Pre Cert. Practice Exam

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ABC Company is attempting to minimize the severity of potential losses within its company. The company is engaged in risk A. transfer B. retention C. reduction D. avoidance
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C. reduction
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“The potential for loss” is also known as a A. hazard B. risk C. transference D. peril
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B. risk
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An insurance applicant MUST be informed of an investigation regarding his/her reputation and character according to the A. State Guaranty Association B. Fair Labor Standards Board C. Fair Credit Reporting Act D. National Association of Insurance Commissioners
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C. Fair Credit Reporting Act
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Which one of these is NOT considered to be an element of an insurable risk? A. Speculative risk B. Pure risk C. Loss cannot be catastrophic D. Loss must be due to chance
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A. Speculative risk
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Who would be the most likely party for legally entering into a contract? A. Mentally ill person B. Minor C. Person under the influence of alcohol D. Small employer
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D. Small employer
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The powers directly given to an agent in an agency contract are called A. express B. apparent C. implied D. assumed
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A. express
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An insurance company’s voluntary refusal to enforce a contract’s provision is called a(n) A. waiver B. warranty C. assignment D. concealment
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A. waiver
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What happens when an initial offer is answered with a counteroffer? A. An arbitrator decides on a compromise B. The counteroffer is legally enforceable C. Initial offer is void D. Initial offer is automatically accepted
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C. Initial offer is void
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An insurance contract may be voided if a misrepresentation found on the application is determined to be A. conditional B. aleatory C. material D. intentional
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C. material
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Which of the following is NOT a function of accidental and health insurance? A. Pays a death benefit as a result of an illness B. Covers the loss of income from a disability C. Covers the cost of medical care as a result of an accident D. Pays for hospice care in the event of a terminal illness
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A. Pays a death benefit as a result of an illness
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A disabled business owner who has payroll and business expenses paid for has what kind of insurance policy? A. Key person B. Franchise disability C. Business overhead expense D. Disability income
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C. Business overhead expense
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Which of the following statements BEST describes disability buy-sell insurance policies? A. Benefits are taxable to the business entity B. Premiums are typically tax-deductible C. Benefits are typically tax-free D. Benefits are paid to the disabled insured
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C. Benefits are typically tax-free
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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? A. The accident must be external and violent B. The cause of the accident must be intentional C. Only the injury resulting from an accident must be unintentional D. Both the cause and the result of an accident must be unintentional
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D. Both the cause and the result of an accident must be unintentional
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How many employees must an employer have for the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) to apply? A. At least 10 B. At least 15 C. At least 20 D. At least 100
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C. At least 20
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Which parties are directly involved in a group accident and health insurance contract? A. Insurer and employees B. Insurer, employees, and employer C. Insurer and employer D. Employer and employees
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C. Insurer and employer
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A characteristic of a Preferred Provider Organizations (PPOs) is A. PPO’s operate like an HMO on a prepaid basis B. If service is obtained outside the PPO, benefits are reduced and costs increase C. PPO’s are generally public in nature rather than private D. Health care providers themselves are barred from forming a PPO due to conflict of interest
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B. If service is obtained outside the PPO, benefits are reduced and costs increase
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Mike had both of his legs amputated after a boulder fell on them. He has a policy that pays a lump sum benefit for this injury. What type of insurance does Mike have? A. Catastrophic B. Accidental death and dismemberment C. Major medical D. Hospital expense
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B. Accidental death and dismemberment
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Typically, states will permit the grouping of two or more small employers in order to obtain group health insurance at a favorable rate. This grouping of employers is known as a multiple employer A. welfare association B. trust C. consortium D. alliance
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B. trust
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A person can receive Medicare Part A Hospital benefits, regardless of age, as long as the person has received which of the following benefits for at least 24 months? A. Unemployment B. Workers compensation C. Medicaid D. Social Security Disability
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D. Social Security Disability
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Medicaid will pay for nursing home expenses under what condition? A. Must have permanent kidney failure B. Must be age 65 or older C. Must be receiving Social Security disability benefits D. Must have financial hardship
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D. Must have financial hardship
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Rick is a disabled worker receiving Social Security benefits. What is his wife and dependent children eligible for? A. No benefits B. Spouse is eligible for an income benefit but the children are not C. An income benefit which is a percentage of his primary insurance amount (PIA) D. An income benefit which equals his entire primary insurance amount (PIA)
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C. An income benefit which is a percentage of his primary insurance amount (PIA)
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Pete is covered by an employer-provided group health insurance plan, which covers employees in multiple states. This plan is governed by the laws of which state? A. Where the certificate of coverage was mailed to B. Where most of the employees reside C. Where the master contract was issued D. Where the insurer’s home office is located
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C. Where the master contract was issued
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Mary has a Health Savings Account (HSA). Distributions that have been made for anything other than qualified medical expenses are considered taxable and subject to a penalty of A. 10% B. 20% C. 30% D. 50%
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B. 20%
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What is the MAXIMUM number of employees an employer may have to qualify for medical savings accounts? A. 20 B. 30 C. 40 D. 50
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D. 50
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Karen is considering replacing her individual accident and health insurance policy with another individual policy. She has had issues in the past with her gall bladder that would be considered a pre-existing condition. How will a pre-existing conditions exclusion affect Karen’s new insurance contract? A. Will not affect the new contract at all B. Could potentially increase her benefits C. Could potentially reduce her benefits D. Will permanently exclude her from insurance coverage
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C. Could potentially reduce her benefits
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Long-term care policies normally cover expenses associated with A. Drug and alcohol dependency treatment B. Halfway homes C. Nursing homes D. Intensive care units
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C. Nursing homes
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Medicare supplement insurance that provides a preventative medical care benefit will often cover A. respite care B. hospitalization C. custodial care D. yearly physical examinations
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D. yearly physical examinations
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Which of these is a type of private insurance that helps pay for the out-of-pocket expenses involved under Medicare? A. Major medical insurance B. Medicaid C. Disability income D. Medicare Supplement
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D. Medicare Supplement
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According to the needs approach, an emergency reserve fund’s primary purpose is to A. pay off debt B. pay for unexpected expenses C. pay for the cost of life insurance D. provide an supplemental income source
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B. pay for unexpected expenses
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A health insurer MUST provide a proof of loss form A. within 10 days of the actual loss B. within 10 days of receipt of the notice of loss C. within 15 days of receipt of the notice of loss D. within 15 days of the actual loss
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C. within 15 days of receipt of the notice of loss
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The insured’s consideration given for a health insurance policy is A. the initial premium payment and the application B. the initial premium payment only C. the application D. the initial premium and an investigative report
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A. the initial premium payment and the application
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Which statement concerning the Entire Contract provision in an individual accident and health insurance policy is CORRECT? A. The agent can waive policy provisions and change the policy with the insurer’s consent B. The agent has the authority to waive the policy’s provisions under certain conditions C. The agent has the authority to change the policy under certain conditions D. The agent doesn’t have the authority to change the policy or waive its provisions
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D. The agent doesn’t have the authority to change the policy or waive its provisions
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An accident and health insurance policy’s premium requirements are set forth in which of the following provisions? A. Insurance clause B. Entire Contract clause C. Consideration clause D. Premium mode
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C. Consideration clause
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The standard provisions of an accident and health insurance policy require that the A. policy, attached papers, and endorsements make up the “entire contract” B. policy summary, conditional receipt, and initial premium make up the “entire contract” C. change of occupation provision is mandatory D. grace period be no shorter than 60
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A. policy, attached papers, and endorsements make up the “entire contract”
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The type of health insurance in which underwriting procedures are the most restrictive is A. Accidental B. Individual C. Group D. Employer-paid
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B. Individual
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To which of the following group plans do HIPAA rules NOT apply? A. PPO’s B. Disability income C. HMO’s D. Major medical
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B. Disability income
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What does the term “field underwriting” refer to in the health insurance industry? A. The interaction of the producer with the applicant B. The interaction of an underwriter with the applicant C. The medical reports issued by the MIB D. An insurer conducting an investigative report
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A. The interaction of the producer with the applicant
question

