The policyholder for a group health benefit plan is considered to be theEmployerAnd employer is issued a group medical insurance policy. This single contract is known as aMaster policyA group disability income plan that pays tax free benefits to covered employees is consideredFully contributoryHealth insurance involves 2 perils, accident and ______SicknessCoordination of Benefits regulation applies to all of the following plans exceptPreferred Provider Organization planWhich of the following would be considered a possible applicant and contract policyholder for group health benefits?EmployerA common exclusion with vision plans isLasik surgeryHow is Medicare Part B funded?General tax revenue and user premiumsA closed network plan offers a primary physician copay of $25. If it's a subscriber chooses a primary care physician outside of the network, the subscriber will likely pay100% of the bailed amountSmall employers who are sponsored by an insurer to provide group benefits to its employees are calledMEWAA health care provider claim may be settled using which of the following payment methods?Fee-for-serviceWhen a preferred provider organization (PPO) insured goes out of network, which of the following actions occur?The insurer will pay a reduced amountWhich of the following is not taken into consideration when determining eligibility for Medicare benefits?IncomeAn individual covered under a Blue Cross Blue shield plan is called aSubscriberA 70-year-old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse is large group employer plan. How much will Medicare be utilized in this situation?Will be the secondary insurer and pay for claims not fully covered by the group planFunding for Medicare Part B is partially provided byUser premiumsMedicare provides coverage for each of the following exceptCustodial careWhat type of injury would not be covered under a health insurance policy?Work-relatedWhich of these will typically authorize treatment from a specialist?GatekeeperWhat is Medicare Part B also known as?Supplementary medical insuranceMedicare Part a coversInpatient hospital stayA medical provider that accepts Medicare assignment mustAccept payment based upon a defined Medicare schedule as payment in fullChris is an insured bricklayer who severed his left hand in an automobile accident. Although as primary duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability income check every month period how does his policy define total disability?Own occupationTom has a rider on his disability income policy that guarantees the right to increase his benefits without a medical exam. What kind of writer is this?Guaranteed insurability riderThe factor used most often when underwriting a disability income policy isAnnual earningsJonas has disability insurance through his employer. The employer pays 75% of the premium, and Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan?Taxes must be paid on 75% of the benefits receivedwhich type of disability would be less than total impairment and equal to permanent impairment?Permanent partial disabilityThe monthly benefit for an individual disability income policy is usually limited to a percentage of the insureds income in order to avoidOver insuranceWhich of these would not be considered a presumptive disability?Loss of a leg or arma disability elimination period is best described as aTime deductibleWhat is the elimination period of an individual disability policy?Time period a disabled person must wait before benefits are paidWhich disability policy provision would address any concerns of the value of the benefits decreasing overtime?Cost of living benefitWhich of the following statements is not true regarding a critical illness plan?coverage is limited to a single devastating diseaseA fee for service health insurance plan will normally coverA diseaseMaximum benefits refers to theUpper limit of the total lifetime benefits the insurance company will payWhich of the following types of deductibles would apply a single deductible to both medical and dental insurance coverage?Integrated deductibleMedical expense insurance would coverAn injury occurring at the insured's residenceAmy has a group medical policy through her employer with a $500 deductible and a 90% coinsurance provision. She incurs $1500 in covered health care services. How much will her group insurance carrier pay?$900All of the following plans allow for employee contributions to be taken on a pretax basis exceptHealth reimbursement arrangement planAnd insured under a major medical expense plan with a zero deductible and 80/20 coinsurance provision files of $1000 claim.$200Kate has a major medical plan with a 75/25 coinsurance and deductible of $25. How much will she have to pay if she, not having met any of her deductible, visits the doctor and receives a bill for $125?$50A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatmentIndicates a pre-existing conditionTed has a health insurance plan that requires him to pay a specific sum out of pocket before any benefits are paid in a calendar year. Which of these does his health plan have?Calendar-year deductiblea health insurance policy will typically coverPreventable health servicesHow is a health provider reimbursed if they do not have an agreement in place with the insurance company?With a usual, customary, and reasonable feeJennifer is required to pay a specific sum out of pocket before any benefits are paid in a year. Her health policy most likely contains aDeductiblethe IRS states that a taxpayer's medical expenses that exceed 7.5% of their adjusted gross income is tax deductible. Which of the following may be considered a medical expense under this rule?Long Term Care Insurance premiumsLong-Term Care policies may provide coverage for claims arising fromSenile dementiaBill requires some nursing care and supervision but NOT full time care. Which of the following Nursing Home options would best serve him?Assisted livingThe open enrollment period for Medicare Supplements begins at age65Tom has a home health care benefit and is confined to his home. Which of these benefits if NOT typically covered?Full-time nursing careAll _____ policies must be guaranteed renewable.Long-term careWhich of the following nursing home options would BEST suit an individual who needs some nursing care and supervision but NOT full-time care?Assisted living facilitiesSomeone needing custodial care at home would require which type of coverage?Long-term careThe difference between a Long Term Care Partnership Plan and a Non-Participating Plan is which of the following?Assisted protectionAll of the following are core benefits of Medicare Supplement Plan A EXCEPTDeductible payments for the first 60 days of hospitalization insuranceA Medicare supplement plan can be canceled by the insurerFor the nonpayment of premiumsThe purpose of Medicare Supplement Insurance is to address gaps in Medicare coverage, which can includeMedicare in-hospice deductibleWhich of the following is NOT a type of Medicare Advantage Plan?Social Security Disability Income (SSDI)A Medicare Supplement Policy isDesigned to fill in the gaps of Part A and Part B MedicareWhich of these statements about Medicare is CORRECT?Funded by federal, state, and local taxesCraig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation?Unpaid premiumA health