Accident and Health Insurance Exam Questions
H has suffered a covered disability away from her job and will shortly begin collecting benefits. The
insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income.
This clause is known as:
A: Over-insurance clause
B: free look
C: relation of earning to insurance
D: relation of economic value - (correct Answer) - C: relation of earning to insurance
The insured should be aware of the issue date upon delivery a policy and the date should be listed on:
A: the policy summary
B: the first page of the contract
C: the delivery receipt
D: upon conditional receipt - (correct Answer) - B: the first page of the contract
The policy has all of the following rights EXCEPT:
A: Right to solely renew a guaranteed renewable policy.
B: Right to terminate a policy
C: Unilateral right to renew an Optionally renewable policy
D: Right to assign a contract - (correct Answer) - C: Unilateral right to renew an Optionally renewable
policy
The part of a contract that specifies which expenses may or may not be covered is known as the:
A: Exclusion
B: Eligible Expense provision
C: Insuring Agreement
D: Consideration Clause - (correct Answer) - B: Eligible Expense provision
Which of the following is considered to be a mandatory provision in a health policy?
A: Time Limit on Certain Defenses
B: Change of Occupation
,C: Illegal Occupation
D: Intoxicant/Narcotic Usage - (correct Answer) - A: Time Limit on Certain Defenses
Which of the following may be considered an eligible expense found in a health policy?
A: Cosmetic Surgery
B: Premium payment
C: cold cream
D: Bus fare to receive treatment for a covered loss - (correct Answer) - D: Bus fare to receive treatment
for a covered loss
K has a policy that covers doctors visits but limits the number of visits per calendar year and pays a
limited indemnification limit per visit. K has:
A: Basic Medical Expense
B: Physician Nonsurgical Coverage
C: Basic Surgical Policy
D: Basic Hospital Coverage - (correct Answer) - B: Physician Nonsurgical Coverage
All of the following are CORRECT about Medicare EXCEPT:
A: An insured who is age 30 but collecting Social Security disability for the last two years is eligible for
Medicare.
B: An insured who is age 60 and is at the end stage of renal failure is eligible for Medicare.
C: An insured who turns age 65 and is still employed is eligible for Medicare.
D: An insured who has Medicare Part A is eligible to enroll for Medigap policies within six months of
enrolling in Part A. - (correct Answer) - D: An insured who has Medicare Part A is eligible to enroll for
Medigap policies within six months of enrolling in Part A.
Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an
insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss?
A: 10
B: 15
C: 20
D: 30 - (correct Answer) - B: 15
The purpose of the Fair Credit Reporting Act is to:
A: protect the consumer from having an adverse action against them based of obsolete credit
,information
B: to ensure that credit information used in underwriting is accurate and updated
C: make sure that any financial institution handles an individual's credit in a correct, proper manner
D: All of the Above - (correct Answer) - D: All of the Above
Most Accident and Health policies require that claims must be paid _________ upon written proof of
loss.
A: 30 days
B: Immediately
C: 60 days
D: 90 days - (correct Answer) - B: Immediately
A LTC policy that will only pay for ADL given occasionally by a licensed professional is:
A: Skilled Care
B: Intermediate Care
C: Custodial Care
D: None of the Above - (correct Answer) - C: Custodial Care
Which of the following policy provisions are optional in a individual health policy?
A: Entire Contract
B: Change of Occupation
C: Entire Contract
D: Reinstatement - (correct Answer) - B: Change of Occupation
Which of the following elements is part of the entire contract clause?
A: The exchange of value between the parties
B: The agreement between the policyholder and insurer
C: The amount of time the insured has to send a policy back for a full refund
D: None of the Above - (correct Answer) - D: None of the Above
All of the following are true regarding Social Security disability EXCEPT:
A: A insured must wait 5 months before collecting benefits
B: To qualify an insured must be unable to do any job in the American economy
, C: To qualify an insured must be disabled for a year or longer or die within a two year period.
D: The insured must have a certain amount of Social Security credits based off age. - (correct Answer) - C:
To qualify an insured must be disabled for a year or longer or die within a two year period.
Health Care FSA contributions are limited to _______ per year.
A: $5,000
B: $3,000
C: $2,700
D: $3,250 - (correct Answer) - C: $2,700
A noncancelable policy means the company
A: may not raise the premium or terminate the policy except for nonpayment of premium
B: may not cancel before the insured reaches age 50
C: may pay limited benefits and cannot cancel all benefits
D: can only terminate coverage if the insured switches occupations - (correct Answer) - A: may not raise
the premium or terminate the policy except for nonpayment of premium
The maximum number of in-hospital days coverage provided by an individual policy under minimum
standards is:
A: 30 days
B: 45 days
C: 90 days
D: 180 days - (correct Answer) - D: 180 days
If there is a dispute on medical necessity under a HMO, there must be a system in place for a second
opinion. If the second opinion determines that a covered service is in fact medically necessary, the HMO
must provide service. The only way that benefits are paid for an out-of-network physician is:
A: if a referral is given
B: state law dictates when coverage out of area exists
C: if it is an emergency
D: None of the Above - (correct Answer) - A: if a referral is given
Which of the following circumstances may lead to the renewal of a producer license without the
requirement of completing continuing education requirements?
A: There are no exceptions to the continuing education law.
