Accident and Health Insurance Agent/Broker Practice Exam

Accident and Health Insurance Agent/Broker Practice Exam Sally is considering her Medicare options. She understands that to enroll in Medicare Part B, she will have to pay a monthly premium. Since she is healthy, she is considering delaying her enrollment until later. Will she be able to enroll at a later date? 1.Yes, she can enroll at anytime in the future 2.Yes, however; she would have a permanent premium penalty when she does enroll 3.No, this is a take or leave it situation 4.Yes, but she would have to show evidence of good health. Yes, however; she would have a permanent premium penalty when she does enroll Under Medicare Part A, a spell of illness begins again and is subject to a new deductible for another admission when: 1.The patient has been discharged from a prior stay and 45 days have elapsed 2.The patient has been discharged from a prior stay and 30 days have elapsed 3.The patient has been discharged from a prior stay and 60 days have elapsed 4.The patient has been discharged from a prior stay and 90 days have elapsed The patient has been discharged from a prior stay and 60 days have elapsed What type of insurer retains risk? 1.Government insurance. 2.Reinsurers. 3.Self insurers. 4.Assessment insurers. Self insurers. A variety of types of care are provided under a long-term care policy. All of the following are types of care generally provided EXCEPT: 1.Home health care 2.Intensive care 3.Custodial care 4.Skilled care Intensive care Melvin has a long-term care policy with a 30-day elimination period. The policy has a daily benefit of $100/day. The policy has a 3-year benefit period. If Melvin is confined to a nursing home for 9 months, how much in benefits will his policy pay? 1.$27,000 2.$18,000 3.$24,000 4.$17,000 $24,000 Martin and his friends were at a local tavern celebrating his birthday. Martin left the bar to drive home, but unfortunately, he was involved in a fatal accident, killing himself and two other individuals. An autopsy reveals that Martin was well above the legal limit on his blood alcohol test. Martin's family will receive the following from his Accidental Death and Dismemberment policy: 1.His family will receive reduced benefits since other deaths were involved. 2.His family will receive the principal sum since this was death 3.His family will receive no benefits, since he was in the act of committing a felony 4.His family will receive no benefits since there was no dismemberment involved. His family will receive no benefits, since he was in the act of committing a felony An exclusion that always appears in a health policy is: 1.No coverage for drug or alcohol related illness 2.Hernia from an accident 3.Travel outside of the USA 4.Injury in the act of committing a felony Injury in the act of committing a felony Bruce owns a plan that pays $100 daily benefit for a hospital stay with no deductible. This kind of policy is known as a (an): 1.Major medical plan 2.Basic plan 3.Indemnity plan 4.Reimbursement plan Indemnity plan Under what conditions is the death benefit (principal sum) payable under an Accidental Death and Dismemberment (AD&D) policy? 1.The insured dies from a grave illness 2.The insured dies from natural causes 3.The insured dies from an accident 4.All of the above The insured dies from an accident An insurance agent told a member of his church who had recently experienced several personal and financial losses that he could see that she got a more favorable rate on her insurance policies than her health and general circumstances would warrant. The woman had been his kindergarten teacher and was a pillar in the community's life. He wanted to help her. Which of the following is FALSE? 1.The agent was breaking the law. 2.The agent is compassionate. 3.The agent was engaging in unfair discrimination. 4.The agent was engaging in twisting. The agent was engaging in twisting. Which of the following is NOT considered to be an unfair claims settlement practice? 1.Knowingly misrepresenting policy provisions. 2.Replacing one insurance policy with another. 3.Failing to promptly acknowledge pertinent communications. 4.Refusing to pay claimants without conducting a reasonable investigation. Replacing one insurance policy with another. The practice of using misrepresentation to induce a policyholder to replace a policy issued by the insurer the producer represents is called: ing. ing. idation. presentation. churning. All of the following acts are considered unfair trade practices EXCEPT: cement. presentation ion. ing. replacement. What gives the insurance company the right to assume rights of the insured in order to sue a responsible third party when damages are inflicted on the insured? 1.Warranties 2.Subrogation 3.Concealment 4.Utmost good faith Subrogation Insurance contracts sometimes contain ambiguities. Which of the following has not been taken to court for further interpretation? 1.Reasonable expectations 2.Subrogation 3.Ambiguities in a contract of adhesion 4.Utmost good faith Subrogation There are various optional provision for health policies. Which of the following is not an optional provision? 1.Intoxicants and narcotics 2.Conformity with state statutes 3.Reinstatement 4.Illegal occupation Reinstatement Tony (the insured) cancelled his health policy by submitting a written notice to the insurer. How are unearned premiums handled? 1.Returned to the insured using a pro-rata basis 2.They are returned to the agent 3.The insurer gets to keep them 4.Returned to the insured using a short-rate basis Returned to the insured using a short-rate basis The Patient Protection and Affordable Care Act allows states to combine their SHOP exchange with - 1.Commercial insurance companies 2.Their Medicaid recipients 3.Their exchange for individual consumers 4.All of the above Their exchange for individual consumers o elect continuation of coverage, the insured must request continuation during the election period (45 days after the date of the _____). Employers must provide the proper forms for election within 14 days of receipt of request of election. 1.Arraignment, annulment, or release on bond 2.Indictment, cancellation, or invalidation 3. incarceration, or arraignment 4.Death, divorce, or termination Death, divorce, or termination Insurers must maintain an advertising file of all material printed, published, or distributed advertisements of policies for _____, subject to examination by the Commissioner. 1.No more than five years 2.No less than four years 3.No more than two years 4.No less than three years No less than three years For dependents that were not previously eligible for enrollment in the Maryland Health Connection, how much time must they be given to enroll after being sent a notice that they are now eligible? 1.30 days 2.45 days 3.60 days 4.90 days 30 daya Individuals covered under a Medicare Supplement policy may suspend benefits and premiums for up to _____ months if the individual applies and is determined to be eligible for Social Security disability benefits. 40 24 10 52 24 Home health care services are long-term care benefits: 1.For medical and non-medical services 2.Provided to the ill, injured, or disabled individuals in their home 3.That includes those of a homemaker, and assistance with activities of daily living 4.All of the Above All of the Above What provides hospital or medical policies or plans, nonprofit health service policies or plans, and health maintenance organizations? Health benefit plans Wellness cooperative plans "Cafeteria" wellness plans Annuitized wellness cooperatives Health benefit plans No policy may be advertised, solicited, or issued as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than: Those of Medicare Those agreed to by the insured Those allowed by the Commissioner Those permitted under Medigap Part B Those of Medicare Continuation of coverage for group medical plans shall continue for up to __ months after the date of death, divorce, or termination, subject to payment of premiums. 9 18 15 4 18 What provides affordable and accessible health insurance to support public and private initiatives for individuals without health insurance and promotes a health