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Louisiana Life and Health Insurance Exam (Actual
Exam 2025)| Updated Questions and Correct
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Which of the following is NOT the purpose of HIPAA? A. To limit exclusions for pre-existing conditions B. To provide immediate coverage to new employees who had been previously covered for 18 months C. To guarantee the right to buy individual policies to eligible individuals D. To prohibit discrimination against employees based on their health status ------- --CORRECT ANSWER-----------------B. To provide immediate coverage to new employees who had been previously covered for 18 months HIPAA does not prohibit employers or providers from establishing waiting periods or pre-existing conditions exclusions, in which case the coverage to new employees would not be immediate. An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider, which of the following will happen?
A. The PPO will pay reduced benefits. B. The PPO will not pay any benefits at all. C. The insured will be required to pay a higher deductible. D. The PPO will pay the same benefits as if the insured had seen a PPO physician. - --------CORRECT ANSWER-----------------A. The PPO will pay reduced benefits. The group health plan will not pay the full amount charged by the non-PPO doctor. Which of the following is the term for the specific dollar amount that must be paid by an HMO member for a service? A. Cost share B. Copayment C. Deductible D. Premium ---------CORRECT ANSWER-----------------B. Copayment
C. 62
D. 65 ---------CORRECT ANSWER-----------------D. 65
After age 65, a withdrawal from an HSA used for a nonhealth purposes will be without a penalty, although taxed. Which of the following statements is NOT correct concerning the COBRA Act of 1985? A. It applies only to employers with 20 or more employees that maintain group health insurance plans for employees. B. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. C. It requires all employers, regardless of the number or age of employees, to provide extended group health coverage. D. It covers terminated employees and/or their dependents for up to 36 months after a qualifying event. ---------CORRECT ANSWER-----------------C. It requires all employers, regardless of the number or age of employees, to provide extended group health coverage. COBRA Act applies to only employers with 20 or more employees.
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days? A. Conversion B. Replacement C. Grace period D. Renewability ---------CORRECT ANSWER-----------------A. Conversion Conversion provisions are required by law. It allows terminated employees to convert their group health coverage to individual insurance without evidence of insurability, within a specified amount of time, and for eligible reasons. Which of the following would be a qualifying event as it relates to COBRA? A. Eligibility for Medicare B. Termination of employment due to downsizing C. Termination of employment for stealing
Your client has a Social Insurance Supplement (SIS) rider on his disability policy. After he becomes disabled, he receives payments from the company. Shortly thereafter, he also begins receiving Social Security benefit payments. Which of the following will happen? A. The SIS rider will discontinue paying benefits. B. Both plans will continue to pay fully. C. The SIS payment will be reduced dollar-for-dollar by the Social Security benefit payment. D. Social Security will discontinue benefits until the SIS rider expires. --------- CORRECT ANSWER-----------------C. The SIS payment will be reduced dollar-for- dollar by the Social Security benefit payment. A Social Insurance Supplement (SIS) rider pays a disability benefit in an amount close to what Social Security would pay. If Social Security benefit payments begin, the SIS payment will be reduced dollar-for-dollar by the Social Security benefit payment. A policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called
A. Partial Disability B. Recurrent Disability C. Business Overhead Expense. D. Credit Accident and Health coverage ---------CORRECT ANSWER-----------------C. Business Overhead Expense. Business Overhead insurance is often purchased by small employers to pay the ongoing business expenses (such as payroll) in the event the owner of the business becomes disabled. Premiums paid are tax deductible as a business expense, but proceeds paid are taxable as income. 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? A. Full benefits for 2 years B. No benefits C. Full benefits D. Partial benefits ---------CORRECT ANSWER-----------------C. Full benefits
The period of time immediately following a disability during which benefits are not payable is A. The residual period. B. The elimination period. C. The probationary period. D. The grace period. ---------CORRECT ANSWER-----------------B. The elimination period. The elimination period is a waiting period, expressed in days, not dollars, imposed on the insured from the onset of disability until benefit payments commence. All of the following benefits are available under Social Security EXCEPT A. Death benefits. B. Welfare benefits. C. Old-age and retirement benefits. D. Disability benefits. ---------CORRECT ANSWER-----------------B. Welfare benefits.
