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South Carolina Life and Health Insurance Final
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A closed network plan offers a primary physician copay of $25. If a subscriber chooses a primary care physician outside of the network, the subscriber will likely pay - ✔✔100% of the billed amount What does Coordination of Benefits allow? - ✔✔Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid A waiver of premium rider allows an insured to waive premium payments if the insured is - ✔✔completely and permanently disabled Under the Time Limit of Certain Defenses Provision, a disability policy is incontestable after it has been in force for a period of - ✔✔ 2 years In what part of an insurance policy are policy benefits found? - ✔✔Declarations What type of annuity stops all payments upon the death of the annuitant? - ✔✔Life annuity A guaranteed issue insurance policy has no - ✔✔medical underwriting What is NOT a qualifying event for Medicare? - ✔✔Falling below the federal poverty level
An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a - ✔✔benefit schedule Craig purchased a life insurance policy for enabling his heirs to pay estate taxes. What is this called? - ✔✔Estate conservation Ownership of a life insurance policy may be temporarily transferred with a(n) - ✔✔collateral assignment Respite care is able to provide - ✔✔temporary relief to the patient's primary caregiver What are employers is required to follow ERISA regulations? - ✔✔A local electrical supply company with 12 employees A policy illustration given at time of sale does NOT typically include the - ✔✔names of the beneficiary How are contributions made to a Roth IRA handled for tax purposes? - ✔✔Not tax deductible With respect to small group health benefit plans, a carrier may discontinue coverage or may refuse to renew such a plan if the employer - ✔✔fails to pay the premium prior to the end of the grace period What is an insurance policy's grace period? - ✔✔period of time after premium is due but the policy remains in force
In most dental plans, a deductible typically is NOT applied to - ✔✔preventative and diagnostic services What is considered to be a point of service (POS) plan? - ✔✔Managed care plan What is a corridor in relation to a Universal Life insurance policy? - ✔✔The gap between the total death benefit and the policy's cash value. Field underwriting performed by the producer involves - ✔✔completing the application and collecting initial premium What is the contract called that is issued to an employer for a Group Medical Insurance plan? - ✔✔Master policy Kim has health insurance with a deductible of $500 and an 80/20 coinsurance. How much will she pay if she incurs a loss of $1,500? - ✔✔$ What is illegal discrimination? - ✔✔Refusing an applicant because of marital status A provision that allows a policy owner to temporarily give up ownership rights to secure a loan is called a(n) - ✔✔collateral assignment What isn't an examples of Business Continuation Plan - ✔✔Deferred Compensation
A group Disability Income plan that pays tax-free benefits to covered employees is considered - ✔✔fully contributory When can a policy no longer be cancelled for nonfraudulent misstatements after its date of issue? - ✔✔ 2 years Premiums paid that exceed 7 1/2% of an insured's Adjusted Gross Income (AGI) are tax- deductible when paid for which of the following plans? - ✔✔Qualified Long-Term Care plan What isn't subject to false advertising regulations - ✔✔gifts A business will typically use which type of life insurance to cover their employees? - ✔✔Group policy The director MUST examine domestic insurers AT LEAST once every - ✔✔ 5 years When are group disability benefits considered to be tax-free to the insured? - ✔✔When the recipient pays the premiums A limited payment whole life policy provides - ✔✔lifetime protection The double indemnity provision in a life insurance policy pertains to an insured's death caused by a(n) - ✔✔accident
What is typically not a source of underwriting information for life or health insurance - ✔✔Disclosure authorization response Claims payable to a disability income insured, even when the insured can continue to work, are the result of a - ✔✔presumptive disability the free-look provision gives the policyowner - ✔✔the right to return the policy for a full refund within a specified number of days An insured individual and the policy's beneficiary die from the same accident. The common disaster provision states the insurer will continue as if - ✔✔the insured outlived the beneficiary An insurer will accept a premium from the insured and continue the coverage in full force as though it was NOT late during which time period - ✔✔grace period When can a policy no longer be cancelled for nonfraudulent misstatements after its date of issue? - ✔✔ 2 years Kathy pays a monthly premium on her health insurance policy. How long is her grace period? - ✔✔10 days Jonas has disability insurance through his employer. The employer pays 75% of the premium, and Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? - ✔✔Taxes must be paid on 25% of the benefits received The MAXIMUM time period that an eligible employee can be excluded from coverage under a group health policy as a late enrollee is - ✔✔18 months
What would be considered a possible applicant and contract policyholder for group health benefits? - ✔✔Employer The legal action provision in a health contract is limited to no more than years - ✔✔ 5 As of January 1, 2004, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of what percentage of the premiums paid by the employer - ✔✔50% Which type of plan would be most appropriate for an individual on Medicare and is concerned that Medicare will NOT pay for chargers exceeding the approved amount? - ✔✔Medicare supplement Plan F To qualify as a small employer, an employer must employ no more than - ✔✔50 eligible employees The deeds and actions of a producer indicate what kind of authority? - ✔✔Apparent What is known as the immediate specific event causing loss and giving rise to risk? - ✔✔Peril People with higher loss exposure have the tendency to purchase insurance more often than those at average risk. What is this called? - ✔✔adverse selection
