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—›
National Health Insurance
National Health Insurance MCQs
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An insurer must provide claim forms to an insured within a MAXIMUM of how many days after receiving notice of an Accident & Health claim?
Five
Fifteen
Twenty
Thirty
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Under a group health plan, an employer may offer additional benefits to classes of employees on the basis of all of the following factors EXCEPT:
length of employment
gender
salary grade
job category
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Which of the following statements is CORRECT about a Waiver of Premium provision in a Disability Income policy?
It allows the insurer to deduct premiums due from the disabled insured's benefit payments.
It allows the insurer to increase the amount of premium during the insured's time of disability.
It allows the insured to extend the length of the Grace Period while disabled.
It allows the insured to maintain a policy in force while disabled and unable to pay premiums.
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Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the following policy features?
Extensions of coverage
Benefits clause
Riders
Exclusions
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An insured becomes disabled three years after his Disability Income policy is issued. The disability is caused by a condition that existed prior to th...
Pay the full claim
Pay the claim for a maximum of six months only
Deny the claim on the basis of misrepresentation
Deny the claim because it involves a pre-existing condition
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A health care plan that reimburses a flat fee for medical care it provides at a clinic it owns and operates is referred to as:
Health Maintenance Organization
Medicaid
Medicare
Multiple Employer Trust (MET)
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Which of the following laws requires an insurer to notify an applicant in writing that an investigative consumer report may be made on the applicant?
Uniform Provisions Law
Freedom of Information Act
Medical Information Bureau Disclosure Act
Fair Credit Reporting Act (Insurance Information and Privacy Protection Act)
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Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to:
increase the premium rate for one insured without increasing the rate for others in the same class
increase the premium rate for an entire class of insureds
increase the benefits for an individual insured
decrease benefits for one insured without decreasing benefits for others in the same class
?
An individual who has had a heart murmur since birth is likely to be issued an individual disability policy that includes:
Guaranteed Insurability rider
an Exclusionary/ Impairment rider
Waiver of Premium rider
Double Indemnity rider
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Which of the following statements is CORRECT about coinsurance?
It applies to deductibles as well as to claim payments.
It helps control overutilization of benefits.
It is effective for the first claim payment and waived for future claims.
Insurance companies may adjust the coinsurance ratio after issuing a policy.
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The insurance policy clause that identifies the contracting parties and defines the scope and limits of coverage is called the:
Insuring clause
Benefit clause
Consideration clause
Renewal clause
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In an Accidental Death and Dismemberment (AD&D) policy, the term "capital sum" refers to:
the benefit paid for death caused by a dread disease
the monthly disability income paid if an insured loses a limb or the sight in one or both eyes
a lump sum payment made when disease causes the amputation of an arm or a leg
a lump sum payment made for an accidental dismemberment
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A group long-term disability plan is integrated with Social Security when which of the following statements is CORRECT?
Social Security and group benefits pay a combined maximum limit.
Full group benefits are paid in addition to Social Security benefits.
Full Social Security benefits are paid after group benefits are exhausted.
Half of the allowable Social Security benefits are paid after group benefits are exhausted.
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Medicare Part A covers which of the following expenses?
Hospital room and board
Surgical expenses
Medications
Physicians' services
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J has a physical impairment, attends school, and is incapable of self-sustaining employment and/ or self care. Which of the following statements is CO...
J's coverage ceases, but J may apply for group student coverage.
J's coverage automatically discontinues at age twenty-six.
J's coverage continues only as long as J is a full-time student.
J’s coverage continues as long as J is continually incapacitated and is financially dependent on J’s father.
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Medicare Supplement policies are primarily designed to:
offset the high cost of Medicare
provide additional retirement income to supplement Social Security retirement benefits
provide additional benefits beyond those provided by Medicare
provide a reinsurance network that spreads the Medicare risk among private insurance companies
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A producer and an applicant complete an application for a health policy and submit it to the insurer for underwriting without any premium. The underwr...
collect the initial premium payment
issue a conditional receipt
have the applicant complete a statement of continued good health
explain the Free Look provision which begins on the policy delivery date
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M and N own a small interior design studio that employs six people. The owners are concerned about the financial continuation of the business if eithe...
Basic Hospital
Disability Buy-Out
Comprehensive Major Medical
Short-Term Disability Income
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Which of the following definitions of disability would cover a permanent partial disability?
Own occupation
Any occupation
Residual disability
Presumptive disability
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Group health insurance specifies that what percentage of eligible individuals MUST be offered coverage under a noncontributory plan?
25
50
75
100
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An Eligible Expenses provision in a comprehensive major medical policy commonly identifies all of the following types of covered health care services ...
professional services of doctors and other medical practitioners
hospital charges for semi-private room and board
experimental and investigative services
pre-approved home health care
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Which of the following provisions explains that a producer does not have the authority to waive the provisions of an insurance contract?
Legal actions
Reinstatement
Time limit on certain defenses
Entire Contract
?
Under the Claims Forms provision of a health policy, if the insurance company fails to send claim forms within the time period required, the insured s...
expect a full refund of all premiums paid plus interest
submit the claim in any form, which must be accepted by the company as adequate proof of loss
request the Department of Insurance mediate the claim settlement
wait for the claim form to arrive
?
