Health Overall

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Health Overall 1. All of the following unreimbursed medical expenses may be considered and lumped together to determine their deductibility except: I. Prescription drugs II. Contributions to group disability III. Contributions to group AD&D IV. Contributions to a group medical plan 1 & 3 3 & 4 1 & 4 2 & 3 2. Which of the following statements about Medicare is true? I. Payments are made directly to the hospital, not to the Medicare recipient. II. Home health care benefits and skilled facility care are provided under Part A. . I only II only I and II Neither I nor II 3. An insured submits a valid documented claim for medical expenses covered by his Major Medical policy. According to the Time of Payment of Claims Provision, how soon must the company pay the claim? Within 14 days Within 10 days Within 45 days Within 30 days 4. The optional short term disability benefit that pays a lump sum for specified injuries is called the: hospital income benefit indemnity benefit supplement income benefit partial disability benefit 5. Select the correct statement below. COBRA permits companies who have terminated employees to stop their group coverage as of the date of termination. When employers discontinue group coverage, employees must prove they are insurable in order to convert to individual coverage. COBRA protects dependents of employees by mandating for them the same extension and conversion privileges available to employees covered by group plans. All of the above are correct 6. A medicare supplement has _______ free look. 10 days 20 days 30 days 45 days 7. The Health Insurance Portability & Accountability Act (HIPAA) requires any person with 18 months of creditable coverage, who does not have access to other health insurance, be given health insurance regardless of their health. True False 8. Which of the following is not a valued contract? a variable universal policy A disability policy an accidental death and dismemberment policy an 80/20 major medical policy 9. Which of the following are NOT eligible for Medicare coverage? People age 65 and older who are eligible for Social Security People age 65 and older not eligible for Social Security, but willing to pay a monthly premium People of any age who have been entitled to S.S. Disability benefits People with any life threatening condition 10. It is possible to predict the approximate number of deaths or frequency of disabilities within a certain group during a specific time. This is based on which of the following principles? Law of Large Numbers Insurance Probabilities Homogeneous Probabilities Law of Large Returns 11. Which of the following statements is not true regarding the Florida Comprehensive Health Association? no new enrollments as of 1991 guaranteed heath coverage to all, provided they could not obtain coverage elsewhere any organization selling health insurance in Florida must belong, sharing in the losses and the gains rates charged are up to 250% of standard rates 12. With the exception of instances of legal incapacity, Proof of Loss for surgical expense benefits must be furnished to the insurance company within: 60 days 90 days 6 months 1 year 13. An employee may generally convert her group health insurance to an individual policy within a maximum of how many days after her employment is terminated? 20 31 45 90 14. Which of the following statements is usually true about a Medical Expense policy? It is available on a group basis only. It covers accidental injuries only. It pays benefits on a cost-incurred basis only. It covers hospital expenses only. 15. All of the following are typically covered under a long-term insurance policy except: Alzheimer's disease senile dementia alcohol dependency Parkinson's disease 16. In group health insurance, unlike most personal insurance, Maternity expenses are treated as any other claim. true false 17. Which of the following statements concerning Blue Cross/Blue shield is/are correct? They are known as commercial insurers The physicians are pre-paid They operate on a capitation arrangement They have contractual arrangements with hospitals and physicians 18. The usual payment arrangement under a Preferred Provider Organization contract is: a fee for each service. a flat monthly amount for each subscriber. reimbursement to the individual subscriber. any of the above. 19. Which statement most accurately describes a unilateral contract? Both parties to the contract are bound to the terms. Both parties adhere to the contract. Both parties exchange goods of equal value. Only one party is legally bound to the contract. 20. Which is true about Medicare? Part A is optional. Part B is mandatory. Both part A and part B are optional. Part A is mandatory and part B is optional. 21. The time limit on a Certain Defenses Provision in a health policy refers to: Pre-existing Conditions Incontestabililty Legal Actions Grace Period 22. When completing an application for medical insurance, an agent should do which of the following? 1. The agent should review the applicant's health statement and bind the coverage. 