prepare to pass Flashcards by Molly bornstad

B’s policy provides coverage on an in-hopsital basis only and contains a limited daily room and board benefit. which of these policies does B have

comprehensive major medical
basic hospital
critical illness
basic surgical

basic hospital

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every 12 months after the initial enrollment period, an HMO must hold an open enrollement period of
10 days
31
45
60

31 days

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the insuring clause

-specifies the additional time given to pay past due premiums
-states the scope and limits of the coverage
-states the amount of premium to be collected
-prohibits the insured from suing the insurer for at least 60 days after filing a written proof of loss

-states the scope and limits of the coverage

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which of the following provisions guarantees that premiums will be waived if a juvenile life policy owner becomes disabled

-family maintenance clause
-payor clause
-assignment provision
-automatic premium loan provision

payor clause

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what is old age and survivors health insurance (OASDHI) also known as

-medicare
-social security
-medicaid
-FICA

Social secuity

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T purchased a 100K single premium straight life annuity 5 years ago. he has received monthly payments since the inception of the annuity. if T dies the insurance company

-does not have to make any further payments
-must make full payments to the beneficiary
-must make half payments to beneficiary

does not have to make any further payments

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S recently received a 500K lump sum retirement buyout from her employer. she would like to buy an annuity that will immediately furnish her with a guaranteed income for life. what type of anuity is best suited for her situation

-403B plan
-deferred premium
-single premium
-period certian

single premium

will start providing income payments within the first year

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all students attending a large university could be covered by

-a blanket policy
-franchise policy
-jumbo group
-commercial insurance

blanket policy

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insurers may request a hearing with _______ if their policy is rejected

20
30
60
90 days

20 days

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with optionally renewable health policies the insurer may

-renew the policy only if no claims have been filed the previous year
-renew the policy only with the insureds consent
-review the policy wheneer they please and determine whether or not renew it
-review the policy annually and determine whether or not to renew it

-review the policy annually and determine whether or not to renew it

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T owns an accident and health policy and notifies her insurance company that she has chosen a less hazardous occupation. under the change of occupation provision, which of the following actions may her insurance company take

-allow her to take a tax deduction on unearned premiums
-increase her policy coverage amount
-decrease her policy coverage amount
-nothing

increase her policys coverage amount

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on Aug 6, D submitted an application for 50K life insurance policy and did not pay the initial premium. on aug 18, D went to his doctor complaining of chest pains, and some tests were given by the doctor. the life policy was delivered by the producer on aug 20 and D explains what had recently taken place with the doctor. what action should the producer then take?

-collect initial premium
-collect the intial premium along with a signed health statment
-explainto the application the policy is no longer in effect due to the change in health condition
-collect the initial premium and leave. a binding receipt

-collect the intial premium along with a signed health statment

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which of these factors does not influence an applicant’s need for life insurance

-lifestyle of the applicant
-number of dependents
-self maintenance expenses
-future educational costs of dependents

future educational costs

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what type of policy would only provide coverage for specific typees of illnesses

(cancer stroke)
-MEWA
-blanekt insurance
dread disease
disability

dread disease

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which of these is not an example of doing insurance business

-selling shares of stock
receiving an insurance application
collecting insurance premium
delivering insurance policy

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XYZ company pays the entire premium for its group health plan. the minimum percentage of eligible employees that must be covered is
-25
-50
-75
-100

100

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when an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans

-joint
-noncontributory
-contributory
-participating

contributory

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K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. which policy provision specifies that coverage may be restored in this situation

-free look
-reinstatment
-grace period
-consideration

reinstatment

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what is the initial source of underwriting for an insurance policy

-application containing statements from the insured
-mib report
-credit report
-medical exam

application containing statements from the insured

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B an insurance agent tells his clients that their rights may be impaired if they fail to complete a release form within a given period of time. B may be found guilty of

-boycotting
-rebating
-coercion
-discrimination

coercion

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which type of provider is known for stressing preventative medical care and routine physical examinations
HMO
PPO
MEWA
Major medical provider

HMO

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a primary beneficiary has died before the insured in a life insurance policy. a contingent beneficiary is also named in the policy, which of the following will occur when the insured dies

