Life and Health
An insured paya a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? A) 7 days B) 10 days C) 31 days D) 60 days
B) 10 days
Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray? A) 80/20 B) 90/10 C) 50/50 D) 75/25
C) 50/50
Which of the following does the insuring Clause NOT specify? A) What kind of losses are covered B) The insurance company C) The insured D) the doctors
D) the doctors
An insured submitted a notice of claim to the insurer, but never receive claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true? A) The insured was in compliance with the policy requirements regarding claims B) The claim most likely will not be paid since the official claims for m was not submitted. C) The insurer will be fined for not providing th claims forms D) the insured must submit proof of loss the Department of Insurance
A) The insured was in compliance with the policy requirements regarding claims
Which of the following terms describe the specified dollar amount beyond which the insured no longer participates in the sharing of expenses? A) Maximum Loss B) Stop-Loss Limit C) Out-of-Pocket Limit D) Maximum Loss Threshold
B) Stop-Loss Limit
A guaranteed renewable disability insurance policy A) Is guaranteed to have a level premium for the life of the policy B) Cannot be cancelled by the insured before age 65 C) Is renewable at the insured's option a specified age D) Is renewable at the option of the insurer to a specified age of the insure
C) Is renewable at the insured's option a specified age
What is the purpose of coinsurance provisions? A) To have the insured pay premiums to more than one company. B) To let insurance companies share the income from the premiums thy get paid. C) To split liability among different insurance companies D) For the insurance company to prevent overtutilization of the policy
D) For the insurance company to prevent overtutilization of the policy
What provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? A) Loss Notification B) Claims Initiation C) Consideration D) Notice of Claim
D) Notice of Claim
Which of the following provision would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? A) Change of beneficiary B) Entire Contract Clause C) Proof of Loss D) Payment of Claims
D) Payment of Claims
Under a health inusrance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to A) Creditors B) beneficiary of the death benefit C) The spouse of the insured D) The insured
D) The insured
An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstance would NOT be a reason for the insurance company to cancel the policy/ A) The insured does not pay the premium B) The insured reaches the maximum age limit specified int he policy C) Within two years of the application, the insurer discovers a misrepresentation D) The insured is in an accident and incurs a large claim
D) The insured is in an accident and incurs a large claim
A policy with a 31-day grace period implies A) The policyholder has a 31-day free look B) The policy lapses if premium is not paid 31 days before it is due C) If something happens within 31 days of the policy issue, the insurer will not pay D) The policy continues for 31 days if premiums are not paid
D) The policy continues for 31 days if premiums are not paid
When Ken purchased his health policy he was a window washer. He has since changed occupations and now manages a library. Upon notifying the insurer of his change of occupation, the insurer should A) Return any unearned premium B) Consider decreasing the premium C) Adjust the benefit in accordance with the decreased risk D) Increase the benefit
B) Consider decreasing the premium
Which of the following is true regarding a term health policy? A) It is noncancellable. B) It is nonrenewable. C) It is conditionally renewable D) It is guaranteed renewable
B) It is nonrenewable.
What type of policy allows the insurance company to cancel a policy at any time? A) Guaranteed renewable B) Noncancellable C) Cancellable D) Renewable
C) Cancellable
Under an individual disability policy, the MINIMUM schedule of time which claim payments must be made to an insured is A) Weekly. B) Biweekly C) Monthly D) Within 45 days
C) Monthly
The premium charge for exercising the Guaranteed Insurability Rider is based upon A) Attained age B) Assumed age C) Spouse's age D) Issue age
A) Attained age
Which of the following is NOT an exclusion in medical expense insurance policies? A) Chiropractic care B) Well baby care C) Hearing aids D) Routine dental care
A) Chiropractic care
What is the main difference between coinsurance and copayments? A) Copayment is a set dollar amount. B) With copaymnets, the insured shares part of the cost with the insurer. C) With coinsurance, the insured shares part of teh cost with the insurer. D) Coinsurnace is a set dollar amount
A) Copayment is a set dollar amount
Sally purchases an individual Health insurance policy on September 1. On September 7 her doctor informs her that she is four month pregnant. Her coverage will most likely pay A) All expenses B) All expenses except those related to the pregnancy C) Only expense related to the pregnancy D) Nothing
B) All expenses except those related to the pregnancy
The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained inthe contract is the A) Legal action against us clause. B) Entire contract clause. C) Time limit on certain defenses clause. D) Incontestability clause.
B) Entire contract clause.
The provision which states that both the printed contract and a copy of the application for the contract between the policyowner and the insurer is called the A) Aleatory contract B) Complete contract C) Entire contract D) Total contract
C) Entire contract
Which of the following entities has the authority to make changes to an insurance policy? A) Broker B) Producer C) Insurer's executive officer D) Department of Insurance
C) Insurer's executive officer
An insured notifies the insurance company that he has become disabled. What provision states that claims bust be paid immediately upon written proof of loss/? A) Physical Exam and Autopsy B) legal Actions C) Time of Payment of Claims D) Incontestability
C) Time of Payment of Claims
Which rider, available in disability income insurance, will provide benefits above the basic policy amount? A) Impairment rider B) Guaranteed insurability rider C) Return of premium rider D) Multiple indemnity rider
D) Multiple indemnity rider
Which of the following is NOT a feature of a noncacncellable policy? A) The premiums cannot be increased beyond the amount stated in the policy. B) The guarantee to renew coverage usually applies until the insured reaches certain age. C) The insured has the right to renew the policy for the life of the contract D) The insurer may terminate the contract only at renewal for certain conditions
D) The insurer may terminate the contract only at renewal for certain conditions
Which of the following will vary the length of the grace period in health insurance policies? A) The length of any elimination period B) The length of time the insured has been insured C) The term of the policy D) The mode of the premium payment
D) The mode of the premium payment
Which renewability provision are you most likely to see on a travel accident policy? A) Period of time B) Noncancellable C) Optionally renewable D) Conditionally renewable
A) Period of time
Jack was treated for hypertension prior to applying for a major medical policy. If Jack incurs medical expenses related to hypertension, the insurer will likely exclude coverage because the hypertension represents a/an A) Pre-existing condition B) Substandard risk C) Recurrent disability D) Uninsurable risk.
