Accident and Health Insurance Exam Questions and Answers (Latest Update 2024), Exams of Nursing

Download Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) and more Exams Nursing in PDF only on Docsity! Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: relation of earning to insurance The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the policy summary B: the first page of the contract C: the delivery receipt D: upon conditional receipt - Correct Answer ✅B: the first page of the contract The policy has all of the following rights EXCEPT: Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: Unilateral right to renew an Optionally renewable policy The part of a contract that specifies which expenses may or may not be covered is known as the: A: Exclusion B: Eligible Expense provision C: Insuring Agreement D: Consideration Clause - Correct Answer ✅B: Eligible Expense provision 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅D: All of the Above Most Accident and Health policies require that claims must be paid _________ upon written proof of loss. A: 30 days B: Immediately C: 60 days D: 90 days - Correct Answer ✅B: Immediately A LTC policy that will only pay for ADL given occasionally by a licensed professional is: A: Skilled Care Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: Intermediate Care C: Custodial Care D: None of the Above - Correct Answer ✅C: Custodial Care Which of the following policy provisions are optional in a individual health policy? A: Entire Contract B: Change of Occupation C: Entire Contract D: Reinstatement - Correct Answer ✅B: Change of 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 Answer ✅D: None of the Above All of the following are true regarding Social Security disability EXCEPT: Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: To qualify an insured must be disabled for a year or longer or die within a two year period. Health Care FSA contributions are limited to _______ per year. A: $5,000 B: $3,000 C: $2,700 D: $3,250 - Correct Answer ✅C: $2,700 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: A and B only - Correct Answer ✅D: A and B only Under minimum standards, the probationary waiting period for illness may not exceed A: 10 days B: 20 days C: 30 days D: 40 days - Correct Answer ✅C: 30 days If a policy owner of a Medicare Supplement becomes eligible for Medicaid, a supplement can be suspended for up to ______ as long as they give the insurer notice within 90 days of being eligible for Medicaid. A: 6 months B: 12 months C: 24 months D: 36 months - Correct Answer ✅C: 24 months Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅A: deny conversion 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 Answer ✅B: an unfair trade practice. 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: $1,000 C: $5,000 D: $10,000 - Correct Answer ✅C: $5,000 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 Answer ✅A: their extent of benefits under the old contract 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 Answer ✅A: $500,000 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) Another name for a Binder is: A: Conditional Receipt B: Unconditional Receipt C: Temporary Coverage Binder D: Pre-Conditional Receipt - Correct Answer ✅B: Unconditional Receipt 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 Answer ✅A: Complete it and have the applicant review and sign it 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? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅B: The insurer will not pay for G's loss Which of the rights of renewable will guarantee premiums remain level? A: Guaranteed Renewable B: Cancelable C: Noncan D: None of the Above - Correct Answer ✅C: Noncan Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 C: 20 D: 30 - Correct Answer ✅B: 15 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: paid to the corporation 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 Answer ✅C: Impairment Rider Lifetime, Per Cause, and Annual maximums are all examples of: A: Benefit Exclusions B: Benefit Limits Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: Physical Examination and Autopsy C: Entire Contract Provision D: Legal Action Provision - Correct Answer ✅B: Physical Examination and Autopsy 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 Answer ✅C: 31 days Doctors in a Preferred Provider Organization are paid: A: Capitation B: Fee for Service C: Salary D: Reimbursement - Correct Answer ✅B: Fee for Service In a health policy, the probationary period begins: Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: upon issuance of a policy B: upon delivery of a policy C: when underwriting takes place D: upon payment of first premium - Correct Answer ✅A: upon issuance of a policy 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 Answer ✅B: Guaranteed Insurability Rider C has a LTC policy that cannot be terminated and has guaranteed premiums. C has which of the following rights of renewability? A: Noncancelable B: Guaranteed Renewable C: Cancelable D: Period of Time - Correct Answer ✅A: Noncancelable Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) Consideration for the insurer is to: A: guarantee coverage B: cover losses that are excluded C: pay covered losses D: share in premium payment - Correct Answer ✅C: pay covered losses 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 Answer ✅A: A doctor seen in-network under a PPO 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: 90 days 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 Answer ✅B: Misrepresentation 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? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: 24-Mar B: 30-Mar C: 31-Mar D: 3-Apr - Correct Answer ✅C: 31-Mar Under law, a LTC policy must provide consecutive coverage for at least: A: 6 months B: 12 months C: 24 months D: 36 months - Correct Answer ✅B: 12 months Company A has decided to cease group coverage in IL. On August 1, Company A notifies all group contract holders of discontinuation. How many days does the contract holder have to notify enrollees? A: 10 days B: 20 days C: 30 days D: 31 days - Correct Answer ✅A: 10 days Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) Each of the following is true regarding a cancelable policy EXCEPT: A: The insured can cancel for any reason B: The insurer can cancel the policy at anytime C: The insurer can only terminate because of nonpayment of premium D: Cancelable is usually the most inexpensive renewability option. - Correct Answer ✅C: The insurer can only terminate because of nonpayment of premium 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 Answer ✅A: reinforce indemnity N has a disability policy and suffers a covered loss. After elimination, what is the maximum time the insurer has to make a claim payment under the Time Payment of Claims provision? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: None of the Above - Correct Answer ✅A: the purchase of insurance is incidental to the business 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 Answer ✅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 Answer ✅D: the Deductible plus any remaining required co- insurance on the loss. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) Which of the following defines a potential definition of a total disability? A: Any Occupation B: Residual C: Partial D: Social Security Disability - Correct Answer ✅A: Any Occupation 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 Answer ✅D: Only Answers A and B 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 Answer ✅B: insurer Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) N has a HMO and has a terrible sinus infection. N decides to go straight to an Ear, Nose and Throat specialist for an office visit. Which of the following is most likely to occur? 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 Answer ✅D: N will be declined to be seen by the specialist for this office visit. K has a policy that will pay a lump sum tax free benefit if he is diagnosed and then survives cancer. K has a: A: Critical Illness Policy B: Specified Disease Plan C: Cancer Policy D: Major Medical - Correct Answer ✅A: Critical Illness Policy 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: 10 days B: 20 days C: 60 days D: 90 days - Correct Answer ✅D: 90 days The fee, every 2 years, for a business entity license is A: $100 B: $150 C: $180 D: $250 - Correct Answer ✅B: $150 If a producer demands a hearing to challenge the reasonableness of a license suspension, when will the hearing take place? A: Within 20 to 30 days of the date the producer demands a hearing. B: A time to be determined by the Director with 20 days prior notice C: A time to be determined by the Director with 10 days prior notice D: The hearing takes place within 20 to 30 days from the date the Director's mailing of the hearing notification. - Correct Answer ✅D: The hearing takes Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) place within 20 to 30 days from the date the Director's mailing of the hearing notification. If an applicant is under age 65, they must apply for a supplement within _______ of enrolling for Part B. A: 3 months B: 6 months C: 12 months D: 18 months - Correct Answer ✅B: 6 months 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 Answer ✅B: $20,000 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅A: 10 days 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 Answer ✅C: 5 years HMOs must provide coverage for low-dose, baseline mammography for all women ages: A: 25-29 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: decrease the premium of the policy - Correct Answer ✅D: decrease the premium of the policy 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 Answer ✅D: None of the Above Which of the following policies' premiums are tax deductible for the employer? A: Group Health insurance B: Group Disability Policy C: Business Overhead Expense D: All of the Above - Correct Answer ✅D: All of the Above Which of the following services would be covered under an LHSO? A: ambulance Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: vision care C: podiatric care D: All of the Above - Correct Answer ✅D: All of the Above V has individual coverage under an HMO plan. V forgot to pay her premium on time and does not want to lose coverage. Under law, an individual policy must have a grace period of at least: A: 15 days B: 30 days C: 31 days D: 45 days - Correct Answer ✅C: 31 days Company Q, a health insurer headquartered in Indiana is advertising directly to Illinois residents about their health plans but Company Q is not a licensed insurance company in Illinois. Company Q is violating which of the following Illinois insurance regulations? A: False Advertising B: Twisting C: Misrepresentation Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: Defamation - Correct Answer ✅C: Misrepresentation A producer who makes misleading comparisons between a product an insured owns and a policy the producer is trying to sell as a replacement is an activity known as A: Misappropriation B: Twisting C: Defamation D: Rebating - Correct Answer ✅B: Twisting All of the following are qualifications that apply to a non-resident producer in Illinois, EXCEPT: A: The non-resident must be licensed in their home state for a minimum of 2 years before Illinois will grant non-resident producer status. B: The non-resident must file an affidavit naming the Director to receive service of process on the non-resident's behalf. C: There is a $250 license fee due and payable every two years. D: The non-resident producer must be in good standing in their home state with reference to their resident producer status. - Correct Answer ✅A: The Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: 90 days - Correct Answer ✅C: 30 days Which of the following out of pocket expenses require the insured to share cost with the insurer? A: Deductible B: Copayment C: Coinsurance D: All of the Above - Correct Answer ✅D: All of the Above Which of the following rights of renewability give the insurer the most control over a policy? A: Noncancelable B: Guaranteed Renewable C: Cancelable D: Guaranteed Noncan - Correct Answer ✅C: Cancelable If an insured does not have a Medigap Supplement policy, Medicare only covers full hospitalization for the first ______ days A: 15 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: 30 C: 60 D: 90 - Correct Answer ✅C: 60 K, an employee who is covered by Workers' Compensation and a group Major Medical plan is injured on the job. If K submits a claim to the group plan, the insurer will most likely: A: pay full benefits B: pay full benefits only after a 1-month elimination C: coordinate benefits with Workers' Compensation D: deny the claim - Correct Answer ✅D: deny the claim Each of the following is true regarding pre-authorization and prior approval requirements EXCEPT: A: An insured must get permission before a planned hospital stay for coverage B: A member must give a statement on necessity prior to receiving care C: If an insured does not get pre-authorization before the loss, they can ask for reinstatement later for the benefit to be covered Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: Pre-authorizations are generally found on Managed Care policies such as HMOs or PPOs - Correct Answer ✅C: If an insured does not get pre- authorization before the loss, they can ask for reinstatement later for the benefit to be covered 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 Answer ✅A: The PPO will cover N's claim and give the best discount under the contract. Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: The policy will be benefits immediately upon a covered loss. 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 Answer ✅B: A Binder K has a basic policy along with a major medical policy. K suffers a loss and receives notice by the insurer that an additional $300 is owed before the major medical policy will pay for all of K's losses. K must satisfy: Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: Deductible B: corridor deductible C: stop loss D: coinsurance - Correct Answer ✅B: corridor deductible 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 Answer ✅D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅B: 6 months The farthest back that a group issuer can name a preexisting condition based off of an insured's medical records is ______ before enrollment. A: 6 months B: 12 months C: 24 months D: 48 months - Correct Answer ✅A: 6 months Under HMO minimum standards for basic health care services, the annual maximum on mental health inpatient services is: A: 10 days B: 31 days C: 60 days Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) C: LHSO D: HMO - Correct Answer ✅C: LHSO 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 Answer ✅A: The Disclosure Rule 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 Answer ✅C: The insuring clause is the face page of the policy and names the parties of a contract Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅D: Adjust the claim benefit amount to the insured's correct age 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 Answer ✅D: It specifies the timing and terms of the insurance coverage. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: The HSA must be coordinated with an HDHP Lifetime, Per Cause, and Annual maximums are all examples of: A: Benefit Exclusions B: Benefit Limits C: Out of Pocket Expenses D: Contractual Losses - Correct Answer ✅B: Benefit Limits 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. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅A: Misstatement of Age is an optional provision All of the following are optional provisions EXCEPT: A: Physical Examination and Autopsy B: Illegal Occupation C: Change of Occupation D: None of the Above - Correct Answer ✅A: Physical Examination and Autopsy All of the following are CORRECT under advertising statutes EXCEPT: A: Insurers can use third party endorsements, but they must be genuine and factual. B: All ads, regardless of mediums, must be clear and complete. C: Details on PEC must be disclosed when replacement is involved. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: Advertisement files must be kept by the insurer for up to 3 years. - Correct Answer ✅D: Advertisement files must be kept by the insurer for up to 3 years. The fee, every 2 years, for a business entity license is A: $100 B: $150 C: $180 D: $250 - Correct Answer ✅B: $150 The minimum grace period under law for an individual HMO police may not be less than: A: 10 days B: 15 days C: 30 days D: 31 days - Correct Answer ✅D: 31 days Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅A: under age 61 Long Term Care coverage may be marketed to individuals or groups. A qualifying group that is considered to be an association plan must originate with at least how many members? A: 2 or more B: 20 or more C: 100 D: 500 - Correct Answer ✅C: 100 The purpose of minimum standards is to: A: prevent preexisting conditions B: allow the insured a right to return their policy for a refund Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: The insuring clause is the face page of the policy and names the parties of a contract If a person is insured under an AD&D policy and loses both of their arms they are considered to be: A: Permanently disabled B: Partially Disabled C: Presumptively Disabled D: Capitally Disabled - Correct Answer ✅C: Presumptively Disabled 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅A: Misstatement of Age is an optional provision Under Notice of Claim provision in an Accident and Health policy, the policy owner must give notice of the loss to the insurance company within a MAXIMUM of how many days after the loss? A: 20 B: 30 C: 45 D: 60 - Correct Answer ✅A: 20 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 Answer ✅D: 60 days Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅D: 90 days 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 Answer ✅C: 31-Mar All of the following are CORRECT under Medicare supplement minimum standards EXCEPT: A: Policies must be issued as noncancelable. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅D: Per Capita Prepaid 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 Answer ✅C: Change of Beneficiary A policy that is issued at standard rates is an example of: A: Adverse Selection B: Risk Classification C: Substandard Risk Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: None of the Above - Correct Answer ✅B: Risk Classification The easiest definition of a total disability is defined as: A: Own Occupation B: Any Occupation C: Partial Occupation D: Residual Occupation - Correct Answer ✅A: Own Occupation 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 Answer ✅A: Claim Forms 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? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: The insurer will deny the claim 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 Answer ✅C: The free look is an unconditional refund provision All of the following are required disclosure forms at application EXCEPT: A: HIPAA B: HIV C: MIB D: None of the Above - Correct Answer ✅C: MIB Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) C: Skilled D: Intermediate - Correct Answer ✅B: Custodial For what period of time must the fiscal or calendar year records of a Premium Fund Trust Account be kept? A: At least 7 years. B: At least 6 years. C: At least 5 years. D: At least 3 years. - Correct Answer ✅A: At least 7 years. 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 Answer ✅C: 35-39 How many separate accounts exist under the life and health guarantee association? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: 4: Variable, HMO, Life, and Health B: 3: Variable, Life, and Health C: 2: Life and Health D: 1: Life and Health - Correct Answer ✅C: 2: Life and Health 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 Answer ✅C: Within 90 days If an applicant is under age 65, they must apply for a supplement within _______ of enrolling for Part B. A: 3 months B: 6 months C: 12 months Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: 18 months - Correct Answer ✅B: 6 months 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 Answer ✅A: 10 days 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅C: To qualify an insured must be disabled for a year or longer or die within a two year period. A provision in a health policy that stipulates that any medical impairments that occurred within a specific time before coverage began that will not be covered under a policy is known as: A: Exclusion B: Waiver of Coverage C: Preexisting Conditions D: All of the Above - Correct Answer ✅C: Preexisting Conditions 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) C: The insurer will provide full coverage less deductible and Coinsurance payment D: The insurer will deny the claim - Correct Answer ✅D: The insurer will deny the claim Workers' Compensation is regulated by: A: State Government B: The Employer C: Federal Government D: The Insurer - Correct Answer ✅A: State Government 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. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: No policy will cover a specified disease if diagnosed occurred before the policy was applied for. - Correct Answer ✅B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. D and B own a business 50/50. D has suffered a total and permanent disability and B is receiving a lump sum benefit to purchase D's share of the business. This policy is called a(an): A: Accidental Death and Dismemberment B: Cross Purchase Disability Buyout Agreement C: Key Person D: Entity Purchase Disability Buyout Agreement - Correct Answer ✅B: Cross Purchase Disability Buyout Agreement 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. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) A: $1,000 B: $2,500 C: $5,000 D: $10,000 - Correct Answer ✅D: $10,000 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 Answer ✅A: deny conversion 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 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: 45 days - Correct Answer ✅A: 21 days If an applicant is under age 65, they must apply for a supplement within _______ of enrolling for Part B. A: 3 months B: 6 months C: 12 months D: 18 months - Correct Answer ✅B: 6 months 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 Answer ✅B: Probationary Period 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? Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) 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 Answer ✅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 Answer ✅C: Special Risk Policy K has an industrial health policy and forgot to pay his premium. How many days does K have to pay his policy before it will lapse? A: 7 days B: 10 days Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: A and B only - Correct Answer ✅D: A and B only Under minimum standards in individual policies, which of the following may exclude an accident or sickness? A: Individual disability policy B: Individual Medicare Supplement C: Workers Compensation D: Individual Long Term Care - Correct Answer ✅C: Workers Compensation 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 Answer ✅C: 30 Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) If a group policy is discontinued, the prior insurer is still liable for claims that occur during the grace period of the policy and: A: may charge premiums during the grace period B: may not charge premiums during the grace period C: may limit benefits D: None of the Above - Correct Answer ✅A: may charge premiums during the grace period 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 Answer ✅A: Impairment Rider D has a group policy through his employer and has five children all under age 21. D's group policy will charge premiums: A: per child B: one amount for all children C: nothing Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) D: None of the Above - Correct Answer ✅B: one amount for all children 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 Answer ✅D: None of the Above B lives in a long term care facility and owns a LTC policy. Three days per week skilled medical personnel attend to her needs. B is receiving: A: Skilled Care B: Intermediate Care C: Custodial Care D: Assisted Daily Living - Correct Answer ✅B: Intermediate Care All of the following are true regarding benefits under a Key Employee policy EXCEPT: A: Benefits may be paid monthly over a year period to make up employee salary. Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) B: Premiums paid by the employee are not tax deductible and the benefits are paid taxable as income. C: Premiums paid by the employer are tax deductible and premiums paid by the employee are not tax deductible. D: Premiums paid by the employee are not tax deductible and benefits are paid as taxable income. - Correct Answer ✅C: Premiums paid by the employer are tax deductible and premiums paid by the employee are not tax deductible. 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 Answer ✅B: Investigative Report L has a major medical policy. Ten years ago, L survived cancer but was sick again five years ago and fully recovered. Unfortunately, L has just be notified that he has relapsed again. Although L has suffered through multiple Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) catastrophic losses, the policy is still providing coverage. L most likely has a policy with: A: Lifetime Benefit Limit B: Annual Limit C: Per Cause Limit D: Indemnity Limit - Correct Answer ✅A: Lifetime Benefit Limit The insured wants to file a lawsuit against an insurer. Under the Legal Actions provision, how long must the insured wait before filing the lawsuit? A: 20 days B: 30 days C: 45 days D: 60 days - Correct Answer ✅D: 60 days Under the mandatory clauses enacted by the NAIC in 1950, which provision specifies the manner in which an insured must make the company aware of a potential loss? A: Notice of Claim B: Written Proof of Loss Accident and Health Insurance Exam Questions and Answers (Latest Update 2024) C: Claim Forms D: Time Limit on Certain Defenses Period - Correct Answer ✅A: Notice of Claim A producer who places insurance with an insurer, either directly or indirectly, with whom the producer does not have an agent contract A: is grounds for license revocation. B: requires a special limited license. C: requires that the producer must post a surety bond in favor of the people of Illinois. D: must pay a state fee based on volume of business placed with such an insurer. - Correct Answer ✅C: requires that the producer must post a surety bond in favor of the people of Illinois. What is the maximum time frame for probationary periods found in Accident policies? A: 10 days B: 20 days C: 30 days