Test Review Health and Accident

Which of the following must be given to consumers under the provisions of the Fair Credit Reporting Act (FCRA)? A Disclosure at the Point of Sale B Notice of Information Practices C Outline of Coverage D Application Receipts

Notice of Information Practices

Medical Expense Insurance is usually written with a policy period of __________. A 1 month B 2, 3, or 5 years C 1 year D The insured's lifetime

1 year

Insurance producers are required to complete how many hours of approved continuing education during each 2-year license period? A 24 B 40 C 15 D 20

15

Producer licenses expire every: A 2 years on one's birthday in odd or even years, depending on one's year of birth B 2 years on June 30th in odd years for life and health; even years for property and casualty C 2 years on the date one is originally licensed D Year on one's birthday

2 years on one's birthday in odd or even years, depending on one's year of birth

The maximum first year commission for the sale of a Medicare Supplement policy is: A The amount regardless of whether the sale is replacement or not B 200% of the commission paid for policy renewals C 50% of the first year premium D The commission paid for policy renewals

200% of the commission paid for policy renewals

If a plan offers coverage to dependents, eligible dependents include all children, natural and adopted, married and unmarried, up to age ______. A 18 B 21 C 26 D 19

26

In New York, under individual and group Medical Expense Insurance, any child is considered a dependent until attaining the age of: A 14 B 19 C 23 D 26

26

Consumer-driven health care allows individuals to use a _____-tiered approach to funding the costs of medical services and treatment. A 4 B 2 C 5 D 3

3

The Medicare Supplement Right of Return Provision (Free Look Period) allows the buyer a period of ________ to return a policy and receive a full refund. A 30 B 15 days C 10 days D 60 days

30

A Medicare Supplement or LTC policy's free look period is: A 15 days B 60 days C 30 days D 45 days

30 days

Applicants seeking a life, accident, and health insurance license are required to complete how many hours of prelicensing education? A 20 B 40 C 15 D 90

40

If notice under an employer group health insurance conversion privilege is provided more than 15 days, but less than 90 days after termination, the conversion privilege must be extended to ______days. A 45 B 180 C 90 D 60

45

A Small Employer is defined as any person, firm, corporation, partnership, or association that is actively engaged in business and has ______ employees or less. A 2 B 20 C 50 D 100

50

Which of the following is a typical benefit period for a group short-term disability benefit? A 5 years B 2 years C To age 65 D 52 weeks

52 weeks

Under the New York required benefits for those entities providing hospital, surgical or medical expense coverage, hospice care is for persons certified as having a life expectancy of ______ months or less. A 12 B 18 C 24 D 6

6

A carrier replacing employer group coverage is not required to cover all employees and dependents covered by, or eligible for, coverage under the previous policy if the replacement takes place more than _____ days after of the previous policy's termination. A 60 B 90 C 30 D 10

60

The Bronze plan covers _______ of medical expenses. A 50% B 70% C 60% D 80%

60%

Originally, Medicare was for U.S. citizens age _______ and over. A 60 B 55 C 65 D 62

65

What percentage of employee participation is required for a contributory employer group plan? A 100% B 50% C 25% D 75%

75%

Which of the following statements is correct with regard to consumer privacy? A A covered entity may be required to give each customer a notice of the right to opt out of disclosure B Once a covered entity has provided an initial privacy notice to an individual, it is not required to provide any further notice to such individual C A covered entity may disclose nonpublic personal financial information for marketing purposes D A covered entity is not required to provide a notice before disclosing a new category of information to any nonaffiliated third party

A covered entity may be required to give each customer a notice of the right to opt out of disclosure

Commissions and compensation can be paid to which of the following individuals? A A licensed insurance producer B An employee inspecting, rating, or classifying risks who is not selling or negotiating insurance C Center of Influence that refers several clients to your agency but has no interest in selling insurance D Any unlicensed employee whose activities are not directly related to sales

A licensed insurance producer

An individual proprietor who is the only employee of a business, or an employer with at least 2 but no more than 50 eligible employees defines which of the following groups? A A small employer B An eligible employee C An association D A large employer

