Health and Insurance and law
An insured should receive necessary claim forms within _____ days after notice of claim. A 15 B 5 C 10 D 20
A 15
If employees pay a portion of the premium for a group health plan, then that plan must provide coverage for at least what percentage of eligible employees? A 50% B 25% C 75% D 100%
A 50%
The issuance or circulation of any illustration or statement indicating that a corporation is permitted to transact any business not authorized by its certificate of authority constitutes which of the following? A False Advertising B Material Misrepresentation C Unfair Discrimination D Misrepresentation
A False Advertising
Which provision is a Mandatory Uniform Provision? A Legal Actions B Misstatement of Age C Illegal Occupation D Conformity with State Statutes
A Legal Actions
Which of the following contracts must be community rated if they provide hospital and medical benefits? A Small group insurance contracts, including Medicare Supplements B Groups of less than 2 C Spouses and dependents of association members D Groups of more than 50
A Small group insurance contracts, including Medicare Supplements
All of the following are true statements regarding testimonials, except: A Testimonials that refer to benefits received under a policy must be retained by the insurer for a period of 10 years B If an advertisement is endorsed by a group, the relationship between the group and the insurer must be disclosed C Testimonials must be genuine D If a person is compensated, the advertisement must be labeled PAID ENDORSEMENT
A Testimonials that refer to benefits received under a policy must be retained by the insurer for a period of 10 years
Consumers must be made aware of all of the following in a replacement sale, except: A The financial ratings from each rating service B The new policy may have a higher premium C The new policy may be offered with lower benefits, limitations, or exclusions of coverage D There may be a waiting period for pre-existing conditions
A The financial ratings from each rating service
Insurance producers are required to complete how many continuing education credits during each biennial licensing period? A 20 B 15 C 24 D 40
B 15
Which of the following statements is correct regarding the prelicensing education requirements for an individual license applicant? A A minimum of 40 hours is required for all lines of insurance B A minimum of 90 hours is required for property and casualty lines C A minimum of 40 hours is required for property and casualty lines D A minimum of 90 hours is required for life, accident and health
B A minimum of 90 hours is required for property and casualty lines
Which of the following statements is false regarding assumed names? A Every licensee must notify the Superintendent about a change to his/her legal name B Every licensee's legal name must be previously approved by the Superintendent C Every licensee must notify the Superintendent about a change to his/her assumed name D A licensee may not use any name, other than his/her legal name, that has not been previously approved by the Superintendent
B Every licensee's legal name must be previously approved by the Superintendent
A temporary insurance license authorizes the licensee to do which of the following? A Solicit new insurance on behalf of the original licensee B Renew existing insurance on behalf of the original licensee C Sell new insurance on behalf of the original licensee D Negotiate new insurance on behalf of the original licensee
B Renew existing insurance on behalf of the original licensee
Suspension or revocation of a license cannot take effect until: A The insurer is notified in writing B The Superintendent holds a hearing C The licensee pays a fine D The courts hold a jury trial
B The Superintendent holds a hearing
Tom submits an application and a premium check. Six days later, the insurer issues the policy as applied for and mails it overnight to Tom's producer. Tom picks up the policy at his producer's office the next day. When did Tom's coverage begin? A The day Tom picked up his policy at his producer's office B The day Tom submitted his application C The day the insurer mailed the policy D The day the insurer issued the policy
B The day Tom submitted his application
Timothy owns an individual A&H policy, and in the event of an accident, he is required to prove only that the injury itself is unforeseen and unintended. Tim's policy is based on which of the following definitions of accident? A Accidental Death B Accidental Dismemberment C Accidental Bodily Injury D Accidental Means
C Accidental Bodily Injury: Tim's policy is based on Accidental Bodily Injury (or, Accidental Injury) as opposed to Accidental Mea
By consumer privacy regulation, a licensee must provide a clear and conspicuous notice to customers that accurately reflects its privacy policies and practices at least: A Every 24 months after a policy is in force B Once at the time of application C At the time of application and annually thereafter D Every 12 months after a policy is in force
C At the time of application and annually thereafter
