Health Insurance
Which provides health insurance coverage?
medical expense plan (MEP)
Christina lives in a state that prohibits medical underwriting in the sale of health insurance. When she applies for an individual health insurance policy, the insurer:
must use a single community rate to set the premium
An insurance producer's responsibilities to insurance applicants include all the following EXCEPT:
offer the same rebate to every applicant
Which optional provision applies when an insured has coverage for the same expenses with another insurer but has not notified this insurer of other existing coverage?
other insurance with other insurer
Alice own a long-term care policy. Her return of premium option allows her to have a portion of the premium:
paid to her estate or a named beneficiary when she dies
Medicare Part A pays for hospital services that are considered to be:
reasonable and medically necessary
After buying a health insurance policy, the insured takes a job that increases the risk of injury. What will the insurer do to accommodate the increased risk?
reduce benefits
Producers and insurers selling Medicare supplement insurance policies are prohibited from engaging in all of the following acts EXCEPT:
replacement
A medical expense policy covers the cost of health care services delivered according to:
the plan or policy
The time of payment of claims provision of a health insurance policy defines "immediately" to mean:
within a period that is defined by individual states
When acting in the best interests of applicants and insureds, producers must:
give all important information about a proposed policy
An insurance company that primarily sells life insurance policies designed for burial and last expense purposes, and whose agents typically collect premiums in person, is known as a:
home service insurance company
Medical expense insurance plans are divided into which two classes?
indemnity plans and managed care plans
In an effort to control the cost of health care, insurers developed:
managed care plans
Andrea earned $3,000 each month before she was injured in an accident. Now she works part-time and earns $1,000 a month. Her disability income policy pays a $2,000 monthly benefit for total disability. The policy uses a flat rate to determine benefits for partial disability. How much will Andrea receive?
$1,000
A major medical policy with a stop-loss feature will typically limit the insured's total annual out-of-pocket payments to:
$2,000 to $5,000
An insured has a comprehensive major medical insurance policy with a $1,000 deductible and 80/20 coinsurance. She incurs a bill of $11,000. What will she pay in total?
$3,000
The free-look provision of a health insurance policy lets policyowners return the policy for any reason within how many days of receiving it from the insurer?
10
To be considered "fully insured" under Social Security, a worker typically needs to work about how many years?
10 years
How many Social Security credits must a worker earn to qualify for Social Security disability benefits?
40 credits
Which statement about workers' compensation disability benefits is correct?
Benefits may include rehabilitation services and replacement income.
Which of the following statements about individual disability income policies is correct?
Benefits never exceed the insured's income.
Larry, Brian, Susan, and Jennifer work for AllPro Insurance Company in Arkansas. Based on their job descriptions below, which of them is NOT acting as an insurance agent?
Brian, who is a vice president in AllPro's human resources department and does not receive commissions
Which statement is NOT correct about the reinstatement of a health insurance policy?
Claims related to illness are covered immediately.
Kim lives in an urban area with a high cost of living. Grace lives in a rural area with a lower cost of living. They have identical medical expense plans from the same insurer which pays claims on a usual, customary, and reasonable (UCR) basis. Why will the insurer pay each a different benefit for the same medical treatment?
Costs for medical treatment in large urban areas are typically higher than costs for the same treatment in rural areas.
Which of the following has primary responsibility for enforcing the Arkansas insurance laws and regulations?
Insurance Commissioner
Ascent Insurance Company receives a claim from its insured on Oct. 1. Although it promptly begins to investigate the claim, it soon determines that it will be unable to complete its investigation before Dec. 1. Which of the following actions should it take with respect to the claimant?
Notify the insured by Nov. 15 that additional time is necessary for the investigation, and give reasons for the additional time.
When comparing her insurance company's policies to those of Zenith Insurance, Melanie makes a misleading statement to convince an insurance prospect to terminate a policy with Zenith and buy one from Melanie's company. Which unlawful act has Melanie committed?
