Download AD Banker Comprehensive Exam: Insurance Multiple Choice Questions and Answers - Prof. Brya and more Exams Nursing in PDF only on Docsity!
AD Banker Comprehensive Exam
5 months correct answerThe waiting period from the start of a disability to be eligible to apply for Social Security disability is: Nonoccupational Basis correct answerMost group Disability Income contracts are offered on a(n): Dental expense insurance deductibles are normally waived for all of the following, except: correct answerRoutinely paying premiums on time and in full Which of the following documents used for underwriting can be completed by talking to the proposed insured over the phone? A APS B Inspection report C Agent's report D MIB correct answerInspection Report Which of the following business disability plans can create a taxable event: A Key person disability insurance B Business overhead expense C Disability buy-sell agreement
D
Accidental death and dismemberment correct answerBusiness overhead expense All of the following are correct regarding the coverage of a cancer policy, except: Coverage under this policy will pay for losses before primary medical expense policiesr to prevent an insured from reaching annual or lifetime policy limits B Benefits are provided for losses associated with a cancer diagnosis C Coverage for experimental treatments is usually provided D The policy will only provide benefits for losses covered on an underlying medical expense policy correct answerThe policy will only provide benefits for losses covered on an underlying medical expense policy After K completed an application for health insurance, a paramedical scheduled an appointment to check height, weight, blood pressure, and collect blood and urine samples. This is an example of which source of underwriting? correct answerMedical exam Under the Legal Actions Mandatory Uniform Provision, an insured must wait at least _____ days after providing proof of loss before he or she can take legal action against the insurer. correct answer60 days When underwriting group life, the underwriter treats the group as if it were: correct answerOne individual If an employer purchases a Key Person disability policy on an employee, when would the disability benefit be received income tax free? correct answerIt is by definition tax-free since the employer buys it for his or her own benefit Upon joining an HMO, the plan will require the subscriber to select a: correct answerPrimary Care Physician
All health insurance policies covering dependents of the insured must provide coverage for newborns: correct answerFrom the moment of birth All of the following are exclusions under an LTC policy, except: correct answerChemical dependency on one's own prescription drugs A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as: correct answerMedicaid Which of the following exclusions applies to Long-Term Care coverage? Home care B Adult day care C Respite care D Rest Cures correct answerRest Cures HIPAA ensures which of the following? A Notice of information practices when received by a third party B Answers on the application are guaranteed to be true C Privacy of health information D The insurer must provide a copy of a third-party report to the applicant correct answerPrivacy of health information
Case managers do all of the following, except: Determining the appropriate course of action for the insured B Requiring a referral or second opinion prior to approving a procedure C Managing the utilization review of a hospital stay D Providing the necessary care correct answerProviding the necessary care Members of the ___________ include state and territorial insurance commissioners or regulators. correct answerNational Association of Insurance Commissioners (NAIC) A qualified Long-Term Care Policy may exclude losses incurred from preexisting conditions for no longer than ______ months from the effective date of coverage. correct answer An insurer NOT authorized to do business within this state is considered what type of insurer? correct answerNon-Admitted Which of the following is a permitted ground for discrimination for a group health policy? A Health status B Medical condition C Material misrepresentation D Genetic information correct answerMaterial misrepresentation
