Examfx Scenarios questions on Health Inusurance

Question 1

Whenever an insurer knows that a person has violated either the fraudulent claims or embezzlement provisions, it is the insurer’s duty to notify which of the following?

Answer 1

The Insurance commissioner

Question 2

Which of the following is CORRECT regarding Business Overhead Expense insurance?

Answer 2

Premiums are tax deductible

Question 3

An insured wants to buy a disability income policy that pays a maximum monthly benefit of $1,2000. To make sure that the disability benefit keeps up with inflation, the insured would need to add

Answer 3

A cost of living rider

Question 4

The provision in a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract the

Answer 4

Entire contact clause

Question 5

The Corridor deductible derives its name from the fact that is applied between the basic coverage and the

Answer 5

Major medical coverage

Question 6

An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?

Answer 6

Adjust the claim benefit to reflect the insured true age

Question 7

After an insurance contract ends, the insurer must maintain records regarding the transaction for at least

Answer 7

5 years

Question 8

When an insurance producer conducts business under any name other than the producer’s legal name, they must

Answer 8

Notify the commissioner before using the assumed name

Question 9

All of the following apply to short- term disability plans EXCEPT

Answer 9

Both group an individual plans arerenewable

Question 10

In an optionally renewable policy, the insurer has which of the following options?

Answer 10

Increase premiums

Question 11

Which of the following disability income policies would have the highest premium?

Answer 11

15-day waiting period/ 10- year benefit period

Question 12

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 12

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

Question 13

An insured who has an Accidental Death an Dismemberment policy loses her left arm in an accident. What type of benefit will she most likely receive from this policy?

Answer 13

The capital amount in a lump sum

Question 14

The Commissioner must examine every domestic insurer at least once every

Answer 14

5 years

Question 15

A policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called

Answer 15

Business Overhead Expense

Question 16

According to the PPACA metal levels classification, if a health plan is expected to cover 90& of the cost for an average population, and the participant would cover the remaining 10%, what type of plan is that?

Answer 16

Platinum

Question 17

Unless exempt, individuals applying for an insurance agent’s license must first complete an approved course of study of

Answer 17

20 hours

Question 18

Which of the following applies to partial disability benefits?

Answer 18

Payment is limited to a certain period of time

Question 19

A men is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

Answer 19

Claim is denied if his policy contains the illegal Occupation provision

Question 20

Insured Z’s health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?

Answer 20

The insured may carry over the amount of this year’s expenses to next year, which will help satisfy next year’s deductible

Question 21

Under the carry over provision, If the insured did not incur sufficient medical costs during the year to meet the deductible, any medical expenses incurred during the last 3 months may

Answer 21

No notice is ever required at the initial completion of the application

Question 22

Certain conditions, such as dismemberment or total and permanent blindness, will atomically qualify the insured for full disability policy provision does this describe?

Answer 22

Presumptive disability

Question 23

A wavier of premium provision may be included with which kind of health insurance policy?

Answer 23

Disability income

Question 24

To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters?

Answer 24

6 credits

Question 25

Which of the following best describe total disability?

Answer 25

A person’s ability to work is significantly reduced or elimated for the rest of their life.

Question 26

CORBA applies to employers with at least

Answer 26

20 employees

Question 27

Which of the following acts would be grounds for a person’s license suspension, revocation, or refusal to renew?

Answer 27

An agent fails to pay state income tax

Question 28

Which renewal option does NOT guarantee renewal and allows the insurance company to refuse of a policy at any premium due date?

Answer 28

Optionally renewable

Question 29

When an insurer combines two periods of disability into one, the insured must have suffered a

Answer 29

Recurrent disability

Question 30

A person licensed to solicit application or to negotiate a policy of insurance is called

Answer 30

An agent

Question 31

If the Commissioner denies an initial application for an agent, how long dos the applicant have to request a review after receiving notification of the denial?

Answer 31

30 days

Question 32

If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?

Answer 32

Adjust the benefit in accordance with the increased risk

Question 33

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

Answer 33

Benefits are usually limited to 6 months

Question 34

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

Answer 34

Insurer to the insured

Question 35

Which type of a hospital policy pays a fixed amount each day that the insured is in hospital?

Answer 35

Indemnity

Question 36

In the event a policy lapse due to nonpayment of premium, within how many days would the policy be atomically reinstated once the outstanding premium is paid?

Answer 36

45 days

Question 37

In order to collect Social Security disability benefits, the claimant must be able to demonstrate that the disability will last at least

Answer 37

12 months

Question 38

What is the purpose of coinsurance provisions?