A small employer

Which of the following is NOT among the powers and duties of the Superintendent? A Act to protect the best interests of authorized insurers B Examine licensees C Implement insurance laws D Receive consumer complaints

Act to protect the best interests of authorized insurers

Experience rating utilizes _______ in determining the rate the insurer will charge for group coverage in each year of coverage. A Actual loss experience of everyone in that zip code B Credit rating of all participants C The plan sponsor's credit rating D Actual loss experience of the group

Actual loss experience of the group

Overseas foreign travel emergency coverage is a Medicare supplement: A Core benefit B Rider C Additional benefit D Exclusion

Additional benefit

Which of the following licensees helps with the investigation and settlement of insurance claims? A Adjuster B Consultant C Agent D Broker

Adjuster

How will a claim be settled if the insured pays their premium late, but during the grace period? A The policy will be rescinded for non-payment B The claim will be reduced by 50% of the settlement amount, plus late fee's C Any unpaid premium may be deducted from the claim D The claim will be denied for non-payment

Any unpaid premium may be deducted from the claim

To act as an agent for an insurer, the producer must be ________ by the insurer: A Appointed B Certified C Licensed D Endorsed

Appointed

Dental plans are normally written with a stated annual maximum on the number of: A Teeth that will treated B Benefit dollars that will be paid C Appointments that will be covered D Cavities that will be filled

Benefit dollars that will be paid

When disabled, which of the following would ensure payment for the wages of a business owner's employees? A Business overhead B Disability buyout C Business expenditures D Presumptive disability

Business overhead

Policy replacement is the process of: A Adding additional coverage B Changing riders and exclusions C Lowering a policy premium D Cancelling an existing policy and issuing a new policy

Cancelling an existing policy and issuing a new policy

All of the following are considered specialty physicians, except: A Neurologist B Urologist C Hospital administrator D Oncologist

Hospital administrator

Jasper owns a policy that combines the best features of Basic Medical Expense Plans and Major Medical Insurance into a single policy to give him the most complete hospital coverage. Jasper owns a: A Blanket Major Medical Policy B Comprehensive Major Medical Policy C Combination Major Medical Policy D Supplementary Major Medical Policy

Comprehensive Major Medical Policy

Which of the following is a Managed Care Provision used by insurers to monitor hospital stays? A Concurrent Review B Prospective Review C Retrospective Review D Precertification

Concurrent Review

If premium is paid at the time of application, the agent will provide the applicant with a: A Claim form B Free look notice C Statement of good health D Conditional receipt

Conditional receipt

The term, 'negotiate', means: A Obtaining information for future marketing purposes B Conferring, only directly, with or offering advice to a purchaser or prospective purchaser of a particular contract of insurance C Conferring directly, or indirectly, with or offering advice directly, or indirectly, to a purchaser or prospective purchaser of a particular contract of insurance D Servicing an existin

Conferring, only directly, with or offering advice to a purchaser or prospective purchaser of a particular contract of insurance

A person who wants to work in the insurance industry but has a prior felony conviction must apply for ________ A Expungement B Amnesty C Clemency D Consent to work

Consent to work

Upon receipt of an application, the insurer's underwriter may issue the contract with exclusions or limitations. This means that: A Coverage is issued, but at a higher rate than quoted B Coverage is issued at the rate that was quoted C Coverage is not issued D Coverage is issued, but there are limits on the insurer's obligation to pay

Coverage is issued, but there are limits on the insurer's obligation to pay

The Medical Information Bureau provides information to the insurer regarding the individual risk of an applicant and does not include: A Hazardous hobbies B Pre-existing conditions C Credit score D General medical information

Credit score

An initial amount the insured must meet per year before benefits are paid is known as the: A Stop loss B Copayment C Deductible D Coinsurance

Deductible

In New York, a health service corporation or medical expense indemnity corporation offering medical, major medical, or similar comprehensive insurance must provide coverage for preventive and primary care services without any: A Premium B Applications C Proof of residency D Deductibles and coinsurance

