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Health and life

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Created by: Tevonbrown

Question	Answer
Which of these do NOT constitute policy delivery? Final Exam - Colorado Health and Accident Question 1Select the appropriate response Which of these do NOT constitute policy delivery? Policy mailed to applicant Policy mailed to producer Policy delive	Policy issues with a rating
xam - Colorado Health and Accident Question 2Select the appropriate response In Colorado, which of the following is true regarding the commingling of an insured's funds with the funds of the producer? It is okay with the insured's written approval It is	Never ok
Final Exam - Colorado Health and Accident Question 3Select the appropriate response Which of the following statements about the classification of applicants is INCORRECT? Substandard applicants are never declined by underwriters Substandard applicant	Substandard applicants are never declined by underwriters
What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision? Insured must be unemployed Insured must be hospitalized Insured must demonstrate financial need Insured must be under a physician's	Insured must be under a physician's care
xam - Colorado Health and Accident Question 5Select the appropriate response 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? 7 10 20 31	31
All accident and health policies issued in Colorado that provide major medical services must offer policyholders the opportunity to purchase disability coverage double indemnity coverage home health care coverage supplemental coverage	Home health coverage
Final Exam - Colorado Health and Accident Question 7Select the appropriate response Which of the following is CORRECT regarding a producer's fiduciary responsibility with client's funds? A producer may commingle personal funds with funds paid by or to	A producer may never commingle personal funds with funds paid by or to a client 118 of 125 Questions Remaining
With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? Gives the policyowner additional time to pay overdue premiums Gives the policyowner additional time to file a lawsuit Gives the policyowner additional time to fi	Gives the policyowner additional time to pay overdue premiums
Final Exam - Colorado Health and Accident Question 9Select the appropriate response G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G’	The insured
xam - Colorado Health and Accident Question 10Select the appropriate response When a claim has been denied, the insurer must cancel the policy refund all paid premiums notify the producer issue a statement to the policyowner explaining the coverage, p	issue a statement to the policyowner explaining the coverage, provision, or laws on which denial was based
Which of the following is NOT required to be disclosed to an applicant for health insurance? Standard compensation schedule for the product being sold Any change to the standard compensation Any contingent compensation received The insurance producer	Any contingent compensation received
An insurer can deny a claim under a long-term care insurance policy for any material misrepresentation made by the insured if it has been in effect for fewer than 6 months more than 6 months at least 1 year no more than 2 years	Fewer than 6 months
From what authority derives the requirement that an insurance application contains a disclosure stating that an investigative consumer report may be obtained on an applicant? Fair Credit Reporting Act Medical Information Bureau Part lll of the applicat	Fair Credit Reporting Act
Paying insurance premiums on a more frequent basis will cause the policy to have lower premiums higher premiums average premiums graded premiums	Highers premium
Which of the following documents are NOT required to mention the Colorado Fraud Statute? Policies Certificates of authority Claim forms Applications	Certificates of authority
When may the Commissioner conduct an examination of an insurance company? maximum once per year maximum every 3 years maximum every 5 years as often as deemed necessary	As often deemed necessary
Final Exam - Colorado Health and Accident Question 17Select the appropriate response M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays	Earned, but unpaid benefits
Basic Medical Expense insurance: normally has a deductible and coinsurance covers an illness but not an accident pays for lost wages while hospitalized has lower benefit limits than Major Medical insurance	has lower benefit limits than Major Medical insurance
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid? 7 days 10 days 31 days 60 days	31 days
xam - Colorado Health and Accident Question 20Select the appropriate response With Optionally Renewable Health policies, the insurer may: renew the policy only if no claims have been filed the previous year renew the policy only with the insured's conse	review the policy annually and determine whether or not to renew it
A company that has not been authorized to operate in Colorado is known as a prohibited entity a nonadmitted insurer an alien company an undesirable carrier	nonadmitted insurer
What does a Guaranteed Insurability rider provide a Disability Income policyowner? The guarantee that the premiums will never increase The guarantee that the policy will never be cancelled The ability to periodically increase the amount of coverage wit	The ability to periodically increase the amount of coverage only with evidence of insurability
Which parts of a health insurance policy are guaranteed to be true? Rating Representation Statement Warranty	Warranty
How long is the typical free look period for Long Term care insurance policies? 20 days 30 days 40 days 50 days	30 days
Final Exam - Colorado Health and Accident Question 25Select the appropriate response In addition to suspending/revoking licenses and issuing fines, the Commissioner has the authority to do all of the following EXCEPT issue orders to carry out his duti	Issue prison sentence
Which information is NOT included in the Colorado Supplement to the Summary of Benefits and Coverage form? Insurer's prior year financials Deductibles Covered cancer screenings Balanced billing	Prior financials
P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax? $20,000 $14,000 $6,000 $0.00	O
A characteristic of Preferred Provider Organizations (PPOs) would be: Discounted fees for the patient Not allowed to see out-of-network physicians Physicians are paid on a capitation basis A primary care physician is required	Discounted fees for patient
Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT? Premiums normally decrease at time of renewal Premiums normally increase at time of renewal Policy can renewed at any time by the company Policy can be	Premiums normally increase at time of renewal
