During the underwriting process for a group health policy, it was discovered that 15 out of 50 members of the group have major health issues. How would the insurer handle this? -Accept or reject the whole group Accept or reject the whole group What percentage of eligible employees must participate in a noncontributory group health plan before it can be put in effect? -0% Who is financially liable for the payment of covered claims in a fully insured group health plan? -Insurer Minimum participation standards exist for group health insurance plans in order to... -cover the agent's commission prevent adverse selection Business Overhead Expense Insurance pays for... -business expenses when a business owner becomes disabled business expenses when a business owner becomes disabled
A policy that covers an NFL quarterback's arm or a singer's voice may not be covered by an AD&D Policy or a health policy is a... -limited risk policy Which of the following is NOT typically covered under vision care insurance? -Retina surgery The problem of overinsurance is addressed in which health insurance provision? -Entire contract Buy-sell plans are typically funded by which two types of insurance? -Life insurance and disability insurance -Life insurance and disability insurance Coverage is limited for vision and dental insurance in all of the following ways EXCEPT... -Number of teeth cleanings per year Specific dollar amount for examinations Which of the following statements pertaining to health insurance policy premium factors is CORRECT? -A "policy fee" is another term for policy premium. Health insurance policies are paid for on a year-by-year basis and are subject to periodic increases. An employee for XYZ Corp is injured on the job. Where does coverage for the employee's injuries come from? -Employer's group health plan Medicare Part B has an initial enrollment period. How many months after an individual's 65th birthday month does this enrollment period end? -1 months Coverage for care received from a network provider pays more than care received from a non-network provider in what type of health plan? -Hospital indemnity Preferred Provider Organization (PPO) At age 65, which of the following is available at no cost to all individuals? -Medicare
Select Which statement is TRUE regarding Workers' Compensation coverage... -Negligence is a factor in determining the employer's liability Employer pays the entire premium for Workers' Compensation coverage How is a Medicare claim submitted? -Expenses are submitted to Medicare by the Commissioner Expenses are submitted to Medicare by the health provider Which statement about Health Maintenance Organizations is NOT true? -Members minimize out-of-pocket expenses by using HMO network providers When a member uses out-of-network providers, a higher monthly fee is charged Which of the following does Medicare Part A NOT provide coverage for? -Doctor's services Which statement regarding Medicare is true? -Nursing home coverage is covered by Part B Benefits for diagnostic tests and X-rays performed on an outpatient basis are provided by Part B Who acts as the gatekeeper in a Health Maintenance Organization (HMO)? -Policyowner Individuals become eligible for Medicare Part A benefits at what age? -50 Disabled workers are covered under Workers' Compensation medical expense benefits for how long? -6 months Medicare Part A covers what type of care? -Skilled nursing facility care Skilled nursing facility care Basic Medical Expense policies generally begin to pay benefits... -on day 1 Which of the following does specified disease insurance NOT cover? -costs covered by medical expense insurance costs covered by medical expense insurance Allen has a disability income policy with a $2,500 monthly benefit and a 30-day elimination period. He is unable to work 90 days following an automobile accident. What will the policy pay? -$0 -$5,000 [90 days - 30 day elimination period is 60 days (2 months). 2 months X $2,500/month benefit = $5,000 total benefit paid] Which of the following is NOT included in comprehensive major medical plans? -Maximum coverage limits Medical expense policies will typically cover which of the following? -Injuries caused by accidents Injuries caused by accidents When does an insured qualify for stop-loss coverage? -When the insured reaches an age stated in the policy When claims exceed a specified limit in a set period of -time Which of these statements is NOT true concerning recurrent disabilities? -The insurer continues coverage after a new elimination period The insurer continues coverage after a new elimination period What does a Hospital Confinement indemnity policy pay for? -Pays for the entire cost of the hospital stay Pays a specified daily amount while the insured is confined to a hospital Which of the following terms is NOT associated with a Major Medical policy? -Stop-loss What does the term coinsurance refer to? -The stated initial dollar amount that the individual insured is required to pay before insurance benefits