CHAPTER 1 & CHAPTER 2: TEST QUESTION

WHOSE RESPONSIBILITY IS IT TO DETERMINE IF ALL THE QUESTIONS ON THE APPLICATION HAVE BEEN ANSWERED

THE AGENT

IF ONLY ONE PARTY TO AN INSURANCE CONTRACT HAS MADE A LEGALLY ENFORCEABLE PROMISE, WHAT KIND OF CONTRACT IS IT?

UNILATERAL CONTRACT BECAUSE ONLY ONE PARTY TO THE CONTRACT IS LEGALLY TO DO ANYTHING

NOT COVERED UNDER BASIC HOSPITAL EXPENSE COVERAGE

SURGEON'S FEES

WHICH OF THE FOLLOWING IS NOT THE CONSIDERATION IN A POLICY?

THE APPLICATION GIVEN TO A PROSPECTIVE INSURED

IN INSURANCE, AN OFFER IS USUALLY MADE WHEN

THE APPLICATION IS SUBMITTED.

WHO CHOOSES A PRIMARY CARE PHYSICIAN IN HMO

THE INDIVIDUAL MEMBER

WHICH OF THE FOLLOWING IS NOT CONSIDERATION ON THE PART OF AN INSURED?

PROMISE TO SUBMIT TIMELY CLAIMS.

WHICH OF THE FOLLOWING WOULD BASIC MEDICAL EXPENSE COVERAGE NOT COVERED?

SURGEON'S SERVICES

WHAT IS THE TYPICAL DEDUCTIBLE FOR BASIC SURGICAL EXPENSE INSURANCE?

$0 THERE IS NO DEDUCTIBLE FOR BASIC MEDICAL EXPENSE COVERAGE BUT COVERAGE IS LIMITED.

WHICH OF THE FOLLOWING REPORTS WILL PROVIDE THE UNDERWRITER WITH THE INFORMATION ABOUT A CONSUMER'S CREDIT?

A CONSUMER REPORT

WHICH OF THE FOLLOWING IS NOT COVERED BY HEALTH HMO

ELECTIVE SERVICES

BENEFITS PERIODS FOR INDIVIDUAL SHORT TERM DISABILITY POLICIES WILL USUALLY CONTINUE FROM

6 MONTHS TO 2 YEARS

WHEN DELIVERING A POLICY WHICH OF THE FOLLOWING IS AN AGENT'S RESPONSIBILITY?

COLLECT PAYMENT AT THE TIME OF DELIVERY

BECAUSE AN INSURANCE POLICY IS A LEGAL CONTRACT, IT MUST CONFORM TO THE STATE CONTRACTS WHICH REQUIRE ALL OF THE FOLLOWING ELEMENTS EXCEPT

CONDITIONS IS NOT ONE.

AS IT PERTAINS TO GROUP HEALTH INSURANCE, COBRA STIPULATES THAT

GROUP COVERAGE MUST BE EXTENDED FOR TERMINATED EMPLOYEES UP TO A CERTAIN PERIOD OF TIME AT THE FORMER EMPLOYEE'S EXPENSE

WHICH OF THE FOLLOWING IS AVAILABLE TO EMPLOYERS OF ALL SIZES

H.R.A. CONSIST OF FUNDS BY EMPLOYERS TO REIMBURSE EMPLOYEE TO QUALIFIED MEDICAL EXPENSES; THEY ARE AVAILABLE TO ALL SIZES OF EMPLOYERS.

IF AN APPLICANT DOES NOT RECEIVE HIS OR HER POLICY, WHO WOULD BE HELD RESPONSIBLE?

THE AGENT

IN FORMING AN INSURANCE CONTRACT, WHEN DOES ACCEPTANCE USUALLY OCCUR?

WHEN AN INSURER APPROVES A PREPAID APPLICATION.

