Exam questions I got wrong
Both subscriber and insured
A man bought an individual health insurance policy for himself. Which of the following roles does he now legally have? Broker Subscriber only Insured only Both subscriber and insured
50
According to the rule of readability of insurance policies in this state, what is a required minimum score on the Flesch reading ease test for Medicare supplement policies? 30 40 50 60
60 days
An insurer decides to renew a policy but at a higher premium rate, starting on the renewal date. How many days in advance must the insured be notified? 30 60 90 100
Consideration
An insurer neglects to pay a legitimate claim that is covered under the terms of the policy. Which of the following insurance principles has the insurer violated?
Complete a prelicensing education course and pass the state exam
An intermediary failed to complete the CE requirements by the due date 14 months ago. What must they do to reinstate their license? Pay a $1,000 fine in addition to completing the CE requirements Complete a prelicensing education course and pass the state exam Complete the CE requirements as usual File an extension with the Commissioner
10 years
Any licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to 3 years. 5 years. 10 years. 12 years.
Reinsurance manager
Any person who has authority to bind, or manages all or part of the assumed reinsurance business of a reinsurer and acts as an agent for the reinsurer
20
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? 20 100 80 3
3
How many copies of replacement forms must be filled out and signed by the agent and the applicant during replacement of disability insurance? 2 3 4 5
Every year
How often are insurers offering health benefit plans required to file a grievance report with the OCI? Every 6 months Every year Every 3 years Every month
The policy will not lapse since payment to the agent is the same as payment to the insurer
If an insurance premium is paid by the policyowner to the agent, and the agent fails to remit that premium to the insurer, which of the following statements is true? a) The premium will be taken out of the Guaranty Association funds. b) The agent's license will be automatically revoked. c) The policy will lapse since the premium was not received by the insurer. d) The policy will not lapse since payment to the agent is the same as a payment to the insurer.
Join the group after the effective date
In a group health policy, a probationary period is intended for people who Want lower premiums. Join the group after the effective date. Have a pre-existing condition at the time they join the group. Have additional coverage through a spouse.
30 days
Life settlements sold in Wisconsin must allow for the rescission of the contract within 10 days. 15 days. 20 days. 30 days.
3
People who have been insured for how many months under a group contract must be allowed to continue group coverage or convert to an individual contract if the group coverage ends? 12 3 6 9
Parts A and B of Medicare
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? Any private insurance policy Only Part A of Medicare Parts A and B of Medicare All four parts of Medicare
The employer
The limits of a health reimbursement account are set by Federal regulation. The employer. State statutes. The insurer.
Notice Regarding Replacement
Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the Certificate of Coverage. Notice Regarding Replacement. Policy application. Buyer's Guide.
Integrated dental plan
The type of dental plan which is incorporated into a major medical expense plan is a/an Stand-alone dental plan. Blanket dental plan. Integrated dental plan. Supplemental dental plan.
Held or transmitted in any form
Under the Privacy Rule for HIPAA, protected information includes all individually identifiable health information Held or transmitted in any form. Transmitted electronically only. Held in a computer format. Held or transmitted in paper form.
Insurer
When a person applies for Medicare supplement insurance, whose responsibility is it to confirm that the applicant does not already have accident or sickness insurance in force? Active physician Agent Insurer State government
Coverage for catastrophic medical expenses
Which of the following is NOT true of basic medical expense plans? Low dollar limits Coverage for catastrophic medical expenses No deductibles First-dollar coverage
Surplus lines agent
Which of the following is a licensee able to place insurance with unauthorized insurers? Reinsurance broker Managing general agent Surplus lines agent Reinsurance intermediary
Benefits are usually limited to six months
Which of the following statements regarding Business Overhead Expense policies is NOT true? Benefits are usually limited to six months. Premiums paid for BOE are tax-deductible. Any benefits received are taxable to the business. Leased equipment expenses are covered by the plan.
They are temporary insuring agreements
Which of the following statements regarding conditional receipts is true? They guarantee the insurer will approve the application. They purchase temporary insurance, up to 6 months. They become part of the policy. They are temporary insuring agreements.
Insurance broker
an intermediary who acts in the procuring of insurance on behalf of an applicant for insurance or an insured
Unearned premiums are retained by the insurance company
According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT Unearned premiums are retained by the insurance company. The insurer must provide the insured a written notice of the cancellation. Claims incurred before cancellation must be honored. An insurance company may cancel the policy at any time.
Has at least 50 members
An association could buy group insurance for its members if it meets all of the following requirements EXCEPT Has a constitution and by-laws. Holds annual meetings. Is contributory. Has at least 50 members.
60 days
An insurance policy is considered a "new policy" if it has been in effect for what maximum time period?
LTC policies are marketed effectively to prospective insureds
Every insurer marketing Long-Term Care insurance must establish marketing procedures to ensure all of the following EXCEPT Excessive insurance will not be sold. Every reasonable efforts is made to identify an applicant's other insurance. LTC policies are marketed effectively to prospective insureds. Comparisons of policies are fair and accurate.
Prospective review
For an individual policy, an intermediary must furnish an applicant with an outline of coverage at what point? When accepting the application During the underwriting process At policy delivery Within 30 days of policy delivery
Must appear as a separate paragraph and be clearly labeled
In a long-term care policy, pre-existing condition limitations Never have specific exclusions. Are not permitted. Must appear as a separate paragraph and be clearly labeled. Apply to 12 months from the effective date of coverage.
