Question one all of the following services are generally covered under medica it accept a cosmetic surgery b mental health services c rural health clinic services d prescription drug services the correct answer is a cosmetic surgery question two medicare part of hospital insurance covers within certain limits all of the
Following expenses except a inpatient hospital costs b long-term care costs c home health care costs d hospice costs the correct answer is b long-term care costs question three employer group health plans are prohibited from offering medicare-covered employees or spouses coverage under a medicare supplement plan that a discriminates based on age
B pays for services covered by medicare c gives preference to one spouse over the other d is more expensive than medicare the correct answer is b pays for services covered by medicare question four during the application process insurance coverage can be profited under a conditional receipt or which of the following a an interim receipt b a temporary insurance receipt
C awaiting period receipt d a grace period receipt the correct answer is b a temporary insurance receipt question five which of the following techniques is not used during the utilization review process a second opinions be preventive care review c discharge planning d concurrent review the correct answer is
Preventive care review question six a disability income policy's benefit period is the maximum period during which monthly benefits are paid for an insured's ongoing disability.which of the following statements about benefit periods is not correct a a physician must care for the insured during a disability and throughout the benefit period v for benefit payments to continue a physician must certify that the insured
Remains disabled c the maximum benefit period is determined at the time the policy is applied for and issued d while benefit periods can vary they cannot last for the duration of the insured's life the correct answer is d while benefit periods can vary they cannot last for the duration of the insured's life question 7. dana is covered by td industries group long-term
Disability plan the company pays 80 of the premium and dana pays the remainder.dana becomes disabled and receives two thousand dollars a month in benefits for three months how much of dana's benefits are subject to income tax a two thousand dollars b one thousand six hundred dollars c one thousand dollars d four hundred dollars the correct answer is b
One thousand six hundred dollars question medical expense policies cover a wide range of services and care the way in which they cover the cost of these services and the way in which covered care services are delivered depends on which of the following a state insurance law b the plan or policy c the insured's age in health d the insurer's marketing of these
Services the correct answer is b the plan or policy question nine all of the following statements about the medicare program are correct except a for those eligible for social security retirement benefits part of coverage is free be medicare pardo coverage is free to those under age 65 who are receiving social security disability benefits or anyone who has been diagnosed with permanent kidney failure
C parts b c and d if elected require the payment of monthly premiums which may be deducted automatically from a person's social security retirement benefits d a 65 65-year-old not receiving social security retirement benefits is required to obtain coverage under medicare part a the correct answer is d a 65-year-old not receiving social security retirement benefits is required to obtain coverage under medicare part a
Question 10 which of the following statements is not true about group insurance a a master contract is issued b underwriting is on a group not an individual basis c exclusions and writers are written for the most at risk members d the cost is lower than it is for individual policies the correct answer is c exclusions and riders are written for
The most at risk members question 11 acme insurance and apogee insurance agree to offer different premium rates for persons of equal risk within a particular class they also agree to limit benefits paid to insureds within this class if the insureds live in certain counties of north carolina what are acme and apogee engaging in a acceptable marketing and underwriting practices
Be unfair and prohibited business practices see insurance fraud d false advertising the correct answer is b unfair and prohibited business practices question 12 which of the following statements is not true about group insurance a a master contract is issued the underwriting is on a group not an individual basis
C exclusions and writers are written for the most at risk members d the cost is lower than it is for individual policies the correct answer is c exclusions and riders are written for the most at risk members question 13. which of the following groups would typically not be eligible for group accident and health insurance a association group b neighborhood group
C labor union d employer group the correct answer is b neighborhood group question 14 abby age 66 just purchased an individual health insurance policy on what basis can the insurer exclude coverage for diabetes a condition that abby was diagnosed with one year ago a the insurer can exclude coverage for up to six months v the insurer can exclude coverage for up to one year
C the insurer may not exclude coverage for abby's pre-existing d the insurer may limit coverage only if abby's pre-existing condition was specifically defined in the policy the correct answer is d the insurer may limit coverage only if abby's pre-existing condition was specifically defined in the policy question 15. robin breaks a leg while snow skiing considering herself lucky at wassily a
Leg she decides she will never again attempt snow skiing which of the following is robin using as a means of risk management a risk retention b risk avoidance c risk reduction d risk transfer the correct answer is b risk avoidance question 16. roy has an insurance policy that pays a fixem directly to him for each day he spends in a hospital
