quiz Flashcards
1
Q
The type of agent authority that is based on words, actions or deeds is:
a. Guaranteed authority
b. Implied authority
c. Apparent authority
d. Express authority
A
c. Apparent authority
2
Q
Playing and winning the lottery is an example of which type of risk:
a.Speculative risk
b.Frivolous risk
c.Subjective risk
d.Pure risk
A
A. Speculative risk
3
Q
Service providers provide benefits to its:
a. Policyowners
b. Shareholders
c. Subscribers
d. Members
A
c. subscribers
4
Q
The Office of Financial Regulation has all of the following responsibilities except:
a. Refer suspected violators to law enforcement agencies
b. Issue Certificate of Authority to insurance companies
c. Investigate wrong doing
d. Regulations of banks
A
b. Issue Certificate of Authority to insurance companies
5
Q
Which of the following is true of the investigation powers of the Office of Financial Regulation with respect to insurance activities in Florida:
a. It may investigate suspected wrongdoing only outside of Florida.
b. The Office of Financial Regulation is not responsible for investigations.
c. It may investigate suspected wrongdoing only inside of Florida.
d. It may investigate suspected wrongdoing both inside and outside of Florida.
A
d. It may investigate suspected wrongdoing both inside and outside of Florida
6
Q
State guaranty associations are funded by:
a. Customer surcharges
b. Local and state governments
c. Assessments to insurance companies
d. A small percentage of agent commissions
A
c. Assessments to insurance companies
7
Q
The Office of Financial Regulation is responsible for all of the following except:
a. Regulation of banks
b. Regulation of federal agencies
c. Regulation of credit unions
d. Regulation of the securities industry
A
b. Regulation of federal agencies
8
Q
The McCarran-Ferguson Act confirms that insurance is regulated by the:
a. Government
b. Counties
c. Cities
d. States
A
d. States
9
Q
The type of contract that does not allow the applicant to negotiate the terms of the contract is a:
a. Conditional contrat
b. Aleatory contract
c. Contract of adhesion
d. Absolute contract
A
c. Contract of adhesion
10
Q
In agent authority, the principal is usually the:
a. Customer
b. Insurance carrier
c. Underwriter
d. Agent
A
b. Insurance carrier
11
Q
The association that protects consumers if an insurer becomes insolvent is the:
a. FEMA
b. Insurance Guaranty Association
c. Office of Insurance Regulation
d. The Florida Bureau of Claim Services
A
b. Insurance Guaranty Association
12
Q
All of the following are examples of soliciting insurance except:
a. Completing orders for insurance contracts
b. Making changes to an insurance policy
c. Making recommendations for insurance products
d. Describing the benefits and terms of insurance coverage
A
b. Making changes to an insurance policy
13
Q
Telling an applicant that an endorsement is required by law when such coverage is not required is an example of:
a. Churning
b. Sliding
c. Misrepresentation
d. Twisting
A
b. Sliding
14
Q
The type of health insurance plan that provides coverage to members of an association or professional society is a:
a.Association health plans
b.Credit accident health plans
c.Franchise health plans
d.Blanket health insurance
A
c. Franchise health plans
15
Q
The intent to deceive an agent or insurer for purposes of insurance is an example of:
a. Fraud
b. Sliding
c. Twisting
d. Churning
A
a. Fraud
16
Q
The act established by Congress which helps to prevent attempts to launder money and finance terrorism is the:
a. Financial Services Modernization Act
b. Intervention of Terrorism Act
c. USA Terrorism Act
d. USA Patriot Act
A
d. USA Patriot Act
17
Q
In Long Term Care insurance, skilled nursing care must be performed by a licensed medical professional under the supervision of a:
a. Paramedic
b. Nursing assistant
c. X-ray technician
d. Physician
A
d. Physician
18
Q
Intermediate care can be provided by all of the following except:
a. Paramedic
b. Practical nurse
c. Registered nurse
d. Nurse’s aid
A
a. Paramedic
19
Q
In a prepaid plan:
a. The subscribers are given an upfront amount of insurance for medical emergencies
b. The subscribers pay a set fee each month for medical services
c. The insurer gives the subscriber a set amount of insurance for hospital stay
d. All choices are correct
A
b. The subscribers pay a set fee each month for medical services
20
Q
Medicare Part B coverage provides benefits for all of the following except:
a. Diagnostic tests
b. Physician services
c. Occupational therapy
d. Prescription drugs
A
d. Prescription drugs
21
Q
Care provided by nurses and licensed practical nurses is known as:
Question 20 Answer
a. Skilled care
b. Alternate care
c. Custodial care
d. Intermediate care
A
d. Intermediate care
22
Q
The act that limited the ability for employers to exclude individuals with preexisting conditions in a group insurance plan is:
a.HIPAA
b.Affordable Care Act
c.Preexisting Conditions Act
d.FINRA
A
a.HIPAA
23
Q
When the language in an insurance contract is unclear or questionable, which of the following is true:
a.The language is interpreted to the benefit of the insurer.
b.The language is interpreted to the benefit of the insured.
c.The language is clarified through binding arbitration.
d.The language is disregarded entirely.
