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Stack #3576297
| Question | Answer |
|---|---|
| A father owns a life insurance policy on his 15-year-old daughter. The policy contains the optional Payor Benefit rider. If the father becomes disabled, what will happen to the life insurance premiums? | The insured's premiums will be waived until she is 21. |
| Which nonforfeiture option provides coverage for the longest period of time? | Reduced paid-up |
| All of the following are dividend options EXCEPT | Fixed-period installments. |
| Upon the death of the insured, the primary beneficiary discovers that the insured chose the interest only settlement option. What does this mean? | The beneficiary will only receive payments of the interest earned on the death benefit. |
| What is the clause that describes the method of paying the death benefit in the event that the insured and beneficiary are both killed in the same accident? | Common Disaster Clause |
| An agent is in the process of replacing the insureds current health insurance policy with a new one. Which of the following would be a proper action? | The old policy should stay in force until the new policy is issued |
| An agent is ready to deliver a policy to an applicant but has not yet received payment. Upon delivery, the agent collects the applicant's premium check, answers any questions the applicant may have, and then leaves. What did he forget to do? | Ask her to sign a statement of good health |
| In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible? | Corridor |
| A policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called | Business Overhead Expense |
| A hospital indemnity will pay | A benefit for each day the insured is in the hospital |
| Which agreement specifies how a business will transfer hands when one of the owners dies or becomes disabled? | Disability Buy Sell |
| The gatekeeper of a HMO helps | Control Specicalist Costs |
| COBRA applies to employers with atleast | 20 employees |
| Which of the following best describes the "first-dollar coverage" principal in basic medical insurance | The insured is not required to pay a deductible |
| All of the following long-term care coverages would allow an insured to receive care at home EXCEPT | skilled care |
| Which of the following answers does NOT describe the principal goal of a Preferred Provider Organization | Provide Medical Services only from Physicians in the Network |
| L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay? | $900 (deductible + 20% of the bill after the deductible [20% of $2,000]) L would first pay the $500 deductible; out of the remaining $2,000, the insurer will pay 80% ($1,600) and the insured will pay 20% ($400). |
| Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is | Monthly |
| An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Which of the following allows for that? | Stop-loss limit |
| An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss? | Time of Payment of Claims |
| Which of the following will vary the length of the grace period in health insurance policies? | The mode of the premium payment |
| Which of the following is true regarding elimination periods and the cost of coverage? | The longer the elimination period, the lower the cost of coverage |
| An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand-written letter to the insurer. Which of the following would be true? | The insured was in compliance with the policy requirements regarding claims. |
| When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact, she was 37. If the policy contains the optional misstatement of age provision | Amounts payable under the policy will reflect the insured's correct age. |
| Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? | Payment of Claims |
| Which of the following riders would NOT increase the premium for a policyowner? | Impairment rider |
| While a claim is pending, an insurance company may require | An independent examination as often as reasonably required. |
| What is the purpose of coinsurance provisions? | To help the insurance company to prevent overutilization of the policy |
| Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true? | The insured may carry over the amount of this year’s expenses to next year, which will help satisfy next year’s deductible |
| The provision that provides for the sharing of expenses between the insured and the insurance company is | Coinsurance. |
| In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party? | Insurer to the insured |
| ___ approach for determining insurance benefits is based upon the fees normally charged for specific procedures in the geographic location where the services are provided. | The Usual, customary and reasonable. |
| Which of the following entities has the authority to make changes to an insurance policy? | Insurer's executive officer |
| An insured wants to name her husband as the beneficiary of her health policy. She also wishes to retain all of the rights of ownership. The insured should have her husband named as what type of beneficiary? | Revocable |
| Which provision concerns the insured’s duty to provide the insurer with reasonable notice in the event of a loss? | Notice of Claim |
| According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT | Unearned premiums are retained by the insurance company. |
| Which of the following is NOT a feature of a guaranteed renewable provision? | The insurer can increase the policy premium on an individual basis. |
| Which of the following is NOT a feature of a noncancellable policy? | The insurer may terminate the contract only at renewal for certain conditions. |
| The relation of earnings to insurance provision allows the insurance company to limit the insured’s benefits to his/her average income over the last | 24 months |
| Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray? | 50/50 |
| The insuring clause of a disability policy usually states all of the following EXCEPT | The method of premium payment |
| A guaranteed renewable disability insurance policy | Is renewable at the insured's option to a specified age. |
| An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day | Elimination period. |
