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Accident & Health Practice Test > Accident & Health 2 > Flashcards

Accident & Health 2 Flashcards

1
Q 
Social security benefits may be payable to a disabled individual after a waiting period of how many months 
(A) 3 
(B) 5 
(C) 6 
(D) 12
A

5

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2
Q

A health insurance contract that does not permit an increase in premiums, modifications to policy provisions, and is not cancellable, best describes a (n)
(A) Non Cancellable and guaranteed renewable policy
(B) Guaranteed renewable policy
(C) Optionally renewable Policy
(D) Conditionally renewable policy

A

Non Cancellable and guaranteed renewable policy

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3
Q 
Most Medicare Supplement (Medigap) policies have a \_\_\_free look period.  
(A) 60 day 
(B) 45 day 
(C) 30 day 
(D) 10 day
A

30

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4
Q 
Which of the following provides the option for an employee to continue to maintain his group health insurance coverage after he is no longer employed by the employer? 
(A) ERISA 
(B) HIPPA 
(C) FICA 
(D) COBRA
A

COBRA

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5
Q

The mandatory physical exam and autopsy provisions found in health insurance policies are most commonly applied by insurers…
(A) To determine the cause and validity of a health insurance claim that exceeds $50,000
(B) To determine the cause of death when a claim is made under an AD&D policy
(C) To validate that an individual claiming disability benefits remains disabled
(D) Whenever benefits are payable to a beneficiary due to the death of the insured

A

To validate that an individual claiming disability benefits remains disabled

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6
Q 
Roger has a major medical policy with a $500 deductible and an 80/20 coinsurance provision. If he incurs medical expenses of $4,000, the insurer would pay 
(A) $800 
(B) $2,700 
(C) $2,800 
(D) $3,200
A

$2,800

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7
Q

All of the following statements concerning the coordination of benefits provision found in accident and health policies are true EXCEPT
(A) The provision guards against duplication of its benefits
(B) It prevents an insured from profiting from an illness or injury
(C) It does not apply to group policies
(D) Premiums would be higher without this provision

A

It does not apply to group policies

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8
Q 
Assume Hal, the insured under a disability income policy, is severely injured in an accident. He is unable to work for a period of 8 months, during which he receives his policies full benefit. After 8 months, he returns to work, but due to his injury, he can work only on a part-time  basis. In order to continue to collect benefits under the policy, the policy must include what kind of provision? 
(A) A total disability provision 
(B) A partial disability provision 
(C) A residual disability provision 
(D) A fully insured disability provision
A

A residual disability provision

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9
Q

In a disability income policy, an elimination period provision refers to the period…
(A) Between the first day of disability and the actual receipt of payment for the disability incurred
(B) During which ant specific accident or illness is excluded from coverage
(C) Between the first day of disability and the day to which the disability must continue before it can result in the insured receiving any benefits
(D) Between the effective date of the policy and the date on which payments under the policy becomes due

A

Between the first day of disability and the day to which the disability must continue before it can result in the insured receiving any benefits

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10
Q

Which of the following is commonly and specifically excluded under a medical expense policy?
(A) Loss of income as a result of illness
(B) Self-inflicted injuries
(C) Hospitalization due to mental illness
(D) Injuries caused by accidents

A

Self-inflicted injuries

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11
Q

The purpose of a grace period in an accident and health insurance contracts is to
(A) Allow the insurer to determine the deceased’s cause of death
(B) Permit the beneficiary to establish an insurable interest in the contract
(C) Protect the insurer against the adverse selection of policy owners
(D) Protect a policyowner against the unintentional lapse of a contract

A

Protect a policyowner against the unintentional lapse of a contract

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12
Q

A guaranteed renewable accident and health policy gives the insurer the right to
(A) Increase premiums on a class basis
(B) Alter policy provisions during the policy term
(C) Reduce the amount of insurance after each claim
(D) Cancel the policy due to the filing of numerous claims

A

Increase premiums on a class basis

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13
Q 
Bob owns a disability income policy paying $1,500 per month in the event that he becomes totally disabled. The policy has a 30-day elimination period. Bob is involved in a traffic accident and is disabled for 105 days. How much will his disability income policy pay? 
(A) $2,250 
(B) $3,750 
(C) $4,500 
(D) $5,250
A

$3,750

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14
Q 
The preexisting condition exclusion found in an accident and health policy is designed to protect the insurer against 
(A) Adverse selection 
(B) Over insurance 
(C) Malingering 
(D) Compliance
A

Adverse selection

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15
Q

Which of the following statements regarding surgical expense benefits is CORRECT?
(A) Benefits are typically subject to deductibles of $250 or more
(B) The amount on the benefit schedule is typically expressed in terms of the maximum benefit payable
(C) Coverage is usually provided for rehabilitation costs following surgery
(D) A small amount, usually no more than $350, is provided for incidentals while hospitalized

A

The amount on the benefit schedule is typically expressed in terms of the maximum benefit payable

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16
Q

A comprehensive medical expense insurance policy combines which of the following coverages under one contract?
(A) Major medical coverage and accidental death
(B) Disability income and accidental death
(C) Basic hospital and surgical coverage with major medical coverage
(D) Disability income with basic hospital and surgical coverage