Twisting
Laura was injured in an accident. She incurred $1,000 in medical bills. Even though she was not disabled or lost any income, her disability income policy paid for these expenses because it has:
a nondisabling injury provision
Which is a penalty for failing to comply with the Patient Protection and Affordable Care Act?
annual fine
Which rider adds a death benefit to a disability income policy?
annually renewable term rider
Deliberately withholding material facts when applying for insurance is called:
concealment
The cost-of-living adjustment (COLA) rider adjusts an insured's disability income benefit payments according to changes in the:
consumer price index
In addition to mandatory and optional provisions, health insurance policies have other provisions that:
define the full scope of a policy's features, benefits, and limitations
Which is NOT a type of basic medical expense policy?
lab expense policy
A group short-term disability income plan (STD) typically has a maximum benefit period of:
less than 2 years
Group short-term disability (STD) coverage typically has a maximum benefit period of:
less than 2 years
Cancer insurance is what type of health insurance?
limited benefits insurance
Which is the principal method that HMOs use to control health care costs?
limiting access to health care providers
Which rider is NOT commonly found in a disability income policy?
long-term care rider
A subscriber's health insurance policy names the caregiver who will provide medical services, which is characteristic of a:
managed care plan
From an insurance perspective, underwriting is best defined as:
the process of determining if an applicant is an insurable risk
An application for health insurance requires the signature of:
the proposed insured and the producer
All of the following are insurable risks EXCEPT:
the risk of one's home value decreasing due to a drop in market prices
How long is the typical elimination period of a business overhead expense (BOE) policy?
15 to 60 days
A disability buy-out insurance policy typically has an elimination period of:
18 to 24 months
A group long-term disability income plan (LTD) typically has a minimum benefit period of:
2 years
The notice of claim provision of a health insurance policy gives the insured how many days to notify the insurer after a covered loss?
2020
Terry has been licensed as a life and health insurance producer in Arkansas for ten years. To maintain his license, how many hours of continuing education must he complete every two years?
24
How long from when an insurance contract is issued does an insurance company have to void a life insurance policy on the basis of fraud?
24 months
The Arkansas Insurance Commissioner can examine the business transactions, accounts, and records of domestic insurers as often as necessary, but must do so at least once every how many years?
Five years
Sporting Life Insurance Company is incorporated in Texas but transacts insurance in Arkansas. Which type of insurer is Sporting Life considered in Arkansas?
Foreign
Which of the following statements about representations and warranties is most correct?
Insurers can rescind (cancel) an insurance contract if a misrepresentation is discovered on the application during the contestability period.
How does the guaranteed renewable provision affect an individual medical expense insurance policy?
It is standard in medical expense policies.
The insured submits a claim to the insurer before the insurer cancels his health policy. How will the insurer treat the claim?
It will pay any valid claim submitted before the policy is canceled.
James is a licensed producer who lives in Little Rock. He moves his office to Perryville on July 1. He is required to notify the Commissioner of this move no later than what date?
July 10
Which type of insurer is incorporated, owned by its policyholders, but does not have capital stock?
Mutual insurer
An insured's health insurance plan pays 80 percent of the covered loss. The fact that it is a reimbursement contract relates to which characteristic of health insurance?
The benefit is based on the loss suffered.
What happens if a person submits an insurance application without the first premium?
The insurer must make an offer to the applicant.
Which statement about HMOs is NOT correct?
The network of providers is limited to a town or city.
Which statement about disability reducing term insurance policies is correct?
The purpose of the policy is to cover the term of a loan.
Which penalty may the Commissioner impose if an agent has violated the Insurance Code?
a fine of up to $1,000 per violation
The Royale Insurance Company, domiciled in Toronto, Canada, transacts business legally in New York. In New York, Royale is classified as a(n):
alien insurance company
Under an indemnity plan, the insured can:
choose doctors and health care providers
A function of the other insurance with this insurer provision and the other insurance with other insurer(s) provision is to:
coordinate benefits
The main purpose for errors and omissions insurance (E&O) is to:
cover damages that arise due to services a producer non-willfully failed to render
The purpose of the insuring clause is to:
describe the type and scope of coverage
When an applicant applies for a health insurance policy, a producer is NOT required to:
determine the premium rate
Jerry owns a life insurance policy with premiums payable directly to the insurer's home office. However, for the past five years Jerry has sent his payments to his agent, who then forwards them to the insurer. The insurer had accepted this arrangement but then tries to cancel Jerry's policy when it learns he had died while the premium was being forwarded by the agent. The insurer will probably not be able to cancel the policy in this case because of which of the following legal principles?
estoppel
Ethical dilemmas involve conflicts between all of the following EXCEPT:
federal and state laws and regulations
Where can a person set up a health care savings account (HSA)?
financial institution
Which is arguably the most significant benefit that employers offer employees?
health insurance
Ralph's AGI is $100,000. His unreimbursed medical expenses are $11,000. He also paid $10,000 for health insurance premiums. How much is Ralph's medical expense deduction?
