Accident and Health Insurance Exam Questions And Correct Answers..A+GRADED.., Exams of Nursing

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A basis of prepayment in which a fixed amount of money is prepaid per individual and found in some managed care plan is known as: A: Per Head Payment B: Fee for Service C: Salaried Amount D: Per Capita Prepaid - CORRECT ANSWERS--D: Per Capita Prepaid A business can provide group insurance to their employees if: A: the purchase of insurance is incidental to the business B: the purchase of insurance is entirely made by the employer C: the purchase of insurance is made regardless of business ownership D: None of the Above - CORRECT ANSWERS--A: the purchase of insurance is incidental to the business A CORRECT statement about benefits payable under a Disability Buy-Out policy that is owned by a business entity is that they are: A: related directly to salary B: paid in installments C: paid to the corporation D: paid directly to the employee - CORRECT ANSWERS--C: paid to the corporation A Long Term Care Group policy that is converted has to be: A: conditionally renewable B: guaranteed renewable C: optionally renewable D: noncancelable - CORRECT ANSWERS--B: guaranteed renewable A LTC policy that will only pay for ADL given occasionally by a licensed professional is: A: Skilled Care B: Intermediate Care C: Custodial Care D: None of the Above - CORRECT ANSWERS--C: Custodial Care A mandatory provision in health policies that specifies when an insurer must send proof of loss forms to the insured within a certain amount of time from notice of claim is known as? A: Claim Forms B: Time Limit on Certain Defenses C: Written Proof of Loss D: Notice of Claim - CORRECT ANSWERS--A: Claim Forms A noncancelable policy means the company A: may not raise the premium or terminate the policy except for nonpayment of premium B: may not cancel before the insured reaches age 50 C: may pay limited benefits and cannot cancel all benefits D: can only terminate coverage if the insured switches occupations - CORRECT ANSWERS--A: may not raise the premium or terminate the policy except for nonpayment of premium A policy that is issued at standard rates is an example of: A: Adverse Selection B: Risk Classification C: Substandard Risk D: None of the Above - CORRECT ANSWERS--B: Risk Classification A producer earned a fee of $500 and a commission for the sale of an insurance product. Forty-five days after coverage began the insured cancelled the policy. What, if any, refund is the insured entitled to in this instance? A: No refund amount is due. B: $250 C: $500 D: $500 and the producer must return any commissions earned from the sale back to the insurance company. - CORRECT ANSWERS--B: $250 A producer is served with a Cease and Desist Order for unfair competition and he violates the Order. The statutory fine for this action is A: 500 B: 1000 C: 2000 D: $100 per day up to a maximum of $5,000. - CORRECT ANSWERS--B: 1000 A producer tells his client that his disability income policy will pay for all of his medical bills if disabled. The producer is guilty of A: Twisting B: Misrepresentation C: Defamation D: False Advertising - CORRECT ANSWERS--B: Misrepresentation A producer violates the written order from the Director pertaining to their market conduct activities. What is the maximum civil penalty that can be assessed by the Director against a producer in this circumstance? A: $10,000 B: $20,000 C: $50,000 D: $100,000 - CORRECT ANSWERS--B: $20,000 A producer violates the written order from the Director pertaining to their market conduct activities. What is the maximum civil penalty that can be assessed by the Director against a producer in this circumstance? A: $10,000 B: $20,000 C: $50,000 D: $100,000 - CORRECT ANSWERS--B: $20,000 D: The insured must have a certain amount of Social Security credits based off age. - CORRECT ANSWERS--C: To qualify an insured must be disabled for a year or longer or die within a two year period. All of the following are true regarding Social Security disability EXCEPT: A: A insured must wait 5 months before collecting benefits B: To qualify an insured must be unable to do any job in the American economy C: To qualify an insured must be disabled for a year or longer or die within a two year period. D: The insured must have a certain amount of Social Security credits based off age. - CORRECT ANSWERS--C: To qualify an insured must be disabled for a year or longer or die within a two year period. All of the following benefits may require a referral EXCEPT: A: A doctor seen in-network under a PPO B: A subscriber uses their point of service plan for a covered specialist C: A subscriber utilizes their HMO coverage for a cardiologist. D: None of the Above - CORRECT ANSWERS--A: A doctor seen in-network under a PPO All of the following provisions found in a health policy are optional EXCEPT: A: Change of Occupation B: Illegal Occupation C: Intoxicant and Narcotic Usage D: None of the Above - CORRECT ANSWERS--D: None of the Above All of the following statements are CORRECT about an Individual Disability policy EXCEPT: A: The income benefit is received tax free and therefore full salary coverage is unnecessary. B: The income benefit is received tax free at a reduced percentage of full salary to give incentive to return to