ACCIDENT AND HEALTH INSURANCE EXAM QUESTIONS/231 QUESTIONS AND ANSWERS

ACCIDENT AND HEALTH INSURANCE EXAM QUESTIONS/231 QUESTIONS AND ANSWERS H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over-insurance clause B: free look C: relation of earning to insurance D: relation of economic value - -C: relation of earning to insurance -The insured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the policy summary B: the first page of the contract C: the delivery receipt D: upon conditional receipt - -B: the first page of the contract -The policy has all of the following rights EXCEPT: A: Right to solely renew a guaranteed renewable policy. B: Right to terminate a policy C: Unilateral right to renew an Optionally renewable policy D: Right to assign a contract - -C: Unilateral right to renew an Optionally renewable policy -The part of a contract that specifies which expenses may or may not be covered is known as the: A: Exclusion B: Eligible Expense provision C: Insuring Agreement D: Consideration Clause - -B: Eligible Expense provision -Which of the following is considered to be a mandatory provision in a health policy? A: Time Limit on Certain Defenses B: Change of Occupation C: Illegal Occupation D: Intoxicant/Narcotic Usage - -A: Time Limit on Certain Defenses -Which of the following may be considered an eligible expense found in a health policy? A: Cosmetic Surgery B: Premium payment C: cold cream D: Bus fare to receive treatment for a covered loss - -D: Bus fare to receive treatment for a covered loss -K has a policy that covers doctors visits but limits the number of visits per calendar year and pays a limited indemnification limit per visit. K has: A: Basic Medical Expense B: Physician Nonsurgical Coverage C: Basic Surgical Policy D: Basic Hospital Coverage - -B: Physician Nonsurgical Coverage -All of the following are CORRECT about Medicare EXCEPT: A: An insured who is age 30 but collecting Social Security disability for the last two years is eligible for Medicare. B: An insured who is age 60 and is at the end stage of renal failure is eligible for Medicare. C: An insured who turns age 65 and is still employed is eligible for Medicare. D: An insured who has Medicare Part A is eligible to enroll for Medigap policies within six months of enrolling in Part A. - -D: An insured who has Medicare Part A is eligible to enroll for Medigap policies within six months of enrolling in Part A. -Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 C: 20 D: 30 - -B: 15 -The purpose of the Fair Credit Reporting Act is to: A: protect the consumer from having an adverse action against them based of obsolete credit information B: to ensure that credit information used in underwriting is accurate and updated C: make sure that any financial institution handles an individual's credit in a correct, proper manner D: All of the Above - -D: All of the Above -Most Accident and Health policies require that claims must be paid upon written proof of loss. A: 30 days B: Immediately C: 60 days D: 90 days - -B: Immediately -A LTC policy that will only pay for ADL given occasionally by a licensed professional is: A: Skilled Care B: Intermediate Care C: Custodial Care D: None of the Above - -C: Custodial Care -Which of the following policy provisions are optional in a individual health policy? A: Entire Contract B: Change of Occupation C: Entire Contract D: Reinstatement - -B: Change of Occupation -Which of the following elements is part of the entire contract clause? A: The exchange of value between the parties B: The agreement between the policyholder and insurer C: The amount of time the insured has to send a policy back for a full refund D: None of the Above - -D: None of the Above -All of the following are true regarding Social Security disability EXCEPT: A: A insured must wait 5 months before collecting benefits B: To qualify an insured must be unable to do any job in the American economy C: To qualify an insured must be disabled for a year or longer or die within a two year period. D: The insured must have a certain amount of Social Security credits based off age. - -C: To qualify an insured must be disabled for a year or longer or die within a two year period. -Health Care FSA contributions are limited to per year. A: $5,000 B: $3,000 C: $2,700 D: $3,250 - -C: $2,700 -A noncancelable policy means the company A: may not raise the premium or terminate the policy except for nonpayment of premium B: may not cancel before the insured reaches age 50 C: may pay limited benefits and cannot cancel all benefits D: can only terminate coverage if the insured switches occupations - -A: may not raise the premium or terminate the policy except for nonpayment of premium -The maximum number of in-hospital days coverage provided by an individual policy under minimum standards is: A: 30 days B: 45 days C: 90 days D: 180 days - -D: 180 days -If there is a dispute on medical necessity under a HMO, there must be a system in place for a second opinion. If the second opinion determines that a covered service is in fact medically necessary, the HMO must provide service. The only way that benefits are paid for an out-of-network physician is: A: if a referral is given B: state law dictates when coverage out of area exists C: if it is an emergency D: None of the Above - -A: if a referral is given -Which of the following circumstances may lead to the renewal of a producer license without the requirement of completing continuing education requirements? A: There are no exceptions to the continuing education law. B: The producer suffers a stroke and is incapable of completing any coursework. C: The producer is called up to military duty and secures a military waiver. D: Once a producer has been licensed for more than 30 consecutive years and is at least 65 years of age, they are exempt from continuing education requirements. - -C: The producer is called up to military duty and secures a military waiver. -Renewability of a Long Term Care policy must be at least: A: Noncancelable B: Guaranteed Renewable C: Cancellable D: A and B only - -D: A and B only -Under minimum standards, the probationary waiting period for illness may not exceed A: 10 days B: 20 days C: 30 days D: 40 days - -C: 30 days -If a policy owner of a Medicare Supplement becomes eligible for Medicaid, a supplement can be suspended for up to as long as they give the insurer notice within 90 days of being eligible for Medicaid. A: 6 months B: 12 months C: 24 months D: 36 months - -C: 24 months -H has had group LTC coverage for the last 5 months. H has decided to leave his job and find a new career. Upon leaving his group, H would like to convert his group LTC policy to an individual plan. The insurer is most likely to: A: deny conversion B: allow conversion C: allow conversion, but they may increase the premium D: allow conversion as long as H converts within 30 days of leaving they group - -A: deny conversion -If an insurance company issues deceptive statements about its assets, this action is A: false advertising. B: an unfair trade practice. C: unfair discrimination. D: falsification. - -B: an unfair trade practice. -Other than when an agent or insurer sells a supplement not approved by the director, all other violations may incur a maximum fine of: A: $500 B: $1,000 C: $5,000 D: $10,000 - -C: $5,000 -If an insurer discontinues a group policy they are only liable for: A: their extent of benefits under the old contract B: half of the new carrier's covered losses C: nothing D: all losses up to a year - -A: their extent of benefits under the old contract -N has a major medical policy through an insolvent insurer. The maximum the Guarantee Association will pay on N's losses is: A: $500,000 B: $300,000 C: $200,000 D: $100,000 - -A: $500,000 -On March 1 C, who holds an Illinois non-resident