Health Overall Missed Questions
44. Basic Medical expense policies do not contain which feature?
Deductibles
A single-employer self-insured health plan covering the employers, employees and their dependents is directly regulated by:
ERISA
14. Which type of coverage is least affected by an increase in medical costs?
Hospital Indemnity
Which of the following statements concerning the Florida Employee Health Care Access Act are true?1. It mandates guarantee issue for small group plans.2. It determines open enrollments for all small group plans.3. It mandated a modified community rating methodology.4. It allowed for genetic information to be used during underwriting.
1 and 3
An agent may write controlled business provided she writes at least what percentage of other similar business?
100%
Which of the following statements concerning Accidental Death and Dismemberment coverage is/are true?1. Death benefits are paid only if death occurs within 60 days of an accident.2. Dismemberment benefits may be paid for loss of use.3. Accidental death benefits are paid only if death results from an accidental bodily injury as defined in the pol
2 & 3
All of the following unreimbursed medical expenses may be considered and lumped together to determine their deductibility except:I. Prescription drugsII. Contributions to group disabilityIII. Contributions to group AD&DIV. Contributions to a group medical plan
2 &3
A Medicare supplement Notice to Buyer must be displayed:1. on the first page of the application2. on the first page of the policy3. on the first page of the Outline of Coverage
2 and 3
An individual has how many days in which to notify the company of a claim?
20 days
Ima Yankee has been licensed for seven years. How many hours of continuing education does Ima need?
20 hours every two years
Under the "relation of earnings to insurance" provision, the insurance company may take into account the insured's average monthly earnings for the past_____ months.
24 months
The non-disabling injury benefit pays:I. a flat amount equal to the insured's salaryII. a percentage amount equal to the insured's salaryIII. the actual cost of medical treatmentIV. a percentage amount equal to the weekly or monthly benefit
3 and 4
A Medicare supplement has _______ free look.
30 day
Medicare supplement policies must contain a minimum free look period of how long?
30 days
The minimum grace period in a health insurance policy paid on a quarterly basis is:
31 days
37. If an agents fails to maintain an appointment with an appointing entity writing the class of business in which the agent is licensed, after what period of time must the agent qualify as a first time applicant?
48 months
52. What % of an agent's business can be controlled business?
50%
There are how many standard Medicare supplement policies?
8
How many exclusions are in the original Medicare system?
9
Total disability does not always occur immediately after an accident but does develop days or weeks later. A specified time frame is allowed for this and the insured would still be eligible for benefits. What is the maximum amount of time specified in a disability income policy?
90 days
Under a health policy, an insured is required to provide written Proof of Loss to the insurance company within a maximum of how many days after a loss?
90 days
The term FIRST DOLLAR often is used to describe benefits payable by which type of policy?
A Hospital Indemnity policy
Tom completes the application, pays the initial premium, and the agent submits this to the insurance company. The insurer issues a policy with several riders and waivers not requested by Tom. Which of the following answers describes the insurer's action?
A counter offer by the insurer
All of the following are permitted to sell HMOs in the state of Florida except:
A licensed life agent
All of the following are true of Medicaid EXCEPT:
Anyone who cannot get Health Insurance coverage due to poor health can qualify for Medicaid.
All the below are characteristics of a mutual company EXCEPT:
Makes a profit for stockholders
Under the optional Illegal Occupation Provision, which of the following applies if a loss occurs while the insured is participating in a felony or an illegal occupation?
The insurer is not liable for the loss.
Which of the following is not correct concerning the insurer's obligation to the applicant regarding HIV testing?
The insurer must notify the insured of any positive results
When individual disability benefits are paid directly to the individual who has paid the premium, a question of taxation arises. Which would be the most appropriate response?
The premium was not tax deductible and the benefit is tax free.
Which of the following statements is/are true about a Medicare Supplement policy?
These policies are designed to cover the deductibles and coinsurance that Medicare patients have to pay
Which of the following statements about deductible provisions in medical insurance policies is NOT correct?
They are most common in basic medical expense policies
Which of the following is not correct concerning Health Maintenance Organizations
They mandate enrollment for groups of 25 or more.
An unaffiliated agent may affiliate with which of the following?
They may not affiliate with anyone
Which of the following is true regarding required provisions of a blanket policy?
They must be at least as favorable to individual insureds as comparable provisions for individual health insurance policies.
Optional Provisions 1 and 2, addressing changes of occupation and misstatement of age, permit the insurer to do which of the following?
They permit the insurer to pay indemnities equal to benefits that would have been purchased at the premium paid had the insurer known the facts when the premium was established.
HMOs are a distinct form of health provider because:
They provide financing for the health care plus the health care itself
Miami Mutual rewards their clients with a matching deposit of 10% into their annuity when they open an account. Which statement below is correct?
