Life, Accident and Health or Sickness Examination Latest 2024-2025, Exams of Nursing

Download Life, Accident and Health or Sickness Examination Latest 2024-2025 and more Exams Nursing in PDF only on Docsity! 1 LIFE, ACCIDENT AND HEALTH OR SICKNESS EXAMINATION LATEST 2024-2025 ACTUAL EXAM TEST BANK 200+ QUESTIONS AND CORRECT ANSWER S (VERIFIED ANSWERS) what is meant by referring to an insurance policy as a unilateral contract? - correct answer Only one party makes a legally enforceable promise. When must insurance records of insurance agents and brokers be made available to the insurance commissioner? - correct answer At all times. Any situation that presents the possibility of a loss is known as? - correct answer a loss exposure. Which of the following information is not required to be communicated in a Life insurance contract? - correct answer Personal Judgement the direct distribution of insurance utilizes all of the following to mote the sale of insurance Except? - correct answer Telephone call from an agent. A contract in which one party promises to indemnify another against loss that arises from an unknown event is - correct answer an insurance policy. All of the occurrences listed below are examples of an insurable event as defined by the California Insurance code EXCEPT? - correct answer an insured suffers a financial loss in the state lottery. all of the following statements about aleatory contracts are true EXCEPT? - correct answer the insured and insurer contribute equally to the contract. all of the following would be considered unfair trade practices EXCEPT? - correct answer committing any act of discrimination whether it be deemed fair or unfair. As authorized by the California Insurance Code, the Insurance Commissioner has provided standards for names used by life insurance agents. Under these standards which, if any, of the following are automatically acceptable for Mary Brown, a holder of the CLU designation? - correct answer Mary Brown Insurance Services. A contract of indemnity is one in which? - correct answer one party is restored to the same financial position the party was in before the loss occurred. In insurance terminology, "indemnity means? - correct answer to make whole. As defined in the California insurance Code, "insurance" is a? - correct answer Contract 2 what would a person be guilty of who refuses to deliver any books records, or assets to the commissioner once a seizure order has been executed? - correct answer A misdemeanor. An agent who is acting as an insurance agent, broker, solicitor, life agent, accident and health, or bail agent acts in which capacity when handling premiums or return premiums for an insured? - correct answer fiduciary which of the following statements regarding risk is TRUE? - correct answer Only pure risks are insurable. the purchase of an insurance policy may accomplish all of the following Except? - correct answer the elimination of risk Insureds are entitled to recover an amount NOT greater than the amount of their loss under the principle of - correct answer Indemnity. What rule is used to determine the importance of a representation? - correct answer The materiality of concealment. The required contents of a policy include all of the following EXCEPT? - correct answer The probability of loss All of the following are characteristics of reinsurance EXCEPT ? - correct answer Increases the unearned premium reserve According to the California code, an insurance policy must specify all of the Following Except? - correct answer the financial rating of the insurer all of the following qualify as "background information" as defined in section 1729.2 of the California Insurance Code, Except? - correct answer misdemeanor charges filed, not resulting in a conviction. Loss retention is an effective risk management technique when all of the following conditions exist EXCEPT the - correct answer probability of loss is unknown. a situation in which there is a possibility of loss or a gain is a - correct answer speculative risk Why is having a large number of similar exposure units important to insurers? - correct answer the greater the number insured, the more accurately the insurer can predict losses and set appropriate premiums. all of the following are benefits of insurance Except it ? - correct answer eliminates fraudulent losses. who are members of the Medical information Bureau? - correct answer Life and Health insurers 5 A person owns a life annuity. He elects to receive his annuity payments monthly for the remainder of his life with "ten years certain". the Annuity will make payments. - correct answer for a minimum of 120 months and a maximum of the remainder of his life. all of the following information is gathered during the personal financial planning process Except - correct answer a listing of a person's civic and professional organization membership. which policy provision allows an insured to continue coverage under a previously lapsed policy? - correct answer the reinstatement provision. According to the California Insurance Code, governing the use of life insurance policy illustrations, the term illustration means. - correct answer a presentation of policy features that includes non-guaranteed elements. The life insurance grace period allows the insured to - correct answer pay the premium after the due date without loss of coverage. When a family policy covers children, all of the following are true EXCEPT - correct answer evidence of insurability is required to convert coverage for children to permanent insurance. An attempt by an agent to deter an insured from replacing an existing life insurance policy is called - correct answer conservation which of the following would an agent be guilty of for misrepresenting the amount of dividends a policy will pay. - correct answer A misdemeanor. The additional premium charged by an insurer for adding the accidental death benefit to a whole life policy - correct answer does not affect the policy's cash value. How much employer-provided group term life insurance is exempt from income taxation? - correct answer $50,000 How long is the free cancellation period for the life insurance offered to individuals who are 60 or older? - correct answer 30 days what does the statement "life