Accident and Health Insurance Exam
Questions/231 Questions and Answers
H has suffered a covered disability away from her job and will shortly begin
collecting benefits. The insurer sends a letter to H stating that she will not
receive any benefit amounts greater than her income. This clause is known
as:
A: Over-insurance clause
B: free look
C: relation of earning to insurance
D: relation of economic value - -C: relation of earning to insurance
-The insured should be aware of the issue date upon delivery a policy and
the date should be listed on: A: the policy summary
B: the first page of the contract
C: the delivery receipt
D: upon conditional receipt - -B: the first page of the contract
-The policy has all of the following rights EXCEPT:
A: Right to solely renew a guaranteed renewable policy.
B: Right to terminate a policy
C: Unilateral right to renew an Optionally renewable policy
D: Right to assign a contract - -C: Unilateral right to renew an Optionally
renewable policy
-The part of a contract that specifies which expenses may or may not be
covered is known as the:
A: Exclusion
B: Eligible Expense provision
C: Insuring Agreement
D: Consideration Clause - -B: Eligible Expense provision
-Which of the following is considered to be a mandatory provision in a health
policy?
A: Time Limit on Certain Defenses
B: Change of Occupation
C: Illegal Occupation
D: Intoxicant/Narcotic Usage - -A: Time Limit on Certain Defenses
-Which of the following may be considered an eligible expense found in a
health policy? A: Cosmetic Surgery
B: Premium payment
C: cold cream
Accident and Health Insurance Exam Questions 231 Questions and Answers
,D: Bus fare to receive treatment for a covered loss - -D: Bus fare to receive
treatment for a covered loss
-K has a policy that covers doctors visits but limits the number of visits per
calendar year and pays a limited indemnification limit per visit. K has:
A: Basic Medical Expense
B: Physician Nonsurgical Coverage
C: Basic Surgical Policy
D: Basic Hospital Coverage - -B: Physician Nonsurgical Coverage
-All of the following are CORRECT about Medicare EXCEPT:
A: An insured who is age 30 but collecting Social Security disability for the
last two years is eligible for Medicare.
B: An insured who is age 60 and is at the end stage of renal failure is eligible
for Medicare.
C: An insured who turns age 65 and is still employed is eligible for Medicare.
D: An insured who has Medicare Part A is eligible to enroll for Medigap
policies within six months of enrolling in Part A. - -D: An insured who has
Medicare Part A is eligible to enroll for Medigap policies within six months of
enrolling in Part A.
-Under the Claim Forms provision in an Accident and Health policy, an
insurance company must supply an insured with claim forms within a
MAXIMUM of how many days after receiving notice of the loss?
A: 10
B: 15
C: 20
D: 30 - -B: 15
-The purpose of the Fair Credit Reporting Act is to:
A: protect the consumer from having an adverse action against them based
of obsolete credit information
B: to ensure that credit information used in underwriting is accurate and
updated
C: make sure that any financial institution handles an individual's credit in a
correct, proper manner
D: All of the Above - -D: All of the Above
-Most Accident and Health policies require that claims must be paid
_________ upon written proof of loss.
A: 30 days
B: Immediately
C: 60 days
Accident and Health Insurance Exam Questions 231 Questions and Answers
,D: 90 days - -B: Immediately
-A LTC policy that will only pay for ADL given occasionally by a licensed
professional is:
A: Skilled Care
B: Intermediate Care
C: Custodial Care
D: None of the Above - -C: Custodial Care
-Which of the following policy provisions are optional in a individual health
policy?
A: Entire Contract
B: Change of Occupation
C: Entire Contract
D: Reinstatement - -B: Change of Occupation
-Which of the following elements is part of the entire contract clause?
A: The exchange of value between the parties
B: The agreement between the policyholder and insurer
C: The amount of time the insured has to send a policy back for a full refund
D: None of the Above - -D: None of the Above
-All of the following are true regarding Social Security disability EXCEPT:
A: A insured must wait 5 months before collecting benefits
B: To qualify an insured must be unable to do any job in the American
economy
C: To qualify an insured must be disabled for a year or longer or die within a
two year period.
