Pre-Licensing Insurance Course Chapter 19 (Part 3)
David passed away and he had designated his wife Susan as his beneficiary. Unfortunately, Susan had died before him. Who will receive the payment? a. Dave's estate b. The state of Indiana c. The Indiana Welfare Fund d. The Indiana Wellness Cooperative
a. Dave's estate
Which of the following must an insurer do before making an advertisement for a Medicare supplemental insurance policy public? a. Give the Commissioner a copy for review or approval b. Get permission from the Federal Trade Commission c. Get permission from the ILTCP d. Get permission from the Indiana Attorney General's office
a. Give the Commissioner a copy for review or approval
An insurer must allow a 42-year old to have at least how many mammograms every year? a. 1 b. 2 c. 3 d. 4
a. 1
For any accident and sickness insurance policy, if the insured is at least 40, coverage must include at least how many breast cancer screenings performed upon the insured per year? a. 1 b. 3 c. 5 d. 7
a. 1
After going to the doctor, how much time does someone have to file a health insurance claim? a. 20 days b. 30 days c. 40 days d. 60 days
a. 20 days
Regarding handicapped children who reach the limiting age, proof of such incapacity and dependency must be provided to the insurer by the policyholder within how many days of the child's attainment of the limiting age? a. 31 days b. 60 days c. 180 days d. 365 days
a. 31 days
For long-term care policies, what is the maximum number of months pre-existing conditions can be excluded? a. 6 months b. 12 months c. 18 months d. 24 months
a. 6 months
What is the grace period for individual health policies with premiums due weekly? a. 7 days b. 10 days c. 21 days d. 31 days
a. 7 days
Which of the following is NOT a required provision of group health insurance in Indiana? a. A waiting period of 60 days b. Grace period of 31 days c. Incontestability period of 2 years d. Applicants' statements are representations, not warranties
a. A waiting period of 60 days
What is described by: "Printed and published material and descriptive literature of an insurer used in newspapers, magazines, radio, and television scripts, billboards and similar displays?" a. Advertisements b. Propaganda c. Benefits d. Regulations
a. Advertisements
Dave accidentally wrote down the wrong date of birth on his insurance application. What will happen with respect to all amounts payable under the policy? a. All amounts payable will be as if he had written the correct age b. The claim is voided c. The policy is voided d. Dave must receive a waiver from the Commissioner of Insurance
a. All amounts payable will be as if he had written the correct age
All individual and group accident and sickness insurance policies which provide coverage for an individual insured or a family member or child of the insured must also provide insurance benefits to a newly born child of the insured: a. At birth b. 1 day after birth c. 2 days after birth d. 3 days after birth
a. At birth
An individual employed by a small employer who has been continuously covered for at least 90 days is entitled to receive the conversion policy for all the following, EXCEPT: a. Becoming disabled b. Termination of employment c. Request of a conversion policy d. Reduction of hours
a. Becoming disabled
A person is eligible for a policy under The Indiana Comprehensive Health Insurance Association if the person: a. Has been rejected by one carrier for coverage under any insurance plan that equals or exceeds the minimum requirements for accident and sickness insurance policies issued in Indiana b. Has or is eligible for coverage under any insurance plan that equals or exceeds the minimum requirements for accident and sickness insurance policies issued in Indiana c. Is eligible for Medicaid d. Is on welfare
a. Has been rejected by one carrier for coverage under any insurance plan that equals or exceeds the minimum requirements for accident and sickness insurance policies issued in Indiana
For indemnities in an individual health policy NOT categorized as periodic payment, when must they be paid? a. Immediately after receiving written proof b. Within 30 days of receiving written proof c. Within 60 days of receiving written proof d. Within 90 days of receiving written proof
a. Immediately after receiving written proof
When must indemnities in an individual health policy NOT categorized as periodic payment be paid? a. Immediately after receiving written proof b. Within 30 days of receiving written proof c. Within 60 days of receiving written proof d. Within 90 days of receiving written proof
a. Immediately after receiving written proof
If a handicapped child remains on their parents' health insurance 2 years after the limiting age for dependent children, how often must proof of the handicap be provided to the insurer? a. Once a year b. Twice a year c. 3 times a year a year d. 4 times a year a year
a. Once a year
Susan was a police officer when she took out her life insurance policy, but she retired and now works as a data processor in a call center. Which of the following will her insurance company do? a. Reduce her premium rate accordingly b. Make no change in her premium rates c. Provide a pro forma amortization of her premium rates d. Provide a pro rata recalculation of her quarterly distributions
a. Reduce her premium rate accordingly
All of the following are producer's duties at the time of application for a Medicare Supplement policy, EXCEPT: a. Require the applicant to sign a disclosure statement b. Act in good faith c. Exercise reasonable discretion d. Provide applicant with outline of coverage
a. Require the applicant to sign a disclosure statement
Insurance Agent Johnson is notified of his client Dave's claim. What does Agent Johnson have to do next? a. Send Dave a claim form within 15 days b. Contact Dave within 5 days c. Contact Dave in writing within 10 days d. Contact Dave by email or telephone within 20 days.
