loose ends

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. Coverage is guaranteed, but rates can be adjusted for the entire class.

A guaranteed renewable health insurance policy allows the a) Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term. b) Insurer to renew the policy to a specified age. c) Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. d) Policyholder to renew the policy to a stated age and guarantees the premium for the same period.

Prepaid plan.

A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called a) Indemnity plan. b) Reimbursement plan. c) Fee-for-service plan. d) Prepaid plan.

Pay dividends to the policyowner A participating insurance policy will pay dividends to the owner based upon actual mortality cost, interest earned and costs.

A participating insurance policy may do which of the following? a) Pay dividends to the policyowner b) Provide group coverage c) Pay dividends to the stock holder d) Require 80% participation

3 years

According to the time limit on certain defenses provision no statement or misstatement (except fraudulent misstatements) made in the application at the time of issue will be used to deny a claim after the policy has been in force for?

180 days. A resident individual applying for an insurance producer license must pass a written examination (unless exempt). Applications for licensure not received by the department within 180 days of the successful completion of the examination will be denied.

After passing the state exam, an individual must apply for a license within a) 30 days. b) 90 days. c) 180 days. d) 365 days.

Low maximum limits. Major medical expense contracts are characterized by high maximum limits, blanket coverage, coinsurance, and a deductible.

All of the following are characteristics of a Major Medical Expense policy EXCEPT a) Coinsurance. b) Low maximum limits. c) Deductibles d) Blanket coverage.

Mental Illness

All of the following are excluded from coverage in an individual health insurance policy EXCEPT? a Treatment received in a government hospital b Mental illness c Experimental procedures d Purely cosmetic surgery

High Premiums

All of the following are features of catastrophic plans EXCEPT a High Premiums b Out of pocket costs c High deductibles d Essential benefits

Apparent

An agent accepts the premium payment 35 days after it is due, telling the insured that their will not be a problem keeping the policy in force. This is an example of what type of agent authority?

twisting

An agent knowilgly misrepresents material information of the purpose of inducing an insured to lapse, forfeit, change or surrender a life insurance policy or annuity has committed an illegal practice known as

Benefit 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?

The company will continue to renew the policy until the insured has reached age 65. As with the noncancellable policy, coverage is generally not renewable beyond the insured's age 65.

An insurance agent proposed an individual health insurance policy that is guaranteed renewable. If the applicant accepts this policy, the insurer agrees that a) The company will change the premium rate based upon the insured's health only. b) The premium rate cannot be changed for any reason. c) The insured will always be able to pay the premiums. d) The company will continue to renew the policy until the insured has reached age 65.

Fee for service

An 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?

He won't collect anything The insured cannot collet anything because he did not satisfy the elimination period.

An insured has an individual disability income policy with a 30-day elimination period. he becomes disabled on June 1st for 15days. When will he collect on his disability income payments?

Cost-containment In a cost-containment setting, daily needs and pain relief are provided for hospice patients, but curative measures are not.

An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangement? a) Selective Coverage b) Limited Coverage c) Claims Saving d) Cost-containment

Custodial Care

Care for meeting personal needs such as assistance in eating, dressing, or bathing which can be provided by nonmedical personal such as relatives or home health care workers.

scheduled bases

Carlos'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. Carlos's policy provides benefits on a?

AD&D

Coverage that can be written as a rider or as a separate policy. It provides payment in a lump sum benefit or in the event of loss of certain body parts caused by an accident

Skilled Care

Daily nursing and rehabilitative care that can only be provided by medical personnel, under the direction of a physician.

Group Medical Group LTC Group Medicare supplement

Deductible for employer - Premiums Non-Taxable - Benefits

Group Disability income BOE

Deductible for employer - Premiums Taxable - Benefits

Respite Care

Designed to provide relief to the family caregiver, and can include a service such as someone coming to the home while the caregiver takes a nap or goes out for a while.

Any occupation - more restrictive than other definitions. If total disability is defined as any occupation, it means the coverage will apply only if the insured cannot find any means of income whatsoever. This is more strict than own occupation, where a person merely has to prove that they cannot perform the job for which they were previously trained.

Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as a) Own occupation - less restrictive than other definitions. b) Any occupation - more restrictive than other definitions. c) Any occupation - less restrictive than other definitions. d) Own occupation - more restrictive than other definitions.

20

Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? a) 3 b) 20 c) 100 d) 80

Both producers must be currently licensed for the same line of authority as the transaction. Insurers or insurance producers may not pay a commission, fee or other valuable consideration to any person unless that person was licensed at the time of transaction in the same line of insurance.

