Life and Health Insurance Final Exam Questions With Correct Verified Answers 100% Pass

Basic Medical Expense - Correct Answers________ is a health insurance policy that only covers physician services and procedures. Proves first dollar benefits by the insurer, but low coverage limits. Basic Hospital Expense - Correct Answers________ is a health insurance policy that only covers room and board if the insured stays overnight in a hospital and the miscellaneous expenses that occur because of that stay. Basic Surgical Expense - Correct Answers________ is a health insurance policy that only covers surgeries, surgeons and anesthesiologists. It provides first dollar benefits by the insurer, but low limits. Major Medical Expense - Correct Answers______ is a health insurance policy that offers broad coverage and high benefits for hospitalization, surgeries, and physician services subject to deductibles and coinsurance. Comprehensive Major Medical - Correct Answers_________ is a type of traditional medical expense insurance designed to reimburse the policyowner for out of pocket medical expenses. It is characterized by typically low deductibles (100-500), coinsurance, and stop loss limits. Stop Loss - Correct AnswersWhat feature of Major Medical policy requires 100% payment of covered expenses after the insured's claim cost reaches a certain level? Deductible - Correct AnswersThe amount of loss paid by the policyowner before the health insurance policy pays the claims is known as.. $1800 - Correct AnswersMary has a Major Medical policy with a $200 deductible and 80/20 coinsurance allocation. If she suffers a covered loss of $8200, how much will Mary be required to pay for this loss? First Dollar Coverage - Correct Answers_______ is a health insurance policy that does not have a deductible. The company pays first when a claim is submitted. $7400 - Correct AnswersCharlie owns a Comprehensive Major Medical policy with a $1000 Base plan, a $500 deductible and 80/20 coinsurance. If he suffers a covered loss of $9500, how much will the company pay? Apply the base plan; subtract the deductible; allocate the coinsurance; check by adding - Correct AnswersWhich is the correct order of the basic claim calculation? Elimination Period - Correct AnswersYou own a Major Medical policy with a $500 deductible and 80/20 coinsurance. You suffer a covered loss of $4500 and calculate that the company will pay $3200 towards your loss. The company only pays $3019.78. Which of the following could NOT account for the difference? owner - Correct AnswersThe individual who controls a Major Medical policy, pays the premiums and is authorized to receive any benefits from the contract is known as the Major Med - Correct AnswersWhich policy would be covered with the rights of a dependent child? Reduces the deductible - Correct AnswersCoinsurance does which of the following? Ancillary expenses - Correct AnswersAll of the following characterizes basic medical EXCEPT Deductibles - Correct AnswersWhich of the following do Medical Expense companies utilize to eliminate small claims? Preexisting conditions limitations - Correct AnswersWhich of the following do Medical Expense companies use to reduce adverse selection? 26 - Correct AnswersThe Affordable Care Act allows dependents to remain on a parent/guardian's healthcare plan until age Elimination Period - Correct AnswersA Disability Income Policy deductible is expressed in time and known as an Occupation - Correct Answers______ is the key rating factor for Disability policy Own Occupation - Correct Answers________ requires that the insured to be unable to perform the duties of his or her own occupation in order to receive disability income benefits. Any Occupation - Correct Answers________ requires the insured to be unable to perform any occupation they would be reasonably suited to do based on education, training or work experience in order to receive disability income benefits from the policy. Two - Correct AnswersShort term disability is ______ year(s) or less. Five - Correct AnswersAny period exceeding ___ years is considered long term. 60%;80% - Correct AnswersGenerally, policy limits are limited to _____% or ____% of your earned income. Presumptive Disability - Correct AnswersWhat type of disability requires no proof of loss of time or duties? Social Security Rider - Correct Answers________ promises to pay the amount Social Security would have paid if Social Security Disability would have been approved. Additional Monthly Benefit - Correct Answers__________ will pay the estimated Social Security Disability benefit while Social Security is determining eligibility. Partial Disability - Correct Answers__________ an illness of injury that prevents an insured from performing