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Colorado Health exam with answers
How often will the Commissioner examine domestic insurers in this state?- Answers โโ๐ฐ Every 5 years Which of the following reasons would allow a small employer carrier to terminate or fail to renew its contract or agreement with a producer?- Answers โโ๐ฐ Failure to pay premiums An individual seeking a license to sell insurance must complete a prelicensing program that includes how many hours pertaining specifically to state laws related to the line of authority?- Answers โโ๐ฐ 4 hours All of the following are regulations for producers using an assumed name EXCEPT a)The name may not be identical to the name of a producer whose license has been revoked. b)The name must be registered with the Commissioner. c)The name must not be misleading to the public. d)The name may be similar to another name currently on file.- Answers โโ๐ฐ The name may be similar to another name currently on file. An insurer must process a clean electronically submitted health claim within- Answers โโ๐ฐ 30 days. A producer is required to remit premiums from a trust account to the insurer within how many days of receipt?- Answers โโ๐ฐ 45 days
A Medicare supplement must have a freeโlook period of at least- Answers โโ๐ฐ 30 days. What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered?- Answers โโ๐ฐ Probationary period An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits?- Answers โโ๐ฐ Full benefits The provision which prevents the insured from bringing any legal action against the company for at least 60 days after proof of loss is known as- Answers โโ๐ฐ Legal actions. Contracts that are prepared by one party and submitted to the other party on a takeโitโorโleaveโit basis are classified as- Answers โโ๐ฐ Contracts of adhesion. Is Routine Dental care provided under part B insurance?- Answers โโ๐ฐ No An HSA holder who is 65 years old decides to use the money in the account for a nonhealth expense. Which of the following is true?- Answers โโ๐ฐ There will be a tax. Which of the following is NOT a feature of a noncancellable policy? a)The guarantee to renew coverage usually applies until the insured reaches certain age. b)The insured has the right to renew the policy for the life of the contract. c)The insurer may terminate the contract only at renewal for certain conditions.
An insurer who receives an Examination Request from the Division of Insurance must provide a complete response within- Answers โโ๐ฐ 10 calendar days All of the following are allowable rating factors for small group EXCEPT a) Health b) Standard industrial classifcation c) Tobacco use d) Tier of coverage- Answers โโ๐ฐ a) Health A firstโtime licensee does NOT have to comply with continuing education requirements until- Answers โโ๐ฐ Their second continuation, then every 2 years thereafter. What is the main justification for the existence of the State Insurance Department?- Answers โโ๐ฐ To protect the public Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilative care? a) Home health care b) Skilled care c) Intermediate care d) Custodial care- Answers โโ๐ฐ c) Intermediate care Under the mandatory provision Proof of Loss, the claimant must submit proof of loss within what time period after the loss?- Answers โโ๐ฐ 90 days A Major Medical Expense policy would exclude coverage for all of the following treatments EXCEPT
a) Drug Addiction b) Eye refractions c) Dental care d) Cosmetic surgery- Answers โโ๐ฐ a) Drug Addiction A dentist is off work for 4 months due to a disability. His dental assistants salary would be covered by- Answers โโ๐ฐ Business overhead insurance A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of deductible do they have in their policy?- Answers โโ๐ฐ Family Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time perameters?- Answers โโ๐ฐ Within 20 days Case characteristics for individuals and small employers include all of the folliowing EXCEPT a) Tobacco Use b) Occupation c) The age of covered individuals d) Family size- Answers โโ๐ฐ b) Occupation An insurance agent visits a potential client and explains various types of policies. The customer displays a lack of interest, so the agent guarantees higher dividends than he knows would be possible. Which term describes what the agent has done?- Answers โโ๐ฐ Misrepresentation The aggregate commissions for controlled business written by a producer are calculated for what period of time?- Answers โโ๐ฐ 12 months
