An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured
incurs $25,000 of covered losses. How much will the insured have to pay?
$500
$5,000
$5,400
$5,600 ANS: $5,000
An indemnity plan
Pays both the insured and health care provider
Provides the insured a specific dollar amount for services
Pays the health care provider directly for services rendered
Is typically issued as a group plan ANS: provides the insured a specific dollar amount for services
Chris is an insured bricklayer who severed his left hand in an automobile accident. Although his primary
duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability
income check every month. How does his policy define total disability?
Recurrent
Any occupation
Own occupation
Presumptive ANS: Own occupation
,Signatures for an insurance application MUST be obtained by the producer from all of the following
sources EXCEPT
The producer
The insured
The policyowner
The beneficiary ANS: The beneficiary
Sole proprietors are permitted tax deductions for health cost paid from their earnings in the amount of
cost that exceed 7 1/2 % of AGI
cost that exceed 10% of AGI
100% of cost
no deduction permitted ANS: 100 % of cost
If an agent is believed to be causing considerable harm, the superintendent
may incarcerate the agent
may suspend the agent's license without a hearing
may issue a cease and desist order against the agent
may take away the agent's appointment ANS: may issue a cease and desist order against the agent
A medical provider that accepts medicare assignment must ANS: accept payment based upon a defined
medicare schedule as payment in full
, Under group health insurance, a certificate of coverage is issued to the
A) employer
B) employee
C) producer
D) sponsor ANS: employee
A spouse and child can be added to the primary insured's coverage as what kind of rider?
Dependent term
Guaranteed insurability
primary term
family term ANS: Family term
Which of the following statements is NOT true regarding Critical Illness Plan ANS: Coverage is limited to
a single devastating disease
A form of medical health insurance covering the treatment and care of gum disease is called ANS:
Dental expense insurance
A beneficiary change can occur ANS: normally at any time during the policy term
Which of these is NOT a qualifying event for Medicare
- On Social Security disability for over 2 years- Kidney failure- Age 65 or older- Falling below the federal
poverty level ANS: Falling below the federal poverty level