a. Send Dave a claim form within 15 days
If an insurance company wants to have an autopsy, who pays for it? a. The insurer b. Larry's estate c. Larry's beneficiary d. The Indiana Autopsy Cooperative
a. The insurer
If the married parents of a dependent child have the same birth date, whose plan covering the child is considered primary? a. The plan that has covered the child for the longest b. The parent born in an even year c. The parent born in an odd year d. The oldest parent
a. The plan that has covered the child for the longest
If an applicant applies for a Medicare supplement policy during the open enrollment period and has continuous creditable coverage for at least 6 months: a. The pre-existing condition exclusion must be reduced by the applicant's total months of creditable coverage. b. The pre-existing condition exclusion must be reduced by 25 percent. c. The pre-existing condition exclusion must be reduced by half. d. The pre-existing condition exclusion must be waived.
a. The pre-existing condition exclusion must be reduced by the applicant's total months of creditable coverage.
What will happen to the unused premiums from a Medicare supplement policy if someone passes away? a. They must be refunded. b. They will be retained by his insurer. c. They will go to fund CHIP. d. They will go to fund ILTCP.
a. They must be refunded.
Dave was an independent contractor for 2 years and bought a health insurance policy for himself. He later went to work for a small business that also provides him with health insurance. Which plan has to provide benefits if he gets sick? a. Whichever plan is the primary plan b. Both plans divide the costs equally c. Whichever plan Dave chooses to file the claim under d. Whichever plan Dave's health care provider chooses to file the claim under
a. Whichever plan is the primary plan
Dave is 25 years old and has autism as well as cystic fibrosis. Can he still be covered by his parents' health insurance? a. Yes b. Not unless his parents sign a release form c. Not unless the Commissioner of Insurance provides a waiver d. No
a. Yes
If Dave is rejected for an insurance policy, is he eligible for another policy issued by an agency that is a member of The Indiana Comprehensive Health Insurance Association? a. Yes b. No c. Not unless the Association provides him a waiver d. Not unless Dave receives a waiver from the Commissioner
a. Yes
If Valerie's mother and her sister had breast cancer, is Valerie considered high risk for the same disease? a. Yes b. Not unless her grandmother also had the disease c. Not unless she tests positive for the Kleeberg-Heinmann trait d. No
a. Yes
Is a recently adopted six-year-old child covered under accident and health insurance? a. Yes b. Not until the child is 7 years old c. Not until the child is 12 years old d. No
a. Yes
Susan is 24 years old, unmarried, and a full-time student. Can she still be covered on her parents' Indiana Comprehensive Health Association insurance policy? a. Yes b. No c. Not unless The Indiana Comprehensive Health Insurance Association provides a waiver d. Not if Susan's parents have a waiver from the Commissioner
a. Yes
Will CHIP cover treatment for a 17-year old who is addicted to cocaine? a. Yes b. Not unless the Commissioner provides a waiver c. Not unless the Indiana Insurance Department provides a waiver d. No
a. Yes
Will expenses for a one-month-old baby with a cleft palate be covered by health insurance? a. Yes b. Not unless the insurance specifically covers this c. Not unless the procedures are performed by a medical doctor rather than a dentist d. No
a. Yes
What is the grace period for individual health policies with premiums due monthly? a. 7 days b. 10 days c. 21 days d. 31 days
b. 10 days
In Indiana, what is the minimum length of coverage for long-term care policies? a. 6 months b. 12 months c. 18 months d. 24 months
b. 12 months
The minimum length of coverage for long-term care policies issued in Indiana is at least: a. 6 months b. 12 months c. 18 months d. 24 months
b. 12 months
With regard to group insurance, within how many days after the insurer receives a claim notice must forms for filing be furnished to the person making the claim? a. 10 days b. 15 days c. 20 days d. 30 days
