Missed Questions WI Health Insurance Exam
Policyholder may return any individual disability policy for a full refund within how many days 10 15 30 90
10
Policies with monthly premiums must provide for a grace period of at least 10 days 15 days 31 days 7 days
10 days
Any licensed person whose activities affect interstate commerce and who knowingly makes false material statements related to the business of insurance may be imprisoned for up to 3 years 5 years 10 years 12 years
10 years
According to OBRA, what is the minimum number of employees required to constitute a large group 15 20 50 100
100
An intermediary has place insured on himself. He can receive compensation for this transaction only if he has placed insurance on other individuals with the same insurer within the last 3 months 6 months 12 months 18 months
12 months
A noncontributory group disability income plan has a 30 day elimination period and offers benefits of 2k per monht. If an employee is unable to work 7 months due covered disability, they will receive: 12k, all is taxable 14k, none is taxable 14k, all of which is taxable 12k, none of which is taxable
12k, all is taxable
To be eligible under HIPAA, how long should an individual converting to an individual health plan have been covered under the previous group plan? 5 years 12 months 63 days 18 months
18 months
An insured has Medigap insurance and later becomes eligible for Medicaid. If the person elects for coverage under Medicaid, how many years can Medigap benefits and premiums be suspended 5 3 2 4
2
An insured has Medigap then becomes eligible for Medicaid. If they elect to receive Medicaid, hoe many years can Medigap premiums and benefits be suspended? 4 5 2 3
2
After the original hearing and final order is issued, an aggrieved person may request a re-hearing within: 40 days 15 days 20 days 30 days
20 days
If group coverage ends, coverage may be continued or converted to an individual policy if a person has been insured under that contract for at least: 9 months 12 months 3 months 6 months
3 months
What is the maximum age for qualifying for a catastrophic plan? 26 30 45 62
30
When the appointment of an individual agent is terminated, the insurer must notify the Commissioner's office with the appropriate forms within how many days after termination? 20 30 10 15
30
How long are oral contracts valid in WI? oral contracts are not valid 48 hours 3 business days 30 days
30 days
What is the maximum coverage period for most short-term care policies? 3 months 6 months 24 months 36 months
36 months
What is the period of coverage for events such as death or divorce under COBRA? 60 days 31 days 12 months 36 months
36 months
An insured is covered by a partially contributory group disability income plan that pays benefits of 4k each month. If inthe insured pays 25% of the monthly premium, how much of the monthly benefit would be taxable? none 1k 3k 4k
3k
If the consumer request additional information concerning an investigative consumer report, how long does the insurer or reporting agency have to comply? 10 days 3 days 5 days 7 days
5 days
Commissioner is required to examine every domestic insurer and every licensed rate service organization every 1 year 2 year 3 year 5 year
5 years
One of the differences between group and individual underwriting is that there is little or no medical information required regarding plan participants in groups of: 25+ fewer than 50 50 or more 100 or more
50+
The sole proprietor a business makes a salary of $50k, his medical expenses have reached 75k. What amount may the sole proprietor deduct in regards to his medical expenses? 10k 25k 50k 75k
50k
To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters? 4 credits 6 credits 10 credits 40 credits
6 credits
How long is open enrollment period for Medicare supplement policies? 1 year 30 days 90 days 6 months
6 months
Once an individual is licensed, how many hours of training must the producer initially compete to sell long-term care insurance 6 hrs 8 hrs 12 hrs 4 hrs
8 hrs
Long-term care policies must cover: pre-existing condition Alzheimer's treatment payable by Medicare alcoholism
Alzheimer's
Which of the following is correct concerning the relationship between Medicare and HMOs? all HMOs and PPOs charge premiums beyond what is paid by Medicare HMOs may pay for services not covered by Medicare HMOs do not pay for services covered by Medicare Medicare advantage is Medicare provided by an approved HMO only
HMOs may pay for services not covered by Medicare
What are the 2 types of flexible spending accounts? Medical Savings and Dependent Care Medical Saving and Health Reimbursement Health Care and Dependent Care Health Care and Health Reimbursement
Health Care and Dependent Care
When health care insurers negotiate contracts with health care providers or physicians to provide health care services for subscribes at a favorable cost, it is: indemnity plans point of service plans preferred provider organization managed care
Preferred provider organization
