Accident and Health Insurance Agent (Broker) Practice Exam with complete Questions and Ans, Exams of Nursing

Download Accident and Health Insurance Agent (Broker) Practice Exam with complete Questions and Ans and more Exams Nursing in PDF only on Docsity! Accident and Health Insurance Agent (Broker) Practice Exam with complete Questions and Answers Sally is considering her Medicare options. She understands that to enroll in Medicare Part B, she will have to pay a monthly premium. Since she is healthy, she is considering delaying her enrollment until later. Will she be able to enroll at a later date? 1. Yes, she can enroll at anytime in the future 2. Yes, however; she would have a permanent premium penalty when she does enroll 3. No, this is a take or leave it situation 4. Yes, but she would have to show evidence of good health. - answerYes, however; she would have a permanent premium penalty when she does enroll Under Medicare Part A, a spell of illness begins again and is subject to a new deductible for another admission when: 1. The patient has been discharged from a prior stay and 45 days have elapsed 2. The patient has been discharged from a prior stay and 30 days have elapsed 3. The patient has been discharged from a prior stay and 60 days have elapsed 4. The patient has been discharged from a prior stay and 90 days have elapsed - answerThe patient has been discharged from a prior stay and 60 days have elapsed What type of insurer retains risk? 1. Government insurance. 2.Reinsurers. 3.Self insurers. 4.Assessment insurers. - answerSelf insurers. A variety of types of care are provided under a long-term care policy. All of the following are types of care generally provided EXCEPT: 1.Home health care 2.Intensive care 3.Custodial care 4.Skilled care - answerIntensive care Melvin has a long-term care policy with a 30-day elimination period. The policy has a daily benefit of $100/day. The policy has a 3-year benefit period. If Melvin is confined to a nursing home for 9 months, how much in benefits will his policy pay? 1. $27,000 2. $18,000 3. $24,000 4. $17,000 - answer$24,000 Martin and his friends were at a local tavern celebrating his birthday. Martin left the bar to drive home, but unfortunately, he was involved in a fatal accident, killing himself and two other individuals. An autopsy reveals that Martin was well above the legal limit on his blood alcohol test. Martin's family will receive the following from his Accidental Death and Dismemberment policy: 1. His family will receive reduced benefits since other deaths were involved. 2. His family will receive the principal sum since this was death 3. His family will receive no benefits, since he was in the act of committing a felony 4. His family will receive no benefits since there was no dismemberment involved. - answerHis family will receive no benefits, since he was in the act of committing a felony 4.rebating. - answerreplacement. What gives the insurance company the right to assume rights of the insured in order to sue a responsible third party when damages are inflicted on the insured? 1.Warranties 2.Subrogation 3.Concealment 4.Utmost good faith - answerSubrogation Insurance contracts sometimes contain ambiguities. Which of the following has not been taken to court for further interpretation? 1.Reasonable expectations 2.Subrogation 3.Ambiguities in a contract of adhesion 4.Utmost good faith - answerSubrogation There are various optional provision for health policies. Which of the following is not an optional provision? 1.Intoxicants and narcotics 2.Conformity with state statutes 3.Reinstatement 4.Illegal occupation - answerReinstatement Tony (the insured) cancelled his health policy by submitting a written notice to the insurer. How are unearned premiums handled? 1. Returned to the insured using a pro-rata basis 2. They are returned to the agent 3. The insurer gets to keep them 4. Returned to the insured using a short-rate basis - answerReturned to the insured using a short-rate basis The Patient Protection and Affordable Care Act allows states to combine their SHOP exchange with - 1. Commercial insurance companies 2. Their Medicaid recipients 3. Their exchange for individual consumers 4. All of the above - answerTheir exchange for individual consumers o elect continuation of coverage, the insured must request continuation during the election period (45 days after the date of the ). Employers must provide the proper forms for election within 14 days of receipt of request of election. 1. Arraignment, annulment, or release on bond 2.Indictment, cancellation, or invalidation 3. incarceration, or arraignment 4.Death, divorce, or termination - answerDeath, divorce, or termination Insurers must maintain an advertising file of all material printed, published, or distributed advertisements of policies for , subject to examination by the Commissioner. 