Health Care > QUESTIONS & ANSWERS > Final Exam - Virginia Accident and Health, Questions and answers. 2022/2023 rated A (All)

Final Exam - Virginia Accident and Health, Questions and answers. 2022/2023 rated A

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Final Exam - Virginia Accident and Health, Questions and answers. 2022/2023 rated A 116. Under the Health Insurance Portability and Accountability Act (HIPAA), all of the following qualify as cr... editable coverage EXCEPT accident only individual major medical Medicare group major medical - ✔✔accident only 120. Select the appropriate response What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy? Premiums may increase at time of renewal Premiums may increase at any time Policy may be renewed at the discretion of the insured Policy may be amended by insurer at any time - ✔✔Premiums may increase at time of renewal 122. What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled? Accidental Death and Dismemberment rider Disability Income rider Guaranteed Insurability rider Waiver of Premium rider - ✔✔Waiver of Premium rider 123. Insurance contracts are known as ____ because certain future conditions or acts must occur before any claims can be paid. consideration unilateral aleatory conditional - ✔✔conditional 124. Question 124Select the appropriate response All of these are considered sources of underwriting information about an applicant EXCEPT Inspection Report Credit Report Rating Services Medical Information Bureau - ✔✔Rating Services 125 Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract? Consideration Entire Contract Free-look Insuring - ✔✔Entire Contract 1. T owns an Accident & Health policy and notifies her insurance company that she has chosen a less hazardous occupation. Under the Change of Occupation provision, which of the following actions may her insurance company take? Allow her to take a tax deduction on unearned premiums Increase her policy's coverage amount Decrease her policy's coverage amount Nothing - ✔✔Increase her policy's coverage amount 2. M becomes disabled and is unable to work for six months. M dies soon after from complications arising from this disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate? $2,000 A lump sum of six times the monthly benefit Nothing Earned, but unpaid benefits - ✔✔Earned, but unpaid benefits 3. With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period? Gives the policyowner additional time to pay overdue premiums Gives the policyowner additional time to file a lawsuit Gives the policyowner additional time to file a claim Gives the policyowner additional time to provide proof of loss - ✔✔Gives the policyowner additional time to pay overdue premiums 9. What is the primary factor that determines the benefits paid under a disability income policy? Education level Wages Type of occupation Age - ✔✔Wages Question 119 The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is Grace Period Physical Examination and Autopsy Entire Contract Time Limit on Certain Defenses - ✔✔Time Limit on Certain Defenses Question 113Select the appropriate response A major medical policy typically provides benefits for surgical expenses only, subject to policy limits contains more limitations than a Basic Hospital, Medical, or Surgical policy contains a 60-day Elimination period for losses due to accident provides benefits for reasonable and necessary medical expenses, subject to policy limits - ✔✔provides benefits for reasonable and necessary medical expenses, subject to policy limits 108. An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet? Entire Contract clause MIB clause Insuring clause Consideration clause - ✔✔Consideration clause Question 106Select the appropriate response Which of these is considered a mandatory provision? Payment of Claims Insurance with Other Insurers Misstatement of Age Change of Occupation - ✔✔Payment of Claims Question 100Select the appropriate response A Business Overhead Expense policy would cover which of the following if a business owner becomes disabled? Contributions to employee retirement plans Utilities and office rent Owner's salary Meals and entertainment - ✔✔Utilities and office rent Question 96Select the appropriate response Making incomplete comparisons of policies in order to induce the purchase of a policy is referred to as discrimination twisting rebating coercion - ✔✔twisting Question 95Select the appropriate response A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013? $500 $1,000 $1,500 $2,000 - ✔✔$1,000 Question 94Select the appropriate response In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments Whenever an insured is unable to work During the time an insured is confined in a hospital Following an accidental injury, but not during sickness After an insured has become totally disabled as defined in the policy - ✔✔After an insured has become totally disabled as defined in the policy Question 92Select the appropriate response Any administration service fees charged by an insurance agent require the written signature by a consumer if the fees are greater than 10% of the premium if the fees are between 5% and 10% of the premium if the fees are less than 5% of the premium in all instances - ✔✔in all instances Question 90Select the appropriate response A Business Overhead Expense policy covers any loss of income by the business owner covers business expenses such as rent and utilities covers employee wages only reimburses the company for any reduction in sales due to the owner's disability - ✔✔covers business expenses such as rent and utilities Question 89Select the appropriate response Which of the following is NOT included in the policy face? Free Look provision Name of the insured Name of the insurer Exclusions - ✔✔Exclusions Question 88Select the appropriate response K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation? Free-look Reinstatement Grace Period Consideration - ✔✔Reinstatement Question 86Select the appropriate response What is issued to each employee of an employer health plan? Provision Receipt Policy Certificate - ✔✔Certificate Question 85Select the appropriate response Which of the following statements describes what an Accident and Health policyowner may NOT do? File a covered claim Assign ownership Cancel the coverage Adjust the premium payments - ✔✔Adjust the premium payments Question 83Select the appropriate response M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? Claim payment is equal to physician's actual charges Claim payment is negotiated between physician and patient Determined by the schedule of benefits from the hospital Determined by the terms of the policy - ✔✔Determined by the terms of the policy Question 80Select the appropriate response Which of the following BEST desscribes a Hospital Indemnity policy? Coverage that reimburses an insured for surgeon expenses Coverage that pays a stated amount per day of a covered hospitalization Coverage that replaces lost income due to hospitalization Coverage that pays for hospital room and board - ✔✔Coverage that pays a stated amount per day of a covered hospitalization Question 78Select the appropriate response J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price. What type of plan does J belong to? Multiple Employer Welfare Arrangement Multiple Employer Trust Health Maintenance Organization Co-op Arrangement - ✔✔Health Maintenance Organization Question 74Select the appropriate response T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable? Benefits are taxable to T Benefits are tax-free to T Benefits are partially taxable to T Benefits are taxable to T's employer - ✔✔Benefits are taxable to T Question 73Select the appropriate response Which of the following statements about a business entity acting as an insurance agent is CORRECT It must designate at least 1 licensed producer to be responsible for the entity's compliance with the insurance laws and rules It must provide a copy of its business plan to the Virginia Commissioner of Insurance It must be located in Virginia To become a business entity acting as an insurance producer, a state bank must be a member of the Federal Deposit Insurance Corporation (FDIC) - ✔✔It must designate at least 1 licensed producer to be responsible for the entity's compliance with the insurance laws and rules Question 72Select the appropriate response On an Accidental Death and Dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation? Payer Primary beneficiary Policyowner Insurer - ✔✔Policyowner Question 69Select the appropriate response Group/voluntary long-term care policy premiums are typically deducted from the employee's income and are approximately the same premium as compared to individual long term care coverage are more expensive as compared to individual long term care coverage are less costly as compared to individual long term care coverage are substantially more costly as compared to the premiums for individual long term care coverage - ✔✔are less costly as compared to individual long term care coverage Question 68Select the appropriate response K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered optionally renewable conditionally renewable guaranteed renewable noncancellable - ✔✔guaranteed renewable Question 67Select the appropriate response K applies for a health insurance policy on herself and submits [Show More]

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