How often do individual producer licenses expire? A Every 5 years on the licensee's birthday B Every 2 years on December 31st C Every 2 years on the licensee's birthday D Every 2 years on June 30th
C Every 2 years on the licensee's birthday
Chapter 1 - General Insurance
Chapter 1 - General Insurance
Which of the following statements concerning advertising accident and health insurance in New York is NOT true? A Ads may not state a contract is an introductory offer unless it is true B Ads must be clear and avoid misleading or deceiving the public C Ads may not make unfair or incomplete policy comparisons D Ads must use words such as "all," "extra," and "comprehensive"
D Ads must use words such as "all," "extra," and "comprehensive"
Which of the following statements regarding producer licenses is true? A Brokers generally represent the insurer B Public Adjusters work for the state C Agents earn both consulting fees and commissions from the same sale D Consultants must have a written agreement in place in order to charge a fee
D Consultants must have a written agreement in place in order to charge a fee
The agency which carries out and enforces the provisions of the Insurance Frauds Prevention Act is: A The Insurance Task Force B The Insurance Department C The Insurance Guaranty Association D The Insurance Frauds Bureau
D The Insurance Frauds Bureau
State Laws
State Laws
Social Security uses which of the following definitions to determine total disability? A Any substantial gainful activity B Own occupation C Loss of income D Any occupation
A Any substantial gainful activity
Which of the following statements is true regarding group short term disability benefits: A Benefits payable can be up to 100% of loss of income B Payments are made on a quarterly basis C The elimination period is 13, 26, or 52 weeks D Benefits are payable to age 65
A Benefits payable can be up to 100% of loss of income: Group short-term disability benefits are payable for 13, 26, or 52 weeks typically, but never longer than 2 years. The elimination period is usually 0-7 days but rarely longer than 15-30 days. Benefits are typically paid weekly and can be as high as 100% of wages.
A specified period that must elapse before new coverage goes into effect for a given condition is known as which of the following? A Probationary period B Benefit period C Exclusion D Waiting period
A Probationary period: A probationary period is a specified period of time after the effective date of a policy before new coverage goes into effect for specified conditions, such as losses due to a sickness or preexisting conditions.
Which Long-Term Care definition does not match the coverage? A Skilled Nursing Facility -- A licensed facility, operated in accordance with the laws of the state, providing skilled nursing care under the supervision of a registered nurse as directed by a licensed physician responsible for all patient care B Residential Care -- Health care provided in one's home under a planned program established by his/her attending physician C Custodial Care Facility -- A licensed facility, operated according to the laws of the state, under the supervision of an R.N. D Respite Care -- Provides relief to the caregiver not the long-term care patient
B Residential Care -- Health care provided in one's home under a planned program established by his/her attending physician
If the insurer issues a health insurance policy without an initial premium, the producer must obtain a signed: A Statement of increased health risks B Statement of Good Health C Rider that the policy is acceptable D Standard provisions endorsemen
B Statement of Good Health: When delivering the policy, the producer must have the insured sign a statement of continued good health. This statement says that everything on the application is still true and there has been no changes to their health status.
The policy conditions represent the obligations of: A The insurance company only B The department of insurance C Both the insured and the insurer D The insured only
C Both the insured and the insurer
If an insurer cancels a contract, written notice must be provided to the insured within a certain period of time. This is a requirement under which of the following provisions? A Conformity with State Statutes B Entire Contract C Cancellation D Legal Actions
C Cancellation
Attaching a(n) ___________ rider excludes coverage for a condition that would otherwise be covered. A Waiver B Rehabilitation benefit C Impairment D Lifetime benefit
C Impairment: impairment rider excludes coverage for a condition that would otherwise be covered.
All of the following are Optional Provisions, except: A Change of Occupation B Misstatement of Age C Legal Actions D Illegal Occupatio
C Legal Actions
Assuming eligibility, which of the following Medicare plans does not require any premium payment? A Part B B Part C C Part A D Part D
C Part A: Part A is premium-free for eligible persons. Parts B and D are optional and require additional premium. Premium payments for Part B are required in order to obtain Part C.
