A warranty is defined as which of the following?

Statement in the application that is guaranteed to be true

If a premium is submitted with the application and a conditional receipt is issued, coverage is effective:

The date of the application, or date of completed medical exam if required

All of the following are characteristics of a group disability plan except:

Benefits are based on a % of income at the time the policy was issued

If a premium is not paid at the time of app, the producer will obtain which of the following at the time of delivery?

Signed statement of good health

Medicaid differs from Medicare in that it is:

A federal-state medical assistance program from low income persons

Producer must meet the applicant in person and have them initial changes

A Flexible spending account can only be opened if:

Offered through an employer-established benefits plan

A LTC policy provides benefits in each setting except:

Therapeutic care in an acute care hospital

To qualify for social security disability, an individual must be unable to:

Perform any substantial gainful activity

The purpose of a respite care benefit in a LTC policy is to:

Give a primary caregiver a break

Which of the following statements regarding reinstatement of a health insurance policy is NOT correct?

The insurer must approve the reinstatement application within 45 days

Under the legal actions provision, the insured cannot take legal action against the insurer for at least:

60 days after providing proof of loss

When an individual pays the full cost of individual disability insurance, the disable insured's benefit will be:

Nontaxable in full, regardless of wage

The terms "usual, customary, and reasonable" refer to which of the following?

The average charge for a medical procedure in a defined geographical area

To be eligible for a Medicare Supplement an individual must be:

enrolled in Medicare Parts A & B

Which of these statements best describes the difference between any and own occupation

Own occupation is less restrictive because it is easier to qualify for

In a guaranteed renewable policy, the premiums may:

Be increased for all similarly classified insureds based on age

A typical hospital indemnity insurance plan provides payment of benefits in which of the following ways?

A daily benefit based on a stated dollar amount paid to the insured

Basic health plans provide "first dollar coverage" which means:

Benefits are payable at the first dollar of expenses without a deductible

When a disability buyout is funded by the partners the premiums are:

Not tax deductible and the value of the benefit is not taxable

Insured is responsible for 3 months premium and will receive a $300 refund

Reduce the benefit based on what the premiums paid would have purchased

Reduce the benefit to amount the actual premium paid would have purchased

A High Deductible Health Plan is a:

A health plan with a high deductible and lower premium

Principal sum of $1 million for double dismemberment

An insurance company would most likely use an impairment rider in which of the following situations?

G is wants a disability policy but is concerned about a heart condition

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General Health Insurance Review

