Exam fX questions
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying?
25%
Disclosure statements issued to an applicant for a Medicare supplement policy in this state must include or prominently displayed all of the following information except
A commission payable to the producer
Of $10,000 in premiums a producer wrote over the past year, $3,000 came from sales to a business which employs the producer's spouse. This is considered
A legal practice
In order to reduce the premium to the lowest monthly amount on his disability income policy, the insured could choose
A longer elimination period and a shorter benefit period
When transacting business in this state an insurer formed under the laws of another country is known as/an
Alien insurer
Which of the following is a requirement for standard Medicare supplement plans
All plans must offer the core benefits
Which of the following persons would qualify for Medicare Part A
Anyone who has permanent kidney failure
To be eligible for tax credits under the ACA, individuals must have income that is what percent of the Federal Poverty Line
Between 100% and 400%
If both parents have family coverage on their respective group health plans and both of the plans include a coordination of benefits clause which of the following methods would be used to split a claim payment for a covered child
Birthday rule
HMOs operate on what basis?
Capitated
If an employee is injured on the job, which of the following will NOT be a standard benefit through Worker's Compensation
Caregiver benefits
All of the following features of a medical plan are expressed as a set dollar amount EXCEPT
Co-insurance
All of the following features of a medical plan are expressed as a set dollar amount EXCEPT
Coinsurance
In NY, how much all medical expense health insurance sold to individuals or small groups be rated
Community rated
Which of the following types of health insurance options will generally cover any sickness or accidents
Comprehensive policy
Which of the following standards is used to determine premiums rates under the Affordable Care Act
Family composition
What phase begins after a new policy is delivered?
Free-look period
All of the following are characteristics of group health insurance EXCEPT
Groups may be formed for the purpose of purchasing insurance
To be eligible for a Health Savings Account, an individual must be covered by a
High-deductible health plan
Which of the following is NOT covered under Medicare Part B?
Hospital room and board coverages
Under which of the following circumstances may the uniform individual accident and sickness policy provisions should be changed
If the change is more favorable to the policyholder
Medicaid provides all of the following benefits EXCEPT
Income assistance for work-related injury
Which of the following refers to "own occupation" disability?
Insured is unable to perform duties of the occupation for which he/she was educated and trained
All of the following statements regarding Medicare Supplement insurance are true EXCEPT
Insurers use the traditional risk rating of preferred, standard, and substandard in underwriting
Regarding health insurance coverage for small groups, insurers are permitted to do any of the following EXCEPT
Limit enrollment to a specific number
Which of the following types of health policies cover medical and hospital expenses, and have deductibles, coinsurance, and high maximum limits
Major medical policies
The term "subscriber" is most commonly associated with which type of medical plan?
Managed care
Which of the following is a private health insurance plan?
Medicare supplement policies
According to the Unpaid Premium provision in health insurance policies, what will the insurer do if the insured missed a premium payment and then submitted a claim
Pay the claim but withhold the amount of the premium due
Which of the following is a characteristic of PPOS?
Plan members who use the services of an in-network facility will pay a lower amount
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to her stated age with the company having the right to increase premiums on the entire class
When a 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)
All of the following is true regarding key person disability income insurance EXCEPT
Premiums are tax deductible as a business expense
An insured owns a disability policy and is in an accident which leaves him permanently blind. Which of the following provisions in a disability policy would qualify the insured for benefits, even if the insured is able to resume working?
Presumptive Disability
LTC coverage may be provided by any of the following EXCEPT
Rider to Medicare Part A
For which of the following reasons can the Department of Financial Services issue a temporary license?
Servicing existing business
Which of the following terms defines an illness that first appears when the policy is in force?
Sickness
Which of the following terms defines an illness that first appears while the policy is in force
Sickness
When an insured chooses the indemnity method of benefit payment, the insurer will pay
The fixed benefit amount, regardless of the actual charge
The Affordable Care Act requires all US citizens and legal residents to have qualifying health care coverage. This is known as
The individual mandate
If an insured has had a New York State Partnership LTC policy for 3 years, and is now eligible for Medicaid benefits, what will happen to the LTC policy assets
The insured will retain all assets
An agent who solicits and files applications for the sale of life insurance represents
The insurer
All of the following characteristics are required in order to establish a group health plan for an association EXCEPT?
The plan must be contributory
Which of the following is an example of a producer's fiduciary duty?
The trust that a client places in the producer in regard to handling premiums
Which of the following is NOT the purpose of the HIPAA?
To provide immediate coverage to new employees who had been previously covered for 18 months
When does the free-look period begin in insurance policies
When the policy's delivered