work, once the insured has recovered from loss. C: The policy will be benefits immediately upon a covered loss. D: The longer the elimination period lasts, the less the premium will cost. - CORRECT ANSWERS--C: The policy will be benefits immediately upon a covered loss. All of the following statements are CORRECT under law, of an HMO EXCEPT: A: A person who enters into a contractual services for care with the HMO is known as a Subscriber. B: HMO's cannot refuse to pay for organ transplants just because they are experimental. C: If there is a complaint against an HMO, the provider must establish a system to handle complaints. D: If the Department of Insurance notifies the HMO of a complaint, the HMO has 31 days to respond in writing. - CORRECT ANSWERS--D: If the Department of Insurance notifies the HMO of a complaint, the HMO has 31 days to respond in writing. All of the following statements are true about a specified disease plan EXCEPT: A: Cancer may be covered up to a fixed dollar benefit amount. B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. C: A specified disease plan will only cover one specific loss. D: No policy will cover a specified disease if diagnosed occurred before the policy was applied for. - CORRECT ANSWERS--B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. All of the following statements are true about a specified disease plan EXCEPT: A: Cancer may be covered up to a fixed dollar benefit amount. B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. C: A specified disease plan will only cover one specific loss. D: No policy will cover a specified disease if diagnosed occurred before the policy was applied for. - CORRECT ANSWERS--B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. All of the following statements regarding the Misstatement of Age provision is not correct EXCEPT: A: Misstatement of Age is an optional provision B: Misstatement of Age is material and will void a policy C: Misstatement of age is not material and if found the insurer will adjust the premiums of the policy D: None of the Above - CORRECT ANSWERS--A: Misstatement of Age is an optional provision All of the following statements regarding the Misstatement of Age provision is not correct EXCEPT: A: Misstatement of Age is an optional provision B: Misstatement of Age is material and will void a policy C: Misstatement of age is not material and if found the insurer will adjust the premiums of the policy D: None of the Above - CORRECT ANSWERS--A: Misstatement of Age is an optional provision An agent tells his clients that the insurer they used to represent does not pay claims in a timely manner although the state has no such events on record. If prosecuted the maximum fine for such action is up to: A: $200 B: $5,000 C: $10,000 D: $20,000 - CORRECT ANSWERS--D: $20,000 An agent told a prospective insured that he was a representative of Medicare there to sell a supplement directly from the government. The Director was notified of this action by the consumer and has decided to fine the producer the maximum amount under law. What would be the maximum fine for such an offense? A: $500 B: $5,000 C: $10,000 D: $15,000 - CORRECT ANSWERS--B: $5,000 An example of a rider that deletes or limits coverage is an: A: Impairment Rider B: Preexisting Condition Rider C: Waiver of Premium D: Exclusion Rider - CORRECT ANSWERS--A: Impairment Rider An insurer denies a claim under a LTC contract, the insurer must give an explanation to the insured within _____ of a request of the insured. A: 30 days B: 31 days C: 45 days D: 60 days - CORRECT ANSWERS--D: 60 days An organization that arranges for one or more limited health care plans under a system which cause any part of limited health care delivery to be borne by the organization or its providers is known as: A: PPO B: Limited Plan C: LHSO D: HMO - CORRECT ANSWERS--C: LHSO Another name for a Binder is: A: Conditional Receipt B: Unconditional Receipt C: Temporary Coverage Binder D: Pre-Conditional Receipt - CORRECT ANSWERS--B: Unconditional Receipt B has an individual PPO contract. B suffered a covered loss but the company delayed the claims resolution process. B wants to file a lawsuit against an insurer, however, he want to wait a while to find the correct lawyer. What is the MAXIMUM time frame in which B can file legal action against the insurer? A: 90 days from the date of loss B: 3 years from the exact date of loss C: 3 years from when proof of loss is required D: 3 years from when notice of claim is required - CORRECT ANSWERS--C: 3 years from when proof of loss is required B is covered under an HMO and just gave birth to her second daughter. B gave the HMO proper notice of birth but now is required to pay an extra premium to include her second child as a dependent under her plan. B has ______ days to pay the additional premium within the birth notification A: 15 B: 20 C: 30 D: 31 - CORRECT ANSWERS--C: 30 B is covered under an HMO and just gave birth to her second daughter. B gave the HMO proper notice of birth but now is required to pay an extra premium to include B: 20 days C: 30 days D: 45 days - CORRECT ANSWERS--A: 10 days G had his policy reinstated on August 1. On August 5, G falls ill and needs to spend a few nights in the hospital. Which of the following is most likely to happen? A: The insurer will pay full