Which of the following pertaining to most LTC policies is true? A They can be cancelled on the grounds of age B They deny coverage for those with a destructive brain disease C They are issued guaranteed renewable D They provide coverage only for skilled nursing care
C They are issued guaranteed renewable
For an accidental means policy to pay a claim, the injury must be an: A Unintentional injury only B Unforeseeable injury only C Unintentional in both the cause and the result of the injury D Unintentional cause only
C Unintentional in both the cause and the result of the injury
Chapter 2 - Health Basics
Chapter 2 - Health Basics
A Basic Hospital Expense Policy provides coverage for the insured while ________. A In a nursing home B At home C In rehabilitation D Confined to the hospital
D Confined to the hospital
If the insurer issues a policy after receiving an application for health insurance in which preexisting conditions were inadvertently omitted, what would be the consequence to the insured's coverage if a preexisting condition caused a claim shortly after being issued? A The policy would be sent back to underwriting for approval B The policy would be reissued C The policy would be cancelled D Coverage would be as stipulated in the policy because the company issued the policy even though the question was left blank
D Coverage would be as stipulated in the policy because the company issued the policy even though the question was left blank: If a policy is issued with questions unanswered, the contract will be interpreted as if the question had not been asked and is therefore waived by the insurer.
Which of the following products replaces lost income when one is unable to work due to a condition for which therapeutic and rehabilitative care services is often necessary? A Long-Term Care Insurance B Accidental Death and Dismemberment Insurance C Medical Expense Insurance D Disability Insurance
D Disability Insurance
A treatment approval procedure used by dental insurance carriers to determine the benefit to be paid is known as? A Preliminary Evaluation B Least Coverage Provision C Pretreatment Examination D Precertification
D Precertification: Precertification or Predetermination of Benefits, although not normally mandatory, allows both the patient and the dentist to know what will be covered before treatment.
Which of the following is considered a field underwriter? A Actuary B Department examiner C Medical doctor D Producer
D Producer
If an employee is age 65 and still working, which of the following statements is correct? A The worker must make Medicare the primary payor B The employee will automatically be enrolled in Medicaid C The group health plan becomes secondary to Medicare D The older employee must be offered the same benefits as younger employees
D The older employee must be offered the same benefits as younger employees
A person who negotiates insurance contracts with insurers on behalf of an applicant is known as a(n): A Advisor B Agent / Producer C Consultant D Broker
D Broker
An individual is eligible for a Medicare Supplement as early as age: A 65 B 62 C 70 1/2 D 59 1/2
A 65
What type of Long-Term Care policy can be renewable and convertible, and can also be purchased at lower rates than for individual coverage? A An Employer Group Policy B A Policy Rider C A Limited Policy D A Franchise Policy
A An Employer Group Policy
When a policy is mailed to an insured by an insurer, it is considered to be: A Delivered B Issued C Rated D Purchased
A Delivered: A policy may be delivered by registered or certified mail with a signed receipt of delivery.
Beth has a contract stating she must be disabled for 3 months before benefits will begin to be paid. This 3-month period is known as the: A Elimination Period B Probationary Period C Contingency Period D Grace Period
A Elimination Period: The Elimination Period is a period of time that must elapse after onset of a disability before benefits begin to be paid.
he Minimum Benefit Standards under a qualified LTC policy include all of the following, except: A Every LTC policy must be issued as noncancellable B An Outline of Coverage must be delivered to an applicant on the initial solicitation and prior to the presentation of the application form C Every LTC policy must offer optional inflation protection to offset the increased costs of care D Every LTC policy must include basic policy requirements in the policy provisions
A Every LTC policy must be issued as noncancellable
Deliberate deception with intent to gain is the definition of: A Fraud B Misrepresentation C Waiver and Estoppel D Concealment
A Fraud
Right to Examine is the same as: A Free Look Period B Waiting Period C Elimination Period D Probationary Period
A Free Look Period
To be eligible for social security disability the insured worker must be: A Fully insured B Partially disabled C Paralyzed D Eligible for Workers' Compensation
A Fully insured: To be eligible for Social Security disability, the insured worker must be fully insured.
