Health Insurance Policies and Regulations, Exams of Nursing

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WISCONSIN ACCIDENT AND HEALTH

INSURANCE EXAM 2024-2025 WITH

ACTUAL CORRECT QUESTIONS AND

VERIFIED DETAILED ANSWERS

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Health insurer's are prohibited from discrimination based on an individual's:

Medical history Genetic makeup Geographical location Pre-existing conditions

Genetic makeup

The Medicare home health care benefit includes coverage for:

Meal delivery House cleaning services Nurse visits Prescription drugs

Nurse visits

A health maintenance organization (HMO) usually provides all of the following inpatient hospital services EXCEPT:

Preadmission certification Concurrent utilization review

Discharge planning Payment for convenience items

Payment for convenience items

Health care plans using a preferred provider network usually discourage the use of non-network providers by:

Restricting the range of covered services Requiring greater cost sharing for the use of non-network services Applying a relative value scale to benefits Prohibiting referrals to non-network doctors

Requiring greater cost sharing for the use of non-network services

In health insurance, an insuring clause might include any of the following EXCEPT:

The identity of the insurer The identity of the insured A change of beneficiary provision A statement of the kind of loss that is covered

A change of beneficiary provision

In a guaranteed renewable disability income contract, the insurance company reserves the right to change premiums after the policy is issued if:

The Consumer Price Index has increased by the same percentage The premium for all insureds is changed by the same percentage The insured's occupation has changed The premium change applies to all insureds in a specific class or classes

The premium change applies to all insureds in a specific class or classes

All of the following statements about HMOs are true EXCEPT:

HMOs combine the financing and provision of health care in one organization. Subscribers are encouraged to have regular medical checkups. Preventive care is encouraged by HMOs. Employees of nonprofit organizations are prohibited from enrolling in HMOs.

Employees of nonprofit organizations are prohibited from enrolling in HMOs.

Under which disability income policy provision might an insured be considered totally disabled, even if working, following the loss of sight in both eyes?

Recurrent disability Residual disability

Presumptive total disability Regular occupation total disability

Presumptive total disability

An insured currently has group coverage issued by different health insurance companies. How will payment for medical expenses typically be handled when both group policies provide coverage?

The policy under which the individual was first insured will pay for the expenses. Payment will be made in accordance with the policies' coordination of benefits provisions. The insured will collect the full amount of expenses from each of the two insurers. Payment of expenses will be made in accordance with the policies' uniform provisions.

Payment will be made in accordance with the policies' coordination of benefits provisions.

In health insurance, initial notice about a potential claim:

May be required within a short time period Usually results in rejection of the claim Is sent to the attending physician's office Must be submitted by the provider of services

May be required within a short time period

Group health insurance usually is written to cover:

People working for the same employer At least 100 people A minimum of 75 people People who have no dependents

People working for the same employer

In group health insurance, a group with a high average age usually has:

Above average maternity claims Above average total health claims Little or no exposure to disability claims Below average rates

Above average total health claims

One objective of a concurrent review provision in group health insurance is to:

Reduce emergency admissions to the hospital Reduce the number of second surgical opinions Monitor length of stay in the hospital once the patient is admitted Enforce the coordination of benefits provision

Monitor length of stay in the hospital once the patient is admitted

Which statement is correct in regard to a disability income policy with a 60-day elimination period?

The premium will be less than that of a policy with a 90-day elimination period. The premium is waived for the first 60 days after policy issue. The insured will be eligible to receive benefits beginning on the 61st day of disability. The first benefit payment will arrive on the 61st day of disability.

The insured will be eligible to receive benefits beginning on the 61st day of disability.

Why would an insurer limit the combined amount of disability income benefits under multiple policies purchased by an insured from the same or another company?

To make it unnecessary for the insured to complete more than one proof of loss form per illness. To make it unnecessary for the physician to submit multiple proofs of disability for the same person. To prevent the insured from receiving a benefit amount which might make becoming disabled financially attractive. To prevent the insured from purchasing additional medical coverage immediately before a scheduled surgery.

To prevent the insured from receiving a benefit amount which might make becoming disabled financially attractive.

The main intent of the cosmetic surgery exclusion is to bar coverage for:

Elective surgery Accidental injuries Birth defects Surgery not supported by a second opinion

Elective surgery

A producer or agent who negligently replaces health insurance for a client creates potential liability for:

Breach of good faith Errors and omissions Personal injury The former insurer

Errors and omissions

All of the following are true about dental insurance EXCEPT:

Preventive services are seldom covered. Orthodontic coverage is sometimes included. Dental x-rays are usually covered. A deductible may have to be satisfied.