Beth is a surgeon who has an own-occupation disability income policy. She was injured six months ago and has been unable to return to her practice. Her monthly benefit from the policy is $15,000. During this time, Beth has been working part-time at a local boutique and receives $2,000 monthly. What is her ongoing monthly benefit while she is unable to perform her surgical duties? A. $13,000 B. $17,000 C. $15,000 D. Nothing
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C. $15,000
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What is taken into consideration when defining “total disability” in a disability income insurance policy? A. Number of days spent in the hospital B. The amount of additional coverage the insured has C. The insured’s education, training and experience D. The elimination period
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C. The insured’s education, training and experience
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Which of these group plans would a claim likely involve the payment of federal estate taxes? A. Disability income B. Blanket health C. Accidental death D. Major medical
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C. Accidental death
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Non-occupational disability coverage is designed for A. 24 hour protection B. those who are exempt from Workman’s Compensation coverage C. sole proprietors and self employed individuals D. employees who suffer non-work related disabilities, since work-related disabilities are
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D. employees who suffer non-work related disabilities, since work-related disabilities are
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An insurance policy that can also be classified as a securities product is called A. variable life B. modified life C. universal life D. a Modified Endowment Contract
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A. variable life
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Which of the following would permit an insurer to delay a covered disability policy claim? A. Probationary period B. Service Waiting period C. Elimination period D. Grace period
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C. Elimination period
question

