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A series of multiple-choice questions and answers related to the minnesota state license exam, focusing on health insurance policies, coverage, and related concepts. it's a valuable resource for students preparing for licensing exams in the insurance field, offering practical application of key insurance principles and terminology. The questions cover various aspects of health insurance, including policy types, coverage details, and claims procedures, providing a comprehensive review of the subject matter.
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the health insurance program which is administered by each state and funded by both the federal and state governments is called : long-term care medicaid medicare supplemental program medicare -Correct AnswerCorrect Answer โ โ medicaid The phrase "this policy will only pay for a semi-private room" is an example of maximum policy limit internal limit stop loss
participation percentage -Correct AnswerCorrect Answer โ โ internal limit Which of the following services is NOT covered under a hospitalization expense policy? daily room and board surgeons fees intensive care miscellaneous expenses -Correct AnswerCorrect Answer โ โ surgeons fees What is being delivered during a policy delivery? a binding receipt to the proposed insured insurance contract to the proposed insured application and initial premium to the insurer
normally paid after a short elimination period -Correct AnswerCorrect Answer โ โ payable to the company or another shareholder
A business disability buyout plan policy is designed: as an incurred expense plan with a very short elimination period to pay benefits to the corporation or other shareholders to pay benefits to the insureds spouse -Correct AnswerCorrect Answer โ โ to pay benefits to the corporation or other shareholders
Which of the following statements is true about most Blue Cross/Blue Shield organizations? they are the same as private insurance companies they are federally sponsored they are nonprofit organizations
they are owned by hospitals and physicians -Correct AnswerCorrect Answer โ โ they are nonprofit organizations
what is considered to be a characteristic of a conditionally renewable health insurance policy? premiums may increase at time of renewal premiums may increase at any time policy may be renewed at the discretion of the insured policy may be amended by the insurer at any time -Correct AnswerCorrect Answer โ โ premiums may increase at time of renewal A disability elimination period is best described as a: time deductible dollar deductible eligibility deductible
probationary period -Correct AnswerCorrect Answer โ โ elimination period Which of these factors do NOT play a role in the underwriting of a health insurance policy? Avocations Credit status Marital status Occupation -Correct AnswerCorrect Answer โ โ Marital Status
An individual who in any manner sells, solicits, or negotiates insurance on behalf of insurance companies for compensation is an insurance: solicitor adjuster producer
representative -Correct AnswerCorrect Answer โ โ producer
A disability income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim? Claim will be paid and coverage will remain in force claim will be denied and coverage will remain in force claim will be denied and coverage will be cancelled claim will be denied, the coverage cancelled, and all premiums paid will be refunded -Correct AnswerCorrect Answer โ โ claim will be paid and coverage will remain in force after a policy has been in force for 2, sometimes 3 years, it enters the incontestable period, in which the insurer may not deny a claim based on information not disclosed at the time of application
if the insured died of accidental causes if the insured died of natural causes -Correct AnswerCorrect Answer โ โ if the primary beneficiary dies before the insured
a contingent beneficiary will receive the policy proceeds if the primary beneficiary dies before the insured's death What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled accidental death and dismemberment rider disability income rider guaranteed insurability rider waiver of premium rider -Correct AnswerCorrect Answer โ โ waiver of premium rider
if a policyowner covered under an accident and health policy wanted to ensure the policy will continue if they ever become totally disabled, they would want to add a waiver of premium rider Medicare is intended for all of the following groups, EXCEPT those enrolled as a full-time student those receiving social security disability benefits for at least 24 months those afflicted with chronic kidney failure those 65 and older -Correct AnswerCorrect Answer โ โ those enrolled as a full-time student An insurer receives proof of loss for an acceptable medical expense claim under an individual health insurance policy. under the time of payment of claims provision, the insurer MUST pay the benefits: immediately
Insurance policies are offered on a take it or leave it basis, which make them: conditional contracts aleatory contracts unilateral contracts contracts of adhesion -Correct AnswerCorrect Answer โ โ contracts of adhesion XYZ Company pays the entire premium for its group health plan. the minimum percentage of eligible employees that must be covered is 25% 50% 75% 100% -Correct AnswerCorrect Answer โ โ 100%
K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income? indemnity major medical travel disability income -Correct AnswerCorrect Answer โ โ disability income In a Disability Income policy, which of these clauses acts as a deductible? elimination period waiver period deductible period probationary period -Correct AnswerCorrect Answer โ โ elimination period
due to the policy not being post-claim underwritten, the insurer must continue to pay this claim claim will be rejected because of this criminal act, but no recovery of payments will be made claim will be denied but the policy will remain in force without further premium payments due to the insureds total disability -Correct AnswerCorrect Answer โ โ the insurer will rescind the policy, deny the claim, and recover all payments made which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? major medical hospital expense surgical expense hospital income -Correct AnswerCorrect Answer โ โ major medical
which of the following statements BEST describes the intent of a coinsurance clause in a major medical policy? discourages over utilization of the insurance coverage minimizes the need for deductibles discourages adverse selection minimizes the waiting period -Correct AnswerCorrect Answer โ โ discourages overutilization of the insurance coverage in order to establish a health reimbursement arrangement (HRA), it MUST be offered in conjunction with other employer provided health benefits limit the benefits to prescription drugs only be established by the employer
workload. Which provision pays reduced benefits to R while he is not working at full capacity? residual disability recurrent disability presumptive disability occupational disability -Correct AnswerCorrect Answer โ โ residual disability usually a percentage of the total disability benefit for periods when the insured is unable to perform some of the duties of his/her occupation who elects the governing body of a mutual insurance company? chairman of the board bondholders stockholders
policyholders -Correct AnswerCorrect Answer โ โ policyholders
If an insurer becomes insolvent, the minnesota life and health guaranty association guarantees individual health claims up to 100, 300, 500, 750,000 -Correct AnswerCorrect Answer โ โ 500, maximum The policyholder has how many days to return an accident/health insurance policy and receive a full refund on premiums? 5 10 15 30 -Correct AnswerCorrect Answer โ โ 10