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Questions 61

Answers

1
A warranty is defined as which of the following?
Statement in the application that is guaranteed to be true
A substantially true statement
Intential misrepresentation on the application
A false statement in the application
2
Which of the following is not an allowable exclusion in an LTC policy?
Services provided outside the United States
Intentionally self-inflicted injury
Care provided in an acute care unit of a hospital
Alzheimer’s disease
3
If a premium is submitted with the application and a conditional receipt is issued, coverage is effective:
The date the insured or owner signed the policy delivery receipt
The date of the application, or date of completed medical exam if required
The date the insurance company received the results of a medical exam
The date the policy is issued and mailed to the producer
4
All of the following are characteristics of a group disability plan except:
Premiums are paid based on contributory or noncontributory basis
Benefits are based on a % of income at the time the policy was issued
Issued as nonoccupational
Coverage can be offered based on short or long term disabilities
5
For life and health insurance, insurable interest must exist at the time of:
Application and Loss
Policy Delivery
Application
Loss
6
The elimination period in a disability policy:
Addresses where accidents and sickness must not occur for claims to be paid
Serves as a time deductible
Defines what causes of loss are eliminated from coverage
Describes how long the policy must be in force before claims can be file
7
If a premium is not paid at the time of app, the producer will obtain which of the following at the time of delivery?
Conditional receipt
Signed statement of good health
Attending Physician's Statement
Notice of consent
8
Medicaid differs from Medicare in that it is:
Optional coverage for Medicare beneficiaries
Only available to persons over 21 and under 65
Health insurance for persons who do not have group health insurance
A federal-state medical assistance program from low income persons
9
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The applicant will be able to make corrections when the policy is delivered
Producer must meet the applicant in person and have them initial changes
The producer can make changes with verbal consent of applicant
Once the app is signed answers cannot be changed
10
A Flexible spending account can only be opened if:
Offered through an employer-established benefits plan
A HDHP is purchased
The insured is self employed
Qualified long term care coverage is purchased
11
A ____ Insurance Company is owned by its policyholders.
Fraternal Benefits Society
Reciprocal
Stock
Mutual
12
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$1,200
$800
$700
$500
13
Original Medicare consists of which of the following?
Part B
Part A and B
Part A
Part A, B, C, and D
14
A LTC policy provides benefits in each setting except:
Therapeutic care in an acute care hospital
The home of the insured
Intermediate care
Hospice Care in a family members home
15
To qualify for social security disability, an individual must be unable to:
Perform any substantial gainful activity
perform more than 50% of one's customary duties
Qualify for benefits under any personal or stat-sponsored benefits
Sit, stand, or lie down for extended periods of time
16
Which one of the following is the primary source of underwriting information?
Medical exam
Investigative consumer report
Attending Physician Statement
Application
17
All of the following are requirements of a Medicare Supplement policy except:
The guide to people with Medicare must be provided at the time of the app
the insurer/producer must explain the relationship of coverage to Medicare
A 10 day free look period
The outline of coverage contains information about the benefits of the plan
18
Which of the following is an insurer that is organized under the laws of another state within the United States?
Alien
Authorized
Foreign
Domestic
19
The purpose of a respite care benefit in a LTC policy is to:
Provide care for a person who is terminally ill
Cover the cost of insurance when a person is disabled
Cover care in an adult day care facility
Give a primary caregiver a break
20
Which of the following statements regarding reinstatement of a health insurance policy is NOT correct?
Upon reinstatement, a 10 day probationary period applies to sickness
Back premiums must be paid
The insurer must approve the reinstatement application within 45 days
Evidence of insurability may be required
21
Under the legal actions provision, the insured cannot take legal action against the insurer for at least:
60 days after providing proof of loss
3 years after the proof of loss was submitted
90 days after the loss occurs
6 months after the Notice of Claim is filed
22
When an individual pays the full cost of individual disability insurance, the disable insured's benefit will be:
Taxable in full, regardless of wage
Nontaxable in full, regardless of wage
Taxable in part, up to 60% of their pretax wage
Nontaxable up to 60% of their pretax wage
23
Question in Image
$1000
$200
$0
$800
24
The terms "usual, customary, and reasonable" refer to which of the following?
The standard accepted medical procedure for a given illness or injury
A non-physician's approval of a medical procedure
The most commonly performed operations or treatments in a give territory
The average charge for a medical procedure in a defined geographical area
25
A business overhead expense policy covers all of the following except:
Raw materials used to manufacture goods sold
Employee wages
Taxes, utilities and rent
Owner's income
26
A disability that is presumed to result from the same or a related cause of prior disability is a ___
Delayed Disability
Recurrent Disability
Presumptive Disability
Residual Disability
27
To be eligible for a Medicare Supplement an individual must be:
Under age 65
Receiving social security disability benefits
Covered under a Medicare Advantage Plan
enrolled in Medicare Parts A & B
28
All of the following are differences between a PPO plan and an HMO, except:
It is a managed care plan
Providers charge a discounted fee negotiated in advance
Freedom to choose any servcie provider
Use of primary care physician
29
Which of these statements best describes the difference between any and own occupation
Own occupation is less restrictive because it is easier to qualify for
Any occupation is more restrictive because it is easier to qualify for
Any occupation is less restrictive because it is harder to qualify for
Own occupation is more restrictive because it is harder to qualify for
30
