Louisiana Life and Health Insurance 300 Practice Questions and Verified Exam 2026

Louisiana Life and Health Insurance 300 Practice Questions and Verified Exam 2026 1. What is meant by referring to an insurance policy as unilateral contract? - ANSWER Only 1 party makes a legally enforceable promise. 2. When must insurance records of insurance agents and brokers be made available to the Insurance Commissioner? - ANSWER-At all times 3. Any situation that presents the possibility of a loss is known as - ANSWER-a loss exposure 4. Which of the following information is not required to be communicated in a Life insurance contract? - ANSWER-Personal Judgment 5. The Distribution of insurance utilizes all of the following to promote the sale of insurance EXCEPT - ANSWER-Telephone call from an agent 6. A contract in which on party promises to indemnify another against loss that arises from an unknown event is - ANSWER-An insurance Policy 7. All of the occurrences listed below are examples of an insurable event as defined by the California Insurance Code EXCEPT - ANSWER-An insured suffers financial loss in the state of lottery 8. All of the following statements about aleatory contracts are true Except - ANSWER The insured and insurer contribute equally to the contract 9. All of the following would be considered unfair trade practices EXCEPT - ANSWER Committing any act of discrimination whether it be deemed fair or unfair 10. As authorized by the California Insurance Code, the insurance Commissioner has provided standards for names used by life insurance agents. Under these standards which, if any, of the following are automatically acceptable for Mary Brown, a holder of the CLU designation? - ANSWER-Mary Brown Insurance Services 11. A contract of indemnity in one in which - ANSWER-one party is restored to the same financial position the party was in before the loss occurred. Insurance Insurance 12. In insurance Terminology "indemnity" Means - ANSWER-Make whole 13. As defined in the California Insurance Code "Insurance" is a - ANSWER-contract 14. What would a person be guilty of who refuses to deliver any books, records, or assets to the commissioner once a seizure order has been executed? - ANSWER-A misdeamanor 15. An agent who is acting as an insurance agent, broker, solicitor, life agent, accident and health or bail agent acts in which capacity when handling premiums for an insured - ANSWER-Fiduciary Which of the following statements regarding risk is TRUE? - ANSWER-Only pure risks are insurable 17. The purchase of an insurance policy may accomplish all of the following for the insured EXCEPT - ANSWER-The elimination of risk 18. Insureds are entitled to recover an amount NOT greater than the amount of their loss under the principle of - ANSWER-Indemnity 19. What rule is used to determine the importance of a representation? - ANSWER-The materiality of concealment 20. The required contents of a policy include all of the following EXCEPT - ANSWER The probability of loss 21. All of the following are characteristics of reinsurance EXCEPT it - ANSWER increases the unearned premium reserve. 22. According to the California Insurance Code, an insurance policy must specify all of the following EXCEPT the - ANSWER-financial rating of the insurer 23. All of the following qualify as "background information: as defined in Section 1729.2 of the CA Insurance Code EXCEPT - ANSWER-Misdemeanor charges filed, not resulting in a conviction 24. Loss retention is an effective risk management technique when all of the following conditions exist EXCEPT the - ANSWER-Probability of loss is unknown 25. A situation in which there is a possibility of loss or a gain is a - ANSWER Speculative Risk Insurance Insurance 26. Why is having a large number of similar exposure units important to insurers - ANSWER-The greater the number insured, the more accurately the insurer can predict losses and set appropriate premiums. 27. All of the following are benefits of insurance EXCEPT it - ANSWER-eliminates fraudulent losses 28. Who are members of the Medical Information Bureau? - ANSWER-Life and health insurers 29. The process by which an insurer decides whether to issue requested insurance is called - ANSWER-underwriting 30. Unless it is merely a statement of an expectation or belief, a representation as to future is considered which of the following? - ANSWER-promise 31. Upon notification of a claim, a claimant must be given access to the California Fair Claims Settlement Practices resolution by all of the following means EXCEPT - ANSWER-by interview appointment with the agent of record. 32. What is the definition of premium? - ANSWER-Money an insured pays an insurer to obtain the benefits provided in the policy 33. What is the goal of the underwriting process? - ANSWER-To avoid selecting a disproportionate number of bad risks 32. Insurer policy expenses include all of the following except - ANSWER-premiums 33. Unintentional Concealment entitles the injured party to which course of action, if any? - ANSWER-Recession of the contract 34. Making an insured whole by restoring them to the same condition as before loss is an example of - ANSWER-the principle of indemnity 35. Risk can be defined as all of the following except - ANSWER-the cause of loss 36. Which of the following is requirement of a contract? - ANSWER-There must be an offer and acceptance of the contact terms 37. Moral Hazard can be defined as the increase - ANSWER-Chance of a loss occurring due to an inured's dishonest tendencies. Insurance Insurance 