Questions I got Wrong
Under which type of alternative group health plan funding arrangement would the employer pay premiums 90 days past the policy's grace period?
The benefits will be coordinated
Which of the following is correct regarding the taxation of group medical expense premiums and benefits?
Premiums are tax deductible and benefits are not taxed
Which of the following are the main factors taken into account when calculating residual disability benefits?
Present earnings and earnings prior to disability
The risk of loss may be classified as
Pure risk and speculative risk
A husband and wife are insured under group health insurance plans at their own places of employment, and as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?
The benefits will be coordinated
In which of the following situations would Social Security Disability benefits NOT cease?
The individual's son gets a part-time job to help support the family
When a creditor informs a debtor that he or she may be covered by a plan after a loan is closed, this is called a
Notice of Proposed insurance
Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?
Payment of Claims
A guaranteed renewable health insurance policy allows the
Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.
An insured loses her left arm in an accident that is covered by her Accidental Death and Dismemberment policy. What kind of benefit will she most likely receive from this policy?
The capital amount in a lump sum
In a group policy, who is issued a certificate of insurance?
The individual insured
An insured submitted a notice of claim to the insurer, but never received 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?
The insured was in compliance with the policy requirements regarding claims.
A person who investigates or settles claims on solely on behalf of the insured would be licensed as
an adjuster
Continuing education requirements are
24 hours
In Kentucky, the state's continuing education requirement
24 hours of CE each biennium
A credit life insurance policy may include a provision excluding or denying a claim for death in the event of suicide within what time limit?
6 months(12 months for contract of more than 3 years) after purchase of the policy)
A person requesting a hearing should file the request within how many days of the act giving rise to the grievance?
60 days
If an insurance company offers Medicare supplement policies, it must offer which of the following plans?
A
A hospital indemnity policy will pay
A benefit for each day the insured is in a hospital.
contributory
A group insurance plan that requires the employees to pay part of the premium.
All of the following statements concerning workers compensation are correct EXCEPT
A worker receives benefits only if the work related injury was not his/her fault.
Which of the following is a comprehensive list of all Medicare supplement policies available?
A-J
An insured 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?
Adjust the claim benefit to reflect the insured's true age
How can a new physician be added to the PPO's approved list?
Agree to follow the PPO standards and charge the appropriate fees.
While a claim is pending, an insurance company may require
An independent examination as often as reasonably required
Which of the following is not true of Disability Buy-Sell coverage?
Benefits are considered taxable income to the business.
Which of the following is NOT true regarding Basic Surgical Expense coverage?
Coverage is unlimited
What option allows the insured to periodically increase benefit levels without providing evidence of insurability
Guarantee of insurability
The Medical Information Bureau (MIB) was created to protect
Insurance companies from adverse selection by high risk persons.
Who makes up the Medical Information Bureau?
Insurers (this is so the insurers can compare the info that have collected on the individual)
A guaranteed renewable disability insurance policy
Is renewable at the insureds option to a specified age
What is NOT a benefit of a POS plan?
It allows guaranteed acceptance of all applicants.
Which of the following is true regarding a term health policy?
It is nonrenewable
Which of the following statements is TRUE concerning the Accidental Death Rider?
It will pay double or triple the face amount
In franchise insurance, premiums are usually
Lower than individual policies, but higher than group policies.
An insurance license issued by the Kentucky Department of Insurance shall include all of the following, EXCEPT:
Name and Address of the appointing insurer
When a loan is closed, the creditor must inform the debtor that he or she may be covered by a plan if desired. This is called a
Notice of Proposed insurance
A 55-year-old employee has worked part-time for his new employer for 3 months now, but has not been offered health insurance. What factor has limited the employee's eligibility?
Number of hours worked per week
According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10%, what type of plan is that?
Platinum
Which statement accurately describes group disability income insurance?
The extent of benefits offered is determined by the insured's income.
Which of the following is a health care program funded by the federal government for the retirees and spouses of the military services?
Tricare
Insurers set aside certain funds when a policy is issued. Which fund category would be used if the insured cancels the policy?