1. No more than five years 2. No less than four years 3. No more than two years 4. No less than three years - answerNo less than three years For dependents that were not previously eligible for enrollment in the Maryland Health Connection, how much time must they be given to enroll after being sent a notice that they are now eligible? 1.30 days 2.45 days 3.60 days 4.90 days - answer30 daya Individuals covered under a Medicare Supplement policy may suspend benefits and premiums for up to months if the individual applies and is determined to be eligible for Social Security disability benefits. 40 24 10 52 - answer24 Home health care services are long-term care benefits: 1. For medical and non-medical services 2. Provided to the ill, injured, or disabled individuals in their home 3. That includes those of a homemaker, and assistance with activities of daily living 4. All of the Above - answerAll of the Above or older Age 75 or older Age 80 or older - answerAge 80 or older Which type of care is a system of cost containment methods used by insurers or their agents to control cost and access to health care services, where insurers and providers review and preauthorize treatment plans? Free Non-critical Managed Supplemental - answerManaged An insurer is anyone who acts as a/an in the business of entering into insurance contracts. Surety Indemnity Contractor All of the Above - answerAll of the Above very Medicare supplement insurer must establish marketing procedures that any comparison of policies is fair and accurate, and is not sold or issued. An unwarranted annuity Excessive insurance Prepaid insurance A disproportionate annuity - answerExcessive insurance Some policies require that the insured be confined to his/her home and be under a doctor's care. This type of policy is called a: Recurrent disability Nonoccupational Residual disability Medically defined disability - answerMedically defined disability Insurance companies use which of the following to limit claims from pre-existing disabilities or to control adverse selection? Recurrent disability clauses Reduced benefits Elimination periods Probationary periods - answerProbationary periods An example of presumptive disability might be any of the following EXCEPT: Severance of a hand Complete loss of hearing Amputation of a leg at the hip Total Blindness - answerSeverance of a hand The government is one of three primary types of insurers. Government insurance provides protections against fundamental risks. Which of the following is an example of a government insurance program? Both private and government insurance are available in every state in the United States. Which of the following is one of the major differences between private and government insurance. 1. Government insurance can be either Federal or state 2. Both private and government have disability coverage 3. Government insurance is more efficient to run. 4. Private insurance can deny coverage to individuals - answerPrivate insurance can deny coverage to individuals In all of the following scenarios, the statements regarding loss are false EXCEPT: 1. Betty submits a claim for $300 to her insurance company. The amount of Betty's loss is $300. 2. Andrew gets in a fender bender, causing $3,000 in property damage to his car. He submits the claim to his insurance company, and the insurance company pays for the repairs. Andrew did not experience a loss. 3. Susie Q purchases a life insurance policy that will pay $100,000 to a beneficiary upon her death. The amount of loss upon Susie Q's death is $1,000,000. 4. Jim Bo has a renter's insurance policy that pays him $2,000 for loss of property caused by theft even though the actual cash value of his loss is $3,000. The amount of Jim Bo's loss is $2,000. - answerBetty submits a claim for $300 to her insurance company. The amount of Betty's loss is $300 Once an insurance agent or company advertises their services, they must maintain a complete file of all material available for periodic inspection as to the content, modes of distribution and frequency. These advertising files must be maintained for: A period of not less than 1 year A period of not less than 3 years A period of not less than 2 years A period of not less than 5 years - answerA period of not less than 3 years Mark is a producer and has authority to sell life and health insurance, but is not associated with ACME Insurance company, but they can accept applications from him if: 1. The insurer can issue the insurance, but it must contain a rider which clearly states the relationship between the insurer and producer 2. The insurer cannot accept applications from producers not associated with the company until after they have been appointed 3. The insurer can issue the insurance and appoint the producer immediately if his license was issued in the state of Maryland 4. If the insurer appoints him as a producer and updates the register within 30 days of the application date - answerIf the insurer appoints him as a producer and updates the register within 30 days of the application date Under which of the following circumstances will the Commissioner not waive the license application requirements for an applicant who is not a resident of Maryland? 