b. 15 days
Within how many days after the insurer receives a claim notice must forms for filing be furnished to the person making the claim? a. 10 days b. 15 days c. 20 days d. 30 days
b. 15 days
A trigger for benefits eligibility for an Indiana Long Term Care Partnership Program policy is that the insured is unable to perform how many activities of daily living? a. 1 b. 2 c. 3 d. 4
b. 2
What is the minimum number of eligible employees to be considered a small employer? a. 1 b. 2 c. 5 d. 10
b. 2
No misstatements, except fraudulent misstatements, made by the applicant in a individual health application can be used to void the policy or to deny a claim for a loss after: a. 1 year b. 2 years c. 3 years d. 4 years
b. 2 years
What is the incontestability period for a group health policy? a. 1 year b. 2 years c. 3 years d. 4 years
b. 2 years
For group health insurance, no action at law or in equity may be brought to recover on the policy less than how many days after proof of loss is filed? a. 30 days b. 60 days c. 90 days d. 120 days
b. 60 days
What is the maximum number of months after the effective date of coverage that benefits for an eligible employee enrolled in a plan may be limited? a. 6 months b. 9 months c. 12 months d. 18 months
b. 9 months
The issuer of a replacement policy must offer coverage to all persons covered under the old group policy on its date of termination, if a group Medicare supplement policy is replaced by: a. An individual Medicare supplement policy b. Another group Medicare supplement policy c. An individual non-Medicare supplement policy d. Another group non-Medicare supplement policy
b. Another group Medicare supplement policy
Jim has insurance at his company that also covers his wife. His wife, Elizabeth, has insurance at her company, as well. When Elizabeth gets sick, who's policy is primary? a. Jim's insurance is primary. b. Elizabeth's insurance is primary. c. The policy that was first. d. Both insurance companies are equal.
b. Elizabeth's insurance is primary.
If Dave is eligible for Medicaid, is he also eligible for a policy issued by an agency that is a member of The Indiana Comprehensive Health Insurance Association? a. Yes b. No c. Not unless the Association provides him a waiver d. Not if Dave has oral permission from the Commissioner
b. No
Dave was in a serious accident and is in the hospital for 7 months. How much of this is Dave's ICHIA health insurance required to cover? a. Only 150 days b. Only 180 days c. Up to 210 days d. All 7 months
b. Only 180 days
In group health insurance, an applicant's statements are: a. Incontestable b. Representations c. Misrepresentations d. Warranties
b. Representations
Which of the following is NOT a coverage under ICHIA? a. Services of a skilled nursing facility for up to 180 days in a year b. Services of a home health agency for up to 320 days in a year c. Use of radium or other radioactive materials d. Anesthetics
b. Services of a home health agency for up to 320 days in a year
Individual accident and sickness insurance policies cover all natural and adopted children in a family until the limiting age specified in the policy or: a. The child has completed an associate or baccalaureate degree from an accredited school and is not a legal dependent of the policyholder. b. The child has mental or physical disabilities that make him chiefly dependent on the policyholder for support. c. The child is self-supporting. d. The child is under treatment for drug, alcohol, or psychological disorders.
b. The child has mental or physical disabilities that make him chiefly dependent on the policyholder for support.
If an insurance producer sells a replacement long-term care policy with slightly greater benefits, a. The sale will be treated as a new sale, with a new-sale commission rate. b. The sale will be treated as a renewal, with a renewal commission rate. c. The sale will be treated as a hybrid sale and the producer must receive a renewal commission plus 5 percent. d. The sale will be treated as a replacement, and the producer must receive the commission designated for that category.
b. The sale will be treated as a renewal, with a renewal commission rate.
