is provided via the 1. producer's apparent authority 2. written contract 3. Law of Agency 4. Principal Capacity
"Law of Agency". According to the Law of Agency, the producer/agent represents the principal/insurer and is granted actual, implied and apparent authority to act on behalf of the insurer. The Law of Agency makes the principal responsible for these acts of the agent.
The time limit for filing claim disputes is addressed in which provision of an accident and health policy? 1.Legal actions 2.Entire contract 3. Time of payment of claims 4. Payment of claims
"Legal actions". The Legal actions provision of an accident and health policy dictates the time limit for filing claim disputes.
Which of these would NOT be considered a presumptive disability? 1. Loss of vision and speech 2. Loss of hearing 3. Loss of a leg or arm 4. Loss of a leg and arm
"Loss of a leg or arm". The loss of ONE arm or a leg is NOT considered a presumptive disability.
Which of the following would probably NOT be considered in underwriting a health insurance risk? 1.Personal habits 2.Credit rating 3.Medical history 4. Marital status
"Marital status". Marital status is not considered when evaluating risk for a health insurance policy.
Tyler purchased a disability policy with a waiver of premium rider on April 1. He is disabled on May 1. On June 1, he receives proof of permanent and total disability, and submits a claim. He begins receiving benefits on June 15. When are his premiums waived? 1. April 1 2. May 1 3. June 1 4. June 15
"May 1". Premiums are waived beginning at the date of disability.
Sonya applied for a health insurance policy on April 1. Her agent submitted the information to the insurance company on April 6. She paid the premium on May 15 with the policy indicating the effective date being May 30. On which date would Sonya have coverage? 1. April 1 2. April 6 3. May 15 4. May 30
"May 30". The "effective date" is the health insurance coverage start date.
Which of the following is Medicare Part B also known as? 1. Hospital insurance 2. Medical insurance 3. Long-term care insurance 4. Medigap
"Medical insurance". Medicare Part B covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
Which of the following is a legal entity created for the sole purpose of providing affordable group health coverage to its participants? 1. Multiple Employer Welfare Arrangement (MEWA) 2. Multiple Trust Arrangement (MTA) 3. Multiple Purchasing Groups (MPG) 4. Fraternal Benefit Society
"Multiple Employer Welfare Arrangement (MEWA)". A MEWA is an arrangement where a group of employers pool their contributions together to purchase group health and other insurance benefits for their employees. By pooling their contributions together, these smaller employers are better positioned to offer the best benefit packages from insurance companies due to economies of scale. MEWA's are also formed to allow a group of employers to self-insure their healthcare needs.
When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? 1.No deductible payment is required 2. Deductible specified in the contract is payable by the insured 3. Insured must pay a percentage of covered losses 4. An initial deductible plus a percentage of the remaining covered loss is owed by the insured
"No deductible payment is required". A health insurance plan with first dollar coverage means no deductible payment is required before expenses are reimbursed.
Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered 1. Guaranteed Renewable 2. Optionally Renewable 3. Conditionally Renewable 4. Noncancellable
"Noncancellable". A noncancellable policy cannot be cancelled nor can its premium rates be increased under any circumstances.
Chris is an insured bricklayer who severed his left hand in an automobile accident. Although his primary duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability income check every month. How does his policy define total disability? 1. Recurrent 2. Any occupation 3. Own occupation 4. Presumptive
"Own occupation". The "own occupation" definition of total disability requires that the insured be unable to perform the insured's current occupation as a result of an accident or sickness.
Joe is a Medicare participant who receives his benefits through a Managed Health Care Plan. Which Medicare plan does he have? 1. Part A 2. Part B 3. Part C 4. Part D
"Part C". Medicare Part C (or "Medicare Advantage") is a Managed Health Care Plan that serves as a substitute for Parts A and B Medicare benefits.