Preventive services are seldom covered.

To minimize adverse selection, a group dental contract may include any of the following provisions for employees who enroll after the date they were initially eligible to participate EXCEPT:

Reduction of benefits by 50% for one year Reduction of maximum benefits for one year Exclusion of certain benefits for a certain period Requirement of a complete physical examination

Requirement of a complete physical examination

If an individual filed a claim under two individual health insurance policies issued by the same insurer, the insurer might return:

50% of the lower of the two premiums, but pay all benefits under both policies. Any annual premium amount in excess of $1,000 combined for both policies. The premium amount paid for coverage, which would cause combined benefits to exceed a maximum benefit amount. All premiums and cancel all existing policies purchased by the insured.

The premium amount paid for coverage, which would cause combined benefits to exceed a maximum benefit amount.

Which of these is required for an injury to be covered under health insurance policies with an "accidental bodily injury" definition of injury?

The injury must be accidental, but the cause need not be. The insured must prove reasonable care. The insured must be treated in an emergency room. External signs of the injury must be visible upon examination.

The injury must be accidental, but the cause need not be.

Long-term care policies may require all of the following before paying benefits EXCEPT:

A prior hospitalization A physician's certification of need A functional assessment An elimination period

A prior hospitalization

Which is required for Medicare coverage of skilled nursing facility care?

The care must be medically necessary for at least one year. The insured must elect it as a benefit in lieu of regular Medicare benefits.

The facility must agree to continue care after Medicare benefits end. The facility must be approved by Medicare.

The facility must be approved by Medicare.

Ambulatory services under case management provisions try to monitor:

Length of stay in a hospital Response time by the ambulance service The cost-effectiveness of outpatient services The driving distance to the nearest hospital

The cost-effectiveness of outpatient services

For groups with high prior claims experience, an insurer would be likely to:

Charge a reduced first year premium Seek higher benefit levels Expect high future claims experience Reduce the required participation percentage

Expect high future claims experience

Medicaid is funded by state governments and by:

Commercial insurers The federal government Blue Cross/Blue Shield organizations Various charitable organizations

The federal government

Which type of health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury?

Disability income Medical expense Accidental dismemberment Workers compensation

Medical expense

If a life insurance policy is transferred to another person in exchange for valuable consideration, then the death proceeds may:

Lose their income tax exempt status Be reduced by the amount of the consideration Be taxed as capital gains Become subject to probate

Lose their income tax exempt status

Risk ____ is the process of analyzing exposures that create risk and designing programs to handle them.

Acceptance Management Administration Transfer

Management

which of these statements is NOT a characteristic of the law of large numbers?

Individual losses can be predicted based on past experience. Group losses can be predicted based on past experience. Losses can be predicted in large groups with a higher degree of accuracy. Rates can be calculated to compensate for losses.

Rates can be calculated to compensate for losses.

what type of risk involves the potential for loss And the possibility for gain?

Homogeneous Adverse Pure Speculative

Speculative

For insurance purposes, similar objects which are exposed to the same group of perils are referred to as

Homogeneous perils Similar exposure units Homogeneous exposure units Common hazards

Homogeneous exposure units

what type of risk involves the potential for loss with no possibility for gain?

Speculative risk Pure risk Adverse risk Morale risk

Pure risk

According to the law of large numbers, how would losses be affected if the number of similar insured units increases?

The higher the exposure, the higher the cost of each loss. No effect on predicting losses. Predictability of losses will be improved. Ability to predict losses decreases.

Predictability of losses will be improved.

which of the following can be defined as a cause of a loss?

Adversity Risk Hazard Peril

Peril

We have an expert-written solution to this problem!

the courts will normally interpret a policy in favor of the insured when the meaning of the policy is not clear. This is because an insurance policy is a(n):

Warranty contract Aleatory contract Contract of adhesion Unilateral contract

Contract of adhesion

The payment of the first premium, the promise to pay a covered loss, and the agreement to abide by policy conditions are all examples of

Consideration Legal purpose Representation Acceptance

Consideration

an insurance company's failure to enforce a contract's provision is called a(n)

Waiver Warranty Assignment Concealment

Waiver

the unwritten authority given to a producer to carry out necessary incidental acts of the agency agreement is called

Implied authority Express authority Apparent Authority Acknowledged Authority

Implied authority

Under the Law of Agency, the principal is considered to be

The producer The insurer The plan administrator The insured

The insurer

The insurer's obligation to pay a claim depends on whether the insured or beneficiary has complied with all policy conditions. This makes the policy a(n):

Agency agreement Aleatory agreement Contract of good faith Conditional contract

Conditional contract

An insured is entitled to coverage under a policy that a prudent person would expect it to provide. This principle is called

Adhesion Reasonable sensibility Reasonable expectations Insurable interest

Reasonable expectations

what is the insurer responsible for when a producer is acting within the scope of authority granted in the agency contract?