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? File a lawsuit Contact the insurer again requesting forms Nothing File written proof of loss	File written proof of loss
D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits? Residual Benefit clause Waiver Benefit clause C	Residual Benefit clause
An insured owns an individual Disability Income policy with a 30-day Elimination Period for sickness and accidents and a monthly indemnity benefit of $500. If the insured is disabled for 3 1/2 months, what is the MAXIMUM amount he would receive for an app	1250
Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase? Applicant's occupation Applicant's monthly income Applicant's health Applicant's previous disabilities	Monthly income
What type of renewability guarantees premium rates and renewability? Optionally renewable Conditionally renewable Noncancellable Guaranteed renewable	Non-cancelable
Who is not eligible to receive commissions from the sale of an insurance product? Licensed home office employee Corporate executive Personal producer General agent	Corporate executive
J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase?	Non canceled
As a condition to be approved for a loan, a creditor may require the borrower to obtain an insurance policy through an insurer of the borrower's preference obtain an insurance policy through an insurer of lender's preference obtain an insurance policy	obtain an insurance policy through an insurer of the borrower's preference
obtain an insurance policy through an insurer of the borrower's preference	They are nonprofit organizations
Which of the following is NOT included in the policy face? Free Look provision Name of the insured Name of the insurer Exclusions	Exclusion
An insurer must provide an insured with claim forms within __ days after receiving notice of a loss. 5 10 15 20	15
S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning: September 21 October 16 November 1	Nov 1. (2 years)
S filed a written Proof of Loss for a Disability Income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning: September 21 October 16 November 1	Pre exsisting conditions
The reason for a business having a Business Overhead Expense Disability Plan is to cover: the cost of providing group disability insurance to the employees fixed business expenses the owner's loss of income all business-related expenses and salaries	Fixed business exspenses
Which health policy clause specifies the amount of benefits to be paid? Insuring Consideration Free-look Payment mode	Insuring
When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following? Waiver of premium Recurring disability Residual disability Presumptive di	Residual disability
Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy? Limited Special risk Reimbursement Blanket	Reimbursement
Which of these is considered a statement that is assured to be true in every respect? Estoppel Warranty Guarantee Representation	Warranty
Which of these is considered a statement that is assured to be true in every respect? Estoppel Warranty Guarantee Representation	Non-renewable
What is the consideration given by an insurer in the Consideration clause of a life policy? Promise to never cancel coverage Promise to pay a death benefit to a named beneficiary Promise to not raise premiums Promise to accept an insured's assignment	Promise to pay a death benefit to a named beneficiary
An insurer cannot deny a claim unless the Commissioner gives a written approval it exceeds a specific dollar amount there is a reasonable explanation of the claim the policy has exceeded the contestable period	there is a reasonable explanation of the claim
The benefits under a Disability Buy-Out policy are: normally paid in installments taxable to the beneficiary payable to the company or another shareholder normally paid after a short elimination period	payable to the company or another shareholder
T calls to file a claim on his health insurance policy. Within how many days must the insurer provide T's proof of loss forms? 10 days 15 days 20 days 30 days	15 days
Which of these terms accurately defines an underwriter's assessment of information on a health insurance application? Risk classification Warranty review Insurable interest Inspection report	Risk classification
All of the following penalties apply to anyone giving intentional false testimony during an insurance examination EXCEPT fine of up to $5,000 imprisonment up to three months guilty of a misdemeanor guilty of a felony	Guilty of felony
Any changes made on an insurance application requires the initials of whom? Insured Producer Applicant Beneficiary	The applicant
A Business Overhead Expense policy: covers any loss of income by the business owner covers business expenses such as rent and utilities covers employee wages only reimburses the company for any reduction in sales due to the owner's disability	Rent and utilities
The primary difference between the Colorado Partnership LTC policy and other LTC policies is Medicaid asset protection optional inflation protection higher daily benefits longer lifetime benefits	Medicaid asset protection
An producer who violates a cease and desist order may, after a hearing, be fined up to	500
Which of the following health policy provisions states that the producer does NOT have the authority to change the policy or waive any of its provisions? Time Limit on Certain Defenses Reinstatement Entire Contract Change of Beneficiary	Entire contract
Final Exam - Colorado Health and Accident Question 62Select the appropriate response If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed und	Insured's contingent beneficiary
Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due? Grace Period Consideration Waiver of Premium Reinstatement	Grace period
Which of the following is an example of defamation? A pamphlet listing a competitor's financial rating A brochure including an untrue statement regarding a competitor's ability to pay claims A verbal statement of a competitor's complaint ratio A truth	A brochure including an untrue statement regarding a competitor's ability to pay claims
What is the maximum amount the Commissioner can fine an insurer for each violation of a cease and desist order? $500 $1,000 $5,000 $10,000	$10,000
Insurance contracts are known as ____ because certain future conditions or acts must occur before any claims can be paid. consideration unilateral aleatory conditional	conditional
According to the Colorado Fraud Statute, all of the following must contain a warning against insurance fraud EXCEPT applications policies certificates of authority claim forms	certificates of authority
What is the maximum Social Security Disability benefit amount an insured can receive?	All of it
Which of these arrangements allows one to bypass insurable interest laws? Concealment Indemnity contract Contract of adhesion Investor-Originated Life Insurance	Life insurance