one or more of the important duties of their job, but not all of the occupational duties. Residual disability benefit - Correct Answers_________ is a disability income payment based on the proportion of mission employer income. Recurrent Disability Provision - Correct Answers__________ is a disability income policy provision that specifies after a period of time if the same disabling condition reoccurs, the stated benefit will be paid without an elimination period. The reoccurrence will be treated as a continuation of the prior claim. Owner's salary - Correct AnswersA Business Overhead Expense policy would NOT pay for Doctors - Correct AnswersDisability Income benefits are intended to pay for all of the following EXCEPT Any Occupation with 30 day elimination period - Correct AnswersWhich of the following would be the least expensive structure for a Disability Income policy? Key Employee - Correct AnswersA policy used as a salary continuation plan for a disabled individual employee is Business overhead expense - Correct AnswersA policy owned by a business that can pay on a reimbursement basis for actual costs incurred during the disability of the owner/operator is called application and policy - Correct AnswersThe Entire Contract is comprised of 2 Years - Correct AnswersThe Incontestable Provision gives companies _______ to legally contest the validity of a contract or deny a claim on the basis of misstatement in the application. 7;10;31 - Correct AnswersStandard premium plan Grace Periods are: _______ days for weekly; ______ days for monthly; ______ days for all other premium payment plans. Reinstate - Correct AnswersCompanies are under no contractual obligation to _______ a lapsed policy, but may do so at their discretion. Notice of Claim - Correct Answers________________ provision requires companies to be notified of a loss within 20 days or as soon thereafter as reasonably possible. Claim Forms - Correct Answers_________________ most be transmitted to the policyowner/insured within 15 days of claim or claim notification. Proof of Loss - Correct Answers________________ must be returned to the company within 90 days of the loss or as soon thereafter as reasonably possible. immediately; monthly - Correct AnswersMedical expense claims must be paid ___________ and Disability Income no less frequently than __________. Policyowner - Correct AnswersClaims are paid to the _________. physical exam; autopsy - Correct AnswersThe company has the right to conduct a __________ and _________ to validate an accidental death claim. 60; 3. - Correct AnswersA policyowner may sue their company for nonpayment of a claim after ____ days of submitting claim forms but no more than ____ years. Beneficiaries. - Correct AnswersA policyowner has the right to name, change and designate _____________. reduction - Correct AnswersFailure to notify a Disability Income carrier of a change to a higher risk occupation will result in a __________ of benefits. Misstatement of age or gender - Correct Answers______________ is an exception to the Incontestable Clause. felony; illegal occupation - Correct AnswersClaims incurred while in the commission of a _______ or while engaged in an ___________ can be denied. Other Insurance with This Insurer - Correct Answers______________ provision provides that you only get paid once regardless of the number of policies with the same company. Medical/Disability Expense Coverage with Multiple Companies - Correct Answers________________ provides that companies may coordinate benefits, but you still only get paid once. Relation of Earnings to Insurance - Correct Answers______________ means that if you earn less at the time of the claim than you did when you bought the contract, your benefits may be reduced within limits set by state statute. Unpaid Premium - Correct Answers_____________ is deducted from a claim payment if the loss is incurred during the grace period. Cancellable Policies; 5 - Correct Answers_______________ allow cancellation with ____ days written notice. Conformity with State Statutes - Correct Answers__________ provides that if a policy is issued in a state that does not conform to state law, it will be interpreted as if it did. Intoxicants or Narcotics - Correct AnswersIf __________ or __________ not prescribed by a doctor are linked directly to a loss then the claim may be denied. the insurance company - Correct AnswersGroup policies create a contract between the organizing entity of the group and Allow the insured to collect some benefits from each of the plans of two employed spouses - Correct AnswersThe Coordination of Benefits provision in a Group Medical Expense policy is designed to Group insurers do not like employee turnover. - Correct AnswersWhich