Deductibles and coinsurance

Edward applies for a disability insurance policy. He pays the initial premium at the time of application and receives a conditional receipt. Three days after the insurance company conducts a medical examination, but before it issues a policy, Edward suffers a stroke. Upon reviewing the results of his medical exam, the company discovers that Edward has been diagnosed with high blood pressure and atherosclerosis. Under the terms of the conditional receipt, the insurance company: A Delays the effective date of the policy B Pays the claim because a receipt has been provided C Denies the claim because the insurer would not have issued the policy as applied for as standard or better D Pays a reduced benefit since the results of the medical exam show a pre-existing condition

Denies the claim because the insurer would not have issued the policy as applied for as standard or better

An insured may find it more difficult to qualify for benefits, but will enjoy a lower premium, when a more restrictive definition of _________ is found in a Disability Income policy. A Benefit B Presumptive C Rehabilitation D Disability

Disability

When an insurer relies on the prior claims history of the group to be insured in determining the rate to be charged, it is called: A Community rating B Cost rating C Experience rating D Claims rating

Experience rating

Which of the following might be covered by an FSA, but not an HRA? A Surgery B Eyeglasses C Coinsurance D Deductibles

Eyeglasses

A ____________ agreement is a reinsurance agreement that allows the reinsurance company an opportunity to reject coverage for individual risks, or price them higher due to their substandard (higher risk) nature. A Sharing B Treaty C Retention D Facultative

Facultative: A facultative agreement is a reinsurance agreement that allows the reinsurance company an opportunity to reject coverage for individual risks, or price them higher due to their substandard (higher risk) nature.

The issuance or circulation of any illustration or statement indicating that a corporation is permitted to transact any business not authorized by its certificate of authority constitutes which of the following? A Misrepresentation B False Advertising C Unfair Discrimination D Material Misrepresentation

False Advertising

No insurer or agent may unnecessarily replace a policyholder's Long-Term Care insurance policy or replace it with a policy that offers: A Fewer benefits and a lower premium B More benefits and a greater premium C Fewer benefits and a greater premium D More benefits and a lower premium

Fewer benefits and a greater premium

For which of the following may any funds remaining at year-end not be rolled over to the next year? A Individual Retirement Account B Medical Savings Account C Health Savings Account D Flexible Spending Account

Flexible Spending Account

Deliberate deception with intent to gain is the definition of: A Fraud B Misrepresentation C Concealment D Waiver and Estoppel

Fraud

If an insured has the right to continue coverage by paying premiums, a policy is considered: A Conditionally renewable B Guaranteed renewable C Cancellable D Noncancellable

Guaranteed renewable

Which of the following health plans will only cover losses by an approved provider: A POS B Blue Cross/Blue Shield C HMO D PPO

HMO: An HMO is designed to provide benefits for losses of an approved provider.

Which of the following is true of Medicare Part A, in terms of coverage? A None of the answers listed B Helps pay for hospital care and skilled nursing facility care as an inpatient plus home or hospice care C Helps pay for routine physical exams D Helps pay for outpatient services

Helps pay for hospital care and skilled nursing facility care as an inpatient plus home or hospice care

Sharon, age 64 is getting ready to file her taxes. Which of the following statements regarding the deductibility of her various, personally-owned health insurance policies is true? A If her disability income premiums and long-term care insurance costs total at least 10% of her income, the excess amount is tax deductible B If her medical expense premiums and out-of-pocket expenses total at least 7.5% of her income, the excess amount is tax deductible C If her deductible long-term care insurance premiums, her medical expense premiums, and her after-tax, out-of-pocket expenses total at least 10% of her income, the excess amount is tax deductible D If her medical expense premiums and out-of-pocket expenses total at least 10% of her income, they are all tax deductible

If her deductible long-term care insurance premiums, her medical expense premiums, and her after-tax, out-of-pocket expenses total at least 10% of her income, the excess amount is tax deductible