license moves from Idaho to Iowa. By which date must C notify the Illinois Director of Insurance about this move? A: By March 31 B: C does not have to notify Illinois since he was a non-resident license holder. C: By May 1 D: By March 16 - -A: By March 31 -V has an HMO who has been financial impaired, the most the HMO Guarantee Association will pay for V's claims is: A: $100,000 B: $250,000 C: $300,000 D: $500,000 - -D: $500,000 -What action would be required of a producer who fails to reinstate a lapsed producer license within the statutory allowed time period? A: The person is barred from entering the insurance business for 5 years. B: The person is barred from entering the insurance business for life. C: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $180 license fee. D: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $360 license fee. - -C: The person would be required to take a certified prelicensing course and state exam for each line or authority sought and then to submit an application with the payment of a $180 license fee. -T has recently replaced her Medicare Supplement policy which was in force for 7 months. The contract has a probationary waiting period on all illness related losses for the first ten days of coverage. On day 5, T suffers an illness. The replacing insurer is most likely to: A: cover the loss B: deny the claim C: require T pay more premium to cover the loss D: None of the Above - -A: cover the loss -Another name for a Binder is: A: Conditional Receipt B: Unconditional Receipt C: Temporary Coverage Binder D: Pre-Conditional Receipt - -B: Unconditional Receipt -When an agent sells an Accident and Health policy, he/she should do which of the following with the application? A: Complete it and have the applicant review and sign it B: The agent should initial any and all changes he/she may make later C: Have the applicant sign and then carefully put in the required information in as thoroughly and accurately a manner as possible D: Advise the applicant to provide information in such a manner to make certain the policy will be issued without restrictions - -A: Complete it and have the applicant review and sign it -G had his policy reinstated on August 1. On August 5, G falls ill and needs to spend a few nights in the hospital. Which of the following is most likely to happen? A: The insurer will pay full benefits for G's loss B: The insurer will not pay for G's loss C: G will have to pay more premium to have the loss covered D: None of the Above - -B: The insurer will not pay for G's loss -Which of the rights of renewable will guarantee premiums remain level? A: Guaranteed Renewable B: Cancelable C: Noncan D: None of the Above - -C: Noncan -Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 C: 20 D: 30 - -B: 15 -A CORRECT statement about benefits payable under a Disability Buy-Out policy that is owned by a business entity is that they are: A: related directly to salary B: paid in installments C: paid to the corporation D: paid directly to the employee - -C: paid to the corporation -The rider that an insurer uses to specifically name and exclude a preexisting condition from coverage is known as: A: Exclusionary Rider B: Preexisting Condition Rider C: Impairment Rider D: Exclusion Rider - -C: Impairment Rider -Lifetime, Per Cause, and Annual maximums are all examples of: A: Benefit Exclusions B: Benefit Limits C: Out of Pocket Expenses D: Contractual Losses - -B: Benefit Limits -If the carrier has a reasonable charge that is below the providers contractual reasonable charge, the insured may be responsible for the difference of medical cost, this is known as: A: Balance Billing B: Reasonable Charges C: Usual Charges D: Customary Charge - -A: Balance Billing -Which of the following rights of renewability stipulate that the insured has the sole right to end coverage? A: Period of Time B: Noncancelable C: Cancelable D: Conditionally Renewable - -B: Noncancelable -All of the following statements are true about a specified disease plan EXCEPT: A: Cancer may be covered up to a fixed dollar benefit amount. B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. C: A specified disease plan will only cover one specific loss. D: No policy will cover a specified disease if diagnosed occurred before the policy was applied for. - -B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. -Which of the following are exclusions under a health policy? A: an annual eye exam B: a biannual dental check-up C: a worker that is injured while working on the job D: All of the Above - -D: All of the Above -The mandatory provision that stipulates the insurer's rights during underwriting and proving fraud is the: A: Proof of Loss provision B: Physical Examination and Autopsy C: Entire Contract Provision D: Legal Action Provision - -B: Physical Examination and Autopsy -What is a contract's grace period if a premium is paid on a quarterly basis? A: 7 days B: 10 days C: 31 days D: 90 days - -C: 31 days -Doctors in a Preferred Provider Organization are paid: A: Capitation B: Fee for Service C: Salary D: Reimbursement - -B: Fee for Service -In a health policy, the probationary period begins: A: upon issuance of a policy B: upon delivery of a policy C: when underwriting takes place D: upon payment of first premium - -A: upon issuance of a policy -Which policy rider would offer an insured the option to increase their benefits of the original policy? A: Impairment Rider B: Guaranteed Insurability Rider C: Waiver of Premium D: None of the Above - -B: Guaranteed Insurability Rider -C has a LTC policy that cannot be terminated and has guaranteed premiums. C has which of the following rights of renewability? A: Noncancelable B: Guaranteed Renewable C: Cancelable D: Period of Time - -A: Noncancelable -Consideration for the insurer is to: A: guarantee coverage B: cover losses that are excluded C: pay covered losses D: share in premium payment - -C: pay covered losses -All of the following benefits may require a referral EXCEPT: A: A doctor seen in-network under a PPO B: A subscriber uses their point of service plan for a covered specialist C: A subscriber utilizes their HMO coverage for a cardiologist. D: None of the Above - -A: A doctor seen in-network under a PPO -T has just returned back to work after a total disability but is only able to work half the day. T's policy pays the difference between what the employer pays T and what T earned prior to disability. T has: A: Own Occupation B: Residual Disability C: Partial Disability D: Any Occupation - -B: Residual Disability -If an agent has completed the initial continuing education for long term care, next renewal they must complete ongoing education that is of continuing education. A: 4 hours B: 8 hours C: 12 hours D: 24 hours - -A: 4 hours -Which of the following is not true regarding Medicare Supplement minimum standards? A: Supplements can only exclude illness or treatment that are excluded under Medicare. B: If a group Supplement was terminated, the insurer does not have to offer certificate holders a right to convert to an individual policy. C: Supplements cannot base payments on standards such as reasonable and customary. D: A preexisting condition is limited to 6 months before effective date of coverage. - -B: If a group Supplement was terminated, the insurer does not have to offer certificate holders a right to convert to an individual policy. -Which of the following is an a example of a unfair trade practice? A: a company rates an individual based on partial blindness B: a company rates an individual with a disability C: an agent discriminates a client because of they are totally blind D: All of the Above - -D: All of the Above -A producer violates the written order from the Director pertaining to their market conduct activities. What is the maximum