What is the purpose of respite care in long-term care insurance?

To provide relief for a major caregiver (usually a family member)

Who is responsible for the costs associated with the examination of insurers?

The insurer who is being examined

How can an HMO member see a specialist?

Referral by the primary care physician

Who is an insurance agent?

A person authorized to sell, solicit, and negotiate insurance contracts

Who is considered a nonresident agent?

Agent who resides in another state, but is licensed and authorized here.

In health insurance, what is considered a sickness?

An illness that first arises while the policy is in force

What are the two types of Flexible Spending Accounts?

Health care accounts and Dependent care accounts

When can the Commissioner or Director examine insurers?

Whenever deemed necessary, but at least once every few years

For what reason can a temporary license be issued?

For business continuation upon producer death/disability.

Under what type of care do insurers negotiate contracts with health care services at a favorable cost?

Preferred Provider Organization (PPO)

What are the three types of basic medical expense insurance?

Hospital, surgical, and medical

What are producers required to do in order to renew their license?

Pay a renewal fee and complete continuing education hours

What is the role of the gatekeeper in an HMO plan?

To control costs for the services of specialists

In general, who can be excluded from producer licensing and examination requirements?

Insurance company employees who do not transact insurance

What is the purpose of a cease and desist order?

To stop producer/insurer law violations in insurance.

What is the purpose of COBRA?

To allow continuation of health insurance coverage for terminated employees

Who may share in the commission from the sale of a life insurance policy?

Only producers properly licensed for the type of insurance transaction

What is the purpose of a buy-sell agreement for health insurance policies?

To outline ownership transition in the event of death or disability.

Can Alzheimer's disease be excluded from coverage under a long-term care policy?

No, Alzheimer's and Parkinson's must be covered.

What is the primary purpose of disability income insurance?

To replace income lost due to a disability

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Health Insurance Exam Guide

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Questions 30

Answers

1
What is the purpose of respite care in long-term care insurance?
To provide coverage for dental procedures
To cover alternative therapies and treatments
To provide relief for a major caregiver (usually a family member)
To offer financial support during retirement
2
What type of licensee represents the insurance company?
The broker
The underwriter
The adjuster
The agent
3
Who is responsible for the costs associated with the examination of insurers?
The reinsurers of the insurer
The insurer who is being examined
The state insurance department
The policyholders of the insurer
4
How can an HMO member see a specialist?
Referral by the primary care physician
Self-referral
Approval from the insurance company
Directly visiting the specialist
5
Who is an insurance agent?
An individual who reviews claims and determines payouts
A representative of an insurance company's legal department
An employee responsible for policy administration
A person authorized to sell, solicit, and negotiate insurance contracts
6
Who is considered a nonresident agent?
An agent who has not completed their license application
An agent who sells policies internationally
Agent who resides in another state, but is licensed and authorized here.
An agent who does not work for any specific insurance company
7
In health insurance, what is considered a sickness?
An illness that first arises while the policy is in force
Any injury or accident-related medical issue
A condition that existed before the policy was purchased
Any medical condition present at birth
8
What are the two types of Flexible Spending Accounts?
Charitable donation accounts and Home improvement accounts
College savings accounts and Entertainment accounts
Health care accounts and Dependent care accounts
Retirement accounts and Vacation savings accounts
9
Who are the parties in a group health contract?
The employee and the insurer
The primary care physician and the insurer
The government and the insurer
The employer and the insurer
10
When can the Commissioner or Director examine insurers?
Every ten years, regardless of circumstances
Annually on the insurer's anniversary date
Whenever deemed necessary, but at least once every few years
Only during business hours
11
For what reason can a temporary license be issued?
To allow producers to work only on weekends
To grant limited access to new producers
To provide trial opportunities for aspiring producers
For business continuation upon producer death/disability.
12
If an insurer is approved to transact business in the state, it is considered what type of insurer?
Qualified or selected
Independent or non-admitted
Exclusive or premium
Authorized or admitted
13
In group insurance, what is the name of the policy?
Shared policy
Group coverage
Groupmaster contract
Master policy
14
Under what type of care do insurers negotiate contracts with health care services at a favorable cost?
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Exclusive Provider Organization (EPO)
Fee-for-Service (FFS)
15
What are the three types of basic medical expense insurance?
Emergency, preventive, and chronic care
Hospital, surgical, and medical
Inpatient, outpatient, and specialist care
Dental, vision, and prescription drugs
16
Agent gives event tickets in exchange for the purchase of insurance The agent is guilty of?
Defamation
Fraud
Rebating
Misrepresentation
17
What are producers required to do in order to renew their license?
Submit a new license application
Provide proof of personal health insurance
Attend an industry conference
Pay a renewal fee and complete continuing education hours
18
What is the role of the gatekeeper in an HMO plan?
To manage appointment schedules for all members
To control costs for the services of specialists
To oversee hospital admissions
To provide direct medical care
19
In general, who can be excluded from producer licensing and examination requirements?
All individuals with a college degree
Insurance company employees who do not transact insurance
All insurance company employees
All individuals with prior insurance experience
20
What's the illegal act of presenting a policy in a more favorable light than the policy really is?
Salesmanship
Marketing
Misrepresentation
Promotion
21
What is the purpose of a cease and desist order?
To ensure that producers receive proper training
To encourage producers to sell more policies
To stop producer/insurer law violations in insurance.
To promote ethical behavior within the industry
22
What if a company falsely claims it has funds that are not avaliblefor the payment of losses or claims guilty of?
Honest errors
Promotional tactics
Marketing strategies
Misrepresentation
23
What type of licensee represents the insured?
Adjuster
Underwriter
Broker
Agent
24
What is the purpose of COBRA?
To offer extended vacation benefits
To allow continuation of health insurance coverage for terminated employees
To provide enhanced dental coverage
To provide coverage for international travel emergencies
25
Who may share in the commission from the sale of a life insurance policy?
Any licensed professional in the financial industry
Only producers properly licensed for the type of insurance transaction
The policyholder's family members
The insurance company's executives
26
What is the purpose of a buy-sell agreement for health insurance policies?
To provide coverage for employees' health care expenses
To facilitate transferring policies to family members
To outline ownership transition in the event of death or disability.
To allow employees to buy insurance policies from the employer
27
Can Alzheimer's disease be excluded from coverage under a long-term care policy?
Yes, any pre-existing conditions are excluded
Only if specifically mentioned in the policy
No, Alzheimer's and Parkinson's must be covered.
No, but only if the policyholder is above a certain age
28
How are HMO territories typically divided?
Number of hospitals in an area
Age groups of members
Geographic areas
Income levels of members
29
With key person disability insurance, who pays the policy premiums?
The insurance company
The employees collectively
The business (employer)
The insured employee
30
What is the primary purpose of disability income insurance?
To provide coverage for routine medical expenses
To replace income lost due to a disability
To offer coverage for mental health issues
To cover only catastrophic disabilities

Health Insurance Exam Guide Flashcards | StudBud