A
b.The language is interpreted to the benefit of the insured.
24
Q
Medical expense policies that provide coverage for specific kinds of illnesses such as cancer or hearth disease are:
a.Pre-existing condition policies
b.Sub-standard risk policies
c.Special risk policies
d.Limited risk policies
A
d.Limited risk policies
25
The insurance provision that states the group insurance plan is primary if more than one insurance policy apply to a claim is:
a.Duplicate insurance
b.Coordination of benefits
c.Double indemnity
d.Multiple policy privilege
b.Coordination of benefits
26
Which mandatory health provision requires the insured to notify the insurer of a loss:
a.First notice of loss
b.Proof of loss
c.Notice of Loss
d.Notice of Claim
d.Notice of Claim
27
Marketing standards in a Medicare supplement policy include all of the following except:
a.Must provide a brochure listing the benefits
b.Must contain a definition of Medicare-eligible expenses
c.Contain a coordination of benefits clause
d.Must be written in simple language
a.Must provide a brochure listing the benefits
28
Grandfathering establishes eligibility for which type of protection:
a.HIPPA
b.FCRA
c.HMO
d.FINRA
a.HIPPA
29
The agent must provide the applicant with which of the following when issuing a new Medicare supplement policy:
a.Buyers Guide and Outline of Coverage
b.Buyers Guide only
c.Outline of Coverage only
d.Neither
a.Buyers Guide and Outline of Coverage
30
Per Florida Statute, all small group health insurance plans must be issued on a:
a.Noncancelable basis
b.Guaranteed issue basis
c.Conditionally renewable basis
d.Cancelable basis
b.Guaranteed issue basis
31
In Long Term Care, the grace period for premium payments is:
a.10 days
b.20 days
c.14 days
d.30 days
d.30 days
32
The USA Patriot Act as passed into Congress in what year:
a.2005
b.1995
c. 2001
d. 2000
c. 2001
33
HMO's and PPO's are examples of which type of insurer:
a.Reinsurance company
b.Risk retention group
c.Service providers
d.Stock insurance company
c.Service providers
34
The head of the Office of Financial Regulation is the:
a.CFO
b.Insurance commissioner
c.CEO
d.Commissioner of Financial Regulation
d.Commissioner of Financial Regulation
35
Statements that are made in the application that are used by insurers to evaluate risks are called:
a.Policy wording
b.Underwriting information
c.Representations
d.Statements
c.Representations
36
Which of the following is NOT among the duties of the Office of Insurance Regulation:
a.Assessing an insurerís solvency
b.Handling unclaimed property
c.Regulating viatical settlements
d.Approving policy forms
b.Handling unclaimed property
37
When must an Outline of Coverage be provided?
