Health Insurance exam guaranteed

Each party relies upon the truthfulness of the other.

For an insurance contract, the principle of utmost good faith means

service

HICs.are known as what type of plans?

Private Duty Nursing

Medicare Part A services do NOT include which of the following?

Those with low income and low assets.

Medicare is a health insurance program for all the following individuals EXCEPT

Inpatient

What type of hospital care would a Health Insuring Corporation (HIC) cover?

The new document must be filed with the Director for approval.

When a health insuring corporation makes changes to its solicitation document, which of the following requirements must be met?

Seeking credible information about an applicant for health

When acting as a field underwriter, a producer is

Cross the incorrect answer out, write the correct one beside it, and initial the answer.

When filling out an application for insurance, the applicant makes a mistake. If a fresh application were not available, what could the applicant do to properly correct the mistake?

Only if the individual is not identified

When may HIV-related test results be provided to the MIB?

Insurance with Other Insurers

Which health insurance provision ensures that multiple policies that provide the same benefits on an expense-incurred basis pay a proportionate share of a claim?

eating and dressing

Which of the following are considered activities of daily living in most long-term care policies?

Insurer can increase the premium above what is stated in the policy if claims experience is greater than expected.

Which of the following is NOT true regarding a noncancellable policy?

The agents

Whose responsibility is it to ensure that the application for health insurance is complete and accurate?

The company's stock value lowers.

For which of the following reasons may group coverage NOT be discontinued?

48 hrs

If prior authorization for urgent care health services is required, how soon from a request must an insurer approve or deny the appeal?

The insurance company.

In a group policy, all of the following can be the policyowner EXCEPT

immediately

Right after an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. When would this accident be covered upon reinstatement of the policy?

a warranty

What guarantees that the information explained in the insurance contract is true?

Insurability

Which of the following is NOT a Medicaid qualifier?

Blanket policy.

A group policy used to provide accident and health coverage on a group of persons being transported by a common carrier, without naming the insured persons individually is called

the insured members are not named.

What is the only difference between blanket insurance and group health insurance?

Medicare SELECT policies contain restricted network provisions.

What is the primary difference between Medigap and Medicare SELECT policies?

To allow the business buyout in case of the owner's disability

What is the purpose of a disability buy-sell agreement?

All of the above must be disclosed.

What must a small employer insurer disclose?

Reciprocal insurers

What type of insurer uses a formal sharing agreement?

Increased.

With a conditionally renewable policy, the premiums are more likely to be

It is an unfair trade practice to mention the Association in advertisements.

Which of the following statements is TRUE regarding advertising that the Insurance Guaranty Association would ensure payment of benefits in the event of insurer insolvency?

Additional Monthly Benefit

Which rider, when added to a disability policy, pays income during the six-month waiting period before Social Security benefits can begin?

180 days

The Director may issue a temporary producer's license that lasts for a maximum period of

Mailing a flyer to a client for whom the insurer previously transacted insurance

Which of the following is an appropriate way for an insurance agent to make unsolicited contact with a Medicare-eligible person?

One that is severe enough that the-insured automatically qualifies for full disability benefits

Which of the following best describes a presumptive disability?

A producer returning part of her commission to her client, as an inducement to buy

Which of the following best describes a rebate?

Premium rates

Which of the following does NOT need to be included on the first page of a Medicare supplement policy?

flagnostic and preventive care

Which of the following features would most likely appear on a dental plan?

If paid by the individual, the premiums are tax deductible.

Which of the following is NOT correct concerning taxation of disability income benefits?

Business Overhead Insurance.

A dentist is off work for 4 months due to a disability. His dental assistant's salary would be covered by

fee for service

A insured has a routine exam, blood work, and a follow-up appointment with a specialist. The insured receives a bill for each service provided. What type of plan does the insured have?

morale

A person has a history of DUIs. To his insurer, this presents what type of hazard?

High premiums.

All of the following are features of catastrophic plans EXCEPT

Premiums are tax deductible as a business expense. TRUE: •The employer receives the benefits if the key person is disabled. •The employer pays the premiums.+The employee is the insured.

All of the following are true regarding key person disability income insurance EXCEPT

Reports may be sent to anyone who requests one.

All of the following are true regarding the federal Fair Credit Reporting Act EXCEPT

twisting

An agent tells an insured that if he replaces his current insurance policy with a newer one, his dividends will be higher and his premiums will be slightly lower. The policy, however, would not offer either one of these things. What type of misrepresentation is being committed?

April 1st through June 30th

Assuming an individual has already signed up for Medicare Part A and Part B during the general enrollment period, when would she be able to enroll in a Medicare Advantage Plan?

20%

Core benefits are included in all Medicare supplemental policies. What percentage of Part B coinsurance is required?

Preferred Provider Plan.

Ed is covered under a health plan provided by his employer. He was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plan's list. If Ed chose to be treated by a provider who was not on the list, his portion of the bill would be greater. Ed is covered under a/an

30

HICs. must have open enrollment periods that last for a minimum of how many days?

Employee paid group disablity income. ARE- •Employer paid group Long-Term Care. •Employer paid group Accidental Death and Dismemberment. •Employer paid group health insurance.

Regarding health insurance, all of the following are tax-deductible EXCEPT

Higher stop-loss means lower premium.

Regarding major medical plans

Persons receiving MAdicaid are not eligible

Regarding the PPACA health care tax credit, which of the following is true?

feeling

The presumptive disablity provision assumes that the insured is totally disabled upon loss of all of the following EXCEPT

Optional benefits.