WHEN AN INSURED MAKES TRUTHFUL STATEMENTS ON THE APPLICATION FOR THE INSURANCE AND PAYS THE REQUIRED PREMIUM, IT IS KNOWN AS WHICH OF THE FOLLOWING?

CONSIDERATION

AN INSURER NEGLECTS TO PAY A LEGITIMATE CLAIM THAT IS COVERED UNDER THE TERMS OF THE POLICY. WHICH OF THE FOLLOWING TERMS BEST DESCRIBES WHAT THE INSURER HAS VIOLATED?

CONSIDERATION BECAUSE THE BINDING FORCE IN ANY CONTRACT IS CONSIDERATION.

WHICH OF THE FOLLOWING INCLUDES INFORMATION REGARDING A PERSON'S CREDIT, CHARACTER, REPUTATION, AND HABITS?

CONSUMER REPORT

WHICH OF THE FOLLOWING IS THE TERM FOR THE SPECIFIC DOLLAR AMOUNT THAT MUST BE PAID BY AN HMO MEMBER FOR A SERVICE?

COPAYMENT

WHICH OF THE FOLLOWING IS NOT TRUE REGARDING BASIC SURGICAL EXPENSE COVERAGE?

COVERAGE IS UNLIMITED.

WHICH TYPE OF HOSPITAL POLICY PAYS A FIXED AMOUNT EACH DAY THAT THE INSURED IS IN A HOSPITAL?

INDEMNITY

WHICH OF THE FOLLOWING ENTITIES CAN LEGALLY BIND COVERAGE?

INSURER ONLY INSURERS, NOT AGENTS

WHAT BEST DESCRIBES MIB

IT IS A NONPROFIT ORGANIZATION THAT MAINTAINS UNDERWRITING INFORMATION ON APPLICANTS FOR LIFE AND HEALTH INSURANCE

WHICH OF THE FOLLOWING BEST DESCRIBES THE ''FIRST DOLLAR COVERAGE'' PRINCIPLE IN BASIC MEDICAL INSURANCE

THE INSURED IS NOT REQUIRED TO PAY A DEDUCTIBLE

AN AGENT IS IN THE PROCESS OF REPLACING THE INSURED'S CURRENT HEALTH INSURANCE POLICY WITH A NEW ONE. WHICH OF THE FOLLOWING WOULD BE A PROPER ACTION?

THE OLD POLICY SHOULD STAY IN FORCE UNTIL THE NEW POLICY IS ISSUED

IN TERMS OF PARTIES TO A CONTRACT, WHICH OF THE FOLLOWING DOES NOT DESCRIBE A COMPETENT PARTY?

THE PERSON MUST HAVE AT LEAST COMPLETED SECONDARY EDUCATION.

TO BE ELIGIBLE UNDER HIPAA REGULATION, FOR HOW LONG SHOULD AN INDIVIDUAL CONVERTING TO AN INDIVIDUAL HEALTH PLAN HAVE BEEN COVERED UNDER THE PREVIOUS GROUP PLAN?

18 MONTHS

ELIMINATION PERIOD

30 DAYS

WHICH OF THE FOLLOWING IS FEATURE OF A DISABILITY BUYOUT PLAN?

A LUMP SUM BENEFIT PAYMENT OPTION

WHICH OF THE FOLLOWING IS A FEATURE OF A DISABILITY BUYOUT PLAN?

A LUMP-SUM BENEFIT PAYMENT OPTIONS

UNDERWRITING IS A MAJOR CONSIDERATION WHEN AN INSURED WISHSES TO REPLACE HER CURRENT POLICY FOR ALL OF THE FOLLOWING EXCEPT

PREMIUMS ALWAYS STAY THE SAME

ALISON WANTS TO BUY A HEATLH INSURANCE POLICY. SHE RETURNS HER COMPLETED APPLICATION TO HER AGENT, ALONG WITH A CHECK FOR THE FIRST PREMIUM. SHE RECEIVES A CONDITIONAL RECEIPT TWO WEEKS LATER. WHICH OF THE FOLLOWING HAS THE INSURER DONE BY THIS POINT?