-proceeds will go to the primary beneficiarys estate
-probate will decide who receives proceeds
-proceeds will go to the contingent beneficiary
-proceeds will to to the insured estate

-proceeds will go to the contingent beneficiary

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in order to sell an ________ life policy, a producer is required to register with the financial industry regulatory authority (FINRA)

-variable
-adjustable
-striaght
-term

variable

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which of the following statements about health reimbursement arrangements HRA is correct

-if the employee had a qualified medical leave from work, lost wages can be reimbursed
-if the employee paid for qualified medical expenses, the reimbursements may be tax free
-an unused amounts are added to employees gross income
-health insurance premiums can be reimbursed to the employee

-if the employee paid for qualified medical expenses, the reimbursements may be tax free

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which of the following statments about health coverage for newborns is not true? -coverage includes treatment of congenital defects -coverage continues after the first 31 days upon payment of the first premium -coverage is limited to only congenital defects -coverage begins at moment of birth

-coverage is limited to only congenital defects

with whome may an agent legally share commissions -the insured -applicant -beneficiary -another agent with same line of insurance

-another agent with same line of insurance

The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is -grace period physical examination and autopsy entire contract time limit on certain defenses

t`ime limit on certain defenses

which of the following statements about the classification of applicants is incorrect -substandard applicants are never declined by underwriters -substandard applicants are occasionally declined by underwririters -preferred risk applicants typically have better premiums rates than standard risk applicants -applicant can be classified as substandard risk because hazardous job

-substandard applicants are never declined by underwriters

in a life insurance policy which provision states who may select policy options, designate and name a beneficiary, and be the recipient of any financial benefits from the policy

owners rights

which of the following best describes a warranty

statement guaranteed to be true

which premium schedule results in the lowest cost to the policy owner

annual

during a sales presentation for a participating life insurance policy, an agent must

make a prospect understand that dividends are not guaranteed

which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures commercial ppo hmm admin services only plan

commerical insurer

periodic health claim payments must be made at least monthly weekly daily annually

monthly

under a long term care policy, which benefit would be typically excluded or limited intermediate nursing skilled nursing home health care alcohol rehab

alcohol rehab

V is insured under and individual disability income policy with a 30-day elimination period. on july 1 he is involved in an accident and temporarily disabled. he returns to work on December 1. how many months of benefit are payable? 6 5 4 4.5 months

4 months

T is covered by two health insurance plans: a group plan through his employer and his spouses plan as a dependent. under the model group coordination of benefits provision, when T files a claim, his employers plan is considered the: principal surplus primary secondary

primary

medicare part c is -government insurance avialable to those who are enrolled in a medicare supplement plan with income under 12K per year original part a and b medicare available to those who are enrolled in medicare part a and b

available to those who are enrolled in medicare part a and b

which of these is not considered to be a right given to a policyowner -surrendering the policys cash value -modify a provision in the insurance contract -assignment of ownership -change the beneficiary if revocable

-modify a provision in the insurance contract

which of these life products is not considered interest sensitive -modified whole life variable universal life interest sensitive whole life variable life

modified whole life

which of these actions is taken when a policyowner uses a life insurance policy as collateral for a bank loan -revocable assignment -beneficiary change -irrevocable assignmengt -collateral assignment

-collateral assignment

the percentage of an individuals primary insurance amount. (PIA) determines the benefits paid in which of the following programs -SS disability income medicare supplements medivaid cobra

-SS disability income

M's insurance company denied reinstatement application for her lapsed health insurance policy. the company did not notify M of this denial. how many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force -10 days 30 days 45 days 60 days

45 days

an evidence of coverage form may be issued by a health maintenance organization HMO after being approved by the -attorny general NAIC commissioner National HMO assoc

commissioner

a life insurance application must be signed by all of these except -the policyowner the agent the insured beneficiary

beneficiary

what type of life policy covers two people and pays upon the death of the last insured? -shared -survivorship -adjustable -joint

survivorship

who is liable when an insured suffers a loss on a policy sold by an agent through an insurer not authorized to conduct business in texas -the insured the agent and the insured the agent the commissioner of insurance

the agent

what is considered to be a characteristic of a conditionally renewable health insurance policy -premiums may increase at time of renewal premiums may increase at any time policy may be renewed at the discretion of the insured policy may be amended by the insurer at an time