1. The applicant has a valid license in his/her home state 2. The applicant pays applicable nonresident license fees 3. The applicant's home state does not award nonresident licenses 4. The applicant submits the home state application - answerThe applicant's home state does not award nonresident licenses Joey would try and lure prospective clients to purchase a policy from him by manipulation. He would subtly suggest or offer to recommend the client for membership to a selective country club if the person purchases a particular policy from Joey. This type of practice is called: 1. Intimidation 2. Bait and switch 3. Discrimination 4. Coercion - answerCoercion In addition to any greater penalty provided under the law, violation of Maryland insurance laws and regulations is a offense, subject to a fine up to $100,000. 1. F ederal 2.Felon y 3.Misdemeanor 4.None of the Above - answerMisdemeanor The Commissioner is given broad powers to establish insurance rules, hold hearings and issue orders, take disciplinary action, and assess penalties and fines. He may examine and investigate individuals or entities as deemed necessary, but must conduct examinations at least every ¬¬¬¬ : 18 months 2 years 5 years 48 months - answer5 years As a disciplinary action, the Commissioner may assess penalties of . $400 to $800 $200 to $600 $100 to $500 $1000 to $5000 - answer$100 to $500 Martha is issued her license on October 17, 2012. When will she need to renew her Every other year Every third year - answerEvery other year The Commissioner may require up to hours of continuing education per renewal period for producer licensed for less than 25 consecutive years. 4 8 16 32 - answer16 Mrs. Brown has also signed up to be an insurance advisor, which will allow her to examine a policy and charge a fee for her expertise. All of the following are duties in her capacity of an advisor EXCEPT: 1. Offering alternative insurance products 2. Giving an applicant advice pertaining to an insurance product 3. Providing a recommendation on an insurance product 4. Explaining specifics/details of an insurance product - answerOffering alternative insurance products The Commissioner sets rules and regulations for minimum standards loss ratios based on claims experience and earned premiums in accordance with the . NAIC City Council State Treasury FDA - answerNAIC Norbert was not making quota as set by his company. As a way of inducing more clients, Norbert offered to split his commissions, provide tickets to a sold out show and use of his vacation condo if they would purchase or renew a policy. This action is considered: Rebating Coercion Intimidatio n Twisting - answerRebating If a producer is terminated, the Insurer must notify the Commissioner if the termination was a result, in part or whole, by the producer's violation of Maryland insurance laws and regulations. How many days does the Insurer have to notify the Commission of the termination? Within 30 days 7 working days Immediately Up to 21 days - answerWithin 30 days The Uniform Provisions Law requires all of the following as mandatory EXCEPT: Grace Period Waiver of Premium Physical examination and autopsy Entire Contract - answerWaiver of Premium All of the following provisions are required provisions for health policies EXCEPT: Grace Period Proof of loss Exclusions Reinstatement - answerExclusions The N.A.I.C. proposes many pieces of model legislation in order to help standardize policy wordings, regulations and required benefits. The initials NAIC stand for: 1. National Association of Insurance Commissioners 2. National Association of International Companies 3. National Association of Interlocking Consortiums 4. National Association of Insurance Companies - answerNational Association of Insurance Commissioners Medicare is funded primarily from which of the following sources? 1. It comes from a payroll tax ear marked for Medicare 2. Loans from China provide most of the funding 3. The premiums that retirees pay provides most of the funding 4. It comes from the general revenue fund from all tax sources - answerIt comes from a payroll tax ear marked for Medicare Which of the following characterizes risk pooling? none of the above spreading risk over a small number of people spreading risk over a large 4. No benefits, since you can perform some of the duties of your occupation - answerNo benefits, since you can perform some of the duties of your occupation Sam is involved in a serious accident. He will not be able to return to his job as an instructor for an undetermined amount of time. He also has training as a welder. His disability policy states that Sam will be considered disabled in the event he is not able to perform the duties of any occupation for which he has been trained, has education or prior experience. Sam is also not able to perform the duties as a welder. Sam should expect the following: 1. Full benefits regardless of his ability to perform other occupations. 