civil penalty that can be assessed by the Director against a producer in this circumstance? A: $10,000 B: $20,000 C: $50,000 D: $100,000 - -B: $20,000 -If an insured has a limited group plan and the carrier discontinues group benefits, as long as the insured has not used up all of their benefits under the policy, in the case of total disability, coverage applies up to after discontinuation or end of disability, whichever occurs first. A: 30 days B: 60 days C: 90 days D: 12 months - -C: 90 days -A producer tells his client that his disability income policy will pay for all of his medical bills if disabled. The producer is guilty of A: Twisting B: Misrepresentation C: Defamation D: False Advertising - -B: Misrepresentation -On March 1 the Director mailed a notice of producer license suspension to R which he received on March 4. If R wishes to request a hearing on the matter, by which date must R make this demand in writing? A: 24-Mar B: 30-Mar C: 31-Mar D: 3-Apr - -C: 31-Mar -Under law, a LTC policy must provide consecutive coverage for at least: A: 6 months B: 12 months C: 24 months D: 36 months - -B: 12 months -Company A has decided to cease group coverage in IL. On August 1, Company A notifies all group contract holders of discontinuation. How many days does the contract holder have to notify enrollees? A: 10 days B: 20 days C: 30 days D: 31 days - -A: 10 days -Each of the following is true regarding a cancelable policy EXCEPT: A: The insured can cancel for any reason B: The insurer can cancel the policy at anytime C: The insurer can only terminate because of nonpayment of premium D: Cancelable is usually the most inexpensive renewability option. - -C: The insurer can only terminate because of nonpayment of premium -The purpose of preventing an insured from collecting twice on losses that are Subrogated is to: A: reinforce indemnity B: to hinder the insured's rights C: to allow the insurer to collect twice D: None of the Above - -A: reinforce indemnity -N has a disability policy and suffers a covered loss. After elimination, what is the maximum time the insurer has to make a claim payment under the Time Payment of Claims provision? A: Immediately B: 15 days C: 20 days D: 30 days - -D: 30 days -The insured must wait to file a lawsuit against an insurer however, the insurer has from proof of loss to file the lawsuit. A: 30 days B: 60 days C: 2 years D: 3 years - -D: 3 years -All of the following provisions found in a health policy are optional EXCEPT: A: Change of Occupation B: Illegal Occupation C: Intoxicant and Narcotic Usage D: None of the Above - -D: None of the Above -J has medical benefits that provide a first dollar coverage but then also applies a deductible and coinsurance for major benefits. J has: A: Comprehensive Major Medical B: Combined Medical Policy C: Comparative Medical D: Major Medical - -A: Comprehensive Major Medical -All of the following are required disclosure forms at application EXCEPT: A: HIPAA B: HIV C: MIB D: None of the Above - -C: MIB -A business can provide group insurance to their employees if: A: the purchase of insurance is incidental to the business B: the purchase of insurance is entirely made by the employer C: the purchase of insurance is made regardless of business ownership D: None of the Above - -A: the purchase of insurance is incidental to the business -Y is injured while robbing a bank and his claim is denied. Which of the following provisions would deny Y's claim? A: Change of Occupation B: Illegal Occupation C: Felony Exclusion D: Illegal Action - -B: Illegal Occupation -Z has a Major Medical policy and incurs her first covered loss of the year. Z must pay: A: the Deductible B: the Deductible plus any remaining required co-pay on the loss C: any Co-Insurance D: the Deductible plus any remaining required co-insurance on the loss. - -D: the Deductible plus any remaining required co-insurance on the loss. -Which of the following defines a potential definition of a total disability? A: Any Occupation B: Residual C: Partial D: Social Security Disability - -A: Any Occupation -Part A of Medicare covers: A: Hospital Care B: Inpatient skilled nursing and home health visits C: doctor visit D: Only Answers A and B - -D: Only Answers A and B -The party that dictates what a reasonable or customary charge is for a health policy is the: A: insured B: insurer C: Department of Insurance D: federal government - -B: insurer -N has a HMO and has a terrible sinus infection. N decides to go straight to an Ear, Nose and Throat specialist for an office visit. Which of the following is most likely to occur? A: The HMO will cover the doctor visit fully. B: The HMO will pay half of the visit because it is out of service area. C: The HMO will pay the claim if N pays extra premium. D: N will be declined to be seen by the specialist for this office visit. - -D: N will be declined to be seen by the specialist for this office visit. -K has a policy that will pay a lump sum tax free benefit if he is diagnosed and then survives cancer. K has a: A: Critical Illness Policy B: Specified Disease Plan C: Cancer Policy D: Major Medical - -A: Critical Illness Policy -J let their health policy lapse. To reinstate the contract, the insurer is requiring J to reapply. J pays a new premium with the hope that she will get her policy back into force. The insurer has days from receipt to deny reinstatement. A: 7 B: 10 C: 31 D: 45 - -D: 45 -Which of the following losses are excluded under minimum standard law? A: hospitalization B: accidental injuries C: eye care D: None of the Above - -C: eye care -If an insured is purchasing a LTC policy, an outline of coverage must be delivered by the agent at: A: time of solicitation B: underwriting C: delivery D: Any of the above - -A: time of solicitation -To sell a LHSO plan, a producer must be licensed in: A: Accident and Health insurance B: Limited Lines producer license C: Accident and Health or Limited Lines License D: None of the Above - -C: Accident and Health or Limited Lines License -What is the largest dollar civil penalty that will be assessed for a single act of misrepresentation? A: $1,000 B: $2,500 C: $5,000 D: $10,000 - -D: $10,000 -If a carrier is terminating a individual policy because of an allowable reason under HIPAA regulations, how many days advance notice must they give the insured? A: 10 days B: 20 days C: 60 days D: 90 days - -D: 90 days -The fee, every 2 years, for a business entity license is A: $100 B: $150 C: $180 D: $250 - -B: $150 -If a producer demands a hearing to challenge the reasonableness of a license suspension, when will the hearing take place? A: Within 20 to 30 days of the date the producer demands a hearing. B: A time to be determined by the Director with 20 days prior notice C: A time to be determined by the Director with 10 days prior notice D: The hearing takes place within 20 to 30 days from the date the Director's mailing of the hearing notification. - -D: The hearing takes place within 20 to 30 days from the date the Director's mailing of the hearing notification. -If an applicant is under age 65, they must apply for a supplement within of enrolling for Part B. A: 3 months B: 6 months C: 12 months D: 18 months - -B: 6 months -A producer violates the written order from the Director pertaining to their market conduct activities. What is the maximum civil penalty that can be assessed by the Director against a producer in this circumstance? A: $10,000 B: $20,000 C: $50,000 D: $100,000 - -B: $20,000 -J has HMO coverage under his employer. J was notified that because of a payroll error, payment for this month's premium was not paid. The minimum possible grace period that J may have to prevent lapse is: A: 10 days B: 15 days C: 30 days D: 31 days - -A: 10 days -If a carrier elects to discontinue all health coverage they must