Long-term care policyholder requests that his policy be cancelled. Which is true? long-term care policies are unique in the assessment of cancellation is left to discretion of the insurance company a prorated premium refund will be issued policyholder will be assessed a cancellation policy policy will be cancelled, policyholder will not be charged any additional fees, no premium refunds are issued
a prorated premium refund will be issued
Which of the following is true regarding an advertisement that includes an invitation to apply for a specific policy: advertisement must be approved by the Commissioner advertisement must include the agent's license number advertisement can never include an invitation to apply for a policy advertisement must include an outline of coverage
advertisement must include an outline of coverage
According to the law of agency, a principal is represented by insurer broker insured agent
agent
Which of the following does not have to be disclosed in a long-term care policy? aggregate amount of premiums due meaning of the terms reasonable and customary any limitation or conditions of eligibility for LTC benefits any riders or endorsements
aggregate amount of premiums due
Which of the following are unlawful with regard to ADEA? refusing to hire any individual because of the individual's age classifying employees in any way which would deprive any individual of employment opportunities or otherwise adversely affect his status as an employee because of the individual's age reduce the wage rate of any employee in order to comply with the ADEA all of the above are unlawful
all of the above are unlawful
What is the benefit of experience ranking? helps employees with low claims experience to become exempt from group premiums allows employees with high claims experience to obtain insurance allows employers with low claims experience to get lower premiums helps employers with high claims experience to get group coverage
allows employers with low claims experience to get lower premiums
If an insurance company wishes to order a consumer report, and if a notice of insurance information has been provided, the report may contain all of the following except the applicant's: prior insurance ancestry credit history habits
ancestry
Which of the following would not be covered in a cost-containment setting at a hospice? antibiotics tylenol morphine special hospital bed
antibiotics
Which of the following is not a characteristic of a group long-term disability plan? benefit can be up to 50% of one's yearly income elimination period is same as short-term plan's benefit period benefit period may be to age 65 benefit can be up to 66 and 2/3% of monthly income
benefit can be up to 50% of one's yearly income
Which of the following is not true of disability buy-sell coverage? benefits are considered taxable income to the business typically written to cover partners or corporate officer of a closely held business premium payments are not deductible to the business policies provide funds for the business organization to purchase the business interest of a disable partner
benefits are considered taxable income to the business
Which of the following is not true of disability buy-sell coverage? benefits are considered taxable income to the business typically written to cover partners or corporate officers of a closely held business premium payments are not deductible to the business policies provide funds for the business organization to purchase the business interest of a disabled partner
benefits are considered taxable income to the business
The insured's employer purchased a group disability income policy for the insured and all eligible employees. The insured suffered an accident on the job that left them unable to work for 4 months. If insured receives benefits from his disability income policy, which of the following would be true? benefits from employer contributions are not taxable insured can deduct his medical expense benefits from his income tax benefits received that are attributable to employer contributions are fully taxable to the employee as income premiums the insured paid for his medial expense policy are normally deductible from his income
benefits received that are attributable to employer contributions are fully taxable to the employee as income
Someone is insured under his employer's group disability income policy. Suffers an accident and can't work for 4 months. If the disability income policy pays the benefit, which of the following would be true? for the business, payments are not tax deductible insured can deduct his medical expense benefits from his income tax benefits that are attributable to employer contributions are fully taxable to employee as income the insured has to wait 2 more months to start receiving benefits
benefits that are attributable to employer contributions are fully taxable to employee as income
Which of the following would qualify someone for disability benefits? injury only intentionally self-inflicted injury losses arising from war both accident and sickness
both accident and sickness
All of the following apply to short-term disability plans except, benefit period of 26 weeks is most common for group plans both group and individual plans are renwable group plans can provide benefit periods of up to 52 weeks individual plans can provide benefit periods of up to 2 years