2. Full benefits until he can return to work or work in another suitable occupation. 3. A full benefit until his health allows him to return to work. 4. Full benefits for two years and then a reduced amount based on a formula. - answerFull benefits until he can return to work or work in another suitable occupation. Janice has received a contract from the agency she plans to work for. The contract defines the agreement in very explicit terms. Signing the contract will allow her to represent the agency. This is an example of: Implied authority Presumptive authority Express authority Apparent authority - answerExpress authority Medicare Part C - also called Medicare Advantage Plans - came about as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Which of the following is available under the Medicare Advantage program? Private fee-for-service plans Managed care plans Preferred Provider plans All of the above - answerAll of the above Group health insurance is a contract between an insurer and a group of some sort - be it an employer, a union, or some other type of group that was established to benefit its members. All of the following are true about group policies EXCEPT: The contract is issued to the employer or union, etc. Groups must exist naturally The policyholder is the employee Each employee receives a certificate of coverage - answerThe policyholder is the employee An employer offers group insurance to his employees on a non-contributory basis. How many of his employees must be offered coverage under the group? 80% 75% 100% 90% - answer100% Insurers that offer insurance to people through the individual market are called private insurers. Which of the following does not fall in the private insurer category? Stock companies Mutual companies Noncommercial organizations Self-insurers - answerSelf-insurers 2. Offer COBRA since she has lost coverage as a result of a reduction in hours 3. Give the spouse credit for time served under the other plan and let her enroll 4. Require her to wait until the anniversary of the group plan - answerRequire a completed health statement and use an accept or reject method to determine eligibility An HMO will generally cover all of the following services from a hospital EXCEPT: Out patient surgery Out patient prescription drugs In patient care, including ancillary services X-ray and laboratory - answerOut patient prescription drugs An HMO will offer basic services to all members. All of the following services are offered as a basic service EXCEPT 1. Doctor services 2.Rehabilitation therapy 3. Durable equipment 4. Preventive and routine care like annual physical and immunizations - answerDurable equipment Mr. Frankston is concerned about the rising cost of health insurance premiums for the group health plan he provides for his employees. His accountant has calculated the premiums he pays vs. the claims his employees receive and finds that he might benefit by accepting some of the risk directly by his company. He wants to avoid premium taxes and minimize administrative expense. He will most likely find this type of plan through a: PPO plan HMO plan TPA arrangement ASO arrangement - answerTPA arrangement Any of the following is considered advertising for a health insurance company EXCEPT Prepared sales talks Material used to recruit new agents Magazine or Newspaper publications Morbidity Tables - answerMorbidity Tables An insurance policy is a legal contract, based on contract law. It is a contract where is exchanged for valuable consideration (i.e. premiums). A representatio n A warranty A promise of benefits An expectation - answerA promise of benefits A contract that heavily restricts one party while leaving the other free (as some standard form printed contracts), and implies inequality in bargaining power is: A contract of adhesion A conditional contract An aleatory contract A unilateral contract - answerA contract of adhesion There are number of clauses in an insurance contract. One of the clauses identifies the contracting The term describing the insured's notification to the insurer requesting payment for a covered loss is: Premium. Deductible . Claim. Limit of liability. - answerClaim. Which of the following types of policies combine multiple benefits and provides a broader range of coverage? 