are paid After the deductible is satisfied, the percentage paid by the insured for the remaining covered expenses Which of the following riders guarantees the insured the option of purchasing additional amounts of disability income coverage at predetermined times without requiring the insured to provide evidence of insurability? -Guaranteed insurability rider Guaranteed insurability rider In what form do disability income policies typically pay benefits? -Lump sum Which type of disability would be less than total impairment and equal to permanent impairment? -Partial total disability Permanent partial disability What is the elimination period of an individual disability policy? -Time period an insured must wait before coverage begins Time period a disabled person must wait before benefits are paid The factor used most often when underwriting a disability income policy is... -annual earnings Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this? -Guaranteed insurability rider Guaranteed insurability rider A disability policyowner is injured and becomes totally disabled. The benefits pay for 2 years, starting from the date of the injury. What is this time period called? -Recurrent
period What is the primary factor that determines the benefits paid under a disability income policy? -Education level Coming from an insurance point of view, which of the following is the main risk associated with disability? -Loss of limbs A disability income policy can prevent an insured from earning a higher income than if he/she were working by utilizing... -elimination periods Frank is shopping for a disability income policy. Which of the following would have the HIGHEST premium? -14 day waiting period / 5 year benefit period 14 day waiting period / 10 year benefit period What portion does an insured pay for covered expenses under Medicare Part B after the deductible? -20% Which of the following would be considered an activity of daily living under a long term care policy? -Bathing Periodic increases in policy benefits are allowed in which long-term care policy provision? -Entire contract All of these statements concerning Medicare are true EXCEPT... -Medicare is primarily funded by Federal payroll and self-employment taxes Long-term care is covered by Medicare Part C Which of the following plans will cover medical costs that Medicare doesn't cover? -Major medical Which of the following is NOT a required uniform provision in individual health policies? -Change of occupation The misstatement of age provision in a health policy states that if an insured gives the wrong age at the time of application, what action can the insurance company take? -Reissue the policy The conditions, times, and circumstances under which an insured is NOT covered by a health policy are called... -reinstatements Under a health insurance policy, the provision that states the kind of benefits provided and the circumstances under which they will be paid is called the... -payment of claims provision In what situation does a waiver of premium provision keep a health insurance policy in force without premium payments? -When an insured becomes
unemployed When an insured becomes totally disabled Under the Payment of Claims provision, when are benefits typically payable after proof of loss is received? -within 60 days The insurer has the option of terminating a health insurance policy on a date stated in the contract. What type of policy is this? -Optionally renewable Which type of health insurance policy cannot be canceled by the insurer nor increase the premiums? -Renewable Christine has a health insurance policy that has been in force beyond the incontestable period. The insurer has discovered that a fraudulent statement was made on the application. What would the insurer have to pay on a claim, assuming this wasn't a guaranteed renewable policy? -Nothing A health insurance policy paid on a quarterly basis has a grace period of... -7 days What type of changes can be made to a guaranteed renewable health insurance policy? -The policy's provisions The premium rates of the policyowner Assume the following individuals are issued health insurance policies with varying renewability provisions. All other factors being equal, who would pay the highest premium? -Dana-cancellable What is the effect of an impairment rider attached to a health insurance policy? -To increase the premium rate charged To exclude from coverage losses resulting from specified conditions Each of the following is a significant consideration in the underwriting of individual health insurance risks except... -Occupation If a health insurance policy has lapsed and it is later reinstated, the reinstated policy will cover only sickness that begins... -After the date of reinstatement At least 10 days after the date of reinstatement An increase in which factor will decrease the disability insurance premium? -Expenses used Which of these factors do NOT affect the rates of medical insurance? -Health Which of the following is NOT considered to be