Download Life and Health Insurance Retake Exam 2024-2025: Verified Questions and Answers and more Exams Finance in PDF only on Docsity!
What is a fiduciary who handles insurer funds in a trust capacity called? A. Agency b. Agent c. Authority d. Life and Health Guaranty Associa=on B. Agent An agent always handles funds in a fiduciary manner The Law of Large numbers means that insurance companies: a. Know the laws over a stated period =me. B. Cannot predict loss and must use some other means to determine loss c. Know how many losses occur with a group over a period of =me, but not with individuals d. Use Law of Large numbers for reasons other than for predic=ng loss
L&H RETAKE EXAM 2024- 2025
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C. Know how many losses occur with a group over =me, but not with individuals The law of large Numbers helps predict loss and establish rates Which of the following is not an underwri=ng factor in Health insurance? A. Job b. Income c. Moral hazards d. Deduc=ble amounts B. Income an applicant's income is not an underwri=ng factor Joan applied for a preferred rate on a Health Insurance policy. Her insurer responded with a standard risk aOer evalua=on her past medical history. Her insurer's response would be considered which of the following? A. A counteroffer b. A solicita=on offer c. An indemnity offer d. An offer
A. Loss of income b. Medical expense c. Dental expense d. Long term care expense B. Medical expense a medical expense policy covers a variety of expenses that an insured may have encountered due to an accident or sickness Alice's Accidental Death and Dismemberment policy will cover all of the following losses except: a. Limb b. Income c. Life d. Eyesight B. Income An Accidental Death and Dismemberment policy will not cover income. Vince sent his insurer a proof of loss valida=on. In regard to the Time Payment of Claims Provision, when will his benefit be paid? A. Within 30 days aOer the insurer received proof of loss
b. Immediately aOer proof of loss was received. C. It depends on the disability d. Within 15 days of his insurer receiving the claim B. Immediately aOer proof of loss was received The Time Payment of Claims provision states that claims should be paid out immediately aOer proof of loss has been submi\ed Hank has a guaranteed renewable health policy. What can he expect his contract to guarantee? A. The standard rate b. The insurer's financial status c. The con=nua=on of his coverage d. The underwri=ng has been completed and his rate will increase on an individual basis C. The con=nua=on of his coverage A Guaranteed Renewable contract will guarantee the con=nua=on of coverage What clause generally states the insuring agreement between an insurer and an insured? A. Insuring clause b. Renewable clause
wri\en proof, nature and extent of a loss may be submi\ed to an insurer
- Under the Misstatement of Age provision, an insurance company must: a. A pay benefits according to the correct age at the =me an applica=on was submi\ed and approved b. Report the person to Maryland Instance Admin. C. Be responsible for any past and present claims d. Immediately void the policy A. A pay benefits according to the correct age at the =me an applica=on was submi\ed and approved If an insured misstated their age, their insurer would pay benefits according to their correct age at the of their applica=on
- All of the following are required provisions in Individual Health Insurance Policies, except: a. Change of occupa=on b. Grace period c. En=re contract; changes d. Reinstatement A. Change of occupa=on Change of Occupa=on is an op=onal policy provision
- Who has the authority to make changes to a policy? A. Execu=ve officer of the company b. Agent and policyholder c. Policyholder d. Agent A. Execu=ve officer of the company the exec. Officer of a company can only make changes to the policy In regard to Paula's individual health policy, what is her grace period if she pays her premium every month? A. 15 days B. 10 days c. 45 days d. 60 days B. 10 days the grace period for a healthy policy paid monthly in 10 days
- What provision in Marian's health policy states to what party must an insurer pay benefits? A. Payment of claim b. En=re contract
purchase addi=onal coverage. What riders do the Watsons have with their policy? A. Exclusive and impairment riders b. Impairment and guaranteed insurability riders c. Cost of loving and guaranteed riders d. Waiver of cost and indemnity riders B. Impairment and guaranteed insurability riders the impairment rider excludes coverage and a guaranteed insurability rides allows the insured to increase their disability benefits
- John was involved in a motorcycle accident and sustained injuries that damagedhis cervical vertebrae and spine. As a result of his injuries, John became a quadriplegic. His disability policy has a waiver of premium rider. What premium will John need to pay? A. John will pay a higher premium due to his permanent disability b. John will have to pay his regular premiums for 6 months, that was stated in his policy. Then he will be reimbursed for those premiums, and any other subsequent premiums will be waived c. John will receive social security benefits that will pay his premium d. John's premium rate will be lower due to his disability B. John will have to pay his regular premiums for 6 months, that was stated in his policy. Then he will be reimbursed for those premiums, and any other subsequent premiums will be waived
a waiver of premium benefit will waive all premiums due aOer a certain period of =me AD