notify the director 180 prior to discontinuance. If the insurer then discontinues they are barred from reentry into the IL market for: A: 1 year B: 3 years C: 5 years D: forever - -C: 5 years -HMOs must provide coverage for low-dose, baseline mammography for all women ages: A: 25-29 B: 31-36 C: 35-39 D: 40 or older - -C: 35-39 -The resident licensing fee for a Limited Lines Car Rental license is A: $50 every year B: $180 every two years C: $50 every two years D: $250 every year. - -B: $180 every two years -The Proof of Loss provision in an individual Accident and Health policy requires that written proof of loss be submitted to the insurance company within how many days after the date of loss? A: 30 B: 60 C: 90 D: 120 - -C: 90 -The policy has all of the following rights EXCEPT: A: Right to solely renew a guaranteed renewable policy. B: Right to terminate a policy C: Unilateral right to renew an Optionally renewable policy D: Right to assign a contract - -C: Unilateral right to renew an Optionally renewable policy -Medicaid is: A: State Subsidized and partially federally reimbursed B: Federally subsidized only C: Run By Congress D: None of the Above - -A: State Subsidized and partially federally reimbursed -In the Change of Occupation provision, if an insured switches to a less hazardous job and a claim occurs the insurer will: A: increase the premium of the policy B: increase the benefits of the policy C: decrease the benefits of the policy D: decrease the premium of the policy - -D: decrease the premium of the policy -Part B of Medicare covers all of the following benefits EXCEPT: A: Doctor's visit B: psychiatric care C: home health services D: None of the Above - -D: None of the Above -Which of the following policies' premiums are tax deductible for the employer? A: Group Health insurance B: Group Disability Policy C: Business Overhead Expense D: All of the Above - -D: All of the Above -Which of the following services would be covered under an LHSO? A: ambulance B: vision care C: podiatric care D: All of the Above - -D: All of the Above -V has individual coverage under an HMO plan. V forgot to pay her premium on time and does not want to lose coverage. Under law, an individual policy must have a grace period of at least: A: 15 days B: 30 days C: 31 days D: 45 days - -C: 31 days -Company Q, a health insurer headquartered in Indiana is advertising directly to Illinois residents about their health plans but Company Q is not a licensed insurance company in Illinois. Company Q is violating which of the following Illinois insurance regulations? A: False Advertising B: Twisting C: Misrepresentation D: Defamation - -C: Misrepresentation -A producer who makes misleading comparisons between a product an insured owns and a policy the producer is trying to sell as a replacement is an activity known as A: Misappropriation B: Twisting C: Defamation D: Rebating - -B: Twisting -All of the following are qualifications that apply to a non-resident producer in Illinois, EXCEPT: A: The non-resident must be licensed in their home state for a minimum of 2 years before Illinois will grant non-resident producer status. B: The non-resident must file an affidavit naming the Director to receive service of process on the non-resident's behalf. C: There is a $250 license fee due and payable every two years. D: The non-resident producer must be in good standing in their home state with reference to their resident producer status. - -A: The non-resident must be licensed in their home state for a minimum of 2 years before Illinois will grant non-resident producer status. -An agent tells his clients that the insurer they used to represent does not pay claims in a timely manner although the state has no such events on record. If prosecuted the maximum fine for such action is up to: A: $200 B: $5,000 C: $10,000 D: $20,000 - -D: $20,000 -All of the following statements are CORRECT under law, of an HMO EXCEPT: A: A person who enters into a contractual services for care with the HMO is known as a Subscriber. B: HMO's cannot refuse to pay for organ transplants just because they are experimental. C: If there is a complaint against an HMO, the provider must establish a system to handle complaints. D: If the Department of Insurance notifies the HMO of a complaint, the HMO has 31 days to respond in writing. - -D: If the Department of Insurance notifies the HMO of a complaint, the HMO has 31 days to respond in writing. -T has recently replaced her Medicare Supplement policy which was in force for 7 months. The contract has a probationary waiting period on all illness related losses for the first ten days of coverage. On day 5, T suffers an illness. The replacing insurer is most likely to: A: cover the loss B: deny the claim C: require T pay more premium to cover the loss D: None of the Above - -A: cover the loss -How many days prior notice of cancellation must an surety, who has issued a producer surety bond, provide to the principal of the bond? A: 10 days B: 15 days C: 30 days D: 90 days - -C: 30 days -Which of the following out of pocket expenses require the insured to share cost with the insurer? A: Deductible B: Copayment C: Coinsurance D: All of the Above - -D: All of the Above -Which of the following rights of renewability give the insurer the most control over a policy? A: Noncancelable B: Guaranteed Renewable C: Cancelable D: Guaranteed Noncan - -C: Cancelable -If an insured does not have a Medigap Supplement policy, Medicare only covers full hospitalization for the first days A: 15 B: 30 C: 60 D: 90 - -C: 60 -K, an employee who is covered by Workers' Compensation and a group Major Medical plan is injured on the job. If K submits a claim to the group plan, the insurer will most likely: A: pay full benefits B: pay full benefits only after a 1-month elimination C: coordinate benefits with Workers' Compensation D: deny the claim - -D: deny the claim -Each of the following is true regarding pre-authorization and prior approval requirements EXCEPT: A: An insured must get permission before a planned hospital stay for coverage B: A member must give a statement on necessity prior to receiving care C: If an insured does not get pre-authorization before the loss, they can ask for reinstatement later for the benefit to be covered D: Pre-authorizations are generally found on Managed Care policies such as HMOs or PPOs - -C: If an insured does not get pre-authorization before the loss, they can ask for reinstatement later for the benefit to be covered -N has a PPO and has a terrible sinus infection. N decides to go straight to an in-network Ear, Nose and Throat specialist for an office visit. Which of the following is most likely to occur? A: The PPO will cover N's claim and give the best discount under the contract. B: The PPO will deny the claim even though it is in-network. C: The PPO will cover the claim as long as N has a referral at the time of service. D: The PPO will cover the claim with extra premium required. - -A: The PPO will cover N's claim and give the best discount under the contract. -Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 C: 20 D: 30 - -B: 15 -H has Disability Insurance through her employer. H has suffered a covered disability and has been informed by the group insurer that she is eligible to received benefits for up to 3 years maximum. H has: A: Long-Term Group Benefits B: Short-Term Group Benefits C: Long-Term Care Benefits D: Short-Term Indemnity Benefits - -A: Long-Term Group Benefits -A Long Term Care Group policy that is converted has to be: A: conditionally renewable B: guaranteed renewable C: optionally renewable D: noncancelable - -B: guaranteed renewable -The name of the organization that made the Payment of Claims provision mandatory in all health policies is: A: IL Department of Insurance B: National