For which of the following is coverage not required to be provided or offered under Medical Expense Insurance by most insurers? A Intentionally self-inflicted wounds coverage B Mental illness coverage C Alcohol abuse coverage D Speech and hearing disorders coverage Sorry!
A Intentionally self-inflicted wounds coverage: Intentionally self-inflicted injuries are typically excluded by Medical Expense policies.
Which of the following is correct concerning an LTC policy? A It may define a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage B It may provide coverage for only skilled nursing care and not any lower levels of care C A new waiting period may be established when existing coverage is converted or replaced by another policy D A policy may be canceled or nonrenewed on the basis of age
A It may define a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage:
What health insurance product is designed to provide coverage for necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital? A Long-Term Care B Medicare Supplement C Retirement Benefits D Outpatient Care
A Long-Term Care
This rider will provide paid-up coverage if the insured cancels or lapses the policy due to nonpayment of premium. A Nonforfeiture B Waiver of premium C Guaranteed insurability (Future increase option) D Return of premium
A Nonforfeiture
In Disability Income underwriting, the single most important rating factor from an underwriting standpoint is the applicant's: A Occupation B Gender C Finances D Health
A Occupation
What type of disability income insurance is designed help a small business continue to make regular monthly payments on its long-term financial commitments in the event of the owner's disability? A Reducing term B Business overhead expense C Buy-sell D Key employee
A Reducing term: Disability Reducing Term helps a small business that has long-term financial commitments requiring regular monthly payments to meet its obligations
To reduce its exposure to claims from a substandard disability risk, an insurer may take all of the following actions, except: A Remove all of the exclusion riders B Reduce the amount of benefit C Increase the elimination period D Charge additional premium
A Remove all of the exclusion riders
Examples of preventative care include all of the following, except: A Restricting travel to within 5 miles of home B Well child visits C Immunizations D Mammography screenings
A Restricting travel to within 5 miles of home
A Medical Expense Policy's list of the amounts the insurer will pay for each medical service is known as a(n) __________. A Schedule of Benefits B Insuring Clause C Payment of Claims provision D Service Program
A Schedule of Benefits: Under a Schedule of Benefits, the amount payable is itemized for each medical expense covered by the plan.
A family has a $1,000 annual family deductible with a coinsurance provision of 80/20. The family's claims for the year are $200, $300, $400, $500, $300, and $300 totaling $2,000. The insured is responsible for paying: A $800 B $1,200 C $2,000 D $1,600
B $1,200: The insured's responsibility is the deductible ($1,000) and 20% of the balance ($200) for a total of $1,200.
If an insurer makes a payment for a claim but the insured is dissatisfied with it, he/she must wait _____ days after proof of loss before he/she might take any legal action. A 20 B 60 C 90 D 45
B 60
Insurance ____________ are captive or independent organizations that recruit, contract with, train, and support insurance producers. A Personal producing general agents B Agencies C Producers D Companies
B Agencies
An insurer which is formed under the laws of another country is a(n): A Domestic insurer B Alien insurer C Foreign insurer D Unauthorized insurer
B Alien insurer
A(n) ___________ has the right to review the consumer report used in the underwriting process. A Beneficiary B Applicant C Producer D Spouse
B Applicant
Insurable interest for life insurance is necessary only at the time of: A Policy delivery B Application C Death D Policy renewal
B Application
Which is not a provider type? A Self-Insured B Blue Cross/Blue Shield C Reimbursement D Service
B Blue Cross/Blue Shield
A(n)____________ is the person or entity that is covered by an insurance policy. A Producer B Insured C Agency D Owner
B Insured: The insured is the person whose life is being used for insurability purposes for a life and/or health insurance policy.
