Colorado Life & Health State Exam

_________ review is a set of formal techniques for monitoring the use or clinical necessity of health care, or for determining if an exclusion applies or a treatment is medically necessary. - answer-Utilization ______________ is a form of whole life in which the insurance company can change the premiums or interest rate being credited to the account based on current money market rates. - answer-Current Assumption Whole Life A life insurance applicant's answers on the application indicate that they in good health. In fact, the applicant actually has a disease that they are not aware of. The statement on the application is considered: - answer-A representation A life Insurance policyowner receives an annual dividend. One option for this dividend is to use it to offset the annual obligation to the insurer. What is this option called? - answer-Premium Reduction A participating life insurance policy has a long-term care rider. The insured qualifies for the benefit. Where does the initial benefit money come from? - answer-It is an advance of the face amount of the policy A partnership has 3 partners who each have an equal ownership interest in their $3,000,000 business. How many policies would have to be purchased under a traditional cross purchase buy-sell agreement plan? - answer-6 (3x2) A permanent policy is surrendered for its cash value, and that sum is greater than the amount of premiums paid in. How is the excess taxed? - answer-Taxed as ordinary income A personalized computer-generated illustration detailing premiums, cash values, interest rates, and surrender values is called __________. - answer-A policy summary A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as: - answer-Medicaid A small employer carrier is applying a premium surcharge to a small employer group. The carrier may apply this increased premium for up to: - answer-12 months A small employer carrier is applying a premium surcharge to a small employer group. The carrier may apply this increased premium for up to: - answer-12 months Admitted life insurers must pay interest on death benefits. From the 31st day until the date of settlement of a claim, the annual interest rate will be: - answer-2 percentage points above the federal discount rate Admitted life insurers must pay interest, at a rate specified by law, on death benefits from the date of the insured's death, through how many days following the date the insurer receives the claim? - answer-30 days After enrolling in Medicare and purchasing a supplement, Rachel withdrew $2,000 from her HSA. She used $600 to pay her Medicare Supplement premium, $200 for out-of- pocket medical expenses, and the remaining $1,200 on a trip to celebrate her retirement. When preparing her taxes for the year, she discovered that: - answer-$1,200 was subject to income tax Agents must have a FINRA registration as well as an insurance license in order to sell - answer-Variable Life Albert owned a $100,000 policy that had accumulated a cash value of $20,000, against which he had borrowed $10,000. If he dies with this loan outstanding, his beneficiary will receive which of the following amounts? - answer-$90,000 All health policies issued in Colorado must provide coverage for preventive breast cancer screenings with mammography on an annual basis for: - answer-Individuals with a family history of breast cancer All individual health benefit plans issued to policyholders that receive federal subsidies under the ACA must contain a provision for a grace period of: - answer-3 months All individual health benefit plans issued to policyholders that receive federal subsidies under the ACA must contain a provision for a grace period of: - answer-3 months All of the following are characteristics of Universal Life Insurance, except: - answer-The policyowner can choose which investment(s) to place the cash values into from those available All of the following are exclusions under an LTC policy, except: - answer-Chemical dependency on one's own prescription drugs All of the following are false statements regarding group disability plans, except: - answer-The plans are typically written on a nonoccupational basis All of the following are Optional Uniform Provisions, except: - answer-Legal Actions All of the following are prohibited provisions in a long-term care policy, except: - answer-Cancelling a policy due to nonpayment of premium All of the following are true regarding Current Assumption Whole Life, except: - answer-If current rates decrease, the policyowner pays reduced premiums, or the cash values will grow faster All of the following are true regarding disclosures at the point of sale and issues relating to AIDS, except: - answer-Much like illegal drugs and nicotine the applicant does not have to provide consent prior to insurer's testing for HIV All of the following are true with regard to utilization review requirements, except: - answer-The insurer who has denied the claim conducts the external review All of the following statements are correct concerning coverage for hospice care and home health care, except: - answer-Benefits may never extend past 6 months All of the following statements regarding a group Accidental Death and Dismemberment policy are incorrect, except: - answer-Any benefits received are not taxable to the recipient All states have adopted the Uniform Individual Accident and Sickness Policy Provision Law. If an insurer changes any of these provisions, it must make sure that the change does not: - answer-Create a meaning that is less favorable to the insured than the original wording All states have adopted the Uniform Individual Accident and Sickness Policy Provision Law. If an insurer changes any of these provisions, they must make sure it does not: - answer-Alter the minimum requirements of any provision All the following qualify for Medicare Part A, except: - answer-Healthy individuals who are under age 65 and not covered by Social Security, but are willing to pay the Part A premium An employer group health insurance sponsor does all of the following, except: - answer-Issue the policy An insurable interest must exist between the _______ and the ________ at the time of application for life insurance to be valid. - answer-Applicant/Insured An insured owns a $50,000 permanent life policy that she purchased 4 years ago that has a disability waiver of premium. The insured becomes disabled and pays premiums during the waiting period until the waiver begins. Once the waiver begins, what happens to the premiums she paid during the waiting period? - answer-The insurer refunds it An insured should receive necessary claim forms within _____ days after notice of claim. - answer-15 An insured with a participating life insurance policy receives an annual dividend check in the mail. He must have selected which Dividend Option: - answer-Cash An insurer offering Medicare Supplements to senior clients must: - answer-Offer Core Benefit Plan A if it sells any of the other plans An organization that transacts insurance only with its own members is a(n): - answer-Fraternal Benefit Society At least how many days in advance must an insurer give an insured notice of non-renewal for a health plan? - answer-180 Attaching a(n) ___________ rider excludes coverage for a condition that would otherwise be covered. - answer-Impairment Basic expense policies typically cover all of the following, except: - answer-Routine vision (optometry) or dental care expenses Beth owns a 20-Pay Life participating policy. She has decided that the dividends should be applied toward future premiums. Which Dividend Option did she choose? - answer-Premium Reduction Carriers must issue group health insurance directly to work-site employers if the employer meets the definition of: - answer-A small group Cash values within an ordinary straight whole life insurance policy _______ over time. - answer-Increase Continuation of group health coverage applies to employees who have had continuous coverage under the policy for what period of time? - answer-6 months Dr. Doe is associated with an HMO. One of his main functions is to oversee referrals to other physicians and specialists. Dr. Doe is functioning in the capacity of a: - answer-Gatekeeper E has a $10,000 traditional whole life policy with a $4,000 cash value. Premiums paid to date are $3,500. If the policy lapses with a $4,000 loan outstanding, what amount will be taxable as income to E? - answer-$500 Each of the following are characteristics of a Current Assumption Whole Life insurance policy, except: - answer-The death benefit is not guaranteed Evelyn paid a $700 annual premium for a business overhead expense policy that paid a monthly benefit of up to $4,000 for a benefit period of 6 months. When Evelyn became disabled she used the entire benefit for 3 months, which covered $8,000 of employee salaries, as well as $3,000 in rent and utilities. This means that the amount of the benefits which was reported as income equaled: - answer-$12,000 For the most part, the highest authority for insurance regulation is: - answer-The individual states Fred's group health plan offers prepaid routine medical exams to provide early treatment and preventive care. He most likely has what type of coverage? - answer-HMO Generally, an individual is eligible to enroll in Medicare at age: - answer-65 Group health plans usually cover: - answer-Nonoccupational injury or disease Group life death benefits may be assigned to a party other than the beneficiary by: - answer-The insured, only