The Coordination of Benefits clause found in group health master contracts is used to:
integrate Disability Income benefits with Major Medical benefits
avoid double payment of benefits to an insured who has duplicate group coverages
investigate the claims history of an insured
avoid duplicate claims to an employer for the same employee
?
A precertification review prior to a nonemergency hospitalization is an example of:
managed care
Medicaid
Medicare
Disability Income
?
Five years ago, at age forty-five, X stated that he was forty years old on a disability income insurance application. X now submits a claim and the in...
Deny the claim due to material misrepresentation on the application
Pay the claim as filed because the policy becomes incontestable after two years
Pay the claim and cancel the policy
Adjust the benefits downward according to the benefits that X would have been entitled to based on the premiums
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When delivering a policy to a client, a producer should take all of the following actions EXCEPT:
collect any premiums due
fully explain all exclusions and/or riders
keep the policy in the producer’s office for safe-keeping on behalf of the client
review all benefits provided by the policy
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A married insured has an Accidental Death and Dismemberment (AD&D) policy that names his brother as the primary beneficiary and his son as the con...
The insured's estate
The brother's estate
The insured’s son
The insured's spouse
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Which of the following definitions MOST accurately describes the Probationary Period?
The period of time from the date of the loss until the benefits begin
The period of time from the date of the loss until benefits are actually received by the policyowner
The waiting period a new hire must satisfy prior to becoming eligible for group health coverage
The period of time once a claim is received by the insurance company before it pays benefits to the policyowner
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The Elimination Period in most Disability Income policies applies:
to each separate disability
to claims for accidents only
during the first 30 days of the contract
during short-term disabilities that are easily managed
?
The PRIMARY purpose of Medicaid is to:
pay for expenses not covered by Medicare
provide Disability Income benefits to people on Medicare
provide Medical Expense coverage to persons meeting certain minimum income requirements
provide funds for people injured in natural disasters
?
In which of the following health policies are both the renewability and the premiums guaranteed?
Noncancellable
Optionally Renewable
Guaranteed Renewable
Conditionally Renewable
?
An insured whose Disability Income policy contains a Change of Occupation clause takes a new job in a more hazardous occupation and fails to notify th...
Cancel the policy and refund one year's premiums
Settle the claim according to what the premiums would have purchased under the more hazardous occupation
Pay the claim in full and then cancel the policy
Pay the claim after deducting an extra one-year premium payment
?
Which of the following reports may include information obtained by a telephone call to the proposed insured?
Medical Information Bureau (MIB) report
Attending physician's report
Inspection report
Precertification Review
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The purpose of the Medical Information Bureau (MIB) is to:
recommend the premium rates for health policies issued to substandard risks
share medical data among member companies
provide background data for large group health plans
provide actuarial data on dread diseases
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An Accident and Health policy Notice of Claim provision requires that an insured give written notice to the insurer within a MAXIMUM of how many days ...
15
20
30
45
?
The Consideration clause in an accident and health policy states the:
the applicant pays the initial premium
conditions under which benefits are paid
premiums will be refunded during the free look period
certain claims will be excluded under the policy
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All of the following elements are required of a contract EXCEPT:
assignment
acceptance
legal capacity
legal purpose
?
Which of the following types of provisions guarantees renewability to a specified date or age unless certain specified events occur?
Noncancellable
Optionally Renewable
Guaranteed Renewable
Conditionally Renewable
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On June 1, S purchased a Major Medical policy and paid the initial premium to Producer T. On July 1, Producer T received the policy from the insurance...
July 1
July 3
July 5
July 7
?
The Social Security program provides all of the following benefits EXCEPT:
retirement
survivor
disability
workers compensation
?
Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?
The insured may periodically increase the amount of benefits payable under the policy.
The insured may assign the policy to a member of the insured's family.
The insurer is not permitted to cancel the policy.
The insurer will issue the policy without a medical examination.
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An applicant for insurance submits an application to an insurer for underwriting but does not forward any premium payment with the application. Legall...
an inquiry for an offer
an offer
a counteroffer
an acceptance
?
The Internal Revenue Service (IRS) considers Disability Income benefits paid under an employer-paid group Disability Income to be:
taxable for thirteen weeks only
nontaxable for twenty-six weeks only
fully taxable
exempt from taxation
?
Which of the following provisions designates to whom claim payments are made?
Time of Payment of Claims
Claim Forms
Notice of Claim
Payment of Claims
?
A Disability Income policy may provide benefits for which of the following losses?
Residual Disability
Catastrophic medical expenses
Long term care
Supplemental payments to Medicare
?
When periodic claim payments are required under a long-term disability income policy, an insurer MUST make payments to an insured at least once every:
month
three months
six months
year
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Under an Accidental Death and Dismemberment (AD&D) policy, insurable interest must exist at which of the following times?
When a change of beneficiary is requested
At the inception of the policy
When a beneficiary other than a relative is named
At the time a claim is submitted
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Health insurance policies are offered on a "take it or leave it" basis and referred to as which of the following types of contracts?
Aleatory Contracts
Valued Contracts
Unilateral Contracts
Contracts of Adhesion
?
Which of the following health policies requires a beneficiary designation?
Travel Accident
Medicare Supplement
Blanket
Long Term Care