Health Questions   

Missed Questions
Question:
A buyers guide and policy summary must be provided to each prospective insured. When, in the sales process, must these documents be given to the prospective buyer?
Answer:
Prior to accepting the applicants initial premium or deposit.
Question:
An individual who is considered chronically ill must be recertified as such:
Answer:
annually..
Question:
Which of the following statements is true regarding advertising of the Iowa Life and Health Guaranty Association?
Answer:
Advertisement of the existence of the Association is not permitted under any circumstance.
Question:
Which of the following statements is true regarding advertising of the Iowa Life and Health Guaranty Association?
Answer:
Advertisement of the existence of the Association is not permitted under any circumstance.
Question:
What is the maximum waiting period an employer can establish in a small employer group plan?
Answer:
60 days
Question:
Guaranteed issue into an individual Medicare supplement policy is assured if the individual enrolls not later than:
Answer:
63 days after the date of the termination or the disenrollement of the prior coverage.
Question:
Both medical and nonmedical care which might include housework and meal preparation is
Answer:
Home health care
Question:
A policy that provides non-occupational coverage would provide benefits if the
Answer:
Insured cannot work because of a hunting accident
Question:
A group sickness and accident policy can be issued to an association if it insures at least:
Answer:
100
Question:
An individual purchased a health insurance policy from a mutual insurer. The insurer declared a dividend that was used to reduce the insured's premium. What are the income tax implications in this situation?
Answer:
The dividend and any claim benefits are income tax free.
Question:
All of the following are uniform optional provisions, EXCEPT:
Answer:
Grace Period
Question:
All of the following could result in suspension of an agent's license, except
Answer:
Selling a policy that replaces an existing policy that has been in force seven years
Question:
What federal law mandates that Medicare coverage is secondary to any group plan covering Medicare employees?
Answer:
TEFRA
Question:
If a violator of the Privacy Act continues to violate the act and the commissioner deems the violation to be one that appears to be a general business practice, the fine imposed may be:
Answer:
$50,000.
Question:
An HMO is a form of health care that emphasizes which of the following?
Answer:
Preventive medicine.
Question:
If Jane cancels her health insurance policy, the insurance company will:
Answer:
Issue a short-rate refund of all of the unearned premium
Question:
No long-term care (LTC) policy may define preexisting conditions more restrictively than a condition for which medical advice or treatment was recommended by, or received from a provider of health services within _____ months before the effective date of coverage.
Answer:
6 months
Question:
An employee begins work at a new employer who provides group insurance benefits on July 1, this employee becomes eligible for group insurance benefits on October 1. The period between the date of hire and the eligibility date for benefits is know as:
Answer:
Probationary period
Question:
Which type of contract may an insurer refuse to renew at the next premium due date?
Answer:
Optionally renewable
Question:
Which of the following is correct about long term care insurance?
Answer:
Current policies are more likely to pay benefits regardless of the level of care required by the insured
Question:
The nonfinancial regulatory activities of an insurance department fall under the broad heading of:
Answer:
market conduc
Question:
Carl, an employee of the ABC Company, paid $2,350 in Social Security taxes based on his earnings for the year. The company paid how much additional in Social Security taxes based on Carl's earnings for the year?
Answer:
$2,350
Question:
When credit life or credit accident and sickness insurance is required as a security for a loan
Answer:
The debtor has the option of selecting insurance either through the lender or through any other authorized insurer
Question:
Small employers, who might not otherwise qualify for a group health insurance plan, may be able to obtain similar low-cost benefits for their employees by joining a
Answer:
Multiple Employer Trust.
Question:
Money set aside by an insurance company to pay claims is called
Answer:
Reserves
Question:
A physician voluntarily communicates a plan of treatment and its cost to an insurer prior to implementation. This is known as:
Answer:
Prospective review
Question:
The primary purpose of the coordination of benefits provision found in group medical expense coverage is to
Answer:
Prevent the claimant from profiting from an injury or sickness
Question:
Which of the following is not a defined type of disability?
Answer:
Partially Total
Question:
What kind of health insurance policy would be issued to indemnify the business if the owner became disabled due to injury or illness?
Answer:
Business Overhead Expense
Question:
Which of the following types of HMO employs member physicians on a salary basis?
Answer:
Closed Panel
Question:
The Social Security program is funded by
Answer:
A special payroll tax on employers, employees and the self-employed
Question:
No long-term care (LTC) policy may define preexisting conditions more restrictively than a condition for which medical advice or treatment was recommended by, or received from a provider of health services within _____ months before the effective date of coverage.
