insurance pretest questions (NEW YORK)
Terms in this set (56)
All of the following may be a part of the risk selection process, except?
Payment of the first premium
Anna has a limited benefit hospital indemnity contract that pays her $100 per day as an inpatient. She was discharged on February 2 and must notify her agent or insurer to claim a benefit on the stay by what date?
General underwriting considerations applicable to most health groups include all of the following, EXCEPT?
The owner's height and weight
Insurers can refuse to renew a health insurance policy for all of the following reasons, EXCEPT?
deterioration of the insured's health status
What are the legal implications of the mandatory health provision "physical examination and autopsy?
This provision is used by the insurer to determine claim malingering or claim denial for injury sustained through intoxication or illegal drug use. .
All of the following are true about an agency relationship between an insurance agent and an insurer, except
A producer has unlimited authority over insurance matters within the agency relationship
_____ is common to all movable joints and permits one surface to move smoothly over an adjacent surface, regardless of shape
In determining whether a disability is permanent, most companies call for a:
Statement about the disability from the insured as well as from the physician of the insured. The physician's prognosis is also required.
Which of the following clauses in a health insurance policy states that the insured and the insurer share in the covered loss?
The common abbreviation "ABG" used in medical reports means
Arterial blood gas
Several small employers joined a trust designed to provide health insurance to members' employees through the trust. This arrangement is known as
A Multi-Employer Trust Group
If a Medicare Supplement (Medigap) policyholder has requested a suspension of benefits and premiums because the policyholder is/has become eligible for Medicaid medical assistance, what options are available to this individual when the Medicaid benefits expire?
Automatic reinstatement will occur provided the medicare beneficiary notifies the insurer that Medicaid medical assistance will terminate within 90 days
____________is a requirement by law that certain persons purchase or otherwise obtain a good or service
Chris is involved in a 2-car accident in which he is disabled and his passenger and the other driver are injured. Which of the following would most likely be covered by his disability income policy?
His lost income
Services or benefits not covered under a long term care policy include
All of the responses listed are correct
Approved Medicare supplement policies must be labeled
By letters, A through N
With an optionally renewable policy, the company reserves the right to
Terminate coverage on any policy anniversary date or premium due date
If a disability income policy provides coverage for work related injuries, it is described as
A first-dollar health and major medical plan may utilize all of the following cost-sharing provisions, EXCEPT
Restoration of benefits
A licensee must report to the Superintendent of Insurance any administrative action taken against the licensee in another jurisdiction or by another governmental agency in this state within _____ of the final disposition of the matter
The health insurance policy that should be recommended to older persons to assure the preservation of their assets in the event a serious medical issue develops is
A long term care policy
Direct response insurance offers coverages to residents without employing the services of
All of the following are true about becoming eligible for Marketplace coverage outside of the open enrollment period and through a special enrollment period, EXCEPT
You are an individual who missed open enrollment because you did not check the website for open enrollment dates
Dental procedures such as crowns, bridges and dentures are classified as
Major dental procedures
All of the following are examples of "limited health policies" EXCEPT
Short term disability
Failure to disclose known facts when completing an application for insurance is an act of
The principle of indemnity
Restores an insured to the same condition enjoyed before a loss
When a caesarean delivery occurs, inpatient coverage will be provided
For a period of 96 hours
A health insurance policy includes an endorsement indicating that the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. Which of the following endorsements is attached to this policy?
Waiver of premium endorsement
All of the following are examples of provisions that MUST be included in a health insurance policy, EXCEPT
Right of the insurer to deduct any unpaid premium from a claims payment
HMOs provide comprehensive health services to subscribers for a fixed, prepaid fee. All of the following statements are characteristics of HMOs, EXCEPT
Service is provided on a fee for service basis
A health policy covering basic medical expenses and major medical expenses is
Comprehensive major medical expense coverage
All of the following are true about a disability income policy issued with a guaranteed purchase option (GPO), except
Any additional benefit purchased will be at the same premium rate..
Which of the following statements regarding utmost good faith in insurance contracts is CORRECT?
Most state insurance laws consider statements made in an application for a life insurance policy to be representations, not warranties.
The conformity with state statutes provision in a health insurance policy stipulates that any policy provision that is in conflict with the statutes of the state where the insured resides is:
Automatically amended to conform to the minimum requirements of the states statutes
With respect to insurable interest, all of the following are true, except
With life insurance insurable interest must exist at the time of claim
A ______ is a procedure wherein contrast dye is injected into the spine to diagnose disk disease or tumors
From the following statements regarding coordination of benefits, select the statement that is untrue
The secondary provider does not pay benefits because "over-insurance" would occur
A Medicare supplement policy, other than a replacement policy, may limit coverage for a preexisting condition for a maximum period of:
6 months after the effective date of coverage. .
The Affordable Care Act requires plans and issuers that offer coverage to children on a parent's plan to make the coverage available until the adult child reaches the age of:
An insurance policy is a legal contract. Each of the following elements is necessary for the creation of a valid contract, except
Signatures of each party
If an insured can receive more money under loss of time benefits than earnings on the job, or more money for the reimbursement of medical expenses than these services cost, this is:
Referred to as over-insurance
The prefix "neo" refers to
Tom has lost 30% of his hearing in both ears. His doctor has advised him that his hearing loss has been caused by exposure to noise at his workplace for the past 25 years. Tom's hearing loss can be catoragized as a
Cumulative Trauma Disorder
The type of nonmedical care provided for an individual living in a facility outside his or her own home who does not need 24-hour nursing care is:
Under the Affordable Care Act, actuarial value is used to determine
if a plan provides minimum value
All of the following are true of Blue Cross/Blue Shield Plans, EXCEPT
They are only provided on a group basis
An electrocardiogram records the electrical activity of the
All of the following describe characteristics of a gatekeeper system, EXCEPT
Determines surgical benefit payments..
A person, firm or corporation that, for compensation, acts on behalf of an insurer in investigating and adjusting claims arising under policies issued by an insurer and who performs any duties required by the insurer that are incidental to those claims is known as a/an:
Bruce has a Disability Income Policy paying him $4,000 per month. The contract also has a 30 day waiting period. Bruce was disabled for 75 days. How much will his policy pay?
Whenever the Superintendent of Insurance believes that a person has committed a violation of an insurance law in New York, the Superintendent will serve on the person a statement of the charges and notice of a hearing. The hearing must be held at least ____ after the date the notice is served
The period between a loss and the beginning of benefit payments in disability income insurance is known as
All of the following are examples of individual health policies, EXCEPT
Credit Health Insurance
Which of the following terms identifies the voluntary relinquishment of a known right?
Under the Entire Contract provision of health insurance policies, when may agents change a policy or waive its provisions?
Agents are never given authority to change or modify an insurance policy
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