KENTUCKY HEALTH INSURANCE EXAM LATEST 2025-2026
WITH ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS
Define accidental bodily injury - ANSWER-Accidental bodily injury is a
| | | | | | | | |
unforeseen and unintended injury that resulted from an accident rather than a
| | | | | | | | | | |
sickness
|
In what ways can accidental death and dismemberment coverage be written? -
| | | | | | | | | | |
|ANSWER-AD&D coverage can be written as a rider or a separate policy. | | | | | | | | | | |
Under accidental death and dismemberment coverage, when would the capital
| | | | | | | | |
amount be paid? When would the principal amount be paid? - ANSWER-The
| | | | | | | | | | | |
principal sum is paid for accidental death. In the case of loss of sight or
| | | | | | | | | | | | | |
accidental dismemberment, a percentage of that principal sum will be paid by
| | | | | | | | | | |
the policy, often referred to as the capital sum.
| | | | | | | | |
Explain the concept of coverage on first-dollar basis - ANSWER-First-dollar
| | | | | | | | |
coverage does not require the insured to pay a deductible
| | | | | | | | | |
What is Risk? - ANSWER-Risk is the uncertainty or chance of loss occurring
| | | | | | | | | | | |
What is a Peril? - ANSWER-Perils are the causes of loss insured against in an
| | | | | | | | | | | | | |
insurance policy
| |
What are the elements of risk? - ANSWER-Loss must be (1) due to chance; (2)
| | | | | | | | | | | | | |
definite and measurable; (3) statistical predictable; (4) not catastrophic; (5)
| | | | | | | | | |
with large loss exposure; and (6) insurance cannot be mandatory.
| | | | | | | | |
,What is the difference between a disability income and medical expense
| | | | | | | | | |
policy? - ANSWER-Medical expense policies cover the hospital and medical
| | | | | | | | | |
expenses of covered injures or illnesses, whereas disability income policies
| | | | | | | | | |
actually pay income to a person who must miss work as the result of an injury
| | | | | | | | | | | | | | |
or illness.
| |
What is the difference between reimbursement and scheduled benefit
| | | | | | | |
payment? - ANSWER-In reimbursement plans, the expenses are reimbursed
| | | | | | | |
directly to the insured for the services provided. In scheduled benefits plans,
| | | | | | | | | | | |
the insurer pays up to a certain amount. for the services, as determined on a
| | | | | | | | | | | | | | |
schedule for the cost of each treatment.
| | | | | | |
What are some common exclusions and limitations in medical expense
| | | | | | | | |
policies? - ANSWER-War and active duty military, intentionally self-inflicted
| | | | | | | |
injuries, pre-existing conditions, elective cosmetic surgery, injuries as a result of
| | | | | | | | | | |
participating in criminal activities, and conditions covered by workers
| | | | | | | | |
compensation or government plans.
| | | |
What coverages are provided by a Major Medical Expense policy? - ANSWER-
| | | | | | | | | | |
After basic policy pays, the supplemental major medical will provide coverage
| | | | | | | | | | |
for expenses that were not covered by the basic policy, and expenses that
| | | | | | | | | | | | |
exceed the maximum. If the time limitation is used up by the basic policy, the
| | | | | | | | | | | | | | |
supplemental coverage will provide coverage thereafter.
| | | | | |
How does restoration of benefits work? - ANSWER-Major medical policies
| | | | | | | | |
include a provision that restores a specific dollar amount at certain intervals
| | | | | | | | | | |
|after the lifetime limit of coverage has been exhausted if the insured maintains
| | | | | | | | | | | |
|the policy claim-free for a given period of time.
| | | | | | | |
Once a disability policy is paying a claim, how long will it pay? - ANSWER-
| | | | | | | | | | | | | |
Disability income insurance is designed to provide a reasonable and
| | | | | | | | | |
,predetermined income to a disabled party for a set period of time subject to a
| | | | | | | | | | | | | |
"time deductible" termed an elimination period.
