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Accident and Health Insurance
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Sally is considering her Medicare options. She understands that to enroll in Medicare Part B, she will have to pay a monthly premium. Since she is healthy, she is considering delaying her enrollment until later. Will she be able to enroll at a later date? 1.Yes, she can enroll at anytime in the future 2.Yes, however; she would have a permanent premium penalty when she does enroll 3.No, this is a take or leave it situation 4.Yes, but she would have to show evidence of good health. - Yes, however; she would have a permanent premium penalty when she does enroll Under Medicare Part A, a spell of illness begins again and is subject to a new deductible for another admission when: 1.The patient has been discharged from a prior stay and 45 days have elapsed 2.The patient has been discharged from a prior stay and 30 days have elapsed 3.The patient has been discharged from a prior stay and 60 days have elapsed 4.The patient has been discharged from a prior stay and 90 days have elapsed - The patient has been discharged from a prior stay and 60 days have elapsed What type of insurer retains risk? 1.Government insurance. 2.Reinsurers. 3.Self insurers. 4.Assessment insurers. - Self insurers. A variety of types of care are provided under a long-term care policy. All of the following are types of care generally provided EXCEPT:
1.Home health care 2.Intensive care 3.Custodial care 4.Skilled care - Intensive care Melvin has a long-term care policy with a 30-day elimination period. The policy has a daily benefit of $100/day. The policy has a 3-year benefit period. If Melvin is confined to a nursing home for 9 months, how much in benefits will his policy pay? 1.$27, 000 2.$18, 3.$24, 4.$17,000 - $24, Martin and his friends were at a local tavern celebrating his birthday. Martin left the bar to drive home, but unfortunately, he was involved in a fatal accident, killing himself and two other individuals. An autopsy reveals that Martin was well above the legal limit on his blood alcohol test. Martin's family will receive the following from his Accidental Death and Dismemberment policy: 1.His family will receive reduced benefits since other deaths were involved. 2.His family will receive the principal sum since this was death 3.His family will receive no benefits, since he was in the act of committing a felony 4.His family will receive no benefits since there was no dismemberment involved. - His family will receive no benefits, since he was in the act of committing a felony An exclusion that always appears in a health policy is: 1.No coverage for drug or alcohol related illness 2.Hernia from an accident 3.Travel outside of the USA 4.Injury in the act of committing a felony - Injury in the act of committing a felony
The practice of using misrepresentation to induce a policyholder to replace a policy issued by the insurer the producer represents is called: 1.twisting. 2.churning. 3.intimidation. 4.misrepresentation. - churning. All of the following acts are considered unfair trade practices EXCEPT: 1.replacement. 2.misrepresentation 3.coercion. 4.rebating. - replacement. What gives the insurance company the right to assume rights of the insured in order to sue a responsible third party when damages are inflicted on the insured? 1.Warranties 2.Subrogation 3.Concealment 4.Utmost good faith - Subrogation Insurance contracts sometimes contain ambiguities. Which of the following has not been taken to court for further interpretation? 1.Reasonable expectations 2.Subrogation 3.Ambiguities in a contract of adhesion 4.Utmost good faith - Subrogation
There are various optional provision for health policies. Which of the following is not an optional provision? 1.Intoxicants and narcotics 2.Conformity with state statutes 3.Reinstatement 4.Illegal occupation - Reinstatement Tony (the insured) cancelled his health policy by submitting a written notice to the insurer. How are unearned premiums handled? 1.Returned to the insured using a pro-rata basis 2.They are returned to the agent 3.The insurer gets to keep them 4.Returned to the insured using a short-rate basis - Returned to the insured using a short-rate basis The Patient Protection and Affordable Care Act allows states to combine their SHOP exchange with - 1.Commercial insurance companies 2.Their Medicaid recipients 3.Their exchange for individual consumers 4.All of the above - Their exchange for individual consumers o elect continuation of coverage, the insured must request continuation during the election period (45 days after the date of the _____). Employers must provide the proper forms for election within 14 days of receipt of request of election. 1.Arraignment, annulment, or release on bond 2.Indictment, cancellation, or invalidation
- incarceration, or arraignment 4.Death, divorce, or termination - Death, divorce, or termination
What provides hospital or medical policies or plans, nonprofit health service policies or plans, and health maintenance organizations? Health benefit plans Wellness cooperative plans "Cafeteria" wellness plans Annuitized wellness cooperatives - Health benefit plans No policy may be advertised, solicited, or issued as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than: Those of Medicare Those agreed to by the insured Those allowed by the Commissioner Those permitted under Medigap Part B - Those of Medicare Continuation of coverage for group medical plans shall continue for up to __ months after the date of death, divorce, or termination, subject to payment of premiums. 9 18 15 4 - 18 What provides affordable and accessible health insurance to support public and private initiatives for individuals without health insurance and promotes a health care system that meets the needs of all of the residents of its jurisdiction? Wellness maintenance associations Prepaid health service alliances Nonprofit health service plans
Prepaid wellness cooperatives - Nonprofit health service plans To act as an insurer in the state of Maryland, an insurer must hold _____ issued by the Commissioner. A compelling warrant of remuneration An applicable diploma of indemnity A valid certificate of authority A legitimate record of credibility - A valid certificate of authority Which type of care is a system of cost containment methods used by insurers or their agents to control cost and access to health care services, where insurers and providers review and preauthorize treatment plans? Non-critical Managed Free Supplemental - Managed Long-term care insurers may require a physical examination of any applicant: Age 70 or older Age 65 or older Age 75 or older Age 80 or older - Age 80 or older Which type of care is a system of cost containment methods used by insurers or their agents to control cost and access to health care services, where insurers and providers review and preauthorize treatment plans? Free Non-critical
Elimination periods Probationary periods - Probationary periods An example of presumptive disability might be any of the following EXCEPT: Severance of a hand Complete loss of hearing Amputation of a leg at the hip Total Blindness - Severance of a hand The government is one of three primary types of insurers. Government insurance provides protections against fundamental risks. Which of the following is an example of a government insurance program? Social Security Blue Cross Lloyd's Associations All of the above - Social Security Medicaid is a needs tested program. It provides medical benefits for the poor and indigent. It is funded as follows: 1.Employer taxes based on payroll 3.Payroll taxes from the employed 4.Part of Medicare 5.Jointly funded by individual states and the federal government - Jointly funded by individual states and the federal government A Medicare Supplement policy is issued with a "Free Look" period. This is usually a minimum of: 10 days 45 days
30 days 20 days - 30 days All long-term care policies are guaranteed renewable. Some long-term policies are called noncancellable. Which of the following is true about a noncancellable policy. 1.Policy cannot be cancelled as long as premiums are paid 2.Provisions of the policy can be changed 3.The insurer can decline to renew 4.The insurer can change the policy premium - Policy cannot be cancelled as long as premiums are paid Both private and government insurance are available in every state in the United States. Which of the following is one of the major differences between private and government insurance. 1.Government insurance can be either Federal or state 2.Both private and government have disability coverage 3.Government insurance is more efficient to run. 4.Private insurance can deny coverage to individuals - Private insurance can deny coverage to individuals In all of the following scenarios, the statements regarding loss are false EXCEPT: 1.Betty submits a claim for $300 to her insurance company. The amount of Betty's loss is $300. 2.Andrew gets in a fender bender, causing $3,000 in property damage to his car. He submits the claim to his insurance company, and the insurance company pays for the repairs. Andrew did not experience a loss. 3.Susie Q purchases a life insurance policy that will pay $100,000 to a beneficiary upon her death. The amount of loss upon Susie Q's death is $1,000,000. 4.Jim Bo has a renter's insurance policy that pays him $2,000 for loss of property caused by theft even though the actual cash value of his loss is $3,000. The amount of Jim Bo's loss is $2,000. - Betty submits a claim for $300 to her insurance company. The amount of Betty's loss is $
1.Intimidation 2.Bait and switch 3.Discrimination 4.Coercion - Coercion In addition to any greater penalty provided under the law, violation of Maryland insurance laws and regulations is a ________offense, subject to a fine up to $100,000. 1.Federal 2.Felony 3.Misdemeanor 4.None of the Above - Misdemeanor The Commissioner is given broad powers to establish insurance rules, hold hearings and issue orders, take disciplinary action, and assess penalties and fines. He may examine and investigate individuals or entities as deemed necessary, but must conduct examinations at least every ¬¬¬¬____________: 18 months 2 years 5 years 48 months - 5 years As a disciplinary action, the Commissioner may assess penalties of ________. $400 to $ $200 to $ $100 to $ $1000 to $5000 - $100 to $ Martha is issued her license on October 17, 2012. When will she need to renew her license?