$11,000
Most states require that a group have at least how many members to qualify for standard group health insurance?
10
On January 1, Meghan lost her job at Acme Inc., a small company with ten employees, where she had worked for the past ten years. To continue her coverage under Acme's group health insurance plan, Meghan must request continuation of coverage within how many days after termination of employment?
10
The owner of a tax-qualified long-term care insurance policy may deduct premium payments by the amount that unreimbursed medical expenses exceed what percentage of adjusted gross income?
10 percent
A Section 125 cafeteria plan may cover which of these expenses?
health insurance premiums
A totally disabled person must pass a waiting period of how long before Social Security disability benefits are paid?
five months
A worker with Social Security coverage for disability benefits has a work status of:
fully insured
Which of the following statements about producer loyalty is TRUE?
Producers owe their loyalty to both their insurance companies and insureds.
How do insurers determine usual, customary, and reasonable (UCR) charges?
They refer to databases that rank costs for medical procedures by geographic area.
A handyman applies for an individual disability income insurance policy. Which definition of total disability will the insurer most likely use when issuing the policy?
any occupation
John, who is covered under Medicare Part A, is hospitalized for 70 days. For hospitalizations beyond the first 60 days, the beneficiary' daily coinsurance is $352 in this case. If the hospital charges $500 per day, what amount will Medicare pay towards the $1,480 excess over the coinsurance amount for the 10 period between days 61 through 70?
100 percent of the total, or $1,480
A long-term care insurance policy is designed to provide coverage for at least how many months?
12
HIPAA applies to group health insurance plans that cover at least how many people?
2
Under a blanket health insurance policy issued in Arkansas, notice of a claim must be given to the insurer within
20 days for sickness or injury; 30 days for disability
Tom is employed by Acme Industries and covered by its group long-term disability income policy. Acme pays 80 percent of the premium. Tom pays 20 percent of the premium. He becomes disabled and receives a monthly benefit payment. How much of this benefit will NOT be taxed as income?
20%
Horace buys a Medicare supplement insurance policy, but decides not to keep it. How many days does he have to return it for a full refund of the premium?
30
A Medicare supplement policy cannot define a pre-existing condition more restrictively than a condition for which medical advice was given or treatment recommended by or received from a medical doctor within how many months before the effective date of coverage?
6
Contributory plans typically require what minimum percentage of eligible employees to participate?
75%
Tom is employed by Acme Industries and covered by its group long-term disability income policy. Acme pays 80 percent of the premium. Tom pays 20 percent of the premium. He becomes disabled and receives a monthly benefit payment. How much of this benefit is subject to federal income tax?
80%
Which statement does NOT describe the standard Medicare supplement plans?
A plan may be cancelled if the insured's health significantly deteriorates.
Which step should employers take to help employees avoid, detect, and prevent ethical violations in the workplace?
Adopt and support a professional code of ethics
Which statement about health insurance advertisements is always TRUE?
Advertisements must disclose the extent to which any loss is not covered if traceable to a pre-existing condition existing before the policy's effective date.
Which statement is correct about state administration of Medicaid?
All states base Medicaid eligibility on financial need.
After Amanda receives premium funds from clients, she deposits them into her personal savings account. She then remits the funds to the insurer. Which statement about Amanda's acts is correct?
Amanda has engaged in commingling, which is unethical and illegal.
Which statement is correct about the tax treatment of group disability income benefits?
An employee pays income tax on the percentage of benefits equal to the percentage of premium the employer paid.
ABC Insurance Company diligently maintains files of advertisements it uses to market its health insurance policies. How long is it required to keep them?
At least four years or until the Commissioner's next examination, whichever is later
Which statement is NOT correct about the income tax implications of the premiums paid and benefits received under a medical expense insurance policy?
Benefits are added to gross income.
What favorable tax treatment do qualified long-term care insurance policies receive?