This is rebating and would be allowed.
9. Which of the following represents certain consumer safeguards enacted by states and patterned after a model act developed by NAIC?
Unfair Trade Practices Act
The usual payment arrangement under a Preferred Provider Organization contract is:
a fee-for-service basis.
45. All of the following must be contained in the Outline of Coverage except:
a statement specifying that dental and vision coverage are not covered in the policy
Which of the following would be considered an agent?
general lines agent
Which of the following is a distinguishing element of an insurance contract?
incontestability
47. The "right of subrogation" means the insurance company may acquire the right of the insured against liable third parties, those that may have contributed to the loss, in the event a claim is paid. This could be found in which type of contract?
indemnity contracts
During an investigation, the Department of Financial Services and the Office of Financial Regulation may do all of the following except:
issue an injunction
Which of the following is not true concerning a Risk Retention Group?
it insures a group of separate businesses
Medicare supplements:
may not duplicate Medicare benefits
Long term care policies must offer coverage for all of the following except:
mental disorders
Eustis had a $2000 per month disability policy with a benefit period to age 65 and a 6 month waiting period. She became disabled at age 64 1/2. How much would she receive?
nothing
Willful violation of the Insurance code is a:
second degree misdemeanor
a fee-for-service basis.
such as cancer
Who is responsible for completing the application?
the agent
Under a credit health policy, what is the maximum amount of the benefit paid?
the monthly amount of the loan
A company transfers a risk. The company assuming the risk is:
the re-insurer
16. Thug Life advised her insurance company of a loss covered by her Major Medical policy. If the insurance company does not provide her with proper claim forms within 15 days, she has which of the following rights?
the right to submit a description of the loss, in her own words, as proof of loss
3. A stock insurance company has stockholders and policyholders. The directors & officers are responsible to which of the following?
the stockholders
Which of the following are considered required provisions for an individual health insurance policy?I. Proof of lossII. Payment of claimIII. Illegal OccupationIV. Conformity with state statutes
1 and 2
All the following benefits from a major medical policy could be expected to be paid except
Homeopath
An insured has a basic hospital expense policy with a $10,000 limit for benefits, coordinated with a major medical policy with a $500 corridor deductible and 80/20 coinsurance provision. If she incurs a loss of $20,000, how much will the insurer pay?
$17,600
Rose Bud receives a hospital bill for $9,500 after being released from the hospital. Her Major Medical policy has a $500 deductible and an 80% - 20% continuous coinsurance feature. Of the total expense, how much will Rose have to pay?
$2,300
Stagmite purchases a major medical policy with a $100 annual deductible, 80/20 co-insurance and a maximum out-of-pocket of $5000. If Stagmite were to incur covered expenses of $10,100, how much would Stag be out of pocket?
$2100
Which of the following concerning group disability insurance is/are true?I. Premiums are tax deductible by the employer, and benefits are taxable to the employee.II. Premiums are not tax deductible by the employer, and the benefits are taxable to the employees.III. Any amount contributed by the employee toward the premium makes the entire benefit tax free.IV. The percentage contributed to the premium by the employee makes the same percentage deductible by the employer.
1
When may a small employer carrier deny health insurance coverage in a small-group market?1. if the insurer does not have the financial reserves necessary to underwrite additional coverage2. if it is applying the denial uniformly to all employers in the small-group market3. if the insurer can prove that the small employer group has had claims experience and health status-related factors that would create an adverse selection for the insurer
1 and 2
28. All of the following may administer self-insured plans except:
Actuaries
52. The following statements about INSURABLE INTEREST are true EXCEPT:
An insurable interest must exist between the policy owner and the insured at the time of the claim.
When would the insurance company require a statement of the insured's good health
At the delivery of the policy if no money was given with the application
35. Which of the following regarding group disability income insurance is NOT correct?
Benefits are expressed as a flat amount
All of the following statements are true about the tax treatment of premiums and benefits for individually owned health insurance, EXCEPT
Benefits received from Hospital & Surgical Expense policies are taxed to the extent that the benefits exceed the premiums paid
Under the NAIC Uniform Provisions Law, which of the following is optional for a health policy
Change of Occupation
23. Which of the following is not true regarding grandfathered health plans?
Grandfathered group insurance may establish annual limits for essential benefits.
27. A Business Continuation Plan may include all of the following except:
Group Insurance
36. Medicare Part "B" does not provide coverage for which of the following?
In Home Services
The purpose of the elimination (waiting) period is:
It helps the insured to reduce the cost of the policy by accepting the risk of a short term disability.
All of the following usually pertain to the probationary period on a disability policy EXCEPT:
It is one of the 12 mandatory clauses.