Which of the following is NOT a purpose of the Indiana Long Term Care Partnership Program (ILTCP)? a. Increase public understanding of LTC risks and costs b. To perpetuate the growth of Medicaid expenditures in the state c. Help individuals plan for their LTC needs without fear of impoverishment d. Provide incentives for the purchase of private long term care insurance policies through a partnership between the Medicaid program and insurance companies
b. To perpetuate the growth of Medicaid expenditures in the state
Mark has an individual health and sickness policy through ICHIA. In 2014, Mark's total expenditures in the form of deductibles and coinsurance for eligible medical expenses was $2,500. What portion of this amount will Mark have to pay? a. $1,000 b. $1,050 c. $1,500 d. $2,500
c. $1,500
The Franks family have a health and sickness policy through ICHIA. Their total expenditures in the form of deductibles and coinsurance for eligible medical expenses in 2014 was $5,250. What portion of this amount will the Franks have to pay? a. $1,050 b. $1,500 c. $2,500 d. $2,750
c. $2,500
An insurer must provide notice to all affected health insurance plans and to the Commissioner at least how many days before ceasing to renew all small employer plans? a. 90 days b. 6 months c. 1 year d. 3 years
c. 1 year
For small group health insurance, a plan may not exclude coverage for a late enrollee or the late enrollee's covered spouse or dependent for more than: a. 9 months b. 12 months c. 15 months d. 18 months
c. 15 months
What is the maximum amount of time that a small business's health insurance plan can exclude coverage for a late enrollee? a. 9 months b. 12 months c. 15 months d. 18 months
c. 15 months
Group health insurance provisions are required to have a provision stating that written notice of a claim must be given to the insurer within: a. 10 days b. 15 days c. 20 days d. 30 days
c. 20 days
Within how many days must a written notice of claim be given to an insurer for a health policy? a. 10 days b. 15 days c. 20 days d. 30 days
c. 20 days
The limiting age for dependent children covered under health insurance policies in Indiana is: a. 19 b. 21 c. 24 d. 28
c. 24
Coverages under ICHIA include services of a home health agency up to: a. 150 days of service a year b. 180 days of service a year c. 270 days of service a year d. 365 days of service a year
c. 270 days of service a year
For group health insurance, no action at law or in equity may be brought to recover on the policy more than how many years after proof of loss is filed? a. 1 year b. 2 years c. 3 years d. 4 years
c. 3 years
A policyholder may return a long-term care policy with a full refund of all premiums paid within: a. 15 days b. 21 days c. 30 days d. 31 days
c. 30 days
An employee is eligible for a small group health plan if he is employed to work for at least how many hours each week? a. 20 hours b. 25 hours c. 30 hours d. 40 hours
c. 30 hours
If a claim is filed by the policyholder and written proof of loss is given, what is the last day the insurer can pay a group policyholder? a. 30 days after written proof of loss b. 31 days after written proof of loss c. 45 days after written proof of loss d. 60 days after written proof of loss
c. 45 days after written proof of loss
What is the maximum number of eligible employees to be considered a small employer? a. 20 b. 25 c. 50 d. 100
c. 50
What is the maximum number of months after the effective date of coverage that benefits for an eligible employee enrolled in a small group plan may be limited? a. 3 months b. 6 months c. 9 months d. 12 months
c. 9 months
If a small employer insurer ceases to renew small employer plans, when should the insurer provide notice to the Commissioner? a. At least 6 months prior to termination b. At least 8 months prior to termination c. At least 1 year prior to termination d. At least 2 years prior to termination
c. At least 1 year prior to termination
Which of the following is covered under ICHIA? a. Benefits which would duplicate the provision of services for any care for injury or disease in the course of an employment subject to worker's compensation b. Services for which a charge is not made in the absence of insurance or for which there is no legal obligation on the part of the patient to pay c. Cosmetic surgery provided as a result of an injury and that is medically necessary d. Care which is primarily for a custodial or domiciliary purpose
c. Cosmetic surgery provided as a result of an injury and that is medically necessary
All of the following must be included in mammography coverage in any accident and sickness insurance policy, EXCEPT: a. If the insured is at least 35, but not 40 years of age, coverage for at least 1 baseline breast cancer screening is provided before the insured reaches 40 years of age. b. If the insured is less than 40 years of age and considered 'at risk' coverage is provided for 1 breast cancer screening each year. c. Coverage for additional mammograms requires copayment. d. If the insured is at least 40 years of age, coverage is provided for 1 breast cancer screening each year.
c. Coverage for additional mammograms requires copayment.