38. According to the California Insurance Code, the Commissioner can disapprove a licensee's request to use a fictitious name for any of the following reasons EXCEPT that the - ANSWER-name is the licensees' actual name. 39. It is considered an unfair method of competition for an agent to advertise that the insurer the agent is appointed with is - ANSWER-a member of the Insurance Guarantee Association 40. All of the following are requirements of contract EXCEPT - ANSWER-There must be equal consideration between the parties 41. If an insurer must have its rates accepted by the insurance Department prior to using them, the insurer would be operating in which of the following types of jurisdictions? - ANSWER-Prior Approval 42. It is Federal Offense for an insurance agent to do all of the following EXCEPT - ANSWER-Misrepresent Facts on an insurance application 43. How often MUST an insurer file the National Association of Insurance Commissioners (NAIC) Financial Statement? - ANSWER-Annually 44. A person authorized by and on behalf of an insurer who transacts life, disability or life and accident and health insurance is defined as a - ANSWER-Life Agent 45. An Insurer entitled to transact business by complying with the California Insurance Code is known as an - ANSWER-Admitted Carrier 46. Who are the members of the Medical Information Bureau? - ANSWER-Life and Health Insurers 47. If you have been convicted off a misdemeanor conviction is later expunged pursuant to CA Penal Code Section 1203.4, Which of the following is true? - ANSWER-Even though your misdemeanor conviction is expunged, you must still disclose your misdemeanor conviction on your individual application for an insurance license. 48. The direct response distribution of Insurance utilizes all of the following to promote the sales of insurance EXCEPT - ANSWER-Telephone call from the agent 50. The increase in the probability of a loss resulting from an insured's dishonest tendencies is known as - ANSWER-Moral Hazard 51. Which is an agreement in which an insurer contacts with a third party to insure itself against losses from insurance policies it issues? - ANSWER-Reinsurance Insurance Insurance 52. Which of the following would an agent be guilty of for misrepresenting the amount of dividends a policy will pay? - ANSWER-A misdemeanor 52. What rule is used to determine the importance of a representation? - ANSWER-The materiality of concealment 53. Which of the following is a hazard? - ANSWER-A condition that may increase the likelihood of a loss occurring 54. When are parties to a contract REQUIRED to communicate information solely based on personal judgement for a matter in question? - ANSWER-NEVER 55. According to the California Insurance Code, if an insurer's certificate of authority is revoked, the Commissioner can proceed with any of the following actions except. - ANSWER-Using Guaranteed Funds to pay salaries 56. Section 1729.2 of the CA Insurance Code requires insurance producer applications and licensee to notify the Insurance Commissioner in writing, within ___ days of charges in background information after an application has been submitted or a license has been issued. - ANSWER-30 57. The insurer's department with PRIMARY responsibility for the risk selection process is called - ANSWER-underwriting 58. A person owes a life annuity. He receives his annuity payments monthly for the remainder of his life with "ten years certain." The annuity will make payments - ANSWER-For a minimum of 120 months and a max of the remainder of his life. 59. All of the following information is gathered during the personal financial planning process EXCEPT - ANSWER-A listing of a person's civic and professional organization memberships. 60. Which policy provision allows an insured to continue coverage under a previously lapsed policy? - ANSWER-The reinstatement provision 61. According to the California Insurance Code, Governing the use of life insurance policy illustrations, the term illustration means - ANSWER-A presentation of policy features that include non-guaranteed elements. 62. The life insurance grace period allows the insured to - ANSWER-pay the premium after the due date without loss of coverage Insurance Insurance 63. When a family policy covers children, all of the following are true except - ANSWER Evidence of insurability is required to convert coverage for children to permanent insurance. 64. An attempt by an agent to deter an insured from replacing an existing life insurance policy is called - ANSWER-Conservation 65. Which of the following would an agent be guilty of for misrepresenting the amount of dividends a policy will pay? - ANSWER-A misdemeanor 66. The additional premium charge by an insurer for adding the accidental death benefit to a whole life policy - ANSWER-Doesn't affect the policy cash value 67. How much employer-provided group term life insurance is exempt from income taxation? - ANSWER-$50,000 68. How long is the free cancellation period for the life insurance offered to individuals who are 60 or older? - ANSWER-30 days 69. What does the statement "Life Insurance created an immediate estate" mean? - ANSWER-The total death benefit is paid whenever the insured dies 70. Which report of an insurance applicant's creditworthiness and personal characteristics may influence eligibility for life and health insurance? - ANSWER Consumer Report 71. In group Life Insurance, who is issued a certificate of insurance? - ANSWER-The participant 72. Which type of insurance guarantees the right to renew