H has suffered a covered disability away from her job and will shortly begin collecting benefits. The
insurer sends a letter to H stating that she will not receive any benefit amounts greater than her income.
This clause is known as:
A: Over-insurance clause
B: free look
C: relation of earning to insurance
D: relation of economic value - (correct Answer) - C: relation of earning to insurance
The insured should be aware of the issue date upon delivery a policy and the date should be listed on:
A: the policy summary
B: the first page of the contract
C: the delivery receipt
D: upon conditional receipt - (correct Answer) - B: the first page of the contract
The policy has all of the following rights EXCEPT:
A: Right to solely renew a guaranteed renewable policy.
B: Right to terminate a policy
C: Unilateral right to renew an Optionally renewable policy
D: Right to assign a contract - (correct Answer) - C: Unilateral right to renew an Optionally renewable
policy
The part of a contract that specifies which expenses may or may not be covered is known as the:
A: Exclusion
B: Eligible Expense provision
C: Insuring Agreement
D: Consideration Clause - (correct Answer) - B: Eligible Expense provision
Which of the following is considered to be a mandatory provision in a health policy?
A: Time Limit on Certain Defenses
B: Change of Occupation
,C: Illegal Occupation
D: Intoxicant/Narcotic Usage - (correct Answer) - A: Time Limit on Certain Defenses
Which of the following may be considered an eligible expense found in a health policy?
A: Cosmetic Surgery
B: Premium payment
C: cold cream
D: Bus fare to receive treatment for a covered loss - (correct Answer) - D: Bus fare to receive treatment
for a covered loss
K has a policy that covers doctors visits but limits the number of visits per calendar year and pays a
limited indemnification limit per visit. K has:
A: Basic Medical Expense
B: Physician Nonsurgical Coverage
C: Basic Surgical Policy
D: Basic Hospital Coverage - (correct Answer) - B: Physician Nonsurgical Coverage
All of the following are CORRECT about Medicare EXCEPT:
A: An insured who is age 30 but collecting Social Security disability for the last two years is eligible for
Medicare.
B: An insured who is age 60 and is at the end stage of renal failure is eligible for Medicare.
C: An insured who turns age 65 and is still employed is eligible for Medicare.
D: An insured who has Medicare Part A is eligible to enroll for Medigap policies within six months of
enrolling in Part A. - (correct Answer) - D: An insured who has Medicare Part A is eligible to enroll for
Medigap policies within six months of enrolling in Part A.
Under the Claim Forms provision in an Accident and Health policy, an insurance company must supply an
insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss?
A: 10
B: 15
C: 20
D: 30 - (correct Answer) - B: 15
The purpose of the Fair Credit Reporting Act is to:
A: protect the consumer from having an adverse action against them based of obsolete credit
,information
B: to ensure that credit information used in underwriting is accurate and updated
C: make sure that any financial institution handles an individual's credit in a correct, proper manner
D: All of the Above - (correct Answer) - D: All of the Above
Most Accident and Health policies require that claims must be paid _________ upon written proof of
loss.
A: 30 days
B: Immediately
C: 60 days
D: 90 days - (correct Answer) - B: Immediately
A LTC policy that will only pay for ADL given occasionally by a licensed professional is:
A: Skilled Care
B: Intermediate Care
C: Custodial Care
D: None of the Above - (correct Answer) - C: Custodial Care
Which of the following policy provisions are optional in a individual health policy?
A: Entire Contract
B: Change of Occupation
C: Entire Contract
D: Reinstatement - (correct Answer) - B: Change of Occupation
Which of the following elements is part of the entire contract clause?
A: The exchange of value between the parties
B: The agreement between the policyholder and insurer
C: The amount of time the insured has to send a policy back for a full refund
D: None of the Above - (correct Answer) - D: None of the Above
All of the following are true regarding Social Security disability EXCEPT:
A: A insured must wait 5 months before collecting benefits
B: To qualify an insured must be unable to do any job in the American economy
, C: To qualify an insured must be disabled for a year or longer or die within a two year period.
D: The insured must have a certain amount of Social Security credits based off age. - (correct Answer) - C:
To qualify an insured must be disabled for a year or longer or die within a two year period.
Health Care FSA contributions are limited to _______ per year.
A: $5,000
B: $3,000
C: $2,700
D: $3,250 - (correct Answer) - C: $2,700
A noncancelable policy means the company
A: may not raise the premium or terminate the policy except for nonpayment of premium
B: may not cancel before the insured reaches age 50
C: may pay limited benefits and cannot cancel all benefits
D: can only terminate coverage if the insured switches occupations - (correct Answer) - A: may not raise
the premium or terminate the policy except for nonpayment of premium
The maximum number of in-hospital days coverage provided by an individual policy under minimum
standards is:
A: 30 days
B: 45 days
C: 90 days
D: 180 days - (correct Answer) - D: 180 days
If there is a dispute on medical necessity under a HMO, there must be a system in place for a second
opinion. If the second opinion determines that a covered service is in fact medically necessary, the HMO
must provide service. The only way that benefits are paid for an out-of-network physician is:
A: if a referral is given
B: state law dictates when coverage out of area exists
C: if it is an emergency
D: None of the Above - (correct Answer) - A: if a referral is given
Which of the following circumstances may lead to the renewal of a producer license without the
requirement of completing continuing education requirements?
A: There are no exceptions to the continuing education law.