For a producer to share his commission with another producer, which of the following must be true? a) Both producers must represent the same insurer. b) Both producers must be authorized to transact surplus lines insurance. c) Both producers must sign a disclosure form regarding commissions. d) Both producers must be currently licensed for the same line of authority as the transaction.

Entire contract

Health insurance policy, signed application and attached riders and amendments.

30 days

How long is a free-look period of a Medicare supplement policy?

3 As a condition for continuation of their licenses, all licensees except for limited lines and temporary licensees, must complete at least 24 hours of continuing education credits during each 2 year licensing period. At least 3 of those hours must be in insurance law and/or ethics. Any hours in excess of the requirement cannot be carried over to the next licensing period.

How many continuing education credits of insurance law and/or ethics is a licensee required to take every 2 years? a) 3 b) 24 c) 4 d) 2

The underwriters approve the application Acceptance takes place when an insurer's underwriter approves the application and issues a policy.

If an applicant submits the initial premium with an application, which action constitutes acceptance?

With in 10 days of when the policy was delivered. A free look period begins at the time the policy is delivered

If an insured is not entirely satisfied with a policy issued, the insured may return it to the insurance company and receive a refund of the entire premium paid, at which of the following times?

Within 30 days of the initial pretrial hearing date Criminal prosecutions of the producer taken in any jurisdiction must be reported within 30 days of the initial pretrial hearing date.

If there is a criminal prosecution taken against a producer in another jurisdiction, when must the producer report that to the Director? a) Immediately b) There is no requirement for reporting actions taken in other jurisdictions. c) Within 30 days of the initial pretrial hearing date d) Within 30 days of the final disposition of the matter

tax deductible & not taxed

In a HRA the employers contributions is ______________________ in the year in which the reimbursement is made to the employee. The employee is ____________________________ not taxed on receipt of the benefit.

tax free & not deductible

In a disability buy-sell policy, whether a cross purchase or entity, the premiums are __________________ to the business, but the benefits are received income _____________ by the business.

30 days

In an insurer decides not to renew and individual disability policy, what is the minimum amount of notice that is must give the insured?

Broader in general

In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is a) More limited in duration. b) Broader in duration. c) Broader in general. d) More limited in general.

not deductible & tax free

Key person disability income premiums are _________ to the business, but the benefits are received income ______________________ Tax free by the business.

Accident Only

Limited policy that provide coverage fro death, dismemberment disability or hospital and medical care resulting form an accident.

Income assistance for work-related injury. Medicaid covers a variety of medical costs, from eyeglasses to hospitalization.

Medicaid provides all of the following benefits EXCEPT a) Eyeglasses. b) Family planning services. c) Income assistance for work-related injury. d) Home health care services. Medicaid covers a variety of medical costs, from eyeglasses to hospitalization

The loss may be intentional

Not all losses are insurable, and there are certain requirements that must be met before a risk is a proper subject for insurance. These requirements include all of the following EXCEPT a) The loss must not be catastrophic b) There must be a sufficient number of homogeneous exposure units to make losses reasonably predictable. c) The loss produced by the risk must be definite. d) The loss may be intentional.

Individual Disability income Individual medical Individual LTC Individual Medicare supplement buy sell key person FSA

Not deductible premiums Not taxable benefits

Intermediate Care

Occasional nursing or rehabilitative care provided for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care.

Completed insurance policy to the policy owner

Policy delivery refers to the delivery of the

Gets higher. LTC policies also define the benefit period for how long coverage applies, after the elimination period. The benefit period is usually 2 to 5 years, with a few policies offering lifetime coverage. Obviously the longer the benefit period, the higher the premium will be; and the shorter the elimination period, the higher the premium will be.

Regarding long-term care coverage, as the elimination period gets shorter, the premium a) Gets lower. b) Gets higher. c) Remains constant. d) Premiums are not based on elimination periods.

6 credits

The minimum number of credits required for partially insured status for Social Security disability benefits is a) 4 credits. b) 6 credits. c) 10 credits. d) 40 credits.

Hospital Indemnity

This policy provides a specific amount on a deadly, weekly or monthly basis while the insured is confined to a hospital. Payment under this type of policy is unrelated to the medical expense incurred, but based only on the number of days confined in a hospital.

Within 20 days

Under the mandatory uniform provision "Notice of claim", written notice of a claim must be submitted to the insurer with what time parameters?

The time of the application

Under the terms of the insurability conditional receipt, the insurance coverage becomes effective a of the date of the receipt, provided the application is approved. When is the policy active?

When the benefits received are equal or less than the employee's percentage of the contribution Benefits received by the employee that are attributable to his or her portion of the contribution are not taxable as income.