What type of insurance policy does roy have a a basic medical expense policy b a major medical policy c a comprehensive policy d a hospital indemnity policy the correct answer is d a hospital indemnity policy question 17 what are the other insurance with this insurer provision and the other insurance with other insurers provision examples of
A the relation of earnings to insurance provision b the change of occupation provision c the misstatement of age provision d coordination of benefits the correct answer is d coordination of benefits question 18. insurers can sell both qualified and non-qualified ltc policies what can those who buy qualified policies do a buy additional benefits unavailable to those who buy
Non-qualified policies v exclude benefits from tax-qualified long-term care insurance policies from the recipient's income with no limits c deduct their premiums from their state income taxes d deduct their premium payments from their federal income taxes within certain specified limits the correct answer is d deduct their premium payments from their federal income taxes within certain
Specified limits question 19. what do group short-term disability income plans generally limit coverage to a occupational disabilities v non-occupational disabilities see both occupational and non-occupational disabilities d sickness-related disabilities only the correct answer is b non-occupational disabilities question 20 which of the following is not one of the
12 required provisions for health insurance policies set forth by the naic a entire contract provision v grace period provision c waiver of premium provision d time limit on certain defenses provision the correct answer is c waiver of premium provision question 21 how long from contract signing an issue does an insurance company have to discover and void an insurance policy due to fraud a 6 months
V 12 months c 18 months d 24 months the correct answer is d 24 months question 22 dave owns a small business he wants disability coverage that would pay routine business expenses if a disability should cause him to bunable to work for a while what kind of insurance does dave probably want
A business overhead expense insurance b small business insurance see entity buy sell insurance d workers compensation the correct answer is a business overhead expense insurance question contributions are tax deductible and accumulate tax-free with tax-free distributions for qualified medical expenses under which of the following a health savings accounts hsas
B medical savings accounts msas c individual retirement accounts iras d flexible spending accounts fsas the correct answer is a health savings accounts hsas question 24 which statement about disability reducing term insurance policies is not correct a the business owner typically buys a policy to cover the term of a loan b the policy pays off the loan balance if the business owner becomes disabled
During the policy term c the benefit payment under such policies increases over the policy's term d reducing term insurance is fairly inexpensive the correct answer is c he benefit payment under such policies increases over the policy's term question 25 jim applied for a health insurance policy the insurer attached a waiver to the
Policy that excludes any loss associated with cardiac illness how has jim's application been classified a preferred v substandard c standard d declined the correct answer is b substandard question 26 susanna has been diagnosed with cancer she has health insurance but wonders how much she will have to pay for her care
And treatments.what is the maximum amount she would have to pay under the terms of her policy a the deductible b the medical condition allocation c the out-of-pocket maximum d the policy limit the correct answer is c the out-of-pocket maximum question 27 zelda a producer selling health insurance assures a prospective applicant that the insurance company she represents is backed by the protections
Of the north carolina life and health insurance guaranty association which of the following statements is correct regarding this kind of assurance a it is recommended when selling health insurance b it is prohibited at all times c it is required when selling to medicare-eligible individuals d it is highly regulated by the insurance department the correct answer is b it is prohibited at all times question
28 joshua's major medical policy requires him to pay 15 every time he goes to see his doctor what is this payment called a the deductible b the policies out of pocket maximum c the doctor visit limit d the copayment the correct answer is d the co-payment question 29 statewide insurers wants to obtain an investigative consumer report about an
Applicant because of questions it is regarding the individual's credit history what must statewide do before it can obtain a report they notify the applicant that he has the right to be interviewed in connection with the report v obtain the applicant's signed consent before obtaining the report c notify the applicant that he has the right to prepare his own report
D require the applicant to sign an affidavit attesting to the truth of the statements in the report the correct answer is a notify the applicant that he has the right to be interviewed in connection with the report question 30 what is the term for voluntarily giving up a known right a estoppel b waiver c voidable
D conditional the correct answer is b waiver question 31 for which of the following transactions does a person need more than an insurance license a selling variable life insurance be comparing an existing policy with one that is being recommended c selling indeterminate premium whole life insurance for example universal life insurance
Dereplacing an existing life insurance policy with one that is recommended by the producer the correct answer is a selling variable life insurance question 32 an employee who suffers a short-term job-related injury may look to his or her employer to do which of the following a provide coverage under its group short-term disability income policy v provide coverage through its group
Medical plan for the lost income c provide coverage through workers compensation insurance d provide coverage through its long-term group disability plan the correct answer is c provide coverage through workers compensation insurance question 33 which of the following represents consideration under the terms of an insurance policy contract a the insurers promise to renew the
