Disability

Question 1

An insured is covered by a disability income policy that contains an accidental means clause. The insured exits a bus by jumping down the steps and breaks an ankle. What coverage will apply?

Answer 1

No coverage will apply, since the injury could have been foreseen.

Question 2

All of the following may be excluded from coverage in a Major Medical Expense policy, EXCEPT

Answer 2

Emergency surgery.

Question 3

If a licensee whose license has been temporarily suspended demands a hearing, the Commissioner must hold the hearing demanded as according to all the following statements EXCEPT

Answer 3

Within 30 days of the license effective date.

Question 4

All of the following are characteristics of a Major Medical Expense policy EXCEPT

Answer 4

Low maximum limits.

Question 5

Which of the following health care plans would most likely provide the insured/subscriber with comprehensive health care coverage?

Answer 5

Health Maintenance Organization plan

Question 6

An insured’s disability income policy includes an additional monthly benefit rider. For how many years can the insured expect to receive payment from the insurer before Social Security benefits begin?

Answer 6

1

Question 7

Which of the following is true of a PPO?

Answer 7

Its goal is to channel patients to providers that discount services.

Question 8

A health carrier that provides coverage for maternity services must provide the same coverage for newborns as for the mother for at least

Answer 8

3 weeks

Question 9

Which of the following hospice expenses would NOT be covered in a cost-containment setting?

Answer 9

Antibiotics

Question 10

The act of voluntarily giving up insurance by the insured is called

Answer 10

Cancellation

Question 11

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?

Answer 11

The insured was in compliance with the policy requirements regarding claims.

Question 12

All of the following events will terminate a producer’s appointment with an insurer EXCEPT

Answer 12

A new Commissioner is put into office.

Question 13

Which of the following is true regarding inpatient hospital care for HMO members?

Answer 13

Care can be provided outside of the service area

Question 14

In group insurance, what is the policy called?

Answer 14

Master policy

Question 15

To sign up for a Medicare prescription drug plan, individuals must first be enrolled in

Answer 15

Medicare Part A.
To receive Medicare prescription drug benefits, beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Medicare Part A or in Parts A and B.

Question 16

Which of the following statements regarding Business Overhead Expense policies is NOT true?

Answer 16

Benefits are usually limited to six months.

Question 17

In disability income insurance, the own occupation definition of disability applies

Answer 17

For the first 2 years of a disability

Question 18

All of the following are essential benefits required to be included in all health plans purchased in the Marketplace EXCEPT

Answer 18

Adult dental care.

Question 19

The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as

Answer 19

Part A.

Question 20

How often must an authorized insurer be examined?

Answer 20

Every 5 years

Question 21

What is the maximum period that an insurer would pay benefits in accordance with an Additional Monthly Benefit rider?

Answer 21

1 year

Question 22

An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy?

Answer 22

10 days

Question 23

Which of the following statements is INCORRECT concerning Medicare Part B coverage?

Answer 23

Part B coverage is provided free of charge when an individual turns age 65.

Question 24

If a licensee whose license has been temporarily suspended demands a hearing, the Commissioner must hold the hearing demanded as according to all the following statements EXCEPT

Answer 24

Within 30 days of the license effective date.

Question 25

Which is true regarding HMO coverage?

Answer 25

It is divided into geographic territories.

Question 26

To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan?

Answer 26

18 months

Question 27

In major medical insurance policies, when the insured’s share of coinsurance reaches a certain amount, the insured is no longer obligated to pay it. This feature is known as

Answer 27

Stop-loss.

Question 28

The general powers and duties of the Insurance Department include all of the following EXCEPT

Answer 28

Enacting statutes to regulate the insurance industry.

Question 29

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?

Answer 29

Payment of Claims

Question 30

An applicant for health insurance has not had a medical claim in 5 years. He exercises daily and does not smoke or drink. What classification do you assume the applicant would receive from his insurer?

Answer 30

Preferred

Question 31

In the state of Washington, a small employer is defined as any person, corporation or association that employed, during the previous year, between 2 and

Answer 31

50 employees.

Question 32

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 written with a 30-day

Answer 32

Elimination period.

Question 33

A participating insurance policy may do which of the following?

Answer 33

Pay dividends to the policyowner

Question 34

An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?

Answer 34

Offer the supplement policy on a guaranteed issue basis

Question 35

Which of the following is a specific dollar amount or a percentage of the cost of care that must be paid by an HMO member?

Answer 35

Copayment

Question 36

Which of the following options best depicts how the eligibility of members for group health insurance is determined?

Answer 36

By conditions of employment

Question 37

According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan?

Answer 37

60%

Question 38

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?

Answer 38

Metal level classification

Question 39

Which of the following is NOT a cost-saving service in a medical plan?

Answer 39

Denial of coverage

Question 40

Under the Fair Credit Reporting Act, if a consumer challenges the accuracy of the information contained in a consumer or investigative report, the reporting agency must

Answer 40

Respond to the consumer’s complaint.

Question 41

Who is involved in completing the agent’s report?

Answer 41

Only the agent