a.At the time the policy is quoted
b.At the time the policy is issued
c.At the time the policy is advertised
d.At the time the policy is bound
b.At the time the policy is issued
38
The benefit payable for accidental loss of sight or dismemberment in an AD&D policy is the:
a.Face amount
b.Cash value
c.Capital sum
d.Principal sum
c.Capital sum
39
The type of arrangement when a specialist within the insurance company who reviews potentially large claims and discuss treatment alternatives with the insured is:
a.Alternative medicine review
b.Case management
c.Benefit reduction measures
d.Alternative treatment review
b.Case management
40
The health insurance feature that limits the insured's out of pocket expense to a certain amount is the:
a.Stop-loss feature
b.Coinsurance
c.Indemnity feature
d.Maximum expense feature
a.Stop-loss feature
41
The health insurance provision that assures the policyowner that no changes will be made to the contract after it has been issued is the:
a.Insured's promise
b.Entire contract
c.Policy provision
d.Guaranteed policy provision
b.Entire contract
42
In Long Term Care insurance, alternative care includes all of the following except:
Question 13 Answer
a.Transportation
b.Home delivered meals
c.Adult day care
d.Dressing or bathing
d.Dressing or bathing
43
All of the following are reasons for the Coordination of Benefits provision except:
a.Prevents over-insurance
b.Allows both insurers to work together to pay claims
c.Avoids duplication of payments
d.Allows the insured to indemnified twice
d.Allows the insured to indemnified twice
44
Medicare Advantage is which part of the Medicare supplements:
a.Plan C
b.Plan D
c.Plan A
d.Plan B
a.Plan C
45
An insurer may cancel a health insurance policy for all of the following reasons except:
a.Failure to pay premiums
b.Fraud
c.Misstatement
d.Intentional material misrepresentation
c.Misstatement
46
All of the following are options included in the Medicare Advantage supplement EXCEPT:
a.Managed care plans
b.Private Fee for service plans
c.PPO
d.Continuity plan
d.Continuity plan
47
The provision that provide the terms for renewal is the:
a.Renewability provision
b.Renewal options
c.Terms for renewal
d.Renewability rider
a.Renewability provision
48
In a group health insurance policy, underwriting guidelines apply to:
a.The employer
b.The individuals in the group
c.The group
d.The group and the individuals in the group
c.The group
49
The entity that provides health insurance for uninsured children is the:
a.COBRA
b.Florida Healthy Kids Corporation
c.JUA
d.Medicaid
b.Florida Healthy Kids Corporation
50
The Medical Expense Insurance portion of a health insurance policy typically covers all of the following EXCEPT:
a. Outpatient treatments related to a covered injury/illness.
b. Disability payments related to a covered injury/illness.
c. Chiropractic treatments related to a covered injury/illness.
d. Surgical expenses related to a covered injury/illness.
b. Disability payments related to a covered injury/illness.
51
Which insurance act requires that the applicant’s information remain confidential and private:
a.Fair Credit Reporting Act (FCRA)
b.Privacy Act
c.Health Insurance Portability and Accountability Act (HIPAA)
d.Confidential Insurability Act
c.Health Insurance Portability and Accountability Act (HIPAA)
52
All of the following are benefits of the USA Patriot Act except:
a.Require insurers to develop new compliance systems and training
b.Increased regulation of financial services
c.Increased ability for financial institution to maintain employee integrity
d.Set rules and rates for insurance companies
d.Set rules and rates for insurance companies
53
The __________ accepts unclaimed checks and other property in the state of Florida. It is part of the __________.
a. Division of Lost Property; Department of Financial Services (DFS)
b. Division of Lost Property; Office of Financial Regulation (OFR)
c. Division of Unclaimed Property; Department of Financial Services (DFS)
d. Division of Unclaimed Property; Office of Insurance Regulation (OIR)
c. Division of Unclaimed Property; Department of Financial Services (DFS)
54
Limited benefit plans are referred to as all of the following except:
a.Limited risk policies
b.Specific illness policies
c.Dread disease policies
d.Critical illness policies
b.Specific illness policies
55
What percentage of benefits received under a group long term care policy are tax-exempt:
Question 6 Answer
a.75%
b.80%
c.100%
d.50%
c.100%
56
Which of the following is true of Medigap and Medicare Part C:
a. Both Medigap and Medicare Part C provide coverages not found in Medicare Advantage.
b. Medigap can be used to supplement the coverages of Medicare Part C.
c. It is not possible to have both Medigap and Medicare Part C.
d. It is illegal to write a Medigap policy for someone who has Medicare Part C.
d. It is illegal to write a Medigap policy for someone who has Medicare Part C.
57
The statistical principle that allows for predicting the degree or amount of loss that will be incurred in a given period is called:
a.Risk pooling
b.Claims experience
c.Loss expectancy
d.Law of large numbers
d.Law of large numbers
58
The duties of the Office of Insurance Regulation include all of the following EXCEPT:
a.Investigating market conduct
b.Approving policy forms
c.Establishing insurance rates
d.Rehabilitating or liquidating insurers
c.Establishing insurance rates
59
The association that pays claims to policyholders when an insurer becomes insolvent is the:
a.DFS
b.OIR
c.Guaranty Fund
d.OFR
c.Guaranty Fund
60
How many hours of course training must an applicant complete for a life and health license:
a.40 hours
b.200 hours
c.60 hours
d.20 hours
c.60 hours
61
The free look provision in a Health insurance policy is:
a.10 days
b.30 days
c.21 days
d.14 days
a.10 days
62
If a health policy includes both a deductible and coinsurance, which of the following is true.
a.