An applicant determined to have below average risk of loss would be: A Issued a standard policy B Issued a preferred policy C Issued a rated policy D Declined for coverage
B Issued a preferred policy
Pete is a valuable veteran of 21 years at Joe's Garage working with 24 people and filling in for Joe when he is not in. Joe wants to insure Pete to offset any losses and the costs of trying to find, recruit and train a replacement, should Pete become disabled. What type of policy should Joe purchase? A Business Overhead Insurance B Key Employee Insurance C Employee Impairment Insurance D Special Insurance Supplement
B Key Employee Insurance: Joe is after a policy that will pay the business a benefit to help pay for hiring a replacement, loss of revenue, etc., when a key employee (Pete) becomes disabled.
This type of policy covers various expenses that an insured may incur due to a routine accident or sickness. A Dental expense B Medical expense C Disability income D Long-term care
B Medical expense: A Medical Expense contract covers the various expenses which an insured may incur due to an accident or sickness.
Based upon Optional Uniform Provisions, an insurer would have the right to deny claim payment in all of the following circumstances, except: A A claim is covered by another insurer B Misstatement of age on the application C A claim involving an injury sustained in a bank robbery D A broken leg injury suffered as the result of ingesting an illegal drug
B Misstatement of age on the application
Three years ago, Charles purchased a health policy from the QRS Company; he has purchased two additional contracts from the same insurer since. Each contract contains the Other Insurance With This Insurer Provision. What happens if Charles has a claim? A Each contract will pay in direct proportion to the loss B Only one policy will pay, the premiums for the other contracts will be returned C The insurer will cancel all contracts because of intent to defraud D Benefits are paid in full by all contracts
B Only one policy will pay, the premiums for the other contracts will be returned
Which of the following is not covered by Medicare Part A? A Hospice care B Outpatient hospital treatment C Hospitalization D Post hospital skilled nursing facility care
B Outpatient hospital treatment
The three types of hazards are: A Direct, indirect, and undecided B Physical, moral, and morale C Known, seen, and unknown D Reduction, avoidance, and risk
B Physical, moral, and morale
Upon joining an HMO, the plan will require the subscriber to select a: A Participating hospital B Primary Care Physician C Specialty physician D Out of network primary care physician
B Primary Care Physician: An HMO will require a subscriber to select a network Primary Care Physician, also known as a Gatekeeper.
Which of the following are NOT typically covered under HMOs: A Psychological services B Private hospital rooms C Physical therapies D Prescription drugs
B Private hospital rooms
Barry has just been hired by OPQ Corporation and finds that he cannot enroll for coverage under OPQ's group health insurance plan for 30 days. This 30-day period is known as a: A Deductible B Probationary Period C Elimination Period D Policy Period
B Probationary Period
What type of contract do commercial insurers traditionally market? A Service B Reimbursement C Practicing medical D Self-Insured
B Reimbursement: Commercial Insurers traditionally market a reimbursement type contract that pays directly to the insured.
The agent's primary underwriting role is: A To determine insurability B To make sure the application provides the proper information C To collect information for marketing purposes D No longer applicable in most situations
B To make sure the application provides the proper information
Susan neglected to make her premium payment and she was injured in an accident. After she submitted the claim, she discovered that the insurer had subtracted $200 (the amount of the overdue premium) from the claim. The insurer may do this under which provision? A Payment of Claims B Unpaid Premiums C Reinstatement D Grace Period
B Unpaid Premiums
Which of the following terms and definitions do not match? A Guaranteed Renewable -- Renewable without proof of insurability, but premiums may increase due to age B Noncancellable -- Guaranteed renewable to a specified age or date with a premium that will not increase C Cancellable -- An effective period for the policy is expressed in its provisions and it cannot be renewed D Optionally Renewable -- Renewable only at the option of the insurer
C Cancellable -- An effective period for the policy is expressed in its provisions and it cannot be renewed
The rates charged by Independent Practice Association HMO physicians are prenegotiated on a ________ basis. A Reimbursement B Out-of-pocket C Capitation, or capitated D Indemnity
C Capitation, or capitated: HMOs compensate physicians with monthly capitation to cover general expenses, in exchange for prenegotiated rates for services actually performed.