benefits for G's loss B: The insurer will not pay for G's loss C: G will have to pay more premium to have the loss covered D: None of the Above - CORRECT ANSWERS--B: The insurer will not pay for G's loss H applied for a individual major medical policy. When H filed a claim within the first year of coverage and the underwriter noticed that the H's age on the claim form was different than what was listed on the application. The insurer will take which of the following actions regarding H's claim? A: Deny the claim and refund premiums B: Deny the claim, cancel the policy and keep all premiums C: Pay the claim in full and keep the policy as is D: Adjust the claim benefit amount to the insured's correct age - CORRECT ANSWERS--D: Adjust the claim benefit amount to the insured's correct age H has Disability Insurance through her employer. H has suffered a covered disability and has been informed by the group insurer that she is eligible to received benefits for up to 3 years maximum. H has: A: Long-Term Group Benefits B: Short-Term Group Benefits C: Long-Term Care Benefits D: Short-Term Indemnity Benefits - CORRECT ANSWERS--A: Long-Term Group Benefits H has had group LTC coverage for the last 5 months. H has decided to leave his job and find a new career. Upon leaving his group, H would like to convert his group LTC policy to an individual plan. The insurer is most likely to: A: deny conversion B: allow conversion C: allow conversion, but they may increase the premium D: allow conversion as long as H converts within 30 days of leaving they group - CORRECT ANSWERS--A: deny conversion H has had group LTC coverage for the last 5 months. H has decided to leave his job and find a new career. Upon leaving his group, H would like to convert his group LTC policy to an individual plan. The insurer is most likely to: A: deny conversion B: allow conversion C: allow conversion, but they may increase the premium D: allow conversion as long as H converts within 30 days of leaving they group - CORRECT ANSWERS--A: deny conversion H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - CORRECT ANSWERS--C: relation of earning to insurance H is 65 and enrolled into Part A and Part B of Medicare. Three months into enrollment H applies for a Medigap Plan A. Which of the following is most likely to happen? A: The insurer will deny the application B: The insurer will most likely approve the supplement, provided that H is insurable C: The insurer will rate the policy D: The Federal Government will have the final say - CORRECT ANSWERS--B: The insurer will most likely approve the supplement, provided that H is insurable H is a legendary flamenco guitar player. If H would like to have only her fingers insured for $500,000 each, which of the following policies would be most likely to insure her potential loss? A: Accidental Death and Dismemberment B: Individual Disability Insurance C: Special Risk Policy D: Group Disability Insurance - CORRECT ANSWERS--C: Special Risk Policy Health Care FSA contributions are limited to _______ per year. A: $5,000 B: $3,000 C: $2,700 D: $3,250 - CORRECT ANSWERS--C: $2,700 HMOs must provide coverage for low-dose, baseline mammography for all women ages: A: 25-29 B: 31-36 C: 35-39 D: 40 or older - CORRECT ANSWERS--C: 35-39 HMOs must provide coverage for low-dose, baseline mammography for all women ages: A: 25-29 B: 31-36 C: 35-39 D: 40 or older - CORRECT ANSWERS--C: 35-39 How many days does the Director have to issue a final written order once a hearing has been held pertaining to a market conduct examination? A: Within 20 to 30 days B: 30 days C: 60 days D: 90 days - CORRECT ANSWERS--D: 90 days How many days prior notice of cancellation must an surety, who has issued a producer surety bond, provide to the principal of the bond? A: 10 days B: 15 days C: 30 days D: 90 days - CORRECT ANSWERS--C: 30 days How many separate accounts exist under the life and health guarantee association? A: 4: Variable, HMO, Life, and Health B: 3: Variable, Life, and Health C: 2: Life and Health D: 1: Life and Health - CORRECT ANSWERS--C: 2: Life and Health If a business owner elects not to have coverage for workers under workers' compensation, they must have which of the following policies? A: Major Medical Policy B: 24-hour coverage C: 36-hour coverage D: Disability Insurance - CORRECT ANSWERS--B: 24-hour coverage If a carrier elects to discontinue all health coverage they must notify the director 180 prior to discontinuance. If the insurer then discontinues they are barred from reentry into the IL market for: A: 1 year B: 3 years C: 5 years D: forever - CORRECT ANSWERS--C: 5 years If a carrier elects to discontinue all health coverage they must notify the director 180 prior to discontinuance. If the insurer then discontinues they are barred from reentry into the IL market for: A: 1 year B: 3 years C: 5 years D: forever - CORRECT ANSWERS--C: 5 years If a carrier is terminating a individual policy because of an allowable reason under HIPAA regulations, how many days advance notice must they give the insured? A: 10 days B: 20 days C: 60 days D: 90 days - CORRECT ANSWERS--D: 90 days If a company charges two separate prospective insureds a different premium rate without a sound actuarial basis, this is an example of A: an unfair trade practice. B: unfair discrimination If an