Answer:
6
Question:
The Insurance Commissioner, Director or Superintendent is responsible for all of the following acts, except
Answer:
Writing and approving state insurance laws.
Question:
The "time limit on certain defenses" provision stipulates all of the following, EXCEPT:
Answer:
The insured has 3 years to file suit against the insurer for a disputed claim
Question:
A waiting period during the beginning of policy coverage during which no benefits will be provided is the:
Answer:
Elimination period
Question:
The Fair Credit Reporting Act guarantees which of the following?
Answer:
The right of an applicant to any information about him in the files of any reporting agency.
Question:
What is the purpose of the department of insurance examining domestic, foreign, and alien insurers?
Answer:
The correct answer is: To determine if the insurers are in financial and regulatory compliance
Question:
Which of the following statements is usually true about the benefits of a group short-term disability income policy?
Answer:
They are not payable for accidents covered by workers compensation.
Question:
The legal right of an insurance company to seek reimbursement from a negligent third party is
Answer:
Subrogation
Question:
The Iowa Insurance Commissioner may suspend or revoke a producer's license for all of the following reasons EXCEPT
Answer:
Being indited of a misdemeanor.
Question:
An employer wishing to obtain insurance coverage for employees from a MET is required to
Answer:
Become a member of the trust. . Explanation: The initials MET represent Multiple Employer Trust. Employers desiring coverage under this arrangement must join the trust to have insurance available.
Question:
In Health Maintenance Organizations (HMOs), the use of a primary care physician or PCP is a common part of:
Answer:
the gatekeeper system
Question:
A long term care insurance policy must include a provision that provides for reinstatement of coverage in the event of lapse if the insurer is provided proof of cognitive impairment or the loss of functional capacity. This provision must be available for_______, and must allow for the collection of any past due premiums.
Answer:
5 months after termination
Question:
Giving a prospect or policyowner anything of significant value as an inducement to buy insurance is prohibited by law and is called:
Answer:
Rebating.
Question:
The compensation payable to a producing agent selling Medicare supplement insurance is
Answer:
200% of the 2nd years premium
Question:
The annual general enrollment period for Medicare Part B begins on:
Answer:
January 1, ending March 31 annually
Question:
Under a provision known as "Time Payment of Claims" in a health insurance policy, after receiving proof of loss, all benefits other than those which are paid in periodic installments must be paid
Answer:
Immediately
Question:
An insured is injured in a fall and the insurer pays 80% of the total cost of treatment, leaving the balance for the insured to pay. This is an example of:
Answer:
Coinsurance.
Question:
This particular insurer is unincorporated and managed by an attorney-in-fact. It's insureds are known as subscribers. This insurer is:
Answer:
A reciprocal insurer
Question:
definition
Answer:
The McCarran-Ferguson Act, a federal law granted authority to the states to regulate the insurance industry. The federal government, however, retains authority over anti-trust matters, self-funded health plans, qualified retirement plans, and union benefit plans.
Question:
Private long term care insurance policies may provide which of the following?

I. Skilled nursing care.
II. Custodial care.
III. Home health care.
IV. Adult day care.
Answer:
I, II, III, and IV.
Question:
If a health insurance policy is issued in violation of the Uniform Policy Provisions law and a claim for benefits is filed:
Answer:
The policy must respond as if it conformed to the law
Question:
Paula is considering a purchase of long term care insurance. Her policy will include all of the following features, EXCEPT
Answer:
acute care facility benefits..
Question:
All of the following are required provisions of accident and health insurance policies, EXCEPT:
Answer:
cancellation
Question:
Thomas submits a claim for medical expenses covered by his major medical policy. According to the typical time of payment of claims provision, how soon must the company pay the claim?
Answer:
Within 60 days
Question:
Which of the following describes an insurer's duty to provide claim forms?
Answer:
Provide claim forms within 15 days following notification of a loss
Question:
Medicare Part A, hospital insurance, is primarily funded by:
Answer:
Social Security payroll taxes.
Question:
All of the following are true about insurance, except
Answer:
Insurance is a mechanism for handling speculative risk.
Question:
Which of the following is a requirement that a professional association must meet to obtain group insurance?
Answer:
t must have been in existance for at least two years.
Question:
Medicare Supplement policies must include all of the following disclosure provisions EXCEPT
Answer:
The correct answer is: Payment of benefits based on reasonable and customary standards. .
Question:
How are proceeds taxed that are received from policies funding a buy-sell agreement?