A

Basic hospital and surgical coverage with major medical coverage

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17
Q

Which of the following is an eligibility requirement in order to receive full Social Security disability benefits?
(A) An individual must have obtained PIA insured status
(B) An individual must have obtained fully insured status
(C) An individual must be at least 65 years old
(D) The recipient must be disabled for at least 12 months before benefits may be received

A

An individual must have obtained fully insured status

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18
Q 
Long-term-care insurance provides all of the following coverages EXCEPT
(A) Skilled nursing care 
(B) Surgical expense
(C) Intermediate (rehabilitative) care
(D) Custodial care
A

Surgical expense

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19
Q 
The contractual provision that specifies the time limit that an insured has to return accident and health claim forms to the insurer is known as
(A) Payment of claims 
(B) Claim forms
(C) Grace Period 
(D) Proof of loss
A

Proof of loss

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20
Q 
Which of the following types of health insurance policies provides for death benefits, payable to the insured’s beneficiary?
(A) DI
(B) AD&D 
(C) LTC
(D) COBRA
A

AD&D

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21
Q

Which of the following statements regarding participation in Part A of Medicare is CORRECT?
(A) The insured must pay a deductible
(B) The insured must pay an annual premium
(C) Benefits are paid directly to the insured
(D) To participate, an individual must be covered by Social Security

A

The insured must pay a deductible

22
Q

All of the following statements concerning Part B of Medicare are correct EXCEPT
(A) A Coinsurance feature of 80/20 is included to cover changes after a deductible is satisfied
(B) Benefit payments are subject to an initial deductible
(C) Annual physical exams are required to maintain coverage
(D) A premium is charged for Part B participation

A

Annual physical exams are required to maintain coverage

23
Q 
Will owns an individual disability income policy paying $800 per month with a 60 day waiting period. If he becomes disabled for 45 days, how much will his contract pay?
(A) Nothing
(B) $200
(C) $400
(D) $800
A

Nothing

24
Q 
The period of time that elapses after the onset of a disability and before monthly disability income benefits begin is referred to as the 
(A) Probationary period 
(B) Conversion period
(C) Elimination period
(D) Holding period
A

Elimination period

25
Q 
An insured must provide written notice of a claim to the insurer within how many days of a loss?
(A) 5
(B) 10
(C) 15
(D) 20
A

20

26
Q 
After receiving notice of a claim from an insured, the insurer must provide claim forms to that insured within how many days of the request?
(A) 5
(B) 10
(C) 15
(D) 20
A

15

27
Q 
Chris receives $50,000 from $100,000 accidental death and dismemberment policy as a result of the loss of his left arm in an accident. He has received the
(A) Primary amount
(B) Principal amount
(C) Capital amount
(D) Contributory amount
A

Capital amount

28
Q 
Medicare Part A Benefit periods end when a person has been released from the hospital or skilled nursing facility for a period of
(A) 60 days
(B) 90 days
(C) 6 months
(D) 12 months
A

60 days

29
Q 
Ann Owns a major medical policy with a $1,000 deductible in a provision that provides for percentage participation of 80/20. Due to an illness, Ann Incurs covered Medical expenses of $3,000. How much of this amount will Ann be responsible for?
(A) $400 
(B) $1,400
(C) $1,600
(D) $2,400
A

$1,400

30
Q 
Responses to questions given by applicants on an accident and health insurance application are considered to be
(A) Warranties
(B) Mandated statements
(C) Entitlements
(D) Representations
A

Representations

31
Q 
Which of the following terms best defines the approach that Blue Cross and Blue Shield organizations used to provide for healthcare?
(A) Indemnity 
(B) Valued
(C) Service
(D) Reimbursement
A

Service

32
Q

With regard to the reinstatement of a health insurance contract, all of the following statements are true EXCEPT
(A) Evidence of insurability may be required
(B) Upon reinstatement, coverage for illness is effective immediately
(C) Upon reinstatement coverage for accidents is effective immediately
(D) Reinstatement is automatic unless the insurer and forms the applicant within 45 days that he has been rejected

A

Upon reinstatement, coverage for illness is effective immediately

33
Q 
Which of the following is a typical benefit period for group short term disability income coverage
(A) 1 to 3 months 
(B) 6 to 18 months 
(C) 12 to 28 months 
(D) 18 to 24 months
A

6 to 18 months

34
Q

Which of the following statements is CORRECT regarding the change of occupation provision found in a disability income policy?
(A) It sets forth the rights and obligations of the insurer and the insured in the event that the insured engages in a more hazardous or less hazardous occupation.
(B) It void the policy if the insured suffers an otherwise compensable Loss while engaged in an illegal occupation
(C) It requires that the insurer deny benefits if the insured changes his occupation following the policy effective date
(D) It provides of formula by which adjustments are made to the elimination periods in the event that the insured changes to a higher risk occupation

A

It sets forth the rights and obligations of the insurer and the insured in the event that the insured engages in a more hazardous or less hazardous occupation.