The deductible amount is only applied if it is greater than the coinsurance amount.
b.
The coinsurance amount is only applied if it is greater than the deductible amount.
c.
Coinsurance is applied after the deductible has been subtracted.
d.
The deductible is applied after the coinsurance has been calculated.
c.
Coinsurance is applied after the deductible has been subtracted.
63
Double and triple indemnity policies are known as:
a.Speculative policies
b.Valued contracts
c.Contracts of indemnity
d.Multiple protection policies
b.Valued contracts
64
In a family high deductible plan, the minimum deductible is:
a.$12,500
b.$1,250
c.$2,800
d.$2,000
c.$2,800
65
All of the following are optional health insurance provisions except:
a. Insurance with other insurers
b. Relations of earnings to insurance
c. Entire contract
d. Unpaid premiums
c. Entire contract
66
In the reinstatement provision, the insurer has how many days to take action on the application before the reinstatement is automatic:
a.20 days
b.45 days
c.31 days
d.30 days
b.45 days
67
The type of employee benefit plan that allow employees to select from multiple benefits is a:
a.Cafeteria plan
b.Adverse selection
c.Selective insurance plan
d.Combined plan
a.Cafeteria plan
68
An illness or disease in which the body can fully recover with medical treatment is an:
a.Chronic illness
b.Short-term disability
c.Acute illness
d.Temporary illness
c.Acute illness
69
All of the following are premium factors in health insurance except:
a.Morbidity
b.Interest
c.Expenses
d.Mortality
d.Mortality
70
Which of the following is true of a guaranteed renewable health insurance policy?
a.The premium may be increased for all members in the same insured class.
b.The premium may be increased for any individual member for any reason other than health issues.
c.The premium may not be increased.
d. The premium may be increased for any individual member for any reason.
a.The premium may be increased for all members in the same insured class.
71
Tom submitted his health insurance premium 20 days after the premium payment was due. It is an annual premium policy. The insurer must:
a.Void the policy
b.Cancel the policy
c.Continue the insurance coverage
d.Cancel the policy and require Tom to submit proof of insurability
c.Continue the insurance coverage
72
Which of the following is true of Major Medical Coverage:
Question 32 Answer
a.It may only be purchased through the government as a part of Medicare.
b.It may only be purchased on a group basis.
c.It may be purchased on either a group basis or an individual basis.
d.It may only be purchased on an individual basis.
c.It may be purchased on either a group basis or an individual basis.
73
Janet purchased an insurance rider that covers the costs of nursing home services. Which type of rider did Janet purchase?
a.Long term care rider
b.Disability income rider
c.Nursing home rider
d.Short term care rider
a.Long term care rider
74
Which provision allows an insurer to non-renew coverage in the event one or more conditions occur:
a.
Guaranteed renewable
b.
Conditionally renewable
c.
Mandatory renewable
d.
Optionally renewable
b.
Conditionally renewable
75
The Stop-Loss feature is designed to:
a.
Limit the claim expenses of the insurer
b.
Limit the out-of-pocket expenses for an insured
c.
Limit the period during which claims may be filed
d.
Limit the type of claims eligible for coverage
b.
Limit the out-of-pocket expenses for an insured
76
The primary purpose of the probationary period is to:
a.
Charge the insured a higher cost due to a pre-existing condition
b.
Lowers the premium of the policy if the insured cannot afford it
c.
Exclude coverage for pre-existing conditions
d.
Exclude coverage if the insured has a major accident
c.
Exclude coverage for pre-existing conditions
76
Insurance that is used to cover specific illnesses such as cancer or heart disease is:
a.
Disability Income Insurance
b.
Medicare supplement
c.
Group Health Insurance
d.
Limited Benefit Plans
d.
Limited Benefit Plans
77
The benefit payable for accidental loss of sight or dismemberment in an AD&D policy is the:
a.
Cash value
b.
Face amount
c.
Principal sum
d.
Capital sum
d.
Capital sum
78
The type of contract that states the insurer will pay a stated amount in the event of a loss is a:
a.
Indemnity contract
b.
Valued contract
c.
Contract of adhesion
d.
Conditional contract
b.
Valued contract
79
The Office of Financial Regulation has all of the following responsibilities except:
a.
Issue Certificate of Authority to insurance companies
b.
Investigate wrong doing
c.
Refer suspected violators to law enforcement agencies
d.
Regulations of banks
a.
