Kentucky Health Insurance Exams (Latest 2024/ 2025
Updates STUDY PACKAGE WITH COMPLETE
SOLUTIONS) Questions and Verified Answers| 100 %
Correct| Grade A
What is Risk? - ANSWERRisk is the uncertainty or chance of loss occurring
What is a Peril? - ANSWERPerils are the causes of loss insured against in an insurance
policy
What are the elements of risk? - ANSWERLoss must be (1) due to chance; (2) definite
and measurable; (3) statistical predictable; (4) not catastrophic; (5) with large loss
exposure; and (6) insurance cannot be mandatory.
What is the difference between a disability income and medical expense policy? -
ANSWERMedical expense policies cover the hospital and medical expenses of
covered injures or illnesses, whereas disability income policies actually pay income
to a person who must miss work as the result of an injury or illness.
Define accidental bodily injury - ANSWERAccidental bodily injury is a unforeseen and
unintended injury that resulted from an accident rather than a sickness
In what ways can accidental death and dismemberment coverage be written? -
ANSWERAD&D coverage can be written as a rider or a separate policy.
Under accidental death and dismemberment coverage, when would the capital
amount be paid? When would the principal amount be paid? - ANSWERThe principal
sum is paid for accidental death. In the case of loss of sight or accidental
dismemberment, a percentage of that principal sum will be paid by the policy, often
referred to as the capital sum.
Explain the concept of coverage on first-dollar basis - ANSWERFirst-dollar coverage
does not require the insured to pay a deductible
What is the difference between reimbursement and scheduled benefit payment? -
ANSWERIn reimbursement plans, the expenses are reimbursed directly to the
insured for the services provided. In scheduled benefits plans, the insurer pays up to
a certain amount. for the services, as determined on a schedule for the cost of each
treatment.
What are some common exclusions and limitations in medical expense policies? -
ANSWERWar and active duty military, intentionally self-inflicted injuries, pre-existing
conditions, elective cosmetic surgery, injuries as a result of participating in criminal
activities, and conditions covered by workers compensation or government plans.
, What coverages are provided by a Major Medical Expense policy? - ANSWERAfter
basic policy pays, the supplemental major medical will provide coverage for
expenses that were not covered by the basic policy, and expenses that exceed the
maximum. If the time limitation is used up by the basic policy, the supplemental
coverage will provide coverage thereafter.
How does restoration of benefits work? - ANSWERMajor medical policies include a
provision that restores a specific dollar amount at certain intervals after the lifetime
limit of coverage has been exhausted if the insured maintains the policy claim-free
for a given period of time.
Once a disability policy is paying a claim, how long will it pay? - ANSWERDisability
income insurance is designed to provide a reasonable and predetermined income to
a disabled party for a set period of time subject to a "time deductible" termed an
elimination period.
What is the difference between own occupation and any occupation? - ANSWERA
policy that has "any occupation" provision will only provide benefits when the
insured is unable to perform any occupation for which they are suited by reason of
education, training, or experience. "own occupation" is the more liberal definition
and therefore provides a better benefit for the insured.
What is the difference between occupational and nonoccupational coverage? -
ANSWEROccupational coverage provides benefits for disabilities resulting from
accidents or sickness that occur on or off the job. Nonoccupational coverage, on the
other hand, only covers disabilities that result from accidents or sickness occurring
off the job.
What is the probationary period? How is it different from the elimination period? -
ANSWERThe probationary period is a waiting period. Elimination period is a waiting
period that is imposed on the insured from the onset of disability until benefit
payments commence (it is a deductible measured in time instead of dollar amount)
What is the difference between confining and non-confining disabilty? - ANSWERA
confining disability requires that the affected individual remain indoors, whereas a
non-confining disability does not.
Describe residual disability - ANSWERResidual disability is the type of disability
income policy that provides benefits for loss of income when a person returns to
work after a total disability, but is still not able to work as long or at the same level
he/she worked before becoming disabled.