the policy each year, regardless of health, but at an increased premium? - ANSWER-Renewable term 73. If a life agent sells a whole life policy to a prospect on behalf of an insurer without an appointment, the - ANSWER-insurer must submit a notice of appointment to the commissioner 74. Which component of a life insurance premium is based on the insured age and gender? - ANSWER-Mortality 75. Which benefits are provided by key employee insurance? - ANSWER-Payment to a business when an important eployee dies. Insurance Insurance 77. Which policy provision protects the insurer against possible adverse selection? - ANSWER-Suicide Clause 76. How can partners guarantee a market for their share of the business in the event of death? - ANSWER-Buy-sell agreements 78. Which policy covering two or more individuals pats the face amount only when the first person dies? - ANSWER-Joint life policy 79. Which two insurance products are commonly used to fund buy-sell agreements? - ANSWER-Life insurance and disability insurance 80. Which type of insurance coverage has both a savings element and a flexible premium option? - ANSWER-Universal life 81. A life insurance policy written after 1988 that feels to meet the seven pay test is known as. - ANSWER-A modified endowment contract 82. What type of insurance policy provides a death benefit that matches the projected outstanding debt on an individuals home? - ANSWER-Mortgage redemption 83. An agent who violates the law governing life insurance policy illustrations is subject to all of the following, except. - ANSWER-Mandatory termination of all insurer appointments 84. Which policy is a saving instrument design to first accumulate funds, and then systematically to liquidate the funds? - ANSWER-Deferred annuity 85. Individual life insurance policy sold to seniors in the state of California must include a prominently placed statement that divulge is all of the following information except - ANSWER-proof of surrender, must be notarized at the agents principal office 86. People commonly purchase an annuity to protect against the risk of. - ANSWER Outliving their financial resources 87. What is one difference between group life and individual life underwriting? - ANSWER-Individual life insurance requires the applicant you answer medical questions 88. An $80,000 whole life policy with a cash value of $10,000 has been in force for 11 years. The policy owner is unable to continue the premium payments. Which of the following describes the reduced paid up non-fordeiture option? - ANSWER-The cash value is used to select a $20,000 paid up policy Insurance Insurance 89. Which of the following is a characteristic of nonqualified annuities? - ANSWER-Tax deferred earnings 90. A 10 year certain annuity with an installment refund is purchased. The annuitant dies after receiving monthly payments for five years. How many remaining payments will the insurer make? - ANSWER-60 payments 91. The payer rider on a juvenile life policy provides that if the Paradies or becomes disabled before the insured juvenile reaches the age specified in the policy that the. - ANSWER-Insurer will make the payments until the insured juvenile reaches a specified page usually 21 or 25 92. Which of the following contracts provides benefits that fluctuate automatically with Investment Results? - ANSWER-Variable life insurance 93. The theory of probability is applied to life insurance through the use of - ANSWER Mortality tables 94. What is the difference between deferred annuity and immediate annuities? - ANSWER-Deferred annuities have longer accumulation periods Q.95-which of the following is NOT an option for the use of the policy dividends? - ANSWER-Fund the distribution of monthly income payments. The insured is totally and permanently disabled. The insured's policy continues in force without payment of further premiums because the policy contains a - ANSWER-Waiver of premium provision. Q.97-- Your client has just bought a new home which he has financed with a $150,000, 7.5% interest. 30-year bank loan. He would like to be sure that if he dies that the unpaid balance of the mortgage would be paid. He wants a policy that will cover the mortgage balance-no more, no less-anytime during the life of the mortgage. Which policy is designed to meet this need? - ANSWER-Decreasing term policy. Q.98-Death benefits that are received by a beneficiary are generally - ANSWER Exempt from federal income tax. Q.99-An insured replaces an existing annuity with a new one and must pay a surrender charge for cancelling the existing annuity. The new policy holds no greater financial benefits to the insured than the existing contract. This is an example of - ANSWER-An unnecessary replacement. Q.100-What do we call the process whereby insurers decide which customers Insurance Insurance to insure and what coverage to offer? - ANSWER-Underwriting. Q.101--what is used to determine the amount of an annuity distribution that is Exempt from taxation? - ANSWER-The exclusion ratio. Q.102--The number of deaths during a year compared with the total number of persons exposed in the class is known as the - ANSWER-Mortalitv rate Q.103--The insured bought an annuity ten years ago. He will retire in five years. To determine the value of his annuity, he must multiply the value of the "accumulation units" he owns, times the value of the "separate account". This type of annuity is known as a - ANSWER-Variable annuity. Q.104--All of the following are true about term life insurance policies EXCEPT the - ANSWER-face amount is paid if the insured survives to the end of the policy period. 