Which rider would eliminate coverage for a preexisting condition? A Return of Premium Rider B Guaranteed Purchase Option C Impairment Rider D Lifetime Benefit Rider

Impairment Rider

Which of the following is not a type of hazard for insurance underwriting purposes? A Moral B Physical C Morale D Incidental

Incidental

A(n)____________ is the person or entity that is covered by an insurance policy. A Agency B Insured C Owner D Producer

Insured

Which of the following statements is false with respect to examinations by the Superintendent? A Insurers must maintain records for 5 calendar years, or until after the filing of an examination report or the conclusion of an investigation B Records must be maintained according to a retention plan approved by the Superintendent C The Superintendent may examine the books and records, including policy, claim, complaint, financial, and producer licensing records, of any insurer or licensee doing business in this state D Failure to provide records in a reasonable time can constitute a violation of law

Insurers must maintain records for 5 calendar years, or until after the filing of an examination report or the conclusion of an investigation

Which provision in a health insurance policy allows a claim to be denied due to the insured being intoxicated or under the influence of narcotics? A Intoxicants and Narcotics B Conformity with State Statutes C Legal Actions D Illegal Act

Intoxicants and Narcotics

The optional guaranteed purchase option rider allows the insured to purchase additional coverage in all of the following situations, except: A Birth of a child B Reaching a specified age or date C Job change D Marriage

Job change

Which is not considered one of the basic benefits required of all HMOs? A Laboratory and x-ray services B Long-term care C Annual open enrollment for group plans D Pre-paid routine medical exams

Long-term care

Joan was told she could only expect about 70% of her weekly salary on a disability check if she was ever disabled. The reason for this is to reduce _________. A Manipulation B Malingering C Malfunctions D Misalignment

Malingering

A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as: A Supplemental Security Income B Medicaid C Medicare Part A D State Supplemental Payment Program

Medicaid

A policy that covers inpatient doctor visits and may be expanded to include payment for office visits, diagnostic x-rays, laboratory charges, ambulance and nurse's expenses when not hospitalized, and maternity benefits for an additional premium is considered which of the following? A Supplementary Major Medical Policy B Basic Physician's Expense Policy C Medical Expense Policy D Major Medical Policy

Medical Expense Policy

Which statement regarding Medicare is not true? A Medicare is the primary payor to any employer group health plan coverage B It is a federal health program for people 65 and older and others of any age who have received Social Security Disability Benefits for at least 2 years C Hospitals and other providers of health care that want to participate in the Medicare program must be licensed by the state D The initial enrollment period lasts 7 months and begins on the 1st day of the 3rd month before one is eligible for Medicare

Medicare is the primary payor to any employer group health plan coverage

All of the following are factors used in the calculation of health insurance premiums, except: A Mortality Table B Morbidity Table C Interest earnings D Expense to administer the policy

Mortality Table

Small group major medical insurance policies in the state of New York: A May be written on a one-person firm, since they are defined as a small group B Must limit participation to employees that work at least 40 hours per week C Must be community-rated D Are often cancelled because of poor claims experience

Must be community-rated

An insurer may refuse to renew a converted group medical or individual policy for which of the following reason(s)? A Continuance of a high risk policy class B Late payments received during the grace period C Non-payment of premium D Insured's refusal to purchase additional riders that have been recommended by the producer

Non-payment of premium

Dominic is a physician associated with a closed panel HMO. This means that Dominic can work with: A Only his own private patients B Only that HMO's subscribers C Both that HMO's subscribers and his own private patients D Subscribers of any HMO operating in the area

Only that HMO's subscribers

Which of the following is not provided under Part A of Medicare? A Home Health Care B Outpatient Medical Treatment C Hospice Care D Post-hospital Skilled Nursing Facility Care

Outpatient Medical Treatment

All of the following are coverages provided under a Basic Hospital Expense Policy, except: A Board B Miscellaneous hospital expenses C Physician/Surgeon expenses D Semi-private room

