Health Insurance Cards
A health insurance plan which involves financing, managing, and delivery of health care services and involves a group of providers who share in the financial risk of the plan or who have an incentive to deliver cost effective service is called A) managed care plan B) preferred care plan C) limited care plan D) self insurer
A
A non resident person can receive a non resident producer lines if all of the following are true EXCEPT: A) the persons home state awards resident producer license to non residents of the state on a limited basis B) the person has submitted the proper request for licensure and has paid the fees prescribed C) the person has submitted or transmitted to the Commissioner the application for licensure D) the person is currently licensed as a resident and in good standing in his home state
A
All of the following are characteristics of a major medical expense policy EXCEPT A) low maximum limits B) deductibles C) blanket coverage D) coinsurance
A
All of the following are correct concerning medical savings accounts (MSA) EXCEPT A) amounts deposited for the employee have large taxes B) amounts deposited for the employee are income tax deductible C) during the year, the employee may deduct from the MSA to cover out of pocket expenses such as deductibles and co insurance D) if there is a balance left in the MSA the balance can be carried over to future years
A
All of the following long term care coverages would allow the insured to receive at home EXCEPT A) skilled care B) custodial care in insureds house C) respite care D) home health care
A
COBRA applies to everyone with at least A) 20 employees B) 80 employees C) 60 employees D) 50 employees
A
If one takes social security retirement benefits at age 62, what needs to be done at age 65 to qualify for medicare A) nothing B) apply for coverage through the state C) appear for a physical at the social security office D) apply at a local social security office
A
In respect to the consideration clause, which of the following is consideration on part of the insurer? A) promising to pay in accordance with the contract terms B) offering a secondary policy to applicant C) offering an unconditional contract D) explaining policy revisions to the applicant
A
Insurance companies may be classified according to the legal form of their ownership. the type of company organized to return any surplus money to their policy holders is A) a mutual insurer B) a reciprocal company C) a fraternal insurer D) a stock company
A
The pregnancy discrimination act specifically prohibits pregnancy discrimination by employers with the minimum of how many employees? A) 15 B) 30 C) 45 D) 100
A
What percentage of individually owned disability benefits is taxable? A) 0% B)50% C) 100% D) amount paid by insured
A
When an individual is covered under 2 health insurance policies that have duplicate benefits which could make a claim for benefits because of an injury or illness profitable, it is called A) overinsurance B) double indemnity coverage C) fraternal coverage D) pro-rate coverage
A
Which of the following facts about the insured determines the amount of disability benefit that the insured will receive A) income B) gender C) marital status D) age
A
Which of the following is NOT a service providers plan? A) medicare B) HMO C) PPO D) Blue Cross
A
Which of the following is NOT required for a producer to tell a prospect A) what requirements the producer needed to meet to obtain the insurance licenser B) from what outside sources the insurer would seek information regarding the insured C) how the insurer would use any outside information regarding the applicant D) an explanation of products that the insurer is selling
A
Which of the following programs is made up of 4 parts, where the first part is paid by FICA, and the second part is paid by premiums and payroll taxes A) medicare B) blue cross C) blue shield D) medicaid
A
Which of the following statements concerning group health insurance is CORRECT? A) the employer is the policy holder B) only the employer receives a certificate of insurance C) each employee receives a policy D) under group insurance, the insurer may reject certain individuals from coverage
A
if an employer provides health insurance for its employees, which of the following is true regarding pregnancy coverage A) it must be covered to the same extent as any medical condition B) it can be excluded C) it must be considered a disability D) it can be grounds for requiring the employee to take leave
A
which of the following is the most common way to transfer risk A) purchase insurance B) increase control of claims C) lessen the possibility of loss D) name a beneficiary
A
In a noncontrubutory health insurance plan, what percentage of eligible employee must participate in the plan before the plan can become effective? A) 100% B) 75% C) 50% D) 25%
A ( i had said B)
An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action? A) the old policy should stay in force until the new policy is issued B) there should be at least a 10 day gap between policies C) policies must overlap to cover pre existing conditions D) the old policy must be cancelled before the new one can be issued
