Megan has covered medical expenses of $15,500. Her health insurance policy has a $1,000 calendar year deductible, 20% coinsurance and $2,500 stop loss. What amount will her Insurance Company pay?

$12,000 ($15,500 – $1,000) = $14,500 $14,500 x 0.2 = 2,900 2,900 > 2,500 14,500 – 2,500 = 12,000 More test answers on https://studyhippo.com/uncc-finn-3272-test-3-clicker-questions/

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

Health insurance policies are paid for on a year-by-year basis and are subject to periodic increases More test answers on https://studyhippo.com/exam-143106/

Which of the following is NOT required in the Outline of Coverage for a health insurance policy? Explanation of the policy’s benefits Listing of the policy’s exclusions and limitations Projection of the policy’s future costs Explanation of the policy’s renewal and cancellation provisions

Projection of the policy’s future costs More test answers on https://studyhippo.com/florida-laws-and-rules-pertinent-to-insurance-ch-8/

Which of the following is the most valid reason for a person to purchase a specified (dread) disease health insurance policy? A) He wants to make sure that he and his family are protected against a major illness. B) Her family has a history of cancer, and she is concerned that she might contract the disease. C) He has been diagnosed with heart disease. D) She wants coverage against the risk of such illnesses as AIDS, tuberculosis, and diabetes.

B) Her family has a history of cancer, and she is concerned that she might contract the disease. More test answers on https://studyhippo.com/practice-tests-test-answers/

When a health insurance policy is purchased in the state of New York, the insured may cancel the policy and receive a premium refund within a) 90 days. b) 10 days. c) 20 days. d) 30 days.

c) 20 days. The Free Look Provision allows for an insured to review his/her policy once it has been delivered; if the insured decides to return it within a certain time period, the premium will be refunded. The Free Look time period varies from state to state. In New York the insured can review the policy from anywhere between 10 and 20 days. More test answers on https://studyhippo.com/test-practice/

the reason for a condination of benefites statement is a health insurance policy is

to prevent duplication or pverlappimg of pymts for the same medical expense More test answers on https://studyhippo.com/chp-347/

Health Insurance Policy test questions and answers | Get Access To Health Insurance Policy Flashcards and exam tests

Q: An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

31 More test answers on https://studyhippo.com/florida-insurance/

Q: Which of the following is NOT required in the Outline of Coverage for a health insurance policy?

Projection of the policy’s future costs ( “Projection of the policy’s future costs”. A table indicating the policy’s projected future costs is not required in an Outline of Coverage. More test answers on https://studyhippo.com/8-florida-laws-and-rules-pertinent-to-insurance-test-only-has-40-questions/

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Personal Finance Chapter 6 – Flashcards 50 terms

Jaxon Wilson

50 terms

Preview

Personal Finance Chapter 6 – Flashcards

question

It is recommended that life insurance be purchased when the

answer

individual has dependents

question

What is the difference between property and liability insurance?

answer

Property insurance pays for loss to the insured person whereas liability insurance pays for loss to other people

question

Alyssa is considering purchasing a car and wants to be sure she can afford to drive it during the school year when she doesn't have a job. Which expense WOULD NOT be considered part of the total transportation expenses:

answer

Depreciation

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Charis wants to decrease the risk of fraudulent use of her credit cards. Which strategy would be the most effective?

answer

signing the back of her card with her signature and "Please see picture ID"

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Leah is trying to explain the difference between open‐end and closed‐end credit to her roommate. Which statement should she include in her description of closed‐end credit?

answer

Equal payments are required on a regular basis until the loan is repaid.

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Which is a general rule when dealing with credit reports to minimize identity theft?

answer

Check each credit reports at least once per year.

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What is NOT an example of a durable good?

answer

Food

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Brett borrowed money to purchase a vehicle without making a down payment and now he owes more on the vehicle than it is worth. This situation is referred to as:

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Being upside down on the loan

question

Which of the following actions will not make an individual vulnerable to identity theft?

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Paying cash for a movie ticket

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Sarah will turn 18 next month. She plans to apply for a credit card. Which statement is true?

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Sarah can only obtain a credit card if she has a co‐signer or proof of sufficient income to make the required payments.

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Maggie will need to pay $120 per month in order to purchase a health insurance policy. This monthly payment is known as the:

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deductible

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When may a person view his/her credit report for free?

