Pearson Vue Health Insurance Exam
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Charges for which of the following items is NOT considered a covered expense under a
Medicare Supplement policy (Part B)? - Answer- Dental services
Health insurance policies are offered on a "take it or leave it" basis and referred to as
which of the following types of contracts? - Answer- Contracts of Adhesion
Under the Claims Forms provision of a health policy, if the insurance company fails to
send claim forms within the time period required, the insured should: - Answer- Submit
the claim in any form, which must be accepted by the company as adequate proof of
loss
In an Accidental Death and Dismemberment (AD&D) policy, capital sum refers to: -
Answer- A lump sum payment made for an accidental dismemberment
The Coordination of Benefits clause found in group health master contracts is used to: -
Answer- Avoid double payment of benefits to an insured who has duplicate group
coverages
Which of the following definitions MOST accurately describes the Probationary Period?
- Answer- The waiting period a new hire must satisfy prior to becoming eligible for group
health coverage
A Health Maintenance Organization (HMO) differs from a traditional insurer in that an
HMO: - Answer- Emphasizes preventive medicine
A married insured has an Accidental Death and Dismemberment (AD&D) policy that
names their sibling as the primary beneficiary and their child as the contingent
beneficiary. If the insured and their sibling are both killed instantly in a train accident, the
policy proceeds would be paid to which of the following? - Answer- The insured's child
The Social Security program provides all of the following benefits EXCEPT: - Answer-
Workers compensation
Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right
to: - Answer- Increase the premium rate for an entire class of insureds
A Disability Income policy may provide benefits for which of the following losses? -
Answer- Residual Disability
Which of the following statements about the Medicare program is CORRECT? -
Answer- It is a federally sponsored program.
, A child has a physical impairment, attends school, and is incapable of self-sustaining
employment and/or self care. Which of the following statements is CORRECT about the
child's medical coverage under their parent's group plan? - Answer- The child's
coverage continues as long as they are continually incapacitated and financially
dependent on their parent.
Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the
following policy features? - Answer- Exclusions
The PRIMARY purpose of Medicaid is to: - Answer- Provide Medical Expense coverage
to persons below certain minimum income requirements
Which of the following provisions designates to whom claim payments are made? -
Answer- Payment of Claims
Under an Accidental Death and Dismemberment (AD&D) policy, insurable interest must
exist at which of the following times? - Answer- At the inception of the policy
When periodic claim payments are required under a long-term disability income policy,
an insurer MUST make payments to an insured at least once every: - Answer- Month
A 68 year-old employee that is covered by a group medical insurance plan has medical
expenses. The employee's company health plan is the: - Answer- Secondary payor
An insured whose Disability Income policy contains a Change of Occupation clause
takes a new job in a more hazardous occupation and fails to notify the insurer of the
change. One year later, the insured becomes disabled. The insurer will most likely take
which of the following actions? - Answer- Settle the claim according to what the
premiums would have purchased under the more hazardous occupation
The purpose of the Medical Information Bureau (MIB) is to: - Answer- Share medical
data among member companies
Which of the following laws requires an insurer to notify an applicant in writing that an
investigative consumer report may be made on the applicant? - Answer- D. Fair Credit
Reporting Act (Insurance Information and Privacy Protection Act)
Which of the following statements is CORRECT about a Waiver of Premium provision in
a Disability Income policy? - Answer- D. It allows the insured to maintain a policy in
force while disabled and unable to pay premiums.
The Internal Revenue Service (IRS) considers Disability Income benefits paid under an
employer-paid group Disability Income to be: - Answer- C. fully taxable
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Charges for which of the following items is NOT considered a covered expense under a
Medicare Supplement policy (Part B)? - Answer- Dental services
Health insurance policies are offered on a "take it or leave it" basis and referred to as
which of the following types of contracts? - Answer- Contracts of Adhesion
Under the Claims Forms provision of a health policy, if the insurance company fails to
send claim forms within the time period required, the insured should: - Answer- Submit
the claim in any form, which must be accepted by the company as adequate proof of
loss
In an Accidental Death and Dismemberment (AD&D) policy, capital sum refers to: -
Answer- A lump sum payment made for an accidental dismemberment
The Coordination of Benefits clause found in group health master contracts is used to: -
Answer- Avoid double payment of benefits to an insured who has duplicate group
coverages
Which of the following definitions MOST accurately describes the Probationary Period?
- Answer- The waiting period a new hire must satisfy prior to becoming eligible for group
health coverage
A Health Maintenance Organization (HMO) differs from a traditional insurer in that an
HMO: - Answer- Emphasizes preventive medicine
A married insured has an Accidental Death and Dismemberment (AD&D) policy that
names their sibling as the primary beneficiary and their child as the contingent
beneficiary. If the insured and their sibling are both killed instantly in a train accident, the
policy proceeds would be paid to which of the following? - Answer- The insured's child
The Social Security program provides all of the following benefits EXCEPT: - Answer-
Workers compensation
Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right
to: - Answer- Increase the premium rate for an entire class of insureds
A Disability Income policy may provide benefits for which of the following losses? -
Answer- Residual Disability
Which of the following statements about the Medicare program is CORRECT? -
Answer- It is a federally sponsored program.
, A child has a physical impairment, attends school, and is incapable of self-sustaining
employment and/or self care. Which of the following statements is CORRECT about the
child's medical coverage under their parent's group plan? - Answer- The child's
coverage continues as long as they are continually incapacitated and financially
dependent on their parent.
Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the
following policy features? - Answer- Exclusions
The PRIMARY purpose of Medicaid is to: - Answer- Provide Medical Expense coverage
to persons below certain minimum income requirements
Which of the following provisions designates to whom claim payments are made? -
Answer- Payment of Claims
Under an Accidental Death and Dismemberment (AD&D) policy, insurable interest must
exist at which of the following times? - Answer- At the inception of the policy
When periodic claim payments are required under a long-term disability income policy,
an insurer MUST make payments to an insured at least once every: - Answer- Month
A 68 year-old employee that is covered by a group medical insurance plan has medical
expenses. The employee's company health plan is the: - Answer- Secondary payor
An insured whose Disability Income policy contains a Change of Occupation clause
takes a new job in a more hazardous occupation and fails to notify the insurer of the
change. One year later, the insured becomes disabled. The insurer will most likely take
which of the following actions? - Answer- Settle the claim according to what the
premiums would have purchased under the more hazardous occupation
The purpose of the Medical Information Bureau (MIB) is to: - Answer- Share medical
data among member companies
Which of the following laws requires an insurer to notify an applicant in writing that an
investigative consumer report may be made on the applicant? - Answer- D. Fair Credit
Reporting Act (Insurance Information and Privacy Protection Act)
Which of the following statements is CORRECT about a Waiver of Premium provision in
a Disability Income policy? - Answer- D. It allows the insured to maintain a policy in
force while disabled and unable to pay premiums.
The Internal Revenue Service (IRS) considers Disability Income benefits paid under an
employer-paid group Disability Income to be: - Answer- C. fully taxable