Answer:
Premiums are not deductible but proceeds are received income tax free. .
Question:
The parties to a group health contract include:
Answer:
Employer and insurance company..
Question:
Underwriting is:

I. The assessment of risks.
II. The process for determing the acceptability of applicants.
III. The classification of acceptable risks.
IV. Another term for waiver.
Answer:
I, II and III only..
Question:
The multiple indemnity rider provides additional benefit coverage for:
Answer:
Certain conditions under which accidental death occurs.
Question:
Medicare Part A covers all of the following, EXCEPT:
Answer:
Inpatient surgeons services and fees.
Question:
Inpatient surgeons services and fees.
Answer:
The amount that, when increased by future premiums on outstanding policies, and interest on those premiums, will enable the company to meet future death claims.
Question:
Which of the following riders is payable during the first six months of a disability to provide income during the period before an employer or government plan of benefits begins or in addition to the government benefit?
Answer:
Additional Monthly Benefit (AMB).
Question:
A person willfully acting without an insurance license in Iowa may be fined up to:
Answer:
$50,000..
Question:
After repairing his roof, Ralph jumped to the ground instead of using a ladder. His right leg was injured so severely that it had to be amputated. His AD&D policy did not make a capital sum payment because:
Answer:
Ralph's policy contains an "accidental means" definition
Question:
For group insurance, employees may be classified in all of the following ways, EXCEPT:
Answer:
Age.
Question:
The appointing insurer must file a notice of appointment within ____ from the date the agency contract is executed or the first insurance application is submitted
Answer:
30 days
Question:
Another name for prepaid health care system is:
Answer:
Health Maintenance Organization. .
Question:
The optional health insurance policy provision "other insurance with this insurer" is specifically designed to:
Answer:
Limit the risk with any one individual insured by the company.
Question:
Second surgical opinions, precertification, concurrent and retrospective reviews, and out patient/ambulatory services are all elements of a cost-containment system commonly known as:
Answer:
case management
Question:
All of the following are true in a coordination of benefits situation, EXCEPT:
Answer:
To prevent overinsurance, the secondary insurer does not pay benefits.
Question:
Who are the covered insureds under a blanket form of group insurance?
Answer:
Persons attending a summer camp
Question:
All of the following are characteristics of self insured health plans, EXCEPT
Answer:
Provide accurate and predictable claim experience for small employers
Question:
After repairing his roof, Ralph jumped to the ground instead of using a ladder. His right leg was injured so severely that it had to be amputated. His AD&D policy did not make a capital sum payment because:
Answer:
Ralph's policy contains an "accidental means" definition.
Question:
When an insurer issues a health insurance policy with a waiver, this means:

I. The waiver excludes coverage for a particular condition indefinitely.
II. The waiver excludes coverage for a particular condition for a specified period of time.
Answer:
Both I and II.
Question:
All of the following statements about the tax consequences of an individual disability income insurance policy are correct, EXCEPT
Answer:
Individual disability income insurance premiums are never deductible.
Question:
When can a Medicare beneficiary change his or her Plan D coverage or insurer?
Answer:
Generally from October 15 through December 7
Question:
A business has purchased key person disability income insurance on several key employees. How are the premiums and monthly benefits treated for income tax purposes?
Answer:
None of these responses are correct. . Explanation: The premiums are not deductible but any benefits received are income tax free.
Question:
A business has purchased key person disability income insurance on several key employees. How are the premiums and monthly benefits treated for income tax purposes?
Answer:
None of these responses are correct. . Explanation: The premiums are not deductible but any benefits received are income tax free.
Question:
An insured's individual health insurance policy was reinstated effective June 1. On June 8 the insured became ill, was hospitalized, and returned to work June 15. The insured's policy would provide which of the following?
Answer:
No benefits. Explanation: Under the reinstatement clause of a health insurance policy, no part of any sickness claim occurring during the first 10 days following reinstatement will be paid. Although sickness claims have a 10-day waiting period following reinstatement, accident claims are paid immediately.
Question:
All of the following statements describe a PPO, EXCEPT:
Answer:
Services are provided on a prepaid basis. . Explanation: PPO providers are paid on a fee-for-service basis, either in- or out-of-network. HMO providers are paid on a capitation - per member per month.
Question:
Newborn children are covered automatically under the parents' group health insurance plan for a minimum period of:
Answer:
31 days.. Explanation: Model legislation provides automatic coverage from the moment of birth for a 31 day period. The insured parent is required to contact the insurer to request extension of coverage to the limiting age provided in the plan.
