1|Page
Colorado Life & Health Insurance
Exam answered Graded A+
utilization review Ans: 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.
30 days for electronic; 45 days for paper Ans: With a clean claim, the insured
has ? days for paying or denying electronic and ? days for paper claims.
Enforces Ans: The Commissioner ______ laws and does not create them.
5 years Ans: Every ____ years, a licensed insurer must be examined by the state
commissioner.
Adverse selection Ans: What is a major concern for Underwriters, especially
during the open enrollment period?
Conversion privilege Ans: Allows individual policy conversion upon plan
group termination
Non-taxable Ans: Benefits are taxable or non-taxable (?) to employees.
20 Ans: Employers with ___ + employees are required to offer COBRA for up
to 18 months after an employee is terminated.
Master policy Ans: In group health insurance a ______ type of policy is issued
to the group sponsor.
,2|Page
Impairment rider Ans: Temporary or permanent rider added to a policy that
includes specific conditions which would normally cause a policy to be
declined.
Free Look Period Ans: The period of time for the insured to look over a policy
after it is issued (10 days for health insurance, 15 for life)
Class Ans: The guaranteed renewable provision states that premiums can only
be increased by _________.
Legal Actions Provision Ans: The ___________ states that one has 60 days after
proof of loss with a 2-year limit on certain defenses.
Insurers Ans: The insuring clause includes ____________'s promise to pay
benefits.
Proof of loss provision Ans: This provision states that the insured must
provide proof of loss within 90 days, up to a 1-year maximum.
elimination period Ans: waiting period after a loss occurs before benefit
period begins (30, 90 days, up to 1 year)
Part C Ans: Medicare Advantage plan, substitution for original benefits (A &
B)
Medicare Part A Ans: Hospital insurance, covers inpatient and hospice
Medicare Part B Ans: Outpatient treatment, ER treatment, preventive care is
looped under Part ___
Supplement Part A Ans: Also known as Medigap, this part covers core
benefits, including hospice care; premiums vary.
, 3|Page
Guaranteed Insurability Rider Ans: Optional rider that enables the policyowner
to purchase additional amounts of coverage at predetermined times without
proof of insurability
Accidental Death Benefit Rider Ans: doubles the face amount of life insurance
if death occurs as a result of an accident
Term Insurance Rider Ans: 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).
Consideration clause Ans: 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.
Higher premium Ans: The more frequent premium payment, the ______ (higher
or lower) the premium.
Joint Life Policy Ans: Covers two or more lives and provides for the payment
of the proceeds at the death of the first among those insured, at which time
the policy automatically terminates.
Survivorship Life Policy Ans: Joint life policy in which the policy proceeds are
paid out upon the death of the second insured. Synonymous with second-to-
die joint life policy.
Long-term care rider Ans: A rider that costs extra; nursing home covered
usual, customary, and reasonable (UCR) Ans: the charge consistent with what
other medical vendors would assess
Colorado Life & Health Insurance
Exam answered Graded A+
utilization review Ans: 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.
30 days for electronic; 45 days for paper Ans: With a clean claim, the insured
has ? days for paying or denying electronic and ? days for paper claims.
Enforces Ans: The Commissioner ______ laws and does not create them.
5 years Ans: Every ____ years, a licensed insurer must be examined by the state
commissioner.
Adverse selection Ans: What is a major concern for Underwriters, especially
during the open enrollment period?
Conversion privilege Ans: Allows individual policy conversion upon plan
group termination
Non-taxable Ans: Benefits are taxable or non-taxable (?) to employees.
20 Ans: Employers with ___ + employees are required to offer COBRA for up
to 18 months after an employee is terminated.
Master policy Ans: In group health insurance a ______ type of policy is issued
to the group sponsor.
,2|Page
Impairment rider Ans: Temporary or permanent rider added to a policy that
includes specific conditions which would normally cause a policy to be
declined.
Free Look Period Ans: The period of time for the insured to look over a policy
after it is issued (10 days for health insurance, 15 for life)
Class Ans: The guaranteed renewable provision states that premiums can only
be increased by _________.
Legal Actions Provision Ans: The ___________ states that one has 60 days after
proof of loss with a 2-year limit on certain defenses.
Insurers Ans: The insuring clause includes ____________'s promise to pay
benefits.
Proof of loss provision Ans: This provision states that the insured must
provide proof of loss within 90 days, up to a 1-year maximum.
elimination period Ans: waiting period after a loss occurs before benefit
period begins (30, 90 days, up to 1 year)
Part C Ans: Medicare Advantage plan, substitution for original benefits (A &
B)
Medicare Part A Ans: Hospital insurance, covers inpatient and hospice
Medicare Part B Ans: Outpatient treatment, ER treatment, preventive care is
looped under Part ___
Supplement Part A Ans: Also known as Medigap, this part covers core
benefits, including hospice care; premiums vary.
, 3|Page
Guaranteed Insurability Rider Ans: Optional rider that enables the policyowner
to purchase additional amounts of coverage at predetermined times without
proof of insurability
Accidental Death Benefit Rider Ans: doubles the face amount of life insurance
if death occurs as a result of an accident
Term Insurance Rider Ans: 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).
Consideration clause Ans: 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.
Higher premium Ans: The more frequent premium payment, the ______ (higher
or lower) the premium.
Joint Life Policy Ans: Covers two or more lives and provides for the payment
of the proceeds at the death of the first among those insured, at which time
the policy automatically terminates.
Survivorship Life Policy Ans: Joint life policy in which the policy proceeds are
paid out upon the death of the second insured. Synonymous with second-to-
die joint life policy.
Long-term care rider Ans: A rider that costs extra; nursing home covered
usual, customary, and reasonable (UCR) Ans: the charge consistent with what
other medical vendors would assess