1st Dollar plan Hospital Expense Comprehensive Major Medical Hospital Indemnity - answerComprehensive Major Medical Yvonne has been hospitalized and is presented with a bill for $19,500. She is covered by a major medical play that imposes a $500 deductible and pays 80% thereafter. Yvonne is limited to $2,500 for out-of-pocket expense. What will Yvonne have to pay for her part of the bill? $3,000 $4,400 $3,900 $2,500 - answer$3,000 The Patient Protection and Affordable Care Act defines a full-time employee as one who works at least how many hours a month? 160 hours 144 hours 120 hours 140 hours - answer120 hours The Patient Protection and Affordable Care Act does NOT require which of the following to provide Essential Health Benefits? Individual health insurance plans Basic health programs Small group health insurance plans Grandfathered health insurance plan - answerGrandfathered health insurance plan Who administers the PCIP? The federal government The counties The cities The states - answerThe states The Patient Protection and Affordable Care Act defines "affordable" health insurance when the cost of the insurance is below what percentage of an employee's household income? 15% 9.5% 20% 7.5% - answer9.5% The Patient Protection and Affordable Care Act requires a gold health insurance plan to meet what specific actuarial value? 80% 70% 90% 100% - answer80% What is the maximum tax credit for a for-profit small business as provided by the Patient Protection and Affordable Care Act? 25% 35% 20% 50% - answer35% The Patient Protection and Affordable Care Act allows an employee's health insurance plan's coverage to be rescinded for which of the following reasons? 3. The sex or gender of the applicant 4. Genetic traits of the applicant - answerThe applicant's history of alcohol abuse All of the following are considered moral hazards EXCEPT: Criminal activity Poor credit history Alcohol abuse Drug abuse - answerPoor credit history Larry, Moe and Curly are equal partners in a furniture company. They have recently had a business evaluation of $300,000 for the entire business. Their accountant has recommended that they consider a buy-out agreement in the event that one or more of the partners is disabled. What steps should Larry, Moe and Curly consider? 1. Have the attorney draft an agreement to eliminates the partnership for the disabled partner 2. Purchase individual disability plans in the amount of the partner's salary. 3. Have their attorney draft a disability buy-out agreement and insure each partner for $100,000 in disability payments to fund the agreement. 4. Have their attorney draft an agreement that allows the continuing partners to pay the disabled partner's spouse. - answerHave their attorney draft a disability buy- out agreement and insure each partner for $100,000 in disability payments to fund the agreement. Matthew is insured under his union plan. He develops End Stage Renal Disease, which culminates, with his need for dialysis. Mathew is eligible for Medicare at that point, but how long must his employer group be primary if he continues on dialysis? 1. Medicare will be primary after 90 days and the union plan is secondary. 2. Group coverage terminates immediately when Matthew is approved for Medicare. 3. Matthew may only be eligible in he has a kidney transplant. 4. Matthew's union plan must be primary for 30 months before Medicare will become primary or sooner if group coverage expires. - answerMatthew's union plan must be primary for 30 months before Medicare will become primary or sooner if group coverage expires. If Tim previously reached his lifetime limit on reimbursement from the Maryland Health Connection, what happens under the new regulations? 1. Tim can apply and a determination will be made of a possible new limit. 2. Tim can apply because there are no limits. 3. Tim can apply because the new limits are higher than before. 4. Tim is still ineligible for coverage. - answerTim can apply because there are no limits. If the employer pays all premiums for , benefits are payable to the employer. Layered annuities Comprehensive indemnities Blanket insurance Layered insurance - answerBlanket insurance A unilateral contract is: 1.A contract that makes a promise or promises in exchange for a performance 2. Insures that both parties are bound to perform 3. Implies inequality of bargaining power 4. Allows the "little guy" some rights over the person writing the contract. - answerA contract that makes a promise or promises in exchange for a performance Evelyn is looking at her options for health insurance. She has decided on a plan that has good flexibility on choice of doctors. She has chosen a: Fee for service POS HMO PPO - answerPPO A reimbursement contract will contain which of the following features: 1. Payment for daily hospital room & board and for surgical procedures. 