insurance created an immediate estate" mean ? - correct answer the total death benefit is paid whenever the insured dies. Which report of an insurance applicant's creditworthiness and personal characteristics may influence eligibility for life and health insurance? - correct answer Consumer report. In group life insurance, who is issued a certificate of insurance - correct answer the participant. which type of insurance guarantees the right to renew the policy each year, regardless of health, but at an increased premium? - correct answer renewable term. 6 If a life agent sells a whole life policy to a prospect on behalf of an insurer without an appointment, the - correct answer insurer must submit a notice of appointment to the commissioner. Which component of a life insurance premium is based on the insured's age and gender? - correct answer Mortality Which benefits are provided by key employee insurance? - correct answer Payment to a business when a important employee dies. How can partners guarantee a market for their share of the business in the event of death? - correct answer Buy-sell agreements Which policy covering two or more individuals pays the face amount only when the first person dies? - correct answer Joint life policy. Which two insurance products are commonly used to fund buy-sell agreements? - correct answer Life insurance and disability insurance Which policy provision protects the insurer against possible adverse selection? - correct answer suicide clause which type of insurance coverage has both a savings element and a flexible premium option? - correct answer Universal life. A life insurance policy written after 1988 that fails to meet the seven pay test is known as - correct answer a modified endowment contract. what type of insurance policy provides a death benefit that matches the projected outstanding debt on an individual's home? - correct answer Mortgage redemption. An agent who violates the laws governing life insurance policy illustrations is subject to all of the following EXCEPT - correct answer mandatory termination of all insurer appointments Which policy is a saving instrument designed to first accumulate funds and then systematically to liquidate the funds? - correct answer Deferred annuity. individual life insurance policies sold to seniors in the state of California must include a prominently placed statement that divulges all of the following information Except - correct answer proof of surrender must be notarized at the agent's principal office. People commonly purchase an annuity to protect against the risk of: - correct answer outliving their financial resources. what is one difference between group life and individual life underwriting? - correct answer individual life insurance requires the applicant to answer medical questions 7 A $50,000 whole life policy with a cash value of $10,000 has been in force for eleven years. The policy owner is unable to continue the premium payments. Which of the following describes the reduced paid up nonforfeiture option? - correct answer the cash value is used to select a $20,000 paid up policy. which of the following is a characteristic of non-qualified annuities? - correct answer Tax- deferred earnings. A 10-year certain annuity with an installment refund is purchased. The annuitant dies after receiving monthly payments for 5 years. How many remaining payments will the insurer make? - correct answer 60 payments. the payor rider on a juvenile life policy provides that if the payor dies or becomes disabled before the insured juvenile reaches the age specified in the policy that the - correct answer insurer will make the payments until the insured juvenile reaches a specified age usually twenty one or twenty five. which if the following contracts provides benefits that fluctuate automatically with investments results? - correct answer Variable life insurance. the theory of probability is applied to life insurance through the use of - correct answer mortality tables what is the difference between deferred annuities and immediate annuities? - correct answer Deferred annuities have longer accumulation periods. which of the following is Not an option for the use of the policy dividends? - correct answer fund the distribution of monthly income payments. The insured is totally and permanently disabled. The insured's policy continues in force without payment of further premiums because the policy contains a - correct answer waiver of premium provisions your client has just bought a new home which he has financed with a $150,000, 7.5% interest, 30--year bank loan. He would like to be sure that if he dies that the unpaid balance of the mortgage would be paid. he wants a policy that will cover the mortgage balance no more, no less anytime during the life of the mortgage. which policy is designed to meet this need? - correct answer Decreasing term policy. Death benefits payable to a beneficiary under a life insurance policy are generally - correct answer exempt from federal income tax An insured replaces an existing annuity with a new one and must pay a surrender charge for cancelling the existing annuity. The new policy holds no greater financial benefits to the insured than the existing contract. This is an example of - correct answer an unnecessary replacement. 10 which government regulation prevents retirement plans from favoring highly compensated employees - correct answer nondiscrimination what is the difference between a conditional premium receipt and a binding premium receipt? - correct answer Only a binding receipt always provides insurance that is effective from the date the receipt is given. a life insurance policy's waiver of premium takes effect if an insured - correct answer becomes totally disabled. Under a group life insurance policy, acts of war and aviation are examples of: - correct answer policy exclusions what does the statement "life insurance creates an immediate estate" mean? - correct answer the total death benefit is paid whenever the insured's dies which policy protects an insurer against a lawsuit before the insurer has had a reasonable opportunity to investigate a claim - correct answer Legal actions. what factor determines the difference between deferred and immediate annuities? - correct