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In group accident and health insurance, a group with a high average age usually has? - ANSWER - Above average total accident and health claims. The accounting measurement of the insurer's future obligations to its policyholders is? - ANSWER - Reserves Unless an individual has previously received benefits, Social Security disability income benefits have a waiting period ? - ANSWER - 5 full consecutive calendar months Which type of accident and health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury? - ANSWER - Medical expense A social organization which is licensed to issue insurance ONLY to its members is an example of which type of insurer? - ANSWER - Fraternal
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In group accident and health insurance, a group with a high average age usually has? - ANSWER - Above average total accident and health claims. The accounting measurement of the insurer's future obligations to its policyholders is? - ANSWER - Reserves Unless an individual has previously received benefits, Social Security disability income benefits have a waiting period? - ANSWER - 5 full consecutive calendar months Which type of accident and health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury? - ANSWER - Medical expense A social organization which is licensed to issue insurance ONLY to its members is an example of which type of insurer? - ANSWER - Fraternal An agent who unintentionally makes misleading statements to a prospect for replacement of accident and health insurance may be found liable on the basis of? - ANSWER - Professional errors and omissions A mandatory second surgical opinion provision typically would encourage all of the following EXCEPT? - ANSWER - Higher total accident and health plan costs for an employer Concurrent review is a form of utilization review that is performed? - ANSWER - During the course of the patient's treatment Employer-sponsored group long-term care insurance generally has all of the following characteristics EXCEPT? - ANSWER - Noncancelable. An electrocardiogram records the electrical activity of the:? - ANSWER - heart When insurers utilize provisions in dental plans such as limited benefits for late enrollees, a reduced maximum annual benefit, and longer eligibility periods before coverage becomes effective, insurers are attempting to: - ANSWER - Minimize adverse selection
What is the minimum number of the "core group" of essential health benefits mandated by ACA for both individual plans and group plans? - ANSWER - One objective of a concurrent review provision in group accident and health insurance is to? - ANSWER - Monitor length of stay in the hospital once the patient is admitted. For groups with high prior claims experience, an insurer would be likely to? - ANSWER - Expect high future claims experience Antigen is the medical term for? - ANSWER - An infectious agent Why would an insurer limit the combined amount of disability income benefits under multiple policies purchased by an insured from the same or another company? - ANSWER - To prevent the insured from receiving a benefit amount which might make becoming disabled financially attractive. Periodontics includes all of the following EXCEPT? - ANSWER - dentures A contract offered for acceptance or rejection without negotiation is called? - ANSWER
Which of the following correctly describes Medicaid? - ANSWER - Provides medical benefits for certain low-income people, for the disabled, and for families with dependent children Which of the following describes the individual covered by insurance? - ANSWER - insured Joann Larson, an adjuster, has had administrative action taken against her in another jurisdiction. What must she do? - ANSWER - Report the final disposition of the matter to the Insurance Superintendent within 30 days What are the lifetime dollar limits on the essential benefits provided under ACA? - ANSWER - There are no lifetime dollar limits on essential benefits. The heartbeat is controlled by? - ANSWER - The peripheral nervous system What is the name of a health care delivery system providing prepaid doctor and hospital care, emphasizing preventive care, and charging a fixed periodic fee to its enrolled members? - ANSWER - Health Maintenance Organization Assume that you are talking to a person who says that he owns 20 shares of stock in an insurance company. You know that this insurance company is a: - ANSWER - Stock insurer The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called: - ANSWER - Non- occupational coverage Which of the following is the required time period that the insured must file a written proof of loss? - ANSWER - Within 90 days of loss, or as soon as reasonably possible
. Which of the following statements about changes to insurance contracts is most correct? - ANSWER - An agent is never permitted to make a change in policy wording. . An insurance professional that is accused of dishonesty or breach of trust involving interstate commerce under the Federal Fraud and False Statement Regulation of the United States Code (USC 1033) will be prosecuted by: - ANSWER - The U.S. Attorney general . Many medical expense policies do not state a specific unit or dollar amount for items such as room and board or surgical procedures. Instead, payment for similar services provided in the same location are based on: - ANSWER - Usual, reasonable and customary
What is the purpose of "navigators" associated with the state insurance exchanges? - ANSWER - To provide information about the available health plans offered by the ACA and assist with enrollment An employer that self-funds its group medical plan may limit its claims exposure by purchasing: - ANSWER - Stop-loss insurance The period between a loss and the beginning of benefit payments in disability income insurance is known as: - ANSWER - Elimination period An employer may require employee contributions for all of the following types of plans, EXCEPT: - ANSWER - A workers compensation plan. Individual long term care insurance policies must provide the right to return the policy within ____ to obtain a premium refund if he or she is not satisfied. - ANSWER - 30 days
. If an insurance company accepts a special class risk: - ANSWER - The premium will be higher than for a normal risk. The optional health insurance policy provision "other insurance with this insurer" is specifically designed to: - ANSWER - Limit the claim risk with any one individual insured by the company.. . Which of the following reimburses its insureds for covered medical expenses? - ANSWER - Commercial insurers.. If an insurance company covered an excluded loss, it may have to continue paying other claims for such losses because of the: - ANSWER - Estoppel rule An individual who is considered chronically ill must be recertified as such: - ANSWER - annually.. Which of the following may be used by an insurer to prevent duplication of benefits? - ANSWER - Coordination of benefits provision The Affordable Care Act requires plans and issuers that offer coverage to children on a parent's plan to make the coverage available until the adult child reaches the age of: - ANSWER - 26 Failure to disclose known facts when completing an application for insurance is an act of: - ANSWER - Concealment . Resident adjusters in New York must maintain a _____ surety bond with the Superintendent for the purpose of assuring faithful performance of the licensee. - ANSWER - $1,
Temporary License - ANSWER - Can be issued to spouse of deceased or next of kim from a disability Tremination of License - ANSWER - Can be done by superintendent for: -providing incorrect or misleading materially untreu info in licesne app -violating any insurance laws
long Term Plan insurance plans must have: - ANSWER - - a residential health care facility beneift (ie daily benefit for custodial care