105--A life insurance policy dividend is - ANSWER-legall defined as a return of excess premium and not taxable. Q.106--Life insurance policies written without a physical examination are called - ANSWER-Non-medical Why is the delivery of a life insurance policy important? - ANSWER-The free-look period begins on the policy delivery date What is an ESOP - ANSWER-Employee Stock Ownership Plan Q.109--Which policy provision protects the insurer against possible adverse selection? - ANSWER-Suicide clause Q.110--An insured replaces an exciting annuity with a new one and must pay a surrender charge for cancelling the existing annuity. The new policy holds no greater financial benefits to the insured than the existing contract. This is an example of - ANSWER-An unnecessary replacement Q.111--A group life policy is issued on a contributory basis. This means that the - ANSWER-Insured employees will pay part of the premium. Q.112-What is the penalty tax imposed on amounts received from a modified endowment contract? - ANSWER-10% 113- A participating life insurance policy is defined as a contract that - ANSWER-Allows the policy owner to receive a share of surplus in the form of policy dividends Insurance Insurance All of the following are contained in a mortality table EXCEPT - ANSWER-number living at the end of designated year Which policy pays the face amount if the insured survives to the end of a certain period? - ANSWER-endowment insurance A husband and wife have a disabled child who is financially dependent upon them. The death of one parent would not result in financial disaster for the disabled child, but the death of both parents would. Which policy should they purchase? - ANSWER-Second to-die policy How can partners guarantee a market for their share of the business in the event of death? - ANSWER-Buy-sell agreements Which policy covering two or more individuals pays the face amount only when the first person dies? - ANSWER-Joint Life Policy The accidental benefit rider is also known as - ANSWER-Double Indemnity The use of non-medical life insurance accomplishes all of the following EXCEPT - ANSWER-insureds can avoid answering medical questions on the application. Who MUST sign a statement acknowledging that a life insurance policy illustration was given to an applicant? - ANSWER-The applicant and the agent In financial planning, the human life value concept is based on an individual's - ANSWER-Income When does an individual have an insurable interest in the life of another person - ANSWER-The individuals depends on the other person for financial support. The cost of employer-provided group life insurance above $50,000 is - ANSWER taxable as income to the employee If a term life insurance policy is renewable, the renewal provision usually states that: - ANSWER-a higher premium is payable at each renewal Life insurers must include all of the following in their financial statements EXCEPT - ANSWER-policy summary description Common life insurance policy riders include all of the following EXCEPT - ANSWER Extended term Insurance Insurance In a group life insurance policy, who are the parties to the master contract? - ANSWER Insurer and employer Which statement is TRUE regarding employer contributions to qualified plans? - ANSWER-They are tax deductible by the employer Which of the following statements about policy dividends is true? - ANSWER-Insureds elect a dividend option at the time of policy purchase. Which policy allows the insured to choose where the assets backing the cash value are invested? - ANSWER-Variable Life Creditors have rights to life insurance policy proceeds when the beneficiary is the - ANSWER-The insured's estate Which distribution from an annuity would be subject to a penalty tax? - ANSWER-A single payment made to a taxpayer who is age 55 The adjustments that insurers make to the cash value account in a universal life policy each time a payment is made includes all of the following EXCEPT - ANSWER-subtract the policy surrender charges The conversion privilege allows a terminating employee to convert - ANSWER-term insurance into permanent insurance Which government regulation prevents retirement plans from favoring highly compensated employees - ANSWER-Nondiscrimination What is the difference between a conditional premium receipt and a binding premium receipt? - ANSWER-Only a binding receipt always provides insurance that is effective from the date the receipt is given. A life insurance policy's waiver of premium takes effect if an insured - ANSWER Becomes totally disabled A 10-year certain annuity with an installment refund is purchased. The annuitant dies after receiving monthly payments for 5 years. How many remaining payments will the insurer make? - ANSWER-60 payments Under a group life insurance policy, acts of war and aviation are examples of: - ANSWER-policy exclusions Insurance Insurance What does the statement "life insurance creates an immediate estate" mean - ANSWER-The total death benefit is paid whenever the insured dies Which policy provision protects the insurer against a lawsuit before the insurer has had a reasonable opportunity to investigate a claim? - ANSWER-Legal actions What factor determines the difference between deferred and immediate annuities? - ANSWER-When annuity benefit payments begin How does the cost recovery rule apply when a life insurance policy is surrendered for its cash value? - ANSWER-The cost basis of the policy is exempt from taxation The