Health insurance
what the typical deductible for basic surgical expense insurance?
$0
an insured has a primary group health plan an an excess plan each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay
$5,000
L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?
$900
in an all health care plans under the affordable care act how many essential benefit categories are there
10
An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?
10 days
a producer has competed of his continuing education hours, but his license has just lapses, within what timeframe must the producer reinstate his license if he wants to avoid taking an exam to regain his licensed status?
12 months
Which of the following disability income policies would have the highest premium?
15 day waiting period / 10 year benefit period
what is the maximum age requirement for Indiana residents to be eligible for a health Indiana plan?
64
how often must insurance producers in this state complete continuing education
every 2 years
which of the following statements is true regarding coinsurance
the larger the percentage that is paid by the insured, the lower the required premium will be
How long can a person hold a consultants license before it expires
2 years
Under writing is a major consideration when an insured wishes to replace her current policy for all of the following reasons EXCEPT
Premiums always stay the same
how is emergency care covered for a member of an HMO
a member of an HMO can receive in or out of the HMO service are but care is preferred in the service area
when an insured purchased her disability income policy she misstated her age to the agent. She told the agent that she was 30 years old when in fact, she was 37. If the policy contains the optional misstatement of age provision
amounts payable under the policy will reflect the insurers correct age
An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery the agent collects the applicants premium check answers any questions the applicant may have and then leaves. What did he forget to do?
ask her to sign a statement of good health
which do the following entities has the authority to make changes to insurance policy?
insurers executive officier
in a health insurance a doctor charges $50 more than what the insurance company considers usual, customary, and readable the extra cost
is not covered
which of the following is NOT a flexible spending account?
it does not have limits an contributions
which of the following is NOT true of a major medical health insurance policy
it is designed to pay on
COBRA applies to employers with at least
20 employees
what is the period of coverage for events such as death or divorce under COBRA
36 months
Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within
90 days of a loss
Which of the following can remove the insurance commissioner from office?
Governor
Which of the following would best describe total disability
a personas ability to work is significantly reduced or eliminated for the rest of his/her life
a person was diagnosed with cancer five months before the effective date of their medicare supplement policy. When losses were reported by the insured to be covered by the medicare supplement policy, cover was denied. This is an example of excluding benefits based on
a pre existing condition
insurance policies are not drawn up through negotiations, and an insured has little to say about its provisions. What contract characteristic does this describe?
adhesion
which of the following would be considered an unfair claims settlement practice?
advising the insured would probably be receive less than what is currently being offered
all of the following would be consider rebating EXCEPT
agent misrepresents policy benefits to convince a policyowner to replace policies
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
at least 2 and not more than 50 persons
the premium charged for exercising the guaranteed insurability rider is based upon the insureds?
attained age
A policy available to business owners that will provide payment for normal business expenses in the event that the owner is disabled, best describes?
business overhead expense
A small business owner is the insured under a disability policy that funds a buy sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?
cash to the owners business partner to accomplish a buyout
in order for a Canadian insurance company to do business in this state, it must apply for an obtain
certificate of authority
The proposed insured makes the premium payment on a new insurance policy. If the insured should die, the insurer will pay the death benefit to the beneficiary if the policy is approved. This is an example of what kind of contract?
conditional
representations are written or oral statements made by the applicant that are
considered true to the best of the applicants knowledge
which of the following reports will provide the underwriter with the information about an insurance applicants credit?
consumer report
contracts that are prepared by one party and submitted to the other party on a take it or leave it bases are classified as
contracts of adhesion
Which of the following terms describes a specific dollar amount of the cost of care that must be paid by the member?
copayment
what is the main difference between coinsurance and copayment
copayment is a set dollar amount
in a disability policy, the probationary periods refer to be time
during which illness - related disability are excluded from coverage
The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the
entire contract clause
if a person feels like he has become a victim of an unfair claims practice, which of the following would be the most effective action
file a complaint with the commissioner
which one of the following is an eligibility requirement for social security disability income benefits?
fully insured status
Which of the following is INCORRECT concerning taxation of disability income benefits?
if paid by the individual the premiums are tax deductible
A typical accidental death & dismemberment policy covers all of the following losses EXCEPT
income
which of the following statements is NOT correct concerning the Cobra Act of 1985?
it requires all employers regardless of the number of age of employees to provide extended group health coverage
the commissioners suitability for office is in part determined by the individuals
knowledge of and skill in insurance
under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is?
monthly
the primary eligibility requirement for medicaid benefits is based upon
need
An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits?
no benefits
all of the following are qualifications of a resident producer EXCEPT
obtaining a sponsorship of an admitted insurance company
with respect to the consideration clause which of the following would be considered consideration on the part of the applicant for insurance?