How are the premiums for an individual disability income policy treated for tax purposes? A. Amount spent on premiums over 7.5% of gross income is tax deductible B. Partially tax deductible C. Fully tax deductible D. No tax deduction
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D. No tax deduction
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A 55 year old recently received a $30,000 distribution from a previous employer’s 401k plan, minus $10,000 withholding. Which federal taxes apply if none of the funds were rolled over? A. Only income taxes on $30,000 B. Only income taxes on $20,000 C. Income taxes plus a 10% penalty tax on $30,000 D. Income taxes plus a 10% penalty tax on $20,000
answer

C. Income taxes plus a 10% penalty tax on $30,000
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Splitting the commission with the buyer on a sale of insurance is known as A. Twisting B. Binding C. Soliciting D. Rebating
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D. Rebating
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In Ohio, when an individual is covered under a small employer’s accident and health plan, the pre-existing conditions exclusion period may be partially or wholly satisfied by A. having creditable coverage with a previous employer B. owning an individual dread disease policy C. electing a high deductible plan D. paying a fee
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A. having creditable coverage with a previous employer
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Under what circumstances must an agent provide his or her business records to the Director of Insurance? A. Upon request of an insured B. Upon request of the Director C. Under no circumstances due to privacy consideration D. By authorization from the National Association of Insurance Commissioners (NAIC)
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B. Upon request of the Director
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Ohio requires advertisements for accident and health insurance policies covering ONLY a specified illness to prominently display A. The premium guarantee B. A statement that the policy is limited C. A schedule of payments D. The policy exclusions
answer

B. A statement that the policy is limited
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Under which marketing system do insurers solicit customers by mass media advertising and mail without the services of an agent? A. Branch office B. Contingent C. Internet exchange D. Direct response
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D. Direct response
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Long-term care insurance policies may contain exclusions for all of the following EXCEPT A. Acute care B. Care outside the U.S. C. Care for intentionally self-inflicted injury D. Care for incurable conditions
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D. Care for incurable conditions
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All of these are used to prevent adverse selection in a group dental plan EXCEPT A. Provide evidence of insurability B. Probationary periods C. Waiting periods D. Decreased participation
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D. Decreased participation
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Which of these is typically regarded as a major treatment in an individual dental plan? A. Fluoride treatment B. X-rays C. Restorative fillings D. Dentures
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D. Dentures
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The Affordable Care Act (ACA) established “exchanges” in order to A. assist individuals and small businesses when making their health insurance purchases B. enforce every U.S citizen to purchase health insurance C. issue fines to those U.S. citizens who do not purchase health insurance D. assist in the conversion of individual policies to government mandated plans
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A. assist individuals and small businesses when making their health insurance purchases
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According to the Affordable Care Act (ACA), health insurance exchanges are expected to be in every state by what year? A. 2014 B. 2015 C. 2016 D. 2017
answer

A. 2014
question

Pam is an HIC subscriber and is involved in an automobile accident outside of the HIC service area. Which of these statements is true regarding her treatment? A. Treatment is covered as an emergency health service B. Treatment is not covered C. Treatment must be accepted by the HIC before given D. Treatment must be given at an approved provider
answer

A. Treatment is covered as an emergency health service
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Which of these statements regarding HIC’s is INCORRECT? A. HIC’s provide emergency care outside the service area B. HIC’s requires subscribers to choose a primary care physician C. HIC’s operate on a prepayment basis D. HIC’s operate on a reimbursement basis
answer

D. HIC’s operate on a reimbursement basis
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Which report contains information regarding an individual’s general reputation and credit standing? A. Credit report B. Consumer report C. MIB report D. Agent’s report
answer

B. Consumer report
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An insurance policy may be issued with a preferred insurance premium in all of these situations EXCEPT A. good credit history B. living in a rural area C. good health history D. being a nonsmoker
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B. living in a rural area
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When does the agent give a premium receipt for an accident and health insurance application? A. When the application has been approved B. When the initial premium has been collected with the application C. During the medical exam D. When the completed application has been collected
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B. When the initial premium has been collected with the application
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Where is the difference between a standard risk and a substandard risk reflected? A. backdating B. coverage is not offered C. premium charges D. back-end charges
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C. premium charges
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Which type of deductible must be satisfied again for each illness or accident in a major medical plan? A. Specific-cause B. Per-cause C. All-cause D. Comprehensive-cause
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B. Per-cause
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Typically, working individuals age 65 or over must be A. offered the same Health benefits as the younger employees B. covered by Medicare exclusively C. paying a higher premium than younger employees D. covered by a Medicare Supplement policy
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A. offered the same Health benefits as the younger employees
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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) A. warranty contract B. aleatory contract C. contract of adhesion D. unilateral contract
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C. contract of adhesion
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A medical fee schedule shows the amount an insurer will pay for a given procedure. This amount is considered to be the A. negotiated amount payable B. average amount payable C. lowest amount payable D. highest amount payable
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D. highest amount payable
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Skilled nursing facility expenses are sometimes covered by _____, but ONLY if the insured was hospitalized prior to entering the facility. A. HMOs B. Medicare C. Medicaid D. Medicare Supplements
answer

B. Medicare
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If group Health benefit levels are too high, what could be the end result? A. Underutilization of the plan B. Overutilization of the plan C. Normal utilization of the plan D. Adverse selection
answer

B. Overutilization of the plan
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Which statement is NOT true regarding health insurance policies that provide limited benefits? A. Only persons under the age of 65 are eligible B. Coverage may be limited to a specific dread disease, such as cancer C. Benefits may be paid on a reimbursement or indemnity basis D. Coverage may be limited to a specific accident
answer

A. Only persons under the age of 65 are eligible
question

Darrell has a group long-term disability income policy paid by his employer. Which of these statements is true? A. Any benefits received will be tax-free B. The premiums paid by the employer are not tax-deductible C. The specified benefit amount is a percentage of his wages D. Long-term policy benefits are not coordinated with Social Security benefits
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C. The specified benefit amount is a percentage of his wages
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Individuals covered with employer-paid group health plans will normally receive tax-free benefits under all of these plans EXCEPT A. Disability income B. HMO C. Vision D. Major medical
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A. Disability income
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How are benefit payments from individually-owned medical expense policies treated for tax purposes? A. Exempt from income taxes B. Taxed as ordinary income C. Taxed as a dividend D. Tax credit given for amount of benefit payment
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A. Exempt from income taxes
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How do preferred provider organization (PPO) dental plans compensate providers for standard dental procedures? A. Capitation B. Prepayment C. Reduced fee schedules D. Usual and customary fees
answer

C. Reduced fee schedules
question

Medicare Part B excess charges are covered by A. long-term care policies B. respite care C. Medicare Part A D. Medicare Supplemental insurance
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D. Medicare Supplemental insurance
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Which of the following does NOT meet the requirements of “skilled nursing care”? A. Must be ordered by a doctor B. Must require daily care C. Must be provided exclusively in a hospital D. Must be provided by skilled medical practitioners
answer

C. Must be provided exclusively in a hospital
question

The grouping of two or more small employers in order to obtain group health insurance at a favorable rate is called a multiple employer A. grouping B. trust C. alliance D. corporation
answer

B. trust
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Alan is an enrollee of a health maintenance organization (HMO) which uses a gatekeeper system. If there ever comes a time when he needs emergency health services, what should he do? A. Receive permission from the primary physician to begin treatment B. Call the HMO to verify coverage C. Proceed to the nearest emergency room D. Contact the HMO for a listing of approved providers
answer

C. Proceed to the nearest emergency room
question

Inflation protection must be included in all long-term policies delivered in Ohio UNLESS A. The inflation rate is below a specified level B. The policyholder rejects the coverage in writing C. The policyholder elects a coverage percentage equal to reasonable charges D. The policy contains a premium rate guarantee
answer

B. The policyholder rejects the coverage in writing
question

Under HIPPA rules, a medical plan’s pre-existing conditions exclusion may be reduced by A. Any period of treatment in the six months prior to enrollment in the plan B. Any period of prior coverage C. The number of months that the exclusion was satisfied under previous qualifying coverage D. A flat three months if the condition was excluded under an earlier plan
answer

B. Any period of prior coverage
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Once an HIC has provided coverage to enrollees for a period of 2 years, it shall hold an open enrollment period of not less than how many days, at least once during each consecutive 12-month period? A. 30 B. 60 C. 90 D. 180
answer

A. 30
question

With whom may the subscriber of an HIC file an appeal regarding the resolution of a complaint concerning services provided? A. Superintendent of Insurance B. Peer Review Committee C. HIC Policy Administrator D. Ohio Chief of Medicine
answer

B. Peer Review Committee
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Which of the following is true regarding an agent who is found to have violated a state insurance law by the Superintendent of Insurance in Ohio? A. All policies written by the agent will be voided B. The agent’s license will be automatically reinstated after 6 months C. The agent must reimburse any customer effected double premiums paid D. The agent must pay the administrate costs associated with the investigation of such violations
answer