The insurer will provide specific instructions as to what changes on the application the producer can make correct answerAny change or correction must be initialed by the applicant When payment under a Medical Expense policy is based on the average fee charged by all doctors in a given geographical area, and the balance of any overcharges or costs of any disallowed services are the insured's responsibility, the payment is known as: correct answerUsual, customary, reasonable (UCR) payment Which of the following types of coverage must provide at least 80% of the charges for semi-private room accommodations, or $100 per day? A Basic Hospital Expense B Major Medical C Basic Medical-Surgical Expense D Accident Only correct answerBasic Hospital Expense A producer whose license has been suspended may not reapply for: correct answer3 years Any person acting as a producer without a license is guilty of: correct answerA Class A misdemeanor Which rider would eliminate coverage for a preexisting condition? A Guaranteed Purchase Option B Lifetime Benefit Rider
C
Return of Premium Rider D Impairment Rider correct answerImpairment Rider A long-term care policy may do which of the following? A Condition eligibility for institutional benefits on a requirement of prior institutionalization B Condition eligibility for non-institutional benefits on a prior institutional stay of 30 days C Condition eligibility for institutional benefits on a requirement of prior hospitalization D Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care correct answerCondition eligibility for non-institutional benefits on a prior institutional stay of 30 days Offering a premium discount, or any other consideration not described in the policy is called: correct answerRebating A Group Health plan may deny coverage for preexisting conditions for no more than how many months after the effective date of coverage? correct answer Insurers include provisions in contracts to help reduce unnecessary claims and the overpayment of claims. Which of the following is not one of those provisions? Consideration Clause B Concurrent Review
D
Adjust claims correct answerAdjust claims Which of the following is not a Mandatory Uniform Provision? Reinstatement B Payment of Claims C Physical Exam and Autopsy D Conformity with State Statutes correct answerConformity with State Statutes Which of the following statements is NOT correct with regard to replacement requirements for individual health insurance? An application must determine whether coverage is intended to replace another health policy in force B The insurer must give the applicant a Notice Regarding Replacement, after issuing or delivering the policy C The insurer must give the applicant a Notice Regarding Replacement, before issuing or delivering the policy D The Notice Regarding Replacement states that certain factors may affect the protection available under a new policy, including preexisting conditions correct answerThe insurer must give the applicant a Notice Regarding Replacement, after issuing or delivering the policy If the insured is receiving regular disability income payments, the insurer can require notice of continuance of claim every ______ months. correct answer
The Insuring Clause under an individual A&H policy would contain all the following, except: correct answerPremium or rate calculations Which of the following is a Managed Care Provision used by insurers to monitor hospital stays? correct answerConcurrent Review Which of the following statements is false concerning disclosure requirements? A soliciting producer's name and signature must be on an application for individual or group life or health coverage B A policy solicited by a producer must identify the name of the firm C A policy solicited by a producer must identify the name of the producer D A soliciting producer's name and signature must be on an individual or group life or health policy correct answerA soliciting producer's name and signature must be on an individual or group life or health policy Guaranteed Renewable means: correct answerRenewable with adjustable premiums, by classification only A Medicare Supplement may deny coverage for preexisting conditions for no more than how many months after the effective date of coverage? correct answer Which of the following is NOT an example of a prohibited practice? correct answerBackdating Which of the following is permitted grounds for discrimination for a group health policy? correct answerMaterial misrepresentation Which of the following correctly describes the difference between a HMO and a Limited Health Service Organization (LHSO)?