A (i had said B)
An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary A) revocable B) primary C) contingent D) irrevocable
A (i had said B)
Which of the following statements is an accurate comparison between private and government insurers? A) private insurers may be authorized to transact insurance by state insurance departments B) insurance provided by the government is called "federal insurance" C) private insurers offer fewer lines of insurance than government insurance D) private insurers provide insurance in areas where the government will not
A (i had said B)
All of the following are ways in which a Major Medical policy premium is determined EXCEPT? A)the average ages of the group B) the amount of the deductible C) the coinsurance percentage D) the stop- loss amount
A (i had said C)
Which of the following insurance providers would be considered a risk sharing arrangement? A) reciprocal B) stock C) mutual D) surplus lines
A (i had said C)
Which of the following is NOT a cost-saving service in a medical plan? A)denial of coverage B) preventive care C) second surgical opinions D) risk sharing
A (i had said C)
Which of the following is NOT a feature of a noncancellable policy? A) the usurer may terminate the contract only at renewal for certain conditions B) the premiums cannot be increased beyond the amount stated in the policy C) the guarantee to renew coverage usually applies until the insured reaches a certain age D) the insure has the right to renew the policy for the life of the contract
A (i had said C)
AN insurance company assures its new policy holders that their premium costs will not increase for a period of at least 5 years. however, due to increasing financial strain, they plan to raise the premium costs for all insureds by 10% over the next 2 years. What term best describes this act? A) fraud B) defamation C) unfair discrimination D) errors and omissions
A (i had said D)
All of the following cases show when a Small Employer Medical plan cannot be renewable EXCEPT: A) when the employer chooses to renew the plan B) for non payment of required premiums C) when the commissioner/director finds that the continuation of the coverage would not be in the best interest of policyholders or certificate holders or may impair the carriers ability to meet its contractual obligations D) when the smaller employer carrier elects to non renew all of its health benefit plans delivered or issued for delivery to small employers
A (i had said D)
An insured wants to transfer his personal insurance policy to a friend. Under what conditions would this be possible A) the insured will need a written consent of insurer B) it is impossible to transfer a policy C) the insured would have to surrender his policy to the insurer, and his friend could then ask to buy it D) the insured can transfer the policy to his friend and then notify the insurer of the change
A (i had said D)
Under workers comp, which of the following benefits are NOT included A) legal benefits B) medical and rehab benefits C) income benefits D) death benefits
A (i had said D)
A hearing may Not occur sooner than how many days after the notice of hearing is served? A) 10 B) 21 C) 30 D) 51
B
A new employee who meets HIPPA eligibility requirements must be issued health coverage on what basis? A) indemnity B) guaranteed C) noncancellable D) nondiscriminatory
B
An insurance institution, producer, or insurance support organization may not disclose any personal or privileged information about an individual collected or received in connection with an insurance transaction unless A) the disclosure has been previously approved by the commissioner B) the disclosure is with the written authorization of the individual C) the information is considered to be nonpublic information D) the commissioner deems the information to be in the best interest of the insurance buying policy
B
Because of the history of cancer in her family, Julie purchased a policy that specifically covers the expense of treating cancer. Her policy would be classified as what type of policy A) term health policy B) dread disease policy C) family history cancer policy D) specified health policy
B
How does a member of an HMO see a specialist A) the member is allowed to choose his or her own specialist B) the primary care physical refers the member C) the insurer chooses the specialist D) HMO's do not cover specialist
B
In a group policy the contact is between A) the employee and the employer B) the employer and the insurance company C) the individual and the insurance company D) the employer and the union
B
Most insurers issue health insurance policy for delivery in many states. Because each state regulates and mandates the requirement for policies delivered to their residents, instead of having a policy form in each state, the insurer attaches A) Nothing. An insurers policy only needs to conform to the regulations of the state where the insurer is domiciled B) conformity with state statutes provisions C) miscellaneous optical provision D) A waiver of other state requirements
