Final Health Insurance Exam
An insurer based in California has just completed a transaction in Hawaii. How long must the Commissioner keep records related to this transaction?
3 years
If an individual obtains a group prepaid health plan, each employer must contribute at least how much of the premium for the coverage required?
50%
In which of the following situations is it legal to limit coverage based on marital status?
It is never legal to limit coverage based on marital status
Insureds have the right to do which of the following if they have NOT received the proper claim forms within 15 days of their notice to the insurer of a covered loss under a major medical policy?
Submit the description in their own words on a plain sheet of paper
Which of the following is NOT an activity of daily living?
Talking
Who is authorized to share confidential insurance records and reports?
The Commissioner
Paul is a producer in California and wants to become a producer in Hawaii. The Commissioner will waive certain examination requirements, provided that California would waive these same requirements if a Nebraska producer sought licensure in Hawaii. What term is used to describe this phenomenon?
Reciprocity
Which of the following optional provisions allows insurers to limit benefits to an insuredʻs average income over the last 2 years?
Relation of Earnings to Insurance
A husband and wife both incur expenses that are attributed to a single major medical insurance deductibles. Which type of deductible do they have in their policy?
Family
An example of an alien insurer doing business in this state is one formed under the laws of
Mexico
What can happen if a person who has been served a subpoena refuses to testify in an insurance case?
The individual can be found in contempt of court
Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?
90 days
The Uniform Provision Law that prevents an insurance company from altering its agreement with a policyholder by referring to documents of other items not contained in the policy is called the
Entire Contract Provision
What specific kind of insurance is often written in conjunction with hospital expense policies and includes surgeonsʻ and anesthesiologistsʻ fees?
basic surgical expense insurance
A part-time employee was injured at work and is seeking temporary disability benefits. Because her average weekly wage was $25, the amount of her disability benefit will be
$14
A retail shop owner is insured under a business overhead expense policy that pays a maximum monthly benefit of $2,500. His actual monthly expenses are $3,000. If the owner becomes disabled, the monthly benefit payable under his policy will be
$2,500
Which of the following must be given to a prospective applicant for long-term care insurance at the time of initial solicitation?
An outline of coverage
Which of the following individuals is NOT required to be licensed?
Directors
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
within 20 days
For any period of disability, temporary disability benefits cannot be issued for more than
26 weeks
The time limit of certain defenses provision prohibits insurers from denying a claim due to misrepresentation, as long as the policy has been in force for at least
2 years
An insured has a prepaid health care plan that includes inpatient benefits for detoxification, Under this coverage, how many admissions are allowed each year?
3 admissions per calendar year, not to exceed 7 days per admission
How many days does the producer have to remit all the premiums to the insurer?
30 days
In the event a policy lapses due to nonpayment of premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid?
45 days
Which of the following statements is NOT true regarding health insurance policy provisions?
All additional provisions written by insurers are cataloged by their respective states
Which of the following premium modes would result in the lowest overall premium?
Annual
A lender who conditions approval of a loan on the condition that the borrower purchase insurance from that lended may be guilty of
Coercion
An insured has an individual disability income policy with a 30-day elimination period. He becomes disabled on June 1st for 15 days. When will he collect on his disability income payments?
He wonʻt collect anything because he did not satisfy the elimination period.
Which of the following would NOT be covered by a disability policy?
Homemaker being hospitalized for a leg amputation caused by a car accident
An insurer devises an intimidation strategy in order to corner a large portion of the insurance market. Which of the following best describes this practice?
Illegal
Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care?
Intermediate care
Which of the following would NOT be considered a limited coverage policy?
Major Medical expense insurance
An insurance agent visits a potential client and explains various types of policies. The customer displays a lack of interest, so the agent guarantees higher dividends than he knows would be possible. Which term describes what the agent has done?
Misrepresentation
Palm Tree Insurance, based in California, wants to start doing business in Hawaii under the name Aloha Insurance on Oct 15. They must file a change of name request with the Commissioner by
Sept 15 (at least 30 days before the effective name change)
What does the application of contract of adhesion mean?
Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured
Which of the following is a daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician?
Skilled care
A Major Medical Expense policy would exclude coverage for all the follow treatments EXCEPT
drug addiction (and alcohol addiction) is provided on a limited basis
All of the following are excluded from coverage in an individual health insurance policy EXCEPT
mental illness
In the event of a loss, business overhead insurance will pay for
Rent
All of the following are features of a health insurance plan purchased on the health insurance marketplace EXCEPT
dollar limits on essential benefits
The Commissioner has the authority to do any of the following EXCEPT
Levy a fine for a violation of the Insurance Code
Which of the following actions does NOT constitute false advertising?
Stating the dividends are not guarantee
A producer licensed in only one group of insurance (such as life or accident and health or sickness) is required to complete 24 hours of continuing education every licensing period. Out of those hours, how many must be in the area of the insurance laws and rules?
3 of those hours must be on insurance laws and rules
Temporary disability benefits are not payable until after how many consecutive days of disability?
7
A core Medicare supplement policy (Plan A) will cover all of the following expenses EXCEPT
Part A deductible
Before the Commissioner will renew or extend an insurance license, the licensee must
Pay fees and complete the required number of credit hours every 2 years
In respect to the consideration clause, which of the following is consideration on the part of the insurer?
Promising to pay in accordance with contract terms
A producer in another state wants to become a producer in Hawaii. The other state gives the same privileges to Nebraska producers wanted to be licensed in that state as it does its own producers. Hawaii therefore extends the privileges of its producers to the prospective producer of the other sate. What is this called?
Reciprocity
In order for an alumni association to be eligible to purchase group health insurance for its members, all of these statements must be true EXCEPT when the association
has been active for 5 years minimum
When may HIV-related test results be provided to the MIB?
Only if the individual is not identified
An insurer is attempting to determine the insurability of an applicant and decides to obtain medical information from several different sources. Which entity must be notified of the investigation?
The applicant
In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe?
Unilateral
If, after a hearing, the Commissioner determines that the person charged has violated insurance regulations and knows or should have known he/she was in violation, the amount of the fine will be
$5,000 for each violation, not to exceed $50,000 in a 6-month period
An elimination (waiting) period may NOT have to be satisfied for a disability in which of the following?
An insured suffers a relapse of a prior disability within 6-months of the initial covered disability
In addition to participation requirements, how does an insurer guard against adverse selection when underwriting group health?
By requiring that the insurance be incidental to the group
Fred and Jody are covered under a group health insurance plan at his place of employment. When Jody gave birth to their first child, what must he do in order to have coverage for their child?
Notify the insurer within 31 days in order for coverage to continue without any evidence of insurability
Which of the following is an example of an unfair claims settlement practice?
Failure to promptly settle a claim when liability has been clearly established
An insured was diagnosed two years ago with kidney cancer. She was treated with surgeries and chemotherapy and is now in remission. She also has a 30-year smoking history. The insured is now healthy enough to work and has just started a full-time job. Which describes the health insurance that she will most likely receive?
She would be covered under her employerʻs group health insurance plan, without higher premiums.
The Medical Information Bureau (MIB) was created to protect
Insurance companies from adverse selection by high risk persons
An. insured is anxious to get treatment for a health condition, and is convinced that a specialist is needed to cure the condition. If the insured has a PPO plan, which of the following is true?
The insured can select any specialist, but non-network specialists will have higher out-of-pocket costs
What is the purpose of a benefit schedule?
To state what and how much is covered in the plan