2. None of the Above 3. Payment of lost income 4. Payment for travel expenses to and from medical facility. - answerPayment for daily hospital room & board and for surgical procedures. Insurers may accept applications for life and health insurance from producers , if the insurer appoints the producer and updates the register within 30 days of the application date. 1. Not appointed by the insurer or on the insurer's register of producers 2. Not appointed by the NAIC 3. Not appointed by the Commissioner 4. Not approved by the NAIC - answerNot appointed by the insurer or on the insurer's register of producers Adrian is a producer with a poor work ethic. He has been known to misrepresent the terms of a policy, make false or misleading statements regarding dividends or other benefits paid and misrepresents the insurer's financial condition or reserves. The state of Maryland has a term for this activity: 3. At the moment of the disability 4. When the claim is filed - answerAt the moment of the disability Medicare Part B provides benefits for all of the following services EXCEPT: Surgeon's fees Outpatient prescription drugs Durable equipment Diagnostic lab and x-ray - answerOutpatient prescription drugs Rick's grandmother has a long-term care policy (LTC). If she becomes disabled, or has a chronic disease, she can expect that it will provide benefits for nursing home, home-based care and respite care: 1. For 10 years 2. If services are provided under medical supervision 3. For as long as she can pay the premiums 4. All of the above - answerIf services are provided under medical supervision Herman and Velma are trying to find a plan that will provide home health care, assisted living and custodial benefits as they become older. All of the following plans may provide the benefits they require EXCEPT: 1.A life insurance policy with a long term care rider 2.A long term care policy with the appropriate options 3. Medicare Part A & B 4. An annuity with long term care waivers - answerMedicare Part A & B An example of an unfair claim settlement practice would include: 1. Denying the payment of a claim because it does not meet the conditions of the insurance contract 2. Denying the claim because it occurred after the cancellation of the policy. 3. Delaying the payment of a claim while it is investigated for possible fraud. 4. Advising a claimant of the possibility that, should the claimant reject a settlement offer, an arbitration award might be less than the offer. - answerAdvising a claimant of the possibility that, should the claimant reject a settlement offer, an arbitration award might be less than the offer. An employer is the owner of a group contract. Does the employee retain any ownership rights under the contract? 1. Yes, the employee may change a beneficiary and make certain assignments 2.No, the employer owns all parts of the plan 3.No, the insurance company will not recognize the employee's standing 4.Yes, the employee may tailor make his individual plan. - answerYes, the employee may change a beneficiary and make certain assignments The Fair Credit Reporting Act states that generally, consumer reports cannot contain the following information EXCEPT: 1. An individual's character 2. Tax liens older than seven years 3. An individual's criminal history 4. Adverse information about an individual that dates back over seven years - answerAn individual's character Frank is covered under his local Blue Cross and Blue Shield plan. All of the following are true about Blue Cross and Blue Shield plans Except: 1. Blue Cross generally pays benefits for hospitals 2.Voluntary non-profit organizations 3.Both are exempt from insurance regulations 4.Blue Shield generally pays benefits for physicians - answerBoth are exempt from insurance regulations An underwriter has reviewed the information submitted on a prospective customer. He has determined that this person will not qualify for a standard issue policy. The underwriter may choose any of the following actions EXCEPT: 1. Issue the policy with a probationary period allowing the company to cancel the policy at a later date at their option. 2. Charge a higher premium than for the standard risk 3. Decline the risk outright 4. Attach a rider that excludes coverage for specific conditions - answerIssue the policy with a probationary period allowing the company to cancel the policy at a later date at their option. A health policy will be issued with an outline of coverage. All of the following will be listed in the outline of coverage EXCEPT: 1. Contractual governing provisions 2. An outline of benefits and coverage 3. Principal exclusions and limitations 4. Renewal and cancellation provisions - answerContractual governing provisions A basic medical plan will usually cover all of the following losses EXCEPT: 1. He can begin legal action to recover his loss 2. Inform the company that since it has not complied with the contract provision, his claim is due and payable immediately. 3. He can refuse to submit proof of loss and the claim must be paid in any event. 