Company
In any case where there is a controversy or dispute between the insurance company and the insured, the soliciting agent is the agent of the
60 days
The Commissioner issues an order without holding a hearing. The person aggrieved by this order demands a hearing shortly after receiving the order. The hearing must be held within a maximum of how many days? 10 30 60 90
"own occupation" -less restrictive than other definitions
A brain surgeon has an accident and develops tremors in her right arm. Which disability income policy definition of total disability will cover her for all losses? "Any occupation" - less restrictive than other definitions "Any occupation" - more restrictive than other definitions "Own occupation" - less restrictive than other definitions "Own occupation" - more restrictive than other definitions
Pay dividends to the policyowner
A participating insurance policy may do which of the following? Require 80% participation Pay dividends to the policyowner Provide group coverage Pay dividends to the stockholder
Firm
A person that markets insurance but does not include an insurer is called a Firm. Broker. Solicitor. Conglomerate.
The condition will be fully covered under the limitations of the contract
An applicant writes conflicting information on his health insurance application. The insurer issues the policy. Later, the new policyowner suffers a medical loss related to the conflicting information. Which of the following is true? The policy can be cancelled because of this, but the insured can purchase a new one without providing proof of insurability, assuming that the conflicting information is resolved. The condition will be fully covered under the limitations of the contract. The condition will be covered but for a lesser amount it would have, if the information had been stated in a way that was not conflicting. The conflicting information can be used to deny the claim.
Increase benefit levels without providing proof of insurability
Guarantee of insurability option in long-term care policies allows the insured to Secure the policy's nonforfeiture values regardless of the insured's age or health status Increase benefit levels without providing proof of insurability Add dependents to the plan without providing proof of their insurability Replace the existing LTC policy based on the original underwriting
It is health coverage for small groups whose numbers are too small to qualify for true group insurance
What is franchise insurance? It is group insurance It is blanket insurance It is health coverage for small groups whose numbers are too small to qualify for true group insurance It provides insurance for franchises, such as a restaurant or hotel chain
It allows employers with low claims experience to get lower premiums
What is the benefit of experience rating? It helps employers with high claims experience to get group coverage. It helps employees with low claims experience to become exempt from group premiums. It allows employers with high claims experience to obtain insurance. It allows employers with low claims experience to get lower premiums.
Early detection through regular checkups
What is the goal of the HMO? Early detection through regular checkups Providing free health services Limiting the deductibles and coinsurance to reduce costs Providing health services close to home
Medical Reimbursement Benefit
What type of benefit helps to pay for accidental injuries that are not severe enough to qualify as disabilities? Basic Accidental Injury Accidental Death & Dismemberment Medical Reimbursement Benefit Partial Disability
Treatments costs can be denied
When Mark fills out his health insurance application, he accidentally forgets to include the fact that he was once diagnosed with high blood pressure. He is then re-diagnosed 1 1/2 years after his policy begins. Which of the following is true? The insurer will have to pay for the full treatment costs. Only the cost of medication must be covered. Only a portion of treatment costs will be covered. Treatment costs can be denied.
Within 6 months of the effective date of coverage
When can a Long-Term Care policy deny a claim for losses incurred because of a pre-existing condition? Within 12 months of the effective date of coverage At any time At no time Within 6 months of the effective date of coverage
They carry over from the old plan to the new plan
When employees are actively at work on the date coverage can be transferred to another insurance carrier, what happens to coinsurance and deductibles? Deductibles carry over, but coinsurance is generally higher. They carry over from the old plan to the new plan. They have to be reevaluated. Coinsurance carries over, but deductibles are generally higher.
When the premium is paid at the time of application
When is the insurability conditional receipt given? When an insured individual needs to obtain an insurability receipt for tax purposes. If the application is approved before the premium is paid When the premium is paid at the time of application After the application has been approved and the premium has been paid
A nursing home or one's own home
Where would Long-term care services be rendered? An acute care unit of a hospital A doctor's office A nursing home or one's own home A surgery center
Basic information about supplementary polcies
Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy? Basic information about supplementary policies The policy number The right to return the policy for a refund Basic information about the insurance company
Policy delivery
Which of the following is the most common time for errors and omissions to occur on the part of an insurer? Application process Policy delivery Policy renewal Underwriting
Medicare Advantage must be provided through HMOs
Which of the following statements is NOT correct regarding Medicare? Medicare Advantage may include prescription drug coverage at no cost Medicare Part A provides hospital care. Medicare Part B provides physician services. Medicare Advantage must be provided through HMOs.
It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income
Which of the following statements is NOT true concerning Medicaid? It is funded by state and federal taxes. It is intended to provide medical assistance for certain categories of people who are needy. It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income. It is a state program.
Agent C uses her license to write only business other than controlled
Which of the following would NOT be a violation of state insurance regulations? Agent D collects premiums due on policies and deposits the funds in his own personal account. Agent A uses her license to write only insurance for herself and her immediate family. Agent B charges his clients a consulting fee, in addition to the premium for placing a policy. Agent C uses her license to write only business other than controlled.
Insureds cannot be randomly selected.
Which statement regarding insurable risks is NOT correct? Insurance cannot be mandatory. The insurable risk needs to be statistically predictable. An insurable risk must involve a loss that is definite as to cause, time, place and amount. Insureds cannot be randomly selected.