B
Non-qualified distributions from an MSA are included in the employee's gross income and subject to penalty tax of A) 10% B) 20% C) 25% D) 50%
B
Underwriting is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT A) benefits may change B) premiums always stay the same C) due to age or health the policy may change dramatically D) pre-existing conditions that were previously covered may not be covered under the replacing policy
B
What provision may allow a small employer health benefit plan to exclude coverage for a pregnancy existing on the effective date of the coverage? A) open enrollment B) pre-existing condition C) specified diseases coverage D) advers selection
B
When would a misrepresentation on the insurance application be considered fraud A) any misrepresentation is fraud B) if it is intentional and material C) never D) when the application is incomplete
B
Which benefits would a disability plan most likely pay A) medical expenses associated with a disability B) income lost by the insureds ability to work C) rehabilitation costs D) copayments
B
at what age does an individual qualify for medicare A) 60 B) 65 C) 70 D) 72
B
how long is an open enrollment period for medicare supplemental policies? A) 90 days B) 6 months C) 1 year D) 30 days
B
which of the following health care plans would most likely provide the insured/subscriber with comprehensive heath care coverage A) basic medical expense plan B) health maintenance organization plan C) group dental insurance plan D) medical surgical expense plan
B
How can a new physician be added to the PPO's approved list A) new physicians are only added once a year, and are selected by the PPOs board of dire cords B) agree to follow the PPO standards and charge the appropriate fees C) fill out the appropriate paperwork and wait to the 12 month pre certification period D) pay an annual fee for being on the PPO list
B (i had said A)
Regarding long term care coverage, as the elimination period gets shorter, the premium A) gets lower B) gets higher C) remains constant D) premiums are not based on elimination periods
B (i had said A)
A medical expense policy that establishes the amount of benefit paid based upon prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in the geographic area is known as A) gatekeepers B) usual, customary and reasonable C) relative-value schedule D) benefit schedule
B (i had said C)
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period for her policy A) 7 days B) 10 days C) 31 days D) 60 days
B (i had said C)
In an individual long term care insurance plan, the insured is able to deduct the premiums for taxes. What income taxation will be imposed on the benefits received? A) state income tax B) no tax C) policy tax D) federal income tax
B (i had said C)
When an employee is still employed upon reaching age 65 and eligibility of Medicare, which of the following is the employee's option A) wait until next birthday to enroll B) remain on the group health insurance plan and defer elegibility for medicare until retirement C) enroll in medicare, while the company must provide additional retirement benefits D) enroll in medicare when eligible; otherwise, medicare benefits will be forfeited
B (i had said C)
When compared with the administrative cost found in individual coverage, the per capita administrative cost in group health insurance is A) equal B) lower C) higher D) comparable
B (i had said C)
Which of the following statements concerning medicare part B is correct A) it pays 100% of medicare standards for reasonable charges B) it pays for physician services, diagnostic tests, and physical therapy C) it is provided automatically to anyone who qualifies for part A D) it pays on a first dollar basis
B (i had said C)
AN employee becomes insured under the PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider, which of the following will happen? A) the PPO will pay the same benefits as if the insured had seen the PPO physician B) The PPO will pay reduced benefits C) The PPO will not not pay any benefits at all D) The insured will be required to pay a higher deductible
B- i had said D
A health insurance plan that covers all accidents and sicknesses that are not specifically excluded form the policy is referred to as A) service plan B) broad plan C) comprehensive plan D) general plan
C
A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called A) reimbursement plan B) fee-for-service plan C) prepaid plan D) indemnity plan
C
A nonresidential producer who moves from one state to another state or a residential producer who moves from the commonwealth to another state must file a change of address and provide certification for the new resident state A) within 60 days of a change of legal residence B) within 10 days " " C) within 30 days of a " " D)within 45 days of a " "
C
A typical accidental death and dismemberment policy covers all of the following losses EXCEPT: A) limb B) life C) income D) eyesight
C
AN insurance company wants to obtain the insurance history of an applicant. which source releases coded information to insurers regarding information included on previous insurance applications A) integrated insurers support B) FBI C) medical information bureau D) insurers protection guild