An insurer may not cancel or refuse to enter into a contract for health care services coverage based on a person's: a. Non-payment of premiums b. Insurability c. Genetic screening d. Suitability
c. Genetic screening
What constitutes an entire contract of individual health insurance? a. Application only b. Policy only c. Policy with endorsements and attached papers d. Application and policy with endorsements and attached papers
c. Policy with endorsements and attached papers
An insurer is liable for a loss resulting from: a. An attempt to commit a felony b. An illegal occupation c. Prescribed narcotics d. Intoxicants
c. Prescribed narcotics
What happens if someone changed to an occupation that is more hazardous than the one they had when they applied for a health policy and they are injured? a. The insurer will pay nothing. b. The insurer will pay an average of what it pays for the 2 occupations. c. The insurer will pay what the policy would have paid for the new occupation. d. The insurer will pay totally.
c. The insurer will pay what the policy would have paid for the new occupation.
Dave forgets to pay his insurance renewal premium on time and his policy lapses. A month later, he accidentally trips and breaks his arm. Ten days later, his policy is reinstated. Is his broken arm covered? a. Yes b. Not unless Larry's agent chooses to provide a waiver c. Not unless the Indiana Commissioner of Insurance provides a waiver d. No
d. No
Which of the following is NOT a provision applicable to long-term care policies? a. Long-term care policies must be guaranteed renewable b. A shopper's guide must be provided to all applicants prior to the sales presentation or completion of an application form c. The outline of coverage must be provided within 1 month after initial solicitation d. In policy recommendation, producers must make every effort to determine that the long-term care policy is suitable to their client's needs
c. The outline of coverage must be provided within 1 month after initial solicitation
In order to be eligible for The Children's Health Insurance Program (CHIP), a child must be under: a. 16 b. 17 c. 18 d. 19
d. 19
A policy under ICHIA that provides coverage of a dependent unmarried child terminates when the child is not a student and becomes: a. 19 b. 21 c. 23 d. 25
d. 25
If parents want to keep their handicapped child on their insurance after the limiting age, proof of incapacity and dependency must be furnished to the insurer within: a. 15 days b. 21 days c. 30 days d. 31 days
d. 31 days
If payment of a specific premium is required to provide coverage for a child, the policy may require that notification of birth and payment of fees must be provided to the insurer within: a. 15 days b. 21 days c. 30 days d. 31 days
d. 31 days
The grace period for group health policies is: a. 20 days b. 21 days c. 30 days d. 31 days
d. 31 days
What is the grace period for individual health policies with premiums due less frequently than monthly? a. 7 days b. 10 days c. 21 days d. 31 days
d. 31 days
Which of the following is covered by CHIP? a. Well-baby and well-child care b. Laboratory and X-ray services c. Inpatient and outpatient hospital services d. All of the above
d. All of the above
Which of the following terms/phrases are NOT allowed for use by the insurer in presentations, prepared sales talks, or other media in order to exaggerate the terms of a policy? a. "This policy will pay your hospital and surgical bills" b. "Comprehensive" c. "As high as" d. All of the above
d. All of the above
All the following are false, EXCEPT: a. An insurer may require an insured or a member of an insured's family to submit the results of certain types of genetic testing. b. An insurer may adjust rates based on genetic testing. c. An insurer may use genetic testing results that were submitted voluntarily to make a decision adverse to the member or a family member. d. An insurer is prohibited from using genetic testing to determine issuance of coverage or decisions regarding specific services or rates.
d. An insurer is prohibited from using genetic testing to determine issuance of coverage or decisions regarding specific services or rates.
