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109 ExamFX Pennsylvania life and health ExamFX simulated exam. Graded A

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109 ExamFX Pennsylvania life and health ExamFX simulated exam Questions and 100% Correct Answers 1. An employee becomes insured under a PPO plan provided by his employer. If the insured decides to... go to a physician who is not a PPO provider, which of the following will happen? ANS: The PPO will pay reduced benefits 2. Insurers may change which of the following on a guaranteed renewable health insurance policy? ANS: Rates by class 3. If a business wants to buy a disability income policy on a key employee, which of the following is considered the applicant? ANS: The employer 4. When must an insurance company present an outline of coverage to an applicant for a Medicare Supplement Policy? ANS: At the time of application 5. According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost for an average population, and the participants would cover the remaining 10% what type of plan is that? ANS: Platinum 6. A producer licensed in Pennsylvania must notify the Insurance Department of any change in address in his or her residence or business address within how many days? ANS: 30 7. Which of the following is true regarding Medicare Supplement Policies? ANS: They must be guaranteed renewable 8. When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery ANS: A statement of good health9. The act of voluntarily giving up insurance by the insured is called ANS: Cancellation 10. What type of benefit helps to pay for accidental injuries that are not severe enough to qualify as disabilities? ANS: Medical Reimbursement Benefit 11. Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy of any premium due date ANS: Optionally renewable 12. In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is?ANS: Broader in general 13. Once it has been reasonably proven that a person unknowingly violated the insurance code regarding unfair methods of competition, the department may impose a civil penalty of?ANS: $1000 for each violation 14. Which renewability provision are you most likely to see on a travel accident policy ANS: Period of time 15. Which of the following conditions would a disability income policy most likely NOT require in order to qualify for benefits? ANS: A specified income status prior to disability 16. When an individual purchases insurance, what risk management technique is he or she practicing? ANS: Transfer 17. An insured does not have to pay coinsurance or deductibles on a full-series mouth x-ray but does have to pay a deductible to get his cavities filled. Which dental plan does he have? ANS: Nonscheduled 18. In which of the following situations is it legal to limit coverage based on marital status? ANS: It is never legal to limit coverage based on marital status19. Which document helps ensure that full and fair disclosure is provided to the recipient of a policy ANS: Outline of coverage 20. Under the affordable care act, what percentage of preventive care must be covered without cost sharingANS: 100% 21. Who is the beneficiary in a credit health policy?ANS: The lending institution 22. What is the maximum age for qualifying for a catastrophic plan?ANS: 30 23. An insured has been injured in an accident. Although he is still receiving benefits from his disability income policy, he does not have to pay premiums. This means that the policy includesANS: Waiver of premium feature 24. Group disability income insurance premiums paid by the employer areANS: Deductible by the employer as an ordinary business expense 25. Under HIPAA which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policyANS: An individual who was previously covered by group insurance for 6 months is eligible 26. In reference to the Standard Medicare Supplement benefits plans, what does the term standard mean?ANS: All providers will have the same coverage options and conditions for each plan 27. All of the following are true regarding the medical information bureau (mib) EXCEPTANS: MIB reports are based upon information supplied by doctors and hospitals 28. All of the following are ways in which a Major Medical policy premium is determined EXCEPTANS: The average age of the group29. The purpose of managed care health insurance plans is toANS: Control health insurance claims and expenses 30. What is the purpose of COBRA?ANS: To provide continuation of coverage for terminated employees 31. The annual contribution limit of a dependent care flexible spending account is set byANS: The IRS 32. A hospital indemnity policy will pay?ANS: A benefit for each day the insured is in a hospital 33. Which health insurance provision describes the insured' s right to cancel coverageANS: Renewal provision 34. What documentation grants express authority to an agentANS: Agents contract with the principal 35. If an insurance company offers Medicare Supplement policies, it must offer which of the following plansANS: A 36. In a disability policy, the elimination (or waiting) period refers to the period betweenANS: The first day of disability and the day the insured starts receiving benefits 37. Which of the following is NOT a feature of a guaranteed renewable provisionANS: The insurer can increase the policy premium on an individual bases 38. If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 daysANS: Conversion39. Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insuredsANS: Optionally renewable 40. An insured is receiving hospice care. His insurer will pay for painkillers but not for an operation to reduce the size of a tumor. What term best fits this arrangementANS: Costcontainment 41. According to the telemarketing sales rules, what are the permissible calling hours for telemarketing callsANS: 8am until 9pm 42. Which type of Medicare policy requires insured's to use specific healthcare providers and hospitals (network providers) EXCEPT in emergency situationsANS: SELECT 43. An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. this results in a long hospitalization period. Which of the following is true?ANS: The group plan will not pay because the employee was injured at work 44. To be eligible under HIPAA regulations, for how long should an individual health plan have been covered under the previous group plan?ANS: 18 months 45. Which of the following describes taxation of individual disability income insurance premiums and benefits?ANS: Premiums are not tax deductible and benefits are not taxable 46. An insurer wishes to compare the information given in an insurance application with the previous insurance applications by the same applicant but for different companies. What organization can help the insurer accomplish this?ANS: The Medical Information Bureau 47. All of the following are true about group disability income insurance EXCEPTANS: Coverage applies both on and off the job48. According to the Future Increase Option Rider (FIO) which of the following is NOT a qualifying event to increase an insured's benefit level?ANS: Death of a spouse 49. The benefits received by the business in a Disability Buy-sell policy areANS: Income tax free 50. Which of the following will vary the length of the grace period in health insurance policies?ANS: The mode of the premium pay [Show More]

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