insurance policy that allows an insurer to change the policy owners premiums, but not cancel the policy is called aGuaranteed renewable policyWritten notice for a health claim must be given to the insurer ____ days after the occurrence of the loss.20which of the following is not a required provision in an accident in health insurance policy?Change of occupationThe entire contract includes the actual policy and theApplicationAll the following are functions of an insuring clause exceptPrimarily describes the free-look periodAn insurer must furnish to a claimant form for filing proof of loss within blank days upon which receiving notice of claim.15In contrast to a guaranteed renewable policy, a noncancellable policyMay never raise the premiumsA health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is calledConditionally renewableA clause that allows an insurer the right to terminate coverage at any anniversary date is called aOptional renewability clauseXYZ company has applied for group health insurance for its employees. What information would the insurers under writers likely use to determine the appropriate coverage and final premium rate given to the group?Experience ratingAnd insured was injured as an innocent bystander when someone committed a felony. The insurer isLiable for the lossHow are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?Not tax deductibleOne of the most important considerations when replacing health insurance would be theExclusions on a new policyWhich of these characteristics of an applicant is not taken into consideration when assessing risk for disability coverage?Number of childrenThe gatekeeper's role when used by an HMO isObtaining referrals to specialists from primary care physiciansTerra the producer is delivering a specified disease insurance policy to a new policy owner. Upon delivery, she may be expected to collect all the following except aModified application with a new signatureWhat happens when an insurance policy is backdated?The policy is affective date is earlier than the presentXYZ Corp pays the tax-deductible insurance premiums for a key employee disability policy. Which of the following would be the appropriate tax consequence?Benefits are fully taxableIn which of the following processes will the insurer oversee the insured hospital stay to confirm everything is going according to schedule and the insured will be released as planned?Concurrent reviewBefore operating under an assumed name, a producer must notify theCommissionerA producer has allowed his/her license two laps by failing to complete the required continuing education credits. The license may be reinstated by completing the requirement within ____ days of the renewal date90a Medicare supplement policy issued in the state of Michigan is required to provide each of the following exceptIt must include outpatient prescription drug coverageWhich of the following is considered to be an active misrepresentation?Falsifying the terms, benefits, advantages, or conditions of an insurance policyFor an individual health insurance, coverage for pre-existing conditions may be excluded for up to _____ months after issuance of the policy12in Michigan, a person providing insurance advice to a person or business for a fee is required to hold which license?CounselorThe acceptance of a credit life application requires the submission of a certificate of insurance to the insured within _____ days.30under which circumstance may a minor receive proceeds from a death benefit?The minor must have an appointed guardianUpon receiving a producer complaint, the commissioner may immediatelyIssue a cease and desist orderIn determining whether a pre-existing condition applies, the enrollee cannot have more than how many days gap in health insurance?63According to the Taft Hartley act, group insurance premium payments made by an employer must be paid to theTrustUnder Michigan law, which of the following would not be considered an illegal inducement?A promotional item with the producers name and address valued at $5Which of these is the best example of misrepresentation?Providing incorrect, misleading, incomplete, or materially untrue information in a licensed applicationA life insurance policy sold in Michigan may be contested by the insurer only during the first blank years of the contract2Which of the following actions is required by a producer who was replacing an existing life insurance policy?Submit to the replacing insurer a list of the policies to be replacedTo be eligible for small employer group coverage, and employee must work a minimum of blank hours in a typical week17.5newborn coverage under health insurance policies must include coverage forBirth abnormalitiesWhich of these best describes the illegal act of twisting?Replacing an insurance policy from one insurer to another based on misrepresentationWhich of the following does restorative dental treatment cover?CrownsABC insurance agency is entering each applicant who purchases insurance through their agency into a drawing to win a free trip. This is an unlawful insurance practice known asIllegal inducementMichigan requires that a licensee complete _______ hours of continuing education on the subject of ethics every reporting period.3an insurer is required to offer which of the following to each long term care applicant at the time of purchase?Inflation protectionIn the state of Michigan, a licensed producerRepresents the insurerA foreign insurance company doing business in MichiganIs a company domiciled under the laws of another stateExample of endodontic treatment is aRoot canalAn insurer would be committing unfair discrimination if coverage was denied based uponSexNeeds dependents on is physically handicapped, but not eligible for Medicare. How long may the sun remain on Nate's health coverage after the age of 26?Coverage remains with written proof of disability and dependencyProducer commissions may not be paid toLicense producers not appointed by an insurerUnder which circumstance do consumer privacy regulations allow an insured financial information to be released?And authorized agency makes a written request to the insurer during an insurance fraud investigationA newborn must be covered under an existing health policyAt the moment of birthWhich of the following is not a valid reason for an insurer to refuse renewal of a small employer group plan?Claims were higher than expectedA universal life policy owner must receive a notice of cash surrender value at least everyYearIn Michigan, legal action may be taken against an insurer for up to _____ years for failing to pay a life insurance claim after proof of loss was submitted.6XYZ insurance company receives satisfactory proof of loss for a claim. If XYZ does not pay the claim within 60 days of receipt, the insurer must pay simple interest of ______ per annum.12%the _______ must notify the producer in the event of the producers insurance appointment being terminated.insurerA producer's insurance license may only be revoked by theDepartment of Insurance and financial services DIFSA producer's fiduciary duty requires thatPremiums are forwarded to the insurer on a timely basisThe act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to asTwistingA life insurance applicant in Michigan may backdate the application for up to _____ months6