Unearned Premium Reserves
Under what condition are group disability income benefits received by an employee NOT taxable as income?
When the benefits received are equal or less than the employee's percentage of the contribution
Which describes the features of a comprehensive major medical policy?
basic medical expenses are provided in a single package
In long-term care (LTC) policies, as the benefit period lengthens, the premium
increases
Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to
insured
a business owner becomes totally disabled, a Business Overhead Expense policy will pay all of the following EXCEPT
loss of owners income
Which renewability provision are you most likely to see on a travel accident policy?
period of time
specified disease policies
provide medical benefits for a specific disease such as cancer
What is the typical deductible for basic surgical expense insurance?`
$0
An insured has an Accidental Death & Dismemberment policy with a principal value of $50,000. He loses sight in both eyes in a hunting accident. How much will he receive?
$50,000
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
$102
Which of the following best describes the concept that the insured pays a small amount of premium for a large amount of risk on the part of the insurance company?
Aleatory
A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability?
Business Overhead Expense Policy
Under what type of group health plan does the insurer issue the plan on a one-year, renewable term basis, and the premium for each year only pays for that year's coverage?
Conventional fully-insured
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This would indicate that his policy was probably written with a 30-day
Elimination period
What option allows the insured to periodically increase benefit levels without providing evidence of insurability?
Guarantee of insurability
. All of the following statements describe a MEWA EXCEPT
MEWAs are groups of at least 3 employers.
All of the following statements concerning Medicaid are correct EXCEPT
Medicaid is a state funded program that provides health care to persons over age 65, only.
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own?
Medicare Select
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?
Metal level classification
What method do insurers use to protect themselves against catastrophic losses?
Reinsurance
Bob is admitted into a nursing home, leaving his wife Sarah to pay the bills. The _________ will allow her to keep a portion of the couple's income and assets equal to a percentage of the federal poverty line.
Spousal Impoverishment rule
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
When both parties to a contract must perform certain duties and follow rules of conduct to make the contract enforceable, the contract is
conditional
Which of the following entities has the authority to make changes to an insurance policy?
insurer's executive officer
Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is
monthly
Which of the following is a comprehensive list of all Medicare supplement policies available
monthly
How many continuing education hours can agents carry over from one licensing period to the next?
up to 12
Employers ______ take a tax deduction for their Social Security taxes. Employees ______ take a tax deduction for their Social Security taxes.
Can:cannot
Coverage ensuring that outstanding indebtedness of an insured will be paid if the debtor dies or becomes disabled is called
Credit insurance
Which of the following is NOT true of a major-medical health insurance policy?
It is designed to pay on a first dollar of expense basis.
Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?
Principle Sum
Upon policy delivery, the producer may be required to obtain any of the following EXCEPT
Signed waiver of premium.
The applicant for insurance agrees to be subject to the policy provisions, if the policy is issued, by
Signing the application.
An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?
The pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off.
Can an individual who belongs to a POS plan use an out-of-network physician?
Yes, and they may use any preferred physician, even if not part of the HMO
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 statement that is sufficiently clear to identify the insured and the nature of the claim
Part B of Medicare is funded primarily by
Premiums from beneficiaries.
Where are the execution agreements found in a health insurance application?
Immediately preceding the applicant's signature
When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply?
Case management provision
Concerning group Medical and Dental insurance, which of the following statements is INCORRECT
Employee benefits are tax deductible the year in which they were received.
Which of the following is INCORRECT concerning taxation of disability income benefits?
If paid by the individual, the premiums are tax deductible.
Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?
Residual disability
An insured wants to transfer his personal insurance policy to a friend. Under what conditions would this be possible?
The insured will need a written consent of the insurer.
Which of the following is true regarding METs?
They allow small employers an opportunity to band together to purchase less expensive insurance.
In disability income insurance, the time between the onset of an injury or sickness and when benefits begin is known as the
elimination period
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
they cover the cost of extended nursing home care
Substandard Risk
An applicant or insured who has a higher than normal probability of loss, and who may be subject to an increased premium.
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the
Insuring clause