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Comprehensive Final Certification Exam: Illinois
Health Insurance (Xcel Solutions) Questions with
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Which type of long-term care benefit would be most appropriate for a stroke victim who requires speech therapy administered at her home? - ✔✔home health care Jennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains a(n) - ✔✔deductible When a producer submits an insurance applicaton, the application is REQUIRED to contain the producer's - ✔✔name and address Which of these provisions is required under an inidvidual Accident and Health policy? - ✔✔renewal, continuation, or nonrenewal provision Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA? - ✔✔it would be considered taxable income to the employee If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called -
✔✔noncancellable
When does a health insurance policy typically become effective? - ✔✔when initial premium is collected and policy is issued An insurer must furnish to a claimaint forms for filing proof of loss within __ days upon recieving a notice of claim - ✔✔ 15 When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? - ✔✔change of occupation provision Which of these is considered a mandatory provision? - ✔✔payment of claims In an insurance contract, the applicatns "consideration" is the - ✔✔statements made in the application and the premium The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the: - ✔✔insuring clause According to Illinois law, when must a producer deliver the Outline of Coverage to a Medicare Supplement applicant? - ✔✔at the time of application
What determines the full amount of Social Security retirement beneits a qualified individual is entitled to recieve? - ✔✔Primary Insurance Amount (PIA) In an employer-sponsored group accident and health plan, a master contract is issued to the - ✔✔employer Which statement would be prohibited in an Accident and Health advertisement? - ✔✔"all hospital bills will be paid by your policy" An insurance aplicant with a below-average likelihood of loss typically considered to be a - ✔✔preferred risk J purchased a Medicare Supplement policy through a direct-response solication. J is allowed at LEAST __days after policy delivery to return the policy and recieve a full refund - ✔✔ 30 A medicare supplement policyholder has __ days to return the policy and recieve a full premium refund - ✔✔ 30 Q the producer gave his client a rebate as an enticement to purchase insurance. Q may be found guilty of a - ✔✔class B misdemeanor
At what point may a health insurer modify coverage for an individual health policy? - ✔✔at the time of coverage renewal Joe is a Medicare participant who receives his benefits through a Managed Health Care Plan. Which Medicare plan does he have? - ✔✔Part C To continue health coverage for a newborn, the policyowner must notify the insurer of birth and provide the first premium payment within _____ days of birth. - ✔✔ 31 Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance?
- ✔✔medicare in-hospital deductable All of the following are primary risk factors in underwriting individual health insurance policies EXCEPT - ✔✔geographical location Which of the following is considered an activity of daily living (ADL) as defined under a long- term care policy? - ✔✔dressing All of the following are functions of an insuring clause EXCEPT - ✔✔primarly describes the free-look period
Insurable interest does NOT occur in which of the following relationships? - ✔✔business owner and business client Long-term care policies issued in Illinois MUST be - ✔✔guaranteed renewable Which situation would qualify an individual for recieving benefits from a long-term care policy?