Benefits are not taxed, within limits.
Which statement is correct about the taxation of benefits paid to a person insured by a group health plan?
Benefits from group AD&D insurance are taxed to the extent an employer paid the premium.
Producers can help prevent insurance fraud by taking all of the following actions EXCEPT:
have proposed insureds sign blank insurance applications
Elena is a life and health agent, and her client Ned asks her about a homeowners policy. Elena states that although she is not licensed to transact that type of insurance, she recommends a certain level of coverage that she thinks Ned should buy. Which of the following characterizes Elena's behavior?
Legal and unethical
A dental plan that categorizes covered treatments into three categories will typically place diagnostic and preventive care in:
Category 1
Which of the following is a benefit trigger under a long-term care insurance policy?
Cognitive impairment
In general, which of the following is NOT a permissible reason for a health insurer in Arkansas to discontinue or refuse to renew major medical health insurance coverage?
Deteriorating health of the insured
The following statements about flexible spending accounts (FSAs) are correct, EXCEPT:
Employees can use FSA funds to pay costs that their employer's health plan covers.
Samantha is an agent for MegaMutual Insurance Company. Under her agent contract, she is allowed to use the company's logo on her office door and on her business cards. What authority type does this illustrate?
Express authority
Which unlawful act involves deceit that is practiced in order to secure unfair or illegal gain?
Fraud
Which statement about group health insurance is NOT correct?
Group health insurance has higher premiums than individual insurance.
Toby unintentionally became involved in a money laundering scheme while handling premiums he received from policyholders. Which statement about Toby's behavior is CORRECT?
His behavior is unethical and illegal.
Which ethical behavior is at the core of all legal and ethical principles and standards?
Honesty
The motivation of stakeholders in an ethical dilemma involve all of the following EXCEPT:
Honesty versus propriety
When faced with an ethical dilemma at work, all of the following would run through the mind of an ethical producer EXCEPT:
If no one is hurt, it's okay
Which of the following must be included in a health insurance advertisement?
Insurer's identity
Which statements is correct about underwriting group health insurance?
Insurers consider the risk characteristics of the group as a whole.
Which statement is correct about the MIB (Medical Information Bureau)?
It collects medical information about insurance applicants.
Which describes the characteristics of the Medicare program?
It is a federal health insurance program designed for people age 65 and over and for certain disabled people.
Which statement about a Medicare Supplement policy is CORRECT?
It must be guaranteed renewable.
Joe is employed by Delta Motors, Inc. He participates in Delta's group health insurance plan for employees. What should this plan be considered?
Joe's primary plan
Which product supplements Medicare by offering benefits delivered through a network of health care providers?
Medicare SELECT plan
Adam is a Medicare beneficiary and enrolled in his state's Medicaid program. When he submits a claim for covered services to both, how will Medicare and Medicaid pay the claim?
Medicare will be the primary insurer, and Medicaid will be the secondary insurer.
Which of the following is an optional provision that may be included in individual health insurance policies issued in Arkansas?
Misstatement of age
Which statement about insurance fraud is correct?
Most states have insurance fraud bureaus that investigate allegations of insurance fraud.
What happens to a group health insurance plan when members leave the group?
Nothing will happen.
Insurers that offer Medicare supplement insurance must, in addition to Plan A, offer at least:
Plan C or Plan F
Which statement about group disability income (DI) insurance is correct?
Plans can offer benefit periods for short-term disability and long-term disability.
Which statement is true about the "any occupation" and "own occupation" definitions of total disability?
Policies with an own occupation definition are more expensive.
Which statement is NOT correct about the tax treatment of business overhead expense (BOE) insurance?
Premiums cannot be deducted.
Which statement is correct about the taxation of health insurance expenses?
Premiums paid for individual disability income insurance are not deductible.
Which statement is correct about group health insurance?
Premiums that employers pay for group coverage are not taxable wages.
Randy's client asks if he can find a low-priced health insurance policy for the client's daughter. However, Randy has never sold health insurance. Which action should Randy take?
Refer the client to a producer who transacts health insurance
Which of the following is NOT an unfair claims settlement practice if committed by an insurance company in Arkansas?
Requiring policyholders to file proof of loss before paying claims
The Commissioner can suspend or revoke a producer's license for all of the following reasons EXCEPT:
Selling insurance to family members or friends
All the following statements regarding perils and hazards are correct EXCEPT:
Smoking cigarettes is an example of a peril.
What is NOT correct about the coordination of benefits in group health insurance plans?
Spouses' plans pay equal benefits for covered dependent children.
A society, community, or business industry determines the collective standards of acceptable ethical conduct. An individual, however, approaches ethical decisions from a personal perspective of life experiences along with other factors. Which of the following is NOT one of the factors from which an individual makes an ethical decision?
State insurance regulations
What process will an insured follow when using funds from a flexible spending account (FSA) to pay for a medical expense?
Submit a claim and proof of payment to the FSA administrator for reimbursement.
Which statement is correct about key person disability income insurance?
The benefit helps the business survive a key employee's disability.
Which statement is correct about the need for long-term care insurance?
The costs of long-term care services are often more than one person or couple can afford.
Which helped Medicare subscribers fill the gaps in Medicare coverage?
The insurance industry created Medicare supplement policies.
Which statement is CORRECT about a guaranteed renewable disability income policy?
The insurer can increase the premium if it increases the premium for all policies in the same class.
Debbie owns a noncancelable individual disability income policy. She receives benefits for one year and then returns to work. Which statement is correct about the policy's renewal?
The insurer must renew the policy if Debbie pays the premium.
Which statement about the right to continue group health insurance under COBRA is NOT correct?
The younger spouse of an insured who becomes eligible for Medicare benefits cannot continue group coverage.
All of the following are characteristics of a mutual insurance company EXCEPT:
They are owned by stockholders.
How does the Pregnancy Discrimination Act prevent discrimination against pregnant employees?
They must be treated the same under the plan as non-pregnant employees.
Which action must producers take when requesting and processing nonpublic personal information from clients?
They must comply with federal privacy laws.
For which of the following prohibited trade practices will an agent licensed in Arkansas be subject to imprisonment if convicted?
Twisting
Which of the following is the leading reason for producers to lose their licenses?
Unethical behavior
Each of the following is a step used to identify an ethical dilemma EXCEPT:
What will happen if the ethical code is not followed?
All of the following are fiduciary duties that producers owe to their insurers EXCEPT:
always placing the interests of customers ahead of the insurer's interests
A person who incurs a deductible medical expense is eligible for reimbursement from:
an FSA
In a medical expense policy, which method uses pre-determined prices for medical or health services to determine the benefit?
benefit schedule
A producer owes a fiduciary duty to:
both the insurer and the customer
To receive tax-free benefits under a qualified LTC insurance policy, the insured must be:
chronically ill
When underwriting an experience-rated plan, the insurer will NOT examine which factor?
claims experience of similar groups
Which occupation would NOT qualify for a disability income policy that pays benefits on the basis of the "own occupation" definition of disability?
construction worker
Which are NOT qualified, unreimbursed medical expenses for purposes of the medical expense deduction?
contributions to premiums for group AD&D insurance
A company's group health plan specifies that if the insured is eligible for benefits under another policy, the plan will be the primary plan. Which provision does this?
coordination of benefits
Like all health insurance plans, dental insurance plans exclude coverage for:
cosmetic treatment, such as tooth alignment and whitening
The elimination period in a disability income insurance policy functions like which of the following in a medical expense policy?
deductible
Pamela is meeting with Todd, an insurance customer, to discuss whether he should buy life insurance. As a producer, Pamela has an ethical duty to take all of the following actions EXCEPT:
disclose that she can give Todd part of her commission to help pay the premium if he buys a policy
An employer applies for a group health insurance plan. The underwriter examines the employer's claims history and group composition. This indicates the plan will be issued on what basis?
experience rating
Which type of group health insurance plan bases premium s and benefits on the group's claims experience?
experience-rated plan
The purpose for the Buyer's Guide, which must be given to every insurance prospect in the first meeting with a producer, is to:
explain the general features, benefits, and conditions of the type of insurance being considered
All of the following information must be included in the evidence of coverage issued by an HMO EXCEPT:
information on Medicaid and other public healthcare benefits to which the enrollee may be entitled
Which occupation would qualify for a disability income policy that pays benefits on the basis of the "own occupation" definition of disability?