Under what condition are group disability income benefits received by an employee NOT taxable as income? a) When the employer makes all the premium payments. b) When the employee is 59 ½. c) When the amount of the benefit is equal or less than the amount of contributed by the employer. d) When the benefits received are equal or less than the employee's percentage of the contribution.

Not covered in individual or group medical policies

War or act of intentionally self-inflicted injuries Elective cosmetic surgery Experimental/ investigation procedures Conditions covered y workers compensation Participation in criminal activity

Skilled nursing, intermediate, and custodial

What 3 levels of care will ltc policies cover?

7 days for weekly, 10 days for monthly and 31 days for all other.

What is the grace period for premiums: *weekly premium policy *monthly policy *all other modes

Probationary period

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? a) Probationary period b) Contestable period c) Elimination period d) Grace period

3 years

What is the time limit on certain defenses

Insurance policy dividend are not guaranteed and are not taxable.

What is true of Mutual insurance co?

Whenever the agent is acting within the conditions of the contract

When is he company responsible for actions of its agents?

Only if the individual is not identified

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

Accident is immediate Sickness is only 10 days after

When reinstatement occurs how long does it take to cover and accident and how long does it take to cover sickness

Indemnity

Which insurance principle states that if a policy allows for greater compensation than the financial loss incurred, the insured may only receive benefits for the amount lost? a) Indemnity b) Stop-loss c) Limited Benefits d) Reasonable Coverage Expectations

It is divided into geographic territories. HMOs offer services to those living within specific geographic boundaries that may be formed county lines or city limits. If one lives within the boundaries they are eligible to belong to the HMO, but if they do not live within the boundaries they are ineligible.

Which is true regarding HMO coverage? a) It is divided by state. b) HMOs provide nationwide coverage. c) It is divided into geographic territories. d) It is divided based on the average tax bracket of a family

Routine and preventive maintenance Routine and preventive maintenance does not require the payment of an annual premium or coinsurance, unlike the other two types, which both require deductible payment. Insurers typically do not charge an annual premium or coinsurance in order to provide an incentive for preventative care.

Which of the following components of dental insurance does NOT require the payment of a deductible? a) Routine and preventive maintenance b) Routine and major restorative care c) Orthodontic care d) 1 & 2

Routine and major restorative care

Which of the following dental insurance categories would cover the filling of cavities? a) Orthodontic care b) This type of work is not covered. c) Routine and preventative maintenance d) Routine and major restorative care

Reciprocal When insurance is obtained through a reciprocal insurer, the insured are sharing the risk of loss with other subscribers of that reciprocal.

Which of the following insurance providers would be considered a risk sharing arrangement? A Stock B Mutual C Surplus lines D Reciprocal

The insurance contract Insurance contracts are defined as the agreements made between an insured and an insurer, where the insurer promises to indemnify the insured for covered losses, in exchange for a premium. Both parties are bound by the conditions of the contract.

Which of the following is an agreement between an insured and an insurer, where the insurer agrees to indemnify the insured for specific losses in exchange for a premium? a) Reciprocity b) The indemnity clause c) The insurance contract d) The insurance guaranty

Excessive benefits may be taxable

Which of the following statements is correct concerning taxation of long-term care insurance? a) Excessive benefits may be taxable. b) Benefits may be taxable as ordinary income. c) Premiums may be taxable as income. d) Premiums are not deductible in any case.

Defamation Defamation is making statements which are false as to the financial condition of any insurer and which are calculated to injure any person engaged in the business of insurance.

Which of the following terms describes making false statements about the financial condition of any insurer that are intended to injure any person engaged in the business of insurance? a) Defamation b) Undercutting c) Twisting d) Slandering

Express The agents contract gives the agent express authority

Which type of authority is found in the agents' contract?

Reciprocal insurance Reciprocals are insurance companies made up of subscribers, who are collectively known as a Reciprocal Insurance Company or Exchange. These types of companies are administered by an appointed Attorney in Fact.

Which type of insurance is based on mutual agreements among subscribers? a) Limited liability b) Reinsurance c) Reciprocal insurance d) Mutual insurance Reciprocals are insurance companies made up of subscribers, who are collectively known as a Reciprocal Insurance Company or Exchange. These types of companies are administered by an appointed Attorney in Fact.

Insurance Companies

Who is a member of and financially supported by the MIB?

Key employees

Who would be the insured in business disability insurance

Home health care

care provided by a skill nursing or other professional services in one's home.

Adult day care

care provided for functionally impaired adults on less than a 24-hour basis.