Answer 38

To help the insurance company to prevent overutilization of the policy

Question 39

Representations are written or oral statements made by the applicant that are

Answer 39

Considered true to the best of the applicant’s

Question 40

An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point?

Answer 40

Neither approved the application nor issued the policy

Question 41

Which of the following is NOT a characteristic or a service of an HMO plan?

Answer 41

Contracting with insurance companies

Question 42

An insured purchased a disability income policy with a 10-year benefit period. The policy stated a 20- day probationary period for illness. If the insured is hospitalized with an illness 2 weeks after the policy was issued, how much will the policy pay?

Answer 42

Nothing; illness is not covered during the first 20 days

Question 43

When an insurer issues an individual health insurance policy that is guarnteed renewable, the insurer agrees

Answer 43

To renew the policy until the insured has reached age 65

Question 44

If a licensee fails to notify the commissioner of insurer insolvency, if known or suspected, and to provide a statement of relevant facts, which of the following is TRUE?

Answer 44

The commissioner may suspend or revoke the person’s license

Question 45

A business wants to make sure that if a key employee becomes disabled, the business will be protected from any resulting loss. Which kind of insurance will protect the business?

Answer 45

Business Disability

Question 46

Regarding the taxation of Business Overhead policies

Answer 46

Premiums are deductible, and benefits are taxed

Question 47

When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured’s changed of occupation, the insurer should

Answer 47

Adjust the benefit in accordance with the decreased risk

Question 48

An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how will the excess plan pay?

Answer 48

$5,000

Question 49

For how long can a Commissioner issue a temporary insurance agent license?

Answer 49

Up to 180 days

Question 50

Which of the following is NOT true Basic Surgical Expense coverage?

Answer 50

Coverage is unlimited

Question 51

While repairing the roof of his house an insured accidentally falls off and breaks his arm and sustains a head injury that results in total blindness of both eyes. His policy contains an Accidental Death & Dismemberment Rider. What is the extent of benefits that he will receive?

Answer 51

Principle sum

Question 52

The Commissioner is empowered to examine the records of any person transacting insurance in the state as an agency, an agent or broker of recorded. If the commissioner does examine a person, the expense of that examination will be paid by

Answer 52

The person examined

Question 53

An insurer or authorized representative of the insurer that terminates the appointment, employment, contract, or other insurance business relationship with an agent shall notify the commissioner

Answer 53

With in 30 days after the effective date of the termination

Question 54

Which of the following groups would probably be covered by blanket insurance?

Answer 54

An university’s sports team

Question 55

A deductible is

Answer 55

A specified dollar amount that the insured that is insured must pay first before the insurance company will pay the policy benefits

Question 56

Which of the following individuals will be eligible for coverage on the Health Insurance Marketplace?

Answer 56

A permanent resident lawfully present in the U.S

Question 57

Which of the following is considered a presumptive disability under a disability income policy?

Answer 57

Loss of 2 limbs

Question 58

Which of the following will vary the length of the grace period in health insurance policies?

Answer 58

The mode of the premium payment

Question 59

Which of the following entities is not an insurer but an organization formed to provided insurance benefits for member of an affiliated lodge or religious organization?

Answer 59

Fraternal benefit society

Question 60

What are the 3 basic coverages for medical expense insurance

Answer 60

Hospital, Surgical, Medical

Question 61

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have ?

Answer 61

$900 ( deductible + 20% of the bill after the deductible

Question 62

In a disability policy, the probationary period refers to the time

Answer 62

During which illness- related disability and the first payment

Question 63

which of the following answers does NOT describe the principle goal of a Preferred provider Organization?

Answer 63

Provide medical services only from physician in the network

Question 64

Prior to approving the application for resident insurance license, the Commissioner shall find that the individual meets all the following requirement EXCEPT?

Answer 64

Is at least 21 years of age

Question 65

By what date must agents complete the required continuing education?

Answer 65

By the last day of the license birth month

Question 66

A hospital indemnity policy will pay

Answer 66

A benefit for each day the insured is in a hospital

Question 67

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

Answer 67

Care can be provided outside of the service area

Question 68

How is the Commissioner of insurance selected for the office

Answer 68

Elected in a general election for 4 year term

Question 69

If an insured is NOT REQUIRED to pay a deductible, what kind of coverage does the insured have?

Answer 69

First dollar

Question 70

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes

Answer 70

Wavier of Premium rider