A person who is a nonsmoker, of average weight, and in excellent health would most likely be in which risk classification? 1. Standard 2. Substandard 3. Acceptable 4. Preferred
"Preferred". In this situation, the individual will most likely have a preferred risk classification.
Which payment method for a health claim settlement is typically made directly to the provider of the services? 1. Settlement 2. Fee-for-service 3. Premium payment 4. Prepaid
"Prepaid". Prepaid medical service plans (HMO's) pay providers directly through a process called capitation.
Premiums paid that exceed 7 1/2% of an insured's Adjusted Gross Income (AGI) are tax-deductible when paid for which of the following plans? 1. Accidental Death and Dismemberment 2. Personal Disability Income plan 3. Qualified Long-Term Care plan 4. Group disability income plan
"Qualified Long-Term Care plan". Premiums paid that exceed 7 1/2% of an insured's Adjusted Gross Income (AGI) are tax-deductible when paid for a Qualified Long-Term Care plan.
The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT: (1)Sale of excessive insurance (2)Replacement of any existing coverage (3)Inaccurate policy provisions (4)Failure to display notice of limitations to buyer
"Replacement of any existing coverage". The marketing of Medicare Supplements is regulated to prevent all of these EXCEPT replacement of any existing coverage.
The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT: (1)Sale of excessive insurance (2) Replacement of any existing coverage (3) Inaccurate policy provisions (4) Failure to display notice of limitations to buyer
"Replacement of any existing coverage". The marketing of Medicare Supplements is regulated to prevent all of these EXCEPT replacement of any existing coverage.
An insurer's claim settlement practices are regulated by the 1. Securities and Exchange Commission (SEC) 2. National Association of Claims Adjusters (NACA) 3. National Association of Insurance Commissioners (NAIC) 4. State insurance departments
"State insurance departments". Claim settlement practices of insurers are regulated by State insurance departments.
Jonas has disability insurance through his employer. The employer pays 75% of the premium, and Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? 1. Taxes must be paid on all benefits received 2. No taxes are payable on any benefits received 3. Taxes must be paid on 25% of the benefits received 4. Taxes must be paid on 75% of the benefits received
"Taxes must be paid on 75% of the benefits received". In this situation, the insured must pay taxes on 75% of the benefits received.
Backdating an insurance policy occurs when 1. the policy's elimination period is waived 2. the time frame for reinstating a lapsed policy is extended 3. the policy's probation period is earlier than the present 4. the policy's effective date is earlier than the present
"The policy's effective date is earlier than the present". Backdating on an insurance policy is the practice of making the policy effective on an earlier date than the present.
A person who has passed the New Jersey insurance licensing examination must apply for a producers license within a MAXIMUM of how many months? 1. Six 2. Nine 3. Twelve 4. Twenty-four
"Twelve". A person who has passed the New Jersey insurance licensing examination must apply for a producers license within a MAXIMUM of twelve months.
Which of the following pertains to the analysis of an applicant's personal information and determining whether insurance should be issued or declined? 1.Adverse calculation 2. Underwriting 3. Risk classification 4. Actuarial determination
"Underwriting". The analysis of information pertaining to an applicant that was obtained from various sources and the determination of whether the insurance should be issued or declined is called underwriting.
When a Producer, domiciled in New York, with an office location in New Jersey, elects New Jersey as their resident state, he is acting as 1. a resident licensee in New York 2. an unauthorized business in New Jersey 3. a foreign producer in New Jersey 4. a resident licensee in New Jersey
"a resident licensee in New Jersey". Producers who are residents of or have their offices in New Jersey fall within the jurisdiction of the Department of Banking and Insurance.
The factor used most often when underwriting a disability income policy is 1. annual earnings 2. sex of the insured 3. marital status 4. occupation
"annual earnings". When an insurer underwrites an individual for disability income coverage, the most commonly used factor is annual earnings.