All actions by the producer. Not responsible for any acts by the producer. Responsible for acts that involve misrepresentation only. Responsible for acts by the producer that are authority only.

Responsible for acts by the producer that are authority only

an arrangement where an individual is authorized to act on behalf of another person or company is established through

Estoppel The law of agency The law of adhesion An aleatory contract

The law of agency

During the application process, a statement made by an applicant that becomes part of the contract is considered to be a(n)

Warranty Representation Waiver Exclusion

Warranty

which situation would not require the insured's consent when a life insurance policy is issued?

A policy is purchased by a husband for his wife. A policy is purchased by a parent for a minor child. A policy is purchased by a business partner for another partner. A policy is purchased by an employer for an employee.

A policy is purchased by a parent for a minor child.

Christopher is issued an insurance policy that contains an attached agreement which alters the terms of the policy. This attached agreement is called a(n)

Extension Endorsement Sanction Restriction

Endorsement

Which of the following situations would an insurance agent need to guard against liability for professional errors and omissions?

Remitting premiums to an insurer.

Conducting a sales meeting with other agents. Making a recommendation to a potential insured to replace existing coverage. setting a sales appointment with a potential client.

Making a recommendation to a potential insured to replace existing coverage.

Which element of a contract constitutes a definite and unqualified proposal by one party to another?

Adhesion Consideration Acceptance Offer

Offer

When must insurable interest exist for a life insurance contract to be valid?

Inception of the contract Throughout the entire length of the contract When the insured dies During the contestable period

Inception of the contract

The powers directly given to a producer in an agency contract are called

Express Apparent Implied Assumed

Express

An insurance application requires an applicant to make a full, accurate disclosure of the risk factor involved. Using this criteria, an insurance policy is considered what type of contract?

Aleatory contract Estoppel contract Contract of utmost good faith Unilateral contract

Contract of utmost good faith

Giving up a known right on a voluntary basis is called a(n)

Disclaimer Estoppel Waiver Surrender

Waiver

Insurable interest involves what assumption?

Insurable interest must exist during the entire life of the insured. One person gains from the death of another person. One person benefits from another person's continued life. Insurable interest must only exist at the time of the insured's death.

One person benefits from another person's continued life.

All of these statements correctly describe an aleatory contract EXCEPT

A legal wager is considered an aleatory contract. Potential unequal exchange of value for both parties. Only one party makes any kind of legally enforceable offer. Element of chance is involved.

Only one party makes any kind of legally enforceable offer.

the following are all elements of a valid contract EXCEPT

Consideration Offer and acceptance Competent parties Written evidence

Written evidence

Voluntarily terminating an insurance policy is also known as

Discontinuation Elimination Estoppel Cancellation

Cancellation

Which of the following relationships demonstrates insurable interest in the absence of economic interest?

Lifelong friends Employees Marriage partners Business associates

Marriage partners

Greg applies for insurance and makes a false statement on the application that will influence whether or not the insurer will accept the risk. Greg's false statement is called a(n)

Substandard representation. Unacceptable risk. Material misrepresentation. Adverse selection.

Material misrepresentation

what is the federal income tax liability of a death benefit paid from a health insurance policy to a named beneficiary?

Benefits are not taxable Benefits are partially taxable Benefits are tax-deferred Benefits are fully taxable

Benefits are not taxable

Under a key person disability income policy, benefits will be received as

Taxable income to the key employee Tax-free to the key employee Tax-free income to the business Taxable income to the business

Tax-free income to the business

When group benefits under COBRA have expired, a fully insured group policy can be converted to a(n)

Individual health policy Blanket policy Group policy with another insurer Disability policy

Individual health policy

A group health insurance policy is a contract between an

Employee and insurance company Employee and employer Employer and insurance company Employer and producer

Employer and insurance company

What type of employee welfare plans are not subject to ERISA regulations?

Church plans Major medical plans Corporate Qualified plans

Church plans

Jill has a group health plan with an employer that covers employees in more than one state. Which of the following aspects is NOT affected by the state regulatory jurisdiction established for this plan?

Eligibility requirements. Required provisions. Minimum enrollment percentage. Continuation of coverage under COBRA.

Continuation of coverage under COBRA

An accident and health insurance policy defines an injury as "bodily injury by accidental means". For an injury to be covered on this policy, what is required?

The accident must be external and violent. The cause of the accident must be intentional. Only the injury resulting from an accident must be unintentional. Both the cause and resultant injury must be accidental.

Both the cause and resultant injury must be accidental

An employer pays the accident and health insurance premiums for its employees. The premiums paid by the employer are

Deductible to the business. Taxable to the employee. Tax-deferred to the business. Reimbursed as a tax credit.

Deductible to the business.

ABC Corporation purchases and is beneficiary of an individual disability income insurance policy on a key employee. Which of the following statements is true?

Premiums paid by the company are tax-deductible. Benefits are taxable to the key employee. Benefits are received tax-free by the company. Premiums paid by the company are tax-deductible to the key employee.

Benefits are received tax-free by the company.

Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy?

Limited. Special risk. Reimbursement. Blanket.

Reimbursement.

When disability buy-sell insurance benefits exceed a partner's cost basis, which of the following is correct?

The excess is taxed as a capital gain to the partner. The excess is taxed as ordinary income to the partner. The excess is partially taxable to the partner. The full amount is non-taxable to the partner.

The full amount is non-taxable to the partner

How are benefit payments from individually-owned medical expense policies treated for tax purposes?

Exempt from income taxes. Taxed as ordinary income. Taxed as a dividend. Tax credit given for amount of benefit payment.

Exempt from income taxes.

Which parties are directly involved in a group accident and health insurance contract?

Insurer and employees. Insurer, employees, and employer. Employer and insurer. Employer and employees.

Employer and insurer.

Which of the following is not a function of accident and health insurance?

Pays a death benefit as a result of natural causes. Covers the loss of income from a disability. Covers the cost of medical care as a result of an accident. Pays for hospice care in the event of a terminal illness.

Pays a death benefit as a result of natural causes.

Trade association groups that are eligible for group medical benefits normally are

In the same industry. In different industries.

Formed for the sole reason of obtaining insurance. Large businesses.

In the same industry.

Group accident and health insurance may be offered by an insurer when the sponsoring group

Was formed to purchase insurance. Provides individual evidence of insurability of its group members. Provides an employer-employee relationship. Consists of unrelated members.

Provides an employer-employee relationship.

Tina is insured under a business overhead expense insurance policy. Which of the following would be covered if she were to become disabled?

A decrease in the company's valuation. Business property rental expense. Tina's salary. Dividends owed to shareholders.

Business property rental expense.

Laura has an employer-based preventative health care plan that focuses on an enrollee's problems, such as drug abuse or stress. These plans are called

Wellness programs. Preventative managed care. Employee utilization plans. Employer-based initiatives.

Wellness programs.

In regards to health insurance, employees age 65 or older are typically required to

Be offered the same group health benefits offered to the younger employees. Provide evidence of insurability for medical insurance offered by the employer. Choose medicaid as their primary provider. Choose Medicare as their primary provider.

Be offered the same group health benefits offered to the younger employees.

Nonqualified medical expense distributions from a Health Savings Account (HSA) have a tax penalty of

7.5% 10% 20% 30%

20%

Mary is an employee who is covered with a disability income policy through her employer. She pays for the portion of the premium attributable to the cost of residual disability benefits, while her employer pays for the remainder. What are the tax implications of this policy?

Residual benefits will be received income tax-free. Residual benefits will be taxable to Mary. Premiums paid by the employer are Not tax-deductible. Premiums paid by Mary are tax-deductible.

Residual benefits will be received income tax-free

What is the name of the period of time during which a new employee is ineligible for group Health insurance coverage?

Free-look period. Elimination period. Probationary Period. Noncontributory period.

Probationary Period.

Laura is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?

Authorize for payroll deductions. Agree to a physical examination. Sign an enrollment card. Register with her state of residency.

Sign an enrollment card.

Under HIPAA requirements, eligibility for the pre-existing conditions exclusion waiver under new coverage is lost if

There is a break in coverage for more than 33 days. There is a break in coverage for more than 43 days. There is a break in coverage for more than 53 days. There is a break in coverage for more than 63 days.

There is a break in coverage for more than 63 days

Mike recently lost sight in both eyes. He has a policy that pays a lump sum benefit for this injury. What type of insurance does Mike have?

Catastrophic. Accidental death and dismemberment. Major medical. Hospital expense.

Accidental death and dismemberment.

ABC Partnership is a business with a limited number of partners. Which disability buy-sell agreement is best suited for this business?

Optional buy-back agreement. Entity purchase agreement. Cross purchase agreement. Organizational group agreement.

Cross purchase agreement.

Which type of group plan is excluded from HIPAA rules?

PPOs. Disability Income. HMOs. Major medical.

Disability Income.

James owns a business and purchased a policy that covers the business expense of finding a permanent or temporary employee to replace a disabled one. This type of disability coverage is called

Key business coverage. Key maintenance coverage. Key employee coverage. Key employer coverage.

Key employee coverage.

For employees covered in multiple states under a group health plan, jurisdiction rules cannot alter

Contract provisions. COBRA Laws. Eligibility standards. Contribution percentages.

COBRA Laws.

Which of the following statements BEST describes the HIPAA portability rules for an individual who changes from one group medical plan to another?

Reduces or eliminates any pre-existing conditions excluded under the new plan. Requires that an employer pays for health coverage. Reduces or eliminates the deductible under the new plan. Allows the employee to convert to individual coverage.

Reduces or eliminates any pre-existing conditions excluded under the new plan.

If group Health benefit levels are too high, what could be the end result?

Underutilization of the plan. Overutilization of the plan. Normal utilization of the plan. Adverse selection.

Overutilization of the plan.

In a disability buy-sell agreement, the policies funding the agreement are owned by the

Business entity. Officers. Shareholders. Employees.

Business entity.

Which of the following statements is NOT true concerning the relationship between group health insurance plans and Medicare? (assuming the business has more than 20 employees)

Group health coverage is NOT available for workers over the age of 65. Group health coverage is available to workers over the age of 65. An active employee's group health plan is primary and Medicare is secondary, unless the employee chooses otherwise. Group health coverage is available to an employee's spouse that also happens to be Medicare-eligible.

Group health coverage is NOT available for workers over the age of 65

A disabled business owner who has payroll and business expenses paid for has what kind of insurance policy?

Key person. Franchise disability. Business overhead expense. Disability income.

Business overhead expense.

According to the Pregnancy Discrimination Act of 1978, employers must treat pregnancy in the same manner as

Any other medical disability. A suspension. An unpaid holiday. A pre-existing condition.

Any other medical disability.

Bert's spouse passed away recently. Bert was covered under his spouse's group family health insurance plan but now is covered under COBRA. How much of the active-employee cost may be passed on to Bert for continued coverage?

No maximum. Maximum of 50%. Maximum of 100%. Maximum of 102%.

Typically, states will permit the grouping of two or more small employers in the same industry for obtaining group health insurance at a favorable rate. This grouping of employers is known as a multiple employer

Welfare association. Trust. Consortium. Alliance.

Trust.

Which of the following statements BEST describes disability buy-sell insurance policies?

Benefits are taxable to the business entity. Premiums are typically tax-deductible. Policy proceeds are typically received income tax-free. Benefits are paid to the disabled insured.

Policy proceeds are typically received income tax-free.

Under HIPAA, medical plan late enrollees may be excluded for pre-existing conditions for a maximum of

6 months. 12 months. 18 months. 24 months.

18 months.

Individuals covered with employer-paid group health plans will normally receive tax-free benefits under all of these plans EXCEPT

Disability Income. HMO. Vision. Major medical.

Disability Income.

Typically, working individuals age 65 or over must be

Offered the same health benefits as the younger employees. Covered by Medicare exclusively. Paying a higher premium than younger employees. Covered by a Medicare supplement policy

Offered the same health benefits as the younger employees.

How many employees must an employer have for the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to apply?

At least 10. At least 15. 20 or more. 100 or more.

20 or more.

A comprehensive group policy also covers expenses related to vision care. Which of the following is not typically covered under a vision plan?

Cataract Surgery. Routine eye exam. Corrective vision glasses. Corrective contact lenses.

Cataract Surgery.

Kim is covered under two medical expense plans. Plan A pays up to $5,000. Plan B pays up to $4,000. If she incurs $7,000 in expenses, the coordination of benefits provision dictates that

Plan A pays up to $7,000. Plan A pays up to $3,500 and Plan B pays up to $3,500. Plan A pays 80% and Plan B pays 20%. Plan A pays up to $5,000 and Plan B pays up to $2,000.

Plan A pays up to $5,000 and Plan B pays up to $2,000.

Which of the following best describes the presumptive disability provision?

Reduces the incontestability period.

Increases the monthly benefits stated in the policy. Waives the normal total disability requirements. Assumes all injuries result in total disability.

Waives the normal total disability requirements.

Which factor determines the maximum disability income benefit that can be purchased by an applicant?

The applicant's income. The applicant's age. The applicant's health. The applicant's credit score.

The applicant's income.

Christine is receiving benefits provided from her disability income insurance. As compared to her previous earnings, the disability benefits should be

The same. Less than 50%. Somewhat less. Somewhat more.

Somewhat less.

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?

Guaranteed insurability rider. Additional coverage rider. Paid-up option rider. Extended insurability rider.

Guaranteed insurability rider.

What does the rehabilitation benefit cover in a disability income policy?

Covers the cost of all out-of-pocket expenses while a disabled worker is unable to work. Covers the approved cost of the rehabilitation necessary to help a disabled insured return to work. Covers the cost of inpatient rehabilitation for alcohol and drug dependency. Pays a lump-sum indemnity to cover all out-of-pocket expenses.

Covers the approved cost of the rehabilitation necessary to help a disabled insured return to work.

Larry wants to purchase an individual disability income policy to provide continuous income while disabled. He is also covered by a two-month wage continuation benefit from his employer. What should the policy elimination period be for his individual policy?

30 days. 60 days. 90 days. 120 days.

60 days.

A policyowner suffers an injury that renders him incapable of performing one or more important job duties. Any decrease in income resulting from this injury would make him eligible for benefits under which provision?

Partial disability. Nondisabling injury. Presumptive disability. Flat amount disability.

Partial disability.

Jim is covered under a disability income policy. He is hurt while engaged in an occupation that is more hazardous than the occupation he specified in the policy. What action will the insurer likely take?

Decrease the premium. Reduce the benefit level. Increase the benefit level. Increase the premium.

Reduce the benefit level.

Dan owns a disability income insurance policy which provides ONLY nonoccupational coverage. Which of the following circumstances would likely NOT be covered under his plan?

He is injured in an automobile accident while driving to work. He suffers third-degree burns while on vacation. He falls from the roof of his personal residence while replacing shingles. He falls and breaks his hip at work.

He falls and breaks his hip at work.

Which of these would NOT likely qualify as a presumptive disability?

Loss of sight in one eye. Loss of both hands. Loss of hearing. Loss of speech.

Loss of sight in one eye.

The inability to perform SOME of the duties of one's own occupation is known as a

Recurrent disability. Total and permanent disability. Residual disability. Presumptive disability.

Residual disability.

Non-occupational disability coverage is designed for

24 hour protection. Those who are exempt from Workers' Compensation coverage. Sole proprietors and self-employed individuals. Employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers' Compensation.

Employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers' Compensation.

Each of the following will trigger a benefit under the presumptive disability provision, EXCEPT

Loss of hearing. Loss of any one limb. Loss of sight. Loss of speech.

Loss of any one limb.

What is taken into consideration when defining "total disability" in a disability income insurance policy?

Number of days spent in the hospital. The amount of additional coverage the insured has. The insured's education, training, and experience. The elimination period.

The insured's education, training, and experience.

Short-term group disability income benefits are

Always paid income-tax free to the employee. A percentage of weekly earning up to a stated maximum. Only payable if the disability was work-related. Taxable to the employee when the plan is fully contributory.

A percentage of weekly earning up to a stated maximum.

Which of the following would permit an insurer to delay a covered disability policy claim?

Probationary period. Service Waiting period. Elimination period. Grace period.

Elimination period.

Jerome is covered by a disability income policy that does NOT provide benefits for losses occurring as the result of his employment. What kind of coverage is this?

Limited coverage. Workers' Compensation coverage. Occupational coverage. Nonoccupational coverage.

Nonoccupational coverage.

An insured covered under a Disability Income policy is disabled and collecting benefits for a period of two months. He returns to work and is again disabled from the same cause, whereupon benefits continue to be paid. This is an example of which of the following?

Presumptive disability. Concurrent disability. Residual disability. Recurrent Disability.

Recurrent Disability.

Disability income policies provide protection for which of the following?

Economic death. Physical death. Hospital expense. Custodial care.

Economic death.

Which of the following BEST describes a "partial disability"?

Becoming deaf in one ear. Unable to perform all job duties due to a short-term disability. Unable to perform one or more job duties. When a disability recurs from a previous illness or accident.

Unable to perform one or more job duties.