components of determining policy premiums include all of the following EXCEPT - ANSWER-dividends From lowest to highest, which is the CORRECT order of initial premiums for life insurance policies? - ANSWER-Modified premium, ordinary life, single premium Underwriters classify insurance risks as any of the following EXCEPT - ANSWER dividends risks Under which group term life provision does an insurer make payments to the guardian of a beneficiary who is a minor? - ANSWER-Facility of payment. A beneficiary wants to let the death benefit accumulate and receive only the monthly investment proceeds. Which settlement option should be chosen? - ANSWER-Interest option Death benefits that are received by a beneficiary are generally - ANSWER-exempt from federal income tax The California Insurance Code requirements regarding the r e t u rof life or annuity contracts issued to seniors - ANSWER-gives a senior at least 30 days to return specified life and/or annuity contracts for a full refund. When a family policy coverschildren, all of the following are true EXCEPT - ANSWER Evidence of insurability is required to convert coverage for children to Permanent insurance An insurer's request for an attending physician's repon MUST be Accompanied by a copy of the - ANSWER-Signed authorization Insurance Insurance What is REQUIRED whenan application reveals conditions that require more information? - ANSWER-Attending physician's statement Which policy provision protects thepolicy owner from unintentional lapse of the contract? - ANSWER-Grace period Underwhich policy provision can apolicy be surrendered for its net cash value? - ANSWER-No forfeiture option The policy owner, age 50, has been paying the premiums on his whole life policy for fifteen vears. Heneeds the equivalent of one-third of his policy'scash value for two years. He wants to continue to have the same amount of life insurance protection and he canafford to continue to pay the policy's premium. Which of the following would appear to be his BEST course of action? - ANSWER-Use the policy loan provision ot borrow money from the policy. but keep Making the premium payments ot keep the policy in force. In a 5-year vesting schedule, what percentage of employer Contributions MUST be vested after 5 years of service? - ANSWER-100% Which of the following is a characteristic of nonqualified annuities? - ANSWER-Tax deferred earnings Which of the following is a correct statement about the premium payment modes? The total premium paid by a life policyowner for one policy year is: - ANSWER-greater if the premium is paid semiannually rather than annually. What is the limit of liability on a life insurance policy? - ANSWER-The face amount of the policy Traditional comprehensive major medical plans include all of the following EXCEPT - ANSWER-First-dollar coverage Under a disability income insurance policy with an own occupation clause, an individual who can no longer perform the tasks of the job held at the time of injury is considered - ANSWER-totally disabled Part-time nursing care that follows a hospitalization and can be provided in a patient's home is covered under - ANSWER-home health care benefits What type of insurance can be purchased at airports, bus terminals, and railroad stations? - ANSWER-travel accident insurance Insurance Insurance During the solicitation of a long term care insurance rider, a life agent must consider all of the following EXCEPT the applicant's - ANSWER-Attending Physician Statement Vision care insurance usually covers all of the following EXCEPT - ANSWER-eye surgery All of the following are optional group medical coverages EXCEPT - ANSWER maternity What is the cost of service from the Health Insurance Counseling Advocacy Program (HICAP)? - ANSWER-no charge All of the following may opt for a self insured medical and disability plan EXCEPT - ANSWER-individuals Which statement about medicare is NOT correct? - ANSWER-Medicare Part C covers long-term care. In order to obtain group insurance without providing evidence of insurability, what do eligible individuals generally have to do? - ANSWER-Enroll within a specified eligibility period The adult day care coverage level of a long term care policy provides for - ANSWER part-time nursing at a facility for elderly who live at home Regarding the Health Benefit Exchanges, as created by PPACA, all of the following statements are true EXCEPT - ANSWER-an individual enrolling in a bronze level plan is not eligible for reduced cost-sharing Under the PPACA, which medical enrollment tier is 80% actuarial value? - ANSWER Gold Provision in a disability income policy include all of the following EXCEPT - ANSWER-Deductible and coinsurance amounts. All of the following statements are true regarding Health Insurance Counseling Advocacy Program (HICAP)counselors EXCEPT HICAP counselors - ANSWER-Are qualified to give legal advice The initial enrollment period for Medicare PartB ends how many months after the 65t birthday month? - ANSWER-Three months Insurance Insurance Which program is designed to provide medical assistance to people with low incomes? - ANSWER-Medi-Cal A commonly used cost containment measure for emergency hospital care under a major medical expense plan is the - ANSWER-Deductible A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as - ANSWER-Hospital confinement indemnity The group medicalplan provision thatapplies when a claimant has coverage under more than one plan is known as - ANSWER-Coordination of benefits Which group provides information about