Health Insurance Questions With Accurate Answers
If an Agent knows the client did not put in an application certain
information about an illness that the client sustained, what should the
agent do?
A. This is not the agent's responsibility.
B. Nothing and hope nothing happens for 2 years.
C. Nothing at all. The company will catch the error from the MIB report.
D. Advise the client he may not have a valid claim later on. Correct Ans
- Advise the client he may not have a valid claim later on.
Yes, the client needs to know that if the information is not valid, the claim
can be rejected.
Which of the following benefits can be included in a group health plan?
A. Medical insurance
B. Disability insurance
C. Accidental death and dismemberment insurance
D. All of the above Correct Ans - All of the above
All of the three categories can be included in a group health plan.
Mr. Finklestein has an accident and goes on disability income. After 9
months, he goes back to work. After 3 more months, he finds he returned to
work too soon and must go back on disability. How will the company
handle this claim?
A. It will be classified as a new disability with a new elimination period
B. It will be considered a continuation of the same disability
C. The company will require Finklestein to wait 6 months before benefits
can begin
D. It will be a new disability but the elimination period will be waived
Correct Ans - It will be considered a continuation of the same disability
Right... it is considered a continuation of the same disability.
An HMO found guilty of unfair trade practices act could be charged a
penalty of:
I. up to $2,500
II. up to $50,000
,III. if the violation is criminal, it can result in imprisonment
IV. $10,000
A. I & III
B. III & IV
C. II & III
D. II only Correct Ans - II & III
The first thing I want to say is that Florida has taken out the roman
numeral questions like this one, but I have these in because they are more
challenging. You won't find any like this on the state test. The answer to
this question is: up to $50,000 and potential imprisonment. Pretty serious
stuff. The state means business and companies are aware of that.
Individual health policies are usually written:
A. participating.
B. nonparticipating.
C. nonadmitted.
D. noncontractual. Correct Ans - nonparticipating
Yes... companies don't normally write par policies on individuals with
health insurance. Life, yes; health, no. Do you remember what "par" means?
Participating with the company on their expenses... with a potential return
in the form of dividends.
What is the Health Insurance Coverage Continuation Act?
A. When group members of large companies were prohibited from
coverage
B. When members of a plan were recently on medicaid
C. When members of a plan were with an HMO
D. Setting requirements for insurers selling plans to employers under 20
employees Correct Ans - Setting requirements for insurers selling
plans to employers under 20 employees
Right. This legislation is for small employers with 20 or fewer employees to
function like COBRA does for larger employers. It allows leaving employees
to continue to be able to pay premiums to stay inside the company's plan
for as long as 18 months.
Which of the following is not a service provider?
,A. HMO
B. Lloyd's of London
C. PPO
D. EPO Correct Ans - Lloyd's of London
It ought to be a fairly easy question. I'm not sure the state exam will be this
nice to you. It's the one answer that really stands out from the rest. Lloyd's
of London isn't a service provider or an insurance company either.
Which is not a requirement of agents soliciting medicare supplements?
A. inquire from each client if they already have coverage
B. explain to the client where there will be overlapping coverage
C. send a signed form to the company explaining why the policy can't be
sold
D. have client sign a form acknowledging information was provided
Correct Ans - send a signed form to the company explaining why the
policy can't be sold
This is not a requirement. What is this exactly? Making excuses to the home
office? Now... rather than concentrate on how dumb this answer was, note
the other three because they are important considerations in selling
Medicare supplements! These are requirements about which the state
could easily ask questions in the exam.
Must a health company return unearned premium on a cancelled policy?
A. yes
B. no
C. only if insurer cancels
D. depends Correct Ans - yes
Easy answer really, because you can think of it this way: insurance
companies do not cheat the public. If the premium is earned because the
time has gone by where the client had the coverage, then the company will
keep the premium. If the time hasn't occurred yet, because the premium
was paid in advance and not earned yet, the company will provide a refund
for the exact amount due.
, Washington takes a skiing trip and breaks a leg. Upon returning home, he
purchases a major medical policy and files a claim which the company
disapproves. The reason they decline the claim is:
A. pre-existing condition
B. consideration
C. entire contract
D. insuring clause Correct Ans - insuring clause
Yes... the insuring clause tells what the company is going to do and WHEN.
It also spells out the dates of the coverage, which in this case the event
occurred outside of the dates of coverage.
Read answer (a.) for more explanation.
(a.) Yes, it was a pre-existing condition alright, but that doesn't have
anything to do with it because he is submitting a claim for something that
happened before the policy was in existence. It's like having an accident
and then driving into an auto insurance office and buying auto insurance ...
and then claiming on the accident you had before the policy was in effect.
The problem is not occurring after the effective date of the policy. With a
pre-existing condition, it exists before the effective date of the policy and
again after the effective date of the policy.
The leg did not break again after the policy was effective.
A difference between life & health policies is:
I. life is a valued contract, health policies can be indemnity contracts
II. life is an indemnity contract, health is a valued contract
III. life is a valued contract, health policies can be reimbursement contracts
A. I only
B. II only
C. III only
D. I & III Correct Ans - I & III
Life is a valued contract because we always know what the amount is going
to be for the proceeds: the face value. A health insurance policy can be
reimbursement because we don't find out the cost of the care until after it
occurs, and then the amount paid by the insurance company will be
reimbursing for the actual cost (or less in the case of deductibles and co-
pay), or it can be an indemnity contract such as the "hospital indemnity"
policy which supplies a set dollar amount for every day the insured is in
the hospital. We won't know ahead of time what the amount will be until
If an Agent knows the client did not put in an application certain
information about an illness that the client sustained, what should the
agent do?