both group and individual plans are renewable
When an insurer offers services life preadmission testing, second opinions regarding surgery, and preventative care services for subscribers at a favorable cost, it is: claims discrimination case management provision cost reduction claims reduction
case management provision
According to the provisions of the PPACA, all of the following are required preventive care services except: cervical cancer exams for all women at age 40 diet counseling for adults well-woman visits and counseling screenings for autism and behavioral disorder in children
cervical cancer exams for all women at age 40
An applicant writes conflicting information on his health insurance application. New policyowner suffers a medical loss related to the conflicting information. Which of the following is true? policy can be cancelled, but can purchase a new one without proof of insurability condition will be fully covered under limitations of the contract condition will be covered for a lesser amount than it would have conflicting information can be used to deny this claim
condition will be fully covered under limitations of the contract
Contracts that are prepared by one party and submitted to the other on a take-it-or-leave it basis are classified as: contracts of ahesion unilateral contracts aleatory contracts binding contracts
contracts of adhesion
Hason is insured under his employer's group health plan. He splits the cost of premiums with his employers, what is this called? half and half plan co-pay plan contributory plan noncontributory plan
contributory plan
An insurance producer just sold a policy to his sister. What kind of business is this? illegal internal personal controlled
controlled
Which of the following is NOT true of basic medical expense plans? no deductibles first-dollar coverage low dollar limits coverage for catastrophic medical expenses
coverage for catastrophic medical expenses
An insurer refuses to renew a policy written by an intermediary whose contract has been terminated. This is allowed if a. The intermediary is the subject of an investigation by the Commissioner b. The policy has been in effect for 5 years or more c. The intermediary has retired d. The notice contains an offer to renew the policy by written request
d. The notice contains an offer to renew the policy by written request
Which of the following is not considered to be a basic service, under a nonscheduled plan? endodontics oral surgery fillings dentures
dentures
Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner? disability interest buy-out corporate transfer corporate disability disability buy-sell
disability buy-sell
Which of the following does not qualify as long-term care policy? nursing home policy that provides institutional benefits home health care policy that provides community-based benefits disability policy that provides hospital coverage only long-term care policy that provides institutional and community-based benefits
disability policy that provides hospital coverage only
In disability income insurance, the time between the onset of an injury or sickness and when benefits begin is known as: qualification period enrollment period probationary period elimination period
elimination period
How often are domestic insurers examined by Commissioner biennially annually every 3 years every 5 years
every 5 years
How often are insurers offering health benefit plans required to file a grievance report with the OCI? EVERY 3 YEARS EVERY MONTH EVERY 6 MONTHS EVERY YEAR
every year
What is the difference between the Medicare approved amount for a service and the actual charge? coinsurance excess charge actual charge limiting charge
excess charge
Which of the following are authorities that an agent can hold? primary and secondary express and implied apparent and allowed authorized and admitted
express and implied
All of the following violations may result in an agentimprisonment except: knowingly obtaining info about a consumer under false pretenses engaging in business of insurance after being convicted of a breach of trust failing to report to the department a criminal prosecution taken against the agent in another jurisdiction embezzling funds from insurer
failing to report to the department a criminal prosecution taken against the agent in another jurisdiction
How many pints of blood will be paid for by Medicare Supplement core benefits first 3 none everything after first 3 1 pint
first 3 pints
Insured is involved in an accident that renders him permanently deaf. The insured is still able to perform his current job. To what extend will he receive presumptive disability benefits? full benefits for 2 years no benefits full benefits partial benefits
full benefits
Under which of the following disability income plans would the benefits be subject to income tax? partnership buy-out group individual key person
group
A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis? nondiscriminatory indemnity guaranteed noncancellable
guaranteed
An association could buy group insurance for its members if it meets all of the following requirements except holds annual meetings is contributory has at least 50 members has a constitution and bylaws