- Tammy received disability income payments for 4 months and then she returned to work. AOer 6 weeks her condi=on returned and now, she is disabled once again. Regarding this example, what would Tammy's insurer do about her second disability period? A. Consider it an occupa=onal disability b. Consider it a worker's comp issue c. Consider it a recurrent disability d. Consider it a residual disability C. Consider it a recurrent disability A second disability from the same or related cause of a prior disability is a recurrent disability
- Tommy has an individual disability policy with a 30 day elimina=on period and a monthly benefit of $1,000. Tommy was totally disabled for 4 months. What was Tommy's total benefit for his claim? A. $4, b. $3, c. $1, d. $2,
- Larry was injured on his job site and it was due to his negligence. Will workers' compensa=on laws pay for his injuries? A. No, because it was his fault b. No, because it was caused by his own negligence c. There is not enough informa=on to determine if his injuries will be covered d. Yes, workers' compensa=on laws will pay for his injuries D. Yes, workers' compensa=on laws will pay for his injuries
- Which Disability occupa=on defini=on has a more liberal defini=on, and therefore provides a be\er benefit for an insured? A. Hazardous occupa=on b. Any occupa=on c. Own occupa=on d. Liberal occupa=on C. Own occupa=on an own occupa=on has a more liberal defini=on compared to any occupa=on
- An Any Occupa=on disability income policy pays for which of the following? A. College tui=on b. Benefits when an insured is sick and cannot perform the du=es of their job c. Benefits when an insured is unable to perform any job for which
they are suited by reason of educa=on, training, or experience d. Benefits for an insured's family C. Benefits when an insured is unable to perform any job for which they are suited by reason of educa=on, training, or experience
- In regard to the maximum benefit offered by a major medical plan, what would a typical maximum benefit be? A. 50, b. 100, c. 500, d. 1,000, D. 1,000,
- The HMO Act states that employers that provide health benefits for their workers to offer enrollment in an HMO must have a certain minimum number of required employees. What is the minimum number of required employees? A. 10 or more b. 15 or more c. 20 or more d. 25 or more D. 25 or more
- When is a doctor considered to be an employee of the PPO? A. In a close panel arrangement b. In an open panel arrangement
B. Health insurer
- In Mr. Johnson's health plan recognizes the phrase "maximum benefits". What does this define in his policy? A. The upper limit of the total life=me benefits the insurer will pay b. The upper limit of the total life=me benefits that will be taxed c. The upper limit of what the insurer will pay in an annual year d. The upper limit that will be paid for a claim in an annual year A. The upper limit of the total life=me benefits the insurer will pay
- Barb's family has a history of breast cancer, so she will most likely buy what type of policy? A. Single b. Comprehensive c. Limited d. Aleatory C. Limited
- How is the experience of a group in a par=cular are rated? A. Experience b. Community c. Geographically d. Preferred B. Community
- Jill's employment form N&B Corpora=on was terminated. It is possible for her to get individual health insurance aOer her job loss from her employer. Which of the following is false in regard to Jill's
situa=on? A. Her new policy must have the same benefits as her group coverage b. She can convert her group insurance to individual within 31 days of her termina=on c. Her new coverage may exclude certain coverage d. Her new coverage may have a higher premium A. Her new policy must have the same benefits as her group coverage
- What percentage of eligible employees must be covered by a non- contributory plan? A. 75% b. More than 50% c. 100% d. 65% C. 100%
- What ra=ng combines claims history over a class of groups that are similar in nature and they may even be in a smaller geographic area? A. Experience ra=ng b. Community ra=ng c. Commercial ra=ng d. Corpora=on ra=ng B. Community ra=ng
- Which state has jurisdic=on over a group policy that covers employees that reside in more than one state? A. The state that has the most coverage
c. Endodon=cs d. Orthodon=cs A. Periodon=cs
- A pa=ent has severe gingivi=s and is seeking treatment from his den=st. Which type of dental treatment is this? A. Orthodon=c b. Endodon=c c. Periodon=c d. SoO dental C. Periodon=c
- Dental expense coverage may include all of the following except: a. Oral surgery b. Periodon=cs c. Preven=ve care d. Cosme=c dental surgery D. Cosme=c dental surgery
- Prior authoriza=on is best associated with which of the following? A. Predetermina=on of benefits b. Concurrent review c. Recurrent review d. Prospec=ve review A. Predetermina=on of benefits
- An insured does not gave to pay co-insurance or deduc=bles on a full-series moth x-ray, but does have to pay a deduc=ble to get his
cavi=es filled. Which dental plan does he have? A. Limited b. Procedure based c. Scheduled d. Non scheduled D. Non scheduled
- Which of the following allows an insured to know in advance if their cavi=es can be filled as a covered expense? A. Prior authoriza=on b. Advance no=ce c. Presump=ve no=ce d. Dental cer=fica=on no=ce A. Prior authoriza=on
- Which of the following statement is not true of a combina=on dental plan? A. The combina=on plan is basically a combina=on of a scheduled and nonscheduled dental plan b. The combina=on plan is known as the "superimposed plan" c. The combina=on plan covers diagnos=c and preven=ve care on the usual, customary, and reasonable basis d. The combina=on plan uses a fee schedule for other dental services B. The combina=on plan is known as the "superimposed plan"
- Jackie is a Medicare par=cipant that gets his benefits through a Managed Health Care Plan. What Medicare plan does Jackie have