insurance company issues deceptive statements about its assets, this action is A: false advertising. B: an unfair trade practice. C: unfair discrimination. D: falsification. - CORRECT ANSWERS--B: an unfair trade practice. If an insured does not have a Medigap Supplement policy, Medicare only covers full hospitalization for the first ______ days A: 15 B: 30 C: 60 D: 90 - CORRECT ANSWERS--C: 60 If an insured has a limited group plan and the carrier discontinues group benefits, as long as the insured has not used up all of their benefits under the policy, in the case of total disability, coverage applies up to ______ after discontinuation or end of disability, whichever occurs first. A: 30 days B: 60 days C: 90 days D: 12 months - CORRECT ANSWERS--C: 90 days If an insured is purchasing a LTC policy, an outline of coverage must be delivered by the agent at: A: time of solicitation B: underwriting C: delivery D: Any of the above - CORRECT ANSWERS--A: time of solicitation If an insurer discontinues a group policy they are only liable for: A: their extent of benefits under the old contract B: half of the new carrier's covered losses C: nothing D: all losses up to a year - CORRECT ANSWERS--A: their extent of benefits under the old contract If an LHSO is terminated prior to annual renewal for the contract, the provider must give the subscriber a: A: 30 day notice B: 31 day notice C: 45 day notice D: 60 day notice - CORRECT ANSWERS--B: 31 day notice If the carrier has a reasonable charge that is below the providers contractual reasonable charge, the insured may be responsible for the difference of medical cost, this is known as: A: Balance Billing B: Reasonable Charges C: Usual Charges D: Customary Charge - CORRECT ANSWERS--A: Balance Billing If there is a complaint against an LHSO with the Department of Insurance, the LHSO has ____ to respond in writing to the complaint. A: 21 days B: 30 days C: 31 days D: 45 days - CORRECT ANSWERS--A: 21 days If there is a dispute on medical necessity under a HMO, there must be a system in place for a second opinion. If the second opinion determines that a covered service is in fact medically necessary, the HMO must provide service. The only way that benefits are paid for an out-of-network physician is: A: if a referral is given B: state law dictates when coverage out of area exists C: if it is an emergency D: None of the Above - CORRECT ANSWERS--A: if a referral is given In a health insurance transaction, an offer is made when: A: the insured pays the initial premium B: when an insured applies for coverage C: when an insurer has approved the policy D: when the insured provides payment in exchange for coverage - CORRECT ANSWERS--B: when an insured applies for coverage In a health policy, the probationary period begins: A: upon issuance of a policy B: upon delivery of a policy C: when underwriting takes place D: upon payment of first premium - CORRECT ANSWERS--A: upon issuance of a policy In a Health policy, the right of the policy owner to make an endorsement to the policy is found in the: A: Proof of Loss provision B: Time Limit on Certain Defenses C: Change of Beneficiary D: Change of Occupation - CORRECT ANSWERS--C: Change of Beneficiary In a Long Term Care Partnership policy, inflation protection must be included under contract. If a policy is required to have a compounded rate of either 3% or 5%, the insured must be: A: under age 61 B: at least 61 but less than 76 years old C: 76 years or older D: None of the Above - CORRECT ANSWERS--A: under age 61 In the Change of Occupation provision, if an insured switches to a less hazardous job and a claim occurs the insurer will: A: increase the premium of the policy B: increase the benefits of the policy C: decrease the benefits of the policy D: decrease the premium of the policy - CORRECT ANSWERS--D: decrease the premium of the policy In the event of Group Health Insurance being discontinued or replaced, in the event of total disability, coverage must extend up to ______ in an HMO provided the insured still has benefit limits available under contract. A: 6 months B: 12 months C: 18 months D: 24 months - CORRECT ANSWERS--B: 12 months It is the insured's responsibility to notify the principal about a claim under an Accident and Health policy within: A: 7 days B: 20 days C: 1 month D: 12 months - CORRECT ANSWERS--B: 20 days J has an Accidental Death and Dismemberment policy that has a principal sum of $30,000. One day, J is in a horrific car accident and slips into a coma. Four months after the accident, J's family takes him off the ventilator and J dies. The insurer will pay J's beneficiary: A: $30,000 B: $15,000 C: $5,000 D: $0 - CORRECT ANSWERS--D: $0 J has HMO coverage under his employer. J was notified that because of a payroll error, payment for this month's premium was not paid. The minimum possible grace period that J may have to prevent lapse is: A: 10 days B: 15 days C: 30 days D: 31 days - CORRECT ANSWERS--A: 10 days J has medical benefits that provide a first dollar coverage but then also applies a deductible and coinsurance for major benefits. J has: A: Comprehensive Major Medical B: Combined Medical Policy C: Comparative Medical D: Major Medical - CORRECT ANSWERS--A: Comprehensive Major Medical J let their health policy lapse. To reinstate the contract, the insurer is