And Answers LATEST 2025/2026
GRADED A+
A medical expense policy that establishes the amount of benefit paid based upon the
prevailing charges which fall within the standard range of fees normally charged for a
specific procedure by a doctor of similar training and experience in that geographic area
is known as - Answer-Usual, customary and reasonable
What provision would prevent an insurance company from paying a reimbursement
claim to someone other than the policyowner? - Answer-Payment of Claims
All of the following are true about group disability Income insurance EXCEPT
a) The longer the waiting period, the lower the premium.
b) Coverage applies both on and off the job.
c) Benefits are usually short term.
d) The waiting period starts at the onset of the injury or sickness. - Answer-Coverage
applies both on and off the job.
Which of the following statements regarding Business Overhead Expense policies is
NOT true?
a) Premiums paid for BOE are tax-deductible.
b) Any benefits received are taxable to the business.
c) Leased equipment expenses are covered by the plan.
d) Benefits are usually limited to six months, - Answer-d) Benefits are usually limited to
six months
In long-term care insurance, what type of care is provided with intermediate care? -
Answer-Occasional nursing or rehabilitative care
After a person's employment is terminated, it is possible to obtain individual health
insurance after losing the group health coverage provided by the employer. Which of
the following is NOT true?
a) The employee can convert from group to individual insurance within 31 days of
termination.
b) The premium of the individual health insurance policy can be higher than the original
policy.
c) By law, the new, individual policy must provide the same benefits as the group
insurance policy.
, d) Continuation of group coverage need not include dental, vision, or prescription drug
benefits. - Answer-c) By law, the new, individual policy must provide the same benefits
as the group insurance policy.
An insured has endured multiple surgeries and hospitalizations for an illness during the
last few months. Her insurer no longer bills her for medical expenses. Which of the
following allows for that?
a) Waiver of premium
b) Maximum loss
c) Stop-loss limit
d) Grace period - Answer-c) Stop-loss limit
L has a major medical policy with a $500 deductible and 80/20 coinsurance. Lis
hospitalized and sustains a $2.500 loss.
What is the maximum amount that L will have to pay? - Answer-$900 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).
Which of the following entities has the authority to make changes to an insurance
policy?
a) Department of Insurance
b) Broker
c) Producer
d) Insurer's executive officer - Answer-d) Insurer's executive officer
Only an executive officer of the company, not an agent, has authority to make any
changes to the policy. The insurer must have the insured's written agreement to the
change.
All of the following statements about Medicare supplement insurance policies are
correct EXCEPT
a) They cover the cost of extended nursing home care.
b) They cover Medicare deductibles and copayments.
c) They supplement Medicare benefits.
d) They are issued by private insurers. - Answer-a) They cover the cost of extended
nursing home care.
Long-term care coverage may be available as any of the following options EXCEPT:
a) Endorsement to a life policy.
b) Endorsement to a health policy.
c) Group long-term care
d) Individual long-term care. - Answer-b) Endorsement to a health policy.