D: The insured must have a certain amount of Social Security credits based
off age. - -C: To qualify an insured must be disabled for a year or longer or
die within a two year period.
-Health Care FSA contributions are limited to _______ per year.
A: $5,000
B: $3,000
C: $2,700
D: $3,250 - -C: $2,700
-A noncancelable policy means the company
A: may not raise the premium or terminate the policy except for nonpayment
of premium
B: may not cancel before the insured reaches age 50
C: may pay limited benefits and cannot cancel all benefits
Accident and Health Insurance Exam Questions 231 Questions and Answers
, D: can only terminate coverage if the insured switches occupations - -A: may
not raise the premium or terminate the policy except for nonpayment of
premium
-The maximum number of in-hospital days coverage provided by an
individual policy under minimum standards is:
A: 30 days
B: 45 days
C: 90 days
D: 180 days - -D: 180 days
-If there is a dispute on medical necessity under a HMO, there must be a
system in place for a second opinion. If the second opinion determines that a
covered service is in fact medically necessary, the HMO must provide
service. The only way that benefits are paid for an out-of-network physician
is:
A: if a referral is given
B: state law dictates when coverage out of area exists
C: if it is an emergency
D: None of the Above - -A: if a referral is given
-Which of the following circumstances may lead to the renewal of a producer
license without the requirement of completing continuing education
requirements?
A: There are no exceptions to the continuing education law. B: The
producer suffers a stroke and is incapable of completing any
coursework.
C: The producer is called up to military duty and secures a military waiver.
D: Once a producer has been licensed for more than 30 consecutive years
and is at least 65 years of age, they are exempt from continuing education
requirements. - -C: The producer is called up to military duty and secures a
military waiver.
-Renewability of a Long Term Care policy must be at least:
A: Noncancelable
B: Guaranteed Renewable
C: Cancellable
D: A and B only - -D: A and B only
-Under minimum standards, the probationary waiting period for illness may
not exceed A: 10 days B: 20 days
C: 30 days
D: 40 days - -C: 30 days
Accident and Health Insurance Exam Questions 231 Questions and Answers
Questions/231 Questions and Answers
H has suffered a covered disability away from her job and will shortly begin
collecting benefits. The insurer sends a letter to H stating that she will not
receive any benefit amounts greater than her income. This clause is known
as:
A: Over-insurance clause
B: free look
C: relation of earning to insurance
D: relation of economic value - -C: relation of earning to insurance
-The insured should be aware of the issue date upon delivery a policy and
the date should be listed on: A: the policy summary
B: the first page of the contract
C: the delivery receipt
D: upon conditional receipt - -B: the first page of the contract
-The policy has all of the following rights EXCEPT:
A: Right to solely renew a guaranteed renewable policy.
B: Right to terminate a policy
C: Unilateral right to renew an Optionally renewable policy
D: Right to assign a contract - -C: Unilateral right to renew an Optionally
renewable policy
-The part of a contract that specifies which expenses may or may not be
covered is known as the:
A: Exclusion
B: Eligible Expense provision
C: Insuring Agreement
D: Consideration Clause - -B: Eligible Expense provision
-Which of the following is considered to be a mandatory provision in a health
policy?
A: Time Limit on Certain Defenses
B: Change of Occupation
C: Illegal Occupation
D: Intoxicant/Narcotic Usage - -A: Time Limit on Certain Defenses
-Which of the following may be considered an eligible expense found in a
health policy? A: Cosmetic Surgery
B: Premium payment
C: cold cream
Accident and Health Insurance Exam Questions 231 Questions and Answers
,D: Bus fare to receive treatment for a covered loss - -D: Bus fare to receive
treatment for a covered loss
-K has a policy that covers doctors visits but limits the number of visits per
calendar year and pays a limited indemnification limit per visit. K has:
A: Basic Medical Expense
B: Physician Nonsurgical Coverage
C: Basic Surgical Policy
D: Basic Hospital Coverage - -B: Physician Nonsurgical Coverage
-All of the following are CORRECT about Medicare EXCEPT:
A: An insured who is age 30 but collecting Social Security disability for the
last two years is eligible for Medicare.