requiring J to reapply. J pays a new premium with the hope that she will get her policy back into force. The insurer has ______ days from receipt to deny reinstatement. A: 7 B: 10 C: 31 D: 45 - CORRECT ANSWERS--D: 45 A: The HMO will cover the doctor visit fully. B: The HMO will pay half of the visit because it is out of service area. C: The HMO will pay the claim if N pays extra premium. D: N will be declined to be seen by the specialist for this office visit. - CORRECT ANSWERS--D: N will be declined to be seen by the specialist for this office visit. N has a major medical policy through an insolvent insurer. The maximum the Guarantee Association will pay on N's losses is: A: $500,000 B: $300,000 C: $200,000 D: $100,000 - CORRECT ANSWERS--A: $500,000 N has a PPO and has a terrible sinus infection. N decides to go straight to an in- network Ear, Nose and Throat specialist for an office visit. Which of the following is most likely to occur? A: The PPO will cover N's claim and give the best discount under the contract. B: The PPO will deny the claim even though it is in-network. C: The PPO will cover the claim as long as N has a referral at the time of service. D: The PPO will cover the claim with extra premium required. - CORRECT ANSWERS--A: The PPO will cover N's claim and give the best discount under the contract. On March 1 C, who holds an Illinois non-resident license moves from Idaho to Iowa. By which date must C notify the Illinois Director of Insurance about this move? A: By March 31 B: C does not have to notify Illinois since he was a non-resident license holder. C: By May 1 D: By March 16 - CORRECT ANSWERS--A: By March 31 On March 1 the Director mailed a notice of producer license suspension to R which he received on March 4. If R wishes to request a hearing on the matter, by which date must R make this demand in writing? A: 24-Mar B: 30-Mar C: 31-Mar D: 3-Apr - CORRECT ANSWERS--C: 31-Mar On March 1 the Director mailed a notice of producer license suspension to R which he received on March 4. If R wishes to request a hearing on the matter, by which date must R make this demand in writing? A: 24-Mar B: 30-Mar C: 31-Mar D: 3-Apr - CORRECT ANSWERS--C: 31-Mar Once a producer has been notified that her license has been suspended by the Director, how many days does she have in which to request a hearing, in writing, from the date the Director mailed the termination notice? A: 10 days B: 15 days C: 20 days D: 30 days - CORRECT ANSWERS--D: 30 days Other than when an agent or insurer sells a supplement not approved by the director, all other violations may incur a maximum fine of: A: $500 B: $1,000 C: $5,000 D: $10,000 - CORRECT ANSWERS--C: $5,000 Part A of Medicare covers: A: Hospital Care B: Inpatient skilled nursing and home health visits C: doctor visit D: Only Answers A and B - CORRECT ANSWERS--D: Only Answers A and B Part B of Medicare covers all of the following benefits EXCEPT: A: Doctor's visit B: psychiatric care C: home health services D: None of the Above - CORRECT ANSWERS--D: None of the Above Part B of Medicare covers all of the following benefits EXCEPT: A: Doctor's visit B: psychiatric care C: home health services D: None of the Above - CORRECT ANSWERS--D: None of the Above Producer J has just received a policy offer from an insurer on behalf of an application J recently wrote. J must deliver the policy and collect the first premium payment. Within how many days must J accomplish this action without violating fiduciary duty? A: Within 10 days B: Within 30 days C: Within 90 days D: Within 20 days - CORRECT ANSWERS--C: Within 90 days R has an individual major medical policy. On October 1 R has an accident causing $10,000 of damages. On October 31, the insurer is first notified by R that an accident occurred. Which of the following is most likely occur? A: The insurer will pay the full $10,000 B: The insurer will pay the loss minus any deductible that is required C: The insurer will deny the claim D: The insurer will pay the loss minus deductible and coinsurance that is required - CORRECT ANSWERS--C: The insurer will deny the claim Renewability of a Long Term Care policy must be at least: A: Noncancelable B: Guaranteed Renewable C: Cancellable D: A and B only - CORRECT ANSWERS--D: A and B only Renewability of a Long Term Care policy must be at least: A: Noncancelable B: Guaranteed Renewable C: Cancellable D: A and B only - CORRECT ANSWERS--D: A and B only Selling insurance without a license without misappropriating premium funds is a A: Class A misdemeanor B: Class C misdemeanor C: Class 4 felony D: not a crime - CORRECT ANSWERS--A: Class A misdemeanor T has just returned back to work after a total disability but is only able to work half the day. T's policy pays the difference between what the employer pays T and what T earned prior to disability. T has: A: Own Occupation B: Residual Disability C: Partial Disability D: Any Occupation - CORRECT ANSWERS--B: Residual Disability T has recently replaced her Medicare Supplement policy which was in force for 7 months. The contract has a probationary waiting period on all illness related losses for the first ten days of coverage. On day 5, T suffers an illness. The replacing insurer is most likely to: A: cover the loss B: deny the claim C: require T pay more premium to cover the loss D: None of