has at least 50 members
Which is incorrect concerning taxation of disability income benefits? if paid by individual, premiums are tax deductible employer paid the premiums, income benefits are taxable to the insured as ordinary income if the insured paid the premiums, any disability income benefits are tax-free if the benefits are for a permanent loss, the benefits paid to the employee are not taxable
if paid by individual, premiums are tax deductible
Issue age policy premiums increase in response to which of the following factors? increased deductible inflation age increased benefits
increased benefits
Which of the following is not a feature of a noncancelable policy? insurer may terminate the contract only at renewal for certain conditions premiums cannot be increased beyond the amount stated in the policy guarantee to renew coverage usually applies until the insured reaches certain age the insured has the right to renew the policy for the life of the contract
insurer may terminate the contract only at renewal for certain conditions
An applicant is considered to be high-risk, but not so much so that the insurer wants to deny coverage. Which of the following is not true? insurer can increase premium insured can add exclusions to the policy insurer can rate-up the policy insurer will issue a conditional coverage
insurer will issue a conditional coverage
Which is true regarding state regulations for record maintenance? insurer's records must be maintained as hard copies of original records any records except for checks may be maintained electronically insurer's records must be kept electronically and in paper form insurer's records may be maintained electronically
insurer's records may be maintained electronically
Which of the following is true regarding a risk retention group? provides support for underwriters and is not an insurance company benefit society formed to provide insurance for members of an affiliated lodge company owned by stockholders that provides nonparticipating policies liability insurance company owned by its members
liability insurance company owned by its members
All of the following are types of indemnity plans except: nonscheduled basic limited comprehensive
limited
An agent is selling a variable life insurance policy and as an inducement shows the client a projection based upon shared or dividends on a similar policy. This is: misrepresentation twisting defamation unacceptable business practice
misrepresentation
In a car accident, he permanently loses the use of his leg an dis rendered completely blind. Blindness improves a month later. To what extend will the insured receive Presumptive Disabiility benfits? no benefits full benefits partial benefits full benefits until blindness lifts
no benefits
If a Medicare supplement policyholder cancels the policy at Midterm, which of the following is true regarding premium? fraction of the premiums must be remitted to insurer premiums must be paid for remainder of policy no further premiums are paid and no refunds are issed no further premiums are paid and prorated premium refund must be offered
no further premiums are paid and prorated premium refund must be offered
The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called: workers compensation nonoccupational coverage unemployment coverage occupational coverage
nonoccupational coverage
An insure ddoes not have to pay coinsurance or deductible on a full-series mouth x-ray but does have to pay deductible to get his cavities filled. Which dental plan does he have? nonscheduled limited procedure-based scheduled
nonscheduled
When does Medicare cover nursing home care? Medicare covers all nursing home care for eligible policyholders only if it is part of treatment for a covered illness or injury only if the deductible has been met only for those age 80 and older
only if it is part of treatment for a covered illness or injury
Which of the following would be a good candidate for short-term medical insurance: individual 65+ low-income individuals and families individuals who otherwise cannot qualify for medical insurance overall healthy person who doesn't need coverage for pre-existing conditions
overall healthy person who doesn't need coverage for pre-existing conditions
A license applicant trustworthiness and competence will be determined by all of these except: misrepresentation in application process criminal record regulatory actions personal testimonies from previous co-workers and managers
personal testimonies from previous co-workers and managers
According to the PPACA metal leve classification, if a health plan is expected to cover 90% of cost for an average population, what type of plan is this? good platinum bronze silver
platinum
If an insurance premium is paid to the agent but agent fails to remit the premium, what will happen? policy won't lapse because a payment to the agent is the same as to the insurer premium will be taken out of the Guaranty Association funds agent's license will be automatically revoked policy will lapse since the premium was not received by the insurer
policy won't lapse because a payment to the agent is the same as to the insurer