Health-related issues to the elderly in California? - ANSWER-Health Insurance Counseling and Advocacy Program (HiCAP) The Employee Retirement Income Security Act of 1974 (ERISA) regulates group health insurance in thearea of - ANSWER-Disclosure and reporting Which health plan pays more for care received from a network provider than it pays for care from a non-network provider? - ANSWER-Preferred Provider Organization (PPO) A Long-Term Care insurance ridercan include coverage foral of the following EXCEPT - ANSWER-Hospital acute care Residual disability income insurance payments are based on - ANSWER-The amount of the insured's income is reduced by the disability Why is an injury caused by an accident at an employee's workplace excluded from individual health insurance coverage? - ANSWER-It is covered by the state Worker's Compensation program. In healthinsurance the coinsurance is - ANSWER-A percentage paid for covered expenses by the insured and the insurer after the deductible is satifsfied Vision insurance usually limits coverage in all of the following ways EXCEPT - ANSWER-Specific dollar amount for examinations What happens if an insurer violates the Medical Loss Ratio rule and spends too much money on administrative costs - ANSWER-Insurers that do not meet the Medical Loss Ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs. Insurance Insurance What is the first step in submitting Medicare claims? - ANSWER-The medical provider submits expenses to Medicare Health insurance counseling and advocacy program (HICAP) counselors can do all of the following EXCEPT - ANSWER-Charge for their services When medical expense policies do notstate specific dollar benefit amounts, but instead base payments upon thecharges for like services in the same geographical area, benefits are designated as - ANSWER-Usual, customary, and reasonable charges. As established by PPACA, an adult child may be covered by a parent's health insurance plan until what age? - ANSWER-26 years old Q.196--Two of the long-term care chronically ill activities of daily living (ADLs) are - ANSWER-Eating and dressing Q.197--For Social Security purposes, a person with 40 quarters of coverage is considered - ANSWER-Fully insured In California, a child may obtain individual health coverage through all of the following EXCEPT - ANSWER-healthy families Which of the following is NOT an example of cost sharing in a health insurance policy? - ANSWER-Coordination The insurer can do which of the following under a noncancelable health insurance policy? - ANSWER-Cancel the policy for nonpayment of premium In the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT: - ANSWER-A worker's medical plan includes a carryover deductible provision. What rights do individuals have if they disagree on the amount Medicare will pay? - ANSWER-They can ask a medicare carrier to review the decision An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT - ANSWER-within 30 days of being diagnosed with an illness. Medicare Part A provides coverage for all of the following EXCEPT - ANSWER Physician's services Insurance Insurance After the deductible, what portion does a patient pay for covered expenses under Medicare Part B? - ANSWER-20% The premium of a proposed disability income policy could be lowered by increasing the - ANSWER-Elimination period Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of Insurance (CDI) EXCEPT - ANSWER-LASIK Which plan covers the medical expenses that are NOT covered by Medicare? - ANSWER-Medicare Supplement The type of health care provider that both the health care services and health care coverage is called - ANSWER-Health Maintenance Organization In medical expense insurance, what serves the same purpose as the elimination period in disability income insurance? - ANSWER-deductible An example of a third-party administrator is an - ANSWER-Outside organization that processes claims for an employer's self-funded group plan The family and medical leave act (FMLA) covers all of the following EXCEPT - ANSWER-traveling with a spouse who has been transferred overseas. What is the purpose of social insurance? - ANSWER-protect certain vulnerable segments of the population Which program pays the cost of nursing home care for people who cannot afford it themselves? - ANSWER-Medi-Cal Benefits under Social Security are available only for workers who are - ANSWER-fully insured Group health plans obligated by the consolidated Omnibus Budget Reconciliation Act (COBRA) cover groups of at least. - ANSWER-20 employees With medicare coverage - ANSWER-Part B provides benefits for diagnostic tests and X rays performed on an outpatient basis. A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ration (MLR) is less than what percentage? - ANSWER-80% Insurance Insurance According to the California Insurance Code, all of the following Long Term Care (LTC) insurance sales are considered unnecessary EXCEPT - ANSWER-a replacement LTC policy with equal benefits for a lower premium. All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT - ANSWER-medical expense The most common type of specified disease insurance policy is - ANSWER-cancer After the deductible is satisfied. what percentage of a reasonable Charges does Medicare Part B pay? - ANSWER-80% Which of the following statements concerning the usual coordination of benefits provision is correct? - ANSWER-When two plans both have the provision, coverage as an employee is primary to coverage as a dependent. Which health insurance provision protects an insured from the