| | | | | |
What is the difference between own occupation and any occupation? -
| | | | | | | | | |
ANSWER-A policy that has "any occupation" provision will only provide benefits
| | | | | | | | | |
when the insured is unable to perform any occupation for which they are
| | | | | | | | | | | | |
suited by reason of education, training, or experience. "own occupation" is the
| | | | | | | | | | |
more liberal definition and therefore provides a better benefit for the insured.
| | | | | | | | | | | |
What is the difference between occupational and nonoccupational coverage? -
| | | | | | | | |
ANSWER-Occupational coverage provides benefits for disabilities resulting from
| | | | | | | |
accidents or sickness that occur on or off the job. Nonoccupational coverage,
| | | | | | | | | | | |
on the other hand, only covers disabilities that result from accidents or sickness
| | | | | | | | | | | | |
occurring off the job.
| | | |
What is the probationary period? How is it different from the elimination
| | | | | | | | | | |
period? - ANSWER-The probationary period is a waiting period. Elimination
| | | | | | | | | |
period is a waiting period that is imposed on the insured from the onset of
| | | | | | | | | | | | | | |
disability until benefit payments commence (it is a deductible measured in time
| | | | | | | | | | |
instead of dollar amount)
| | | |
What is the difference between confining and non-confining disabilty? -
| | | | | | | | |
ANSWER-A confining disability requires that the affected individual remain
| | | | | | | |
indoors, whereas a non-confining disability does not.
| | | | | | |
Describe residual disability - ANSWER-Residual disability is the type of disability
| | | | | | | | | |
income policy that provides benefits for loss of income when a person returns
| | | | | | | | | | | | |
to work after a total disability, but is still not able to work as long or at the
| | | | | | | | | | | | | | | | | |
same level he/she worked before becoming disabled.
| | | | | |
What must a worker prove in order to receive benefits for a non disabling
| | | | | | | | | | | | |
injury? - ANSWER-That treatment caused a loss of work time
| | | | | | | | | |
, What is the purpose of key person disability insurance? - ANSWER-The key
| | | | | | | | | | |
person's economic value to the business is determined in terms of the
| | | | | | | | | | | |
potential loss of business income which could occur as well as the expense of
| | | | | | | | | | | | |
hiring and training a replacement for the key person.
| | | | | | | | |
With key person insurance, who pays the premium, who is the beneficiary and
| | | | | | | | | | | |
the insured? - ANSWER-The contract is owned by the business, so the premium
| | | | | | | | | | | | |
is paid by the business, and the business is the beneficiary. The key employee
| | | | | | | | | | | | | |
would be insured.
| | |
What is the purpose of a buy-sell agreement? - ANSWER-The buy sell
| | | | | | | | | | |
agreement specifies how the business will pass between owner when one of
| | | | | | | | | | |
the owners dies or becomes disabled.
| | | | | |
Why do HMO's encourage members to get regular checkups? - ANSWER-in this
| | | | | | | | | | |
way the HMO hopes to catch disease in its earliest stages when treatment has
| | | | | | | | | | | | | |
the greatest chance for success.
| | | | |
Is a producer's cooperative a for-profit or nonprofit organization? What about a
| | | | | | | | | | |
|consumer's cooperative? Define these terms in your answers. - ANSWER-
| | | | | | | | |
|Producers' cooperatives are for-profit organizations operated by a group of
| | | | | | | | |
|physicians. Consumers' cooperatives are non profit organizations made up pf
| | | | | | | | |
|doctors that are salaried employees. | | | |
What is the difference between open and closed panel HMO's? - ANSWER-
| | | | | | | | | | |
Under an open panel HMO, all the providers who want to provide services for
| | | | | | | | | | | | | |
the HMO may do so as long as they agree to the HMO's requirements. Under a
| | | | | | | | | | | | | | | |
closed panel HMO, the HMO selects a limited number of providers.