NEITHER APPROVED THE APPLICATION NOR ISSUED THE POLICY

BETHANY IN ENGLAND. INJURES HERSELF. BETHANY OWNS A GENERAL DISABILITY POLICY, WHAT WILL BE THE EXTENT OF BENEFITS THAT SHE RECEIVES?

NONE, GENERAL DISABILITY DOES NOT COVER LOSS BY WAR, OVERSEAS RESIDENCE, MILITARY SERVICES, INJURIES TRYING TO COMMIT A FELONY

AN HSA HOLDER WHO IS 65 YEARS OLD DECIDES TO USE THE MONEY IN THE ACCOUNT FOR A NONHEALTH EXPENSE. WHICH OF THE FOLLOWING IS TRUE?

THERE WILL BE A TAX

AN INSURED STATED ON HER APPLICATION FOR LIFE INSURANCE THAT SHE HAD NEVER HAD A HEART ATTACK, WHEN IN FACT SHE HAD A SERIES OF MINOR HEART ATTACKS LAST YEAR FOR WHICH SHE SOUGHT MEDICAL ATTENTION. WHICH OF THE FOLLLOWING WILL EXPLAIN THE REASON A DEATH BENEFIT IS DENIED?

MATERIAL MISREPRESENTATION

AN INSURANCE CONTRACT REQUIRES THAT BOTH THE INSURED AND THE INSURER MEET CERTAIN CONDITIONS IN ORDER FOR THE CONTRACT TO BE ENFORCEABLE. WHAT CONTRACT CHARACTERISTIC DOES THIS DESCRIBE?

CONDITIONAL

WHICH OF THE FOLLOWING IS NOT TRUE REGARDING BASIC SURGICAL EXPENSE COVERAGE?

COVERAGE UNLIMITED

EACH POINT REPRESENTS 10.00, WHICH MEANS THAT 2000 OF HIS SURGERY WILL BE COVERED BY HIS INSURANCE PLAN. WHAT SYSTEMS IS TODD'S INSURANCE COMPANY USING?

RELATIVE VALUE

ROLAND HAD 500 DOLLARS IN HIS HEALTH REIMBURSEMENT ACCOUNT WHEN HE QUIT HIS JOB. WHAT HAPPENS TO THAT MONEY?

ROLAND CAN ACCESS TO THE 500 DOLLARS AT HIS PREVIOUS EMPLOYER'S DISCRETION.

WHICH OF THE FOLLOWING IS TRUE OF A PPO

ITS GOAL IS TO CHANNEL PATIENTS TO PROVIDERS THAT DISCOUNT SERVICES

WHICH OF THE FOLLOWING WOULD NOT BE CONSIDERED A LIMITED COVERAGE POLICY?

MAJOR MEDICAL EXPENSE INSURANCE

WHICH OF THE FOLLOWING WOULD BE AN EXAMPLE OF LIMITED ACCIDENT AND HEALTH INSURANCE POLICY?

A DREAD DISEASE POLICY LIMITED RISK POLICIES COVER SPECIFIC ILLNESS OR ACCIDENTS.

WHICH OF THE FOLLOWING WOULD BE AN EXAMPLE OF A LIMITED ACCIDENT AND HEALTH INSURANCE POLICY?

A DREAD DISEASE POLICY COVERS LIMITED RISK POLICIES FOR ILLNESS OR ACCIDENTS

WHAT IS A MATERIAL MISREPRESENTATION?

A STATEMENT BY THE APPLICANT THAT, UPON DISCOVERY, WOULD AFFECT THE UNDERWRITING DECISION OF THE INSURANCE COMPANY

IF AN EMPLOYEE TERMINATES, WHICH OF THE FOLLOWING PROVISIONS WOULD ALLOW HER TO CONTINUE HEALTH COVERAGE UNDER AN INDIVIDUAL POLICY, IF REQUESTED WITHINH 31 DAYS?