2. The agent should complete the Medical Information Bureau report. 3. The agent should witness the applicant's signature. 4. The agent should sign the applicant's name if the applicant lives out of state. 1, 2 & 3 1 & 3 2 only 3 only 23. A 35 year old male computer programmer and his 35 year wife, also a computer programmer, apply for disability insurance. Which would pay the higher monthly premium? The male programmer The female programmer They would both pay the same Not enough info 24. Which of the following would not be considered a small employer under the Health Care & Insurance Reform Act of 1993? a sole proprietor an independent contractor a self-employed individual none of the above 25. The minimum grace period in a health insurance policy paid on a quarterly basis is: 7 days 10 days 30 days 31 days 26. An HMO contract must list all of the following except: All services and limitations covered Outline of pre-existing conditions for covered members and their children a grace period of not less than ten days Provisions pertaining to Medicare enrollment and disenrollment 27. Answers given by Health Insurance applicants are considered to be the absolute truth warranties representations negotiable 28. The time period specified in the Free Look provision begins: when the policy is issued when the policy is delivered when the application is signed when the application is approved 29. Which of the following is not correct concerning Health Maintenance Organizations? Members may be part of a group, individual, or family plan. They may be self-funded. They finance health care on a pre-payment basis. They mandate enrollment for groups of 25 or more. 30. Under the Notice of Claim provision in a Health policy, the insured must give notice to the insurance company within a maximum of how many days after incurring a covered loss? 20 30 60 90 31. If all or part of a $500 deductible is offset by a Basic Medical policy, what type of deductible applies? integrated corridor flat split 32. Which of the following policies can be written on a non-cancelable and guaranteed renewable basis? I. A Dental Care Policy II. A Disability Income Policy III. Comprehensive Medical Expense Policy IV. A Major Medical Expense Policy I only II only III and IV only None of the above 33. Lisa was covered under an individual health insurance policy for the last five years which lapsed February 28. Six weeks later she felt dizzy and her vision blurred. Thinking better of her situation she immediately purchased an individual health insurance policy. On April 15th, she was diagnosed with a brain tumor. Which statement reflects poor Lisa's plight? she is fully covered no coverage, pre-exisiting condition 34. With regard to group insurance, who has the responsibility to apply for coverage, provide information about the group, maintain the policy, and pay premiums? The agent that wrote the group coverage The insurer that provides the group coverage The individuals that make up the group The master policyowner 35. Which of the following accurately describes the 'free look' provision? It allows the proposed insured to look over a policy carefully before applying for it. It allows the proposed insured to look over the application carefully before completing it. It allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired. It allows the insurance company to obtain an inspection report and medical examination on the proposed insured prior to issuing the policy. 36. All of the following usually pertain to the probationary period on a disability policy EXCEPT: It is found in the insuring clause. It is one of the 12 mandatory clauses. It requires a certain waiting period for illness. It requires no waiting period for accidents. 37. Which Act gives the Chief Financial Officer the right to suspend licenses, assign fines, and prosecute insurance companies? The McCarran-Ferguson Act Advertising Code The Florida Legislature The Unfair Trade Practices Act 38. Regarding Limited Risk, Special Risk, and Disability Income policies, which statement is true? Accidental means are more limiting than accidental results. Accidental results is more limiting than accidental means. Accidental results and accidental means do not apply to these types of policies. My interest in this subject matter is about shot. 39. For group insurance, employees may be classified in all the following ways EXCEPT: by type of payroll by duties by length of service by age 40. All of the following are true of Medicaid EXCEPT: Medicaid is operated by the State and subsidized by the Federal Government. Medicaid covers the total cost of visiting nurses to the home. Medical assistance is provided to the aged, blind, disabled, and families with dependent children who are financially poor. Anyone who cannot get Health Insurance coverage due to poor health can quality for Medicaid. 