Issue Certificate of Authority to insurance companies
80
Continuous around the clock care provided by licensed medical professionals is known as:
a.
Alternate care
b.
Custodial care
c.
Skilled care
d.
Intermediate care
c.
Skilled care
81
HIPAA requires health insurance policies to limit the exclusions of pre-exixting medical conditions to no longer than:
a.
18 months
b.
12 months
c.
6 months
d.
24 months
b.
12 months
82
All of the following must be contained in the Outline of Coverage except:
a.
A statement that identifies the category of insurance
b.
A brief description of the main benefits and coverages
c.
A statement from the agent about the insured physical health
d.
A summary statement of the cancellation and renewal provision
c.
A statement from the agent about the insured physical health
83
The free-look provision in Medicare insurance is how many days:
a.
20 days
b.
14 days
c.
10 days
d.
30 days
d.
30 days
84
An employer within a group insurance plan is issued which of the following as evidence of insurance:
a.
Certificate of coverage
b.
Master contract
c.
Binder
d.
Letter of insurance
b.
Master contract
85
Which of the following is true of non-grandfathered health plans:
a.
They must comply with all provisions of PPACA only.
b.
They must comply with all provisions of HIPPA only.
c.
They must comply with all provisions of HIPPA and PPACA.
d.
They are exempt from complying with the provisions of either HIPPA or PPACA.
b.
They must comply with all provisions of HIPPA only.
86
Which of the following is NOT true of an HMO:
a.
Members typically pay a fixed monthly fee plus an additional amount (copayment) for each medical service
b.
Non-emergency care is usually only covered if it is within the network
c.
A contract with an HMO may not be cancelled
d.
Health care providers are either employed by or contacted by the HMO
c.
A contract with an HMO may not be cancelled
87
In AD&D Insurance, the maximum death benefit amount is known as the:
a.Maximum sum
b.Principal sum
c.Total sum
d.Capital sum
b.Principal sum
88
If a Medicare-eligible person has an employer sponsored plan from a company with 20 or more employees, Medicare will pay benefits for covered expenses that:
a.
Are not covered by the Primary payor
b.
Are also covered by the primary payor
c.
Do not require a deductible
d.
Are split between the primary and secondary payor
a.
Are not covered by the Primary payor
89
The free look provision for a health insurance policy is:
a.
10 days
b.
7 days
c.
30 days
d.
14 days
a.
10 days
90
Workers Compensation insurance covers all of the following except:
a.
Death
b.
Sickness
c.
Disability
d.
Employee termination
d.
Employee termination
91
Which of the following relates to disability income insurance:
a.
Residual amount benefit
b.
Coinsurance
c.
First-dollar
d.
Indemnity benefits
a.
Residual amount benefit
92
Limited risk policies provide coverage for which of the following:
a.
Illnesses such as cancer or heart disease
b.
Accidents
c.
Injuries
d.
Work related accidents
a.
Illnesses such as cancer or heart disease
92
ABC Insurance canceled Bill's policy. The insurance contract had a cancellable provision in it. The insurer must:
a.
Charge Bill a surcharge since the policy was cancelled before the expiration date
b.
Notify the DFS that they cancelled Bills policy early
c.
Make Bill pay back the interest and dividends received
d.
Refund any unearned premium that has been paid
d.
Refund any unearned premium that has been paid
93
Jane has been diagnosed with terminal cancer. Which type of policy could Jane purchase to pay benefit for doctors visits, medicine etc.:
a.
A Medicare supplement
b.
A comprehensive major medical policy
c.
A major medical policy
d.
A dread disease policy
d.
A dread disease policy
94
ABC Company received a health claim from Bob the insured. ABC ordered a physical examination on Bob to check for pre-existing conditions. The insurer must:
a.
The insurer is not allowed to conduct a physical exam on a insured
b.
Pay for the examination
c.
Reduce the amount of the claim for the cost of the examination
d.
Require Bob the pay for the examination
b.
Pay for the examination
95
Long term care coverage may be classified into which of the following conditions:
a.
Acute illnesses only
b.
Chronic illnesses only
c.
Critical illnesses
d.
Both acute and chronic illnesses
d.
Both acute and chronic illnesses
96
XYZ Insurance Company excluded coverage for 6 months after Dan became disabled from falling off his ladder. Which provision allows the insurer to exclude coverage:
a.
Waiting period
b.
Probationary period
c.
Elimination period
d.
Exclusion period
c.
Elimination period
97
All of the following are mandatory provisions in health insurance policy except:
a.
Entire Contract
b.