D. The agent must pay the administrate costs associated with the investigation of such violations
question

Which of the following is a key characteristic of an HIC compared to other health and accident plans? A. HIC does offer group insurance B. HIC provides medical and disability insurance C. HIC combines health care delivery and financing D. Private commercial insurers will not accept nonprofit groups
answer

C. HIC combines health care delivery and financing
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Which of the following describes the treatment service of a crown? A. Endodontics B. Periodontics C. Prosthodontics D. Orthodontics
answer

C. Prosthodontics
question

Employer group dental plans may attempt to minimize adverse selection by utilizing all of the following EXCEPT A. deductibles B. probationary periods C. coinsurances D. encouragement of reduction in employee participation
answer

D. encouragement of reduction in employee participation
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What is covered under a limited accident and health insurance policy? A. Losses that occur only in limited occupations B. Limited pre-existing conditions C. Losses that occur only in limited age groups D. Limited perils and amounts
answer

D. Limited perils and amounts
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In long-term care insurance, what is the length of time for which claims will be paid? A. Benefit period B. Free-look period C. Grace period D. Elimination period
answer

A. Benefit period
question

After joining a health maintenance organization (HMO), a subscriber will typically select a(n) A. capitation level B. primary care physician C. closed panel D. deductible level
answer

B. primary care physician
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Which of the following can be defined as a cause of a loss? A. Adversity B. Risk C. Hazard D. Peril
answer

D. Peril
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Which of the following accurately describes the “time limit on certain defenses”? A. After a stated period of time, claims cannot be denied due to material misrepresentation on the application B. All claims can be disputed after two years C. An insured cannot file a lawsuit within 90 days of the claim being filed D. The right to return an accident and health policy must be within 10 days of policy delivery
answer

A. After a stated period of time, claims cannot be denied due to material misrepresentation on the application
question

A significant difference between HICs and private commercial accident and health insurers is that A. Private commercial insurers do NOT offer group coverage B. HICs are limited to providing coverage for nonprofit organizations C. HICs combine medical care delivery and funding in one organization D. Private commercial insurers will NOT offer coverage to nonprofit organizations
answer

C. HICs combine medical care delivery and funding in one organization
question

What is a prosthodontics dental procedure? A. A filling B. A root canal C. Bridgework D. Teeth cleaning
answer

C. Bridgework
question

Quality care in HIC specialty plans is evidenced by all of the following EXCEPT A. The buildings and equipment are in good repair B. The plan’s service area is unlimited C. The providers provide accurate diagnosis and treatment D. The participants experience improved health
answer

B. The plan’s service area is unlimited
question

An Ohio agent’s license to sell insurance may be revoked for all of the following reasons EXCEPT A. Rebating or twisting B. Misrepresenting contract provisions C. Being convicted of a felony D. Sharing commissions with licensed agents
answer

D. Sharing commissions with licensed agents
question

An example of illegal inducement would be A. Announcing the opening of a new agency B. Publishing guaranteed dividend rates on a new type of policy C. Delaying payment on a claim because of an incomplete accident report D. Advertising that your agency can provide policies with competitive rates
answer

B. Publishing guaranteed dividend rates on a new type of policy
question

Under the Affordable Care Act (ACA), what is the proportion of premium revenues spent on clinical services and quality improvements? A. Medical loss ratio B. Minimum essential coverage C. Issue rebate D. Market rate reform
answer

A. Medical loss ratio
question

In Ohio, continuation of medical plan coverage for a handicapped child beyond the age limit stated in the policy may require proof of the child’s A. Continued insurability B. Incapacity only C. Incapacity and dependency upon reaching the age limit D. Dependency for the first two years of continued coverage only
answer

C. Incapacity and dependency upon reaching the age limit
question

Under the Affordable Healthcare Act, which group works with states to establish new Health Insurance Marketplaces? A. CICCIO B. OOIICC C. IIOCC D. CCIIO
answer

D. CCIIO
question

Before a policyowner replaces an existing individual health insurance policy, all of the following types of provisions in the new policy need to be reviewed EXCEPT A. Coverage exclusions B. Benefit levels C. Coverage limitations D. Experience rating
answer

D. Experience rating
question

An applicant for life insurance must be informed that testing for Human Immunodeficiency Virus (HIV) infection is used to help determine A. The type of policy that will be issued B. Effective date and term of coverage C. Whether an insurable interest exists D. The insurability of the proposed insured
answer

D. The insurability of the proposed insured

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