41. The amount paid by the HMO to the provider in exchange for services is called: Pre-payment arrangement Capitation Arrangement Provider agreement Co-payment Arrangement 42. The lifetime reserve for Medicare is: 30 days 60 days 90 days 120 days 43. Which of the following statements about a dismemberment provision in a health insurance policy is true? It provides benefits for the loss of specific parts of the body. It lists the ways in which a policy can be dismembered. It is included in all health policies. It provides coverage only for work-related accidents. 44. Which of the following is not a federal government insurance program? National Service Life Service members group life Veterans group life medicaid 45. Which of the following statements about Medicaid is/are true? I. It is one of the major parts of Medicare. II. It is intended to provide medical assistance for certain categories of people who are needy. III. It supplements Medicare for those over age 65, who qualify. IV. It is funded entirely by the State Government. II, III, and IV I and II only II & lll IV only 46. Which of the following companies can sell health insurance? I. Mono-Line II. Home Service/Industrial III. Property/Casualty IV. Multi-Lines Company I II & III III & IV All the above 47. The Internal Revenue Service (IRS) considers Disability Income benefits paid under an employer-paid group Disability Income policy to be: taxable for 13 weeks only nontaxable for 26 weeks only fully taxable as ordinary income exempt from taxation 48. Melli Noma, a subscriber in an HMO, discovers an unusually colored mole on her shoulder. Knowing skin cancer runs in her family, she should do which of the following? Contact her HMO for a referral to her dermatologist Contact an open or closed panel dermatologist 49. The term FIRST DOLLAR often is used to describe benefits payable by which type of policy? A Hospital Indemnity policy A Disability Income policy A Business Overhead Expense policy A Major Medical policy 50. If an insured did not pay his premium the company may or may not exercise their right to cancel the policy. This would apply to which of the following contracts? A void contract A voidable contract An implied contract A verbal Contract 51. An agent takes an application for health insurance on Bone and Marrow Lykes and their family. When the agent returns to her office she discovers two unanswered questions on the application. Which action should she take? Call the Lykes and get the information over the telephone. Reconstruct the sales interview and answer the questions based on the information she can remember. Submit the application to her company as is. Go back to the Lykes and have them complete the unanswered questions. 52. Which is not true concerning a Hospital Fixed-Rate plan? Claim costs are not affected by rising health care costs High benefits for relatively low premiums Simple underwriting and administration Benefits are paid directly to the hospital 53. Which of the following limits coverage under an insurance contract? Waiver of Premium Conditions Exclusions Declarations 54. Which of the following concerning group disability insurance is/are true? I. Premiums are tax deductible by the employer, and benefits are taxable to the employee. II. Premiums are not tax deductible by the employer, and the benefits are taxable to the employees. III. Any amount contributed by the employee toward the premium makes the entire benefit tax free. IV. The percentage contributed to the premium by the employee makes the same percentage deductible by the employer. I II I & III I & IV 55. Robert was insured under an own occupational residual disability policy which had a 5 year benefit period along with a six month elimination period. He was totally disabled by a chicken bone. He received disability payments for 2 years after which he returned to work on a full time basis. Five months later he was disabled by the same chicken bone. Which of the following statements is correct? It is a recurrent disability and the policy will pick up where it left off. There is no waiting period and it will pay for 3 years. It is a new disability and will require a new elimination period, but it will pay for 5 more years. It is a recurrent disability and it will pay for 5 years. None of the above. Chicken bone disabilities are never covered. 56. Which of the following is usually not considered health insurance? Dental Insurance Medical Expense Disability Insurance Acc. Death & Dismemberment 57. A health insurance policy includes an endorsement indicating the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. What endorsement is attached to this policy? Guaranteed insurability Impairment Rider Multiple indemnity Waiver of premium 58. There are how many standard Medicare supplement policies? 10 12 15 20 59. Under the optional Illegal Occupation Provision, which of the following applies if a loss occurs while the insured is participating in a felony or an illegal occupation? The insured's policy is automatically canceled. The insurer is not liable for the loss. The benefits are reduced 50%. The insurer has the right to increase the premiums. 60. Self inflicted injuries are excluded from which of the following? 