On or before October 17, 2015 By midnight on December 31, 2014 On or before October 17, 2014 By midnight on December 31, 2015 - On or before October 17, 2014 The Commissioner may require up to __ hours of continuing education per renewal period for producer licensed for less than 25 consecutive years. 8 4 32 16 - 16 Insurers must report _________of a producer and update the producer register with the Commissioner within 30 days of the effective date. Termination Resignation Appointment Hiring - Termination Licenses expire ___________on the anniversary of the date the license was issued? Every fifth year Every year Every other year Every third year - Every other year The Commissioner may require up to __ hours of continuing education per renewal period for producer licensed for less than 25 consecutive years.
If a producer is terminated, the Insurer must notify the Commissioner if the termination was a result, in part or whole, by the producer's violation of Maryland insurance laws and regulations. How many days does the Insurer have to notify the Commission of the termination? Within 30 days 7 working days Immediately Up to 21 days - Within 30 days The Uniform Provisions Law requires all of the following as mandatory EXCEPT: Grace Period Waiver of Premium Physical examination and autopsy Entire Contract - Waiver of Premium All of the following provisions are required provisions for health policies EXCEPT: Grace Period Proof of loss Exclusions Reinstatement - Exclusions The N.A.I.C. proposes many pieces of model legislation in order to help standardize policy wordings, regulations and required benefits. The initials NAIC stand for: 1.National Association of Insurance Commissioners 2.National Association of International Companies 3.National Association of Interlocking Consortiums 4.National Association of Insurance Companies - National Association of Insurance Commissioners
Medicare is funded primarily from which of the following sources? 1.It comes from a payroll tax ear marked for Medicare 2.Loans from China provide most of the funding 3.The premiums that retirees pay provides most of the funding 4.It comes from the general revenue fund from all tax sources - It comes from a payroll tax ear marked for Medicare Which of the following characterizes risk pooling? none of the above spreading risk over a small number of people spreading risk over a large number of people dissimilar risks - spreading risk over a large number of people Peter is covered by a hospital expense policy that has specified benefits. His plan allows $100 for daily room and board and $1,000 maximum for ancillary expenses. The surgical expense allows $ maximum on a scheduled basis. Peter is hospitalized for 10 days with a surgeon's fee of $2,000. How much of the total expense for this hospital stay will Peter's insurance provide? The room rate is $ and the ancillary expense is $1, $5, $1, $2, $3,500 - $2, Ken has a medical plan through his employer that provides a schedule of benefits and payment allowances for those benefits in his employee group certificate booklet. Ken most likely in enrolled in a: Point of Service Plan PPO Plan Basic Surgical Expense Plan
Medicare Part C - also called Medicare Advantage Plans - came about as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Which of the following is available under the Medicare Advantage program? Private fee-for-service plans Managed care plans Preferred Provider plans All of the above - All of the above Group health insurance is a contract between an insurer and a group of some sort - be it an employer, a union, or some other type of group that was established to benefit its members. All of the following are true about group policies EXCEPT: The contract is issued to the employer or union, etc. Groups must exist naturally The policyholder is the employee Each employee receives a certificate of coverage - The policyholder is the employee An employer offers group insurance to his employees on a non-contributory basis. How many of his employees must be offered coverage under the group? 80% 75% 100% 90% - 100% Insurers that offer insurance to people through the individual market are called private insurers. Which of the following does not fall in the private insurer category? Stock companies Mutual companies Noncommercial organizations Self-insurers - Self-insurers
In addition to a cafeteria plan, how many other plans offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable? Six One None Two - None Isaac is enrolled in his employer's group plan on a non-contributory basis. He contract pneumonia and is hospitalized. Isaac is reimbursed for the medical expense he incurred less a $500 deductible. How much of his benefits will be taxed? 1.Isaac will have to include only the benefits that exceed 7.5% of his adjusted gross income in his income. 2.Isaac will have to include benefits in his income if his adjusted gross income is more than $65,000. (He is single) 3.Isaac will have no tax liability, as medical benefits are not taxable. 4.Isaac will have to include all benefits beyond the $500.00 deductible - Isaac will have no tax liability, as medical benefits are not taxable. Who maintains a cafeteria plan? An employer The state in which the plan was purchased The federal government An insurance company - An employer Various riders and provisions affect how, when and how much the insured received in benefits. The _____________ limits income benefits based on the insured's income for the past two years. Impairment rider Future increase option (FIO)