Association of Insurance Commanders C: National Association of Insurance Commissioners D: National Association of Insurance Underwriters - -C: National Association of Insurance Commissioners -Which mandatory provision states that a policy holder cannot change an irrevocable beneficiary unless that beneficiary gives written consent to be changed? A: Mandatory Revocability B: Irrevocable Beneficiary Designation C: Change of Beneficiary Provision D: Entire Contract - -C: Change of Beneficiary Provision -All of the following statements are CORRECT about an Individual Disability policy EXCEPT: A: The income benefit is received tax free and therefore full salary coverage is unnecessary. B: The income benefit is received tax free at a reduced percentage of full salary to give incentive to return to work, once the insured has recovered from loss. C: The policy will be benefits immediately upon a covered loss. D: The longer the elimination period lasts, the less the premium will cost. - -C: The policy will be benefits immediately upon a covered loss. -The strongest evidence an applicant would have that a recently applied for policy was immediately providing coverage is ownership of: A: A Conditional Receipt B: A Binder C: A receipt for which first premium is due D: No Receipt - -B: A Binder -K has a basic policy along with a major medical policy. K suffers a loss and receives notice by the insurer that an additional $300 is owed before the major medical policy will pay for all of K's losses. K must satisfy: A: Deductible B: corridor deductible C: stop loss D: coinsurance - -B: corridor deductible -What is the main purpose of Regulation 919? A: To assure that insurance claimants are treated in a prompt and courteous manner B: To encourage insurance companies to make claim forms available to all claimants within 30 days. C: To help minimize groundless legal actions by insureds against insurance companies relating to claims. D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. - -D: To help the Director decide which insurance companies doing business in the state should be examined based on their business conduct. -Under a Long Term Care policy, any existence or symptoms care or treatment or a condition for which medical advice was recommended or received can only be excluded as a preexisting condition on policy if loss occurred within before effective date of coverage. A: 3 months B: 6 months C: 12 months D: 24 months - -B: 6 months -The farthest back that a group issuer can name a preexisting condition based off of an insured's medical records is before enrollment. A: 6 months B: 12 months C: 24 months D: 48 months - -A: 6 months -Under HMO minimum standards for basic health care services, the annual maximum on mental health inpatient services is: A: 10 days B: 31 days C: 60 days D: 120 days - -A: 10 days -B purchases a Traditional Long Term Care policy. Upon delivery the agent makes B aware that they have a certain amount of time to send the policy back for a refund if desired. The free look period that B has for her policy is: A: 10 days B: 20 days C: 30 days D: 45 days - -C: 30 days -An agent told a prospective insured that he was a representative of Medicare there to sell a supplement directly from the government. The Director was notified of this action by the consumer and has decided to fine the producer the maximum amount under law. What would be the maximum fine for such an offense? A: $500 B: $5,000 C: $10,000 D: $15,000 - -B: $5,000 -Under law, a Medicare supplement preexisting condition period is limited to before the policy was issued. A: 3 months B: 6 months C: 12 months D: 24 months - -B: 6 months -Free Look for an agent delivered individual disability policy is A: 10 days B: 20 days C: 30 days D: 45 days - -A: 10 days -An organization that arranges for one or more limited health care plans under a system which cause any part of limited health care delivery to be borne by the organization or its providers is known as: A: PPO B: Limited Plan C: LHSO D: HMO - -C: LHSO -The regulation that requires a producer to sign their name on an individual or group life or accident and health insurance application is called A: The Disclosure Rule B: The Insurance Fraud Prevention Act C: The Replacement Rule D: The Unfair Trade Practice Act - -A: The Disclosure Rule -Which of the following is CORRECT about the insuring clause? A: The Insuring clause states the exchange of value in the policy B: The insuring clause states if an illegal occupation is covered C: The insuring clause is the face page of the policy and names the parties of a contract D: None of the Above - -C: The insuring clause is the face page of the policy and names the parties of a contract -H applied for a individual major medical policy. When H filed a claim within the first year of coverage and the underwriter noticed that the H's age on the claim form was different than what was listed on the application. The insurer will take which of the following actions regarding H's claim? A: Deny the claim and refund premiums B: Deny the claim, cancel the policy and keep all premiums C: Pay the claim in full and keep the policy as is D: Adjust the claim benefit amount to the insured's correct age - -D: Adjust the claim benefit amount to the insured's correct age -Which of the following statements about a conditional receipt is CORRECT? A: It is given as a receipt for an initial premium payment is cash, but not by check. B: It describes the physical condition of the applicant at the time the application is taken. C: It lists the conditions of the insurance policy at the time of issue. D: It specifies the timing and terms of the insurance coverage. - -D: It specifies the timing and terms of the insurance coverage. -Which of the following statements are CORRECT about a Health Savings Account? A: The HSA plan is only available to large businesses B: The HSA contribution is only tax deductible if an insured itemizes C: The HSA must be coordinated with an HDHP D: The IRS does not set a limit on annual contributions paid in to an HSA - -C: The HSA must be coordinated with an HDHP -Lifetime, Per Cause, and Annual maximums are all examples of: A: Benefit Exclusions B: Benefit Limits C: Out of Pocket Expenses D: Contractual Losses - -B: Benefit Limits -The taxation of individually owned Disability Insurance policies is correctly stated as which of the following? A: Premiums paid are deductible and benefits received are tax-free. B: Premiums paid are not deductible and benefits are received tax-free. C: Premiums paid are deductible and benefits are received are taxable income. D: Premiums paid are not deductible and benefits received are taxable income - -B: Premiums paid are not deductible and benefits are received taxfree. -Under the Time Limit on Certain Defenses Clause fraud uncovered by the insurer can be used to void a claim. A: at anytime B: within the first year of the policy C: within the first two years of the policy D: never - -A: at anytime -The maximum Indemnity Period under a BOE policy is: A: 6 Months-1 year B: 2-3 Years C: 1-2 Years D: 1-4 Years - -C: 1-2 Years -Under an Accident and Health policy, an insurance company must provide appropriate forms to the insured within a maximum of how many days after the loss? A: 15 B: 30 C: 45 D: 60 - -A: 15 -W has a policy through work that is funded by her salary being reduced and provides very specific limited benefits for cancer insurance only. W has: A: Dental Coverage B: Cancer Plan C: Specified Disease D: Worksite Insurance Plans - -D: Worksite Insurance Plans -All of the following statements regarding the Misstatement of Age provision is not correct EXCEPT: A: Misstatement of Age is an optional provision B: Misstatement of Age is material and will void a policy C: Misstatement of age is not material