the Above - CORRECT ANSWERS--A: cover the loss T has recently replaced her Medicare Supplement policy which was in force for 7 months. The contract has a probationary waiting period on all illness related losses for the first ten days of coverage. On day 5, T suffers an illness. The replacing insurer is most likely to: A: cover the loss B: deny the claim C: require T pay more premium to cover the loss D: None of the Above - CORRECT ANSWERS--A: cover the loss The APS is: A: a short set of questions sent to the insured's doctor regarding a medical issue of the insured B: a database in which the insurer collects adverse information found during underwriting C: an at home medical exam conducted by a paramedic D: a provision found in the Fair Credit Reporting Act - CORRECT ANSWERS--A: a short set of questions sent to the insured's doctor regarding a medical issue of the insured A: Exclusion B: Eligible Expense provision C: Insuring Agreement D: Consideration Clause - CORRECT ANSWERS--B: Eligible Expense provision The part of a health policy that limits the scope of coverage is called: A: Limitation B: Exclusion C: Eclipse D: Reduction - CORRECT ANSWERS--B: Exclusion The party that dictates what a reasonable or customary charge is for a health policy is the: A: insured B: insurer C: Department of Insurance D: federal government - CORRECT ANSWERS--B: insurer The policy has all of the following rights EXCEPT: A: Right to solely renew a guaranteed renewable policy. B: Right to terminate a policy C: Unilateral right to renew an Optionally renewable policy D: Right to assign a contract - CORRECT ANSWERS--C: Unilateral right to renew an Optionally renewable policy The policy has all of the following rights EXCEPT: A: Right to solely renew a guaranteed renewable policy. B: Right to terminate a policy C: Unilateral right to renew an Optionally renewable policy D: Right to assign a contract - CORRECT ANSWERS--C: Unilateral right to renew an Optionally renewable policy The Proof of Loss provision in an individual Accident and Health policy requires that written proof of loss be submitted to the insurance company within how many days after the date of loss? A: 30 B: 60 C: 90 D: 120 - CORRECT ANSWERS--C: 90 The purpose of minimum standards is to: A: prevent preexisting conditions B: allow the insured a right to return their policy for a refund C: prohibit coverage on a class of insureds D: prevent restrictive definitions and language in a policy contract - CORRECT ANSWERS--D: prevent restrictive definitions and language in a policy contract The purpose of preventing an insured from collecting twice on losses that are Subrogated is to: A: reinforce indemnity B: to hinder the insured's rights C: to allow the insurer to collect twice D: None of the Above - CORRECT ANSWERS--A: reinforce indemnity The purpose of the Fair Credit Reporting Act is to: A: protect the consumer from having an adverse action against them based of obsolete credit information B: to ensure that credit information used in underwriting is accurate and updated C: make sure that any financial institution handles an individual's credit in a correct, proper manner D: All of the Above - CORRECT ANSWERS--D: All of the Above The regulation that requires a producer to sign their name on an individual or group life or accident and health insurance application is called A: The Disclosure Rule B: The Insurance Fraud Prevention Act C: The Replacement Rule D: The Unfair Trade Practice Act - CORRECT ANSWERS--A: The Disclosure Rule The resident licensing fee for a Limited Lines Car Rental license is A: $50 every year B: $180 every two years C: $50 every two years D: $250 every year. - CORRECT ANSWERS--B: $180 every two years The rider that an insurer uses to specifically name and exclude a preexisting condition from coverage is known as: A: Exclusionary Rider B: Preexisting Condition Rider C: Impairment Rider D: Exclusion Rider - CORRECT ANSWERS--C: Impairment Rider The strongest evidence an applicant would have that a recently applied for policy was immediately providing coverage is ownership of: A: A Conditional Receipt B: A Binder C: A receipt for which first premium is due D: No Receipt - CORRECT ANSWERS--B: A Binder The taxation of individually owned Disability Insurance policies is correctly stated as which of the following? A: Premiums paid are deductible and benefits received are tax-free. B: Premiums paid are not deductible and benefits are received tax-free. C: Premiums paid are deductible and benefits are received are taxable income. D: Premiums paid are not deductible and benefits received are taxable income - CORRECT ANSWERS--B: Premiums paid are not deductible and benefits are received tax-free. The Time Limit on Certain Defenses provision allows an insurance company to question the validity of an insurance claim for which of the following reasons? A: The insured omitted information from the application concerning a condition that would have affected the insurance company's underwriting decision. B: A change of occupation by the insured prior to a specified time limit. C: The application contained a misstatement of the insured's age. D: The insured has a certain amount of time to notify the insurer of a loss. - CORRECT ANSWERS--A: The insured omitted information from the application concerning a