An insured's disability income policy defines total disability as the insured's inability to perform the duties of any occupation for which he or she is reasonably qualified by education, training or experience. Which of the following is true about this definition?
It is the any occupation definition and is more restrictive than other definitions.
26. Which of the following is not an approach MCOs use for medical cost management?
Optional Second Opinions
All of the following characteristics apply to disability buy-sell agreements except:
Providing for a death benefit
Quack Inthebox has been covered by the same Medicare supplement with HelpU Insurance company for the last two years, and 3 months ago suffered a stroke. This afternoon, she has an appointment with an insurance agent from Insurance4Less insurance company who says his company has a better supplement. Quack is worried that issues related to her stroke will not be immediately covered. When she tells the agent from Insurance4Less about her stroke, what should be the agent's response?
Quack will have immediate coverage, including coverage of the stroke.
When medical expense policies do not state specific dollar benefit amounts, but instead base payment upon the charges for the services in the same geographical area, benefits are designated as which of the following?
Reasonable and Customary Approach
Primary support for Medicare Part A comes from:
Social Security payroll taxes
33. A Health Savings Account does not allow:
Tax free non-qualified withdrawals
Which of the following is correct concerning Medicaid's "look back" and home equity exemption?
The "look back" is 5 years and the exemption is $750,000
The Financial Services Commission consists of all the following except:
The Insurance Commissioner
Which of the following statements is true regarding Multiple Employer Trusts ?
The Multiple Employer Trust, not the employer, is the contract holder.
Which of the following is not true when an agent is soliciting Medicare Supplemental insurance?
The agent can not sell an additional policy if replacing an existing one
Which of the following statements concerning Long Term Care policies is correct?
The benefits are tax-free if the policy is " qualified"
Luke has had a disability income policy for 7 years in which the premium is paid semi-annually. He forgot to pay the premium that was due on July 1, 2014. On July 31, 2014 he became totally disabled and notified the insurance company immediately. How will the insurance company respond?
The company will pay the full benefit less the premium owed.
Jack Inthebox has a long term care policy, and the premium is due on February 1. Jack has forgotten to pay his premium, and on February 25 he suffers a stroke and is admitted to a skilled nursing facility. How will the insurance company respond?
The full benefit, less the premium with an interest rate of up to 8% per year will be deducted from the claim.
An employee has decided to leave a group coverage and convert to individual health insurance. Which of the following is true regarding the coverage of the individual plan?
The individual plan will have the same benefits as the group coverage.
Sam's father had sickle-cell anemia, as well as his uncle. Sam otherwise represents a very favorable risk to the insurance company. Which course of action would the insurance company most likely pursue?
The insurance company would issue the policy as applied for.
Which of the following statements concerning an agent's license is not correct?
The insurance license is suspended automatically for bankruptcy
What must the insured do if the insurance company does not send a claim form within the appropriate time frame?
The insured should present proof of the loss in any written manner showing the nature of the loss, extent of loss and other information.
63. Which of the following is not a required coverage in the state of Florida?
Veteran's Administration treatment
A health insurance policy includes an endorsement indicating the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. What endorsement is attached to this policy?
Waiver of premium
Which of the following describes a representation?
When a prospect's statement on an application is held to be substantially true.
Coverage under COBRA terminates
When a worker was terminated for gross misconduct
Who underwrites the risk for children covered by the Florida Health Kids Corporation?
Who underwrites the risk for children covered by the Florida Health Kids Corporation?
7. An insured submits a valid documented claim for medical expenses covered by his Major Medical policy. According to the Time of Payment of Claims Provision, how soon must the company pay the claim?
Within 45 days
Which of the following statements would mean that the values of the contract are unequal?
aleatory
Which of the following statements best describes an element of an insurable risk?1. The loss must be due to chance.2. The loss must be definite and measurable.3. The loss must not be catastrophic.4. The loss exposures to be insured must be large.
all of the above
Which of the following is not covered under Medicare Part A?
ambulance services
A company that is licensed to sell insurance in a particular state isYour Answer:
an authorized company
Under the Basic Hospital Expense policy, what would not be covered under the miscellaneous expense benefit?
anesthesiologist
How does a basic medical plan avoid small claims and keep the cost of premiums down?
by imposing benefit limits
The factor in premium computation that has to do with the record-keeping and statistical analysis insurance companies perform is:
claims experience
Regarding dental insurance, deductibles and co-insurance typically do not apply to which of the following?
cleaning and exams
61. Any activity limiting a client's free choice regarding transacting insurance is
coercion
Because an insurance contract has been prepared by an insurance company without negotiation, it is considered a/an
contract of adhesion
In a Basic Hospital Expense policy, the miscellaneous expense limits are a multiple of what factor?
daily room and board