Time limit on certain defenses
c.
Change of occupation
d.
Grace period
c.
Change of occupation
98
Jack was injured while burglarizing Susan's home. The insurer will:
a.
Pay only the premiums paid by Jack
b.
Pay the claim
c.
Deny Jack's claim
d.
Pay 50% of the claim since Jack committed a felony
c.
Deny Jack's claim
99
In a cancelable policy, the insurer may:
a.
Cancel the policy at any time
b.
Increase the premium
c.
Cancel the policy and/or increase the premium any time
d.
Deny any claim
c.
Cancel the policy and/or increase the premium any time
100
If an insured makes a warranty in an application and the warranty is untrue, the insurer may:
a.
Deny claims on the policy only
b.
Cancel the policy only
c.
None of these
d.
Cancel the policy and deny any claims on the policy
d.
Cancel the policy and deny any claims on the policy
101
The Office of Insurance Regulation does not concern itself with:
a.
Whether a life insurance agent became licensed simply because he/she wanted to write policies for his/her family only
b.
Whether insurers have developed adequate premium financing arrangements
c.
Whether a life insurance company has a sound marketing plan
d.
Whether a life insurance company is making sound investment decisions
c.
Whether a life insurance company has a sound marketing plan
102
The head of the Office of Financial Regulation is the:
a.
CFO
b.
CEO
c.
Commissioner of Financial Regulation
d.
Insurance commissioner
c.
Commissioner of Financial Regulation
103
A health insurance applicant with HIV must be given all of the following except:
a.
A mandatory 90 day elimination period
b.
Full notice of privacy
c.
Full notice of rights
d.
An opportunity to refuse permission for the use of information
a.
A mandatory 90 day elimination period
104
A customer may enroll in Medicare supplement insurance under the age of 65 only if which of the following occurs:
a.
The customer has benefits provided by Medicaid
b.
The customer has heart disease
c.
The customer has an approval from the Medicare insurer
d.
The customer is eligible for social security benefits
d.
The customer is eligible for social security benefits
105
intermediate care can be provided by all of the following except:
a.
Paramedic
b.
Registered nurse
c.
Practical nurse
d.
Nurse's aid
a.
Paramedic
106
When an employer has a key person disability income policy in place, which of the following is true:
a.
The employer may deduct the premiums as a business expense, and it may collect any benefits it receives tax free
b.
The employer may not deduct the premiums as a business expense, and it must pay taxes on any benefits it receives.
c.
The employer may deduct the premiums as a business expense, but it must pay taxes on any benefits it receives.
d.
The employer may not deduct the premiums as a business expense, but it may collect any benefits it receives tax free.
.
d. The employer may not deduct the premiums as a business expense, but it may collect any benefits it receives tax free.
107
In an individual high deductible plan, the minimum deductible is:
a.
$1,400
b.
$500
c.
$5000
d.
$4500
a.
$1,400
108
n a Health Reimbursement Account, ___ sets aside pre-tax dollars to pay for certain medical expenses.
a.
The employer
b.
The employer and the employee
c.
The employee
d.
The insurer
a.
The employer
109
The insured has how many days to submit proof of loss to the health insurer:
a.
60 days
b.
45 days
c.
90 days
d.
30 days
c.
90 days
110
The corridor deductible is only found is which type of insurance:
a.
Medicare
b.
Major medical
c.
Annuities
d.
Life insurance
b.
Major medical
111
The health insurance provision that requires the insurer to make immediate payment of the claim once the notification and proof of loss is received is the:
a.
Mandatory payment provision
b.
Time of payment of claims
c.
Immediate payment for loss
d.
Claims payment provision
b.
Time of payment of claims
112
The Misstatement of Age or Sex Provision is used in both life insurance and health insurance. Which of the following is true of this provision:
a.
It is a standard provision in both life and health insurance.
b.
It is an optional provision in life insurance, but a standard provision in health insurance.
c.
It is a standard provision in life insurance, but an optional provision in health insurance.
d.
It is an optional provision in both life and health insurance.
c.
It is a standard provision in life insurance, but an optional provision in health insurance.
113
Long term care defines all of the following as the types of care based on frequency and type of provider except:
a.
Professional care
b.
Custodial care
c.
Skilled nursing care
d.
Intermediate nursing care
a.
Professional care
114
Matt purchased a disability income policy with a noncancelable provision. The insurer may not:
a.
Make a policy change
b.
Raise the policy premium
c.
Renew the policy
d.
Process an endorsement
b.