Under a group medical policy, prescription drug plans are

Prospective and concurrent review.

Utilization management consists of an evaluation of the appropriateness, necessity and quality of health care, and may include

the producer

Which of the following is required to provide a notice of information practices to applicants and policyholders?

Conversion provision

Which of the following provisions gives an employee the right to exchange group insurance for an individual policy within a certain number of days from termination of employment?

January 1st through March 31st

Which of the following time periods is the general enrollment period for Medicare Part B?

Adult day care

Which of the following types of care could be provided at a community center?

Medicare Advantage Plans

Which of the following used to be called Medicare + Choice Plans?

fire

Which of the following would be considered a peril?

Dental procedure due to birth defect

Which.of the following is NOT a common exclusion found in most health policies?

Prevent overinsurance.

in group insurance, the primary purpose of the Coordination of Benefits provision is to

Disability buy-sell

in the event one of two business partners becomes disabled and unable to work, what type of arrangement would help the nondisabled partner to buy the disabled partner's business interest?

January

the annual open enrollment period for state insurance exchanges runs from November through

Integrated dental plan.

the type of dental plan which is incorporated into a major medical expense plan is a/an

40

to attain fully insured status under Social Security, an individual must have earned how many credits?

an applicant is declined for an insurance policy, he or she has no right to know what was in the report.

According to the Fair Credit Reporting Act, all of the following statements are true EXCEPT

Suspension of License

Agent X tells an insured that her new policy requires lower premiums than the original, even though the premium amounts are actually the same. Which of the following could happen?

Maliciously criticize another insurance company.

Agents may be found guilty of defamation if they make false statements that are intended to

The employee has a right of conversion upon leaving the group coverage.

All of the following are true of a Multiple Employer Trust (MET) EXCEPT

Producers may commingle personal funds with company funds.

All of the following are true regarding a producer's fiduciary responsibilities EXCEPT

Protect consumers against the circulation of inaccurate or obsolete personal or financial information.

The purpose of the Fair Credit Reporting Act is to

Specialty HIC.

The supplemental health care services provided by a health insuring corporation on an outpatient-only basis and not in combination with other supplemental health care services is called a

Integrated dental plan.

The type of dental plan which is incorporated into a major medical expense plan is a/an

insured's primary beneficiary

Under the Payment of Claims provision, to whom will the insured's benefits be paid if the insured is deceased?

100%

Your client is sole proprietor and wishes to include his family on a medical expense plan. How much of the cost of the medical expense plan can be deducted (since he is considered self-employed?

Benefits paid will be those that would have been purchased at the correct age.

an applicant misstates his age on his application for a health insurance policy. He states that he is 39, but his actual age is 49. When he files a claim, what will most likely happen?

20%

if an insured withdraws money from a Medical Savings Account (MS) on a medical expense that is generally not tax deductible, the withdrawal will be income taxable and carry a penalty tax of

200%

An agent's first-year commission CANNOT exceed what percentage of the renewal commission for servicing a Medicare Supplement policy in its second year?

To cover the employer's administration costs

An employee is covered under COBRA. His previous premium payment was $100 per month. His employer now collects $102 each month. Why does the employer collect an extra $2?

Within 60 days.

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extension of benefits under COBRA

Prosthodontics.

An individual covered under a group Dental Expense plan needs to have bridgework done. Bridgework is covered as

Acute.

An individual is approaching retirement age and is concerned about having proper coverage should he have to be placed in a Long-Term Care (LTC) facility. His agent told him that LTC policies would provide necessary coverage at all of the following levels EXCEPT

Reaches age 65.

An insured purchased a health insurance policy with a renewability clause that states the policy is "Guaranteed Renewable." This means that as long as the required premiums are paid, the policy will continue until the insured

The insurer

Which entity has the option of including optional provisions in a health insurance policy?

Agents

Who.acts on behalf of the principal?

SiS rider

An individual was denied coverage under Social Security because his disability did not meet the strict definition of total disability used by Social Security. Which of the following would provide disability income coverage?

Stock insurers are owned by the shareholders and issue nonparticipating policies.

in contrasting stock insurers with mutual insurers, which statement is true?

30

An agent moves from an apartment to a new house in the same city. The agent must notify the Director of the address change within how many days?

Renewability provision

An insured wants to cancel her health insurance policy. Which portion of the contract would explain cancellation rights?

Received income tax free by the individual.

The benefits in Medical Expense Insurance are

30 days

if an insurer's chief executive officer suspects the insurer has or will become insolvent, the officer must notify the Director within how many days of discovery?

Scheduled

An insured's health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. That means the policy provides benefits on what basis?

the insurer

An insurer wants to create a brochure to advertise its company, so a professional advertiser is hired to create and print the material. Several months after the publication of the brochure, a client threatens to sue the insurer for false advertising because of misleading information included in the brochure. Who is legally responsible for the false material?

Attending Physician's Statement

An underwriter is reviewing an applicant with an extensive medical history. Which of the following would give the underwriter a better understanding of how the applicant has been treated for various illnesses?

copayment

HIC members pay a small fee when they see their primary care physician. This fee is called a

$2,500

If an individual willfully violates provisions of the Fair Credit Reporting Act, what is the maximum civil penalty?

Ohio Public Employees Retirement System (OPERS) Connector

Which of the following is designed to provide Ohio residents with education, advocacy, plan selection, and enrollment assistance pertaining to Medicare?

Limited Policy Notice

Which statement is required to be printed on the first page of a health insurance policy, which signals to the insured that the policy's benefits are limited?