and if found the insurer will adjust the premiums of the policy D: None of the Above - -A: Misstatement of Age is an optional provision -All of the following are optional provisions EXCEPT: A: Physical Examination and Autopsy B: Illegal Occupation C: Change of Occupation D: None of the Above - -A: Physical Examination and Autopsy -All of the following are CORRECT under advertising statutes EXCEPT: A: Insurers can use third party endorsements, but they must be genuine and factual. B: All ads, regardless of mediums, must be clear and complete. C: Details on PEC must be disclosed when replacement is involved. D: Advertisement files must be kept by the insurer for up to 3 years. - -D: Advertisement files must be kept by the insurer for up to 3 years. -The fee, every 2 years, for a business entity license is A: $100 B: $150 C: $180 D: $250 - -B: $150 -The minimum grace period under law for an individual HMO police may not be less than: A: 10 days B: 15 days C: 30 days D: 31 days - -D: 31 days -In a Long Term Care Partnership policy, inflation protection must be included under contract. If a policy is required to have a compounded rate of either 3% or 5%, the insured must be: A: under age 61 B: at least 61 but less than 76 years old C: 76 years or older D: None of the Above - -A: under age 61 -Long Term Care coverage may be marketed to individuals or groups. A qualifying group that is considered to be an association plan must originate with at least how many members? A: 2 or more B: 20 or more C: 100 D: 500 - -C: 100 -The purpose of minimum standards is to: A: prevent preexisting conditions B: allow the insured a right to return their policy for a refund C: prohibit coverage on a class of insureds D: prevent restrictive definitions and language in a policy contract - -D: prevent restrictive definitions and language in a policy contract -If an LHSO is terminated prior to annual renewal for the contract, the provider must give the subscriber a: A: 30 day notice B: 31 day notice C: 45 day notice D: 60 day notice - -B: 31 day notice -The Notice of Claim provision in an Accident and Health Policy states that an insurance company must receive notice of a claim within a MAXIMUM of how many days after a loss occurs? A: Ten B: Fifteen C: Twenty D: Thirty - -C: Twenty -The APS is: A: a short set of questions sent to the insured's doctor regarding a medical issue of the insured B: a database in which the insurer collects adverse information found during underwriting C: an at home medical exam conducted by a paramedic D: a provision found in the Fair Credit Reporting Act - -A: a short set of questions sent to the insured's doctor regarding a medical issue of the insured -Under Core Benefits, the insured must pay the approved deductible for Part B. After the deductible is met, Plan A covers of co-insurance requirements that is normally paid out of pocket by the insured. A: 0% B: 5% C: 10% D: 20% - -D: 20% -Which of the following is CORRECT about the insuring clause? A: The Insuring clause states the exchange of value in the policy B: The insuring clause states if an illegal occupation is covered C: The insuring clause is the face page of the policy and names the parties of a contract D: None of the Above - -C: The insuring clause is the face page of the policy and names the parties of a contract -If a person is insured under an AD&D policy and loses both of their arms they are considered to be: A: Permanently disabled B: Partially Disabled C: Presumptively Disabled D: Capitally Disabled - -C: Presumptively Disabled -All of the following statements regarding the Misstatement of Age provision is not correct EXCEPT: A: Misstatement of Age is an optional provision B: Misstatement of Age is material and will void a policy C: Misstatement of age is not material and if found the insurer will adjust the premiums of the policy D: None of the Above - -A: Misstatement of Age is an optional provision -Under Notice of Claim provision in an Accident and Health policy, the policy owner must give notice of the loss to the insurance company within a MAXIMUM of how many days after the loss? A: 20 B: 30 C: 45 D: 60 - -A: 20 -An insurer denies a claim under a LTC contract, the insurer must give an explanation to the insured within of a request of the insured. A: 30 days B: 31 days C: 45 days D: 60 days - -D: 60 days -How many days does the Director have to issue a final written order once a hearing has been held pertaining to a market conduct examination? A: Within 20 to 30 days B: 30 days C: 60 days D: 90 days - -D: 90 days -On March 1 the Director mailed a notice of producer license suspension to R which he received on March 4. If R wishes to request a hearing on the matter, by which date must R make this demand in writing? A: 24-Mar B: 30-Mar C: 31-Mar D: 3-Apr - -C: 31-Mar -All of the following are CORRECT under Medicare supplement minimum standards EXCEPT: A: Policies must be issued as noncancelable. B: Payments on benefits may not be labeled as usual or customary. C: Supplements cannot pay benefits on losses resulting for sickness any differently than accidents. D: Except for replacement, it is illegal for an agent to sell a supplement to an insured that already owns one. - -A: Policies must be issued as noncancelable. -If an agent has completed the initial continuing education for long term care, next renewal they must complete ongoing education that is of continuing education. A: 4 hours B: 8 hours C: 12 hours D: 24 hours - -A: 4 hours -If a company charges two separate prospective insureds a different premium rate without a sound actuarial basis, this is an example of A: an unfair trade practice. B: unfair discrimination C: an unfair claims practice D: insurance company prerogative. - -B: unfair discrimination -If an employer is notified of discontinuance of a group carrier, the policyholder has to notify covered enrollees. A: 5 days B: 10 days C: 15 days D: 20 days - -B: 10 days -Selling insurance without a license without misappropriating premium funds is a A: Class A misdemeanor B: Class C misdemeanor C: Class 4 felony D: not a crime - -A: Class A misdemeanor -A basis of prepayment in which a fixed amount of money is prepaid per individual and found in some managed care plan is known as: A: Per Head Payment B: Fee for Service C: Salaried Amount D: Per Capita Prepaid - -D: Per Capita Prepaid -In a Health policy, the right of the policy owner to make an endorsement to the policy is found in the: A: Proof of Loss provision B: Time Limit on Certain Defenses C: Change of Beneficiary D: Change of Occupation - -C: Change of Beneficiary -A policy that is issued at standard rates is an example of: A: Adverse Selection B: Risk Classification C: Substandard Risk D: None of the Above - -B: Risk Classification -The easiest definition of a total disability is defined as: A: Own Occupation B: Any Occupation C: Partial Occupation D: Residual Occupation - -A: Own Occupation -A mandatory provision in health policies that specifies when an insurer must send proof of loss forms to the insured within a certain amount of time from notice of claim is known as? A: Claim Forms B: Time Limit on Certain Defenses C: Written Proof of Loss D: Notice of Claim - -A: Claim Forms -R has an individual major medical policy. On October 1 R has an accident causing $10,000 of damages. On October 31, the insurer is first notified by R that an accident occurred. Which of the following is most likely occur? A: The insurer will pay the full $10,000 B: The insurer will pay the loss minus any deductible that is required C: The insurer will deny the claim D: The insurer will pay the loss minus deductible and coinsurance that is required - -C: The insurer will deny the claim -Which of the following is CORRECT about the Free Look Provision? A: The policy owner can only