Managed health care plans generally refer to covered persons as:
Employees
Subscribers
Providers
Insureds
31
Which of the following sources of insurability alerts members about an applicants previous claims information?
MIB
Agent's report
APS
Consumer investigative report
32
In a guaranteed renewable policy, the premiums may:
Be increased only in relation to the number of claims paid in the past year
Not be changed at all from the original premium
Be increased based on the increased risk of an individual insured’s health
Be increased for all similarly classified insureds based on age
33
A typical hospital indemnity insurance plan provides payment of benefits in which of the following ways?
An amount equal to insured's deductible and coinsurance amounts
As reimbursements for UCR necessary medical expenses paid by the insured
A daily benefit based on a stated dollar amount paid to the insured
A percentage of benefits based on a written schedule of common procedures
34
Basic health plans provide "first dollar coverage" which means:
The insurance company pays for 100% of all claims
The beneficiary of an insured must pay first dollar of expenses
The insured must pay a deductible first before receiving benefits
Benefits are payable at the first dollar of expenses without a deductible
35
When a disability buyout is funded by the partners the premiums are:
Not tax deductible and the value of the benefit is taxable
Tax deductible and the value of the benefit is taxable
Not tax deductible and the value of the benefit is not taxable
Tax deductible and the value of the benefit is not taxable
36
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Insured is responsible for 3 months premium and will receive a $300 refund
The premiums must be paid for entire 6 months
Premiums do not have to be paid during the entire 6 months
Insured does not qualify for waiver since disability was a sickness
37
Which of the following benefits is payable to an eligible employee is considered to be primary?
contributory group disability
social security
worker's compensation
Noncontributory group disability
38
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Reduce the benefit based on what the premiums paid would have purchased
Cancel the policy if the discovery is made within 2 years of policy issue
Pay the benefit as stated in the policy with no adjustment to the policy
Refund the excess premiums since the insured overpaid premiums
39
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Pay no benefit since the insured failed to inform the insurer
Reduce the benefit to amount the actual premium paid would have purchased
Pay the benefit as contracted for since the policy is over 2 years old
Reduce benefits dollar for dollar to account for underpayment
40
The time period that must elapse after a loss before benefits are payable under a policy is the:
Elimination or waiting period
Probationary period
Grace period
Free look
41
A federal regulation called the __ protects consumer privacy.
Fraudulent Insurance Act
Fair Credit Reporting Act
Privacy Protection Act
COBRA
42
A High Deductible Health Plan is a:
A health plan offered by a job to minimize the cost of employee insurance
A health plan with a high deductible and lower premium
Basic medical expense plan that pays first dollar coverage
HMO established to provide medical services on a prepaid basis
43
Which of the following terms best describes the max length of time that a disability income benefits will be paid?
Elimination Period
Benefit Period
Disability Period
Coverage Period
44
Which of the following is not an example of a cost containment measure?
Replacement
Mandatory second opinion
Preventive care
Utilization review
45
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The capital sum of $500,000 for dismemberment
Principal sum of $1 million for double dismemberment
Medical Expense reimbursement of $300,000
$410k for medical expense and loss of income, and $500k for dismemberment
46
An insurance company would most likely use an impairment rider in which of the following situations?
G is wants a disability policy but is concerned about a heart condition
is looking to buy a disability income policy, but is unemployed
F has cancer and is looking to buy a cancer only policy
T age 70 wants to buy a LTC policy but is receiving care in a nursing home
47
All disability policies cover __ disabilities, which are those occurring outside work.
Contributory
Occupational
Noncontributory
Nonoccupational
48
The insurer’s promise to pay benefits is expressly stated in the:
Legal actions provision
Entire contract clause
Insuring clause
Consideration clause
49
Question in Image
10
90
190
100
50
If a premium is paid at the time of the app and the policy is issued as applied, legal delivery occurs at the time of:
Delivery to the insured or policyowner
Application
Completed medical exam
Issuance of the policy
51
All of the following are considered ADLs except:
Dressing
Cooking
Eating
Bathing
52
A Medicare beneficiary enrolled in a Medicare Advantage plan may have any of these other plans except:
Long-term care
Disability Income
Medicare Supplement
Life insurance with a cash value in excess of $1500
53
Question in Image
10
1
5
2
54
To fund an HSA, an individual must:
Purchase a basic hospital expense plan
Be enrolled in an FSA
Purchase a HDHP
Designate up to $2500 of pre-tax income to withheld for med expenses
55
HMOs usually require patients to select a __ as the person who will oversee their basic health care in most cases.
Primary Care Physician
Insurance Agent or Broker
Medical Social Worker
Care Coordinator
56
All of the following are individual underwriting factors except:
Age
Tobacco Use
Marital Status
Gender
57
If an incomplete application is accepted and the policy is issued which statement applies?
Insurer waives its right to contest claim based on incomplete application
The policy can be contested if a loss occurs within 2 years of issuance
Insurer can void the contract at any time since this is considered fraud
The producer will personally be responsible out of pocket for claims
58
Newborn children are covered under medical expense plans beginning ___.
Immediately at birth and for at least 31 days
On the 14th day following birth
On the 15th day following birth
On the 31st day following birth
59
Each of the following is an element of a legal contract, except:
Indemnity
Consideration
Agreement
Legal Purpose
60
Which of following is state-mandated benefit?
worker's comp
Group disability
social security
subrogation
61
Which party to a health insurance contract is responsible for making the premium payments?
Policyowner
Beneficiary
Insured
Producer

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