insurer expenses? -Maintenance costs Which of the following is NOT a factor in determining the morbidity of a group of individuals? -Health What is the term used to describe the frequency and severity of certain illnesses and accidents? -Morbidity Jim is the insured on a health insurance policy and holds 2 jobs. If "occupation" is used to classify the risk, the insurer will most likely classify Jim according to the occupation that... -is most hazardous Which of the following is the purpose of medical cost management? -To influence hospital charges and doctors' fees To control health claim expenses Which of the following statements most aptly describes health insurance benefits? -Each policy offers a single type of benefit. The greater the benefits, the higher the premium. One technique that helps to control health care costs is a requirement for... -Preexisting conditions Which of the following is considered a moral hazard in health insurance underwriting? -Morbid
obesity The cost of services charged by the Health Insurance Counseling Advocacy Program (HiCap) is... -$25 per appointment Which of the following is NOT covered by the Family and Medical Leave Act (FMLA)? -Pregnancy Traveling overseas with a spouse The California Insurance Code allows an individual how many days to cancel a life policy for a full-refund? -Up to 10 days MRMIP is a... -state program that offers health coverage to California residents who are not able to obtain coverage due to pre-existing conditions state program that offers health coverage to California residents who are not able to obtain coverage due to pre-existing conditions Both the Federal and state governments jointly finance which health insurance entitlement program? -Medi-Cal Where must you specifically reside to qualify for MRMIP? -North America MRMIP stands for... -Minor Risk Medical Insurance Program Major Risk Medical Insurance Program Which of the following does the California Department of Insurance (CDI) have NO jurisdiction over? -Medicare According to PPACA, what is a health benefits exchange? -An entity to which individuals and small
businesses can have access to affordable health coverage An entity to which individuals and small businesses can have access to affordable health coverage Who does a life settlement broker represent? -Insurance company Individual wanting to sell their life policy to a third party Before an insurer is allowed to test an individual for HIV, what must be completed? -Consent form What is an insurance solicitor authorized to do? -Settle life insurance claims Help an agent or broker sell insurance
What does the term "illustration" mean when used in the phrase "life insurance policy illustration", according to the California Insurance Code? -Publication designed to help an applicant reach an informed decision about which coverage is appropriate Presentation of policy features that includes non-guaranteed elements An individual who transacts life, disability, or life and accident and health insurance on behalf of an insurer is called a(n)... -adjuster What is the insurance term the State of California uses for an insurer that is eligible to transact business in this state? -Admitted How many "activities of daily living" must an insured be UNABLE to perform in order to meet the chronically ill requirement of a Long-Term Care policy? -Minimum of one activity of daily living Minimum of two activities of daily living A person who asserts a right of recovery under an insurance policy is called... -tertiary What is required after a life agent sells an insurance policy to an applicant without being appointed by the insurer? -Notice of appointment must be submitted to the Commissioner Notice of appointment must be submitted to the Commissioner Which of the following does NOT have to be included on life insurance policy illustrations? -Age of the insured Statement that all values and benefits are guaranteed Pete is a life agent who has misappropriated fiduciary funds to his own use. What is Pete guilty of? -Fiduciary
misappropriation According to the PPACA, an adult can be covered by a parent's health care plan until what age? -Age 18 What does the term "indemnity" mean as it pertains to insurance? -To overinsure The free-look period for life insurance policyowners age 60 or older is... -10 days In California, the elderly can receive information about health related issues from... -Medi-Cal Health Insurance Counseling and Advocacy Program (HiCAP) According to PPACA, how long can an adult be covered as a dependent under their parents' insurance plan? -Up to age 18 Kimberly is an employee on leave under the Family and Medical Leave Act (FMLA). What will happen to her group health coverage? -She will have to purchase short-term health coverage through the State while on leave She continues to be enrolled during the leave The California Insurance Code requires that an insurer must have enough assets to cover its liabilities and for reinsurance of all outstanding risks. To remain solvent, it must also