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30 Cards in this Set
- Front
- Back
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1
In a group health policy, a probationary period is intended for people |
A Who want lower premiums. B Who joined the group after the effective date. C Who had a pre-existing condition at the time they joined the group. D Who have additional coverage through a spouse. |
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2
Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date? |
A Optionally renewable B Conditionally renewable C Guaranteed renewable D Non cancellable |
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3
Will's health insurance includes a Narcotics & Intoxicants provision. Will has been drinking alcohol before leaving his house and driving his car into an embankment. After the police arrive on the scene, they determine that Will has been drinking. Will his policy pay for his injuries? |
A The extent of Will’s benefits depends upon which variation of this provision is attached to Will’s policy. B Yes, he will get full benefits. C He will only receive partial benefits. D He will receive no benefits. |
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4
Which provision states that the insurance company must pay Medical Expense claims immediately? |
A Relation of Earnings to Insurance B Time of Payment of Claims C Payment of Claims D Legal Actions |
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5
If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following? |
A Cancel the policy. B Increase the premium. C Exclude coverage for on-the-job injury. D Adjust the benefit in accordance with the increased risk. |
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6 What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur? |
A Optionally renewable B Non cancellable C Guaranteed renewable D Conditionally renewable |
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7
The expense for an autopsy covered under the physical exam and autopsy provision is paid by |
A The state's autopsy fund. B The limits of coverage under the health insurance policy. C The estate of the insured. D The insurer. |
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8
In an optionally renewable policy, the insurer has which of the following options? |
A Shorten the notice that the insured receives B Increase premiums C Increase the grace period D Alter the due date so the policy can be cancelled sooner |
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9
Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? |
A Free Look Period B Grace Period C Elimination Period D Probationary Period |
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10
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? |
A $900 (deductible + 20% of the bill after the deductible [20% of $2,000]) B $500 (amount of deductible) C $1,000 (deductible + 20% of the entire bill) D $2,500 (the entire bill) |
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11
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 |
A Amounts payable under the policy will reflect the insured's correct age. B The contract will be deemed void because of the misstatement of age. C The elimination period will be extended 6 months for each year of age misstatement. D Because the misstatement occurred more than 2 years ago, it has no effect. |
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12
Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to |
A The spouse of the insured. B The insured. C Creditors. D Beneficiary of the death benefit. |
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13
Which of the following is true regarding a term health policy? |
A It is conditionally renewable. B It is guaranteed renewable. C It is noncancellable. D It is nonrenewable |
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14
A woman misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued? |
A Deny any claims and cancel the woman's policy B Deny paying a claim based on misrepresentation C Pay the full amount of a claim because the contestable period has ended D Adjust the claim benefit to reflect the woman's true age |
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15
Which of the following statements is true concerning the alteration of optional policy provisions? |
A Once any kind of provision is written, it cannot be changed. B An insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder. C An insurer may change the wording of optional provisions, regardless of its effect on the policyholder. D An insurer may change the wording of optional policy provisions that would adversely affect the policyholder but must first receive state permission before the change goes into effect |
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1
In a group health policy, a probationary period is intended for people |
B Who joined the group after the effective date. Correct! Incorrect! The probationary period is the waiting period new employees must satisfy before becoming eligible for benefits. |
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2 Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date? |
A Optionally renewable Incorrect! In an optionally renewable policy, it is the insurer's option as to whether to renew or not. |
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3 Will's health insurance includes a Narcotics & Intoxicants provision. Will has been drinking alcohol before leaving his house and driving his car into an embankment. After the police arrive on the scene, they determine that Will has been drinking. Will his policy pay for his injuries? |
D He will receive no benefits.
Correct! Incorrect! The Narcotics & Intoxicants Provision stipulates that the insurer will not cover any injury or illness resulting from intoxication created by drugs or alcohol. Treatment for substance abuse is typically still covered under most policies. This provision is geared specifically toward injuries and illnesses resulting from substance abuse. |
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4 Which provision states that the insurance company must pay Medical Expense claims immediately? |
C Time of Payment of Claims Correct! Incorrect! The Time Payment of Claims provision requires that claims will be paid immediately upon receipt of proofs of loss except for periodic payments, which are to be paid as specified in the policy. |
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5 If the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?
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D Adjust the benefit in accordance with the increased risk.
Correct! Incorrect! A part of the premium rating concerns the hazard of occupation. |
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6 What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur?
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D Conditionally renewable
Correct! Incorrect! The conditionally renewable provision is very similar to the optionally renewable provision. The primary difference is that conditionally renewable policies may be canceled for specific conditions contained in the policy, but optionally renewable policies do not specify a condition or reason for cancellation. |
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7 The expense for an autopsy covered under the physical exam and autopsy provision is paid by
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D The insurer.Correct! Incorrect! Where not forbidden by state law, the insurer, at its own expense, may cause an autopsy to be performed on a deceased insured.
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8 In an optionally renewable policy, the insurer has which of the following options?
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B Increase premiums Correct! Incorrect! Optionally renewable policies allow the insurer to cancel a policy for any reason whatsoever. Policies can only be cancelled by class on the policy anniversary or premium due date (renewal date). If the insurer elects to renew coverage, it can also increase the policy premium. |
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9 Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it?
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A Free Look Period Incorrect! The Free Look provision allows a policyholder 10 days after the policy is delivered in which to decide whether or not he/she wants the policy. If the policyholder decides to return the policy within this period, he/she receives a full refund of all premiums paid. |
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10 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?
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A $900 (deductible + 20% of the bill after the deductible [20% of $2,000]) Incorrect! 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). |
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11When 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
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A Amounts payable under the policy will reflect the insured's correct age. Incorrect! If an insured misstates his or her age upon policy application, the optional misstatement of age provision will change the payable benefit to that which would have been purchased at the insured's actual age. |
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12 Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to
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B The insured. Incorrect! Payments for loss of life benefits are to be made to the designated beneficiary. If no beneficiary has been named, payment proceeds are to be paid to the deceased insured's estate. Claims other than death benefits are to be paid to the insured or the insured's estate, unless otherwise assigned by the insured. |
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13 Which of the following is true regarding a term health policy?
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D It is nonrenewable.
Correct! Incorrect! In term health policies, the owner has no rights of renewal. |
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14 A woman misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?
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D Adjust the claim benefit to reflect the woman's true age
Correct! Incorrect! The Misstatement of Age provision says that if a client has misstated her age, whether intentional or unintentional, they will adjust the benefit being paid. It doesn't matter when the mistake was found. |
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15 Which of the following statements is true concerning the alteration of optional policy provisions?
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B An insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder. Correct! Incorrect! Optional policy provisions can be changed by an insurer, as long as the changes do not adversely affect the policyholder. |