A. This is not the agent's responsibility.
B. Nothing and hope nothing happens for 2 years.
C. Nothing at all. The company will catch the error from the MIB report.
D. Advise the client he may not have a valid claim later on. Correct Ans
- Advise the client he may not have a valid claim later on.
Yes, the client needs to know that if the information is not valid, the claim
can be rejected.
Which of the following benefits can be included in a group health plan?
A. Medical insurance
B. Disability insurance
C. Accidental death and dismemberment insurance
D. All of the above Correct Ans - All of the above
All of the three categories can be included in a group health plan.
Mr. Finklestein has an accident and goes on disability income. After 9
months, he goes back to work. After 3 more months, he finds he returned to
work too soon and must go back on disability. How will the company
handle this claim?
A. It will be classified as a new disability with a new elimination period
B. It will be considered a continuation of the same disability
C. The company will require Finklestein to wait 6 months before benefits
can begin
D. It will be a new disability but the elimination period will be waived
Correct Ans - It will be considered a continuation of the same disability
Right... it is considered a continuation of the same disability.
An HMO found guilty of unfair trade practices act could be charged a
penalty of:
I. up to $2,500
II. up to $50,000
,III. if the violation is criminal, it can result in imprisonment
IV. $10,000
A. I & III
B. III & IV
C. II & III
D. II only Correct Ans - II & III
The first thing I want to say is that Florida has taken out the roman
numeral questions like this one, but I have these in because they are more
challenging. You won't find any like this on the state test. The answer to
this question is: up to $50,000 and potential imprisonment. Pretty serious
stuff. The state means business and companies are aware of that.
Individual health policies are usually written:
A. participating.
B. nonparticipating.
C. nonadmitted.
D. noncontractual. Correct Ans - nonparticipating
Yes... companies don't normally write par policies on individuals with
health insurance. Life, yes; health, no. Do you remember what "par" means?
Participating with the company on their expenses... with a potential return
in the form of dividends.
What is the Health Insurance Coverage Continuation Act?
A. When group members of large companies were prohibited from
coverage
B. When members of a plan were recently on medicaid
C. When members of a plan were with an HMO
D. Setting requirements for insurers selling plans to employers under 20
employees Correct Ans - Setting requirements for insurers selling
plans to employers under 20 employees
Right. This legislation is for small employers with 20 or fewer employees to
function like COBRA does for larger employers. It allows leaving employees
to continue to be able to pay premiums to stay inside the company's plan
for as long as 18 months.
Which of the following is not a service provider?
,A. HMO
B. Lloyd's of London
C. PPO
D. EPO Correct Ans - Lloyd's of London
It ought to be a fairly easy question. I'm not sure the state exam will be this
nice to you. It's the one answer that really stands out from the rest. Lloyd's
of London isn't a service provider or an insurance company either.
Which is not a requirement of agents soliciting medicare supplements?
A. inquire from each client if they already have coverage
B. explain to the client where there will be overlapping coverage
C. send a signed form to the company explaining why the policy can't be
sold
D. have client sign a form acknowledging information was provided
Correct Ans - send a signed form to the company explaining why the
policy can't be sold
This is not a requirement. What is this exactly? Making excuses to the home
office? Now... rather than concentrate on how dumb this answer was, note
the other three because they are important considerations in selling
Medicare supplements! These are requirements about which the state
could easily ask questions in the exam.
Must a health company return unearned premium on a cancelled policy?
A. yes
B. no
C. only if insurer cancels
D. depends Correct Ans - yes
Easy answer really, because you can think of it this way: insurance
companies do not cheat the public. If the premium is earned because the
time has gone by where the client had the coverage, then the company will
keep the premium. If the time hasn't occurred yet, because the premium
was paid in advance and not earned yet, the company will provide a refund
for the exact amount due.
, Washington takes a skiing trip and breaks a leg. Upon returning home, he
purchases a major medical policy and files a claim which the company
disapproves. The reason they decline the claim is:
A. pre-existing condition
B. consideration
C. entire contract
D. insuring clause Correct Ans - insuring clause
Yes... the insuring clause tells what the company is going to do and WHEN.
It also spells out the dates of the coverage, which in this case the event
occurred outside of the dates of coverage.
Read answer (a.) for more explanation.
(a.) Yes, it was a pre-existing condition alright, but that doesn't have
anything to do with it because he is submitting a claim for something that
happened before the policy was in existence. It's like having an accident
and then driving into an auto insurance office and buying auto insurance ...
and then claiming on the accident you had before the policy was in effect.
The problem is not occurring after the effective date of the policy. With a
pre-existing condition, it exists before the effective date of the policy and
again after the effective date of the policy.
The leg did not break again after the policy was effective.
A difference between life & health policies is:
I. life is a valued contract, health policies can be indemnity contracts
II. life is an indemnity contract, health is a valued contract
III. life is a valued contract, health policies can be reimbursement contracts
A. I only
B. II only
C. III only
D. I & III Correct Ans - I & III
Life is a valued contract because we always know what the amount is going
to be for the proceeds: the face value. A health insurance policy can be
reimbursement because we don't find out the cost of the care until after it
occurs, and then the amount paid by the insurance company will be
reimbursing for the actual cost (or less in the case of deductibles and co-
pay), or it can be an indemnity contract such as the "hospital indemnity"
policy which supplies a set dollar amount for every day the insured is in
the hospital. We won't know ahead of time what the amount will be until
