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A practice test for a national health insurance exam, likely for the pearson vue testing platform. It covers a variety of topics related to health insurance policies, including provisions, riders, exclusions, and claims processing. Multiple-choice questions and answers, testing the reader's knowledge of health insurance concepts and regulations. The level of detail and technical terminology suggests this document would be most useful for university students or professionals studying for a health insurance certification or licensing exam.
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An insurer must provide claim forms to an insured within a MAXIMUM of how many days after receiving notice of an Accident & Health claim? A. Five B. Fifteen C. Twenty D. Thirty โโb Under a group health plan, an employer may offer additional benefits to classes of employees on the basis of all of the following factors EXCEPT: A. length of employment
B. gender C. salary grade D. job category โโb Which of the following statements is CORRECT about a Waiver of Premium provision in a Disability Income policy? A. It allows the insurer to deduct premiums due from the disabled insured's benefit payments. B. It allows the insurer to increase the amount of premium during the insured's time of disability. C. It allows the insured to extend the length of the Grace Period while disabled. D. It allows the insured to maintain a policy in force while disabled and unable to pay premiums. โโd
C. Deny the claim on the basis of misrepresentation D. Deny the claim because it involves a pre-existing condition โโa A health care plan that reimburses a flat fee for medical care it provides at a clinic it owns and operates is referred to as: A. Health Maintenance Organization B. Medicaid C. Medicare D. Multiple Employer Trust (MET) โโa Which of the following laws requires an insurer to notify an applicant in writing that an investigative consumer report may be made on the applicant?
A. Uniform Provisions Law B. Freedom of Information Act C. Medical Information Bureau Disclosure Act D. Fair Credit Reporting Act (Insurance Information and Privacy Protection Act) โโd Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to: A.increase the premium rate for one insured without increasing the rate for others in the same class A. increase the premium rate for one insured without increasing the rate for others in the same class B. increase the premium rate for an entire class of insureds C. increase the benefits for an individual insured
A. Guaranteed Insurability rider B. an Exclusionary/ Impairment rider C. Waiver of Premium rider D. Double Indemnity rider โโb Which of the following statements is CORRECT about coinsurance? A.It applies to deductibles as well as to claim payments. A. It applies to deductibles as well as to claim payments. B.It helps control overutilization of benefits. C. It is effective for the first claim payment and waived for future claims.
D. Insurance companies may adjust the coinsurance ratio after issuing a policy. โโb The insurance policy clause that identifies the contracting parties and defines the scope and limits of coverage is called the: A. Insuring clause B. Benefit clause C. Consideration clause D. Renewal clause โโa In an Accidental Death and Dismemberment (AD&D) policy, the term "capital sum" refers to: A.the benefit paid for death caused by a dread disease A. the benefit paid for death caused by a dread disease
A. Hospital room and board B. Surgical expenses C. Medications D. Physicians' services โโa J has a physical impairment, attends school, and is incapable of self-sustaining employment and/ or self care. Which of the following statements is CORRECT about J's medical coverage under J's father's group plan? A. J's coverage ceases, but J may apply for group student coverage. B. J's coverage automatically discontinues at age twenty-six. C. J's coverage continues only as long as J is a full-time student.
D. J's coverage continues as long as J is continually incapacitated and is financially dependent on J's father. โโd Medicare Supplement policies are primarily designed to: A.offset the high cost of Medicare A. offset the high cost of Medicare B. provide additional retirement income to supplement Social Security retirement benefits C. provide additional benefits beyond those provided by Medicare D. provide a reinsurance network that spreads the Medicare risk among private insurance companies โโc A producer and an applicant complete an application for a health policy and submit it to the insurer for underwriting without any premium. The underwriter issues a policy and mails it to the producer for delivery to the applicant. The producer should take all of the following actions during the delivery of the policy to the applicant EXCEPT:
D. Short-Term Disability Income โโb Which of the following definitions of disability would cover a permanent partial disability? A. Own occupation B. Any occupation C. Residual disability D. Presumptive disability โโc Group health insurance specifies that what percentage of eligible individuals MUST be offered coverage under a noncontributory plan? A. 25
D. 100 โโd An Eligible Expenses provision in a comprehensive major medical policy commonly identifies all of the following types of covered health care services EXCEPT: A. professional services of doctors and other medical practitioners B. hospital charges for semi-private room and board C. experimental and investigative services D. pre-approved home health care โโc Which of the following provisions explains that a producer does not have the authority to waive the provisions of an insurance contract?
D. wait for the claim form to arrive โโb The Coordination of Benefits clause found in group health master contracts is used to: A.integrate Disability Income benefits with Major Medical benefits A. integrate Disability Income benefits with Major Medical benefits B. avoid double payment of benefits to an insured who has duplicate group coverages C. investigate the claims history of an insured D. avoid duplicate claims to an employer for the same employee โโb A precertification review prior to a nonemergency hospitalization is an example of: A. managed care B. Medicaid
C. Medicare D. Disability Income โโa Five years ago, at age forty-five, X stated that he was forty years old on a disability income insurance application. X now submits a claim and the insurer discovers X's true age. The insurer will most likely take which of the following actions? A. Deny the claim due to material misrepresentation on the application B. Pay the claim as filed because the policy becomes incontestable after two years C. Pay the claim and cancel the policy D. Adjust the benefits downward according to the benefits that X would have been entitled to based on the premiums โโd
C. The insured's son D. The insured's spouse โโc Which of the following definitions MOST accurately describes the Probationary Period? A. The period of time from the date of the loss until the benefits begin B. The period of time from the date of the loss until benefits are actually received by the policyowner C. The waiting period a new hire must satisfy prior to becoming eligible for group health coverage D. The period of time once a claim is received by the insurance company before it pays benefits to the policyowner โโc The Elimination Period in most Disability Income policies applies:
A. to each separate disability B. to claims for accidents only C. during the first 30 days of the contract D. during short-term disabilities that are easily managed โโa The PRIMARY purpose of Medicaid is to: A. pay for expenses not covered by Medicare B. provide Disability Income benefits to people on Medicare C. provide Medical Expense coverage to persons meeting certain minimum income requirements D. provide funds for people injured in natural disasters โโc