All states have adopted the Uniform Individual Accident and Sickness Policy Provision Law. If an insurer changes any of these provisions, it must make sure that the change does not: correct answerCreate a meaning that is less favorable to the insured than the original wording The Outline of Coverage must be provided: correct answerDuring the initial solicitation Which of the following statements is false regarding required provisions for Medicare supplement policies? A Medicare supplement policies must be guaranteed renewable B A Medicare supplement policy may not deny coverage for preexisting conditions for more than 12 months after the effective date of coverage C If a Medicare supplement policy is terminated by a group policyholder and is not replaced, the insurer must offer certificate holders an individual Medicare supplement policy D An insurer may not cancel or nonrenew a Medicare supplement policy solely based on the insured's health status correct answerA Medicare supplement policy may not deny coverage for preexisting conditions for more than 12 months after the effective date of coverage The Insurance Director: correct answerIs appointed by the Governor The Director may take all of the following actions, except: Amend the insurance code as needed B Subpoena witnesses C Make reasonable rules and regulations to enforce the Insurance Code
D
Issue a Cease and Desist order correct answerAmend the insurance code as needed Which of the following statements is correct? A Any sale of Medicare supplement coverage that will provide an individual more than one Medicare supplement policy or certificate is prohibited B A Medicare supplement policy must be noncancellable C Medicare supplement policies and certificates may be returned within 10 days for a full premium refund D A producer must provide a completed Policy Checklist at the time of policy delivery correct answerAny sale of Medicare supplement coverage that will provide an individual more than one Medicare supplement policy or certificate is prohibited An insured should receive necessary claim forms within _____ days after notice of claim. correct answer The Illinois Guaranty Association will pay up to all of the following limits of liability, except: correct answer$350,000 in the present value of annuity benefits The health care risk involved with an HMO is borne by: correct answerThe HMO or its providers Which of the following is NOT true of an examination by the Director? A Examinees have 10 days to request a hearing upon receipt of the Director's report B
Which of the following statements is true with respect to maintaining a producer license? Up to 24 excess credit hours of continuing education may be carried over to the next biennial reporting period B A producer who allows his/her license to lapse must wait 6 months to have another license issued C Controlled business is insurance written to cover the risks of the producer or his/her spouse, employer, or business D Licensees must inform the Director of a change of address within 90 days after the change correct answerControlled business is insurance written to cover the risks of the producer or his/her spouse, employer, or business Which of the following is NOT an unfair claims practice? A Neglecting to investigate a claim fully before denying it B Failure to instruct an insured in how to file a claim C Failing to adopt claims settlement standards D Requiring duplicate submissions of proof of loss documentation correct answerFailure to instruct an insured in how to file a claim Which of the following statements is true with respect to the Illinois Health Insurance Portability and Accountability Act (HIPAA)? Group plans are optionally renewable
B
Pregnancy and genetic information are considered preexisting conditions C A group health plan may impose a preexisting condition exclusion for a period of not more than 18 months D A preexisting condition exclusion period is reduced by any creditable coverage that ended less than 63 days before the enrollment date of the new policy correct answerA preexisting condition exclusion period is reduced by any creditable coverage that ended less than 63 days before the enrollment date of the new policy Which of the following statements is false with regard to marketing practices? An insured's misrepresentation will void a policy only if the misrepresentation was intended to deceive the insurer or materially affects the acceptance of the risk B It is an unfair practice to refuse to issue a policy due to an applicant's occupation C Misrepresenting a policy's terms, benefits, or dividends is punishable by a fine of $100 to $5, D It is an unfair practice to imply that a governmental agency guarantees or approves an insurer correct answerIt is an unfair practice to refuse to issue a policy due to an applicant's occupation Which of the following is false regarding HMO plans? An HMO may nonrenew a contract by giving the insured at least 30 days' written notice B A contract issued by an HMO may not restrict services because the enrollee or any covered dependent receives Medicaid benefits C An HMO must maintain a process for resolving grievances
C
Accident Only D Basic Hospital Expense correct answerAccident Only Which of the following types of riders would require signed acceptance by the insured if it was added after the base policy is issued? A rider needed to avoid duplication of Medicare benefits B A rider designed to exercise a specific, reserved right C A rider to reduce coverage under the policy D A rider requested in writing by the insured correct answerA rider to reduce coverage under the policy If an insurer makes a payment for a claim but the insured is dissatisfied with it, the insured must wait _____ days after proof of loss before taking any legal action. A 90 B
C
D
60 correct answer Which of the following is not allowed regarding the payment of commissions? A licensed life producer in Ohio paying a commission to his/her subagent who is licensed in another state B A licensed producer paying a commission to a person who does not sell, solicit, or negotiate insurance in Illinois C A licensed producer paying a commission to another licensed producer who is licensed for the same class of insurance D A licensed producer paying a commission to another licensed producer who is licensed for a different class of insurance correct answerD A licensed producer paying a commission to another licensed producer who is licensed for a different class of insurance Regarding HIPAA disclosures and privacy rules, before an insurer can share any medical information, the applicant must be notified of all the following, except: A