4. He can submit a claim with a description of the loss with proof of loss in any form he chooses. - answerHe can submit a claim with a description of the loss with proof of loss in any form he chooses. Question 110 Most dental plans require a dentist to submit a plan of treatment for dental expenses that exceed a specified dollar amount. Such as $500.00. This process is known as: 1. Pre-operative notification 2.Prospective treatment planning 3.Pre-certification 4.Pre-authorization - answerPre-authorization Home healthcare services are long-term care benefits for medical and nonmedical services provided to ill, injured, or disabled individuals in their home. Which of the following services is NOT included? Respite care Reprieve therapy Assistance with activities of daily living Homemaker - answerReprieve therapy Insurers and plan providers may not exclude coverage for diagnosis, treatment, and other medically necessary services associated with the off-label use of drugs, so long as the use is recognized as treatment for the illness or injury: By the Commissioner By the State Attorney General's Office In medical reference or literature By the NAIC - answerIn medical reference or literature Harold has received a new policy from his agent. After reviewing the contract Harold decides to return the policy under the free look provision. The company is required to do all of the following EXCEPT: 1.Handle the transaction promptly 2.Reimburse the agent for lost commissions 3.Cancel the policy 4.Refund all premiums paid to Harold - answerReimburse the agent for lost commissions Which of the following statements is not true about a binding receipt? 1. It is referred to as a temporary insurance agreement 2. Coverage begins on the date of the application, even if the applicant is uninsurable. 3. Coverage lasts 120 days 4. It is referred to as an unconditional receipt. - answerCoverage lasts 120 days Sylvia did not pay her initial premium when the agent took her application. Because she paid the premium when he delivered her policy, the agent is required to obtain in order for the policy to be in effect. 3. Salaries for his clerical staff 4. Lease payments for his office space - answerLease payments for his personal automobile The Pre-Existing Condition Insurance Plan (PCIP) offers coverage to people who have been without coverage for at least what length of time? 6 months 9 months 18 months 12 months - answer6 months The period of time that must elapse from the onset of a disability before an insured can collect benefits is called: Elimination period The time deductible Both of the above Neither of the above - answerBoth of the above John has been disabled for three years. He has been released to come back to work on a part-time basis. His policy contains a partial disability provision. If he qualifies for that benefit, he will receive what percent of his pre-disability wage from disability benefits in addition to his part time salary? 1.30% flat with no offsets. 2.70% if the part time wage is less per hour than his pre-disability wage 3.50%, but the total wage may not exceed his pre-disability wage 4.60% offset by Social Security - answer50%, but the total wage may not exceed his pre-disability wage A change of occupation provision will allow the insurance company to do any of the following at the time of claim EXCEPT: 1. Increase the premiums for that individual 2. Pay a reduced benefit for a higher risk occupation 3. Pay the benefits stated in the policy 4. Require a doctor's statement confirming disability - answerIncrease the premiums for that individual Olivia is employed by Affluent Mfg. Inc. When she came to work, her supervisor neglected to provide her enrollment material for the company's health plan, even though the company paid the full cost of the plan. Six months later Olivia suffers a severe accident in her home requiring hospitalization. What action will the insurance company take under these circumstances? 1. Olivia will have a reduced benefit, since the enrollment was not turned in on time. 2. Olivia should have inquired about her benefits; since she did not there is no coverage. 3. Olivia will be covered and Affluent Mfg. will be required to pay premiums from her date of eligibility. 4. Olivia will have to report this to the insurance commissioner and the will arbitrate a reasonable solution. - answerOlivia will be covered and Affluent Mfg. will be required to pay premiums from her date of eligibility. Matthew has purchased a special risk policy. Which of the following policies will fall into that category? Dread disease Travel Accident Roger is enrolled in his employer's medical plan. His benefit booklet states that all medical expenses are payable at 80% up to $5,000 in any calendar year, but the total benefit for all illnesses and accidents is $1,000,000. Roger is enrolled in a: 1.A limited major medical plan with annual limits 2. An HMO plan 3. Comprehensive major medical with a lifetime maximum 4. A PPO plan - answerComprehensive major medical with a lifetime maximum