ACCIDENT AND HEALTH INSURANCE EXAMS EVALUATION
2025/2026 QUESTIONS AND SOLUTION RATED A+
✔✔Residual Disability - ✔✔- attempts to measure the amount of income lost
- will be paid when a partial disability reduces total income below a designated level
- benefit paid will be the same percentage of the total disability benefit that the insured
is losing of their income
- benefits are reduced as income increase
- compensates for cut in pay; when your new job pays less than the old one you had
before you became disabled
✔✔Recurrent Disability - ✔✔- the onset of disability, after recovery from a preceding
disability period, resulting from the SAME accident or illness
- will be treated as a continuation of the previous disability if occurring within a stated
period of time, such as 6 months (do not have to meet elimination period again, but part
of benefit period has already passed)
✔✔Benefit Period - ✔✔- may be short term (up to 2 years) or long term (over 2 years
with a max to age 65)
✔✔Non-Occupational v. Occupational (Full) Coverage - ✔✔- non-occupational: benefits
restricted to only non-occupational related occurrences
- occupational: coverage provided both on and off the job; provides around the clock
protection without regard to any payment received under workers comp
- occupational coverage is generally reserved for those individuals not covered under a
workers comp plan
✔✔Temporary Disability - ✔✔- total or partial disability where complete recovery is
anticipated
✔✔Permanent Disability - ✔✔- total or partial disability that is expected to remain for the
duration of life
✔✔Probationary Period - ✔✔- time from issuance to the effective date of the policy,
generally 30 days or less during which time losses from sickness will not be covered;
losses from accidents may be covered
- purpose is to eliminate coverage for pre-existing conditions and protect against
adverse selection
✔✔Elimination (Waiting) Period - ✔✔- time from onset of a disability until benefit
payment begins
- a time deductible that eliminates benefits for a period the insured feel appropriate (30
days, 60 days, etc.); the longer the elimination period, the lower the premium
- found only in disability policies; benefits start after this
- can receive back pay for the elimination period with a retroactive feature
, ✔✔Disability Optional Benefits/Riders - ✔✔1. Cost of Living Rider: increase maximum
benefits during a period of disability in relation to increases in the Consumer Price Index
(known as the Cost of Living Adjustment Rider, COLA); must have been receiving
benefits for 12 months before activated
2. Guaranteed Purchase Option (Guaranteed Insurability): insured can purchase
additional amounts of benefits at selected intervals without proving insurability
3. Waiver of Premium: will make premium payments on behalf of the insured from the
date of disability if disabled for longer than the elimination period
✔✔Policy Exclusions - ✔✔- common exclusions are war, military service, intentionally
self-inflicted injuries, aviation, overseas residence, and disabilities arising from
committing a felony
- coverage may also be denied if a loss is caused by the insured being intoxicated or
under the influence
✔✔Social (Government) Disability Insurance - ✔✔- disabilities may also be eligible for
benefits provided by some form of social insurance
- private policies will coordinate their benefits to consider the possibility of over-insuring
individuals who receive social program benefits
**Social Security and Workers Comp**
✔✔Social Security Disability - ✔✔Eligibility Requirements:
- available to those individuals who have made a minimum of 40 quarters (work credits)
of FICA contributions
- disabilities must be permanent and total, with permanent being defined as in existence
for 5 months and anticipated to last at least 1 year or end in death
- total disability is defined as the complete inability to do ANY productive work
- benefit is based upon the amount of FICA tax contributions and number of dependents
**social security is NOT funded by the federal government; the PIA is the base used to
calculate a person's eligible benefits
✔✔Medical Expense Policies - ✔✔- deals with medical expenses that are incurred when
an individual become sick or injured
- types:
1. Basic Medical Expense
2. Major Medical Policies
3. Comprehensive (Supplemental) Policies
✔✔Basic Medical Expense - ✔✔- pays hospital confinement expenses on a
reimbursement basis (paying benefits to the policy holder) or on a service basis (to the
medical professionals)
- combination of a hospital policy, basic medical policy, and surgical coverage
- generally do not have a deductible or coinsurance feature (1ST DOLLAR