CONVERSION

IN A RELATIVE VALUE SYSTEM OF DETERMINING COVERAGE FOR A GIVEN PROCEDURE, WHAT TERM DESCRIBES THE TOTAL AMOUNT PAYABLE PER POINT?

CONVERSION FACTOR

THIS ARRANGMENT SPECIFIES WHO WILL PURCHASE DISABLED PARTNER'S INTEREST IN THE EVENT HE OR SHE BECOMES DISABLED.

DISABILITY BUYOUT

ANOTHER TERM USED TO DESCRIBE ''NO DEDUCTIBLE'' IS

FIRST DOLLAR BASIS

IF AN INSURED IS NOT REQUIRED TO PAY A DEDUCTIBLE, WHAT KIND OF COVERAGE DOES HE/SHE HAVE?

FIRST DOLLAR COVERAGE DO NOT REQUIRE THE INSURED TO PAY DEDUCTIBLE

AN AGENT MAKES A MISTAKE ON THE APPLICATION AND THE CORRECTS HIS MISTAKES BY PHYISCALLY ENTERING THE NECESSARY INFORMATION. WHO MUST THEN INITIAL THE CHANGE?

THE APPLICANT

UNDER THE CONDITIONS WOULD A CONTRACT BETWEEEN AN INSURER AND PROSPECTIVE INSURED BE LEGAL?

THE APPLICANT HAS BEEN CONVICTED OF A FELONY.

THE FOLLOWING WOULD PROVIDE AN UNDERWRITER WITH INFORMATION CONCERNING AN APPLICANT'S HEALTH HISTORY?

THE MEDICAL INFORMATION BUREAU

WHICH OF THE FOLLOWING IS TRUE REGARDING UNDERWRITING FOR A PERSON WITH HIV?

THE PERSON MAY NOT BE DECLINED

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 A CONSUMER REQUESTS ADDITIONAL INFORMATION CONCERNING AN INVESTIGATIVE CONSUMER REPORT, HOW LONG DOES THE INSURER OR THE REPORTING AGENCY HAVE TO COMPLY?

5 DAYS

C.H.A.P.T.E.R. 2 WHICH OF THE FOLLOWING IS NOT TRUE OF A MAJOR MEDICAL HEALTH INSURANCE POLICY?

IT IS DESIGNED TO PAY ON FIRST DOLLAR OF EXPENSE BASIS

WHICH OF THE FOLLOWING STATEMENTS IS NOT CORRECT CONCERNING THE COBRA ACT OF 1985

IT REQUIRES ALL EMPLOYERS, REGARDLESS OF THE NUMBER OR AGE OF EMPOLYEES TO PROVIDE EXTENDED GROUP HEALTH COVERAGE

DON HAS BOTH A BASIC AND A MAJOR MEDICAL POLICY. HE QUICKLY EXHAUST HIS BASIC EXPENSE POLICY. WHAT MUST DON DO BEFORE HIS MAJOR POLICY CAN PICK UP WHERE THE BASIC EXPENSE POLICY LEFT OFF?

PAY A SPECIAL DEDUCTIBLE ON HIS MAJOR MEDICAL POLICY

IN BASIC EXPENSE POLICY, AFTER THE LIMITS OF THE BASIC POLICY ARE EXHAUSTED, THE INSURED MUST PAY WHAT KIND OF DEDUCTIBLE?

CORRIDOR

WHICH OF THE FOLLOWING IS NOT AN ESSENTIAL ELEMENT OF AN INSURANCE CONTRACT?

COUNTEROFFER

WHAT ARE THE MEMBERS OF THE MEDICAL INFORMATION BUREAU REQUIRED TO REPORT?

ADVERSE MEDICAL INFORMATION ABOUT INDIVIDUALS

WHAT IS THE GOAL OF HMO

EARLY DETECTION THROUGH REGULAR CHECK UPS