1. Medical Expense policies 2. Disability Income policies 1 only 2 only 1 and 2 Neither 1 or 2 61. Larry was a brick layer who had puchased a $5000 per month disability policy back in brick-laying school. He was issued a standard policy which he had been paying premiums for five years. In the evenings he finished medical school and has since been practicing medicine as a surgeon. Having sliced off his hand with a scaple he submits a claim. Which course of action would the company most likely follow? the company would pay the $5000 the company would pay a higher benefit to reflect what the premium would have purchased at a surgeon's occupational classification the company would pay the $5000 and refund any premium the company would deny the claim 62. There are _____ standard Medicare supplement policies. 5 10 12 14 63. ThugLife advised her insurance company of a loss covered by her Major Medical policy. If the insurance company does not provide her with proper claim forms within 15 days, she has which of the following rights? the right to receive automatic payment of her claim the right to submit a description of the loss, in her own words, as proof of loss the right to file a suit against her company immediately the right to refuse to submit the required proof of loss 64. Dread disease, travel accident, vision care, and hospital indemnity policies are all examples of: LTC policies limited risk policies special risk blanket policies 65. When a medical expense policy pays benefits on an indeminty basis,it pays a certain percentage of whatever the hospital room charges are for total hospital expenses, less a deductible a flat amount per day for hospital room and board only for surgery and miscellaneous hospital expenses 66. Which of the following statements is/are true about a Medicare Supplement policy? 1. Only insurance companies affiliated with Medicare can provide Medicare Supplement policies. 2. These policies may be issued to anyone 59 1/2 or older without evidence of insurability. 3. Anyone who qualifies for Medicaid benefits may be issued these policies. 4. These policies are designed to cover the deductibles and coinsurance that Medicare patients have to pay. 1 only 2 & 3 3 & 4 4 only 67. Which of the following are considered required provisions for an individual health insurance policy? I. Proof of loss II. Payment of claim III. Illegal Occupation IV. Conformity with state statutes I & II III & IV II & IV I & III 68. All of the following are permitted to sell HMOs in the state of Florida except: 1. A licensed health only agent 2. An unlicensed officer of an HMO 3. A licensed life agent 2 only 2 and 3 3 only all the above 69. Which part of Medicare requires premium payment by most eligible participants? Part A, basic hospital insurance Part B, supplementary medical insurance Respite Care All of the above 70. The purpose of Disability Income insurance is to provide: protection against economic death unemployment income surgical expense reimbursement hospitalization expense reimbursement 71. Which of the following is not considered a "service provider"? Lloyds of London Blue Cross/ Blue Shield Health Maintenance Organizations Preferred Provider Organizations 72. Stagmite purchases a major medical policy with a $100 annual deductible, 80/20 co-insurance and a stop loss of $5000. If Stagmite were to incur covered expenses of $10,100, how much would Stag be out of pocket? $5000 $5100 $2000 $2100 73. A certain major medical policy states a maximum number of days for which convalescent care will be paid as well as a maximum number of X-rays that will be paid for under any one claim. These are examples of: First dollar coverage Inside limits Carryover provisions Stop-loss limits 74. The authority of an agent to undertake certain functions for an insurance company would be found under which of the following? A contract of agency Agency law A contract of principal The general agency principal 75. The opposite of an Aleatory contract is a: Unilateral Commutative Adhesion Bilateral 76. If an employer pays the premiums for an insurance plan that automatically covers all eligible employees, the plan is known as Salary savings insurance Contributory group insurance Noncontributory group insurance Franchise group insurance 77. Statements made by an applicant for a life insurance policy which are supposed to be true are referred to as: representations facts warranties information 78. In a Basic Surgical policy, which of the following pays per point? Relative Value Surgical Schedule Reasonable and Customary Surgical Point 79. Which of the following statements best describes an element of an insurable risk? 1. The loss must be due to chance. 2. The loss must be definite and measurable. 3. The loss must not be catastrophic. 4. The loss exposures to be insured must be large. 1 & 2 1, 2, & 3 2 & 3 All the above 80. Johnson was covered under a residual individual disability income plan with a benefit period to age 65. The policy had a six month elimination period and a 14 day probationary period. Johnson suffered a heart attack 10 days into the policy's effective date. The earliest the benefits would become payable would be: after the six month waiting period after the 14 day elimination period immediately never 81. Which type of authority does a contract give the agent? Contractual Implied Apparent Expressed 82. Andy the agent was fired by the general agent three months ago for conduct "unbecoming". Andy's general agent later was known to accept business that Andy had written after having been fired. One of these policy holders died before the policy was issued but had paid the required premium. Assuming the applicant had been insurable at standard rates, the company would pay because of: apparent authority implied authority expressed authority agency law 83. Which of the following most accurately and completely describes an application? A form furnished by the insurer requesting certain inofrmation to become part of the insurance policy A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in the application An oral request from an agent to an insurer to issue an insurance policy An application can be any of the above. 84. John's individual health insurance policy was reinstated effective November 15. He was injured in an accident the following day. Choose the correct statement pertaining to this situation. there would be no coverage for ten days after reinstatement John would be covered as accidents are covered immediately after reinstatement there would be no coverage until the probationary period has expired John would be covered as there is no new waiting period for sickness or accidents following reinstatement 85. Which of the following is/are true concerning Blue Cross/Blue Shield? 1. They are mutual companies. 2. They are stock companies. 3. They are non-profit. 4. They sell only family and group plans. 1 only 2 only 1 & 3 1, 3, & 4 86. Required Provision 7 indicates that, except in the absence of the insured's legal capacity, if it was not reasonably possible for the insured to provide proof of loss as required in a policy, the latest time the proof of loss may be furnished is: three years from the time proof is otherwise required one year from the time proof is otherwise required within 90 days of a final notice from the insurer unlimited 87. The Legal Action provision states that a policyowner must wait a minimum of how many days after submitting Proof of Loss to an Insurance company before a lawsuit against the company? 30 60 45 90 88. Which of the following statements concerning HMO "open enrollments" is not true? Open enrollment must be offered every year Open enrollment period lasts no less than 30 days During open enrollment, eligible members may enroll regardless of health condition Open enrollment must be offered every 18 months 89. Selling insurance through a vending machine would be: mass marketing direct selling a yank and pull a prohibited practice 90. Before Crankston was disabled, he was a fulltime grave digger earning about $70,000 annually. Now, two years later, he is only able to work part time, earning about $25,000 annually. Under a Residual Disability policy it is likely that Crankston would be classified as: totally and permanently disabled recurrently disabled partially disabled not disabled at all 91. Which statement concerning the newborn child coverage of a family member in an HMO contract is correct? The child is covered after 14 days for a period of 12 months. The child is covered after 14 days for a period of 18 months. The child is covered immediately for a period of 12 months. The child is covered immediately for a period of 18 months. 92. An unlicensed salaried officer of an insurance company may sell life insurance in the state of Florida. True False 93. The insurance industry is second only to which of the following as a source of investment funds? Housing Commercial Banking Brokerage Houses Wire Houses 94. The N.A.I.C refers to the National Association of Insurance Companies. True False 95. Under a credit health policy, what is the maximum amount of any accidental death benefit included? $20,000 the amount of the original indebtedness the amount of outstanding indebtedness at any given time a specified multiple of the monthly loan payment 96. All of the following relate to Owner's Rights EXCEPT: The Reinstatement Provision The Listed Exclusions The Free Look Provision The Incontestable Provision 97. Rute Canal, a dentist is disabled. His disability overhead expense policy will cover all the expenses below EXCEPT: Electricity Leased X-ray equipment Payments to the doctor Uniforms for the staff 98. Which of the following statements is true regarding Multiple Employer Trusts ? Multiple Employer Trusts require employers to have an employment-related common bond. The Multiple Employer Trust, not the employer, is the contract holder. Multiple Employer Welfare Arrangements are designed for those below a certain income level. An employer must subscribe to all the coverages of the Multiple Employer Trust. 99. Under the Claims Forms Provision, it is the company's responsibility to supply claim forms to an insured within how many days after receiving notice of a claim? 21 30 10 15 100. Which of the following is not considered an insurance company? Lloyd's of London Risk Retention Groups Reciprocal Insurers Assessment Insurers

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