COVERAGE)
2025/2026 QUESTIONS AND SOLUTION RATED A+
✔✔Residual Disability - ✔✔- attempts to measure the amount of income lost
- will be paid when a partial disability reduces total income below a designated level
- benefit paid will be the same percentage of the total disability benefit that the insured
is losing of their income
- benefits are reduced as income increase
- compensates for cut in pay; when your new job pays less than the old one you had
before you became disabled
✔✔Recurrent Disability - ✔✔- the onset of disability, after recovery from a preceding
disability period, resulting from the SAME accident or illness
- will be treated as a continuation of the previous disability if occurring within a stated
period of time, such as 6 months (do not have to meet elimination period again, but part
of benefit period has already passed)
✔✔Benefit Period - ✔✔- may be short term (up to 2 years) or long term (over 2 years
with a max to age 65)
✔✔Non-Occupational v. Occupational (Full) Coverage - ✔✔- non-occupational: benefits
restricted to only non-occupational related occurrences
- occupational: coverage provided both on and off the job; provides around the clock
protection without regard to any payment received under workers comp
- occupational coverage is generally reserved for those individuals not covered under a
workers comp plan
✔✔Temporary Disability - ✔✔- total or partial disability where complete recovery is
anticipated
✔✔Permanent Disability - ✔✔- total or partial disability that is expected to remain for the
duration of life
✔✔Probationary Period - ✔✔- time from issuance to the effective date of the policy,
generally 30 days or less during which time losses from sickness will not be covered;
losses from accidents may be covered
- purpose is to eliminate coverage for pre-existing conditions and protect against
adverse selection
✔✔Elimination (Waiting) Period - ✔✔- time from onset of a disability until benefit
payment begins
- a time deductible that eliminates benefits for a period the insured feel appropriate (30
days, 60 days, etc.); the longer the elimination period, the lower the premium
- found only in disability policies; benefits start after this
- can receive back pay for the elimination period with a retroactive feature
, ✔✔Disability Optional Benefits/Riders - ✔✔1. Cost of Living Rider: increase maximum
benefits during a period of disability in relation to increases in the Consumer Price Index
(known as the Cost of Living Adjustment Rider, COLA); must have been receiving
benefits for 12 months before activated
2. Guaranteed Purchase Option (Guaranteed Insurability): insured can purchase
additional amounts of benefits at selected intervals without proving insurability
3. Waiver of Premium: will make premium payments on behalf of the insured from the
date of disability if disabled for longer than the elimination period
✔✔Policy Exclusions - ✔✔- common exclusions are war, military service, intentionally
self-inflicted injuries, aviation, overseas residence, and disabilities arising from
committing a felony
- coverage may also be denied if a loss is caused by the insured being intoxicated or
under the influence
✔✔Social (Government) Disability Insurance - ✔✔- disabilities may also be eligible for
benefits provided by some form of social insurance
- private policies will coordinate their benefits to consider the possibility of over-insuring
individuals who receive social program benefits
**Social Security and Workers Comp**
✔✔Social Security Disability - ✔✔Eligibility Requirements:
- available to those individuals who have made a minimum of 40 quarters (work credits)
of FICA contributions
- disabilities must be permanent and total, with permanent being defined as in existence
for 5 months and anticipated to last at least 1 year or end in death
- total disability is defined as the complete inability to do ANY productive work
- benefit is based upon the amount of FICA tax contributions and number of dependents
**social security is NOT funded by the federal government; the PIA is the base used to
calculate a person's eligible benefits
✔✔Medical Expense Policies - ✔✔- deals with medical expenses that are incurred when
an individual become sick or injured
- types:
1. Basic Medical Expense
2. Major Medical Policies
3. Comprehensive (Supplemental) Policies
✔✔Basic Medical Expense - ✔✔- pays hospital confinement expenses on a
reimbursement basis (paying benefits to the policy holder) or on a service basis (to the
medical professionals)
- combination of a hospital policy, basic medical policy, and surgical coverage
- generally do not have a deductible or coinsurance feature (1ST DOLLAR
COVERAGE)