| In health insurance, if a doctor charges $50 more than what the insurance company considers usual, customary and reasonable, the extra cost | Is not covered. |
| Insurers may change which of the following on a guaranteed renewable health insurance policy? | Rates by class |
| What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application? | As long as the policy is in force |
| An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy? | The insured is in an accident and incurs a large claim. |
| Which health insurance provision describes the insured’s right to cancel coverage? | Renewal provision |
| Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain | A statement that is sufficiently clear to identify the insured and the nature of the claim. |
| Which statement regarding qualifications for Social Security disability benefits is NOT true? | The individual must be at least 65 years old. |
| Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? | Parts A and B of Medicare |
| All of the following statements about Medicare supplement insurance policies are correct EXCEPT | They cover the cost of extended nursing home care. |
| Which one of the following is an eligibility requirement for Social Security disability income benefits? | Fully insured status |
| A Medicare supplement plan must have at least which of the following renewal provisions? | Guaranteed renewable |
| All of the following statements about Medicare Part B are correct EXCEPT | It is a compulsory program. |
| Following an injury, a policyowner covered under Medicare Parts A & B was treated by her physician on an outpatient basis. How much of her doctor's bill will she be required to pay out-of-pocket? | 20% of covered charges above the deductible |
| An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits? | Have accumulated 6 work credits in the past 3 years |
| Social Security disability definition includes all of the following EXCEPT | Disability expected to last for at least 6 months. |
| Which of the following statements is NOT correct regarding Medicare? | Medicare Advantage must be provided through HMOs. |
| Medicare Part A services do NOT include which of the following? | Outpatient Hospital Treatment |
| In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? | All providers will have the same coverage options and conditions for each plan. |
| In which of the following situations would Social Security Disability benefits NOT cease? | The individual's son gets a part-time job to help support the family |
| Which of the following is NOT covered under Plan A in Medigap insurance? | The Medicare Part A deductible |
| What is another term for the general enrollment period for Medicare Part B? | Annual enrollment period |
| Which of the following is NOT a factor in determining qualifications for Social Security disability benefits? | Worker's occupation |
| Medicaid provides all of the following benefits EXCEPT | Income assistance for work-related injury. |
| Which of the following statements is CORRECT concerning the relationship between Medicare and HMOs? | HMOs may pay for services not covered by Medicare. |
| Concerning Medicare Part B, which statement is INCORRECT? | It is fully funded by Social Security taxes (FICA). |
| Which of the following statements pertaining to Medicare Part A is correct? | Individuals who have ALS automatically qualify for Medicare Part A, regardless of age. |
| All of the following qualify for Medicare Part A EXCEPT | Anyone who is willing to pay a premium. |
| You did not enroll in Medicare Part B when you first became eligible. Which of the following would allow you another opportunity to enroll? | AGeneral enrollment period |
| Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? | 20 |
| For group medical and dental expense insurance, what percentage of premium paid by the employer is deductible as a business expense? | 100% |
| Concerning group Medical and Dental insurance, which of the following statements is INCORRECT? | Employee benefits are tax deductible the year in which they were received. |
| Disability income coverage specifies that the policy covers the insured if he is unable to perform any job for which he is qualified. In this case, total disability is defined as | Any occupation - more restrictive than other definitions. |
| An insured is covered under 2 group health plans – under his own and his spouse’s. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amou | $500 |
| An insured has health insurance that covers them at work and at home. This policy was written on what basis? | Occupational |
| Which of the following are the main factors taken into account when calculating residual disability benefits? | Present earnings and earnings prior to disability |
| When may an insurer require an insured to provide genetic information? | Never |
| Who does the secondary notice of provision protect? | Eldery Insureds |
| An insured purchased an insurance policy 5 years ago, Last year she received a dividend check from the insurance company that was not taxable. This year, she didnt receive a check from insurer. From what type of insurer did the insured purchase the policy | Mutual |
| Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as | Contracts of adhesion. |
| Which of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract? | warranty |
| An applicant signs an application for a $25,000 life insurance policy, pays the initial premium, and receives a conditional receipt. If the applicant dies the following day, which of the following is TRUE? | The beneficiary will receive the full death benefit if it is determined that the applicant qualified for the policy. |
| As a field underwriter, a producer is responsible for all of the following tasks EXCEPT | Issue the policy that is requested. |
| If only one party to an insurance contract has made a legally enforceable promise, what kind of contract is it? | Unilateral |
| In insurance policies, the insured is not legally bound to any particular action in the insurance contract, but the insurer is legally obligated to pay losses covered by the policy. What contract element does this describe? | Unilateral |
Created by:
Hayley92