Physician/Surgeon expenses

Which of the following Medicare Supplement policies have Core Benefits? A Plans A through N B Plans C through J only C Plan A through C only D Plan A only

Plans A through N

Which of the following is correct pertaining to underwriting a group health policy? A All participants are always eligible immediately B The average age of the group is not taken into consideration C Group insurance cannot be based upon community experience D Premiums are generally re-evaluated annually and may be based upon prior claims

Premiums are generally re-evaluated annually and may be based upon prior claims

If an insured dies under the AD&D policy, which of the following will provide benefit payouts to the beneficiary: A Capital funds B Capital sum C Principal investments D Principal sum

Principal sum

Which of the following is NOT an unfair claims practice? A Requiring an insured to sue by offering less than the amount due B Misrepresenting pertinent policy facts or provisions to claimants C Promptly acknowledging communications pertinent to a claim D Failing to attempt, in good faith, to promptly, fairly, and equitably settle a claim in which the insurer's liability has become reasonably clear

Promptly acknowledging communications pertinent to a claim

The purpose of the Social Insurance Supplement rider is to: A Waives the elimination period if insured is hospitalized during the period of elimination, but only pays when being treated as an inpatient B Pay the medical expenses that are related to an injury that does not result in total disability C Provide a refund of 80% of premiums paid in to that point, less any dollar amounts paid out in claims D Provide benefits in case an insured is declined Social Security disability benefits

Provide benefits in case an insured is declined Social Security disability benefits

Case managers do all of the following, except: A Requiring a referral or second opinion prior to approving a procedure B Determining the appropriate course of action for the insured C Managing the utilization review of a hospital stay D Providing the necessary care

Providing the necessary care

Penelope received benefits from her disability policy and went back to work. After 30 days she found she was not able to work and began to immediately receive her disability payments. Which of following provisions made this possible? A Second Injury Provision B Residual Disability Provision C Presumptive Disability Provision D Recurrent Disability Provision

Recurrent Disability Provision:

When, Peter, an independent contractor, purchased his own personal medical and dental insurance, he discovered that: A Self-employed persons may deduct up to 100% of the cost of their medical insurance for themselves and their dependents, but not dental insurance B Self-employed persons may deduct up to 100% of the cost of health insurance for themselves and their dependents C Self-employed persons may deduct up to 100% of the cost of health insurance for themselves and their dependents over the 10% of AGI threshold D Self-employed persons may deduct up to 100% of the cost of health insurance, including long-term care insurance, for themselves and their dependents

Self-employed persons may deduct up to 100% of the cost of health insurance for themselves and their dependents

Blue Cross and Blue Shield have traditionally offered benefits under the form of: A Reimbursement contracts B Indemnity contracts C Service contracts D Compensation contracts

Service contracts

If two individuals are licensed in the same line with two different companies join together to sell a policy, the commission can be: A Shared between the two agents and the insured B Withheld by the insuring company since this is an illegal practice C Paid only to the agent who initiated the sale D Shared between the two agents

Shared between the two agents

Which of the following insurance policies may be written in conjunction with a Basic Medical Expense Coverage and utilizes a Corridor Deductible after the basic plan benefits have been exhausted? A Comprehensive Major Medical B Surgical Expense C Supplementary Major Medical D Hospital Expe

Supplementary Major Medical

The agency which carries out and enforces the provisions of the Insurance Frauds Prevention Act is: A The Insurance Task Force B The Insurance Department C The Insurance Frauds Bureau D The Insurance Guaranty Association

The Insurance Frauds Bureau

If a change or correction must be made on the application for insurance, which of the following applies? A The change must be made in red ink B The producer can make and initial the change at any time prior to submitting the application C A change cannot be made once the application is signed D The Producer can make the change and have the insured initial the change

The Producer can make the change and have the insured initial the change

Who among the following is required to display his/her license? A All licensees who are employed in that place of business B Only a broker if he/she is the supervising person responsible for that place of business C Only an agent if he/she is the supervising person responsible for that place of business D The broker or agent who is the supervising person responsible for that place of business

