Colorado Accident and Health General State Exam Simulator Questions and Answers 2023

Which of the following statements about Health Reimbursement Arrangements (HRA) is correct? - Answer- If the employee paid for qualified medical expenses, the reimbursements may be tax free. Which parts of a health insurance policy are guaranteed to be true? - Answer- warranty What is usually excluded from medical expense policies? - Answer- Intentionally self-inflicted injuries insurable interest only needs to exist at the time of application. - Answer- F Blue Cross/Blue Shield - Answer- non-profit organizations reimbursement of benefits for the treatment of a beneficiary's injures caused by a third party? - Answer- subrogation is the right for an insurer to purse a third party the caused an insurance loss to the insured accident policy will most likely pay a benefit for an - Answer- off-the-job-accident deductibles are used in health policies to lower - Answer- coinsurance amount must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds - Answer- guaranteed renewable dental care indemnity coverage - Answer- services are reimbursed after insurer receives the invoice agent authority - Answer- express, implied, and apparent document NOT required to mention the Colorado fraud statute - Answer- certificates of authority which of these arrangements allows one to bypass insurable interest laws? - Answer- investor-originated life insurance sometimes called stranger originated life insurance is used to circumvent state insurable interest statutes. all of the following are considered to be typical characteristics describing nature of an insurance contract except - Answer- bilateral (unilateral, aleatory, and adhesion are all characteristics of insurance contract) surgeon's fees are not - Answer- covered under hospitalization expense policy after an insured gives notice of loss what must be done if the insurer does not furnish forms? - Answer- file written proof of loss medicare is interned for all of the following groups except - Answer- those enrolled as full-time students disability income policy the ___ acts as a deductible clause - Answer- deductible period the elimination period serves as the deductible - Answer- in a disability income policy a characteristic of preferred provider organizations (PPOs) - Answer- discounted fees for the patient. feed are discounted in return for using listed providers the primary difference between the Colorado partnership LTC policy and the other LTC policies are - Answer- medicaid assest protection single premium is not used by - Answer- health insurance policies 45 days from the reinstatement application date the insurance comply has to notify the person - Answer- of the denial before the policy will be automatically placed back in force t. became disabled due to a fire t set insurer found out after the company began making monthly benefit payments the insurer will then - Answer- rescind the policy, deny the claim, and recover all payments made accidental death and dismemberment insurance beneficiary requires consent when a change of beneficiary is made? - Answer- irrevocable beneficiary an insured should submit the claim in any form if the insurer - Answer- does not send the claims forms within the time period set forth in a health policy's claims forms provision reinstatement - Answer- coverage may be restored under the reinstatement provision a policy owners rights are limited under which beneficiary designation? - Answer- irrevocable irrevocable - Answer- beneficiary designation requires that consent and signature of that named beneficiary before a change of beneficiary occurs 2 years to contest information provided on an A&H app beings on the date - Answer- insurer dates the policy grace period provision minimum days is - Answer- 31 pre-exisiting condition - Answer- 6 months the intent of a coinsurance clause in a major medical policy is - Answer- discourages over utilization of the insurance coverage the premiums may increase at time of renewal - Answer- conditionally renewable health insurance policy information obtained from a phone conversation to the proposed insured can be found on the - Answer- inspection reports irrevocable designation may not be changed without the - Answer- written consent of the beneficiary insuring clause - Answer- identifies which losses resulting from an accident or sickness are insured by the policy Guaranteed Renewable - Answer- policy must be renewed as long as the premiums are paid until the insured reaches a specified age Medicare - Answer- part A covers hospitalization , part B covers doctor's services coverage will be contingent upon the insurer's underwriting policies - Answer- if the producer completes app social security does not provide benefits for - Answer- dismemberment a health insurance contract is valid only if the insured provides - Answer- consideration Accidental Bodily Injury - Answer- less restrictive Accidental means - Answer- more restrictive internal limit - Answer- this policy will only pay for a semi-private room insurer must wait 60 days after written proof of loss before - Answer- legal action can be brought against the company 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 less than - Answer- 6 months major medical expense plans have a - Answer- one year benefit period Benefits Payable under disability buy-out policy are paid to the - Answer- company or another shareholder common accident deductible provision states - Answer- that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied if a policy-owner covered under a A&H policy wanted to ensure the policy will continue if the ever become totally disabled, they would want to add a - Answer- waiver of premium rider the waiver of premium provision in a health insurance contract suspends the insurer's right to - Answer- receive premiums during a covered period of disability residual disability benefit - Answer- is usually a percentage of the total disability benefit for periods when the insured is unable to perform some of the duties of occupation. health reimbursement arrangement - Answer- are employer established benefit plans that must be funded by the employer payment of claims is considered a mandatory pr