receive a refund under certain conditions B: The free look starts at issue date C: The free look is an unconditional refund provision D: The free look allows the insured to change the mode of premium - -C: The free look is an unconditional refund provision -All of the following are required disclosure forms at application EXCEPT: A: HIPAA B: HIV C: MIB D: None of the Above - -C: MIB -It is the insured's responsibility to notify the principal about a claim under an Accident and Health policy within: A: 7 days B: 20 days C: 1 month D: 12 months - -B: 20 days -Which of the following is not true about a Noncancelable health policy? A: premiums are level B: the insured has the sole right to cancel a policy C: if the insured does not pay premium, they have a year to pay back without being cancelled D: it is a very scarce renewability option because the insurer has suffered many losses - -C: if the insured does not pay premium, they have a year to pay back without being cancelled -Which of the following is NOT true regarding FSAs for dependent expenses? A: The annual contribution is limited by the IRS B: The IRS limit is per person, per FSA account C: Many families use dependent FSA for day care expense, if allowed. D: The IRS limit is a per family limit - -B: The IRS limit is per person, per FSA account -B has an individual PPO contract. B suffered a covered loss but the company delayed the claims resolution process. B wants to file a lawsuit against an insurer, however, he want to wait a while to find the correct lawyer. What is the MAXIMUM time frame in which B can file legal action against the insurer? A: 90 days from the date of loss B: 3 years from the exact date of loss C: 3 years from when proof of loss is required D: 3 years from when notice of claim is required - -C: 3 years from when proof of loss is required -Which of the following levels of Long Term Care is the least expensive? A: Assisted Daily Living (ADL) B: Custodial C: Skilled D: Intermediate - -B: Custodial -For what period of time must the fiscal or calendar year records of a Premium Fund Trust Account be kept? A: At least 7 years. B: At least 6 years. C: At least 5 years. D: At least 3 years. - -A: At least 7 years. -HMOs must provide coverage for low-dose, baseline mammography for all women ages: A: 25-29 B: 31-36 C: 35-39 D: 40 or older - -C: 35-39 -How many separate accounts exist under the life and health guarantee association? A: 4: Variable, HMO, Life, and Health B: 3: Variable, Life, and Health C: 2: Life and Health D: 1: Life and Health - -C: 2: Life and Health -Producer J has just received a policy offer from an insurer on behalf of an application J recently wrote. J must deliver the policy and collect the first premium payment. Within how many days must J accomplish this action without violating fiduciary duty? A: Within 10 days B: Within 30 days C: Within 90 days D: Within 20 days - -C: Within 90 days -If an applicant is under age 65, they must apply for a supplement within of enrolling for Part B. A: 3 months B: 6 months C: 12 months D: 18 months - -B: 6 months -When a non-financial conduct examination is held and the party examined makes a written request for a hearing, at least how many days notice must the Director provide of time and place of a hearing as designated in the notice? A: 10 days B: 15 days C: 20 days D: 30 days - -A: 10 days -A producer earned a fee of $500 and a commission for the sale of an insurance product. Forty-five days after coverage began the insured cancelled the policy. What, if any, refund is the insured entitled to in this instance? A: No refund amount is due. B: $250 C: $500 D: $500 and the producer must return any commissions earned from the sale back to the insurance company. - -B: $250 -If a Corporation owns a Disability Buyout policy on another Corporation they are partners will this is known as: A: A Cross-Purchase Agreement B: An Entity Purchase C: A Business Disability Buyout D: A Key Person Policy - -B: An Entity Purchase -J has an Accidental Death and Dismemberment policy that has a principal sum of $30,000. One day, J is in a horrific car accident and slips into a coma. Four months after the accident, J's family takes him off the ventilator and J dies. The insurer will pay J's beneficiary: A: $30,000 B: $15,000 C: $5,000 D: $0 - -D: $0 -If a business owner elects not to have coverage for workers under workers' compensation, they must have which of the following policies? A: Major Medical Policy B: 24-hour coverage C: 36-hour coverage D: Disability Insurance - -B: 24-hour coverage -The mandatory provision that stipulates the insurer's rights during underwriting and proving fraud is the: A: Proof of Loss provision B: Physical Examination and Autopsy C: Entire Contract Provision D: Legal Action Provision - -B: Physical Examination and Autopsy -All of the following are true regarding Social Security disability EXCEPT: A: A insured must wait 5 months before collecting benefits B: To qualify an insured must be unable to do any job in the American economy C: To qualify an insured must be disabled for a year or longer or die within a two year period. D: The insured must have a certain amount of Social Security credits based off age. - -C: To qualify an insured must be disabled for a year or longer or die within a two year period. -A provision in a health policy that stipulates that any medical impairments that occurred within a specific time before coverage began that will not be covered under a policy is known as: A: Exclusion B: Waiver of Coverage C: Preexisting Conditions D: All of the Above - -C: Preexisting Conditions -Y has group insurance through his employer. One day, while Y is walking up the stairs to get to his office, he slips and falls down and suffers a few minor injuries. After going to the doctor, he submits the claim through his group insurance. Which of the following is most likely to happen? A: The insurer will provide full coverage B: The insurer will provide full coverage less deductible C: The insurer will provide full coverage less deductible and Coinsurance payment D: The insurer will deny the claim - -D: The insurer will deny the claim -Workers' Compensation is regulated by: A: State Government B: The Employer C: Federal Government D: The Insurer - -A: State Government -All of the following statements are true about a specified disease plan EXCEPT: A: Cancer may be covered up to a fixed dollar benefit amount. B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. C: A specified disease plan will only cover one specific loss. D: No policy will cover a specified disease if diagnosed occurred before the policy was applied for. - -B: A specified disease plan is a good substitute for a major medical policy because it is cheaper premiums. -D and B own a business 50/50. D has suffered a total and permanent disability and B is receiving a lump sum benefit to purchase D's share of the business. This policy is called a(an): A: Accidental Death and Dismemberment B: Cross Purchase Disability Buyout Agreement C: Key Person D: Entity Purchase Disability Buyout Agreement - -B: Cross Purchase Disability Buyout Agreement -The Time Limit on Certain Defenses provision allows an insurance company to question the validity of an insurance claim for which of the following reasons? A: The insured omitted information from the application concerning a condition that would have affected the insurance company's underwriting decision. B: A change of occupation by the insured prior to a specified time limit. C: The application contained a misstatement of the insured's age. D: The insured has a certain amount of time to notify the insurer of a loss. - -A: The insured omitted information from the application concerning a condition that would have affected the insurance company's underwriting