Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health and Life 2024 Chpt1 > chapter 4 > Flashcards

chapter 4 Flashcards

1
Q

Low frequency diseases can be exclusively covered by what kind of health insurance
policies?

A

✔️✔️-Limited policies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Respite care is able to provide:

A

✔️✔️-temporary relief to the patient’s
primary caregiver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which of the following is NOT an example of utilization review?

A

✔️✔️-
Ongoing inspection of accident prone individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What makes an insurance policy a unilateral contract?

A

✔️✔️-Only the
insurer is legally bound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A producer who knowingly submits a FALSE statement in support of a claim may be
found guilty of:

A

✔️✔️-Fraud

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The type of policy where the insurer can send a notice to the insured that the policy has
been cancelled in the middle of the term is called:

A

✔️✔️-Cancelable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

All of the following plans allow for employee contributions to be taken on pre-tax basis
EXCEPT:

A

✔️✔️-Health Reimbursement Arrangement Plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

All of these are typically sources of underwriting information for life or health insurance
EXCEPT:

A

✔️✔️-Disclosure authorization response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which would evidence ownership in a participating health insurance contract?

A

✔️✔️-Policy ownership

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Kathy pays a monthly premium on her health insurance policy. How long is her grace
period?

A

✔️✔️-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

An individual can enroll in a Part C Medicare Advantage Plan at what time?

A

✔️✔️-When becoming eligible for Medicaid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Under a contract of adhesion:

A

✔️✔️-the terms must be accepted or
rejected in full

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Richard owns an insurance policy that is renewable only at the option of the insurance
company. His policy is considered to be:

A

✔️✔️-Optionally renewable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_______ is NOT an element of a valid contract:

A

✔️✔️-Countersignature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What amount will be paid under a policy where the insured misstated his/her age?

A

✔️✔️-An amount the premium would have purchased at the correct age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are premiums paid by the insured for personally owned disability income insurance
treated for tax purposes?

A

✔️✔️-Not tax deductible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How many employees must an employer have for a terminated employee to be eligible
for COBRA?

A

✔️✔️-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Frank is shopping for a disability income policy. Which of the following would have the
HIGHEST premium? -

A

✔️✔️-14 day waiting period / 10 year benefit
period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Major Medical expense plans provide coverage for each of the following EXCEPT:

A

✔️✔️-Work-related injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Medicare Part A covers

A

✔️✔️-Inpatient hospital stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is not a function of an insuring clause?

A

✔️✔️-Primarily describes
the free-look period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

An example of rebating would be:

A

✔️✔️-returning a portion of a
premium as inducement to purchase insurance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

The term which describes the fact that both parties of a contract may NOT receive the
same value is referred to as:

A

✔️✔️-Aleatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which is an organization that only sells insurance among its members?

A

✔️✔️-Fraternal benefit society

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

When comparing an HMO to a PPO, the PPO:

A

✔️✔️-Provides a greater
choice of providers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Who is a mutual insurance company owned by?

A

✔️✔️-Policyholders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The Contestable Period for a health insurance policy remains in effect for a MAXIMUM
period of:

A

✔️✔️-Two years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which of these will typically authorize treatment from a specialist?

A

✔️✔️-Gatekeeper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

A producer who sells insurance in Arkansas but resides in another state is called a(n):

A

✔️✔️-Nonresident producer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A stock insurance company:

A

✔️✔️-Is owned exclusively by its
shareholders

31
Q

An indemnity plan:

A

✔️✔️-provides the insured a specific dollar amount
for services

32
Q

Group health plans may deny participation based upon the:

A

✔️✔️-
Member’s part-time employment status

33
Q

What type of injury would NOT be covered under a health insurance policy?

A

✔️✔️-Work-related

34
Q

In Arkansas, monthly-premium health insurance policies must provide a grace period of
at least:

A

✔️✔️-10 days

35
Q

The entire contract includes the actual policy and the:

A

✔️✔️-Application

36
Q

An HMO that involves a partnership of physicians and other providers who practice out
of a central facility is called a(n)

A

✔️✔️-Group HMO

37
Q

What is NOT included as part of a contract in the entire contract provision?

A

✔️✔️-Changes made by the producer

38
Q

Which disability policy provision would address any concerns of the value of the benefits
decreasing over time?

A

✔️✔️-Cost of living benefit

39
Q

Ron has a new employer and wishes to enroll in the company’s group health plan. In
determining whether his pre-existing health condition applies, Ron cannot have more
than a _____ day gap without previous health insurance.

A

✔️✔️-63

40
Q

A Medicare Supplement basic benefit is

A

✔️✔️-The first 3 pints of blood
per year

41
Q

Written proof of loss must be furnished to the health insurer within how many days after
the date of loss?