payment of premium
what is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered
probationary period
which of the following is legal representative of a specific insurance company?
producer
which of the following answers does NOT describe the principal goal of preferred provider organization
provide medical services only from physician in the network
a producer licensed in another state wants to become a non resident producer in Indiana. The other state gives the same privileges to Indiana producers as it does to its own producer, Indiana, therefore, extend the licensing privileges to the prospective producer of the other state. What is this called?
reciprocity
which of the following is not provided by an HMO?
reimbursement
which health insurance provision describes the insureds right to cancel coverage?
renewal provision
an insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain if the right of ownership. the insured should have her husband named as what type of beneficiary?
revocable
Which of the following basic medical expense coverage NOT cover?
surgeons services
Which of the following may NOT be included in an insurance company's advertisement
that its policies are coverage by a state guaranty association
An employee becomes insured under a 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?
the PPO will pay reduced benefits
which of the following would qualify as a competent party in an insurance contract?
the applicant has a prior felony conviction
Insurance interest can be best described by which of the following
the applicant must experience a financial loss due to an accident or sickness that befalls the insured
What happens if a non member physician is utilized under the point of service plan?
the attending physician will be paid a few for service, but the member patient will have to pay a higher coinsurance amount
an insured was pregnant when she applied for an individual accident and health sickness insurance policy. When will her insurance benefits extend to the newborn?
the child may not be covered
Which of the following true able the commissioner of insurance?
the commissioner is authorized to participate in the NAIC
What entity decides whether a persons license will be suspended or revoked
the commissioner of insurance
if a business wants to by a disability income policy on a key employee, which of the following is considered the beneficiary?
the employer
Which of the following protects consumers against the circulation of inaccurate or obsolete personal or financial situation?
the fair credit reporting act
an insured purchase a noncancelable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?
the insured is in an accident and incurs a large claim
which of the following is NOT covered under plan a in medigap insurance
the medicare part A deductible
Which of the following definitions woul dmake it easier to quialify for total disability benefits
the more liberal "own occupation"
which of the following statements regarding the change of beneficiary provision is false?
the policy owner has the right to change beneficiaries in any case
a policy with a 31 day grace period implies
the policy will not lapse for 31 days if the premium is not paid when due
When a producer is trying to reinstate a lapses license what kind of fees would he be required to pay
the producer will have to pay a penalty 3 times the unpaid renewal fees
How long does the commissioner serve in office
there is no specified length of term, the commissioner serves at the pleasure of the governor
An insured is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true? A There is nothing wrong with this form of policy delivery. B The insured should complain to the insurer. C The insured should ask for a new policy to be delivered. D The policy will not be legal until it is delivered by an agent.
there is nothing wrong with this form of policy delivery
which do the following is true regarding optional benefits with long term care policies?
they are available for an addition premium
What do long term care policies offer to policyholders to account for inflation?
they offer the option of purchasing coverage that raises benefit levels accordingly
An insured offers a policy very similar to Medicare, although it differs slightly. An agent tells an applicant that the policy is Medicare, since the policies are so similar anyway. Which of the following is true?
this practice is illegal
which provision states that the insurance company must pay medical expense claims immediately?
time of payment of claims
Agents who persuaded insurance to ax axle a policy in favor of another one when it might not be in the insured's best interest are guilty of
twisting
under the physical exam and autopsy provision, how many times can an insurer have the insured examined, at its own expense, which claim is pending?
unlimited
A medical expense policy that establishes the amount of the benefit paid based upon the 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 that geographic area is known as
usual, customary, and reasonable
Manny has been insured in an accident. Although she is still receiving benefits form her policy, she does not have to pay premiums. Her policy includes
waiver of premium rider
Rule 18 governing accident and sickness insurance advertising includes all of the following EXCEPT
want add soliciting new agents
all of the following cases show when a small employer medical plan cannot be renewable EXCEPT
when the employer choose to renew the plan
Which of the following would be considered a class A misdemeanor
willingfully violating the Indiana insurance code
Once a complain has been filed with the commissioner regarding an unfair claims practice, the commissioner
within 10 business days will send a copy of the final min to the company involved
which is NOT a characteristic of group health insurance?
a policy is issued to each insured individual
long term care coverage may be available as any of the following options EXCEPT
Endorsement to a health policy
medicare advantage is also known as
Medicare part c
A long term care insurance shoppers guide must be provided in the format developed by which of the following?
NAIC
An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply?
no coverage will apply since the injury could have been forseen
which provision concerns the insured duty to provide the insurer with reasonable notice in the even of a loss?
notice of claim