condition that would have affected the insurance company's underwriting decision. The time period starting from issuance of a policy, before a Disability policy covers certain types of losses is known as: A: Elimination Period B: Probationary Period C: Indemnity Period D: Restoration Period - CORRECT ANSWERS--B: Probationary Period To sell a LHSO plan, a producer must be licensed in: A: Accident and Health insurance B: Limited Lines producer license C: Accident and Health or Limited Lines License D: None of the Above - CORRECT ANSWERS--C: Accident and Health or Limited Lines License Under a Long Term Care policy, any existence or symptoms care or treatment or a condition for which medical advice was recommended or received can only be excluded as a preexisting condition on policy if loss occurred within ______ before effective date of coverage. A: 3 months B: 6 months C: 12 months D: 24 months - CORRECT ANSWERS--B: 6 months Under an Accident and Health policy, an insurance company must provide appropriate forms to the insured within a maximum of how many days after the loss? A: 15 B: 30 C: 45 D: 60 - CORRECT ANSWERS--A: 15 Under Core Benefits, the insured must pay the approved deductible for Part B. After the deductible is met, Plan A covers _____ of co-insurance requirements that is normally paid out of pocket by the insured. A: 0% B: 5% C: 10% D: 20% - CORRECT ANSWERS--D: 20% Under HMO minimum standards for basic health care services, the annual maximum on mental health inpatient services is: A: 10 days What action would be required of a producer who fails to reinstate a lapsed producer license within the statutory allowed time period? A: The person is barred from entering the insurance business for 5 years. B: The person is barred from entering the insurance business for life. C: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $180 license fee. D: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $360 license fee. - CORRECT ANSWERS--C: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $180 license fee. What is a contract's grace period if a premium is paid on a quarterly basis? A: 7 days B: 10 days C: 31 days D: 90 days - CORRECT ANSWERS--C: 31 days What is the largest dollar civil penalty that will be assessed for a single act of defamation? A: $1,000 B: $2,500 C: $5,000 D: $10,000 - CORRECT ANSWERS--D: $10,000 What is the largest dollar civil penalty that will be assessed for a single act of misrepresentation? A: $1,000 B: $2,500 C: $5,000 D: $10,000 - CORRECT ANSWERS--D: $10,000 What is the main purpose of Regulation 919? A: To assure that insurance claimants are treated in a prompt and courteous manner B: To encourage insurance companies to make claim forms available to all claimants within 30 days. C: To help minimize groundless legal actions by insureds against insurance companies relating to claims. D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. - CORRECT ANSWERS--D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. What is the maximum time frame for probationary periods found in Accident policies? A: 10 days B: 20 days C: 30 days D: None of the Above - CORRECT ANSWERS--D: None of the Above When a non-financial conduct examination is held and the party examined makes a written request for a hearing, at least how many days notice must the Director provide of time and place of a hearing as designated in the notice? A: 10 days B: 15 days C: 20 days D: 30 days - CORRECT ANSWERS--A: 10 days When an agent sells an Accident and Health policy, he/she should do which of the following with the application? A: Complete it and have the applicant review and sign it B: The agent should initial any and all changes he/she may make later C: Have the applicant sign and then carefully put in the required information in as thoroughly and accurately a manner as possible D: Advise the applicant to provide information in such a manner to make certain the policy will be issued without restrictions - CORRECT ANSWERS--A: Complete it and have the applicant review and sign it When an insured is covered under a group plan, the law that helps them port coverage from one carrier to another without preexisting conditions applying is known as: A: COBRA B: HIPAA C: HIPPO D: PPO - CORRECT ANSWERS--B: HIPAA Which mandatory provision states that a policy holder cannot change an irrevocable beneficiary unless that beneficiary gives written consent to be changed? A: Mandatory Revocability B: Irrevocable Beneficiary Designation C: Change of Beneficiary Provision D: Entire Contract - CORRECT ANSWERS--C: Change of Beneficiary Provision Which of the following are exclusions under a health policy? A: an annual eye exam B: a biannual dental check-up C: a worker that is injured while working on the job D: All of the Above - CORRECT ANSWERS--D: All of the Above Which of the following circumstances may lead to the renewal of a producer license without the requirement of completing continuing education requirements? A: There are no exceptions to the continuing education law. B: The producer suffers a stroke and is incapable of completing any coursework. C: The producer is called up to military duty and secures a military waiver. D: Once a producer has been licensed for more than 30 consecutive years and is at least 65 years of age, they are exempt from continuing education