A woman is considered high risk for breast cancer if she meets which of the following descriptions? a. The woman has a history of breast disease that was proven benign by biopsy b. The woman is 30 years of age or older and has not given birth c. The woman's mother, sister, or daughter has had breast cancer d. Any of the above
d. Any of the above
What provision establishes an order in which plans pay their claims? a. Free look b. Length of Coverage c. Birthday Rule d. Group Coordination of Benefits
d. Group Coordination of Benefits
Long-term Care Policies must be: a. Nonrenewable b. Optionally Renewable c. Conditionally Renewable d. Guaranteed Renewable
d. Guaranteed Renewable
All the following statements are true, EXCEPT: a. The Indiana Comprehensive Health Insurance Association (ICHIA) is a nonprofit legal entity, whose job is to assure that health insurance is made available throughout the year to each eligible Indiana resident applying to the association for coverage. b. A person qualifies for ICHIA policy if insurers have refused to issue an insurance comparable to the one offered by ICHIA, except at a rate exceeding the association plan rate. c. The ICHIA policy must assure that coverage of a dependent unmarried child terminates when the child becomes at age 26 unless that child is incapable of self-sustaining employment by reason of mental retardation or mental and physical disability and relies on the policyholder for support and maintenance. d. ICHIA is an alternative service to the service of federal Medicaid; buyers may choose between the two.
d. ICHIA is an alternative service to the service of federal Medicaid; buyers may choose between the two.
Harvey was trying to rob a liquor store and received a non-fatal wound in the shoulder. Is his insurer liable for Harvey's injury? a. Yes b. Not unless he was trying to steal property or monies valued at less than $500 c. Not unless he was trying to steal property or monies valued at less than $1000 d. No
d. No
In Indiana, would the words "reinstatement" or "capital" need further clarification in the context of an insurance advertisement? a. Yes b. Not unless the Insurance Commissioner requires it c. Not if the Insurance Agency has oral permission from the Commissioner d. No
d. No
Is an insurer liable for someone who broke their arm while drunk? a. Yes b. Not unless his blood alcohol level was over 0.8 c. Not unless his blood alcohol level was over 1.0 d. No
d. No
Susan lost her arm while serving with the Army in Iraq. Is this injury covered under her ICHIA health insurance policy? a. Yes b. Not unless ICHIA provides a waiver c. Not unless Susan receives a waiver from the Commissioner d. No
d. No
The secretary to Vice President of the Acme Insurance Company approves a change in Larry's health insurance policy. Is this change valid? a. Yes b. Not unless Larry's agent changes the policy c. Not unless the Indiana Commissioner of Insurance changes the policy d. No
d. No
Will ICHIA health insurance cover braces for teeth? a. Yes b. Not unless ICHIA provides a waiver c. Not unless the Commissioner gives a waiver d. No
d. No
Of the following, what must be contained on the first page of a Medicare supplement policy? a. Notice of full disclosure b. Notice outline of coverage c. Notice of renewability d. Notice to buyer that policy may not cover all medical expenses
d. Notice to buyer that policy may not cover all medical expenses
Which of the following is NOT a purpose of the Indiana Long Term Care Partnership Program (ILTCP)? a. Help individuals plan for their LTC needs without fear of impoverishment b. Assist the state with containing the growth of Medicaid expenditures c. Increase public understanding of LTC risks, costs, and financing d. Provide incentives for the purchase of short-term care wellness supplements
d. Provide incentives for the purchase of short-term care wellness supplements
Which of the following is NOT covered by CHIP? a. Psychiatric residential treatment services b. Community mental health rehabilitation services c. Outpatient mental health services and substance abuse services d. Psychiatric online grief counseling
d. Psychiatric online grief counseling
Coverage for adoptive children of parents who have a health and sickness policy begins: a. On their birthdate b. On the date of placement with the adoptive family c. On the date the court order granting adoptive parents custody d. The earlier of these two dates: the date of placement with the adoptive family or the date of the court order giving adoptive parents custody
d. The earlier of these two dates: the date of placement with the adoptive family or the date of the court order giving adoptive parents custody
Who is responsible for paying for an autopsy on the person of the insured? a. The beneficiary b. The insured's family c. The Commissioner d. The insurer
d. The insurer