Field underwriting is very important: A Due to the risk of morale hazard B For individual insurance only C Due to the risk of a moral hazard D For policies that do not require home office underwriting
C Due to the risk of a moral hazard
LTC coverage for such things as occasional visits and care by registered, practical or vocational nurses or a hospice organization in the home would be a feature of: A Adult Day Care B Custodial Care C Home Health Care D Intermediate Care
C Home Health Care
Between the ages of 19 and 65, an America worker is more likely to be disabled than to die. This is a comparison of: A Adverse selection to Mortality B Adverse selection to Normal selection C Morbidity to Mortality D Adverse Selection to Morbidity
C Morbidity to Mortality: Morbidity is the likelihood of being disabled; mortality is the likelihood of dying.
A company owned by stockholders that does NOT pay dividends to policyholders is considered: A Contributory B Noncontributory C Nonparticipating D Participating
C Nonparticipating
Which of the following Medicare Supplement policies have Core Benefits? A Plan A only B Plan A through C only C Plans A through N D Plans C through J only
C Plans A through N
The principal objectives of a HMO include all of the following, except: A Reducing unnecessary hospital admissions B Reducing the average number of days per hospital visit C Providing only inpatient medical care D Keeping patients well with preventative medicine
C Providing only inpatient medical care: The principal objectives of an HMO are to reduce medical expenses by emphasizing preventive medicine, reducing the number of unnecessary hospital admissions, reducing the average number of days per hospital visit, reducing duplication of benefits, and saving on administrative costs.
A temporary license authorizes the holder to: A Sell insurance until a permanent license is issued B Sell insurance if one's initial licensing period is less than 2 full years C Renew existing business, and on behalf of a deceased producer D Sell new insurance on behalf of a disabled producer
C Renew existing business, and on behalf of a deceased producer: Temporary licenses are a tool to aid in business continuation, not an authorization to sell.
Which of the following terms refers to the risk management technique of assuming the responsibility for a loss? A Reduction B Avoidance C Retention D Transfer
C Retention: Risk retention involves assuming the responsibility for loss.
The process of analyzing risk exposures and designing programs to handle them is known as: A Insurable Risks B Loss Exposure C Risk Management D Adverse Selection
C Risk Management
Which of the following parties does not sign an application for life insurance? A The agent/producer B The insured C The beneficiary D The applicant
C The beneficiary
Which statement is inaccurate regarding the Change of Occupation Provision? A If the insured changes to a more hazardous occupation, benefits will be reduced to the amount which the premiums paid would purchase at the more hazardous occupation B If the insured works at two occupations, rates for the most hazardous occupation will be charged C The insured must notify the insurer of a change of occupation, or the policy will be cancelled D If the insured changes to a less hazardous occupation, he/she may apply for a rate reduction
C The insured must notify the insurer of a change of occupation, or the policy will be cancelled
An insured is hospitalized for at least 3 days. How long will Medicare pay for confinement in a skilled nursing facility? A Up to 30 days B Up to 90 days C Up to 100 days D Up to 365 days
C Up to 100 days
Chapter 3 - Medical Expense Plans and Concepts
Chapter 3 - Medical Expense Plans and Concepts
Chapter 4 - Disability Income
Chapter 4 - Disability Income
Chapter 5 - Senior Needs
Chapter 5 - Senior Needs
Chapter 6 - Individual Policy Provisions
Chapter 6 - Individual Policy Provisions
Eileen's health insurance had a $500 deductible and 80% / 20% coinsurance. Her first claim of the policy year amounted to $1,000, of which she paid $600. How much was her coinsurance? A $600 B $400 C $500 D $100
D $100: The answer is $100. The other $500 she paid covers her policy deductible.
When Harry completed his insurance application, the agent discovered that he was under treatment for a chronic condition. In order to gather the necessary information, Harry's agent ordered a/an: A A medical exam B An inspection report C A Medical Information Bureau report D An attending physician statement
D An attending physician statement: An attending physician's statement is ordered when the application reveals the presence of a chronic or other condition for which additional information regarding treatment and prognosis is required. A medical exam is ordered based on a variety of factors including the age, and condition of the applicant as well as the amount of coverage requested. A Medical Information Bureau report will be ordered on all applicants as a matter of course.