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Once a year, from each of the three main credit reporting agencies

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When Bryce attempted to borrow money at the bank, he learned that his credit score is low. Which statement best describes what this is likely to mean for Bryce?

answer

The interest rates on his loan will be higher, since his credit score is low.

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Tyler is trying to be responsible in using his new credit card and has heard there is a way to avoid paying interest on the things he charges. How can he LEGALLY avoid paying interest when using his credit card?

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Tyler needs to pay the credit card balance in full every month before the due date listed on the credit card statement

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Why is investing in product research an important part of the planned buying process?

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Research enhances satisfaction

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Tiffany was recently involved in a vehicle accident. In order to get her car fixed, her insurance company is requiring her to pay the first $500 of the repair bill because:

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Her policy's deductible is $500

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Which is NOT an example of a data furnisher?

answer

Credit card company

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James received his first medical bill of the year. It was a total of $1000. His health insurance policy has a $500 deductible and a 20% co‐insurance. How much of the medical bill will Jade be responsible to pay?

answer

600

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Which of the following is NOT included in an individual's credit report?

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Medical information

question

In which scenario below should renters insurance be considered?

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Zach and Leah have rented an apartment in an urban area.

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Megan's credit card statement indicates that she is now paying a Penalty APR. Which scenario best describes what may have happened?

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Megan's missed making her January and February credit card payments while she was participating in her college's Study Abroad program when the friend she left in charge of sending the payments in forgot.

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As part of Nicholas' new job, his employers will provide health, life, and disability insurance. Access to this insurance is provided in addition to his regular salary. This is known as:

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Employee Benefits

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The financial counselor that Ariel consulted about her use of credit recommended that she keep her use of credit within safe boundaries. Ariel's financial counselor most likely told her to:

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Keep the total amount of money she has borrowed, not including her house, under 20% of her net income.

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Chad has decided to rent an apartment and is gathering information to be sure he has enough money saved for all the expenses when his moves in. His landlord explained to him that he would need to pay a fee to cover any potential damages that might occur while Chad is living in the apartment. This fee is called the:

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security deposit

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Carson wallet with his driver's license, a debit card and his credit card has been stolen. Which of the following is NOT something an identity thief might realistically do with this information?

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Take a college admissions exam in Carson's name.

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David earns $5000 per month at his accounting job. He has a student loan payment of $120, a car loan of $300. Which statement is true?

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David's credit payments are within the safe range for someone with his income.

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To answer the essay test question about the meaning of open‐end credit, Ryan should include which statement?

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Credit is extended in advance so the borrower does not have to apply for credit each time credit is desired.

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The equity that you build by making mortgage payments is:

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The value of the home after the mortgage debt is subtracted

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Matt wants to guard his personal information. Which personal information is LEAST LIKELY to be used by scammers?

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Phone numbers

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Becky no longer wants to use her Clothes‐R‐Us store credit card. What is the best thing she could do with the credit card?

answer

Close the account by phone and in writing, then destroy the card.

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Patty recently moved into a new apartment with her friend Emma. Who is responsible for purchasing renter's insurance?

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Patty and Emma

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Melissa needs to a vehicle and is considering leasing one. This means:

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She would be renting the vehicle by making payments over time, although the vehicle title would remain with the lease grantor.

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Perry would like to purchase a new car. What should he consider first in the planned buying process?

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Evaluate the opportunity cost and trade‐offs to purchasing the car

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Which of the following best describes the benefits of having insurance?

answer

Insurance combined with emergency savings provides a sense of financial security and peace of mind

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When making food decisions, which of the following is most likely to be least expensive?

answer

convenience foods

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Sally is researching a new tablet and conducting research using a variety of sources. What is an example of an unbiased source?

answer

A product review from an independent company

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Shelby is working on her spending plan and would like to spend less on her food for 6 months as she saves toward purchasing a more reliable vehicle. As she makes her plan, which factor would be least important to consider:

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Her personal preferences

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Insurance can be purchased to protect one from which of the following losses?

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Health care expenses

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Jenny is 18‐years‐old and has applied for credit for the first time. Her credit application was declined because she has no credit history. What would you recommend Jenny do to being to build a positive credit history?

answer

Jenny should obtain a secured credit card.

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Jake's credit application has been declined because of his negative credit history. Which statement is most likely to be true?

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Jake has applied for 4 credit cards and a car loan in the past 6‐weeks.

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Paying the minimum payment on a credit card every month will:

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Make the final amount paid substantially higher than the amount initially charged to the card

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Paxten is purchasing a new phone online. What is the best tip should he consider to do so safely and maximize his satisfaction?

answer

Review shipping and return policies in advance

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Edward wants to develop a positive credit history. How should he do this?

answer

Maintain reasonable amounts of available credit

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If a person drives an automobile, they are required by law to have Automobile Liability Insurance. In which situation would this type of policy protect the policyholder?

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James backed into a vehicle in the grocery store parking lot and caused $2000 in damages to his own car and $3000 in damages to the other vehicle.

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A rental agreement is often referred to as:

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A lease

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Which of the following is an act of identity theft?

answer

Wrongfully acquiring and using someone's personal identification

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Evan is writing a scholarship essay about the importance of responsible money management. He wants to explain the meaning of borrowing. Which statement below would explain the importance of understanding the process of borrowing money?

answer

When you are borrowing, you are spending future income.

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Eric has chosen Amanda to be the beneficiary of his life insurance policy. What does this mean for Amanda?

answer

Amanda will receive any proceeds if the Eric dies

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Ashley plans to do some of her Christmas shopping online. What is a safety tip to follow when she is shopping online?

answer

Use a credit card

question

Rent is defined as:

answer

The cost of using someone else's property

STUDY

Health Insurance Policy High Deductible Health Plan Insurance Marketing-Insurance Room And Board

Medical Expense – Flashcards 35 terms

Brooke Sharp

35 terms

Preview

Medical Expense – Flashcards

question

For which of the following expenses does a Basic Hospital policy pay?

answer

Hospital room and board

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Which of the following services is NOT covered under a hospitalization expense policy?

answer

surgeon's fees

question

An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses?

answer

$3,000

question

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

answer

Discourages overutilization of the insurance coverage

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Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

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The maximum amount considered eligible for reimbursement by an insurance company under a health plan

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All of the following statements about Major Medical benefits are true EXCEPT

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Benefits have no maximum limit

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Which of the following types of health coverage frequently uses a deductible?

answer

Major Medical policy

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Which of the following phrases refers to the fees charged by a healthcare professional?

answer

Usual, customary, and reasonable expenses

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Which of these options can an individual use their medical flexible spending account to pay for?

answer

Prescription drugs

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T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition?

answer

Insurer will likely treat as a pre-existing condition which may not be covered for one year

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C was injured while deep sea diving and requires a hospital stay. C has a Major Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the MAXIMUM C will pay if the covered medical expenses are $2000?

answer

$720

question

Which of the following medical expenses does Cancer insurance NOT cover?

answer

Arthritis

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M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim?

answer

$1,600

question

Which of the following statements BEST describes dental care indemnity coverage?

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Services are reimbursed after insurer receives the invoice

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A characteristic of Preferred Provider Organizations (PPOs) would be:

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Discounted fees for the patient

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N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as

answer

Coinsurance

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Which of the following BEST describes a Hospital Indemnity policy?

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Coverage that pays a stated amount per day of a covered hospitalization

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In Major Medical Expense policies, what is the intent of a Stop Loss provision?

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Limits an insured's out-of-pocket medical expenses

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M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

answer

Determined by the terms of the policy

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An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred?

answer

$7,000

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Major Medical policies typically

answer

contain a deductible and coinsurance

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S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a

answer

High-deductible health plan

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A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

answer

$1,000

question

Which of the following situations does a Critical Illness plan cover?

answer

Leukemia

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J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay

answer

$3,600

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With a Basic Medical Expense policy, what does the hospitalization expense cover?

answer

hospital room and board

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Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?

answer

$2,100

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Deductibles are used in health policies to lower

answer

overuse of medical services

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Comprehensive Major Medical policies usually combine

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Major Medical with Basic Hospital/Surgical coverage

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Basic Hospital and Surgical policy benefits are

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lower than the actual expenses incurred

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Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deducitble?

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Carryover provision

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Which of the following costs would a Basic Hospital/Surgical policy likely cover?

answer

Surgically removing a facial birthmark

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Basic Medical Expense insurance

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has lower benefit limits than Major Medical insurance

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The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the

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initial deductible

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Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?

answer

If the employee paid for qualified medical expenses, the reimbursements may be tax-free

STUDY

Health Insurance Policy Health Science

Ancient Times in Medicine – Flashcards 20 terms

Martha Hill

20 terms

Preview

Ancient Times in Medicine – Flashcards

question

Who identified microorganisms as the cause of infection in people?

answer

Joseph Lister

question

Which age is known for an attitude of intellect and reason?

answer

Renaissance

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What is the name of the time period in which curiosity and experimentation lead to a dramatic increase in discoveries and inventions?

answer

Industrial Revolution

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Who is known as the "Father of Medicine"?

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Hippocrates

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What is the name of the world's first pandemic, which occurred during the Dark Ages?

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Bubonic Plague

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Which medicine was created in the Primitive Era and is still used today?

answer

Morphine

question

Which invention allowed scientists to discover cells?

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Microscope

question

In ancient times, which of the following helped to slow the spread of disease?

answer

Development of sewer systems

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What major medical breakthrough was made during the Industrial Revolution?

answer

The connection between structure and function is realized

question

Which of Hippocrates teachings did Claudius Galen ignore?

answer

Observation and note taking

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Trained in many types of surgery. Developed a sewer system.

answer

Hindus

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Required that physicians were paid for their services

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Babylonians

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Hippocrates and Aristotle teach that illness is the result of natural causes

answer

Greeks

question

Documented 1000 medicinal herbs. Established the science of acupuncture

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Chinese

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The study of medicine is forbidden

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Dark Ages

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In the Middle Ages most common people received medical treatment from

answer

Barbers

question

What did Joseph lister identify as the cause of infection in people ?

answer

Microorganisms

question

Did the first medical school practiced human dissection?

answer

question

Who promoted conservative medical practices?

answer

Egyptians

question

Did the ancient Romans contributed a lot to medical advancement?

answer

STUDY

Group Health Insurance Health Insurance Policy Insurance Marketing-Insurance Six Months Ago

Pre Cert. Practice Exam – Flashcards 99 terms

Patricia Harrah

99 terms

Preview

Pre Cert. Practice Exam – Flashcards

question

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

answer

C. reduction

question

"The potential for loss" is also known as a A. hazard B. risk C. transference D. peril

answer

B. risk

question

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

answer

C. Fair Credit Reporting Act

question

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

answer

A. Speculative risk

question

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

answer

D. Small employer

question

The powers directly given to an agent in an agency contract are called A. express B. apparent C. implied D. assumed

answer

A. express

question

An insurance company's voluntary refusal to enforce a contract's provision is called a(n) A. waiver B. warranty C. assignment D. concealment

answer

A. waiver

question

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

answer

C. Initial offer is void

question

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

answer

C. material

question

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

answer

A. Pays a death benefit as a result of an illness

question

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

answer

C. Business overhead expense

question

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

answer

C. Benefits are typically tax-free

question

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

answer

D. Both the cause and the result of an accident must be unintentional

question

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

answer

C. At least 20

question

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

answer

C. Insurer and employer

question

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

answer

B. If service is obtained outside the PPO, benefits are reduced and costs increase

question

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

answer

B. Accidental death and dismemberment

question

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

answer

B. trust

question

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

answer

D. Social Security Disability

question

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

answer

D. Must have financial hardship

question

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)

answer

C. An income benefit which is a percentage of his primary insurance amount (PIA)

question

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

answer

C. Where the master contract was issued

question

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%

answer

B. 20%

question

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

answer

D. 50

question

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

answer

C. Could potentially reduce her benefits

question

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

answer

C. Nursing homes

question

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

answer

D. yearly physical examinations

question

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

answer

D. Medicare Supplement

question

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

answer

B. pay for unexpected expenses

question

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

answer

C. within 15 days of receipt of the notice of loss

question

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

answer

A. the initial premium payment and the application

question

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

answer

D. The agent doesn't have the authority to change the policy or waive its provisions

question

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

answer

C. Consideration clause

question

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

answer

A. policy, attached papers, and endorsements make up the "entire contract"

question

The type of health insurance in which underwriting procedures are the most restrictive is A. Accidental B. Individual C. Group D. Employer-paid

answer

B. Individual

question

To which of the following group plans do HIPAA rules NOT apply? A. PPO's B. Disability income C. HMO's D. Major medical

answer

B. Disability income

question

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

answer

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

answer

C. $15,000

question

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

answer

C. The insured's education, training and experience

question

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

answer

C. Accidental death

question

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

answer

D. employees who suffer non-work related disabilities, since work-related disabilities are

question

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

answer

A. variable life

question

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

answer

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

answer

D. No tax deduction

question

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

question

Splitting the commission with the buyer on a sale of insurance is known as A. Twisting B. Binding C. Soliciting D. Rebating

answer

D. Rebating

question

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

answer

A. having creditable coverage with a previous employer

question

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)

answer

B. Upon request of the Director

question

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

question

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

answer

D. Direct response

question

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

answer

D. Care for incurable conditions

question

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

answer

D. Decreased participation

question

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

answer

D. Dentures

question

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

answer

A. assist individuals and small businesses when making their health insurance purchases

question

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

question

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

question

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

question

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

answer

B. living in a rural area

question

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

answer

B. When the initial premium has been collected with the application

question

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

answer

C. premium charges

question

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

answer

B. Per-cause

question

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

answer

A. offered the same Health benefits as the younger employees

question

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

answer

C. contract of adhesion

question

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

answer

D. highest amount payable

question

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

question

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

question

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

answer

C. The specified benefit amount is a percentage of his wages

question

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

answer

A. Disability income

question

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

answer

A. Exempt from income taxes

question

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

answer

D. Medicare Supplemental insurance

question

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

question

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

question

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

question

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

question

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

question

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

question

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

question

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

answer

D. Peril

question

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

STUDY

Five Years Ago Health Insurance Policy Insurance Marketing-Insurance

Florida Insurance – Flashcards 109 terms

Sean Hill

109 terms

Preview

Florida Insurance – Flashcards

question

An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?

answer

Consideration clause

question

An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?

answer

question

Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business?

answer

Business owner becoming disabled

question

The Notice of Claims provision requires a policyowner to

answer

notify an insurer of a claim within a specified time

question

Under which of the following circumstances do the benefits under COBRA continuation coverage expire?

answer

All group health plans are eliminated by the employer

question

Which of the following statements describes what an Accident and Health policyowner may NOT do?

answer

Adjust the premium payments

question

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

answer

Monthly

question

Which statement is TRUE regarding a group accident & health policy issued to an employer?

answer

The employer is the policyowner and each employee receives a certificate of coverage

question

What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?

answer

Submit the claim in any form

question

Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?

answer

Entire Contract

question

Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is

answer

Business Overhead Expense

question

T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision?

answer

Primary carrier

question

When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans?

answer

Contributory

question

Which of the following statements is correct regarding an employer/employee group health plan?

answer

the employer receives a master policy and the employees receive certificates

question

What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?

answer

Premiums may increase at time of renewal

question

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's ages as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?

answer

The insurer will adjust the benefit to what the premiums paid would have purchased at the time the insured's actual age

question

Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that used the "accidental means" definition?

answer

Less restrictive

question

M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?

answer

45 days

question

With Optionally Renewable Health policies, the insurer may

answer

review the policy annually and determine whether or not to renew it

question

Which of the following BEST describes a short-term medical expense policy?

answer

Nonrenewable

question

If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best describes this policy is called

answer

noncancellable

question

Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires?

answer

An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed

question

A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The orginal neck injury occurred before the application. How will the insurer handle this claim?

answer

Claim will be paid and coverage will remain in force

question

The provision in a Group Health policy that allows the insurer to postpone coverage for aa covered illness 30 days after the policy's effective date is referred to as the

answer

Waiting Period

question

Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?

answer

Premiums are waived after the insured has been totally disabled for a specified time period

question

R had received full disability income benefits for 6 months. when he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?

answer

Residual Disability

question

M becomes disabled and is unable to work for six months. M dies soon after from complications arising from his disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?

answer

earned, but unpaid benefits

question

K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?

answer

Disability Income

question

Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase?

answer

Applicant's monthly income

question

An individual Disability Income insurance applicant may be required to submit all of the following EXCEPT

answer

spouse's occupation

question

A Disability Income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insurer may cover the second disability without a new elimination period under the

answer

Recurrent Disability provision

question

A medical care provider which typically delivers health services at its own local medical facility is known as a

answer

Health Maintenance Organization

question

Which type of provider is known for stressing preventative medical care?

answer

Health Maintenance Organizations (HMO's)

question

The individual who provides general medical care for a patient as well as the referral for specialized care is known as a

answer

Primary Care Physician

question

M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?

answer

Determined by the terms of the policy

question

Medicare is intended for all of the following groups EXCEPT

answer

Those enrolled as a full-time student

question

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?

answer

The maximum amount considered eligible for reimbursement by an insurance company under a health plan

question

Which of the following situations does a Critical Illness plan cover?

answer

Leukemia

question

Which of the following statements BEST describes dental care indemnity coverage?

answer

Services are reimbursed after insurer receives the invoice

question

Major Medical policies typically

answer

contain a deductible and coinsurance

question

The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the

answer

initial deductible

question

Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?

answer

Discourages overutilization of the insurance coverage

question

Which of these is considered a true statement regarding Medicaid?

answer

Funded by both states and federal governments

question

T was treated for an ailment 2 moths prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?

answer

Insurer will likely treat as a pre-existing condition which may not be covered for one year

question

The individual most likely to buy a Medicare Supplement policy would be a(n)

answer

68-year old male covered by Medicare

question

N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as

answer

Coinsurance

question

Which of the following statements is true about most Blue Cross/Blue Shield organizations?

answer

They are nonprofit organizations

question

In Major Medical Expense policies, what is the intent of a Stop Loss provision?

answer

Limits an insured's out-of-pocket medical expenses

question

Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?

answer

If the employee paid for qualified medical expenses, the reimbursements may be tax-free

question

Deductibles are used in health policies to lower

answer

overuse of medical services

question

Which of the following phrases refers to the fees charged by a healthcare professional?

answer

Usual, customary, and reasonable expenses

question

Basic Hospital and Surgical policy benefits are

answer

lower than the actual expenses incurred

question

A characteristic of Preferred Provider Organizations (PPOs) would be:

answer

Discounted fees for the patient

question

All of the following statements about Major Medical benefits are true EXCEPT

answer

Benefits have no maximum limit

question

Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy?

answer

Issue the policy with an altered Time of Payment of Claims provision

question

Which of the following are NOT managed care organizations?

answer

Medical Information Bureau (MIB)

question

Which of the following BEST describes how pre-admission certificates are used?

answer

Used to prevent nonessential medical costs

question

An example of unfair discrimination would be

answer

offering different terms of coverage for different policyowners having the same risk classification

question

Which of the following is NOT required in the Outline of Coverage for a health insurance policy?

answer

Projection of the policy's future

question

A person insured under a health policy is required to give the insurance company a Notice of Claim within how many days after a covered loss?

answer

Twenty

question

How many hours of continuing education must a newly licensed agent complete every two years?

answer

question

What do Dread Disease policies cover?

answer

A specific disease or illness

question

Within how many days after policy delivery can a Medicare Supplement policy be returned for 100% premium refund?

answer

question

A mutual insurance company and a stock insurance company have one main difference between them. What is this major contrast?

answer

Stock company is owned by its shareholders. Mutual company is owned by its policyholders.

question

What type of insurance company is domiciled in England, but conducts business in Florida?

answer

Alien

question

What is the required minimum percentage of employee participation for a noncontributory group health insurance plan according to Florida Law?

answer

question

Which of the following professional organizations has its code of ethics incorporated into Florida law?

answer

National Association of Insurance and Financial Advisors (NAIFA)

question

According to Florida law, which of the following statements accurately describes an admitted mail order insurance company?

answer

It may solicit insurance business by mail without the assistance of a licensed agent

question

An example of an unfair trade practice is

answer

an agent making a material misrepresentation to the insured

question

In Florida, the underwriting and issuance of a master group health policy requires that all employees

answer

are eligible to participate, regardless of their individual health history

question

Within how many days must a licensee notify the Department of Financial Services of a change in address?

answer

question

All of the following are eligibility requirements for an association group EXCEPT

answer

Contributory plans require a minimum of 25 participants

question

Which two entities regulate variable annuities?

answer

Department of Financial Services; and Securities Exchange Commission

question

All of the following are Nonforfeiture Options EXCEPT

answer

Automatic Premium Loan Option

question

During the application process, the agent's primary responsibility is to

answer

the insurance company

question

In Florida, what is the maximum percentage of controlled business an agent may produce?

answer

50%

question

Association Plans that are designed to provide health benefits to their members are regulated by the state because

answer

they are insured by an authorized insurer

question

What percentage of eligible persons must a policy cover in a noncontributory group?

answer

100%

question

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

answer

acting with fiduciary responsibility

question

According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant?