Raise the policy premium
115
Rick submitted a claim to the insurer on July 1st. The insurer must provide or supply claim forms by:
a.
July 16
b.
July 1, same day
c.
August 1
d.
July 30
a.
July 16
116
in a long term care policy, the average age limit for policy issue is:
a.
79 years old
b.
65 years old
c.
55 years old
d.
50 years old
a.
79 years old
117
When an insurance policy may not be cancelled while it is in force but can be non-renewed for any reason, the policy is said to be:
a.
Cancellable
b.
Optionally renewable
c.
Noncancellable
d.
Conditionally renewable
b.
Optionally renewable
118
Noncancelable provisions are generally found in what types of policies:
Question 46 Answer
a.
Life insurance
b.
Disability income
c.
Annuities
d.
Medical expenses
b.
Disability income
119
The type of arrangement where the employer sets aside pre-tax dollars to pay for the employee's coinsurance or deductible is:
a.
HRA
b.
PPO
c.
FSA
d.
HMO
a.
HRA
120
The provision that states that the policy must be renewed as long as premiums are paid is:
a.
Cancelable
b.
Non-renewable
c.
Guaranteed renewable
d.
Optionally renewable
c.
Guaranteed renewable
121
The insurer may cancel or terminate the policy at any time. The insurer must provide written notice of cancellation at least 45 days in advance.
a.
Cancelable
b.
Non-renewable
c.
Guaranteed renewable
d.
Optionally renewable
a.
Cancelable
122
The insurer under no circumstances may cancel the policy nor can the premium or rates be increased.
a.
Non-renewable
b.
Guaranteed renewable
c.
Optionally renewable
d.
nonCancelable
d.
nonCancelable
123
Allows the insurer to terminate the coverage if one or more of the conditions in the contract are not met. The insurer may not terminate the coverage due to the insured’s health.
a.
Non-renewable
b.
Conditionally renewable
c.
Optionally renewable
d.
nonCancelable
b. Conditionally renewable:
124
The insurer has the option to terminate the policy on a specific date in the con- tract (usually the renewal date).
Optionally renewable:
125
In surgical expenses, the insurer determines how much benefit is payable based on what approach:
a.
Market value cost
b.
Reasonable and customary
c.
Actual cost
d.
Speculative cost
b.
Reasonable and customary
126
Group disability income plans are classified into which type of policies:
a.
Group variable plans
b.
Both, group short and long term disability plans
c.
Group short term disability plans only
d.
Group long term disability plans only
b.
Both, group short and long term disability plans
127
The type of beneficiary that may never be changed is a:
a.
Irreplaceable
b.
Revocable
c.
Irrevocable
d.
Unchanging
c.
Irrevocable
128
Which Medicare Part provides coverage for physicians and surgeons:
a.
Part B
b.
Part C
c.
Part A
d.
Part D
a.
Part B
129
The disability rider that stops insurance premiums if the insured becomes completely disabled is the:
a.
Waiver of premium rider
b.
Guaranteed insurability rider
c.
Delayed disability rider
d.
Estoppel premium rider
a.
Waiver of premium rider
130
The mandatory health insurance provision that states how and to whom claim payments are to be made is the:
a.
Claims limitation provision
b.
Beneficiary provision
c.
Payment of claims
d.
Time of payment of claims
c.
Payment of claims
131
ABC Company received a health claim from Bob the insured. ABC ordered a physical examination on Bob to check for pre-existing conditions. The insurer must:
a.
Require Bob the pay for the examination
b.
Reduce the amount of the claim for the cost of the examination
c.
Pay for the examination
d.
The insurer is not allowed to conduct a physical exam on a insured
c.
Pay for the examination
132
The sharing of medical expenses by the insured and the insurer is known as:
a.
Co-insurance
b.
Participation
c.
Contributory
d.
Integrated deductible
a.
Co-insurance
133
The amount payable as a death benefit in an accidental death and dismemberment policy is known as the:
a.
Capital sum
b.
Primary amount
c.
Principal sum
d.
Indemnity amount
c.
Principal sum
134
Employers are subject to COBRA compliance if they have at least how many employees:
a. 1
b. 5
c. 10
d. 20
d. 20
135
The Health Maintenance Act requires than an employer must have at least how many employees if providing health care benefits under an HMO:
a.
20
b.
25
c.
10
d.
5
b.
25
136
The insured must provide notice of a claim to the insurer within how many days after the loss occurs:
a.
30 days
b.
90 days
c.