If an individual starts receiving Social Security retirement benefits at age 62, when will they be eligible for Medicare Part A? A At age 62 B 24 months after receiving Social Security retirement benefits C An individual is not eligible for Part A if they receive Social Security retirement benefits D At age 65
D At age 65
Precertification, Mandatory Second Surgical Opinion, and Concurrent Review are provisions in health insurance policies known as: A Protect Insurer Provisions B Policy Abilities Provisions C Miscellaneous Provisions D Case Management Provisions
D Case Management Provisions
An initial amount the insured must meet per year before benefits are paid is known as the: A Stop loss B Copayment C Coinsurance D Deductible
D Deductible
Insurance companies writing disability income generally have an occupational classification system based on considerations of all of the following, except: A Claims history of the occupation B Job duties C Stability of the industry D Earning potential
D Earning potential: Insurance companies writing disability income generally have an occupational classification system based on considerations, such as job duties, claims history of the occupation, and stability of the industry.
A commercial insurer who reimburses insureds for medical expenses they incur is known as what type of a provider? A Service B Self-insured C Practicing medical D Indemnity
D Indemnity: Commercial insurers who reimburse the insured for medical expenses incurred are known as indemnity providers: Commercial insurers who reimburse the insured for medical expenses incurred are known as indemnity providers.
Which clause in a contract would state that Jim is covered by XYZ insurer for a monthly benefit of $2,000 in the event of disability? A Free Look Provision B Consideration Clause C Entire Contract D Insuring Clause
D Insuring Clause
A policy that only covers cancer is considered a: A Blanket Insurance plan B AD&D plan C Hospital Income plan D Limited sickness plan
D Limited sickness plan: Critical Illness, Dread Disease, or Limited Sickness Plans provide specific benefits for a specified sickness, such as Cancer Plans and Heart Disease Plans.
When offering Long-Term Care coverage, nonforfeiture benefits: A Must be offered on plans providing coverage on individuals over age 65 B Must be offered on plans providing coverage on individuals up to age 50 C Are not required to be offered D Must be offered in all policies
D Must be offered in all policies
Which of the following is a limited form of medical expense coverage added to a disability income policy? A Hospital confinement rider B Additional monthly benefit rider C Social insurance supplement rider D Non-disabling injury rider
D Non-disabling injury rider: A Non-Disabling Injury Rider does not pay disability income, but pays medical expenses related to an injury that does not result in total disability (emergency room, x-rays, durable medical equipment, etc.).
What provision states that if there is a second disability due to the same cause within a specified period, the elimination period will be waived? A Rehabilitation Disability B Second Disability C Residual Disability D Recurrent Disability
D Recurrent Disability:
Sam is totally disabled and receiving benefits while attending an insurer-approved vocational training program. What provision guarantees the continuation of benefits while Sam participates in the training program and remains totally disabled? A Temporary Disability B Impairment Disability C Presumptive Disability D Rehabilitation
D Rehabilitation: Under the Rehabilitation Provision, total disability benefits will be continued as long as the insured is actively participating in the training program and remains totally disabled.
To reduce the risk of insuring a substandard disability applicant, an insurer may take all of the following actions, except: A Reduce the amount of benefit B Increase the elimination period C Charge additional premium D Remove all of the exclusion riders
D Remove all of the exclusion riders: The underwriter might add, not remove, exclusions for conditions that appear certain to result in claims.
Which provision provides a loss of earnings benefit to an employee who returns to work after sustaining a total disability, if the insured's earnings are less than they were before the disability. A Restorative Disability B Presumptive Disability C Recurrent Disability D Residual Disability
D Residual Disability
The Initial Enrollment Period for Medicare is 7 months in length. Which of the following are the start and stop dates for this period? A January 1 to July 31 in the year of his/her 65th birthday B The 1st day of the month before the individual turns age 65 and the last day of the 5th month after the month the individual turns age 65 C 7 months after his/her 65th birthday D The 1st day of the 3rd month before the individual turns age 65 and the last day of the 3rd month after the month the individual turns age 65
D The 1st day of the 3rd month before the individual turns age 65 and the last day of the 3rd month after the month the individual turns age 65