35
Q 
All of the following are optional uniform health insurance policy provisions EXCEPT
(A) Reinstatement
(B) Change of occupation
(C) Conformity with state statutes
(D) Unpaid premiums
A

Reinstatement

36
Q

What advantage does the recurrent disability provision provide to the insured under disability income policy?
(A) It eliminates the imposition of a second elimination period for the same disability.
(B) It provides the insured with lifetime disability benefits.
(C) It eliminates the imposition of an elimination period for a separate disability.
(D) All of the above

A

It eliminates the imposition of a second elimination period for the same disability.

37
Q 
The amount payable in the event of the insured’s death under an accidental death policy is referred to as the
(A) Capital sum
(B) Principal sum
(C) Accidental death sum
(D) Dismemberment benefit
A

Principal sum

38
Q

With regard to the taxation of disability income insurance provided by a business on a key employee, whereby the premium is paid by the employer and the benefits are paid to the employee, which of the following statements is TRUE?
(A) Premiums are not tax deductible; benefits are tax-free
(B) Premium are tax deductible; Benefits are tax-free
(C) Premiums are not tax-deductible; benefits are taxed
(D) Premiums are tax-deductible; benefits are taxed

A

Premiums are tax-deductible; benefits are taxed

39
Q

When added to a health insurance contract, an impairment rider
(A) Provides for a discontinuance of premium payments if the policy owner becomes impaired as defined by the rider
(B) Defines the criteria for a disability or impairment before benefits are playable
(C) Excludes from coverage any loss associated with the defined impairment
(D) Identify specific impairments or disabilities that the contract will cover

A

Excludes from coverage any loss associated with the defined impairment

40
Q

A medical expense policies coinsurance provision
(A) Specifies the percentage of costs that will be paid each by the insurer and the insured
(B) Defined the amount of costs the insured must cover before any benefits under the policy are payable
(C) Identifies which provider has primary responsibility for benefit payments if the insured is covered by more than one policy
(D) Provides that once an insured’s costs have exceeded the specified limit, the insured pays 100% of covered expenses

A

Specifies the percentage of costs that will be paid each by the insurer and the insured

41
Q

When Lupe 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 timeframe.
(B) The insurer is considered to be notified since the notification to its agent amounts to the notification to the insurer; the claim will be paid in full.
(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 had the notification been provided in a timely manner

A

The insurer is considered to be notified since the notification to its agent amounts to the notification to the insurer; the claim will be paid in full.

42
Q

Which of the following statements concerning a Health Maintenance Organization (HMO) is CORRECT?
(A) It provides coverage for overhead expenses in the event that a business owner becomes disabled.
(B) It is an organization stressing preventive health care in early diagnosis
(C) Closed-panel plans account for approximately 10% of all HMO‘s
(D) Routine physical exams are generally not covered

A

It is an organization stressing preventive health care in early diagnosis

43
Q 
What is the maximum number of months that group health coverage be continued for a terminated employee under the COBRA rule? 
(A) 12
(B) 18
(C) 24
(D) 36
A

18

44
Q 
A stop-loss provision is common to what kind of health insurance policy?
(A) major medical
(B) Basic medical
(C) Disability income
(D) All of the above
A

major medical

45
Q

What kind of coverage does a business overhead expense policy provide?
(A) monthly income payments to a business owner in the event of a key employee’s disability
(B) Monthly income payments to cover the operational cost of a business if the owner becomes disabled
(C) Disability income payments for a business owner
(D) Medical expense insurance for a business owner

A

Monthly income payments to cover the operational cost of a business if the owner becomes disabled

46
Q 
Medicare Part A provides coverage for all of the following EXCEPT 
(A) hospitalization
(B) Home health care services
(C) Hospice care 
(D) Surgeon fees
A

Surgeon fees

47
Q

With regard to health insurance, the fair credit reporting act
(A) restricts and insurers review of an applicants credit history to only those sources the applicant approves
(B) Requires the insures to contact at least one source named by the applicant to gain information on the applicant
(C) Requires applicants for health insurance to submit a credit report with the insurance application
(D) Requires the disclosure of the third party source if the applicant is denied coverage due to information provided by a third-party

A

Requires the disclosure of the third party source if the applicant is denied coverage due to information provided by a third-party

48
Q 
John’s major medical policy contains an annual deductible of $1,000; 50/50 coinsurance; and a $5,000 stop-loss limit. If John incurs $21,000 in coverage medical expenses, what will be his total out-of-pocket cost?
(A) $11,000
(B) $10,500
(C) $10,000
(D) $5,000
A

$5,000

49
Q 
Carol health insurance policy pays benefits according to a list which indicates the amount that is payable under each type of covered treatment or procedure. Carols policy provides benefits on a 
(A) scheduled basis
(B) Reimbursement basis
(C) Service basis
(D) Cash basis
A

scheduled basis

50
Q

Company X receives a health insurance application from David with a prepaid premium. One week later, they received the MIB report indicating a prior health condition. Company X will most likely
(A) disregard the MIB report
(B) Return David’s premium and declined coverage
(C) Cover the applicant
(D) Cover the applicant excluding the pre-existing condition

A

Cover the applicant excluding the pre-existing condition

Accident & Health Practice Test (10 decks)

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