Hard quiz questions
What is the maximum fine for rebates in this state?
$200 ($60-$200)
In all health care plans under the ACA, how many essential benefit categories are there?
10
Individuals who itemize deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their gross income?
10%
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? 15% 16% 23% 25%
25%
If a health insurance carrier withdraws from the smaller employer market, how soon may they reenter that market if they later choose to do so?
5 years
After an insurance company examination, the Commissioner or the examiner appointed by the commissioner must file a written report of examination within 10 days 30 days 60 days 90 days
60 days
Under the uniform required provisions, proof of loss under a health insurance policy normal should be filed within
90 days of a loss
Any regularly salaried employee of a licensed insurer, without license or other qualification, may act on behalf of the insurer in the negotiation of insurance for that insurer, provided
A licensed producer participates in the sales of insurance
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
A statement that is sufficiently clear to identify the insured and the nature of the claim
Under which conditions would an employee's group medical benefits be exempt form income taxes?
An employee's group medical benefits are generally exempt from taxation as income
Under which condition would an employee's group medical benefits be exempt from income taxes?
An employees group medical benefits are generally exempt from taxation as income
Which of the following is NOT true regarding workers compensation Benefits are not regulated by fed gov Benefits vary from state to state Benefits are regulated by state Benefits are offered by insurer
Benefits are offered by insurer
Which of the following elements of an insurance contract requires paying premium and providing a statement of good health? Competent parties Offer and acceptance Consideration Legal purpose
Consideration
A health insurance policy that pays a lump sum if the insured suffers a heart attack or stroke is known as Major medical AD&D Medical expense Critical illness
Critical illness
Social security disability includes all of the following except: A physical impairment expected to result in death Disability expected to last for at least 6 months The inability to engage in any gainful work Disability resulting from a medically determinable mental impairment
Disability expected to last for at least 6 months
Which of the following statements is correct concerning taxation of long-term care insurance
Excessive benefits may be taxable
Which of the following best describes the aleatory nature of an insurance contract
Exchange of unequal values
Which of the following are perils that are NOT insured against? Exclusions Limitations Liabilities Losses
Exclusions
An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive disability benefits? Partial benefits Full benefits for 2 years No benefits Full benefits
Full benefits
In a group health policy, a probationary period is intended for people who
Join the group after the effective date
If an applicant does not receive a copy of the new insurance policy, who would be held responsible
The agent
Which of the following is NOT a feature of a guaranteed renewable program? Coverage is not renewable beyond the insured's age 65 The insured's benefits cannot be reduced The insurer can increase the policy premium on an individual basis The insured has a unilateral right to renew the policy for the file of the contract
The insurer can increase the policy premium on an individual basis
Which of the following definitions would make it easier to quality for total disability benefits
The more liberal "own occupation"
Regarding Medicare SELECT policies, what are restricted network provisions?
They condition the payment of benefits
What is the purpose of a benefit schedule? To list the insured's copayments and deductibles To state what and how much is covered in the plan To include the average charges for procedures To provide the dates for the payment of benefits
To state what and how much is covered in the plan
When may an insured deduct medical expenses paid under a long-term care policy
When the expense exceed a certain percentage of the insured's adjusted gross income
the sole proprietor of a business makes a total salary of $50,000 a year. this year his medical expenses have reached a total of $75,000. what amount may the sole proprietor deduct in regard to his medical expense
$50,000
Following hospitalizations 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
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
An individual recently lost her job. She intends to convert her group policy to an individual policy. In order to avoid proving insurability, the conversion must occur within 61 days 30 days 31 days 60 days
31 days
When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy?
31 days
An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer? $0 500 1,000 2,000
500 (once primary insurer has paid full available benefit, the secondary insurer will cover what the first company will not pay, such as deductibles and coinsurance. the insured will, then, be reimbursed for out of pocket costs)
Which of the following would be considered an unfair claims settlement practice? Requesting the insured to submit a signed, proof of loss statement, after the insured has already verbally advised the insurer of the claim Requesting the insured swear under oath concerning the facts of the claim The settlement of the claim is delayed for 30 days in order for the insured to conduct an investigation A claims adjuster advises the insured that if the claim goes to arbitration, the insured would probably receive less than what is currently being offered
A claims adjuster advises the insured that if the claim goes to arbitration, the insured would probably receive less than what is currently being offered
Which statement accurately describes the Change of Beneficiary provision? Changing beneficiaries requires the consent of the original beneficiary Any policy that has a death benefit must also have a change of beneficiary provision Spouses are automatically irrevocable beneficiaries, with the exception of divorce or death Beneficiaries can only be changed in the event of divorce, death, or severe psychiatric disorders
Any policy that has a death benefit must also have a change of beneficiary provision
How is the Minnesota Comprehensive Health Association funded? By the Department of insurance By the government By its members-authorized insurers By NAIC
By its members- authorized insurers (CHA- members pay an annual assessment to the CHA and share losses to claims and the administrative expenses of maintaining CHA)
Chris, who is unlicensed, works part time in her father's insurance agency. she may perform all of the following activities except Collect premium for in force policies and explain coverages to client that have existing policies written by her father Make appointment with clients and prospective clients to meet with her father Assist her father in completing applications for insurance Call prospects and collect expiration date of their existing policies for her father.
Collect premium for in force policies and explain coverages to client that have existing policies written by her father
Who sets the standards for persons who act as agents for Nonprofit Health Service Plan corporations? The National Association of Insurance Commissioners Commissioner Corporation Commissioner of Human services
Commissioner
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
It consists of 3 parts Part A, B, C (MEDICARE)
Which of the following best describes the MIB? It is a rating organization for health insurance It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance It is a government agency that collects medical information on the insured from the insurance companies
It is a nonprofit organization that maintains underwriting information on applicants for life and health 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? Twisting Defamation Misrepresentation Rebating
Misrepresentation
Which of the following provision states that it is the insured's responsibility, to notify the insurer of a loss within a specified number of days? Time of payment claims Notice of claim Proof of loss Claim forms
Notice of claim
In long-term care insurance, what type of care is provided with intermediate care? Nonmedical daily care Daily care, but not nursing care Intensive care Occasional nursing or rehabilitative care
Occasional nursing or rehabilitative care
A participating insurance policy may do which of the following? Provide group coverage Pay dividends to the stockholder Require 80% participation Pay dividends to the policyowner
Pay dividends to the policyowner
Medicare Part A service does NOT include which of the following? Post hospital skilled nursing facility care Hospitalization Hospice care Private duty nursing
Private duty nursing
Insurers may change which of the following on a guaranteed renewable health insurance policy? No changes are permitted Rates by class Coverage Individual rates
Rates by class
The benefits in medical expense insurance are nonexistent taxed when reach $25,000 per year Received income tax free by the individual taxable
Received income tax free by the individual
Which health insurance provision describes the insured's right to cancel coverage?
Renewal provision
Which of the following is NOT true regarding partial disability? This is a form of insurance that covers part-time workers The insured can still report to work and receive benefits Benefits payments are typically 50% of the total disability benefit An insured would qualify if he couldn't perform some of his normal job duties
This is a form of insurance that covers part-time workers
Which type of care is NOT covered by medicare hospital long-term care hospice respite
long-term care