a) Dread diease policy b) Accidental death and dismemberment policyc) Supplement social security coverage d) Travel insurance policy- Answers โโ๐ฐ c) Supplement social security coverage Which statement best describes agreement as it relates to insurance contracts? a) One party accepts the exact terms of the other party's offer b) The intent of the contract must be legally acceptable to both parties c) All parties must be capable of entering into a contract d) Each party must offer something of value- Answers โโ๐ฐ a) One party accepts the exact terms of the other party's offer HMOs are known as what type of plans?- Answers โโ๐ฐ Service Under the Affordable Care Act, when would pregnancy be considered a preโ existing condition?- Answers โโ๐ฐ Never What is the purpose of the impairment rider in a health insurance policy?- Answers โโ๐ฐ To exclude coverage for a specific impairment An insured had a heart attack while jogging, but is expected to return to work in approximately 6 weeks. The insured's Disability Income policy will- Answers โโ๐ฐ Replace a percentage of his lost income Which of the following is consideration on part of an insurer? a) Decreasing premium amounts b) Paying the premium c) Underwriting
d) Paying a claim- Answers โโ๐ฐ d) Paying a claim What is the purpose of a benefit schedule?- Answers โโ๐ฐ To state what and how much is covered in the plan What is maximum age that a disabled insured worker may receive Social Security disability benefits?- Answers โโ๐ฐ 65 Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within- Answers โโ๐ฐ 90 days of a loss. In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?- Answers โโ๐ฐ The insured must have first been hospitalized for 3 consecutive days. Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?- Answers โโ๐ฐ Attending physician An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she has not met the conditions specified in the- Answers โโ๐ฐ Consideration Clause. In order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits?- Answers โโ๐ฐ 60 days In what situation is it legal to limit coverage based on marital status?- Answers โโ๐ฐ It is never legal to limit coverage based on marital status.
How many hours of instruction must be completed by attending CE courses or programs of instruction approved by the commissioner?- Answers โโ๐ฐ 24 hours At least how many hours of the 24 credit hours must be approved in courses in the authorities for which the producer is licensed?- Answers โโ๐ฐ 18 Individual and insurance agency producer licensees will inform the Commissioner in writing, in a form prescribed by the Commission of any change of address within how many days?- Answers โโ๐ฐ 30 days How long can a producer reinstate his license after cancellation?- Answers โโ๐ฐ 1 year Insurance producers may charge specific fees for- Answers โโ๐ฐ Risk management, financial planning, investment consoling, qualified retirement design or administration, estate planning All insurance transactions must be conducted through an- Answers โโ๐ฐ Authorized insurer The insurer must provide the person making the claim with all necessary forms for filing proof of loss within how many days of receiving a notice of claim?- Answers โโ๐ฐ 15 days Group health policies must include a provision requiring written notice of claim within how many days after the occurrence or commencement of a covered loss?- Answers โโ๐ฐ 20 days Fine for a violation of insurance code- Answers โโ๐ฐ 1,
Types of licenses- Answers โโ๐ฐ Individual: resident, nonโresident and business entity. Possible disciplinary actions- Answers โโ๐ฐ License denial/revoke, cease and desist, monetary fines or imprisonment. The affordable care act (ACA) requires that all health care plans include the- Answers โโ๐ฐ 10 essential benefits Individual catastrophic plans that cover essential benefits are available for adults under the age of- Answers โโ๐ฐ 30 years old Health policies must provide coverage for annual prostate cancer screening for the early detection of prostate cancer in men over the age of what and what age for those who are in high risk categories?- Answers โโ๐ฐ Age of 50 and 40 for high risk Coverage for diabetes must include- Answers โโ๐ฐ Equipment & Supplies, outโpatient selfโmanagement training and education, medical nutrition therapy. Insurers providing coverage for prescription insulin drugs cannot require an insured to pay more than what for a 30 day supply?- Answers โโ๐ฐ $ The benefit period for hospice care is limited to- Answers โโ๐ฐ 90 days When in hospice care a patient is assumed to be in the terminal stage of illness and is expected to live- Answers โโ๐ฐ 6 months or less The total benefit for each benefit period for hospice services cannot be less than the per diem benefit, multiplied by- Answers โโ๐ฐ 90 days
Demographic characteristics that carriers consider when determining premium rates for individuals and small employers- Answers โโ๐ฐ Case characteristics In a small employer plan there cannot be a waiting period for more than- Answers โโ๐ฐ 90 days In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no individual Medicare supplement policy or certificate will be delivered or issued for delivery in this state unless what is delivered?- Answers โโ๐ฐ Outline of coverage Preโexisting condition means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within how many months of the effective date of coverage?- Answers โโ๐ฐ 6 months