- ✔✔being cognitively impaired (mentally ill) The period in which there are no social security benefits for the surviving spouse
- ✔✔blackout period J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? - ✔✔Noncancelable Evidence of coverage issued by a Limited Health Service Organization (LHSO) MUST include a description of the - ✔✔limited health services that the enrollee is entitled to receive In which of the following situation would the insurer be liable for loss? - ✔✔the insured suffered an injury as an innocent bystander during a bank robbery
What is the required renewability status of all medicare supplement policies - ✔✔guaranteed renewable Which of the following typically does NOT provide a form of managed care? - ✔✔Major medical indemnity plan A business entity wishes to become approved as a producer for soliciting insurance business. Before doing so, the business entity is required to submit to the Director a(n) - ✔✔designated producer assigned for compliance with Illinois insurance laws Long-Term Care policies may provide coverage for claims arising from - ✔✔senile dementia Which type of renewability best describes a Disability Income policy that covers an individual until the age of 65, but the insurer has the right to change the premium rate? - ✔✔guaranteed renewable The Director MUST be notified of a producer's change of home address within ___ days - ✔✔ 30 It is acceptable to discriminate the amount of benefits for life and health policies between individuals of - ✔✔different classes
How does one qualify as a fully-insured individual under Social Security disability coverage? - ✔✔individual has been credited with the appropriate number of quarters of coverage All of the following are included as part of a contract in the entire contract provision EXCEPT the - ✔✔changes made by the producer What is medicare part b also known as - ✔✔supplementary medical insurance in a group health care what is the purpose of the coordination of benefits provision? - ✔✔determines what is paid by the primary and secondary insurers in the event of a claim An applicant's character and personal habits can be obtained for underwriting purposes from which source? - ✔✔investigatrive consumer report Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? - ✔✔increase the premiums on an individual basis what is the purpose of the medical information bureau (MIB) - ✔✔to help underwriters evaluate risk
The power given to an individual producer that is not specifically addressed in his/her contract is considered what type of authority? - ✔✔implied Which of the following types of insurance may a limited lines producer sell? - ✔✔industrial life The holder of a business entity registration is REQUIRED to notify the Director whtin __ days of a change in office location - ✔✔ 30 Continuous 24-hour care provided by licensed medical professionals under the direct supervision of a physician is calle? - ✔✔skilled nursing care Which of the following pertains to the analysis of an applicant's personal information and determining whether insurance should be issued or declined? - ✔✔underwriting Which of these is NOT an unfair method of competition? - ✔✔replace coverage written by another producer Which of these is considered a mandatory provision? - ✔✔payments of claims When are group disability benefits considered to be tax-free to the insured? - ✔✔When the recipient pays the premiums
The sections of an insurance contract which limit coverage are called - ✔✔exclusions The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is: - ✔✔time Limit on Certain Defenses A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation? - ✔✔will be the secondary insurer and pay for claims not fully covered by the group plan How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes? - ✔✔not tax deductible The MAXIMUM time period that pre-existing conditions can be excluded in long-term care policies is - ✔✔6 months a disabled individual is eligible to receive benefits for a medicare supplement policy at age - ✔✔ 65 If an individual has an accidental death and dismemberment policy and dies, an autopsy can be performed in all these situations, EXCEPT: - ✔✔when the state prohibits by law
All of the following are elements of an insurance policy EXCEPT - ✔✔claim forms Which of the following services is NOT covered under a Limited Health Service Organzation? - ✔✔home health care services What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision? - ✔✔Insured must be under a physician's care According to the Mandatory Uniform Policy Provisions, the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid? - ✔✔31 days An insurance company normally has 2 years to contest information provided on an accident and health application. This 2 year period begins on the date that the - ✔✔insurer dates the policy Which of the following is not a required provision in an accident and health insurance policy - ✔✔change of occupation what is the minimum benefit period for long-term care policy? - ✔✔12 months
An insurance producer is often responsible for field underwriting during the application process. All of these are possible field underwriting roles EXCEPT - ✔✔providing commission informaion to the applicant Which of the following MUST be delivered with a Medicare Supplement policy? - ✔✔Outline of coverage Which of the following would be a valid reason why a policy premium would be higher than the standard premium? - ✔✔The insured does not meet established underwriting requirements All of these MUST be included on an insurance producer's license EXCEPT - ✔✔appointing insurance company A dread disease policy is considered to be a type of - ✔✔limited health insurance policy Small employers who are sponsored by an insurer to provide group benefits to its employees are called - ✔✔MEWA (a multiple employer Welfare Association) Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract? - ✔✔entire contract
What is the primary factor that determines the benefits paid under a disability income policy - ✔✔wages Before applying for an Illinois resident producer license, an applicant MUST - ✔✔complete a prelicensing course A group disability income plan that pays tax-free benefits to covered employees is considered? - ✔✔fully contributory Medicare provides coverage for each of the following EXCEPT - ✔✔custodial care With Optionally Renewable Health policies, the insurer may - ✔✔review the policy annually and determine whether or not to renew it A payment system for healthcare in which the provider is paid for each service given is called - ✔✔fee-for-service What is the minimum grace period for an individual health policy that is paid monthly - ✔✔10 days Which of the following describes a person who is NOT acceptable by an insurer at standard rates because of health history, occupation, or hobbies? - ✔✔substandard risk