of the following statements about Group Medical Expense contracts is NOT true? indefinitely - Correct AnswersMentally or physically handicapped dependent children can remain on their parents plans COBRA. - Correct AnswersIf you are terminated from your employment, you may be able to continue Group Health coverage under 20 employees. - Correct AnswersCOBRA is available for departing employees of plans which insure more than taxable. - Correct AnswersBenefits paid to employees under a Group nonparticipating Disability Income policy are Jill's - Correct AnswersJack and Jill are married, each has employer-sponsored Major Medical Coverage for the entire family. Jack was born on June 13, 1979 and Jill on April 1, 1981. Whose plan is primary for the children? Whichever has been in effect the longest. - Correct AnswersWhich plan is primary if two employer-sponsored spouses share the same birthday? $4000 - Correct AnswersBoth Jack and Jill's plan contains a $1000 deductible and 80/20 coinsurance. If Jill sustains a covered loss of $6000, how much will her policy pay? $2000 - Correct AnswersUsing the information above, how much would Jack's policy pay? 63 days. - Correct AnswersTimely entry is defined under HIPAA as no more than termination due to gross misconduct - Correct AnswersA COBRA qualifying event does NOT include: 6 months - Correct AnswersCOBRA extends coverage for you and your dependents for up to 6 - Correct AnswersIf the Social Security qualifications for Disability are met within 60 days of employment termination, COBRA may be extended for an extra _____ months 12 - Correct AnswersIf the COBRA qualifying event is death or divorce, benefits may be extended up to ____ months. Medicare Part C - Correct Answers_________ is a program that offers a variety of Medicare managed care choices. Medicare Part D - Correct Answers_______ is the prescription drug benefit program offered to Medicare beneficiaries who pay a monthly premium and an annual deductible to share the cost of prescription drugs with Medicare. Medicare Part A - Correct Answers________ is teh compulsory hospitalization insurance funded by all workers through FICA taxation that provides coverage for inpatient care. Medicare Part B - Correct Answers_______ is a voluntary coverage for supplementary medical insurance to pay some of the costs of physician and medical services on an outpatient basis; a monthly fee is paid by beneficiary. Medicare - Correct Answers________ is the federal government sponsored health care program for individuals age 65+, suffering from renal failure, or recognized by Social Security as disabled and collected 24 months of Social Security Disability benefits. A - Correct AnswersHospital insurance is found in Medicare Part Medicare - Correct AnswersIf you are still covered by Group Major Medical plan at age 67, what is considered to be the secondary payer? Part A - Correct AnswersWhich part of Medicare provides nursing home coverage? 3 - Correct AnswersThe annual blood deductible under Parts A and B is _____ pints. Hospice - Correct AnswersWhat type of facility exists to serve the needs of the terminally ill? 80% - Correct AnswersUnder Part B of Medicare, what % of the costs does Medicare pay after the deductible? Medicaid - Correct AnswersWhat federally funded, state administered Medical Expense program is designed to serve the poor? Being impoverished - Correct AnswersWhich of the following does not qualify a person for Medicare? Medicare Supplemental Policy - Correct Answers______ is a health insurance policy offered by commercial health insurers to fill the gaps in Medicare coverage. Long Term Care Policy - Correct Answers_______ is a type of health insurance that provides stated benefits for long-term care services typically taking place in a nursing home or home health care. Guaranteed Income - Correct Answers______ provides that individuals over 65 who have just enrolled in Medicare Plan B for the first time cannot be refused an MSP or rated if they apply for coverage within 6 months of the Part B enrollment. Definitions - Correct Answers______ provide that the terminology used in an MSP can be defined no more restrictively than it is defined by Medicare. 30 - Correct AnswersAn MSP must offer a Free Look period of ____ days. Mirroring Medicare - Correct Answers_______ provides that changes in Medicare will automatically trigger a change in an MSP. Duplication - Correct Answers_________ provides that an MSP may not simply duplicate Medicare benefits. 6 months; 6 months - Correct AnswersMSP's are allowed to classify medical diagnoses and treatments as preexisting if occuring withing _____ of the policy date and excluded for _______ of the policy date. Guaranteed Renewable - Correct An