B: An insured who is age 60 and is at the end stage of renal failure is eligible
for Medicare.
C: An insured who turns age 65 and is still employed is eligible for Medicare.
D: An insured who has Medicare Part A is eligible to enroll for Medigap
policies within six months of enrolling in Part A. - -D: An insured who has
Medicare Part A is eligible to enroll for Medigap policies within six months of
enrolling in Part A.
-Under the Claim Forms provision in an Accident and Health policy, an
insurance company must supply an insured with claim forms within a
MAXIMUM of how many days after receiving notice of the loss?
A: 10
B: 15
C: 20
D: 30 - -B: 15
-The purpose of the Fair Credit Reporting Act is to:
A: protect the consumer from having an adverse action against them based
of obsolete credit information
B: to ensure that credit information used in underwriting is accurate and
updated
C: make sure that any financial institution handles an individual's credit in a
correct, proper manner
D: All of the Above - -D: All of the Above
-Most Accident and Health policies require that claims must be paid
_________ upon written proof of loss.
A: 30 days
B: Immediately
C: 60 days
Accident and Health Insurance Exam Questions 231 Questions and Answers
,D: 90 days - -B: Immediately
-A LTC policy that will only pay for ADL given occasionally by a licensed
professional is:
A: Skilled Care
B: Intermediate Care
C: Custodial Care
D: None of the Above - -C: Custodial Care
-Which of the following policy provisions are optional in a individual health
policy?
A: Entire Contract
B: Change of Occupation
C: Entire Contract
D: Reinstatement - -B: Change of Occupation
-Which of the following elements is part of the entire contract clause?
A: The exchange of value between the parties
B: The agreement between the policyholder and insurer
C: The amount of time the insured has to send a policy back for a full refund
D: None of the Above - -D: None of the Above
-All of the following are true regarding Social Security disability EXCEPT:
A: A insured must wait 5 months before collecting benefits
B: To qualify an insured must be unable to do any job in the American
economy
C: To qualify an insured must be disabled for a year or longer or die within a
two year period.
D: The insured must have a certain amount of Social Security credits based
off age. - -C: To qualify an insured must be disabled for a year or longer or
die within a two year period.
-Health Care FSA contributions are limited to _______ per year.
A: $5,000
B: $3,000
C: $2,700
D: $3,250 - -C: $2,700
-A noncancelable policy means the company
A: may not raise the premium or terminate the policy except for nonpayment
of premium
B: may not cancel before the insured reaches age 50
C: may pay limited benefits and cannot cancel all benefits
Accident and Health Insurance Exam Questions 231 Questions and Answers
, D: can only terminate coverage if the insured switches occupations - -A: may
not raise the premium or terminate the policy except for nonpayment of
premium
-The maximum number of in-hospital days coverage provided by an
individual policy under minimum standards is:
A: 30 days
B: 45 days
C: 90 days
D: 180 days - -D: 180 days
-If there is a dispute on medical necessity under a HMO, there must be a
system in place for a second opinion. If the second opinion determines that a
covered service is in fact medically necessary, the HMO must provide
service. The only way that benefits are paid for an out-of-network physician
is:
A: if a referral is given
B: state law dictates when coverage out of area exists
C: if it is an emergency
D: None of the Above - -A: if a referral is given
-Which of the following circumstances may lead to the renewal of a producer
license without the requirement of completing continuing education
requirements?
A: There are no exceptions to the continuing education law. B: The
producer suffers a stroke and is incapable of completing any
coursework.
C: The producer is called up to military duty and secures a military waiver.
D: Once a producer has been licensed for more than 30 consecutive years
and is at least 65 years of age, they are exempt from continuing education
requirements. - -C: The producer is called up to military duty and secures a
military waiver.
-Renewability of a Long Term Care policy must be at least:
A: Noncancelable
B: Guaranteed Renewable
C: Cancellable
D: A and B only - -D: A and B only
-Under minimum standards, the probationary waiting period for illness may
not exceed A: 10 days B: 20 days
C: 30 days
D: 40 days - -C: 30 days
Accident and Health Insurance Exam Questions 231 Questions and Answers