expense of a catastrophic illness? - ANSWER-stop loss Which health insurance contract provision addresses the problem of over insurance? - ANSWER-coordination of benefits Relevant factors in the health insurance principle of morbidity include all of the following EXCEPT - ANSWER-intelligence A surviving spouse without dependent children is eligible for Social Security survivor benetits at age - ANSWER-60 What happens if an insurer violates the Medical Loss Ratio rate and spends too much money on administrative costs? - ANSWER-Insurers that do not meet the Medical Less Ratio standard will be required to provide rebates to their customers and reduce on their administrative costs Which health plan might apply 90% coinsurance to network providers and 70% coinsurance to non-network providers? - ANSWER-Preferred Provider Organization (PPO) The Family and Medical Leave Act(FMLA) covers all of the following EXCEPT - ANSWER-traveling with a spouse who has been transferred overseas. To reach currently insured status under the Social Security system, an individual must be credited with a minimum of - ANSWER-6 quarters of coverage during the last 13 quarter period Insurance Insurance In health insurance, the result of rising morbidity rates is - ANSWER-Increased premiums Vision insurance usually limits coverage in all of the following ways EXCEPT - ANSWER-Specific dollar amount for examinations When an agent writes a replacing long-term care policy, the agent's first year sales commission will be determined based on the - ANSWER-difference between the new and original policy annual premiums Why is an injury caused by an accident at an employee's workplace excluded from individual health insurance coverage? - ANSWER-It is covered by the state Worker's Compensation program. All of the following conditions must be met to qualify for residual disability benefits under a disability income policy EXCEPT - ANSWER-Qualifies for Social Security disability benefits. All of the following features of a Preferred Provider Organization (PPO) EXCEPT - ANSWER-primary care physicians act as gatekeepers. In the Worker's Compensation policy. Part One, Workers Compensation, pays for - ANSWER-sums the insured is required to pay under state Workers' Compensation law. Under Social Security, the definition of disability is the inability to engage in - ANSWER-Any substantial gainful activity At what age are individuals eligible for Medicare Part A benefits? - ANSWER-65 The Employee Retirement Income Security Act of 1974(ERISA) regulates group health insurance in the area of - ANSWER-Disclosure and reporting Which plan covers the medical expenses that are NOT covered by Medicare? - ANSWER-Medicare Supplement Which of the following conditions would NOT be included among the chronic illness triggers of a long-term care policy? - ANSWER-deafness Which of the following conditions would NOT be included among the chronic illness triggers of long-term care policy? - ANSWER-deafness Insurance Insurance Insurers are prohibited from denying claims based on misrepresentations in a disability policy application after the policy has been in force for - ANSWER-two years Which funded government program is jointly administered by the federal and state governments? - ANSWER-Medi-Cal What rights do individuals have if they disagree with a decision on the amount Medicare will pay? - ANSWER-They can ask a Medicare carrier to review the decision Which long-term care policy provision allows for a periodic increase in policy benefits? - ANSWER-Inflation protection All of the following statements about Medicare Part B are correct EXCEPT it - ANSWER-pays for virtually all drugs prescribed by a physician Under PPACA, what is a health benefit exchange? - ANSWER-PPACA creates new entities called American Health Benefit Exchanges through which individuals, small businesses, and those who do not have access to affordable employer coverage, can purchase coverage. The initial enrollment period for Medicare Part B ends how many months after the 65m birthday month? - ANSWER-Three months. What is the first step in submitting medicare claims? - ANSWER-The medical provider submits expenses to Medicare Unless certified by another governmental agency, which entity has jurisdiction over providers of coverage designed to pay for health care services? - ANSWER-Department of Insurance Long-term care insurance may be purchased in all of the following forms EXCEPT - ANSWER-federal government-sponsored policies Under the Consolidated Omnibus Budget Reconciliation Act(COBRA).a qualifying event ensures that an employee who loses coverage can - ANSWER-Elect to continue coverage Which statement is TRUE regarding Worker's Compensation? - ANSWER-Employer pays the entire premium for Workers' Compensation coverage Which program is designed to provide medical assistance to people with low incomes? - ANSWER-Medi-Cal Insurance Insurance The Social Security normal retirement age depends upon the - ANSWER-worker's year of birth Who submits Medicare part A claims? a. Patients. b. Hospitals. c. Pharmacies. d. Physicians. - ANSWER-b. hospitals How long do Worker's Compensation medical expenses continue for disabled workers? - ANSWER-There is no limit Which of the following statements concerning the usual coordination of benefits provision are CORRECT? - ANSWER-When two plans both have the provision, coverage as an employee is primary to coverage as a dependent. The Americans with Disabilities Act(ADA) defines a disabled person as one who is unable to perform