Colorado Life & Health Insurance Exam
Questions and Answers 100% Solved
a set of formal techniques to monitor the use or clinical necessity of health
care, determining the application of exclusions, and the medical necessity
of treatment. - ✔✔utilization review
With a clean claim, the insured has ? days for paying or denying electronic
and ? days for paper claims. - ✔✔30 days for electronic; 45 days for paper
The Commissioner ______ laws and does not create them. - ✔✔Enforces
Every ____ years, a licensed insurer must be examined by the state
commissioner. - ✔✔5 years
What is a major concern for Underwriters, especially during the open
enrollment period? - ✔✔Adverse selection
Allows individual policy conversion upon plan group termination -
✔✔Conversion privilege
Benefits are taxable or non-taxable (?) to employees. - ✔✔Non-taxable
Employers with ___ + employees are required to offer COBRA for up to 18
months after an employee is terminated. - ✔✔20
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,In group health insurance a ______ type of policy is issued to the group
sponsor. - ✔✔Master policy
Temporary or permanent rider added to a policy that includes specific
conditions which would normally cause a policy to be declined. -
✔✔Impairment rider
The period of time for the insured to look over a policy after it is issued (10
days for health insurance, 15 for life) - ✔✔Free Look Period
The guaranteed renewable provision states that premiums can only be
increased by _________. - ✔✔Class
The ___________ states that one has 60 days after proof of loss with a 2-
year limit on certain defenses. - ✔✔Legal Actions Provision
The insuring clause includes ____________'s promise to pay benefits. -
✔✔Insurers
This provision states that the insured must provide proof of loss within 90
days, up to a 1-year maximum. - ✔✔Proof of loss provision
waiting period after a loss occurs before benefit period begins (30, 90 days,
up to 1 year) - ✔✔elimination period
Medicare Advantage plan, substitution for original benefits (A & B) -
✔✔Part C
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, Hospital insurance, covers inpatient and hospice - ✔✔Medicare Part A
Outpatient treatment, ER treatment, preventive care is looped under Part
___ - ✔✔Medicare Part B
Also known as Medigap, this part covers core benefits, including hospice
care; premiums vary. - ✔✔Supplement Part A
Optional rider that enables the policyowner to purchase additional amounts
of coverage at predetermined times without proof of insurability -
✔✔Guaranteed Insurability Rider
doubles the face amount of life insurance if death occurs as a result of an
accident - ✔✔Accidental Death Benefit Rider
Often added to a whole life policy to increase coverage.
Coverage more affordable. Insured buys some whole life and some term
(TERM coverage may be level or decreasing). - ✔✔Term Insurance Rider
A part of the insurance contract that states that both parties must give
something of value for the transfer of risk, and specifies the conditions of
the exchange. - ✔✔Consideration clause
The more frequent premium payment, the ______ (higher or lower) the
premium. - ✔✔Higher premium
3
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Questions and Answers 100% Solved
a set of formal techniques to monitor the use or clinical necessity of health
care, determining the application of exclusions, and the medical necessity
of treatment. - ✔✔utilization review
With a clean claim, the insured has ? days for paying or denying electronic
and ? days for paper claims. - ✔✔30 days for electronic; 45 days for paper
The Commissioner ______ laws and does not create them. - ✔✔Enforces
Every ____ years, a licensed insurer must be examined by the state
commissioner. - ✔✔5 years
What is a major concern for Underwriters, especially during the open
enrollment period? - ✔✔Adverse selection
Allows individual policy conversion upon plan group termination -
✔✔Conversion privilege
Benefits are taxable or non-taxable (?) to employees. - ✔✔Non-taxable
Employers with ___ + employees are required to offer COBRA for up to 18
months after an employee is terminated. - ✔✔20
1
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
,In group health insurance a ______ type of policy is issued to the group
sponsor. - ✔✔Master policy
Temporary or permanent rider added to a policy that includes specific
conditions which would normally cause a policy to be declined. -
✔✔Impairment rider
The period of time for the insured to look over a policy after it is issued (10
days for health insurance, 15 for life) - ✔✔Free Look Period
The guaranteed renewable provision states that premiums can only be
increased by _________. - ✔✔Class
The ___________ states that one has 60 days after proof of loss with a 2-
year limit on certain defenses. - ✔✔Legal Actions Provision
The insuring clause includes ____________'s promise to pay benefits. -
✔✔Insurers
This provision states that the insured must provide proof of loss within 90
days, up to a 1-year maximum. - ✔✔Proof of loss provision
waiting period after a loss occurs before benefit period begins (30, 90 days,
up to 1 year) - ✔✔elimination period
Medicare Advantage plan, substitution for original benefits (A & B) -
✔✔Part C
2
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
, Hospital insurance, covers inpatient and hospice - ✔✔Medicare Part A
Outpatient treatment, ER treatment, preventive care is looped under Part
___ - ✔✔Medicare Part B
Also known as Medigap, this part covers core benefits, including hospice
care; premiums vary. - ✔✔Supplement Part A
Optional rider that enables the policyowner to purchase additional amounts
of coverage at predetermined times without proof of insurability -
✔✔Guaranteed Insurability Rider
doubles the face amount of life insurance if death occurs as a result of an
accident - ✔✔Accidental Death Benefit Rider
Often added to a whole life policy to increase coverage.
Coverage more affordable. Insured buys some whole life and some term
(TERM coverage may be level or decreasing). - ✔✔Term Insurance Rider
A part of the insurance contract that states that both parties must give
something of value for the transfer of risk, and specifies the conditions of
the exchange. - ✔✔Consideration clause
The more frequent premium payment, the ______ (higher or lower) the
premium. - ✔✔Higher premium
3
©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