What provision may allow a small employer health benefit plan to exclude coverage for a pregnancy existing on the effective date of coverage? open enrollment pre-existing condition specified disease coverage adverse selection
pre-existing condition
If a policy is rated-up, which of the following is true? number of benefits increases premium increases premium decreases exclusions decreases
premium increases
Which of the following describes taxation of individual disability income insurance premiums and benefits? premiums not tax deductible, benefits taxable premiums tax deductible, benefits not taxable premiums tax deductible, benefits taxable premiums not tax deductible, benefits not taxable
premiums not tax deductible, benefits not taxable
Certain conditons such as dismemberment or total and permanent blindness will automatically qualify the insured for full disability benefits. Which of the disability policy provision does this describe? dismemberment disability partial disability residual disability presumptive disability
presumptive disability
At what point during the policy applcation process must replacement forms be completed? time of submitting application any time before policy delivery time of policy delivery prior to submitting application
prior to submitting application
Revealing a specific charge level for a procedure or a specific provider name are examples of information that might be construed as: procedural proprietary nonproprietary methodological
proprietary
What method do insurers use to protect themselves from catastrophic losses? indemnity pro rata liability risk management reinsurance
reinsurance
An application for a life policy was rejected because of information disclosed in an inspection report. The consumer reporting agency had incorrect information. What can he require the agency to do? reinvestigate cease and desist delete the incorrect information provide him with a written apology
reinvestigate
What provision can reduce the disability benefit based upon the insured's current income? pro rata provision rehabilitation benefits relation of earnings to insurance waiver of monthly premium
relation of earnings to insurance
What provision can reduce the disability benefit based upon the insured's current income? rehabilitation benefit relation of earnings to insurance waiver of monthly premium pro rate provision
relation of earnings to insurance
All of the following are true about policy replacement except: replacement rules only apply to sales of policies to persons age 65+ intermediary must give the applicant proper notice and leave a copy of this notice with the applicant signed copy must be kept with insurer application must include a question as to whether the insurance to be issued is replacing any insurance currently in force
replacement rules only apply to sales of policies to persons age 65+
Which of the following components of dental insurance does not require the payment of a deductible? cosmetic dentistry routine and preventive maintenance routine and major restorative care orthodontic care
routine and preventive maintenance
Your client wants to know what the tax implications are for contributions to a Health Savings Account. You should advise her that the contributions are: post-tax dollars subject to capital gains taxes tax deductible subject to personal income taxes
tax deductible
If an insurance premium is paid by the policyowner, and the agent fails to remit premium to insurer, which of the following statements is true? premium will be taken out of Guaranty Association funds agent's license will be automatically revoked the policy will lapse since premium was never received the policy will no lapse since payment to agent is the same as payment to insurer
the policy will no lapse since payment to agent is the same as payment to insurer
When employees are actively at work on the date of coverage can be transferred to another insurance carrier, what happens to co insurance and deductibles? coinsurance carries over but deductibles are higher deductibles carry over but coinsurance is higher they carry over from the old plan to the new plan they have to be reevaluated
they carry over from the old plan to the new plan
IN addition to any other forfeiture imposed, any person who violates an effective order may be required to: triple the amount of profit gained half the amount of profit gained the full amount of profit gained twice the amount of profit gained
twice the amount of profit
Under what condition are group disability income benefits received by an employer not taxable as income? when the employer makes all premium payments when the employee is 59 1/2 when the amount of the benefit is equal or less than the amount of contribution by the employer when the benefits received are equal or less than the employee's percentage of contributions
when the benefits received are equal or less than the employee's percentage of contributions
Which of the following determines whether disability insurance benefits are taxed? if total of benefits paid meets the minimum state taxation standard whether the premiums were tax deductible state statuses contract provisions
whether the premiums were tax deductible