20 days
d.
45 days
c.
20 days
137
When an insurance policy may not be cancelled while it is in force but can be non-renewed for any reason, the policy is said to be:
a.
Noncancellable
b.
Optionally renewable
c.
Cancellable
d.
Conditionally renewable
b.
Optionally renewable
138
The type of deductible that applies once per year is the:
a.
Lifetime deductible
b.
Per cause deductible
c.
Policy year deductible
d.
Calendar year deductible
d.
Calendar year deductible
139
Brian has been diagnosed with heart disease and needs insurance coverage to pay for doctor visits and medicine. Which type of policy should Brian purchase:
a.
A Specific illness policy
b.
A rare disease policy
c.
A critical illness policy
d.
A major medical policy
c.
A critical illness policy
140
The corridor deductible is only found is which type of insurance:
a.
Medicare
b.
Major medical
c.
Life insurance
d.
Annuities
b.
Major medical
141
John filed claim for disability due to a major accident. John's doctor stated he would be disabled for at least two years. How often must John submit proof of loss to the insurer:
a.
Every 6 months
b.
Only once
c.
John does not have to submit a proof of loss for disability
d.
Once a year
a.
Every 6 months
142
Reasonable and customary charges must be based on:
a.
The geographical part of the country where the insurer is domiciled
b.
The geographical part of the country where the surgery was performed
c.
Neither
d.
The geographical part of the country where the insured lives
b.
The geographical part of the country where the surgery was performed
143
xpenses in a major medical plan include all of the following except:
a.
Hospital room & board
b.
Nursing home facility
c.
Surgery
d.
Nursing services
b.
Nursing home facility
144
The policy clause that transfers the insured's rights of recovery against others to the insurer is:
a.
Subrogation clause
b.
Assignment clause
c.
Transfer clause
d.
Recovery clause
a.
Subrogation clause
145
All of the following are mandatory provisions in health insurance policy except:
a.
Time limit on certain defenses
b.
Change of occupation
c.
Grace period
d.
Entire Contract
b.
Change of occupation
146
All of the following are ways to qualify for Medicaid nursing home benefits except:
a.
Be at least age 65, bling or disabled
b.
Meet certain income tests
c.
Live in a low income city
d.
Be a US citizen
c.
Live in a low income city
147
The insurer allowed Sam to purchase additional amounts of disability income insurance without providing proof of insurability. Which type of rider does Sam have attached to his policy:
a.
Increase of coverage rider
b.
Benefit adjustment rider
c.
Additional coverage rider
d.
Guaranteed insurability rider
d.
Guaranteed insurability rider
148
Workers Compensation insurance covers all of the following except:
a.
Employee termination
b.
Death
c.
Disability
d.
Sickness
a.
Employee termination
149
All of the following are types of managed care organizations except:
a.
DPO
b.
EPO
c.
HMO
d.
PPO
a.
DPO
150
Which of the following is usually true about a group insurance policy:
a.
Requires physical exams for every employee
b.
It provides a lower cost than insuring each employee on separate policies
c.
The employer can exclude employees with medical conditions
d.
All choices are correct
b.
It provides a lower cost than insuring each employee on separate policies
151
The provision that prevents a company from exercising a right is a:
a.
Condition
b.
Estoppel
c.
Exclusion
d.
Waiver
b.
Estoppel
152
The act of persuading a policyowner to drop a policy for the purpose of selling another policy with the same insurer is considered:
a.
Twisting
b.
Coercion
c.
Churning
d.
Rebating
c.
Churning
153
The Office of Financial Regulation is responsible for all of the following except:
a.
Regulation of federal agencies
b.
Regulation of the securities industry
c.
Regulation of credit unions
d.
Regulation of banks
a.
Regulation of federal agencies
154
The maximum period that a policy may exclude coverage for a pre-existing condition is:
a.
12months
b.
6 months
c.
18 months
d.
8 months
a.
12months
155
The Medicare marketing provisions are established by the:
a.
OIR
b.
FINRA
c.
NAIC
d.
DFS
c.
NAIC
156
In a conditional contract, the insurer will pay benefits:
a.When the occurrence occur
b.When demanded by the beneficiary
c.Anytime before and after the contract effective dates
d.As soon as the
application is signed
a.When the occurrence occur
157
The provision in a Disability Income insurance policy that specifies a certain period in which no benefits will be payable is the:
a.
Waiting period
b.
Incontestable period
c.
Exclusion provision
d.
Probationary period
d.
Probationary period