According to the Time Limit of Certain Defenses provision in an Individual Health Insurance Policy, nonfraudulent misstatements first become incontestable: two years from the date of the policy was issued two years after collection of the initial premiu	two years from the date of the policy was issued
An insured must notify an insurer of a medical claim within how many days after an accident? 10 20 30 40	20
When an insurance application is taken by a producer, which of these statements is true? The applicant should have an attorney present during the application process Any changes made on the application require the applicant's initials Any changes made	Any changes made on the application require the applicant's initials
Which of the following is an example of a misrepresentation? Failing to affirm or deny coverage of claims within a reasonable time Returning a portion of a premium as inducement to purchase insurance Making malicious statements about an insurer Descri	Describing a universal life policy as a security
Which of the following statements BEST describes dental care indemnity coverage? Services are reimbursed before the insurer receives the invoice Services are reimbursed after insurer receives the invoice In-network dentists must always be used	Services are reimbursed after insurer receives the invoice
Which of the following is NOT a required provision for an accident and health policy? Reinstatement Grace period Incontestable Insurance with other insurers	Insurance with other insurers
Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate for the overall risk class? Conditionally Renewable Noncancellable Guaranteed R	Garenteed renewable
Pre-hospitalization authorization is considered an example of: managed care PPO care Medicaid Major Medical insurance	Managed insurance
Which of the following statements describes what an Accident and Health policyowner may NOT do? File a covered claim Assign ownership Cancel the coverage Adjust the premium payments	Adjust premium payments
When an insurance company sends a policy to the insured with an attached application, the element that makes the application part of the contract between the insured and the insurer is called the: Entire Contract provision Insuring clause Time Limit on	Entire contract clause
Which of the following reimburses its insureds for covered medical expenses? Health maintenance organizations Preferred provider organizations Commercial insurers Service providers	Commercial insurers
When may the Commissioner issue an emergency cease and desist order? If there is suspicion of an insurance policy being replaced If there is suspicion of an unauthorized person engaging in insurance business without being licensed When an insurance age	If there is suspicion of an unauthorized person engaging in insurance business without being licensed
Which of these is considered a mandatory provision? Payment of Claims Insurance with Other Insurers Misstatement of Age Change of Occupation	Payment of claims
An insurer that terminates a producer’s appointment must inform the Commissioner within how many days? 15 30 45 55	30
In regards to maternity care, which of the following is not required to be covered in the State of Colorado? Injuries or sickness Congenital defects Standard newborn circumcision Birth abnormalities	Standard newborn circumcision
Which of the following are NOT managed care organizations? Point-of-Service plan (POS) Preferred Provider Organization (PPO) Medical Information Bureau (MIB) Health Maintenance Organization (HMO)	Medical Information Bureau
A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to t	Final Exam - Colorado Health and Accident Question 93Select the appropriate response A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred befo
If a producer is found to be writing primarily controlled business, the producer will be forced to return all commissions to the insurer the Commissioner will have the producer imprisoned the Commissioner will not renew the license the producer must a	The commissioner will not renew the license
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 p	3,000
What is the elimination period of an individual disability policy?	The time waited for payment
Which of the following health insurance policy provisions specifies the health care services a policy will provide? Insuring clause Usual, Customary, and Reasonable clause Consideration clause Benefit clause	Insuring clause
Which type of plan normally includes hospice benefits? Short-term disability plans Group life plans Workers' Compensation Managed care plans	Managed
Final Exam - Colorado Health and Accident Question 105Select the appropriate response Non-occupational disability coverage is designed for: 24 hour protection those who are exempt from Workers' Compensation coverage sole proprietors and self-employe	employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers' Compensation
Which of these is NOT a type of agent authority? Express Implied Principal Apparent	Principal
What is the purpose of the Time of Payment of Claims provision?	Prevents delayed payments
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and their families) whose employment has been terminated the right to: continue group health benefits take out an individual health policy transfer their coverage to another insu	continue group health benefits
Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT? If the employee had a qualified medical leave from work, lost wages can be reimbursed If the employee paid for qualified medical expenses, the reimbursements may	If the employee had a qualified medical leave from work, lost wages can be reimbursed
A medical care provider which typically delivers health services at its own local medical facility is known as a: Health Maintenance Organization Regional Provider Multiple Employer Trust Preferred Provider Organization	Health Maintenance Organization
How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy? If the primary beneficiary is a minor at the time of the insured's death If the primary beneficiary dies before the insured If the in	If the primary beneficiary dies before the insured
The Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for: insolvency health information financial information overinsurance	Health
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? Relation of earnings to insurance provision Change of occupation provision Conformity of state statutes pro	Change of occupation provision
Ultimately, who is responsible for a producer-generated advertisement? Producer Insurer The Department of Insurance Life and Health Guaranty Association	Insurerer
The health insurance program which is administered by each state and funded by both the federal and state governments is called: Long-term care Medicaid Medicare Supplemental Program Medicare	Medicaid