Contract v the policy's benefits c the premium paid d any claims paid the correct answer is c the premium paid question 34 an insurance company can exclude coverage for a specific medical condition by including which type of writer in a health insurance policy a specified disease or illness b cancellation
C pre-existing condition d impairment the correct answer is d impairment question 35 what are the premiums that alan pays for his individually owned medical expense insurance a a business expense b a personal expense c a medical expense d unnecessary expense the correct answer is b
A personal expense question 36 dr sanjay has agreed to become part of the alliance ppo when ppo enrollees come to his office for care dr sanjay must then a bill the patients directly for the care b accept the ppo's negotiated fee as full payment for services see negotiate with the ppo regarding the amount that it will pay d require patients to immediately pay the entire bill and to seek
Reimbursement from the ppo the correct answer is b accept the ppo's negotiated fee as full payment for services question 37 debbie lisa greta and jessica apply for individual health insurance policies at the end of the underwriting process the insurer classified them as follows debia substandard lisa as standard and jessica's preferred greta's application was declined which of the following statements is
Correct a debbie's policy will be issued at standard premium rates b lisa's policy may be charged an additional premium c essica's policy will be issued with the lowest premium rate d greta can submit to another medical exam in order to qualify for a policy with the insurer the correct answer is c essica's policy will be issued with the lowest premium rate question 38 becky
Works as an agent for delta insurance company which is located in north carolina what must becky do in order to sell life insurance on behalf of delta to u.s military personnel who are stationed in germany a she must obtain a non-resident license b she must obtain a surplus lines agent's license c she must obtain a restricted license d nothing because she is already
Licensed as an agent the correct answer is c she must obtain a restricted license question 39 if an agent is selling insurance for a company that does not have a certificate of authority to operate in that state what is the status of the company in that state a it is an alien company b it is a non-admitted company c it is an unregistered company d it is a limited lines company the
Correct answer is b it is a non-admitted company question 40. betsy's policy states that the insurer can increase premium rates by class of insureds but it cannot make any other changes to the policy and the policy can be cancelled only if betsy fails to pay her premiums.what type of policy does betsy have a non-renewable b guaranteed renewable c non-cancelable
Decancelable the correct answer is b guaranteed renewable question 41 a claimant on a health insurance policy must give written notice of the claim to the insurer within how many days following a loss a 7 b 10 c 14 d 20 the correct answer is d 20.
Question 42 abby received 15 000 of benefits this year under her group hmo plan.which of the following statements is correct a she is not required to include any part of the benefits in her income v she must include part of the benefits in her income c she must include all of the benefits in her income d she must include the benefits in her income to the extent they exceed a
Certain percentage of her adjusted gross income the correct answer is a she is not required to include any part of the benefits in her income question 43 which of the following optional provisions applies to policies that provide income payments if the insured becomes disabled a the relation of earnings to insurance provision b the unpaid premium provision c the cancellation provision
D the conformity with state statutes provision the correct answer is a the relation of earnings to insurance provision question 44 which of the following can be used either to limit or expand coverage by adding optional benefits a a non-renewable cancel label or term policy b a conditionally renewable policy c a guaranteed renewable policy d a health insurance policy writer the
Correct answer is d a health insurance policy writer question 45 comprehensive major medical plans provide a broad range of coverage.they most likely cover all of the following except a hospital expenses surgeons and doctors fees and nursing care b physical and occupational therapy diagnostic tests and lab fees see cosmetic surgery experimental procedures or treatment and alcohol and
Drug abuse treatment d medical supplies and equipment and ambulatory costs the correct answer is c cosmetic surgery experimental procedures or treatment and alcohol and drug abuse treatment question 46 the 12 mandatory provisions included in all health policies originated with which of the following a hipaa b the affordable health care act see medicare
D the naic uniform accident and sickness policy provision law the correct answer is d the naic uniform accident and sickness policy provision law question 47 harvey's health insurance policy covers only treatment for cancer what type of insurance policy does harvey have a a basic medical expense policy b a restricted policy c a dread disease policy
D a cancer policy the correct answer is c a dread disease policy question 48 harold has short-term disability income policy were he to become disabled benefits would typically be payable for no more than a six months b one year c two years d five years the correct answer is c
Two years question 49 workers compensation plans offer all of the following benefits to covered workers except a wage replacement benefits for disability b medical treatment c vocational rehabilitation d expenses of running a business until a disabled worker can return to work the correct answer is d expenses of running a business until a
Disabled worker can return to work question 50. if an insurer issues a disability income policy that pays a set monthly benefit of 500 which approach is the insurer using a percentage limitation approach b income formula approach c flat rate approach d specified benefit approach the correct answer is c flat rate approach