-premiums may increase at time of renewal

which of the following consists of an offer, acceptance and consideration warranty estoppel contract representation

contract

what type of life insurance are credit policies issued as whole variable term universal

term

if an individual is covered under an accidental death policy and dies, an autopsy can be performed in all these situations except when the cause of death is unknown when the state prohibits this by law when consent for the autopsy is not obtained when foul play was a contributing factor

when the state prohibits this by law

_______ of continuing education MUST be completed in the classroom or classroom equivalent 20 50 80 100

50%

an insured must notify an insurer of a medical claim within ______days after an accident 10 20 3040

an insurer must provide an insured with claim forms within ______days after receiving notice of a loss 5 10 15 20

which of the following is an important underwritiing principal of group life insurance physical examinations are required everyone must be covered in the group employer must pay for the entire premium the group must be formed for the purpose of gettting affordable insurance

everyone must be covered in the group

upon policy delivery, a signed good health statment is requested from the applicant. why would this be necessary? -the applicant chose an annual premium mode -the applicant is suspected of making a material misrepresentation -the initial premium was submited with the application -the initial premium was not submitted with the app

-the initial premium was not submitted with the app

which of the following is not a required provision in group life policies -free look incontestable conversion right to loan

right to loan

additional coverage can be added to a whole life policy by adding an payor rider accelerated benefit rider decreasing term rider automatic premium loan rider

decreasing term rider

a student pilot can pay regular premium costs for her life insurance policy with the addition of which of the following guaranteed insurability rider aviation exclusion impairment rider accidental death benefit rider

aviation exclusion

ABC insurance company is actively engaging in boycott, coercion, and intimidation that results in the unreasonable restraint of trade. abc is comitting a prohibited act under texas insurance laws covering twisting flase advertising rebating unfair methods of competition

unfair methods of competition

what should an insured do if the insurer does not send claims forms within the time period set forth in a health policys claims forms provision -file a lawsuit submit the claim in any form wiat for the claim form to arrive resubmit the request for a claim form

submit the claim in any form

which of these are not an example of nonforfeiture option extnded term reduced paid up cash surrender life income

life income

whole life policies are guaranteed to provide all the following except cash value that will ultimately replace the death benefit nonforfeiture benefit options fixed premiums partial withdraw features beyond surrender of charge

partial withdraw features beyond surrender of charge

investment gains from a universa life policy go towards

the cash value

what is considered to be a characteristic of a conditionally renewable health insurance policy premiums may increase at a time of renewal

premiums may increase at a time of renewal

A Policy that becomes a MEC will loose many of its tax advantages

will loose many of its tax advantages

free look provision begins upon receipt of the policy by policyowner

upon receipt of the policy by policyowner

which of these statements concerning an individual disability income policy is true normally includes an elimination period

normally includes an elimination period

all of these statments about the waiver of premium provision are true except individual must be eligible for SS disability for claim to be accepted

individual must be eligible for SS disability for claim to be accepted

which of the following statments is true about a acceleerated death benefit must have a terminal illness to qualify

must have a terminal illness to qualify

who elects the governing body of mutual insurance company policyholders

policyholders

who owns a stock insurance company stockholders

stockholders

less hazardous occupation under change of occupation which would the insurance comapny take increase policy coverage amount

increase policy coverage amount

which of these is not a reason to purchase life insurance on life of a minor if both parents were to die it would provide death benefit to a child

if both parents were to die it would provide death benefit to a child

when a person returns to work after a period of total disability but cannot earn as much as they did before the disability this situation is called which of the following residual disability

residual disability

what type of life insurance are credit policies issued as term

term

What type of insurance includes flexible premiums and an adjustable death benefit universal life

universal life

pre hospital authorization is considered an example of managed care

managed care

situation in which a group of physicians are salaried employees and conduct business in a hmo facility is closed panel

closed panel