A Medicare Supplement Policy is 1. government insurance designed to provide healthcare to the elderly 2. designed to provide prescription drug coverage to the elderly 3. designed to fill in the gaps of Part A and Part B Medicare 4. a supplement to Medicare Advantage Part C
"designed to fill in the gaps of Part A and Part B Medicare". A Medicare Supplement policy is designed to fill in the gaps of Part A and Part B Medicare
A Medicare Supplement Policy is : 1. government insurance designed to provide healthcare to the elderly 2. designed to provide prescription drug coverage to the elderly 3. designed to fill in the gaps of Part A and Part B Medicare 4. a supplement to Medicare Advantage Part C
"designed to fill in the gaps of Part A and Part B Medicare". A Medicare Supplement policy is designed to fill in the gaps of Part A and Part B Medicare.
All of these are characteristics of a major medical expense policy EXCEPT 1. large benefit maximums 2. deductibles 3. elimination periods 4. coinsurance
"elimination periods". The elimination period is the period of time between the onset of a disability, and the time you are eligible for benefits. It is typically a characteristic of disability policies, not major medical expense policies.
Key Person Disability Insurance pays benefits to the 1. hospital 2. employee 3. employer 4. employee's creditors
"employer". Key Person Disability Insurance provides crucial benefits to protect the company financially in the event that a key employee can no longer work due to a disability. Key Person coverage provides cash flow to help companies move forward and maintain a profit in the event that a key employee becomes disabled. The employer is the policyowner and pays premiums that are NOT tax-deductible. Benefits, however, are received tax-free to the employer.
Premium mode is a term used to describe the 1. premium past due 2. method of payment 3. frequency of the premium payment 4. premium paid
"frequency of the premium payment". The premium mode defines the frequency of the premium payment.
A group Disability Income plan that pays tax-free benefits to covered employees is considered: (1) non-contributory (2)partially contributory (3)group contributory (4)fully contributory
"fully contributory". Fully contributory group plans require the employee to pay all premium cost, therefore, any benefits received by covered employees are received tax-free.
If a producer fails to respond to a subpoena from the New Jersey Banking and Insurance Commissioner, the Commissioner may 1. sentence the producer to prison 2. revoke the producer's company appointment 3. impose an administrative penalty 4. confiscate earned commissions
"impose an administrative penalty". If a producer fails to respond to a subpoena from the New Jersey Banking and Insurance Commissioner, the Commissioner may impose an administrative penalty.
The Do Not Call Registry offers exemptions for calls placed from all of the following EXCEPT 1. charities 2. political organizations 3. insurance sales calls 4. surveys
"insurance sales calls". All of these types of calls are exempt from the Do Not Call Registry EXCEPT insurance sales calls.
A certification of license status contains all of the following information EXCEPT (1)licensee's place of birth (2)license reference number (3)license expiration date (4) license authorities granted
"licensee's place of birth". A certification of license status contains all of these except the "licensee's place of birth".
All _____ policies must be guaranteed renewable. 1. dental 2. long-term care 3. critical illness 4. disability
"long-term care". All long-term care policies must be guaranteed renewable.
In contrast to a guaranteed renewable policy, a noncancellable policy 1. may cancel the policy only at renewal 2. may raise premiums at policy renewal 3. may raise premiums at anytime 4. may never raise premiums
"may never raise premiums". Noncancellable policies may not be changed in anyway by the insurer up to a specified age so long as the premiums are paid.
The New Jersey Individual Health Coverage Program is designed to provide comprehensive health benefits for 1. low income residents of New Jersey 2. senior citizens residing in New Jersey 3. medically uninsurable New Jersey residents 4. children of low-income New Jersey residents
"medically uninsurable New Jersey residents". The New Jersey Individual Health Coverage Program is designed to provide comprehensive health benefits for medically uninsurable New Jersey residents.
Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n) 1. initial premium 2. signed impairment rider acknowledgement 3. modified application with a new signature 4. good health statement
"modified application with a new signature". All of these may be collected upon policy delivery EXCEPT a "modified application with a new signature".
Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n) 1. initial premium 2. signed impairment rider acknowledgement 3. modified application with a new signature 4. good health statement
"modified application with a new signature". All of these may be collected upon policy delivery EXCEPT a "modified application with a new signature".
States that have "no loss no gain" laws require a replacing policy to 1.keep the same type of coverage as the policy it replaces 2.not charge a different premium from the policy it replaces 3.pay for half of any ongoing claims under the policy it replaces 4.pay for ongoing claims under the policy it replaces
"pay for ongoing claims under the policy it replaces". No loss no gain legislation requires that when health insurance is replaced, ongoing claims under the former policy must continue to be paid under the new policy.
The purpose of the New Jersey Temporary Disability Benefits law is to (1) supplement Unemployment Compensation benefits (2) supplement Workers Compensation benefits (3) provide Medical Expense benefits (4) provide non occupational Disability benefits
"provide non occupational Disability benefits". To qualify for the New Jersey Temporary Disability Benefits program, you must have a non-work related illness or injury that keeps you from working and be under medical care for treatment of the disabling condition.
An indemnity plan 1. pays both the insured and health care provider 2. provides the insured a specific dollar amount for services 3. pays the health care provider directly for services rendered 4.is typically issued as a group plan
"provides the insured a specific dollar amount for services". With an indemnity plan, an insured is provided a specific dollar amount for services.
Health insurance involves two perils, accident and ____. 1. death 2. sickness 3. disability 4. liability
"sickness". The two perils in health insurance are accident and sickness.
An insurer has the right to recover payment made to the insured from the negligent party. These rights are called 1. contributory 2. indemnity 3. estoppel 4. subrogation
"subrogation". The rights of the insurer to recover payment made to the insured from the negligent party is called subrogation.
The elimination period under a hospital indemnity plan is: (1)the period in which pre-existing conditions are not taken into consideration (2)the period in which all deductibles are eliminated (3)the specified number of days after an insurance policy's issue date during which coverage is not afforded for sickness (4)the specified number of days an insured must wait before becoming eligible to receive
"the specified number of days an insured must wait before becoming eligible to receive benefits for each hospitalization". In a hospital indemnity plan, an elimination period refers to the number of days an insured must wait before becoming eligible to receive benefits for each hospital stay.
The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as 1. twisting 2. subrogation 3. rebating 4. churning
"twisting". The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as twisting.
Karen is a producer who has obtained personal information about a client without having a legitimate reason to do so. Under the McCarran-Ferguson Act, what is the minimum penalty for this? (1)$0 (2)$5,000 (3)$10,000 (4)$15,000
$10,000 A fine of $10,000 or up to one year in jail is the penalty for any person who obtains information about a client without having a legitimate reason to receive it.
All group health-care service contracts MUST provide coverage for: 1. alcoholism treatment 2. routine vision care 3. routine hearing examinations 4. unlimited psychiatric care
Alcoholism Treatment All group health-care service contracts must provide coverage for alcoholism treatment.
Which type of business insurance is meant to cover the costs of continuing to do business while the owner is disabled? 1. Disability overhead policy 2. Business continuation policy 3. Disability buy-sell policy 4. Business overhead expense policy
Business overhead expense policy". A form of business disability insurance that is designed to cover the actual costs of continuing to do business while an insured business owner is disabled is called a business overhead expense policy.
All of the following are core benefits of Medicare Supplement Plan A EXCEPT 1. Deductible payments for the first 60 days of hospitalization under Medicare hospitalization insurance 2. Medicare Part A hospice coinsurance or copayment 3. Medicare Part B coinsurance or copayment 4. The first three pints of blood received
Deductible payments for the first 60 days of hospitalization under Medicare hospitalization insurance Medicare Supplement Plan A does NOT cover the Medicare Part A deductible. However, the remaining Medicare Supplement plans cover 50-100% of this cost.
