Health Insurance Cert Exam

A health maintenance organization (HMO) is an alternative provider of medical services. Which of the following statements is correct regarding an HMO? An HMO functions like a commercial insurer An HMO enrollee may utilize any physician desired It covers overhead expenses in the event that a businessowner dies. It is an organization stressing preventive health care and early diagnosis

D

Joe Gerber applied for medical expense insurance on February 2. The application was submitted to underwriting on February 4th. Underwriting approved the application on February 7th and the agent delivered the policy to Joe on February 11th. When does the free-look period end? February 12th February 14th February 17th February 21st

D

The consideration clause which appears in an accident and health insurance policy states that the insured's consideration is the: Premium paid Representations on the application Insured's signature on the application Premium paid and representations

D

Which of the following would be covered by a business overhead expense Policy? Employer salary Owners income Business profit Rent expenses

D

An insurance company has two years in which to determine that an insured concealed material information on a health insurance application according to which of the following provisions? Incontestable clause Notice of claim provision Reinstatement Time limit on certain defenses

D. Time limit on certain defenses

Medicaid provides medical expense coverage for needy individuals and families. Medicaid provides health care benefits for all of the following, EXCEPT: An individual receiving welfare benefits A physically challenged millionaire A nineteen year old needy person A blind person with insufficient income

b

Medicare is comprised of Part A, Hospital Insurance, and Part B, Supplementary Medical Insurance. All of the following regarding Hospital Insurance is true, EXCEPT: Payment of bills are made directly to the hospital Hospital insurance is subject to a deductible Part A covers outpatient services Benefits may continue beyond the hospitalization period if approved

c

Social security provides a lump sum death benefit, medical expense benefits and disability income benefits. Disability benefits will begin to an eligible recipient following a waiting period of: One month Three months Five months Six months

c

Medicare covers medical expense benefits for those over age 65 and for qualified persons who become disabled. Which of the following individuals would be eligible for such coverage? A fifty-five year old woman who is partially disabled Sixty year old man who plans to retire next year. Sixty-two year old woman who has taken early retirement Sixty-eight year old man

d

If an insurer fails to notify an applicant that his reinstatement application was not approved, coverage must automatically be reinstated within what period of time? 10 days 15 days 30 days 45 days

45 days

Health insurance policies include twelve uniform mandatory provisions, one of which is the proof of loss provision. An insured must submit a proof of loss to an insurer within how many days of the loss? 20 30 60 90

90

A long term care policy must have a renewability feature of no less than: Guaranteed renewable Cancelable Noncancelable Conditionally renewable

A

All are true statements regarding dependent children except: In all cases, a child is no longer considered dependent once they turn age 19. A full time college student under the age of 23 would be considered a dependent child. A mentally handicapped child can remain covered under a group plan for as long as their handicap exists. The Affordable Care Act allows children to remain under the parent s group plan until age 26.

A

An illegal comparison of insurance policies made by a producer which persuades an insured to lapse, surrender or cancel another policy currently in force is known as: Misrepresentation or twisting Notice of claim replacement Sound business practices Rebating

A

Each of the following may be a source of underwriting information, EXCEPT: Agent ledger statements Medical Information Bureau report Attending physician's statement Blood test results

A

A common provision appearing in a health insurance policy is misstatement of age. Which of the following is accurate with regard to this provision? A misstatement of age on a health insurance application will result in a policy benefit adjustment If an applicant's age is misstated on an application for health insurance, a premium refund will be made to the insured If an applicant unintentionally misstates his age on an application, an insurer will take no action If an applicant intentionally misstates his age on an application no action will be taken by the insurer.

A.

All states require the inclusion of a free-look provision in health insurance policies. Which of the following statements is true with regard to this provision? The free-look period begins when the policy is delivered to the policyowner This provision provides the applicant with an opportunity to review the policy at a higher cost The free-look provision permits an insured to increase coverage without demonstrating insurability The free-look period begins on the date the application is completed

A.

Some disability income policies include an accidental death and dismemberment benefit. The term dismemberment would include which of the following? Amputation of a person's thumb The severance of an arm at the elbow The loss of a finger and toe All the toes on one foot are severed

B

The only instance where a death benefit is provided under an accident and health policy involves an accidental death benefit. The amount payable under this benefit is known as the: Capital sum Principal sum Accidental means sum Accidental bodily injury sum

B

Which long term care benefit provides the highest level of nursing home care? Custodial nursing care Skilled nursing care Intermediate nursing care Respite care

B

Which of the following policies provides for a reimbursement of regular operating expenses if the owner of a business becomes disabled? Credit health insurance Business overhead expense insurance Residual disability insurance Long term disability insurance

B

Which of the following would generally be considered earned income for the purpose of calculating an insured's monthly disability income benefit? Rental income Income received from salary Interest earned from a savings account Dividends received from mutual funds

B

Which provision in a major medical policy states that an insurer will pay 100% of covered expenses after the insured's out of pocket payments reach a specified level? Coinsurance provision Stop-loss provision Common accident provision Principle of indemnity

B

A basic hospital plan may be made up of hospital expense benefits and surgical expense benefits. Which of the following is true with regard to surgical expense benefits? Coverage for the cost of ancillary expenses is provided on a reimbursement basis The cost of x-rays is generally covered without the satisfaction of a deductible. Amounts listed in the policy's benefit schedule are usually expressed in terms of the maximum benefit payable Policy benefits are subject to deductibles of $1,000 or more

C

According to the guaranteed insurability benefit rider, an insured will automatically qualify for additional amounts of guaranteed disability income insurance without: Selecting a death benefit Naming a beneficiary Providing insurability Submitting premium

C

Bob Singer owns an individual disability income policy paying a monthly benefit of $1,500 per month with a 30 day waiting period. If he becomes disabled for 135 days, how much will his policy pay? $ 800 $4,500 $5,250 $6,750

C

Mrs. Thomas is covered by a major medical policy with a $100 initial deductible. The policy includes a coinsurance clause of 80/20. If she incurs medical expenses of $3,000, how much will the insurer pay? $ 680 $2,320 $2,400 $4,000

C

Ted breaks his leg while being chased by police following a burglary attempt. His insurer may deny the claim filed for his injury based upon which of the following? Time limit on certain defenses clause Change of occupation provisions Illegal occupation provision Free-look provision

C

The purpose of an insurance application is to: Eliminate the need for home office underwriting Complete underwriting Discover facts about the applicant Collect the premium

C

Which of the following is true regarding taxation of disability income benefits? Benefits are not taxable if the premium is paid by the employer. Benefits are taxable if they are paid following a waiting period. Benefits are not taxable if the premium for coverage is paid by the insured. Benefits paid are always taxable to the insured.

C.

What type of insurer has its principal office in the state where it is licensed? Stock Mutual Domestic Alien

C. Domestic

According to the guaranteed insurability benefit rider, an insured will automatically qualify for additional amounts of guaranteed disability income insurance without: Selecting a death benefit Naming a beneficiary Providing insurability Submitting premium

C. Providing insurability

A producer offering something of value in order to induce the applicant to purchase an insurance policy has engaged in: Twisting Defamation Rebating Coercion

C. Rebating

All of the following are required uniform policy provisions which appear in a health insurance policy EXCEPT: Entire contract Notice of claim Time limit on certain defenses Change of occupation

Change of Occupation

All would be considered an advantage of a Health Savings Account, EXCEPT: Funds can be used to fund college tuition expenses Contributions are tax-deductible Growth is tax-deferred Funds are designed to offset out-of-pocket medical expenses

a