A) Pre-existing condition
An insured is killed when a drunk driver's car slams into his truck. His beneficiary receives triple the amount of the stated benefit. What provision allows this? A) Other insurance in this insurer B) Multiple indemnity rider C) Guaranteed insurability D) Irrevocable beneficiary
B) Multiple indemnity rider
Which is true regarding the Uniform Individual Accident and Sickness Policy Provision Law? A) There are twelve optional policy provisions. B) Provisions may be reworded by the insurer C) The purpose of the provision is to define the right of the policyholder; there is a separate law outlining the rights of insurers D) There are ten mandatory provisions
B) Provisions may be reworded by the insurer
While a claim is pending, an insurance company may require A) The insured to be examined only within the first 30 days. B) The insured to be examined only once annually C) An independent examination only once every 45 days D) An indpendent examination as often as reasonably required
D) An indpendent examination as often as reasonably required
The provision which prevents the insured from bringing any legal actions against the company for at least 60 days after proof of loss is known as A) Time limit on certain defenses B) Payment of claims C) Proof of loss D) Legal actions
D) Legal actions
A guaranteed renewal health insurance policy allows the A) Insurer to renew the policy to a specified age B) Policyholder to renew the policy to state age, with the company having the right to increase premiums on the entire class C) Policyholder to renew the policy to a stated age and guarantees the premium for the same period D) Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term
B) Policyholder to renew the policy to state age, with the company having the right to increase premiums on the entire class
Which health insurance provision describes the insured's right to cancel coverage? A) Cancellation provision B) Renewal provision C) Policy duration provision D) Insuring clause
B) Renewal provision
All of the following are correct about the required provisions of a health insurance policy EXCEPT A) A grace period of 31 days if found in annual pay policy B) The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract C) A reinstated policy provides immediate coverage for an illness. D) Proof-of-loss forms must be sent to the insured within 15 days of notice of claim
C) A reinstated policy provides immediate coverage for an illness.
A woman misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued? A) Deny paying a claim based on misrepresentation B) pay the full amount of a claim because the contestable period has ended C) Adjust the claim benefit to reflect the woman's true age D) Deny any claims and cancel the woman's policy
C) Adjust the claim benefit to reflect the woman's true age
What is the health provision that allows the insurer to nonrenew health coverage if certain events occur? A) Noncancellable B) Guaranteed renewable C) Conditionally renewable D) Optionally renewable
C) Conditionally renewable
A Health insurance policy lapses but is reinstated within an acceptable time frame. How soon from the reinstatement date will coverage for accidents become effective? A) Immediately B) After 14 days C) After 31 days D) After 31 days
A) Immediately
Sarah has battled a chronic orthopedic condition for most of her life. The only way she can obtain individual health insurance at a reasonable cost is by allowing the insurer to exclude her condition from coverage. What is the name of this rider? A) Impairment Rider B) Pre-Existing Conditions C) Multiple INdemnity Rider D) Exclusionary rider
A) Impairment Rider
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain A) A complete physicians statement B) A statement that is sufficiently clear to identify the insured and the nature of the claim C) A statement from the insured's employer showing that the insured was unable to work. D) An estimate of the total amount of medical and hospital expense for the loss
B) A statement that is sufficiently clear to identify the insured and the nature of the claim
An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary? A) Irrevocable B) Revocable C) Primary D) Contingent
B) Revocable
When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. Which of the following statements correctly explains how this claim would be handled? A) The insurer may deny the claim since it was not notified within the required 20-day time frame B) The insured is considered to be notified since the notification to agent equals notification to the insurer C) The insurer may delay the payment of this claim for up to 6 months D) The insurer may settle this claim for less than it otherwise would have had the notification been provided in atimely manner
B) The insured is considered to be notified since the notification to agent equals notification to the insurer
Which of the following is NOT a feature of a guaranteed renewable provision A) The insured's benefits cannot be reduced B) The insurer can increase the policy premium on an individual basis C) The insured has a unilateral right to renew the policy for the life of the contract. D) Coverage is not renewable beyond the insured's age 65..
B) The insurer can increase the policy premium on an individual basis
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 A) The elimination will be extended 6 months for each year of age misstatement B) Because the misstatement occurred more than 2 years ago, it has no effect. C) Amounts payable under the policy will reflect the insured's correct age D) The contract will be deemed void because of the misstatement of age.
C) Amounts payable under the policy will reflect the insured's correct age
Marsha pays her Major Medical Insurance annually on March 1, each year. Last Marsh she forgot to mail her premium to the company. On March 19, Marsha had an accident and broke her leg. Her insurance company would A) Deny the claim B) Pay half of her claim because she had an outstanding premium C) Pay the claim D) Hold the claim as pending until the end of the grace period.
C) Pay the claim
Which of the following statements is most correct concerning the changing of an irrevocable beneficiary? A) They can never be changed B) They may be changed only on the anniversary date of the policy C) They can be changed only with the written consent of that beneficiary D) They may be changed at any time
C) They can be changed only with the written consent of that beneficiary