An example of elective cosmetic surgery would be - ✔✔removing excess fat from an insured's waistline What scenario would most life insurance policies exclude coverage for? - ✔✔racing cars once a month What MUST a producer do to recommend the purchase or replacement of any Medicare Supplement Policy? - ✔✔Make a reasonable effort to determine the appropriateness of the need What does the Group Life underwriting risk selection process help protect insurance companies from? - ✔✔Adverse selection Preferred risk policies with reduced premiums are issued by insurance companies because the insured has - ✔✔better than average mortality or morbidity experience A form of medical health insurance covering the treatment and care of gum disease is called - ✔✔Dental expense insurance What would be an expense factor in an insurance program? - ✔✔Mortality costs In SC what is the MAXIMUM length of time an insurer can defer payment of a cash surrender value of an annuity? - ✔✔ 6 months How long can an insurer exclude coverage for a preexisiting condition on a Medicare Supplement Policy? - ✔✔ 6 months
Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him? - ✔✔assisted living In SC, within how many days does the free-look provision allow the insured the right to return an individual insurance policy for full premium? - ✔✔ 10 days What % of participant's income are group long-term disability benefit amounts typically limited to? - ✔✔60% The authority granted to a licensed producer is provided via the - ✔✔Law of Agency One of the most important considerations when replacing health insurance would be the - ✔✔exclusions on a new policy The role of the federal government was expanded when Medicaid was established by allowing the state to - ✔✔receive matching funds to expand public assistance programs When a life insurance policy is issued to replace another life insurance policy, which of the following does NOT need to be provided to the purchaser at or before the time the policy is delivered? - ✔✔The replacing insurer's financial statements Which of these premium payment frequencies is not typically available to a policyowner? - ✔✔bi-weekly Which disability policy provision would address any concerns of the value of the benefits decreasing over time? - ✔✔cost of living benefit
Disability income plans which require that the insurer can NEVER change or alter premium rates are usually considered - ✔✔noncancellable yeah - ✔✔yeah Tom has a rider on his disability income policy that guarantees the right to increase his benefits without a medical exam. What kind of rider is this? - ✔✔guaranteed insurability rider If an insured's age on a life insurance policy has been missated, what is the insurer's liability if the insured dies? - ✔✔a proprated death benefit based on the amount of insurance the insured's premiums would have been if purchased at the correct age under SC law, the buyer's guide and policy summary MUST be delivered - ✔✔with or prior to the policy delivery mhm - ✔✔mhm in group health care, what is the purpose of the coordination of benefits provision? - ✔✔determines what is paid by the primary and secondary insurers in the event of a claim. When is the accumulated value in an annuity paid out - ✔✔annuitization phase How does one become eligible for Part D: Prescription Drug coverage? - ✔✔Must have medicare coverage tired - ✔✔tired
Lisa has recently bought a fixed annuity. Which of these is considered to be a disadvantage of owning this type of annuity? - ✔✔During periods of inflation, annuitants will experience a decrease in purchasing power of their payments. The limited period of time given to all members to sign up for a group health plan is called the - ✔✔enrollment period An example of a presumptive disability would be - ✔✔deafness when an insured changed to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates? - ✔✔change of occupation provision Under a long-term care insurance, which of the following MUST an insurer offer to each policyowner at the time of purchase? - ✔✔An inflation protection feature Phil is shopping for an annuity that guarantees he CANNOT outlive the benefits. Which of these benefit options would he choose? - ✔✔Guaranteed lifetime withdrawal benefit Which of the following is an example of an unfair claim settlement practice? - ✔✔failure to provide a reasonable basis for the denial of a claim upon request all of the following are functions of an insuring clause EXCEPT - ✔✔primarily describes the free- look period sleepy - ✔✔sleepy
Which settlement option pays a stated amount to an annuitant, but no residual value to a beneficiary? - ✔✔life income When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? - ✔✔No deductible payment is required yess - ✔✔yess When life insurance is not sold by mail the grace period is - ✔✔ 10 days talking - ✔✔talking foreign - ✔✔foreign Which clause defines total disability as being unable to perform the major duties of the insured's regular occupation? - ✔✔own occupation clause 63 days - ✔✔ 63 days SC - ✔✔SC Which of the following is considered to be an alternative to a life settlement? - ✔✔accelerated death benefit rider
hangec - ✔✔change the term which describes the fact that both parties of a contract may NOT receive the same value is referred to as - ✔✔aleatory Addy - ✔✔addy What is medicare part b also known as? - ✔✔medical insurance A deliberate lie by an insured to the insurer to obtain a lower premium is an example of - ✔✔fraud 65 - ✔✔ 65 retirement - ✔✔please When must a claim on a life insurance policy be paid after proof of loss has been received by the insurer? - ✔✔within 30 days which of the following does medicare part d cover - ✔✔prescription drugs
