Notes

Chapter 7 Quiz
1.) A guaranteed renewable health insurance policy allows the
A.) Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class.
2.) 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.
A.) Elimination Period
3.) 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?
A.) The insured is in an accident and incurs a large claim.
4.) A policy with a 31-day grace period implies.
A.) The policy will not lapse if the premium is not paid when its due
5.) Which of the following is NOT a feature of a noncancellable policy?
A.) The insurer may terminate the contract only at renewal
6.) An insured 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.) Adjust the claim benefit to reflect the insured's true age
7.) When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees.
A.) To renew the policy until the insured has reached age 65.
8.) 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.) A statement that is sufficiently clear to identify the insured and the nature of the claim.
9.) Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes.
A.) Waiver of Premium rider.
10.) What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?
A.) As long as the policy is in force
11.) Insurers may change which of the following on a guaranteed renewable health insurance policy?
A.) Rates by class
12.) The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as
A.) Legal Actions
13.) Which of the following is true regarding elimination periods and the cost of average?
A.) The longer the elimination period, the lower the cost of coverage
14.) A man is injured while robbing a convenience store. How does the major medical policy handle the payment of his claim.
A.) Claim is denied if his policy contains the illegal occupation provisions.
15.) With respect to the Consideration clause, which of the following would be considered consideration on the part of the applicant for insurance.
A.) Payment of Premium

Chapter 8 Quiz
1.) A 63-year-old man is planning to be employed until age 68. When will he be eligible for Medicare?
A.) Age 65, regardless of his employment status
2.) Which of the following must be present in all Medicare supplement plans?
A.) Plan A
3.) All of the following statements concerning Medicaid are correct EXCEPT
A.) Medicaid is a state funded program that provides health care to persons over age 65, only.
4.) 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?
A.) 20% of covered charges above the deductible
5.) If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits?
A.) 12 credits
6.) The primary eligibility requirement for Medicaid benefits is based upon.
A.) Need
7.) What is another name for social security benefits?
A.) Old Age, Survivors, and Disability Insurance
8.) To sign up for a Medicare prescription drug plan, individuals must first be enrolled in
A.) Medicare Part A
9.) Which of the following is NOT a factor in determining qualifications for Social Security disability benefits?
A.) Workers Occupation
10.) 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?
A.) Have accumulated 6 work credits in the past 3 years
11.) Which of the following programs expands individual public assistance programs for people with insufficient income and resources?
A.) Medicaid
12.) Which of the following statements is NOT true concerning Medicaid?
A.) It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income.
13.) Medicare Part D Provides
A.) Prescription drug benefit
14.) Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?
A.) 5 months
15.) How long is an open enrollment period for Medicare supplement policies?
A.) 6 months

Chapter 9 Quiz

1.) Which statement accurately describes the Change of Beneficiary provision?
A.) Any policy that has a death benefit must also have a Change of Beneficiary provision.

2.) Which of the following statements is correct concerning taxation of long-term care insurance?
A.) Excessive benefits may be taxable.

3.) A provision found in insurance policies which prevents the insured from collecting twice for the same loss is called.
A.) Subrogation

4.) Which of the following statements about occupational vs. nonoccupational coverage is TRUE?
A.) Disability insurance can be written as occupational or nonoccupational.

5.) Under which provision can a physician submit claim information prior to providing treatment?
A.) Prospective Review

6.) Which of the following applies to partial disability benefits?
A.) Payment is limited to a certain period of time.

7.) Workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from
A.) Work-related disabilities.

8.) An insured has a primary group health plan and an excess plan, each covering losses up to $10,000. The insured suffered a loss of $15,000. Disregarding any copayments or deductibles, how much will the excess plan pay?
A.) 5.000

9.) Under which condition would an employee's group medical benefits be exempt from income taxes?
A.) An employee's group medical benefits are generally exempt from taxation as income.

10.) Which of the following is not true of Disability Buy-Sell coverage?
A.) Benefits are considered taxable income to the business.

11.) Which of the following is NOT true regarding partial disability?
A.) This is a form of insurance that covers part-time workers.

12.) What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid?
A.) Prospective Review

13.) The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called.
A.) Nonoccupational coverage.

14.) Which of the following is NOT a cost-saving service in a medical plan?
A.) Denial of Coverage

15.) Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner?
A.) Disability Buy-Sell

16.) 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
A.) Any occupation- more restrictive than other definitions

17.) A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim
A.) The insurance through his company is primary.

18.) Which of the following hospice expenses would NOT be covered in a cost-containment setting?
A.) Antibiotics











































































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