Maine Life Insurance Exam Updated 2024/2025 Actual Questions and answers with complete solutions

(Funding of group insurance) Min. premium arrangement - Employer self-insure the normal and expected claims up to a given amount and the insurer funds only the excess amounts (Funding of group insurance) retrospective premium arrangement - Insurer agrees to collect a provisional premium but may collect additional premium/make a premium refund at the end of the year based on actual incurred losses. (Funding of group insurance) Self-funding arrangement - Large employers may elect to fully selffund, or may self-fund a plan but contract for administrative services only (ASO). (Funding of Group Insurance) Shared funding - Allows employer to self-fund health care expenses, select a deductible and pay covered expenses for any individual incurring claims up to that max, insurer assumes risk 1. Change of Occupation (11 Optional Provisions) - Allows the insurer to reduce the maximum benefit payable if the insured switches to a more hazardous job or to reduce the premium rate charged if they switch to a less hazardous job. 1. Entire Contract (12 Mandatory Policy Provisions) - Entire contract includes the actual policy and application. - Nothing outside the contract can be considered part of the contract - Assures policy owner that no changes will be made or will any of the contacts provisions be waived after it has been issued. - Any changes to the policy must be approved by the executive officer of the insurance company whose approval must be endorsed in the policy. 10. Illegal Occupation (11 Optional Provisions) - Insurer is not liable for losses attributed to them being connected to a felony or participation in any legal occupation.10. Physical Exam and Autopsy - Entitles a company, at its own expense, to make physical examinations of the insured at reasonable intervals during the period of the claim, unless forbidden by state law. 11. Intoxicants and Narcotics (11 Optional Provisions) - Insurer is not liable for any loss attributed to the insured while intoxicated or under the influence of narcotics. 11. Legal Actions (12 Mandatory Policy Provisions) - The insured cannot take legal action in a claim dispute until after 60 days from the time the insured submits proof of loss. Time is limited to no more than 5 years. 12. Change of Beneficiary (12 Mandatory Policy Provisions) - Policy owner may change beneficiary at any time, unless irrevocable 2. Misstatement of Age (11 Optional Provisions) - Allows insurer to adjust benefits payable if age was incorrect on application 2. Time limit on certain defenses (12 Mandatory Policy Provisions) - the policy is incontestable after it has been enforced for a certain amount of time (usually two years). Unlike life insurance, a fraudulent statement on health insurance application is grounds for contest at any time, unless the policy is guaranteed renewable. 3 basic categories of health insurances - Medical Expense, Disability Income Insurance, AD&D 3. Grace Period (12 Mandatory Policy Provisions) - Policy owner given a number of days after the premium due date during which time the premium payment may be delayed without penalty and the policy continues. Minimum grace period for weekly payments are 7 days, 10 days for monthly, 31 for all others. 3. Other insurance with this insurer (11 Optional Provisions) - Designed to protect insurer4. Reinstatement (12 Mandatory Policy Provisions) - A policy lapsed may be reinstated. If the insurer takes no action for 45 days, the policy is reinstated automatically. Losses resulted from sickness occurs at least 10 days after the reinstatement date