| | | | | | | | | | |
What is a primary care physician? - ANSWER-The primary care physician will be
| | | | | | | | | | | |
regularly compensated for being responsible for the care of that member
| | | | | | | | | | |
WITH ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS
Define accidental bodily injury - ANSWER-Accidental bodily injury is a
| | | | | | | | |
unforeseen and unintended injury that resulted from an accident rather than a
| | | | | | | | | | |
sickness
|
In what ways can accidental death and dismemberment coverage be written? -
| | | | | | | | | | |
|ANSWER-AD&D coverage can be written as a rider or a separate policy. | | | | | | | | | | |
Under accidental death and dismemberment coverage, when would the capital
| | | | | | | | |
amount be paid? When would the principal amount be paid? - ANSWER-The
| | | | | | | | | | | |
principal sum is paid for accidental death. In the case of loss of sight or
| | | | | | | | | | | | | |
accidental dismemberment, a percentage of that principal sum will be paid by
| | | | | | | | | | |
the policy, often referred to as the capital sum.
| | | | | | | | |
Explain the concept of coverage on first-dollar basis - ANSWER-First-dollar
| | | | | | | | |
coverage does not require the insured to pay a deductible
| | | | | | | | | |
What is Risk? - ANSWER-Risk is the uncertainty or chance of loss occurring
| | | | | | | | | | | |
What is a Peril? - ANSWER-Perils are the causes of loss insured against in an
| | | | | | | | | | | | | |
insurance policy
| |
What are the elements of risk? - ANSWER-Loss must be (1) due to chance; (2)
| | | | | | | | | | | | | |
definite and measurable; (3) statistical predictable; (4) not catastrophic; (5)
| | | | | | | | | |
with large loss exposure; and (6) insurance cannot be mandatory.
| | | | | | | | |
,What is the difference between a disability income and medical expense
| | | | | | | | | |
policy? - ANSWER-Medical expense policies cover the hospital and medical
| | | | | | | | | |
expenses of covered injures or illnesses, whereas disability income policies
| | | | | | | | | |
actually pay income to a person who must miss work as the result of an injury
| | | | | | | | | | | | | | |
or illness.
| |
What is the difference between reimbursement and scheduled benefit
| | | | | | | |
payment? - ANSWER-In reimbursement plans, the expenses are reimbursed
| | | | | | | |
directly to the insured for the services provided. In scheduled benefits plans,
| | | | | | | | | | | |
the insurer pays up to a certain amount. for the services, as determined on a
| | | | | | | | | | | | | | |
schedule for the cost of each treatment.
| | | | | | |
What are some common exclusions and limitations in medical expense
| | | | | | | | |
policies? - ANSWER-War and active duty military, intentionally self-inflicted
| | | | | | | |
injuries, pre-existing conditions, elective cosmetic surgery, injuries as a result of
| | | | | | | | | | |
participating in criminal activities, and conditions covered by workers
| | | | | | | | |
compensation or government plans.
| | | |
What coverages are provided by a Major Medical Expense policy? - ANSWER-
| | | | | | | | | | |
After basic policy pays, the supplemental major medical will provide coverage
| | | | | | | | | | |
for expenses that were not covered by the basic policy, and expenses that
| | | | | | | | | | | | |
exceed the maximum. If the time limitation is used up by the basic policy, the
| | | | | | | | | | | | | | |
supplemental coverage will provide coverage thereafter.
| | | | | |
How does restoration of benefits work? - ANSWER-Major medical policies
| | | | | | | | |
include a provision that restores a specific dollar amount at certain intervals
| | | | | | | | | | |
|after the lifetime limit of coverage has been exhausted if the insured maintains
| | | | | | | | | | | |
|the policy claim-free for a given period of time.
| | | | | | | |
Once a disability policy is paying a claim, how long will it pay? - ANSWER-
| | | | | | | | | | | | | |
Disability income insurance is designed to provide a reasonable and
| | | | | | | | | |
,predetermined income to a disabled party for a set period of time subject to a
| | | | | | | | | | | | | |
"time deductible" termed an elimination period.
