Question 1

``` What type of renewability guarantees premium rates and renewability? Optionally renewable Conditonally renewable Noncancellable Guaranteed renewable ```

Accepted Answer

Noncancellable

Question 2

All of the following statements about Major Medical benefits are true, EXCEPT: The deductible can be expressed as a fixed dollar amount The benefit period begins only after a specified amount of expenses have accrued Benefits are generally expressed as a percentage of eligible expenses Benefits have no maximum limit

Accepted Answer

Benefits have no maximum limit

Question 3

``` A disability elimination period is best described as a: time deductible dollar deductible eligibility period probation period ```

Accepted Answer

time deductible

Question 4

The difference between group insurance and blanket health policies is: Blanket health policies do not issue certificates Group health policies do not issue certificates Group health plans may be issued to an airline to cover its passengers Blanket health policies are sometimes called wholesale plans

Accepted Answer

Blanket health policies do not issue certificates

Question 5

An assignment of benefits of a Health Policy: transfers payments to someone other than the policyowner is prohibited by state law is allowed only on policies dates after 1992 transfers rights from the company to the policyholder

Accepted Answer

transfers payments to someone other than the policyowner

Question 6

``` Which of the following statements describes what an Accident and Health policyowner may NOT do? File a covered claim Assign ownership Cancel the coverage Adjust the premium payments ```

Accepted Answer

Adjust the premium payments

Question 7

The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately described as: Employee's coverage paid for by the employer is considered taxable income to the employee Employee's premiums paid by the employer is tax-deductible to the employer as a business expenditure Employer is given tax credits for contributions made to an employer-provided group health plan Benefits are taxable to the employee

Accepted Answer

Employee's premiums paid by the employer is tax-deductible to the employer as a business expenditure

Question 8

``` S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? 36 18 15 6 ```

Accepted Answer

36

Question 9

``` A policy of adhesion can only be modified by whom? The agent The applicant The primary beneficiary The insurance company ```

Accepted Answer

The insurance company

Question 10

What action should a producer take if the initial premium is NOT submitted with the application? Keep the application until premium is paid Forward the application to the insurer after giving the applicant a binding receipt Forward the application to the insurer without the initial premium Forward the application to the insurer after giving the applicant a conditional receipt

Accepted Answer

Forward the application to the insurer without the initial premium

Question 11

When must insurable interest exist for a life insurance contract to be valid? Inception of the contract Throughout the entire length of the contract When the insured dies During the contestable period

Accepted Answer

Inception of the contract

Question 12

What is the purpose of the Time of Payment of Claims provision? Requires the insured to wait 60 days after submitting Proof of Loss before filing a lawsuit Prevents delayed claim payments made by the insurer Requires a probation period for each claim filed by the insured Protects the insurer from frivolous lawsuits

Accepted Answer

Prevents delayed claim payments made by the insurer

Question 13

``` Any changes made on an insurance application requires the initials of whom? Insured Producer Applicant Beneficiary ```

Accepted Answer

Applicant

Question 14

``` A medical care provider which typically delivers health services at its own local medical facility is known as a: Health Maintenance Organization Regional Provider Multiple Employer Trust Preferred Provider Organization ```

Accepted Answer

HMO

Question 15

``` The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs? Social Security Disability Income Medicare Supplements Medicaid COBRA ```

Accepted Answer

SS

Question 16

Which type of provider is known for stressing preventative medical care? Multiple Employer Welfare Arrangements (MEWA) Major medical provider Health Maintenance Organizations (HMO's) Preferred Provider Organizations (PPO's)