A fee for service health insurance plan will normally cover 1. vitamins and natural remedies 2. cosmetic procedures 3. gym membership 4. a disease
Diseases are usually covered by fee for service health insurance plans.
What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? (1)MEWA (2)Blanket insurance (3)Dread disease insurance (4)Disability insurance
Dread Disease Insurance Dread disease insurance provides benefits for ONLY specific types of illnesses such as cancer or stroke.
Which of the following typically does NOT provide a form of managed care? 1. Preferred Provider Organization (PPO) 2. Point-of-Service (POS) plan 3. Major medical indemnity plan 4.Health Maintenance Organization (HMO)
Major Medical Indemnity plan Managed care is typically provided under all of these EXCEPT a "major medical indemnity plan".
An insurance company owned by its policyholders is known as which of the following? (1)Reinsurance company (2)Stock company (3)Mutual company (4) Domestic company
Mutual company A Mutual Company, also known as a Participating Company, is owned by its policyholders, who elect the Board of Directors each year. A Stock company also known as a non-participating company.
What makes an insurance policy a unilateral contract? 1. Only the insured pays the premium 2. Only the insured can change the provisions 3. Only the insurer is legally bound 4. Only the insured is legally bound
Only the insurer is legally bound". Insurance contracts are unilateral, meaning that only the insurer makes legally enforceable promises in the contract.
Claims payable to a Disability Income insured, even when the insured can continue to work, are the result of a 1. Total disability 2. Recurrent disability 3. Presumptive disability 4. Lengthy elimination period
Presumptive disability A presumptive disability provision specifies certain conditions that automatically qualify the insured for the full benefit because the severity of the conditions presumes the insured is totally disabled, even if the insured is able to work.
Which of the following provides Medicare supplement policies? (1)Medicare (2)Medicaid (3)Private insurance companies (4)Associations and employers
Private Insurance Companies Medicare supplement policies are provided by private insurers.
A producer who shares commissions with a client may be guilty of: (1)fraud (2)redlining (3)rebating (4)commingling
Rebating
In New Jersey, a producer who violates a New Jersey insurance law for the first time may be fined up to 1. $1,000 2. $2,000 3. $3,000 4. $5,000
The correct answer is "$5,000". In New Jersey, a producer who violates a New Jersey insurance law for the first time may be fined up to $5,000.
What is the elimination period of an individual disability policy? 1. Time period an insured must wait before coverage begins 2. Time period a disabled person must wait before benefits are paid 3. Time period after the policy issue date in which the provisions are still contestable 4. The point in time when benefits are no longer payable
Time period a disabled person must wait before benefits are paid". The elimination period of an individual disability insurance policy refers to the amount of time a disabled person must wait before benefits are paid.
The purpose of advertising regulations is to (1) ensure that the prospect has all the required information to make an informed decision (2)ensure that the insurance company is supervising the agents properly (3) assure that spokespersons are properly compensated (4) assure full and truthful disclosures to the public
assure full and truthful disclosures to the public
Medicare Part B covers 1. long-term care 2. hospital room and board 3. doctor's charges 4. prescription drugs
doctor's charges". Doctor's charges are one of the services covered by Medicare Part B
A health insurance policy that allows an insurer to change the policyowner's premiums, but NOT cancel the policy is called a(n) 1.guaranteed renewable policy 2.conditionally renewable policy 3.optionally renewable policy 4.noncancelable policy
guaranteed renewable policy An insurer has the right to change the premium for policyowners with a guaranteed renewable policy, but CANNOT cancel the policy.
The primary purpose of replacement regulation is to 1. protect the renewal commissions of the existing producers 2. protect policyowners from misrepresentations and loss of benefits 3. protect insurance company home offices from loss of in-force business 4. inform consumers of the availability of additional policy coverages
protect policyowners from misrepresentations and loss of benefits The primary purpose of replacement regulation is to protect policyowners from misrepresentations and loss of benefits.