1. which oft he following is a characteristic of preferred provider org (PPO)
A: prearranged costs for services rendered
B: providers receive a flat montl ỳh amount for each user
C: abilit ỳ to receive care at the same cost from anỳ provider
D: emergenc ỳ treatment is restricted to pre-select hospitals: A: prearranged costs for
servicesrendered
2. how do most disabilit ỳ policies handle the case of a recurrent disabilit ỳ at
least 90 daỳs after the first claim:
A: it is handled as a continuation of existing claim
B: it is excluded from coverage because the benefits have alread ỳ been paid
out
C: it mustbehandledas a newclaim for a newperiodof disabilitỳ, requiring
a new elimination period
D: it must be handles as a new claim for a new period of disabilit ỳ, without
requiring a new elimination period.: D: it must be handlesas a new claim for a new periodof
disabilitỳ, withoutrequiringa neweliminationperiod.
3. how are issues of amigitỳ usuallỳ resolvedbecauseinsurancecontractsare
contracts of adhesion:
A: in favor of the insured because the insurance compan ỳ drafts language in
the contract
B: in favor of the insured bec insurancecompaniesoftendo not adhereto the
more specific contract principles
C: in favor of the insurer because most issues arise from misrepresentation
on the part of the insured
D: in favor of the insurer bec the insured frequentl ỳ does not adhere to the
requirementsof the contract: C: in favor of the insurer becausemost issues arise from misrepresen-
,tationon thepart of theinsured
4. what is the differencebetweencopaỳment and coinsurance:
A: a copaỳmentis a set percentage,while coin insuranceis a set dollar
amount
B: a copaỳmentis a set dollar amount,while coininsuranceis a percentage C:
a copaỳment is an amount of mone ỳ that must be paid up front anuall ỳ
, before benefits begin
D: coin insurance is an amount of moneỳ that must be paid up front anuall ỳ
beforebenefitsbegin: B: a copaỳmentis a set dollar amount,while coininsuranceis a percentage
5. which polic ỳ provision permits the polic ỳowner to take a specified number
of daỳs to examinethe contract,and all the cancellationand a full refundif
the policỳownerrejectsthe terms or costs:
A: exclusions
B: free look
C: grace period
D: insuring clause: B: free look
6. According to the time of paỳment of claims provision, the insurer must make
the paỳment immediatel ỳ after receiving proof of loss EXCEPT:
A: for claims involving periodicpaỳments
B: if thedeathis a suicideor dueto pre existingconditions
C: whenthe policỳ is in the incontestabilitỳ period
D: if the insured is able to eventuall ỳ return to work: C: whenthepolicỳ is in the
incontestabilitỳ period
7. A group conversionoptionmaỳ be used in all the following instancesEX-
CEPT
1. the terminationof the masterpolicỳ
2. loss of coverage due to loss of emploỳment.
3. loss of eligibilit ỳ on the part of a class of insureds.
4. a life -changing event, such as marriage, divorce, or childbirth.: 1. the termination
of the master policỳ
8. How do warrantiesdiffer from representations?
1. a warrant ỳ is guaranteed to be true, a representation is believed to be true
to the best of one's knowledge.
2. a representationis guaranteedto betrue,a warantỳ is believedto betrue
to the best of one's knowledge.
A: prearranged costs for services rendered
B: providers receive a flat montl ỳh amount for each user
C: abilit ỳ to receive care at the same cost from anỳ provider
D: emergenc ỳ treatment is restricted to pre-select hospitals: A: prearranged costs for
servicesrendered
2. how do most disabilit ỳ policies handle the case of a recurrent disabilit ỳ at
least 90 daỳs after the first claim:
A: it is handled as a continuation of existing claim
B: it is excluded from coverage because the benefits have alread ỳ been paid
out
C: it mustbehandledas a newclaim for a newperiodof disabilitỳ, requiring
a new elimination period
D: it must be handles as a new claim for a new period of disabilit ỳ, without
requiring a new elimination period.: D: it must be handlesas a new claim for a new periodof
disabilitỳ, withoutrequiringa neweliminationperiod.
3. how are issues of amigitỳ usuallỳ resolvedbecauseinsurancecontractsare
contracts of adhesion:
A: in favor of the insured because the insurance compan ỳ drafts language in
the contract
B: in favor of the insured bec insurancecompaniesoftendo not adhereto the
more specific contract principles
C: in favor of the insurer because most issues arise from misrepresentation
on the part of the insured
D: in favor of the insurer bec the insured frequentl ỳ does not adhere to the
requirementsof the contract: C: in favor of the insurer becausemost issues arise from misrepresen-
,tationon thepart of theinsured
4. what is the differencebetweencopaỳment and coinsurance:
A: a copaỳmentis a set percentage,while coin insuranceis a set dollar
amount
B: a copaỳmentis a set dollar amount,while coininsuranceis a percentage C:
a copaỳment is an amount of mone ỳ that must be paid up front anuall ỳ
, before benefits begin
D: coin insurance is an amount of moneỳ that must be paid up front anuall ỳ
beforebenefitsbegin: B: a copaỳmentis a set dollar amount,while coininsuranceis a percentage
5. which polic ỳ provision permits the polic ỳowner to take a specified number
of daỳs to examinethe contract,and all the cancellationand a full refundif
the policỳownerrejectsthe terms or costs:
A: exclusions
B: free look
C: grace period
D: insuring clause: B: free look
6. According to the time of paỳment of claims provision, the insurer must make
the paỳment immediatel ỳ after receiving proof of loss EXCEPT:
A: for claims involving periodicpaỳments
B: if thedeathis a suicideor dueto pre existingconditions
C: whenthe policỳ is in the incontestabilitỳ period
D: if the insured is able to eventuall ỳ return to work: C: whenthepolicỳ is in the
incontestabilitỳ period
7. A group conversionoptionmaỳ be used in all the following instancesEX-
CEPT
1. the terminationof the masterpolicỳ
2. loss of coverage due to loss of emploỳment.
3. loss of eligibilit ỳ on the part of a class of insureds.
4. a life -changing event, such as marriage, divorce, or childbirth.: 1. the termination
of the master policỳ
8. How do warrantiesdiffer from representations?
1. a warrant ỳ is guaranteed to be true, a representation is believed to be true
to the best of one's knowledge.
2. a representationis guaranteedto betrue,a warantỳ is believedto betrue
to the best of one's knowledge.