Question:
Which of the following are requirements for payment of Social Security disability benefits?

I. Total and permanent disability.
II. Fully insured and disability insured.
III. Expected total disability for 12 months or longer, or ending in death.
Answer:
I, II and III. . Explanation: All three are the Social Security definitions of disability.
Question:
Last Question:
Eddie added a return of premium rider to his non-cancellable individual long term disability plan. How often and how much premium can Eddie expect to be returned to him?
Answer:
80% minus claims paid every 10 years, at age 65 and at death. Explanation: For an additional premium, the policyowner gets 80% of his money back in the form of premium or claims paid every 10 years, at age 65 and at death.
Question:
The "free look" provision usually gives a new insured _________ after delivery or receipt of the policy to determine its value
Answer:
10 days.. Explanation: With the exceptions of Long Term Care and Medicare supplement insurance, the individual health products have a mandatory 10 day free look provision.
Question:
Insurance laws are generally written by:
Answer:
the state legislature.. Explanation: The states are authorized through the McCarren-Ferguson Act to regulate the business of insurance. Therefore, most insurance laws originate with state legislatures.
Question:
Under the Uniform Policy Provisions Act, which of the following is not a mandatory provision for individual health insurance policies?
Answer:
Cancellation. . Explanation: Cancellation is an optional policy provision.
Question:
In the replacement process, a notice regarding replacement must be presented to the applicant:
Answer:
No later than the time the application is taken.. Explanation: The notice regarding replacement is part of the replacement process and must be presented not later than the time the application for a new policy is presented.
Question:
An individual who is considered chronically ill must be recertified as such:
Answer:
annually.. Explanation: This is a federal requirement to maintain the qualified status of long term care insurance.
Question:
Blue Cross provides benefits for all of the following, EXCEPT:
Answer:
Surgical expenses. . Explanation: Blue Cross is a hospital service corporation and addresses hospital claims on a service basis.
Question:
The exclusion for pre-existing conditions in a health insurance policy is designed to protect the insurer against:
Answer:
Adverse selection. . Explanation: Covering pre-existing conditions immediately in a health contract would have an adverse action on morbidity in rate making and would dramatically increase health rates.
Question:
Temporary licenses can be issued by the Commissioner for a maximum period of:
Answer:
180 days.. Explanation: The duration of a temporaty licensed is statutorily established.
Question:
In health insurance policies, a "waiver of premium" provision keeps the coverage in force without premium payments:
Answer:
After an insured has become disabled as defined in the policy.
Question:
Standards for health insurance policy provisions have been established by the uniform policy provisions law. A required provision concerning "notice of claim" obligates a policyholder to give the insurer or its agent notice of a claim within:
Answer:
20 days of a loss.. Explanation: The policyholder must submit a notice of claim within 20 days of the loss
Question:
Medicare Part A covers all of the following, EXCEPT:
Answer:
Inpatient surgeons services and fees. . Explanation: Physician's services are covered under Medicare Part B.
Question:
All of the following statements about coordination of benefits in group health policies are true, EXCEPT:
Answer:
to prevent over insurance, the secondary insurer does not pay benefits.. Explanation: The term coordination of benefits speaks to coordinating a claim benfit between the primary insurer and a secondary insurer.
Question:
Long term care premums take into consideration:

I. Benefit period, elimination period and age of applicant
II. Type of renewal provision and coinsurance level
III. Health of applicant, deductible and selection of inflation protection option.
Answer:
I and III only. Explanation: Long term care coverages are based on the selection of a policy benefit amount (typically $50 to $200 per day). LTC policies are "guaranteed renewable."
Question:
Long term care premums take into consideration:

I. Benefit period, elimination period and age of applicant
II. Type of renewal provision and coinsurance level
III. Health of applicant, deductible and selection of inflation protection option.
Answer:
I and III only. Explanation: Long term care coverages are based on the selection of a policy benefit amount (typically $50 to $200 per day). LTC policies are "guaranteed renewable."
Question:
Vera did not disclose her ongoing treatment for kidney disease to her agent when applying for a health policy for fear of being rejected. If the insurer becomes aware of her condition, her policy:

I. could be voided.
II. is still valid and will pay for other conditions automatically.
Answer:
I only. Explanation: For a misrepresentation to be grounds for voiding a policy, it must be intentional (Vera purposely concealed her condition) and it must be material to the risk (the insurer would have rejected her application or charged a higher premium).
Question:
All of the following are required provisions of accident and health insurance policies, EXCEPT:
Answer:
cancellation.. Explanation: The cancellation clause is an optional provision.
Question:
An employer's health insurance plan states that workers are not eligible to enroll in the plan until after they have been continuously employed for at least 30 days. This period of time is known as the:
Answer:
Probationary period. . Explanation: Probationary periods for newly hired persons is common with most employers. It is intended to determine the compatibility of the new hires with the established work force during which time, group coverage IS NOT extended to the probationary worker.
Question:
A policy that provides benefits for specific illnesses such as a cancer policy is called:
Answer:
A dread disease policy. . Explanation: May also be known as a specified disease policy.
Question:
Which of the following terms best describes the legal doctrine that any ambiguities in a policy are resolved in the favor of the insured because the insurer writes the contract?
Answer:
Adhesion. . Explanation: A contract of adhesion is one drafted entirely by one party, which the other must accept in full, or reject entirely. There is no negotiating over policy language.
Question:
The Age Discrimination in Employment Act applies to employees age:
Answer:
40 or older.. Explanation: This Act applies to employers with 20 or more employees and is directed toward employees age 40 and older.
Question:
Basic medical expense policies include coverage for miscellaneous expenses up to specific limits. These services can include all of the following, EXCEPT:
Answer:
Physician exams.. Explanation: Physician services are excluded under a basic hospital expense plan.
Question:
If a producer accepts a premium on a lapsed accident and sickness policy when an application for reinstatement is not required, which of the following causes of loss would be covered immediately?
Answer:
Accident only. . Explanation: A 10-day waiting period exists for a sickness claim upon reinstatement. No waiting period exists for accident losses.
Question:
Sam applied for and was issued a health insurance policy five years ago. At that time, his age was recorded as age 36 when in fact he was age 38. Sam's policy includes a misstatement of age provision and he has a claim at age 42. How will this claim be addressed?
Answer:
Claim benefits will be reduced.. Explanation: Under the misstatement of age provision, the benefits will be adjusted.
Question:
Long term care premums take into consideration:
I. Benefit period, elimination period and age of applicant
II. Type of renewal provision and coinsurance level
III. Health of applicant, deductible and selection of inflation protection option.
Answer:
I and III only. Explanation: Long term care coverages are based on the selection of a policy benefit amount (typically $50 to $200 per day). LTC policies are "guaranteed renewable."
Question:
The initial premium sent with an application for insurance constitutes which part of the insurance contract?
Answer:
Consideration. Explanation: The initial premium (money) paid with an application is consideration. However, complete and truthful answers to the questions on the application are also part of the broad definition of consideration.
Question:
The legal term that means that all preceding oral agreements are presumed to be incorporated in any written agreement is known as the:
Answer:
Parol Evidence Rule. . Explanation: Parol evidence is a principle governing written agreements. It presumes all prior oral agreements are included in any written contract.
Question:
When the benefits provided by Robert's basic medical expense plan were exhausted, he had to pay a $300 deductible before his major medical plan began paying benefits. Which kind of deductible does Robert's plan have?
Answer:
Corridor deductible. Explanation: Robert purchased a comprehensive major medical policy and it is made up of a basic medical (first dollar coverage) followed by a corridor deductible that separates the basic coverage from the major medical portion of the policy
Question:
The first year commissions on the sale of Medicare supplement policies may not exceed the second year's commission by:
Answer:
200%. . Explanation: This commission restriction is intended to prevent "churning" by the producing agent.
Question:
The Fair Credit Reporting Act guarantees which of the following?
Answer:
The right of an applicant to any information about them in the files of any reporting agency.. Explanation: An applicant may seek a summary of the information contained in a file that is given to insurers. This is a right provided under the Fair Credit Reporting Act.
Question:
Under the Uniform Policy Provisions Act, which of the following is not a mandatory provision for individual health insurance policies?
Answer:
Optionally Renewable. Explanation: Cancellation is an optional policy provision.
Question:
If a surgeon lost two fingers in an accident and unable to perform surgery, his disability would be considered:
Answer:
Permanent partial. Explanation: The disability would be considered permanent partial.
Question:
Under the requirements for newborn infant coverage, health insurance policies which provide coverage for family members must automatically cover a newborn child. If a specific premium or fee is required for each child, the policy may require that in order for the coverage to continue the insurer must be notified and the premium must be paid within:
Answer:
60 days.. Explanation: This time period allows the insured time to add the newborn dependent to be covered until the limiting age.
120 flash cards