Simulate

What percentage of individually-owned disability income benefits is taxable?

0%

COBRA applies to employers with at least

20 employees

Which of the following must the patient pay under Medicare Part B?

20% of covered charges above the deductible

How many days of notice must insurers provide when canceling accident and health policies?

30

What if the maximum age for qualifying for a catastrophic plan?

30

What is the duration of the free-look period for Medicare supplement policies?

30 days

During replacement, producers must list any other health policies sold during the past

5 years

The minimum number of credits required for partially insured status for Social Security disability benefits is

6 credits

Benefit periods for individual short-term disability policies will usually continue from

6 months to 2 years.

Most policies will pay the accident death benefits as long as the death is caused by the accident and occurs within

90 days

If an insurance company offers Medicare supplement policies, it must offer which of the following plans?

A

An insured carries health insurance with two different providers and is covered on an expense incurred basis. He has an appendectomy and files the claims to both insurers. Neither company is notified in advance that the insurer has other coverage. What should each insurer pay?

A proportionate amount

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

In which of the following situations is it illegal for an insurer to disclose privileged information about an insured?

A researcher for marketing purposes

All of the following individuals may qualify for Medicare health insurance benefits EXCEPT

A retired person age 50

The 30 day payment of claims requirement applies to which of the following persons?

A state worker filing a personal injury claim

If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?

Adjust the benefit in accordance with the increased risk

If an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association, that would be considered

An unfair trade practice

Which of the following hospice expenses would NOT be covered in a cost-containment setting?

Antibiotics

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force

The classification "small employer" means any person actively engaged in a business that during the preceding year employed

At least 2 and not more than 50 persons.

Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?

Attending physician

Which of the following options best depicts how the eligibility of members for group health insurance is determined?

By conditions of employment

The document that indicates that an insurer has been approved and is authorized to transact insurance in a particular state is known as

Certificate of Authority

If an applicant for a health insurance policy is found to be a substandard risk, the insurance company is most likely to

Charge an extra premium

Which of the following is NOT a line of authority for an insurance producer may obtain a license?

Commercial Property

When an insured makes truthful statements on the application for insurance and pays the required premium, it is known as which of the following?

Consideration

In a group prescription drug plan, the insured typically pays what amount of the drug cost?

Copayment

Which of the following is not a cost saving service in a medical plan?

Denial of coverage

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

All of the following may be excluded from coverage in a Major Medical Expense policy, EXCEPT

Emergency surgery.

An association could buy group insurance for its members if it meets all of the following requirements EXCEPT

Has at least 50 members

Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage?

Health Maintenance Organization plan

Which of the following factors about the insured determines the amount of disability benefit that the insured will receive?

Income

In the event of loss after a notice of claim is submitted to the insurer who is responsible for providing claims forms and to which party?

Insurer to the insured

In health insurance if a doctor charges $50 more than what the insurance company considers usual customary and reasonable the extra cost...

Is not covered

Insurance that would pay for hiring a replacement for an important employee who becomes disabled is called

Key employee disability insurance

A policyowner is reading a statement on the first page of his health insurance policy, which says "this is a limited policy." What is the name of this statement?

Limited Policy Notice

Which of the following is a qualification for a producer's license?

Must be at least 18 years old

Which of the following is NOT a qualification for obtaining a producer's license?

Must be retained by a licensed insurance agency

On a participating insurance policy issued by a mutual insurance company dividends paid to policy holder are

Not taxable since the IRS treats them as a return of a portion of the premium paid.

Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?

Notice of Claim

A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility?

Number of hours worked per week

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date?

Optionally renewable

An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

Pay the claim

A patient has severe gingivitis and is seeking treatment from his dentist. Which type of dental treatment is this?

Periodontics

All of the following are covered by Part A of Medicare EXCEPT

Physician's and surgeon's services.

When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribers at a favorable cost, it is called

Preferred Provider Organization (PPO).

Underwriting 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.

Which of the following is NOT among the goals of a Medicare supplement application?

Presuming the applicant is eligible for Medicaid, based on the nature of the policy

While repairing the roof of his house an insured accidentally falls off and breaks his arm and sustains a head injury that results in total blindness of both eyes. His policy contains an Accidental Death & Dismemberment Rider. What is the extent of benefits that he will receive?

Principal Sum

A Medicare SELECT policy does all of the following EXCEPT

Prohibit payment for regularly covered services if provided by non-network providers

What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid?

Prospective review

In dental insurance, what type of care will cover crowns?

Restorative

Which of the following is an example of a peril covered in an accident and health insurance policy?

Sickness

In major medical insurance policies when the insurers share of counsurance reaches a certain amount the insured is no longer obligated to pay it this feature is known as

Stop-loss

An insurer wishes to compare the information given in an insurance application with previous insurance applications by the same applicant but for different companies. What organization can help the insurer accomplish this?

The Medical Information Bureau

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

The Medicare Part A deductible

An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider, which of the following will happen?

The PPO will pay reduced benefits

A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?

The benefits will be coordinated

An insured who has an accidental death and dismemberment policy loses her left arm in an accident what type of benefit will she most likely receive from this policy?

The capital amount in a lump sum

In a group policy, the contract is between

The employer and the insurance company.

If a policy is rated-up, which of the following is true?

The premium increases

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of claims

What is the purpose of COBRA?

To provide continuation of coverage for terminated employees

What if the purpose of a certificate of authority?

To show the line of insurance an insurer is authorized to transact

An insured owes his insurer a premium payment since then he incurs medical expenses the insurer deducts the unpaid premium amount for the claim amount and pays the insured difference what provision allows for this?

Unpaid premium

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as

Usual, customary and reasonable.

A health insurance policy may cover all of the following risks EXCEPT

War related injuries

An agent is completing an application for a long term care policy. The agent is required to do all of the following except

Warn the applicant about the 10day free look period

Which of the following entities is automatically qualified to enroll in a health insurer's mandatory, guaranteed issue policy?

all small employers

Because an agent is using stationery with the logo of an insurance company, applicants for insurance assume that the agent is authorized to transact on behalf of that insurer. What type of agent authority does this describe?

apparent

In order to qualify for group coverage, associations must insure

at least 25 members

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

for the first 2 years of a disability

Insurers may change which of the following on a guaranteed renewable health insurance policy?

rates by class

Which type of care re-establishes functional use to natural teeth?

restorative

Which of the following services would be covered by endodontics?

root canal