lawyer
A tax-qualified long-term care insurance policy lets policyowners deduct premiums as a medical expense while also receiving:
limited tax-free benefits
Jana applied for a life insurance policy and submitted the initial premium with her application. When Acme Insurers reviewed Jana's application, it decided to offer her a modified policy at a higher premium. In this case, what has Acme Insurers done?
made a counteroffer to Jana
An applicant for a $500,000 whole life insurance policy pays the initial premium along with his application. In this case, what has the applicant done?
made an offer to the insurer
Which of the following does NOT constitute the transaction of insurance?
mailing an insurance contract
Under the Patient Protection and Affordable Care Act, essential health benefits (EHBs) are best described as:
pediatric, laboratory, preventive, rehabilitative and emergency care services that are not subject to benefit limits.
A major medical expense policy requires the insured to pay separate deductibles for each illness or each accident. What type of deductible does it have?
per cause deductible
The Arkansas Life and Health Insurance Guaranty Association provides coverage for all of the following EXCEPT:
policies that provide Medicare Part C or Part D coverage
Which payment arrangement do managed care plans like HMOs and PPOs typically use?
pre-payment
After a disability income policy has been issued, what period of time must pass before the insured may file a claim for benefits?
probationary period
A Medicare supplement policy that duplicates the benefits provided by Medicare is
prohibited under any circumstances
ERISA does NOT regulate group health insurance plans with respect to:
promoting the sponsor's best interests
All of the following practices have been adopted by various states to protect seniors EXCEPT:
requiring producers to post a bond and undergo special training in order to sell products to seniors
Buying life or health insurance is an example of which risk management technique?
risk transfer
Which level of long-term care provides continuous, 24-hour care delivered by licensed medical professionals who are under a doctor's supervision?
skilled nursing care
Which of the following is NOT a duty of the Commissioner of Insurance?
soliciting insurance contracts
If assets exceed the allowable limits for Medicaid, an applicant must reduce them to become eligible for Medicaid assistance, a practice that is known as:
spending down
Jim applies for a health insurance policy. Although the insurer issues the policy, it excludes coverage for losses associated with cardiac illness. The insurer has classified Jim's risk as:
substandard
Which tax deduction is available to a self-employed person who buys health insurance?
tax deduction for medical, dental, and long-term care insurance premiums
HIPAA treats premiums paid for tax-qualified long-term care insurance plans as medical expenses that qualify for what type of tax status?
tax-favored status
A business overhead expense policy does NOT provide:
tax-free benefits
An income replacement disability insurance policy pays a monthly benefit that equals:
the actual amount of income lost
In order to be grounds for the insurer to void a contract, an applicant's statements on an insurance application must involve:
the deliberate withholding of material facts
Under either a benefit schedule or usual, customary, and reasonable charge method, benefit payments are based on:
the stipulated amount or the amount charged, whichever is lower
Dental plans commonly group covered treatment and benefits into how many classes?
three
Into how many categories do indemnity dental plans classify covered treatment and benefits?
three categories
The normal reinstatement period for a lapsed health insurance policy is:
three years from the date of lapse
How may an HMO member get covered medical care from a provider who is outside the provider network, without a reduction in coverage?
through a point-of-service (POS) plan
Why does a disability income insurance policy limit the maximum benefit to a percentage of the insured's pre-disability wages and earnings?
to encourage the insured to return to work
What is the principal purpose of Medicaid?
to provide health care and health-related services to people with low incomes
Benefit periods for short-term disability income policies are usually limited to:
two years or less
When enrolling in a group health plan, eligible employees do NOT:
undergo individual underwriting
What determines whether a health insurance policy will be issued with an impairment rider?
underwriting
The insurance company function responsible for evaluating the insurable risks and assigning appropriate premium rates, is the:
underwriting division
Which of the following contract characteristics is unique to insurance contracts but NOT all contracts?
unilateral
Medicare Part B benefits exclude coverage for:
vaccinations
An insured's health plan provides specific coverage, which means it is NOT likely to cover:
visits to doctors' offices
In which case is the amount payable for a covered service based on the amount that is typical for the area in which the service is performed?
when coverage is paid on a usual, customary, and reasonable (UCR) charge basis
When does a waiver of premium rider excuse the insured from paying the policy's premium?
when the insured is totally disabled