answer when annuity benefit payment begin. How does the cost recovery rule apply when a life insurance policy is surrendered for its cash value? - correct answer the cost basis of the policy is exempt from taxation. The components of determining policy premiums include all of the following EXCEPT - correct answer dividends From lowest to highest, which is the Correct order of initial premiums for life insurance policies? - correct answer Modified premium, ordinary life, single premium. Underwriters classify insurance risks as any of the following EXCEPT - correct answer dividends risks Under which group term life provision does an insurer make payments to the guardian of a beneficiary who is a minor? - correct answer facility of payment a beneficiary wants to let the death benefit accumulate and recieve only the monthly investment proceeds. which settlement option should be chosen? - correct answer interest option. Death benefits that are received by a beneficiary are generally - correct answer are exempt from federally income tax. the California insurance code requirements regarding the return of life or annuity contracts issued to seniors. - correct answer gives a senior at least 30 days to return specified life and/or annuity contracts for a full refund. 11 An insurer's request for an attending physician's report MUST be accompanied by a copy of the - correct answer signed authorization what is required when an application reveals conditions that require more information? - correct answer Attending physician's statement. Which policy provision protects the policyowner from unintentional lapse of the contract? - correct answer Grace period. Under which policy provision can a policy be surrendered for its net cash value? - correct answer Nonforfeiture options the policy owner, age 50, has been paying the premiums on his whole life policy for fifteen years. He needs the equivalent of one-third of his policy's cash value for two years. he wants to continue to have the same amount of life insurance protection and he can afford to continue to pay the policy's premium. Which of the following is his best course of action? - correct answer Use the policy loan provision to borrow money from the policy, but keep making the premium payments to keep the policy in force. in a 5-year vesting schedule, what percentage of employer contributions MUST be vested after 5 years of service? - correct answer 100% which of the following is a characteristic of non-qualified annuities? - correct answer tax- deferred earnings. which of the following is a correct statement about the premium payment modes? the total premium paid by a life policy owner for one policy year is: - correct answer greater if the premium is paid semiannually rather than annually. What is the limit of liability on a life insurance policy? - correct answer the face amount of the policy. traditional comprehensive major medical plans include all of the following except - correct answer first-dollar coverage. Under a disability income insurance policy with an own occupation clause, an individual who can no longer perform the tasks of the job held at the time of injury is considered - correct answer totally disabled. Part-time nursing care that follows a hospitalization and can be provided in a patient's home is covered under - correct answer home health care benefits. what type of insurance can be purchased at airports, bus terminals, and railroad stations? - correct answer travel accident insurance. During the solicitation of a long term care insurance rider, a life agent must consider all of the following EXCEPT the applicant's - correct answer attending physician statement. 12 Vision care insurance usually covers all of the following EXCEPT - correct answer eye surgery all of the following are optional group medical coverages except - correct answer maternity What is the cost of service from the Health Insurance Counseling Advocacy Program (HICAP)? - correct answer No charge All of the following may opt for a self insured medical and disability plan except - correct answer individuals which statement about Medicare is NOT correct? - correct answer Medicare Part C covers long-term care. in order to obtain group insurance without providing evidence of insurability, what do eligible individuals generally have to do? - correct answer enroll within a specified eligibility period the adult day care coverage level of a long term care policy provides for - correct answer part time nursing at a facility for elderly who live at home. Regarding the Health Benefit Exchanges, as created by PPACA, all of the following statements are true EXCEPT - correct answer an individual enrolling in a bronze level plan is not eligible for reduced cost-sharing. Under the PPACA, which medical enrollment tier is 80% actuarial value? - correct answer gold Provision in a disability income policy include all of the following EXCEPT - correct answer deductible and coinsurance amounts all of the following statements are true regarding Health Insurance Counseling Advocacy Program (HICAP) counselors EXCEPT HICAP counselors - correct answer are qualified to give legal advice. which program is designed to provide medical assistance to people with low incomes? - correct answer Medi-Cal. a commonly used cost containment measure for emergency hospital care under a major medical expense plan is the - correct answer deductible. a supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as - correct answer hospital confinement indemnity The group medical plan provision that applies when a claimant has coverage under more than one plan is known as - correct answer coordination of benefits which group provides information about Health-related issues to the elderly in California? - correct answer The Health Insurance Counseling and Advocacy Program (HICAP). 15 Which program pays the cost of nursing home care for people who cannot afford it themselves? - correct answer Medi-Cal. Benefits under Social Security are available only for workers who are - correct answer fully insured. Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act (COBRA) cover groups of at least - correct answer 20 employees. With Medicare coverage - correct answer Part B provides benefits for diagnostic tests and X- rays performed on an outpatient basis. A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage? - correct answer 80% According to the California insurance code, all of the following Long-term Care (LTC) insurance sales are considered unnecessary except - correct answer Replacement LTC policy with equal benefits for a lower premium. all of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT - correct answer Medical expense. the most common type of specified disease insurance policy is - correct answer cancer After the deductible is satisfied, what percentage of a reasonable charges does Medicare Part B pay? - correct answer 80% which of the following statements concerning the usual coordination of the benefit provisions is correct? - correct answer When two plans both have the provision, coverage as an employee is primary to coverage as a dependent. Which health insurance provision protects an insured from the expense of a catastrophic illness? - correct answer Stop-loss which health insurance contract provision addresses the problem of overinsurance? - correct answer Coordination benefits Relevant factors in the health insurance principle of morbidity include all of the following EXCEPT. - correct answer Intelligence. To reach currently insured status Under the Social Security system, an individual must be credited with a MINIMUM of - correct answer 6 quarters of coverage during the last 13- quarter period. in health insurance, the result of rising morbidity rates is - correct answer increased premiums which health plan might apply 90% coinsurance to network providers and 70% coinsurance to non-network providers. - correct answer Preferred Provider Organization (PPO) 16 The Family and Medical Leave Act (FMLA) covers all of the following except - correct answer traveling with a spouse who has been transferred overseas. a surviving spouse without dependent children is eligible for social security survivor benefits at age - correct answer 60 what happens if an insurer violates the Medical Loss ratio rate and spends too much money on administrative costs? - correct answer Insurers that do not meet the medical loss ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs. When an agent writes a replacing long-term care policy, the agent's first year sales commission will be determined based on the - correct answer difference between the new and original policy annual premiums. all of the following conditions must be met to qualify for residual disability benefits under a disability income policy Except - correct answer qualifies for Social security disability benefits all of the following features of a preferred provider organization (PPO) Except - correct answer Primary are physicians act as gatekeepers in the Worker's Compensation policy, Part one, Workers' Compensation, pays for - correct answer sums the insured is required to pay under state Workers' Compensation law. Under Social Security, the definition of disability is the inability to engage in - correct answer any substantial gainful activity at what age are individuals eligible for Medicare Part A benefits? - correct answer 65 the employee retirement income security act of 1974 (ERISA) regulates group health insurance in the area of - correct answer disclosure and reporting. which of the following conditions would Not be included among the chronic illness triggers of long term care policy? - correct answer Deafness Insurers are prohibited from denying claims based on misrepresentations in a disability policy application after the policy has been in force for - correct answer two years Which funded government program is jointly administered by the federal and state governments? - correct answer Medi-Cal. What rights do individuals have if they disagree with a decision on the amount medicare will pay? - correct answer they can ask the medicare carrier to review the decision. which long term care policy provision allows for a periodic increase in policy benefits - correct answer inflation protection 17 All of the following statements about Medicare Part B are correct EXCEPT it - correct answer pays for virtually all drugs prescribed by a physician. Under PPACA, what is a health benefit exchange? - correct answer PPACA creates new entities called American Health Benefit Exchanges through which individuals, small businesses, and those who do not have access to affordable employer coverage, can purchase coverage. the initial enrollment period for Medicare Part B ends how many months after the 65th birthday month? - correct answer Three months what is the first step in submitting Medicare claims - correct answer the medical provider submits expenses to medicare Unless certified by another governmental agency, which entity has jurisdiction over providers of coverage designed to pay for health care services? - correct answer the department of Insurance Long-term care insurance may be purchased in all of the following forms Except - correct answer federal government sponsored policies Under the Consolidated Omnibus Budget Reconsolidation Act (COBRA), a qualifying event ensures that an employee who loses coverage can - correct answer elect to continue coverage. which statement is TRUE regarding Worker's compensation? - correct answer the employer pays the entire premium for Worker's Compensation coverage. which program is designed to provide medical assistance to people with low incomes - correct answer Medi-Cal. the social security normal retirement age depends upon the - correct answer Worker's years of birth. Who submits Medicare Part A claims? - correct answer hospitals How long do Worker's Compensation medical expenses continue for disabled workers? - correct answer there is no limit. which of the following statements concerning the usual coordination of benefits provisions are CORRECT? - correct answer When two plans both have the provision, coverage as an employee is primary to coverage as a dependent. the Americans with Disabilities Act (ADA) defines a disabled person as one who is unable to perform any of the following life activities EXCEPT - correct answer driving Probationary periods reduce costs to employers in all of the following ways EXCEPT - correct answer employees must pay the entire premium during this time.