any of the following life activities EXCEPT - ANSWER-Driving After the deductible, what portion does a patient pay for covered expenses under Medicare Part B? - ANSWER-20% Probationary periods reduce costs to employers in all of the following ways EXCEPT - ANSWER-employees must pay the entire premium during this time Members of the Medical Information Bureau are REQUIRED to report - ANSWER medical impairments found during the underwriting process A worker dies who is credited with 6 quarters of coverage during the last 13-quarter period. What status does the worker have under Social Security? - ANSWER-Currently insured What is the cost of service from the Health Insurance Counseling Advocacy Program (HICAP)? - ANSWER-no charge What is covered by part A medicare? - ANSWER-hospitalization The frequency and severity of certain illnesses and accidents is known as - ANSWER morbidity A Long-Term Care Insurance rider can include coverage for all of the Insurance Insurance following EXCEPT - ANSWER-Hospital acute care A terminating employee who wants to exercise the conversion privilege must meet all of the following requirements EXCEPT - ANSWER-supply evidence of insurability An insured has a disability income policy with a $1500 monthly benefits and a 30-day elimination period. The insured is unable to work for 120 days following an accident. What amount will the policy pay? - ANSWER-$4500 Social Security survivor benefits are available for all of the following EXCEPT - ANSWER-parents of any age who were dependent upon the deceased worker Under group disability insurance an employee is eligible for a partial disability benefit when they can - ANSWER-Perform some of their job activities on a part time basis after injury. Which of the following is NOT an example of cost sharing in a health insurance policy? - ANSWER-coordination The insurer can do which of the following under a no cancelable health insurance policy? - ANSWER-Cancel the policy for nonpayment of premium In the absence of a coordination of benefits clause, all of the following circumstances might result in recovery of more than 100% of actual health care expenses EXCEPT: - ANSWER-a worker's medical plan includes a carryover deductible provision. What rights do individuals have if they disagree with a decision on the amount Medicare will pay? - ANSWER-They can ask a Medicare carrier to review the decision Medicare Part A provides coverage for all of the following EXCEPT - ANSWER physician's services The premium of proposed disability income policy could be lowered by increasing the - ANSWER-Elimination period An individual is allowed to enroll in individual health insurance under the following circumstances EXCEPT - ANSWER-within 30 days of being diagnosed with an illness. After the deductible, what portion does a patient pay for covered expenses under Medicare Part B? - ANSWER-20% Insurance Insurance Providers of coverage for all of the following types of care are subject to the jurisdiction of the California Department of Insurance(CDI)EXCEPT - ANSWER-LASIK Which plan covers the medical expenses that are NOT covered by Medicare? - ANSWER-Medicare Supplement The type of health care provider that provides both the health care services and health care coverage is called - ANSWER-health maintenance organization (HMO) In medical expense insurance, what serves the same purpose as the climination period in disability income insurance? - ANSWER-Deductible An example of a third-party administrator is an - ANSWER-Outside organization that processes claims for an employer's self-funded group plan The Family and Medical Leave Act(FMLA) covers all of the following EXCEPT - ANSWER-traveling with a spouse who has been transferred overseas. What is the purpose of social insurance? - ANSWER-protect certain vulnerable segments of the population Which program pays the cost of nursing home care for people who cannot afford it themselves? - ANSWER-Medi-Cal Which program pays the cost of nursing home care for people who cannot afford it themselves? - ANSWER-Medi-Cal Benefits under Social Security are available only for workers who are - ANSWER-fully insured Group health plans obligated by the Consolidated Omnibus Budget Reconciliation Act(COBRA) cover groups of at least - ANSWER-20 employees With Medicare coverage - ANSWER-Part B provides benefits for diagnostic tests and X rays performed on an outpatient basis. A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MIL) is less than what percentage? - ANSWER-80% Insurance According to the California Insurance Code, all of the following Long-Term Care (LTC) insurance sales are considered unnecessary EXCEPT - ANSWER-a replacement LTC policy with equal benefits for a lower premium. All of the following types of insurance pay benefits in addition to those paid by other insurance policies held by the insured EXCEPT - ANSWER-medical expense The most common type of specified disease insurance policy is - ANSWER-cancer After the deductible is satisfied, what percentage of a reasonable charge does Medicare Part B pay? - ANSWER-80% Which of the following statements concerning the usual coordination of benefits provision is correct? - ANSWER-When two plans both have the provision, coverage as an employee is primary to coverage as a dependent. Which health insurance provision protects an insured from the expense of a catastrophic illness? - ANSWER-stop loss Which health insurance contract provision addresses the problem of over insurance? - ANSWER-coordination of benefits Insurance