A

✔️✔️-90 days

42
Q

The reinstatement provision in a health insurance policy is:

A

✔️✔️-
Mandatory

43
Q

Which is not considered sources of information that can assist an underwriter in
determining whether or not to accept a risk:

A

✔️✔️-National Association
of Insurance Underwriters

44
Q

Which is NOT a qualifying event for Medicare?

A

✔️✔️-Falling below the
federal poverty level

45
Q

Exclusions to continued coverage include:

A

✔️✔️-Dental care
Vision care
Prescription Drugs

46
Q

Which type of business insurance is meant to cover the costs of continuing to do
business while the owner is disabled?

A

✔️✔️-Business overhead
expense policy

47
Q

Without a Section 125 Plan in place, what would happen to an employee’s payroll
contribution to an HSA?

A

✔️✔️-It would be considered taxable income to
the employee

48
Q

A clause that allows an insurer the right to terminate coverage at any anniversary date
is called a(n):

A

✔️✔️-Optional renewability clause

49
Q

Credit Accident and Health Plans are designed to:

A

✔️✔️-Help pay off
existing loans during periods of disability

50
Q

Which of the following statements is CORRECT regarding an individual applying for life
or health insurance?

A

✔️✔️-The applicant’s medical history may be
analyzed and reported

51
Q

One or more necessary or appropriate diagnostic, preventive, therapeutic, rehabilitative,
maintenance, or personal care services in a setting other than an acute care unit of a
hospital is provided by:

A

✔️✔️-Long-term care insurance

52
Q

The Federal Employees Benefit Program consists of two types of health plans for
federal civilian employees. The two plans are fee-for-service and:

A

✔️✔️-
Prepaid

53
Q

An insurer’s ability to make unpredictable payouts to policyowners is called:

A

✔️✔️-Liquidity

54
Q

Why are dividends from a mutual insurer not subject to taxation?

A

✔️✔️-
Because dividends are considered to be a return of premium

55
Q

What is the elimination period of an individual disability policy?

A

Correct Answer ✔️✔️-
Time period a disabled person must wait before benefits are paid

56
Q

Defamation occurs when a producer makes a false statement intended to:

A

✔️✔️-Malign another insurer

57
Q

Which situation would qualify an individual for receiving benefits from a qualifies long-
term care policy?

A

✔️✔️-Becoming cognitively impaired

58
Q

Which of the following is present when an applicant stands to lose value if the insured
dies? -

A

✔️✔️-Insurable interest

59
Q

A proposed insured for a health insurance policy was treated for heart disease within
the past year. When applying for health insurance, the heart disease treatment:

A

✔️✔️-Indicates a pre-existing condition

60
Q

Under a disability income policy, which provision would be payable if the cause of an
injury is unexpected and accidental?

A

✔️✔️-Accidental bodily injury
provision

61
Q

A person covered with an individual health plan:

A

✔️✔️-is issued a policy

62
Q

Field underwriting performed by the producer involves:

A

✔️✔️-
Completing the application and collecting initial premium

63
Q

When an insured has a major medical plan with first dollar coverage, how does this
impact the benefits paid?

A

✔️✔️-No deductible payment is required

64
Q

A Medicare Supplement Policy is

A

✔️✔️-Designed to fill in the gaps of
Part A and Part B Medicare

65
Q

An example of an unfair claims settlement practice is:

A

✔️✔️-Turning
down a claim without providing the basis of denial

66
Q

The difference between pre-certification and concurrent review is that pre-certification:

A

✔️✔️-Occurs before the treatment is provided

67
Q

Which is NOT a qualification for establishing a health savings account (HSA)?

A

✔️✔️-Enrolled in a health plan with a prescription drug benefit

68
Q

Which of the following actions may an insurance company NOT do in an health policy
that contains a guaranteed renewable premium benefit?

A

✔️✔️-Increase
the premiums on an individual basis

69
Q

In an employer-sponsored group accident and health plan, a master contract is issued
to the:z

A

✔️✔️-Employer

70
Q

All of these are considered key factors in underwriting health insurance EXCEPT:

A

✔️✔️-Marital status

71
Q

Karen is a producer who has obtained personal information about a client without
having a legitimate reason to do so. Under the McCarran-Ferguson Act, what is the
minimum penalty for this?

A

✔️✔️-$10,000

72
Q

The election of COBRA for continuation of health coverage will:

A

✔️✔️-
Maintain the same coverage and increase premium

73
Q

A health insurance policy where the insurer has the right to terminate the policy for
reasons other than the insured’s health is called:

A

✔️✔️-Conditionally
renewable

74
Q

Bob and Tim start a business. Since each partner contributes an important element to
the success of the business, they decide to take life insurance policies out on each
other, and name each other as beneficiaries. Eventually, they retire and dissolve the
business. Bob dies 12 months later. The policies continue in force with no change. Both
partners are still married at the time of Bob’s death. In this situation, who will receive
Bob’s policy proceeds?

A

✔️✔️-Tom

Health and Life 2024 Chpt1 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions