question

Which of the following statements pertaining to health insurance policy premium factors is correct?

answer

Health insurance policies are paid for on a year-by-year basis and are subject to periodic increases

question

Which is not a basic form of health insurance coverage?

answer

Limited pay health

question

Which of the following premium factors is unique to health insurance as opposed to life insurance?

answer

Morbidity

question

Which of the following statements regarding health insurance Is correct?

answer

Medical expense policies reimburse the insured for the costs of medical care.

question

Assume a health insurance contract states that it will pay $350 a month to the insured, should she become total disabled? Which term must aptly define this kind of contract?

answer

Valued

question

HMOs are known for stressing

answer

Preventing medicine and early treatment

question

Which of the following organization would make reimbursement payments directly to the insured individual for covered medical expenditures?

answer

Commercial Insurer

question

Marty just received his first social security disability payment from this, we can assume

answer

His disability is expected to least 12 months

question

Which of the following statements pertaining to health maintenance organizations is CORRECT?

answer

An insurance company may sponsor an HMO or assist an HMO by providing contractual services

question

The waiting period before qualifying for social security disability benefits is how many months?

answer

5 months

question

Which of the following individuals would probably qualify for social security disability benefits?

answer

John who experiences serious early onset Alzheimer's and is unable to remember how to get to work.

question

Which of the following statements pertaining to Medicaid is not correct?

answer

It limits financial assistance to persons age 65 or over who are need of medical services they cannot afford

question

Jerry is injured while working under state workers compensation laws, we can assume that?

answer

Jerry will probably receive workers compensation benefits on a monthly or weekly basis.

question

The miscellaneous expense benefits in a basic hospital expense policy normally will cover?

answer

Drugs and medicine administered in the hospital

question

Clarence is to enter the hospital for a thyroidectomy. His basic medical expense policy includes a relative value schedule for surgical expense. The schedule lists 55 units for a thyroidectomy and a conversion factor of $8. How much will the policy pay?

answer

$440

question

Which of the following statements about deductible provisions in medical insurance policies is not correct?

answer

They are most common in basic medical expense policies.

question

When a medical expense policy pays benefits on a fixed-rate basis, it pays?

answer

A flat amount per day for hospital room and board.

question

Wilbur's basic medical expense policy limiys the miscellaneous expense benefits to 20 times the $90 daily room and board benefits. During his recent hospital stay, miscellaneous expenses totaled $2,100. How much, if any of this amount will Wilbur have to pay?

answer

$300

question

Assume an insurer will issue a maximum monthly disability income benefit of $5,000. Provided the total of such benefits payable by all companies does not exceed 60% of the insured's regular monthly income. Ted earns $4,500 per month and has no existing disability income policy. The maximum monthly disability income benefit this insurer would issue to Ted is?

answer

$2,700

question

Which of the following is not a basis for occupational suitability when determining total disability?

answer

Job Interest

question

Which of the following statements about elimination periods in disability income policies is not correct?

answer

Benefits are not payable during an elimination period but are paid retroactively to the beginning of the period if the insured remains disable throughout the period.

question

Which of the following riders provides for changes In the benefit payable based on changes in the consumer prices index (CPI)

answer

Cost-of-living adjustment rider

question

Benefit periods for individual short-term disability policies typically vary from?

answer

6 months to 2 years

question

Which of the following statements about waiver of premium in health insurance policies is not correct

answer

It normally applies to both medical expense and disability income policies.

question

Which of the following terms relates to disability income insurance?

answer

Residual amount benefit

question

Which definition of total disability is more favorable to the insured?

answer

\"own Occupation\" is more favorable

question

Sidney has a monthly benefit of $2,500 for total disability under a residual disability income policy. If Sidney suffers a 40% los of his predisability income, how much will his benefit be?

answer

$1,000

question

What is the initial period of time specified in a disability income policy that must pass, after a policy is in force, before a loss due to sickness can be covered?

answer

Probationary period

question

The amount payable as a death benefit in an accidental death and dismemberment policy is known as the?

answer

Principal Sum

question

Theodore received a $15,000 cash benefit from his $50,000 accidental death and dismemberment policy for the accidental loss of the eye. The amount he received could be identified as the policy's?

answer

Capital Sum

question

Which of the following examples pertaining to accidental death and dismemberment insurance is correct?

answer

Linda has a $40,000 AD-n-D policy that pays triple indemnity. If she should be killed in a train wreck, her beneficiary would receive $120,000.

question

Agnes purchases a round trip travel accident policy at the airport before leaving on a business trip. Her policy would be which type of insurance?

answer

Limited risk

question

which of the following statements pertaining to medicare is correct?

answer

medicare part A, is automatically provided when a qualified individual applies for social security benefits.

question

under medicare part B, the participant must pay all of the following except?

answer

a per benefit deductible

question

which of the following statements about medicare part B is not correct?

answer

it is a compulsory program

question

for how many days of skilled nursing facility care will medicare pay benefits?

answer

100

question

which of the following statements concerning workers compensation is not correct?

answer

a workers receiver benefits only if the work related injury was not her fault.

question

the core policy (plan-A) developed by the NAIC as a standard medicare supplement policy includes all the following except?

answer

the medicare part A deductible

question

which of the following is a serious condition from which a patient can fully recover with proper medical attention?

answer

acute illness

question

skilled nursing care differs from intermediate care in which of the following ways?

answer

it must be available 24 hours a day while intermediate care is daily but not 24-hour care

question

all of the following conditions are typically covered in a long-term insurance policy except?

answer

alcohol dependency

question

which of the following statements about long-term care insurance policies is not correct?

answer

premiums for a long-term care policy are based solely on the insureds age,health,and the type of benefits provided.

question

a company may change the wording of a uniform policy provision in its health insurance policies only if the?

answer

modified provision is not less favorable to the insured

question

children of the insured are eligible for health insurance coverage until they attain age 19, or if they remain in school full time till age?

answer

23

question

which of the following statements pertaining to the grace period and reinstatement provision in health insurance policies is not correct?

answer

under a health policys reinstatement terms, insured losses from accidental injuries and sickness are covered immediately after reinstatement.

question

which of the following is the usual grace period for a semiannual premium policy

answer

31-days

question

dianna, the beneficiary under her husband AD-n-D policy submits an accidental death claim on may 1, 2010 following his death . however the company denies the claim on the basis that death was due to natural causes. she decides to talk to her attorney what is the earliest date for taking legal action against the insurer?

answer

july 1, 2010 (two months)

question

Which is not a required uniform provision in individual health insurance?

answer

Change of occupation

question

Under the misstatement of age provision in a health insurance policy, what can a company do if it discovers that an insured gave a wrong age at the time of application?

answer

Adjust the benefits

question

The conformity with state statutes provision in a health insurance policy stipulates that any policy provision that is in conflict with the statutes of the state where the insured resides is?

answer

Automatically amended to conform to the minimum requirements of the state's statutes

question

Which section of a health insurance policy specifies the conditions, times, and circumstances under which the insures is not covered by the policy?

answer

Exclusions

question

Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?

answer

Guaranteed renewable

question

According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after the loss occurs?

answer

20 days

question

Which of the following types of health insurance policies prevents the company from changing the premium rate or modifying the coverage in any way?

answer

Noncancellable

question

Susan is covered under her employer-sponsored disability group plan. The premium is $150 a month. Susan pays $10 and the employer pays $40. Assuming Susan were to become disabled and receive monthly disability benefits of $700 from the plan, how much, if any, of the monthly benefit would be taxable income?

answer

$560

question

Assume the following individuals are issued health insurance policies with varying renewability provisions. All other factors being equal, who would pay the highest premium?

answer

Jack-noncancellable

question

Which of the following is the purpose of medical cost management?

answer

To control health claims expenses

question

Which is not a primary risk factor in underwriting individual health insurance policies?

answer

Geographical location

question

Which of the following statements most aptly describes health insurance benefits?

answer

The greater the benefits, the higher the premium

question

Which of the following would probably NOT be considered in underwriting a health insurance risk?

answer

Martial status

question

All of the following factors would affect a health insurance policy's premium rate except?

answer

Residential address of the insured.

question

Rick, who has no health insurance, experienced $3000 in medical expenses this year. Assuming his adjusted gross income was $29,000, how much of those medical expenses can he deduct from his income taxes, if any?

answer

$825

question

What kind of table reflects the average number of disabilities due to sickness or accidents at various ages?

answer

morbidity

question

What is the effects of an impairment rider attached to a health insurance policy?

answer

To exclude from coverage losses resulting from specified conditions

question

Which of the following statements about group health insurance is CORRECT?

answer

Group health plans provide more extensive benefits that individual health plans.

question

Which type of group health coverage typically does NOT contain a conversion privilege?

answer

Accidental death and dismemberment

question

Which of the following can an individual include as qualifying expenses for purposes of determining a medical tax deduction?

answer

Premium contributions paid by the individual to a group medical expense plan.

question

An individual purchased group credit accident and health insurance to cover a car loan. Following an accident, the individual was disabled for eight months. Which of the following benefits were paid under the policy?

answer

An amount equal to eight months of the loan payment to the insured's creditor

question

Dan is a participant in his company's group health plan. One of the plan's provisions specifies that, in the event he is eligible for benefits under another policy, his group plan will serve as the primary plan. What is this provision called?

answer

Coordination of benefits provision.

question

A vacation cruise line that wants group health coverage for its passengers would purchase what kind of insurance?

answer

Blanket health insurance

question

The purpose of cobra requirements concerns?

answer

Continuation of health insurance

question

Sally is covered by her employer's noncontributory group disability income plan, the premium for which is $50 a month. If she were to become disabled and receive $1000 a month, how much of each benefit payment would be taxable income to her?

answer

$1,000

question

which of the following statements regarding group disability income plans is not correct?

answer

Employees covered under both a short term and long term plan collect benefits from each simultaneously

question

Which of the following statements about cobra is correct?

answer

The premium for continued group medical coverage may be up to 102% of the premium that would otherwise be charged.

question

All of the following are methods of keeping premium costs to a minimum in a health policy EXCEPT?

answer

Waiving the right to receive benefits

question

Fred owns a small hardware store and is covered under a business overhead expense policy. If he becomes disabled, he can expect all the following expenses to be covered EXCEPT

answer

His salary

question

Which of the following characteristics is associated with disability buy-out plans?

answer

The option to elect a lump-sum payment

question

What is the income tax consequence if Marie's employer pays for her group disability income coverage?

answer

The employer can deduct the premium payments

question

With regard to health insurance policies, which of the following statements is CORRECT?

answer

A disability policy with a -month elimination period is less expensive than one with a 60-day elimination period, all other factors being equal.

question

The general powers and duties of the Office of Insurance Regulation include all of the following EXCEPT to

answer

To enact statutes to govern the insurance industry

question

The major areas of regulation by the Office of Insurance Regulation include which of the following?

answer

Policing against unauthorized insurance activities

question

All of the following are reasons the insurance industry is subject to government regulation EXCEPT?

answer

The need to monitor the premium payment practices of the public

question

What two authorities can impose penalties for violation of state insurance laws?

answer

Chief financial officer and the courts.

question

A fraternal life insurance organization can operate as any of the following EXCEPT

answer

Charitable Trust

question

An insurance company cant be which of the following?

answer

Domestic and alien

question

In insurance regulatory language, which of the following property identifies a \"foreign\" insurance company?

answer

Insurance company whose home office is in another state

question

The definition of transacting insurance includes all of the following EXCEPT

answer

Underwriting a contract of insurance

question

Of the following terms, which best describes that of replacing existing life insurance with a new life insurance policy based upon incomplete or incorrect representation?

answer

Twisting

question

All of the following activities could result in the suspension of an agent's license EXCEPT

answer

Selling any replacement policy that causes an insured to lapse an existing policy

question

which of the following would be considered an unfair claim practice?

answer

Misrepresenting insurance policy provisions affecting a loss

question

All of the following activities violate the Florida insurance code except

answer

Dividing commission on a life insurance policy with another agent who is licensed and appointed to sell the same line of insurance

question

Violation of the controlled business statute occurs if an agent sells most of his or her business to

answer

Employees of a business owned by his or her father

question

Sliding consists of all of the following activities except?

answer

Recommending that a client take cash value from a policy to make other investment

question

Which of the following statements is correct about the department of financial services right to examine an agent's records?

answer

An examination can be conducted at any time to discover any unfair trade practices.

question

Which of the following penalties imposed upon an agent by the Chief Financial Officer does NOT match the offense?

answer

Violation of a cease-and desist order can result in a fine of no more that $2,500

question

Which of the following activities is not a violation of the insurance code?

answer

Writing as much noncontrolled insurance business as controlled business.

question

All of the following are characteristics of a mutual insurance company EXCEPT

answer

Management elects the board of directors.

question

Transacting insurance business does NOT include which of the following activities?

answer

Negotiating an agency contract with an insurance company

question

If an agent changes her residence address, she must notify the department of financial services within

answer

60 days

question

Which of the following is correct about the replacement rule?

answer

Instructions regarding the rule are available from appointed life insurers.

question

Which of the following is not considered to be an element of replacement?

answer

An existing policy is subjected to a loan of 10 percent of its value.

question

In which of the following ways is a beneficiary protected from the creditors of the deceased insured?

answer

If the policy is made payable to a named beneficiary, then the creditors can make no claim on the proceeds.

question

All of the following statements are correct about policy loan interest rates except?

answer

Policy loan interest rates were set by the offices of insurance regulation in 1993 and may not be changed

question

Which of the following applies when an insured wishes to convert industrial insurance policies for an ordinary policy?

answer

It is possible to convert $3,000 or more of industrial insurance

question

In a typical family policy, coverage on the children is usually provided by which of the following?

answer

Term life

question

All of the following groups are eligible for group life insurance EXCEPT

answer

Social clubs

question

Which of the following is the correct number of lives required in Florida for a group life insurance policy?

answer

No minimum

question

Which of the following is not required when a group life insurance policy is cancelled?

answer

The insurance company must request that the policy owner notify the group members

question

A trusteeship group insurance policy

answer

Insures employees of two or more employers

question

Which of the following is a requirement of a participating life insurance policy?

answer

Pays individuals to policyholders

question

All of the following apply under the Federal ERISA law except

answer

The Florida law on retirement plans supersedes ERISA

question

Variable life insurance policies involve all of the following except?

answer

A traditional approach to term life insurance

question

All of the following apply to a universal life insurance policy except?

answer

There are no restrictions on it as far as receiving favorable tax treatment

question

Which of the following statements applies to the right of a surviving spouse under a group insurance policy?

answer

Conversion privileges extend to the spouse but not to the children

question

Which of the following rules would apply if an agent knows an applicant is going to cash in an old policy and use the funds to purchase new insurance?

answer

Replacement Rule

question

During what period is a new policyowner entitled to review a policy and return it for a full refund?

answer

Within 14 days after deliver of the policy

question

All of the following statements about life insurance benefits are correct except?

answer

Benefits payable to the insured's estate are protected from the insured's creditors

question

All of the following are correct about the policy loan interest rate except

answer

there are no restrictions or limitations on policy loan interest rates

question

All of the following statements are correct about the law for conversion (change of plan) except

answer

The maximum amount of face value that can be converted is $2,000

question

All of the following are correct about a family plan policy except

answer

Only children living when the policy is issued are covered

question

Which of the following statements is correct about life insurance?

answer

It Is written with a master policy for members of qualified groups

question

Under group life insurance, which of the following statements is correct

answer

If cancelled, the members be notified

question

All of the following are eligible groups under Florida law except

answer

Groups established to buy insurance

question

All of the following statements are correct about group life insurance except

answer

Certificate holders need not be notified if the policy expires

question

All of the following statements are correct about a participating policy except

answer

Dividends are not considered in comparison to nonparticipating policies

question

An insurance policy dividend can be all of the following except

answer

Paid by a nonparticipating policy

question

Which of the hollowing applies to retirement plans in florida?

answer

Federal ERISA regulation override Florida law

question

Which of the following is a requirement that a professional association must meet to obtain group insurance?

answer

It must have been in existence for at least 2 years

question

All of the following statements about a participating policy are correct except

answer

Policy dividends paid in cash are taxable

Chapter 15 – Health Insurance Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards