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Life License-Test#1
Part 5
| Question | Answer |
|---|---|
| 121. which of the following is not a limited health contract? | Basic Medical expenses |
| 122. which of following is a feature of managed care? | arrangements with selected physicians and facilities to provide healthcare services to members, financial incentives for members to use providers covered by the plan, and formal programs of quality control |
| 123. which of following is a correct statement? | CA has a compulsory Workers' Compensation law; |
| 124. all of the following are covered by Medicare part B, except: | private duty nursing; covered are: doctors services, home health care, some outpatient treatment of mental illness |
| 125. medical expense insurance does not include: | disability income policies, disability income insurance is not medical insurance |
| 126. in managed care, the member's choice of providers is most restricted in which of the following? | an HMO plan |
| 127. if the insured changes to a higher risk occupation and receives an injury the insurer can: | reduce benefits based on the premiums paid and the higher risk involved |
| 128. physicians and surgeons services provided in a hospital or elsewhere: | are covered by Medicare Part B with a premium charge |
| 129. what is the grace period for disability policies with a monthly premium? | 10 days |
| 130. what is the effect of the "Change of Occupation" provision on an individual disability policy? | reduce the benefits according to correct risk assumption; the insurer may reduce benefits based on the occupational risk |
| 131. which of the following is NOT a contributing factor to an agent acting unethically? | keeping the client's best interest foremost in mind |
| 132. 12 months ago, a man slipped and fell down a flight of stairs while on vacation. As a result he has a paralysis for which he is not expected to recover. This 46 yr old person may be able to collect disability income benefits from: | Social Security; neither Medicare nor Medicaid provide Disability Income benefits and the injury is not work related |
| 133. an example of a moral (NOT morale) hazard is relation to a life insurance application would be: | misstating your health history to an insurance company; insurance company must have correct info to assign the correct risk classification that will generate enough premiums to cover the risk |
| 134. which of these statements with regard to the tax treatment of life insurance is true? | death benefits are generally exempt from taxation; this is how death benefits are treated under current tax law |
| 135. the CA Insurance Code contains very specific regulations regarding the ability of a senior citizen to return a life insurance policy or annuity. The regulation: | allows a senior citizen a minimum of 30 days to return a life or annuity contract to the insurer. They are entitled to a full refund of premium; older people have longer to review their policies |
| 136. a hospital confinement indemnity insurance policy pays: | a daily dollar benefit for each day the insured is confined to a hospital; def |
| 137. which of the following are common insurance policy provisions? | entire contract, grace period, reinstatement; the "entire contract" provision = policy, together with copy of attached application, is the entire contract. pre-existing conditions are not a provision, and right to return is an optional provision |
| 138. which is NOT part of transacting insurance? | establishing a list of clients; this does not come under the CA Insurance Code definition of "transact" |
| 139. hospice care is for: | terminally ill persons; hospice is a facility which provides short periods of stay for a terminally ill person in a homelike setting for either direct care or respite. "terminally ill" person = life expectancy of 6 months or less |
| 140. each of the following terms is an important characteristic of a major medical policy, except: ..agreed upon any covered person | capitation; major medical provides benefits for a serious, prolonged, or catastrophic illness or hospitalization, whereas capitation is a rate paid, usually monthly, to a health care provider. in return, provider agrees to deliver health services .. |
| 141. the Guaranteed Insurability Option provides the ability to: | purchase additional insurance regardless of insurability; GIO gives insured the option of obtaining additional insurance on their own life at certain selected dates in the future, at certain policy intervals or at specified ages |
| 142. if an insurer is not able to meet financial obligations when due, the insurer would be considered: | insolvent; to be solvent, insurer must be able to continue business functions and the insurer's asset must exceed the insurer's liabilities |
| 143. to which of the following classifications of transactions do the regulations regarding replacement of life insurance and annuity contracts NOT apply? | new agents who are contacting the clients of former agents from the same company; transactions where the replacing insurer and existing insurer are the same or are subsidiaries under common ownership are excluded from replacement laws |
| 144. from the examples below, choose the one that gives the best description of a reduced paid-up non-forfeiture option | the insured decides to cease paying premiums on his $100,000 cash value policy. He uses the cash value to buy a paid-up policy of $40,000 face amount |
| 145. which of the following is a true statement regarding the Social Security (OASDHI) program? | the program provides only a minimum floor of income. individuals are expected to supplement this with tier own personal programs; SS benefits are intended to help supplement a worker's income, not replace entire amt of worker's earnings |
| 146. when may a representation be withdrawn? | only before the insurance is in effect; a representation may be altered or withdrawn before the insurance is in effect, but not afterwards |
| 147.the conversion privilege allows a person to change coverage from: ..within 31 days of termination of employment | a group policy to an individual policy; this conversion right give a certificate holder the ability to convert group life or group health insurance to an individual policy w/out a physical exam to furnish evidence of insurability. usually, must be done .. |
| 148. what is required when an applicant reveals conditions that require more information? | attending physician's statement; the question assumes medical conditions are revealed but more info is needed |
| 149. which of the following is true regarding agency names? | all names must be approved; every individual and org licensee, and every applicant for a license, must file in writing with Commissioner the true name of the individual or org, also all fictitious names which the licensee conducts/intends to do business |
| 150. all of the following are features of a preferred provider organization (PPO), except: | primary care physicians act as gatekeepers; gatekeepers are typically a feature of HMOs |
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jennyhqs2
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