What must a worker prove in order to receive benefits for a non disabling injury? -
ANSWERThat treatment caused a loss of work time
What is the purpose of key person disability insurance? - ANSWERThe key person's
economic value to the business is determined in terms of the potential loss of
Updates STUDY PACKAGE WITH COMPLETE
SOLUTIONS) Questions and Verified Answers| 100 %
Correct| Grade A
What is Risk? - ANSWERRisk is the uncertainty or chance of loss occurring
What is a Peril? - ANSWERPerils are the causes of loss insured against in an insurance
policy
What are the elements of risk? - ANSWERLoss must be (1) due to chance; (2) definite
and measurable; (3) statistical predictable; (4) not catastrophic; (5) with large loss
exposure; and (6) insurance cannot be mandatory.
What is the difference between a disability income and medical expense policy? -
ANSWERMedical expense policies cover the hospital and medical expenses of
covered injures or illnesses, whereas disability income policies actually pay income
to a person who must miss work as the result of an injury or illness.
Define accidental bodily injury - ANSWERAccidental bodily injury is a unforeseen and
unintended injury that resulted from an accident rather than a sickness
In what ways can accidental death and dismemberment coverage be written? -
ANSWERAD&D coverage can be written as a rider or a separate policy.
Under accidental death and dismemberment coverage, when would the capital
amount be paid? When would the principal amount be paid? - ANSWERThe principal
sum is paid for accidental death. In the case of loss of sight or accidental
dismemberment, a percentage of that principal sum will be paid by the policy, often
referred to as the capital sum.
Explain the concept of coverage on first-dollar basis - ANSWERFirst-dollar coverage
does not require the insured to pay a deductible
What is the difference between reimbursement and scheduled benefit payment? -
ANSWERIn reimbursement plans, the expenses are reimbursed directly to the
insured for the services provided. In scheduled benefits plans, the insurer pays up to
a certain amount. for the services, as determined on a schedule for the cost of each
treatment.
What are some common exclusions and limitations in medical expense policies? -
ANSWERWar and active duty military, intentionally self-inflicted injuries, pre-existing
conditions, elective cosmetic surgery, injuries as a result of participating in criminal
activities, and conditions covered by workers compensation or government plans.
, What coverages are provided by a Major Medical Expense policy? - ANSWERAfter
basic policy pays, the supplemental major medical will provide coverage for
expenses that were not covered by the basic policy, and expenses that exceed the
maximum. If the time limitation is used up by the basic policy, the supplemental
coverage will provide coverage thereafter.
How does restoration of benefits work? - ANSWERMajor medical policies include a
provision that restores a specific dollar amount at certain intervals after the lifetime
limit of coverage has been exhausted if the insured maintains the policy claim-free
for a given period of time.
Once a disability policy is paying a claim, how long will it pay? - ANSWERDisability
income insurance is designed to provide a reasonable and predetermined income to
a disabled party for a set period of time subject to a "time deductible" termed an
elimination period.
What is the difference between own occupation and any occupation? - ANSWERA
policy that has "any occupation" provision will only provide benefits when the
insured is unable to perform any occupation for which they are suited by reason of
education, training, or experience. "own occupation" is the more liberal definition
and therefore provides a better benefit for the insured.
What is the difference between occupational and nonoccupational coverage? -
ANSWEROccupational coverage provides benefits for disabilities resulting from
accidents or sickness that occur on or off the job. Nonoccupational coverage, on the
other hand, only covers disabilities that result from accidents or sickness occurring
off the job.
What is the probationary period? How is it different from the elimination period? -
ANSWERThe probationary period is a waiting period. Elimination period is a waiting
period that is imposed on the insured from the onset of disability until benefit
payments commence (it is a deductible measured in time instead of dollar amount)
What is the difference between confining and non-confining disabilty? - ANSWERA
confining disability requires that the affected individual remain indoors, whereas a
non-confining disability does not.
Describe residual disability - ANSWERResidual disability is the type of disability
income policy that provides benefits for loss of income when a person returns to
work after a total disability, but is still not able to work as long or at the same level
he/she worked before becoming disabled.
What must a worker prove in order to receive benefits for a non disabling injury? -
ANSWERThat treatment caused a loss of work time
What is the purpose of key person disability insurance? - ANSWERThe key person's
economic value to the business is determined in terms of the potential loss of