requirements. - CORRECT ANSWERS--C: The producer is called up to military duty and secures a military waiver. Which of the following defines a potential definition of a total disability? A: Any Occupation B: Residual C: Partial D: Social Security Disability - CORRECT ANSWERS--A: Any Occupation Which of the following elements is part of the entire contract clause? A: The exchange of value between the parties B: The agreement between the policyholder and insurer C: The amount of time the insured has to send a policy back for a full refund D: None of the Above - CORRECT ANSWERS--D: None of the Above Which of the following is an a example of a unfair trade practice? A: a company rates an individual based on partial blindness B: a company rates an individual with a disability C: an agent discriminates a client because of they are totally blind D: All of the Above - CORRECT ANSWERS--D: All of the Above Which of the following is considered to be a mandatory provision in a health policy? A: Time Limit on Certain Defenses B: Change of Occupation C: Illegal Occupation D: Intoxicant/Narcotic Usage - CORRECT ANSWERS--A: Time Limit on Certain Defenses Which of the following is considered to be an allowable report to be done on a proposed insured under the Fair Credit Reporting Act? A: HIPAA Report B: Investigative Report C: Paramedical Report D: MIB Report - CORRECT ANSWERS--B: Investigative Report Which of the following is CORRECT about the Free Look Provision? A: The policy owner can only receive a refund under certain conditions B: The free look starts at issue date C: The free look is an unconditional refund provision D: The free look allows the insured to change the mode of premium - CORRECT ANSWERS--C: The free look is an unconditional refund provision Which of the following is CORRECT about the insuring clause? A: The Insuring clause states the exchange of value in the policy B: The insuring clause states if an illegal occupation is covered C: The insuring clause is the face page of the policy and names the parties of a contract D: None of the Above - CORRECT ANSWERS--C: The insuring clause is the face page of the policy and names the parties of a contract Which of the following is CORRECT about the insuring clause? A: The Insuring clause states the exchange of value in the policy D: Guaranteed Noncan - CORRECT ANSWERS--C: Cancelable Which of the following rights of renewability stipulate that the insured has the sole right to end coverage? A: Period of Time B: Noncancelable C: Cancelable D: Conditionally Renewable - CORRECT ANSWERS--B: Noncancelable Which of the following services would be covered under an LHSO? A: ambulance B: vision care C: podiatric care D: All of the Above - CORRECT ANSWERS--D: All of the Above Which of the following statements about a conditional receipt is CORRECT? A: It is given as a receipt for an initial premium payment is cash, but not by check. B: It describes the physical condition of the applicant at the time the application is taken. C: It lists the conditions of the insurance policy at the time of issue. D: It specifies the timing and terms of the insurance coverage. - CORRECT ANSWERS--D: It specifies the timing and terms of the insurance coverage. Which of the following statements are CORRECT about a Health Savings Account? A: The HSA plan is only available to large businesses B: The HSA contribution is only tax deductible if an insured itemizes C: The HSA must be coordinated with an HDHP D: The IRS does not set a limit on annual contributions paid in to an HSA - CORRECT ANSWERS--C: The HSA must be coordinated with an HDHP Which of the rights of renewable will guarantee premiums remain level? A: Guaranteed Renewable B: Cancelable C: Noncan D: None of the Above - CORRECT ANSWERS--C: Noncan Which policy rider would offer an insured the option to increase their benefits of the original policy? A: Impairment Rider B: Guaranteed Insurability Rider C: Waiver of Premium D: None of the Above - CORRECT ANSWERS--B: Guaranteed Insurability Rider Workers' Compensation is regulated by: A: State Government B: The Employer C: Federal Government D: The Insurer - CORRECT ANSWERS--A: State Government Y has group insurance through his employer. One day, while Y is walking up the stairs to get to his office, he slips and falls down and suffers a few minor injuries. After going to the doctor, he submits the claim through his group insurance. Which of the following is most likely to happen? A: The insurer will provide full coverage B: The insurer will provide full coverage less deductible C: The insurer will provide full coverage less deductible and Coinsurance payment D: The insurer will deny the claim - CORRECT ANSWERS--D: The insurer will deny the claim Y is injured while robbing a bank and his claim is denied. Which of the following provisions would deny Y's claim? A: Change of Occupation B: Illegal Occupation C: Felony Exclusion D: Illegal Action - CORRECT ANSWERS--B: Illegal Occupation Z has a Major Medical policy and incurs her first covered loss of the year. Z must pay: A: the Deductible B: the Deductible plus any remaining required co-pay on the loss C: any Co-Insurance D: the Deductible plus any remaining required co-insurance on the loss. - CORRECT ANSWERS--D: the Deductible plus any remaining required co-insurance on the loss.