Social Security is an entitlement program, not a welfare program. An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits? A. No benefits B. Full benefits C. Partial benefits D. Full benefits until the blindness lifts ---------CORRECT ANSWER-----------------A. No benefits Presumptive Disability plans offer full benefits for specified conditions. These policies typically require the loss of use of at least two limbs, total and permanent blindness, or loss of speech or hearing. Benefits are paid, even if the insured is able to work. Because the insured's blindness was only temporary and the loss of use in only 1 leg, he does not qualify for presumptive disability benefits.
D. During the elimination period. ---------CORRECT ANSWER-----------------B. For the first 2 years of a disability. The own occupation definition of disability usually applies to the first 24 months after a loss. Which of the following is considered a presumptive disability under a disability income policy? A. Loss of hearing in one ear B. Loss of one hand or one foot C. Loss of two limbs D. Loss of one eye ---------CORRECT ANSWER-----------------C. Loss of two limbs Presumptive disability is a provision that is found in most disability income policies that specifies conditions that will automatically qualify the insured for full disability benefits, such as the loss of two limbs. Which statement accurately describes group disability income insurance?
A. Short-term plans provide benefits for up to 1 year. B. The extent of benefits is determined by the insured's income. C. In long-term plans, monthly benefits are limited to 75% of the insured's income. D. There are no participation requirements for employees. ---------CORRECT ANSWER-----------------B. The extent of benefits is determined by the insured's income. Group plans usually specify the benefits based on a percentage of the worker's income. Group long-term plans provide monthly benefits usually limited to 60% of the individual's income. The amount of Social Security disability benefits is based upon the worker's Primary Insurance Amount (PIA), which is calculated from their Average Indexed Monthly Earnings over which years? Which years of income may be deleted from calculation? A. Their highest 20; lowest 2 B. Their highest 35; lowest 5 C. Their highest 40; lowest 5
A. Probationary period. B. Disability period. C. Elimination period. D. Black-out period. ---------CORRECT ANSWER-----------------C. Elimination period. The elimination period is the time immediately following the start of a disability when benefits are not payable. This is used to reduce the cost of providing coverage and eliminates the filing of many claims. If a business wants to buy a disability income policy on a key employee, which of the following is considered the applicant? A. The producer B. The employer C. The insurer D. The employee ---------CORRECT ANSWER-----------------B. The employer
In key person disability insurance purchased by a business, the business is the applicant and the key person is the insured. When the policy is issued, the business is the policyowner and is responsible for paying the premiums. All of the following are correct about the required provisions of a health insurance policy EXCEPT A. The entire contract clause means the signed application, policy, endorsements, and attachments constitute the entire contract. B. A reinstated policy provides immediate coverage for an illness. C. Policies become incontestable after being in force for 3 years. D. A grace period of 31 days is found in an annual pay policy. ---------CORRECT ANSWER-----------------B. A reinstated policy provides immediate coverage for an illness. Accidental injury is covered immediately, but to protect the insurer against adverse selection, losses resulting from sickness are covered only if the sickness occurs at least 10 days after the reinstatement date. An insured pays a monthly premium of $100 for health insurance. What would be the duration of the grace period under the policy?
The consideration clause specifies that both parties to the contract must give some valuable consideration. The payment of the premium is the consideration given by the applicant. Because the applicant had not paid an initial premium, she is not covered by insurance. Question 12 of 15 Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain A. An estimate of the total amount of medical and hospital expense for the loss. B. A complete physician's statement. C. A statement that is sufficiently clear to identify the insured and the nature of the claim. D. A statement from the insured's employer showing that the insured was unable to work. ---------CORRECT ANSWER-----------------C. A statement that is sufficiently clear to identify the insured and the nature of the claim. The Insurance Code requires that each policy must include, "Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible".
Question 13 of 15 The expense for an autopsy covered under the physical exam and autopsy provision is paid by A. The estate of the insured. B. The insurer. C. The state's autopsy fund. D. The limits of coverage under the health insurance policy. ---------CORRECT ANSWER-----------------B. The insurer Where not forbidden by state law, the insurer, at its own expense, may cause an autopsy to be performed on a deceased insured. An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss? A. Time of Payment of Claims B. Incontestability C. Physical Exam and Autopsy