| | | | | |
What is the difference between own occupation and any occupation? -
| | | | | | | | | |
ANSWER-A policy that has "any occupation" provision will only provide benefits
| | | | | | | | | |
when the insured is unable to perform any occupation for which they are
| | | | | | | | | | | | |
suited by reason of education, training, or experience. "own occupation" is the
| | | | | | | | | | |
more liberal definition and therefore provides a better benefit for the insured.
| | | | | | | | | | | |
What is the difference between occupational and nonoccupational coverage? -
| | | | | | | | |
ANSWER-Occupational coverage provides benefits for disabilities resulting from
| | | | | | | |
accidents or sickness that occur on or off the job. Nonoccupational coverage,
| | | | | | | | | | | |
on the other hand, only covers disabilities that result from accidents or sickness
| | | | | | | | | | | | |
occurring off the job.
| | | |
What is the probationary period? How is it different from the elimination
| | | | | | | | | | |
period? - ANSWER-The probationary period is a waiting period. Elimination
| | | | | | | | | |
period is a waiting period that is imposed on the insured from the onset of
| | | | | | | | | | | | | | |
disability until benefit payments commence (it is a deductible measured in time
| | | | | | | | | | |
instead of dollar amount)
| | | |
What is the difference between confining and non-confining disabilty? -
| | | | | | | | |
ANSWER-A confining disability requires that the affected individual remain
| | | | | | | |
indoors, whereas a non-confining disability does not.
| | | | | | |
Describe residual disability - ANSWER-Residual disability is the type of disability
| | | | | | | | | |
income policy that provides benefits for loss of income when a person returns
| | | | | | | | | | | | |
to work after a total disability, but is still not able to work as long or at the
| | | | | | | | | | | | | | | | | |
same level he/she worked before becoming disabled.
| | | | | |
What must a worker prove in order to receive benefits for a non disabling
| | | | | | | | | | | | |
injury? - ANSWER-That treatment caused a loss of work time
| | | | | | | | | |
, What is the purpose of key person disability insurance? - ANSWER-The key
| | | | | | | | | | |
person's economic value to the business is determined in terms of the
| | | | | | | | | | | |
potential loss of business income which could occur as well as the expense of
| | | | | | | | | | | | |
hiring and training a replacement for the key person.
| | | | | | | | |
With key person insurance, who pays the premium, who is the beneficiary and
| | | | | | | | | | | |
the insured? - ANSWER-The contract is owned by the business, so the premium
| | | | | | | | | | | | |
is paid by the business, and the business is the beneficiary. The key employee
| | | | | | | | | | | | | |
would be insured.
| | |
What is the purpose of a buy-sell agreement? - ANSWER-The buy sell
| | | | | | | | | | |
agreement specifies how the business will pass between owner when one of
| | | | | | | | | | |
the owners dies or becomes disabled.
| | | | | |
Why do HMO's encourage members to get regular checkups? - ANSWER-in this
| | | | | | | | | | |
way the HMO hopes to catch disease in its earliest stages when treatment has
| | | | | | | | | | | | | |
the greatest chance for success.
| | | | |
Is a producer's cooperative a for-profit or nonprofit organization? What about a
| | | | | | | | | | |
|consumer's cooperative? Define these terms in your answers. - ANSWER-
| | | | | | | | |
|Producers' cooperatives are for-profit organizations operated by a group of
| | | | | | | | |
|physicians. Consumers' cooperatives are non profit organizations made up pf
| | | | | | | | |
|doctors that are salaried employees. | | | |
What is the difference between open and closed panel HMO's? - ANSWER-
| | | | | | | | | | |
Under an open panel HMO, all the providers who want to provide services for
| | | | | | | | | | | | | |
the HMO may do so as long as they agree to the HMO's requirements. Under a
| | | | | | | | | | | | | | | |
closed panel HMO, the HMO selects a limited number of providers.
| | | | | | | | | | |
What is a primary care physician? - ANSWER-The primary care physician will be
| | | | | | | | | | | |
regularly compensated for being responsible for the care of that member
| | | | | | | | | | |