possess additional assets equal to what amount?. -50% of its stock value Jim is applying to become an insurance agent and has a past misdemeanor conviction that was later expunged due to California Penal Code 1203.4. Which of the following statements is correct? -Jim is not required to disclose the conviction on his insurance license application Jim must still disclose the conviction on his insurance license application How long must life agents keep their transaction records? -3 years Life insurance surplus must be distributed to policyowners at what frequency? -Monthly The California Insurance Code defines "policy" as a(n)... -accepted offer Which of the following acts is NOT a Federal offense committed by an insurance agent? -Embezzlement Misrepresentation on an insurance application Which of the following is NOT a primary objective of insurance regulation? -Insurance Code enforcement Interpret policy provisions In what order are people on the MRMIP waiting list allowed to enroll? -Based on the date an individual's application is received Based on the date an individual's application is received What type of license is required for an individual who charges a fee to review an insured's existing life insurance policy? -Adjuster Life and disability analyst In California, an insurer organized under the state laws of Oregon is called a(n)... -unauthorized insurer What is an insurance solicitor authorized to do? -Settle life insurance claims Help an agent or broker sell insurance An insurance company entitled to transact business in California is called a(n)... -authorized carrier Which word implies permissiveness according to the California Insurance Code? -May Which of the following is NOT considered to be an unfair claims settlement practice? -Advising a claimant to hire an attorney Advising a claimant to hire an attorney When intentional concealment is involved, what course of action is the injured party entitled to? -Rescission of the contract Rescission of the contract Which of the following is NOT protected under the California Life and Health Guarantee Association? -Policyowners According to the California Insurance Code, what term is used to describe a fact so important it could affect the policy premium? -Guarantee According to the California Insurance Code, what is "insurance"? -A
contract People with low income can be provided with medical assistance through which program? -Medi-Cal How long must a policy be in force before an insurer is prohibited from denying claims based on misstatements made on the health policy application? -1 year Paul has an existing annuity and is sold a new one, in which the new policy holds no greater financial benefit to him than the existing contract. This is considered a(n)... -illegal transaction When an insurer has met the qualifications necessary to transact business in California, it is said to be... -admitted Anyone employed in California to assist an insurance agent in transacting insurance is called an insurance... -assistant The California Life and Health Insurance Guarantee Association covers all of these types of policies EXCEPT... -Whole life Which type of jurisdiction requires an insurer to have its rates accepted by the Insurance Department prior to using them? -Prior acceptance What is the purpose of the Pre-Existing Condition Insurance Plan (PCIP)? -PCIP was created by the PPACA for people rejected by private health insurers due to pre-existing
conditions PCIP was created by the PPACA for people rejected by private health insurers due to pre-existing conditions What effect did the Pregnancy Discrimination Act have on the health industry? -Pregnancy qualifies a woman for paid leave from work Pregnancy must be treated as any other medical condition How is an agent's first year commission calculated for a replacement long-term policy? -Based on the new policy's annual premium Based on the difference between the new and original policy annual premiums According to the California Insurance Code, how is the word "may" interpreted? -Irrevocable According to the California Insurance Code, what is the maximum penalty per violation for anyone who unwillfully commits an unfair method of competition? -$1,000 An agent's attempt to stop the replacement of an existing life insurance policy is known as... -preservation In what situation does a waiver of premium provision keep a health insurance policy in force without premium payments? -When an insured becomes unemployed When an insured becomes totally disabled Which of the following is NOT an accurate description of Access for Infants and Mothers Program (AIM)? -Eligibility is based on income Only women who have private insurance plans with a maternity-only deductible or copayment greater than $1,500 are eligible
Which of the following actions is NOT allowed by Health Insurance Counseling and Advocacy Program (HiCAP) counselors? -Medical record keeping assistance According to the PPACA, the medical enrollment tier that has 80% actuarial value is called... -platinum |