answer

At the same time of application

question

Which entity approves the insurance policy forms used in Florida?

answer

Office of Insurance Regulation (OIR)

question

All of the following entries are classified under the four principal areas of Florida insurance law EXCEPT

answer

An agent's commission

question

Which of the following is NOT an unfair claim settlement practice?

answer

Needing written documentation of claim details

question

A group plan was recently terminated. In Florida, how many days are covered individuals guaranteed coverage after a group plan's termination?

answer

31 days

question

What do families pay that are covered by the Florida Healthy Kids Corporation?

answer

A portion of the premium

question

In Florida, deceptive advertising is considered to be

answer

a form of misrepresentation

question

Who is a mutual insurance company owned by?

answer

Its policyholders

question

A stock life insurance company that issues both participating and nonparticipating policies is doing business on

answer

a mixed plan

question

During the course of an insurance transaction, if an agent makes a false or incomplete statement, he/she could be found guilty of

answer

misrepresentation

question

Employers with less than ____ employees are affected by Florida's Health Insurance Coverage Continuation Act (Mini COBRA).

answer

question

An agent's license can be suspended or revoked by

answer

writing primarily controlled business

question

Insurance companies that are organized in countries outside the United States are referred to as

answer

alien

question

In Florida, an element of an insurance transaction would be

answer

issuing an insurance contract

question

Florida requires that an insurance agent must complete ___ hours of continuing education of the subject of law and ethics every two years.

answer

question

An example of sliding would be

answer

charging for an additional product without the applicant's consent

question

In Florida, when agents recommend changes be made for existing coverage, the agent must follow established procedures. The name of this rule is called the

answer

Florida Replacement Rule

question

In Florida, which of the following is considered an Unfair Trade Practice?

answer

Coercion

question

Which Unfair Trade Practice involves an agent telling a prospective client that a policy's dividends are guaranteed?

answer

Misrepresentation

question

Which of the following is NOT considered rebating?

answer

Sharing commission with an agent licensed in the same line of business

question

J is an agent who has induced through misrepresentation to surrender an existing insurance policy. What is J guilty of?

answer

Twisting

question

Which type of insurance company allows their policyowners to elect a governing body?

answer

Mutual

question

A stock insurance company

answer

is owned exclusively by its shareholders

question

An example of rebating would be

answer

offering a client something of value not stated in the contract in exchange for their business

question

Which of the following is an example of an Unfair Trade Practice?

answer

Coercion

question

Upon reaching the limiting age, a handicapped child can extend their health insurance coverage as a dependent

answer

only if the child is incapable of employment and chiefly dependent on the policyowner

question

An incomplete health insurance application submitted to an insurer will result in which of these actions?

answer

application will be returned to the writing procedure

question

Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine

answer

probability of making timely premium payments

question

Which of these terms accurately defines an underwriter's assessment of information on a health insurance application?

answer

question

All of these are considered sources of underwriting information about an applicant EXCEPT

answer

Rating Services

STUDY

Federal Income Tax Finance Health Insurance Policy Insurance Insurance Company Personal Finance Risk Management

Insurance Flashcards 9 terms

Roman Peck

9 terms

Preview

Insurance Flashcards

question

Why does insurance often provide "peace of mind"?

answer

People are less worried when they know they have protection from risk.

question

Which type of insurance policy would someone get to protect others only?

answer

Life insurance

question

Which is always a cost when buying insurance?

answer

Premium

question

Maria's family has a health insurance plan. Her mother has $350 deducted from her paychecks each month.When Maria visited the doctor, her mother paid a $25 fee. The insurance company covered the rest of the cost of the visit.When Maria's mother went to the hospital, her family was responsible for paying the first $1,000 of the bill. After this payment, the insurance company covered the rest of the costs. What is the $25 fee Maria's mother paid when Maria visited the doctor?

answer

Copayment

question

If two people are invited to invest and become partners in a business, the business owners will then ____ the risk.

answer

question

The basic purpose of insurance is to provide

answer

protection

question

If Roland wants to invest money in his own business, how can he avoid risk?

answer

by deciding not to invest the money

question

Under which circumstance would someone need disability insurance?

answer

A person was in a car accident and cannot work for several months.

question

How can an insurance company make a profit by taking in premiums and making payouts?

answer

The value of the premiums the company takes in is higher than the value of the payouts it makes.

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