decision. -The part of a health policy that limits the scope of coverage is called: A: Limitation B: Exclusion C: Eclipse D: Reduction - -B: Exclusion -B is covered under an HMO and just gave birth to her second daughter. B gave the HMO proper notice of birth but now is required to pay an extra premium to include her second child as a dependent under her plan. B has days to pay the additional premium within the birth notification A: 15 B: 20 C: 30 D: 31 - -C: 30 -A producer is served with a Cease and Desist Order for unfair competition and he violates the Order. The statutory fine for this action is A: 500 B: 1000 C: 2000 D: $100 per day up to a maximum of $5,000. - -B: 1000 -If a carrier elects to discontinue all health coverage they must notify the director 180 prior to discontinuance. If the insurer then discontinues they are barred from reentry into the IL market for: A: 1 year B: 3 years C: 5 years D: forever - -C: 5 years -What is the largest dollar civil penalty that will be assessed for a single act of defamation? A: $1,000 B: $2,500 C: $5,000 D: $10,000 - -D: $10,000 -H has had group LTC coverage for the last 5 months. H has decided to leave his job and find a new career. Upon leaving his group, H would like to convert his group LTC policy to an individual plan. The insurer is most likely to: A: deny conversion B: allow conversion C: allow conversion, but they may increase the premium D: allow conversion as long as H converts within 30 days of leaving they group - -A: deny conversion -If there is a complaint against an LHSO with the Department of Insurance, the LHSO has to respond in writing to the complaint. A: 21 days B: 30 days C: 31 days D: 45 days - -A: 21 days -If an applicant is under age 65, they must apply for a supplement within of enrolling for Part B. A: 3 months B: 6 months C: 12 months D: 18 months - -B: 6 months -The time period starting from issuance of a policy, before a Disability policy covers certain types of losses is known as: A: Elimination Period B: Probationary Period C: Indemnity Period D: Restoration Period - -B: Probationary Period -H is 65 and enrolled into Part A and Part B of Medicare. Three months into enrollment H applies for a Medigap Plan A. Which of the following is most likely to happen? A: The insurer will deny the application B: The insurer will most likely approve the supplement, provided that H is insurable C: The insurer will rate the policy D: The Federal Government will have the final say - -B: The insurer will most likely approve the supplement, provided that H is insurable -H is a legendary flamenco guitar player. If H would like to have only her fingers insured for $500,000 each, which of the following policies would be most likely to insure her potential loss? A: Accidental Death and Dismemberment B: Individual Disability Insurance C: Special Risk Policy D: Group Disability Insurance - -C: Special Risk Policy -K has an industrial health policy and forgot to pay his premium. How many days does K have to pay his policy before it will lapse? A: 7 days B: 10 days C: 31 Days D: 45 Days - -A: 7 days -In a health insurance transaction, an offer is made when: A: the insured pays the initial premium B: when an insured applies for coverage C: when an insurer has approved the policy D: when the insured provides payment in exchange for coverage - -B: when an insured applies for coverage -Limited health services provided under an LHSO may provide benefits for all of the following EXCEPT: A: ambulance B: dental C: surgical D: None of the Above - -C: surgical -Once a producer has been notified that her license has been suspended by the Director, how many days does she have in which to request a hearing, in writing, from the date the Director mailed the termination notice? A: 10 days B: 15 days C: 20 days D: 30 days - -D: 30 days -If a long term care partnership policy allows the insurer to offer inflation protection and it is not required under law, the insured must be: A: under age 61 B: at least 61 but less than 76 years old C: 76 years or older D: None of the Above - -C: 76 years or older -Renewability of a Long Term Care policy must be at least: A: Noncancelable B: Guaranteed Renewable C: Cancellable D: A and B only - -D: A and B only -Under minimum standards in individual policies, which of the following may exclude an accident or sickness? A: Individual disability policy B: Individual Medicare Supplement C: Workers Compensation D: Individual Long Term Care - -C: Workers Compensation -B is covered under an HMO and just gave birth to her second daughter. B gave the HMO proper notice of birth but now is required to pay an extra premium to include her second child as a dependent under her plan. B has days to pay the additional premium within the birth notification A: 15 B: 20 C: 30 D: 31 - -C: 30 -If a group policy is discontinued, the prior insurer is still liable for claims that occur during the grace period of the policy and: A: may charge premiums during the grace period B: may not charge premiums during the grace period C: may limit benefits D: None of the Above - -A: may charge premiums during the grace period -An example of a rider that deletes or limits coverage is an: A: Impairment Rider B: Preexisting Condition Rider C: Waiver of Premium D: Exclusion Rider - -A: Impairment Rider -D has a group policy through his employer and has five children all under age 21. D's group policy will charge premiums: A: per child B: one amount for all children C: nothing D: None of the Above - -B: one amount for all children -Part B of Medicare covers all of the following benefits EXCEPT: A: Doctor's visit B: psychiatric care C: home health services D: None of the Above - -D: None of the Above -B lives in a long term care facility and owns a LTC policy. Three days per week skilled medical personnel attend to her needs. B is receiving: A: Skilled Care B: Intermediate Care C: Custodial Care D: Assisted Daily Living - -B: Intermediate Care -All of the following are true regarding benefits under a Key Employee policy EXCEPT: A: Benefits may be paid monthly over a year period to make up employee salary. B: Benefits may be taxable or tax free depending on premium deduction by the payor. C: Benefits may be paid up to three times employee salary in a lump sum amount. D: None of the Above - -D: None of the Above -Which of the following is not true regarding Incontestability periods for Long Term Care policies? A: If a policy is in force for less than 6 months, the company can rescind or deny coverage upon showing a material misrepresentation to acceptance for coverage B: If a policy is in force for at least 6 months but less than 2 years, a policy can be cancelled or claim denied upon showing that a material misrepresentation to acceptance for coverage and pertains to a condition for the benefits sought. C: If a policy is in force for 2 years or longer, the only way a policy is contestable is if the insurer can prove fraud. D: None of the Above - -D: None of the Above -In the event of Group Health Insurance being discontinued or replaced, in the event of total disability, coverage must extend up to in an HMO provided the insured still has benefit limits available under contract. A: 6 months B: 12 months C: 18 months D: 24 months - -B: 12 months -If an agent wants to market a long term care policy, they must successfully complete a continuing education course on the partnership policy that contains how many CE hours? A: 4 B: 8 C: 12 D: 24 - -B: 8 -Which of the following is true regarding Group Disability Income Policies? A: Premiums paid by the employer are tax deductible and the employee's benefits are tax free. B: Premiums paid by the employee are not tax deductible and the benefits are paid taxable as income. C: Premiums paid by the employer are tax deductible and premiums paid