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Health and Life 2024 Chpt1 > Chapter 2 > Flashcards

Chapter 2 Flashcards

1
Q

An insurer must furnish to a claimant forms for filing proof of loss within _____ days
upon receiving a notice of claim:

A

✔️✔️-15 days

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2
Q

Written notice for a health claim must be given to the insurer ____ days after the
occurrence of the loss:

A

✔️✔️-20 days

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3
Q

How much does Medicare Part B pay for physician fees?

A

✔️✔️-80%

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4
Q

Tom has a rider on his disability income policy that guarantees the right to increase his
benefits without a medical exam. What kind of rider is this?

A

Guaranteed insurability rider

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5
Q

One definition of replacement is “the act of replacing an existing insurance policy with
another.” Replacement is:

A

✔️✔️-Closely regulated and required full
disclosure

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6
Q

Ambiguities in an insurance policy are always resolved in favor of the:

A

✔️✔️-Insured

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7
Q

Which would NOT be considered in underwriting a health insurance risk?

A

✔️✔️-Marital status

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8
Q

If a health insurance claim is not promptly paid, legal action may be taken against the
insurer after:

A

✔️✔️-60 days from the date proof of loss is furnished

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9
Q

An accident and health policy that provides reimbursement benefits makes them
payable to the:

A

✔️✔️-Insured

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10
Q

According to Arkansas law, when must a producer deliver the outline of coverage to a
medicare supplement applicant?

A

✔️✔️-At the time of application

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11
Q

Which is the best way to describe controlled business?

A

✔️✔️-Policies
written on people that a producer has influence over

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12
Q

An insurance producer must notify the commissioner of a change in legal name, email
or address:

A

✔️✔️-Within 30 days of change

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13
Q

This mandatory health policy provision states that the policy, including endorsements
and attached papers, constitutes:

A

✔️✔️-The entire insurance contract
between the parties

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14
Q

Insurable interest does NOT occur in which of the following relationships?

A

✔️✔️-Business owner/client

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15
Q

Craig submits a $500 claim for medical expenses with a past due premium of $100, the
insurer pays $400. Which of the uniform optional provisions covers this situation?

A

✔️✔️-Unpaid premium

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16
Q

A pharmacy benefit covers prescription drugs derived from a list called a:

A

✔️✔️-Drug formulary

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17
Q

How often must a Commissioner examine each domestic insurance company?

A

✔️✔️-Every 5 years

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18
Q

Which of the following is a legal entity created for the sole purpose of providing
affordable group health coverage to its participants?

A

✔️✔️-Multiple
Employer Welfare Arrangement (MEWA)

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19
Q

Which is NOT considered to be included in a health benefit plan?

A

✔️✔️-
Hospital Indemnity Plan

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20
Q

The monthly benefit for an individual disability income policy is usually limited to a
percentage of the insured’s income in order to avoid:

A

✔️✔️-Over
insurance

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21
Q

Which of the following is considered to be a POS plan?

A

✔️✔️-Managed
care plan

22
Q

A health insurance policy that allows an insurer to change the policy owners premiums,
but NOT cancel the policy is called a(n):

A

✔️✔️-Guaranteed renewal
policy

23
Q

An accident and health insurer has just received written proof of loss from one of its
insureds. The insured must now wait 60 days before:

A

✔️✔️-Bringing
legal action against the insurer

24
Q

Which of the following is NOT a reason for the commissioner to deny or refuse a
producer license application?

A

✔️✔️-Unintentionally misrepresented a
material fact on the application

25
Q

Which of the following is NOT an unfair claim settlement practice?

A

✔️✔️-Needing written documentation of claim details

26
Q

A nonparticipating policy will:

A

✔️✔️-Not pay dividends

27
Q

Jonas has disability insurance through his employer. The employer pays 75% of the
premium, and Jonas pays the other 25%. What is Jonas’s tax liability for any benefits
paid from the disability plan?

A

✔️✔️-Taxes must be paid on 75% of all
benefits received

28
Q

In what form do disability income policies typically pay benefits?

A

✔️✔️-
Periodic income

29
Q

The DO NOT CALL registry offers exemptions for calls placed from all of the following
EXCEPT:

A

✔️✔️-Insurance sales calls

30
Q

Signatures for an insurance application MUST be obtained by the producer from all of
the following sources EXCEPT:

A

✔️✔️-The beneficiary

31
Q

Premium mode is a term used to describe the:

A

✔️✔️-Frequency of the
premium payment

32
Q

Medicare A does not pay for medical benefits provided for treatment in a skilled nursing
facility beyond: -

A

✔️✔️-100 days

33
Q

Which of the following is NOT considered advertising? -

A

✔️✔️-A.M Best
company ratings

34
Q

The waiver of premium does NOT include which provision?

A

✔️✔️-All
future premiums are waived if the insured recovers from the disability

35
Q

A dread disease policy is considered to be a type of

A

✔️✔️-Limited
health insurance policy

36
Q

Which type of long-term care benefit would be most appropriate for a stroke victim who
requires speech therapy administered at her home?

A

✔️✔️-Home
healthcare

37
Q

The Arkansas Insurance Department may take each of the following actions EXCEPT:

A

✔️✔️-Incarceration

38
Q

Bill requires some nursing care/supervision but NOT full time care. Which of these
nursing home options would best serve him?

A

✔️✔️-Assisted living

39
Q

What is issued to each employee of an employer health plan?

A

✔️✔️-
Certificate

40
Q

A beneficiary change can occur:

A

✔️✔️-Normally, at any time

41
Q

What is the tax liability for employer contributions in Health Savings Accounts (HSA’s)?

A

✔️✔️-No tax payment needed

42
Q

All insurers must be members of what organization, as a condition of their authority to
transact insurance in Arkansas?

A

✔️✔️-Arkansas Life and Disability
Insurance Guaranty Association

43
Q

The deeds and actions of a producer indicate what kind of authority?

A

✔️✔️-Apparent

44
Q

A 70 y/o insured individual has suffered from kidney failure for the past 24 months. She
is covered by her spouses large-group employer plan. How will Medicare be utilized in
this situation?

A

✔️✔️-Will be the 2nd insurer & pay for claims not fully
covered by the group plan

45
Q

According to the life insurance contract law, insurable interest exists

A

✔️✔️-At the time of the application

46
Q

Who is the individual paid on a fee-for-service basis?

A

✔️✔️-Provider

47
Q

Medical Expense Insurance would cover:

A

✔️✔️-Injury occurring at the
insured’s residence

48
Q

After an insured gives notice of loss, what must he/she do if the insurer does not furnish
forms? -

A

✔️✔️-File written proof of loss

49
Q

In group health care, what is the purpose of the coordination of benefits provision?

A

✔️✔️-Determines what is paid by the primary & secondary insurers in the
event of a claim

50
Q

Simon purchased a fixed immediate annuity. His payment amount will be dependent
upon principle, interest and the contracts ______: - Correct Answer ✔️✔️-Income period
What kind of life insurance policy issued by a mutual insurer provides a return of
divisible surplus?

A

✔️✔️-Participating life insurance policy

Health and Life 2024 Chpt1 (4 decks)

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