C
All of the following statements concerning workers compensation are correct EXCEPT A) all states have workers compensation B) benefits include medical, disability income, and rehab coverage C) a worker receives benefits only if the work related injury was not his/her fault D) workers compensation laws are established by each state
C
An agent accepts the premium payment 35 days after it is due, telling the insured that there will not be a problem keeping the policy enforced, this is an example of what type of agent authority? A) implied B) assumed C) apparent D) express
C
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy? A) the insured reaches the maximum age limit specified in the policy B) within 2 years of the application, the insured discovers a misrepresentation C) the insured is in an accident and incurs a large claim D) the insured does not pay the premium
C
In a group policy, who is issued a certificate of insurance A) the insurance company B) the employer C) the individual insured D) the health care provider
C
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met? A) there is no benefit provided under Medicare Part A for skilled nursing care B) The insured must over daily co payments C) the insured must first have been hospitalized for 3 consecutive days D) the insured must have a Medicare supplement insurance policy
C
The patient protection and affordable care act mandates that insurers provide coverage for adult children of the insured up to the age of A) 19 B) 21 C) 26 D) 30
C
Under most dental plans, what limitations are posed for denture replacement A) no limitations B) only the initial dentures are covered C) once every 5 years D) once every 10 years
C
What type of information is NOT included in a certificate of insurance? A) the procedures for filing a claim B) the length of coverage C) the cost the company is paying for monthly premiums D) the policy benefits and exclusions
C
Which of the following is true of a PPO A) claim forms are completed by members on each claim B) no copayment fees are involved C) its goal is to channel patients to providers that discount services D) a most common type of PPO is the staff model
C
Which state has jurisdiction over a group policy that covers individuals that reside in more than one state? A) All states in which covered individuals reside B) the state in which the majority of the individuals live C) the state in which the policy was delivered D) the state of employers choice
C
All of the following are true regarding her use of pretext interviews to obtain consumer information for an insurance transaction EXCEPT: A) the insurer believes that the applicant misrepresented material facts B) the insurer believes that the applicant is guilty of insurance fraud in any form C) the use of pretext interviews is never permitted D) if there is a reasonable believe that criminal activity is involved
C (i had said A)
As it pertains to group insurance, COBRA stipulates that A) terminal employees must be allowed to convert their group coverage to individual policies B) group coverage must be extended to terminated employees up to a certain period of time at the employers expense C) group coverage must be extended for terminated employees up to a certain period of time at the former employee's expense D) retiring employees must be allowed to convert their group coverage to individual policies
C (i had said A)
Which of the following statements is NOT correct? A) medicare advantage may include prescription drug coverage at no cost B) medicare part A provides hospital care C) medicare part B provides physician services D) medicare advantage must be provided through HMO's
C (i had said A)
An insured was involved in an accident and could not perform her current job for 3 years. if the insured could reasonably perform another job utilizing similar skills after 1 month, for how long would she be receiving benefits under an "own occupation" disability plan A) she would not receive any benefits B) 3 years C)2 years D) 1 month
C (i had said B)
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home heath care? A) licensed practical nurses B) community-based organization professionals C) attending physician D) registered nurses
C (i had said B)
What is the maximum penalty for habitual willful noncompliance with the fair credit reporting act A) $100 per violation B) revocation of license C) $2,500 D) $1,000
C (i had said B)
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? A) active physician B) agent C) insurer D) state governgovernemnt
C (i had said B)
An insured severely burns her hand, but is not classified as disabled. which of the following types of coverage would cover at least a portion of the insured's medical expenses A) accidental death and dismemberment B) partial disability C) medical reimbursement benefit D) medical expense compensation
C (i had said B0