Accepted Answer

HMO

Question 17

``` Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract? Consideration Entire Contract Free-look Insuring ```

Accepted Answer

Entire Contract Policy must include everything including initial application

Question 18

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges? The maximum premium an insurer can charge for their health insurance based on geography The maximum amount an employer can contribute to a contributory health plan The maximum deductible an insured can be charged The maximum amount considered eligible for reimbursement by an insurance company under a health plan

Accepted Answer

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

Question 19

M applies for a health insurance policy and pays the initial premium. When the agent completes the application, a conditional receipt is left with the applicant. The insurance company’s underwriting department request’s M’s medical records and determines that M has had asthma for many years. All of the following are probable underwriting outcomes, EXCEPT: Deny coverage Approve with a higher premium Changing the policy's provisions Attach a rider excluding specified coverages

Accepted Answer

Changing the policy's provisions

Question 20

Which of the following statements regarding a referral is INCORRECT? Referral fees may only be nominal The person making the referral may not discuss the specific policy terms and conditions Referral fees may not be tied to the purchase of a policy Referral fees must be filed and approved with the Commissioner of Insurance

Accepted Answer

Referral fees must be filed and approved with the Commissioner of Insurance

Question 21

P is a producer who notices 5 questions on a health application were not answered. What actions should P take? Mail incomplete application to applicant to be completed and returned to the agent Submit the application as-is to the insurer Call the applicant and complete application over the phone Set up a meeting with the applicant to answer the remaining questions

Accepted Answer

Set up a meeting with the applicant to answer the remaining questions

Question 22

``` A physician opens up a new practice and qualifies for a $7,000/month Disability Income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow? Extended Term rider Cost of Living Adjustment rider Guaranteed Insurability Option rider Waiver of Premium rider ```

Accepted Answer

Guaranteed Insurability Option rider

Question 23

``` According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid? 7 days 10 days 31 days 60 days ```

Accepted Answer

31

Question 24

``` If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses? Long-term care Indemnity Medicare Supplement Medicaid ```

Accepted Answer

Medicare Supplement

Question 25

What is the maximum Social Security Disability benefit amount an insured can receive? 50% of the insured's Primary Insurance Amount (PIA) 75% of the insured's Primary Insurance Amount (PIA) 100% of the insured's Primary Insurance Amount (PIA) 100% of the insured's Primary Insurance Amount (PIA) minus any monies received from a retirement plan

Accepted Answer

100% of the insured's Primary Insurance Amount (PIA)

Question 26

``` Taking receipt of premiums and holding them for the insurance company is an example of: Commingling Misappropriation Theft Fiduciary responsibility ```

Accepted Answer

Fiduciary responsibility A trustee

Question 27

``` J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? Think Guaranteed Renewable Noncancelable Optionally Renewable Conditionally Renewable ```

Accepted Answer

Noncancelable

Question 28

``` When must insurable interest be present in order for a life insurance policy to be valid? When the insured dies Within the incontestability period When the application is made Before the insured dies ```

Accepted Answer

When the application is made

Question 29

``` T is covered by two health insurance plans: a group plan through his employer and his spouse’s plan as a dependent. Under the Model Group Coordination of Benefits provision, when T files a claim, his employer's plan is considered the: Principal carrier Surplus carrier Primary carrier Secondary carrier ```

Accepted Answer

Primary

Question 30

what is a warranty? guarantees that an insurance company will pay a benefit is a statement believed to be true to the best of one's knowledge cannot be used to void the contract is a statement guaranteed to be true

Accepted Answer

a statement guaranteed to be true

Question 31

What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled? Accidental Death and Dismemberment rider Disability Income rider Guaranteed Insurability rider Waiver of Premium rider

Accepted Answer

Waiver of Premium rider

Question 32

P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA laws, which of the following statements is TRUE? She DOES need to provide evidence of insurability She does NOT need to provide evidence of insurability She will have up to 6 months to convert to an individual policy She will be paying exactly the same premium for the individual plan as she did the group plan

Accepted Answer

She does NOT need to provide evidence of insurability

Question 33

``` When does a Probationary Period provision become effective in a health insurance contract? At the policy's inception 30 days after the policy's inception When a claim is submitted When a covered loss occurs ```

Accepted Answer

Policy's inception

Question 34

``` An insurer must provide an insured with claim forms within __ days after receiving notice of a loss. 5 10 15 20 ```

Accepted Answer

15

Question 35

Basic Hospital and Surgical policy benefits are: lower than the actual expenses incurred higher than the actual expenses incurred normally subject to deductibles normally subject to coinsurance

Accepted Answer

lower than the actual expenses incurred

Question 36

``` Which of these factors do NOT play a role in the underwriting of a health insurance policy? Avocations Credit status Marital status Occupation ```

Accepted Answer

Marital status

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TN Health Flashcards

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