Pearson Vue National Health Insurance Practice Test Questions and answers, 100% Accurate, rated A+

Document Content and Description Below

Pearson Vue National Health Insurance Practice Test Questions and answers, 100% Accurate, rated A+ An insurer must provide claim forms to an insured within a MAXIMUM of how many days after receiv... ing notice of an Accident & Health claim? A. Five B. Fifteen C. Twenty D. Thirty - ✔✔-b 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: A. length of employment B. gender C. salary grade D. job category - ✔✔-b Which of the following statements is CORRECT about a Waiver of Premium provision in a Disability Income policy? A. It allows the insurer to deduct premiums due from the disabled insured's benefit payments. B. It allows the insurer to increase the amount of premium during the insured's time of disability. C. It allows the insured to extend the length of the Grace Period while disabled. D. It allows the insured to maintain a policy in force while disabled and unable to pay premiums. - ✔✔-d Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the following policy features? A. Extensions of coverage B. Benefits clause C. Riders D. Exclusions - ✔✔-d An insured becomes disabled three years after his Disability Income policy is issued. The disability is caused by a condition that existed prior to the policy issue date but was not specifically excluded from coverage. In this situation, the insurer will most likely take which of the following actions? A. Pay the full claim B. Pay the claim for a maximum of six months only C. Deny the claim on the basis of misrepresentation D. Deny the claim because it involves a pre-existing condition - ✔✔-a 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: A. Health Maintenance Organization B. Medicaid C. Medicare D. Multiple Employer Trust (MET) - ✔✔-a 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? A. Uniform Provisions Law B. Freedom of Information Act C. Medical Information Bureau Disclosure Act D. Fair Credit Reporting Act (Insurance Information and Privacy Protection Act) - ✔✔-d Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to: A.increase the premium rate for one insured without increasing the rate for others in the same class A. increase the premium rate for one insured without increasing the rate for others in the same class B. increase the premium rate for an entire class of insureds C. increase the benefits for an individual insured D. decrease benefits for one insured without decreasing benefits for others in the same class - ✔✔-d Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to: A.increase the premium rate for one insured without increasing the rate for others in the same class A. increase the premium rate for one insured without increasing the rate for others in the same class B. increase the premium rate for an entire class of insureds C. increase the benefits for an individual insured D. decrease benefits for one insured without decreasing benefits for others in the same class - ✔✔-b An individual who has had a heart murmur since birth is likely to be issued an individual disability policy that includes: A. Guaranteed Insurability rider B. an Exclusionary/ Impairment rider C. Waiver of Premium rider D. Double Indemnity rider - ✔✔-b Which of the following statements is CORRECT about coinsurance? A.It applies to deductibles as well as to claim payments. A. It applies to deductibles as well as to claim payments. B.It helps control overutilization of benefits. C. It is effective for the first claim payment and waived for future claims. D. Insurance companies may adjust the coinsurance ratio after issuing a policy. - ✔✔-b The insurance policy clause that identifies the contracting parties and defines the scope and limits of coverage is called the: A. Insuring clause B. Benefit clause C. Consideration clause D. Renewal clause - ✔✔-a In an Accidental Death and Dismemberment (AD&D) policy, the term "capital sum" refers to: A.the benefit paid for death caused by a dread disease A. the benefit paid for death caused by a dread disease B. the monthly disability income paid if an insured loses a limb or the sight in one or both eyes C. a lump sum payment made when disease causes the amputation of an arm or a leg D. a lump sum payment made for an accidental dismemberment - ✔✔-d A group long-term disability plan is integrated with Social Security when which of the following statements is CORRECT? A. Social Security and group benefits pay a combined maximum limit. B. Full group benefits are paid in addition to Social Security benefits. C. Full Social Security benefits are paid after group benefits are exhausted. D. Half of the allowable Social Security benefits are paid after group benefits are exhausted. - ✔✔-a Medicare Part A covers which of the following expenses? A. Hospital room and board B. Surgical expenses C. Medications D. Physicians' services - ✔✔-a J has a physical impairment, attends school, and is incapable of self-sustaining employment and/ or self care. Which of the following statements is CORRECT about J's medical coverage under J's father's group plan? A. J's coverage ceases, but J may apply for group student coverage. B. J's coverage automatically discontinues at age twenty-six. C. J's coverage continues only as long as J is a full-time student. D. J's coverage continues as long as J is continually incapacitated and is financially dependent on J's father. - ✔✔-d Medicare Supplement policies are primarily designed to: A.offset the high cost of Medicare A. offset the high cost of Medicare B. provide additional retirement income to supplement Social Security retirement benefits C. provide additional benefits beyond those provided by Medicare D. provide a reinsurance network that spreads the Medicare risk among private insurance companies - ✔✔-c A producer and an applicant complete an application for a health policy and submit it to the insurer for underwriting without any premium. The underwriter issues a policy and mails it to the producer for delivery to the applicant. The producer should take all of the following actions during the delivery of the policy to the applicant EXCEPT: A. collect the initial premium payment B. issue a conditional receipt C. have the applicant complete a statement of continued good health D. explain the Free Look provision which begins on the policy delivery date - ✔✔-b 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 either of them should become permanently disabled. In this situation, a producer would MOST likely recommend which of the following types of contracts? A. Basic Hospital B. Disability Buy-Out C. Comprehensive Major Medical D. Short-Term Disability Income - ✔✔-b Which of the following definitions of disability would cover a permanent partial disability? A. Own occupation B. Any occupation C. Residual disability D. Presumptive disability - ✔✔-c Group health insurance specifies that what percentage of eligible individuals MUST be offered coverage under a noncontributory plan? A. 25 B. 50 C. 75 D. 100 - ✔✔-d An Eligible Expenses provision in a comprehensive major medical policy commonly identifies all of the following types of covered health care services EXCEPT: A. professional services of doctors and other medical practitioners B. hospital charges for semi-private room and board C. experimental and investigative services D. pre-approved home health care - ✔✔-c Which of the following provisions explains that a producer does not have the authority to waive the provisions of an insurance contract? A. Legal actions B. Reinstatement C. Time limit on certain defenses D. Entire Contract - ✔✔-d 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 should: A. expect a full refund of all premiums paid plus interest B. submit the claim in any form, which must be accepted by the company as adequate proof of loss C. request the Department of Insurance mediate the claim settlement D. wait for the claim form to arrive - ✔✔-b The Coordination of Benefits clause found in group health ma [Show More]

Last updated: 1 year ago

Preview 1 out of 20 pages