In cases of a loss, the indemnity provision in insurance policies A) pays the insured a percentage of the loss above and beyond the loss B) pays the insured as much as 95% of the loss C) restores an insured person to the same financial state as before the loss D) allows the insured to collect 20% more than the actual loss
C (i had said D)
What type of benefit helps to pay for accident injuries that are not severe enough to qualify as disabilities? A) basic accidental injury B) accidental death and dismemberment C) medical reimbursement benefit D) partial disability
C (i had said D)
A 55 year old employee has worked part time for his new employer for 3 months now, but has not been offered health insurance. what factor has eliminated the employees eligibility A) total amount of time worked for the company B) age C) income D) number of hours worked per week
D
A woman obtains health coverage through Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy? A) pregnancy will only be covered if additional premium is paid B) pregnancy will not be covered as a pre-existing condition C) pregnancy may be covered with the insurers special approval D) pregnancy will be covered immediately
D
How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company? A) as soon as possible B) within 20 days C) within 60 days D) within 90 days or as soon as reasonably possible, but not to exceed 1 year
D
The classification "small employer" means any person actively engaged in a business that on at least 50% of its working days during the preceding year employed A) at least 2 and not more than 15 persons B) at least 3 and not more than 25 persons C) at least 10 and not more than 100 persons D) at least 1 and not more than 50 persons
D
What documentation grants express austerity to an agent A) agents insurance license B) fiduciary contract C) state provisions D) agents contract with the principle
D
What is the limiting age for dependent children of the insured in blanket policies A) there is no limit B) age 19 C) age 21 D) age 26
D
What is the period of coverage for events such as death or divorce under COBRA? A) 60 days B) 31 days C) 12 months D) 36 months
D
how are HMO territories typically divided A) type of physical services available B) community rating system C) by where the HMO can find the least expensive physicians D) geographic areas
D
when does medicare cover nursing home care A) only if the deductible has been met B) only for those 80 and older C) medicare covers all nursing home care for eligible policy holders D) only if it is part of treatment for a covered illness or injury
D
The patient protection and affordable care act includes all of the following provisions EXCEPT: A) right to appeal B) no lifetime dollar limits C) coverage for preventive benefits D) individual tax deduction for premiums paid
D (i had said A)
An insured is admitted to the hospital for surgery on a herniated disc. The insurance company monitors the treatment and progress in order to make sure that everything proceeds according to the insurers schedule. This is called A) prospective review B) comprehensive review C) schedule monitoring D) concureent review
D (i had said B)
In a group prescription drug plan, the insured typically pays what amount of the drug cost? A) none B) full amount until deductible is met, then nothing for the rest of the year C) full amount until a deductible is met, then a small copy D) copayment
D (i had said B)
The continuing education requirement for licensees, during the initial licensing period, is a A) minimum of 45 hours of instruction B) minimum of 45 hours of instruction to include 6 hours of ethics training C) minimum of 30 hours of instruction to include 4 hours of ethics training D) minimum of 60 hours of instruction
D (i had said B)
A man is still employed at age 65 and is now eligible for medicare. he wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him A) reapplication for group health B) medicare only C) both group health and medicare D) continuation of group health
D (i had said C)
All of the following are essential benefits required to be included in all health insurance plans purchased in the Market place EXCEPT? A) hospitalization B) maternity care C) pediatric vision care D) adult dental care
D (i had said C)
What kind of LTC benefit would provide coverage for care for functionally impaired adults on a less than 24 hour basis? A) residential daycare B) respite daycare C) home health care D) adult daycare
D (i had said C)
When an insurer offers services like pre admission testing, second opinions regarding surgery, and preventative care, which term would apply best A) cost reduction B) claims reduction C) claims discrimination D) case management provision
D (i had said C)
Which of the following includes information regarding a person's credit, character, reputation, and habits? A) consumer history B) insurability report C) agent's report D) consumer report
D(i had said A)
The requirement that agents not commingle insurance monies with their own fund is known as
Fiduciary responsibility
Which would protect the owner of a mobile phone, laptop, tablet, or other similar device against the devices theft or malfunction?
Portable electronics insurance