The broker or agent who is the supervising person responsible for that place of business

Which of the following statements regarding health insurance advertising is not correct? A Statistical information may be used as long as it is accurate and the source is named B Insurers are responsible for the accuracy of their personal testimonials C An agent must include the insurer's full name of when specifically advertising their product or product type D The history of very high or unique claim settlements if often used in agent advertising

The history of very high or unique claim settlements if often used in agent advertising

When an insured is discharged from the military, what happens to health insurance coverage that was in place prior to being called up for active military service? A The insured will have to apply for new coverage, but can obtain a military discount B The insured will have to go through the normal waiting period as if it were a reinstatement C The insured will be permitted to resume coverage and premiums without any waiting periods D The insured will be subject to service-related pre-existing condition exclusions

The insured will be permitted to resume coverage and premiums without any waiting periods

If a child is covered under more than one group health insurance plan how is it determined which carrier is primary? A The parent whose date of birth is closest to the end of the year determines which is primary B The younger parent's plan will become primary C The plan covering the parent whose birthday occurs first in the calendar year will be the children's primary coverage D The date of birth of the child that is closest to either parent becomes primary

The plan covering the parent whose birthday occurs first in the calendar year will be the children's primary coverage

Regarding group health insurance, which is true? A The premium payment is the responsibility of each individual B Individual underwriting is utilized C The plan sponsor is issued the Master Policy D Each plan participant receives a policy

The plan sponsor is issued the Master Policy

All of the following are false statements regarding group disability plans, except: A The plans usually cover work-related disabilities B Benefits are not available to individuals employed beyond age 65 C There is individual medical underwriting D The plans are typically written on a non-occupational basis

The plans are typically written on a non-occupational basis

All of the following are correct regarding regulatory jurisdiction over group insurance, except: A Unless the state of delivery has a significant relationship to the insurance transaction, other states may seek to exercise their regulatory authority B The contract must conform to the laws of the state where the Master Policy is delivered even though certificates of insurance may be delivered in other states C The policy only needs to provide benefits as required by the state in which the insurer is incorporated D The state in which the group contract is delivered generally has governing jurisdiction

The policy only needs to provide benefits as required by the state in which the insurer is incorporated

Which of the following best describes the consideration on the part of an insurer? A The promise to pay in the event of a covered claim B The acceptance of the contract C The purpose of the contract must be legal D The offer of the contract

The promise to pay in the event of a covered claim

Which of the following statements about small group major medical policies issued in New York IS true? A They may be cancelled because of poor claims experience B They can only be written for a single person, or a single employee C They must be community rated D They apply to groups with up to 200 employees

They must be community rated

Which provision states that the insurance company must pay claims immediately? A Relation of Earnings to Insurance B Payment of Claims C Time of Payment of Claims D Legal Actions

Time of Payment of Claims

Which Government health plan is available for military personnel? A Tricare B Social Security Disability C Medicaid D Medicare

Tricare

The contract type in which only one party is legally bound to its contractual obligations after a premium is paid is a(n)_______ contract. A Conditional B Unilateral C Aleatory D Personal

Unilateral

Many insurers pay benefits based on the average fee charged in a geographical area. This is referred to as which of the following? A Reimbursement B Usual Customary and Reasonable C Cash D Scheduled

Usual Customary and Reasonable

Group Disability Income is usually offered only on a nonoccupational basis, which will not cover work-related disabilities, because: A Work related injuries are normally covered under Workers' Compensation B The insurer may reduce its financial obligation this way C Damages for work-related injuries are determined in court D Most individuals have their own disability income policy

Work related injuries are normally covered under Workers' Compensation

Does the insured have the right to change the beneficiary designation of a health insurance policy? A Yes, the beneficiary designation is always revocable in health policies B Yes, unless the beneficiary is designated as irrevocable C No, only the insurer has that right in health policies D No, the beneficiary designation in health policies is always irrevocable

Yes, unless the beneficiary is designated as irrevocable