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Aflac > Exam Prep > Flashcards

Exam Prep Flashcards

1
Q

Which type of coverage pays an amount per day for hospitalization directly to the insured regardless of the insured’s other health insurance?

A

Hospital Indemnity Policy

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2
Q

The limited period of time given to all members to sign up for a group health plan is called the…

A

Enrollment Period

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3
Q

An insurer may refuse to renew an employer’s small group health plan due to…

A

Nonpayment of Premium

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4
Q

Preferred risk policies with reduced premiums are issued by insurance companies because the insured has..

A

Better than average mortality or morbidity experience

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5
Q

The first payment for a newborn accident and health coverage is due ___ days after the birth.

A

31

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6
Q

Ohio requires that a licensee completes ___ hours of continuing education on the subject of ethics every reporting period.

A

3

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7
Q

Medicare Part A covers what?

A

Inpatient hospital stay

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8
Q

If an agent is believed to be causing considerable harm, the superintendent…

A

May issue a cease and desist order against the agent

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9
Q

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

A

Liquidity

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10
Q

The policyholder for a group health benefit plan is considered to be the

A

Employer

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11
Q

An example of a health insuring corporation (HIC) specialty care provider is a

A

Neurologist

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12
Q

An agent’s license may only be suspended or revoked if the agent…

A

Has been afforded a right to a hearing

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13
Q

Replacement can best be described as

A

Exchanging a new policy for one already in force

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14
Q

Long-Term Care policies or certificates issued in Ohio are required to have what?

A

A nonforfeiture value

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15
Q

An insurance producer is often responsible for field underwriting during the application process. All of these are possible field underwriting roles except?

A

Providing commission information to the applicant

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16
Q

An insurer can exclude coverage for a preexisting condition on a Medicare Supplement policy for up to

A

6 months

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17
Q

Coverage for newborns under an accident and health plan must include coverage for

A

Birth abnormalities

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18
Q

Insurance represents the process of risk…

A

Transference

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19
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…

A

Indicates a preexisting condition

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20
Q

Long-Term Care policies may provide coverage for claims arising from

A

Senile dementia

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21
Q

A Medicare Supplement policy is

A

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

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22
Q

Justin is receiving disability income benefits from a group policy paid for by his employer. How are these benefits treated for tax purposes?

A

Taxable income

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23
Q

What is not typically included under “hospital care” for most health insuring corporation (HIC) plans?

A

Private duty nursing

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24
Q

Which three levels of care are long-term policies provided with?

A

Skilled nursing, intermediate, and custodial care

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25
Q

Confidentiality of health information (stated by Ohio HIC laws) applies to information supplied by…

A

Both by the covered individual and by the providers

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26
Q

An individual who removes the risk of loosing money in the stock market by never purchasing stocks is said to be engaging in

A

Risk avoidance

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27
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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28
Q

Which of the following signatures is not required on an individual insurance application?

A

Insurer

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29
Q

Which of these preventative care services is not provided by health insuring corporation (HIC) primary care physicians?

A

Adult hearing screenings

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30
Q

What 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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31
Q

Ted has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?

A

Calendar-year deductible

32
Q

What does Medicare Part D cover?

A

Prescription drugs

33
Q

What do coordination benefits allow?

A

Allows secondary payor to reduce their benefit payments so no more than 100% of the claim is paid

34
Q

What is the primary factor that determines the benefits paid under a disability income policy?

A

Wages

35
Q

A health care provider claim may be settled using what payment method?

A

Fee-for-service

36
Q

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of…

A

100% of costs

37
Q

An employer is issued a group medical insurance policy. This single contract is known as?

A

Master policy

38
Q

Which of the following statements is true about Medicaid?

A

It’s funded by federal, state and local taxes

39
Q

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

A

20

40
Q

HIPAA considers what as “individually identifiable health information”?

A

A person’s health claim information

41
Q

What is not considered a supplemental health insuring corporation (HIC) service?

A

Outpatient medical services

42
Q

An employee has ___ days after the date of marriage to add a new spouse to a small group health care plan

A

30

43
Q

Intentional withholding of material facts that would affect an insurance policy’s validity is

A

Concealment

44
Q

Medicaid is intended for

A

Poverty stricken people

45
Q

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

A

Home health care

46
Q

Key Person Disability insurance pays benefits to the…

A

Employer

47
Q

An order issued by the superintendent that prohibits a specific practice listed in the order is called?

A

Cease and desist order

48
Q

Advertisements for accident and health policies that only cover a stated illness must display a statement that the…

A

Policy is limited

49
Q

Group dental plans will frequently place a limit on annual benefits in order to minimize what?

A

Adverse selection

50
Q

All plans allow for employee contributions to be taken out on a pre-tax basis except?

A

Health Reimbursement Arrangement Plan

51
Q

Which of the following would evidence ownership in a participating health insurance contract?

A

Policy ownership

52
Q

_____ is not an element of a valid contract

A

Countersignature

53
Q

What percent of a participant’s income are group long-term disability benefit amounts typically limited to?

A

60%

54
Q

The typical long-term care insurance policy is designed to provide a minimum of ___ year(s) of coverage

A

1

55
Q

An insurance policy that is only renewable only at the option of the insurance company. This policy is considered to be?

A

Optionally renewable

56
Q

An agent’s appointment may only be terminated by the

A

Insurer

57
Q

An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called?

A

Coinsurance

58
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

59
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

60
Q

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

A

15

61
Q

What is not considered advertising?

A

A rating from a service company

62
Q

One of the most important considerations when replacing health insurance would be the…

A

Exclusions on a new policy

63
Q

What would not be considered a presumptive disability?

A

Loss of a leg OR arm

64
Q

Long-term care insurance applications must contain plain and unambiguous health questions. The exception to this rule would be applications for…

A

Guaranteed issue

65
Q

The superintendent determines an examination of insurer’s books and records is necessary. After receiving the notification, the insurer…

A

Must not impede the examination

66
Q

A Medicare supplement plan can be cancelled by the insurer…

A

For nonpayment of premiums

67
Q

The purpose of the Coordination of Benefits provision in group accident and health plans is to?

A

Avoid overpayment of claims

68
Q

An example of an endodontic treatment is a

A

Root canal

69
Q

What would be considered a possible applicant and contract policyholder for group health benefits?

A

Employer

70
Q

An employer with under 20 employees must allow a terminated employee to continue accident and health coverage for a minimum of ___ months

A

12

71
Q

A beneficiary change can occur when?

A

Normally at any time during the policy term

72
Q

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

A

Determines what is paid by the primary and secondary insurers in the event of a claim

73
Q

Loss of income insurance provides what?

A

An individual the means to replace wages

74
Q

Backdating an insurance policy occurs when

A

The policy’s effective date is earlier than the present

75
Q

In what form do disability income policies typically pay benefits?

A

Periodic income

76
Q

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

A

Insured

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