Accident and Health Insurance Exam Questions With Verified Answers
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Course
Accident and Health Insurance
Institution
Accident And Health Insurance
Accident and Health Insurance Exam
Questions With Verified Answers
H has suffered a covered disability away from her job and will shortly begin collecting benefits.
The insurer sends a letter to H stating that she will not receive any benefit amounts greater than
her income. This clause is know...
EXAM STUDY MATERIALS July 23, 2024 4:26 PM Accident and Health Insurance Exam Questions With Verified Answers H has suffered a covered disability away from her job and will shortly begin collecting benefits. The insurer sends a letter to H stat ing that she will not receive any benefit amounts greater than her income. This clause is known as: A: Over -insurance clause B: free look C: relation of earning to insurance D: relation of economic value - answer✔✔C: relation of earning to insurance The in sured should be aware of the issue date upon delivery a policy and the date should be listed on: A: the policy summary B: the first page of the contract C: the delivery receipt D: upon conditional receipt - answer✔✔B: the first page of the contract The policy has all of the following rights EXCEPT: A: Right to solely renew a guaranteed renewable policy. B: Right to terminate a policy C: Unilateral right to renew an Optionally renewable policy D: Right to assign a contract - answer✔✔C: Unilateral righ t to renew an Optionally renewable policy The part of a contract that specifies which expenses may or may not be covered is known as the: A: Exclusion B: Eligible Expense provision C: Insuring Agreement D: Consideration Clause - answer✔✔B: Eligible Expense provision EXAM STUDY MATERIALS July 23, 2024 4:26 PM Which of the following is considered to be a mandatory provision in a health policy? A: Time Limit on Certain Defenses B: Change of Occupation C: Illegal Occupation D: Intoxicant/Narcotic Usage - answer✔✔A: Time Limit on Certain Defenses Which o f the following may be considered an eligible expense found in a health policy? A: Cosmetic Surgery B: Premium payment C: cold cream D: Bus fare to receive treatment for a covered loss - answer✔✔D: Bus fare to receive treatment for a covered loss K has a policy that covers doctors visits but limits the number of visits per calendar year and pays a limited indemnification limit per visit. K has: A: Basic Medical Expense B: Physician Nonsurgical Coverage C: Basic Surgical Policy D: Basic Hospital Coverage - answer✔✔B: Physician Nonsurgical Coverage All of the following are CORRECT about Medicare EXCEPT: A: An insured who is age 30 but collecting Social Security disability for the last two years is eligible for Medicare. B: An insured who is age 60 and is at the end stage of renal failure is eligible for Medicare. C: An insured who turns age 65 and is still employed is eligible for Medicare. D: An insured who has Medicare Part A is eligible to enroll for Medigap policies w ithin six months of enrolling in Part A. - answer✔✔D: An insured who has Medicare Part A is eligible to enroll for Medigap policies within six months of enrolling in Part A. Under the Claim Forms provision in an Accident and Health policy, an insurance com pany must supply an insured with claim forms within a MAXIMUM of how many days after receiving notice of the loss? A: 10 B: 15 EXAM STUDY MATERIALS July 23, 2024 4:26 PM C: 20 D: 30 - answer✔✔B: 15 The purpose of the Fair Credit Reporting Act is to: A: protect the consumer from having an adverse ac tion against them based of obsolete credit information B: to ensure that credit information used in underwriting is accurate and updated C: make sure that any financial institution handles an individual's credit in a correct, proper manner D: All of the Ab ove - answer✔✔D: All of the Above Most Accident and Health policies require that claims must be paid _________ upon written proof of loss. A: 30 days B: Immediately C: 60 days D: 90 days - answer✔✔B: Immediately A LTC policy that will only pay for ADL giv en occasionally by a licensed professional is: A: Skilled Care B: Intermediate Care C: Custodial Care D: None of the Above - answer✔✔C: Custodial Care Which of the following policy provisions are optional in a individual health policy? A: Entire Contract B: Change of Occupation C: Entire Contract D: Reinstatement - answer✔✔B: Change of Occupation Which of the following elements is part of the entire contract clause? A: The exchange of value between the parties B: The agreement between the policyholder and insurer C: The amount of time the insured has to send a policy back for a full refund EXAM STUDY MATERIALS July 23, 2024 4:26 PM D: None of the Above - answer✔✔D: None of the Above All of the following are true regarding Social Security disability EXCEP T: A: A insured must wait 5 months before collecting benefits B: To qualify an insured must be unable to do any job in the American economy C: To qualify an insured must be disabled for a year or longer or die within a two year period. D: The insured must have a certain amount of Social Security credits based off age. - answer✔✔C: To qualify an insured must be disabled for a year or longer or die within a two year period. Health Care FSA contributions are limited to _______ per year. A: $5,000 B: $3,000 C: $2,700 D: $3,250 - answer✔✔C: $2,700 A noncancelable policy means the company A: may not raise the premium or terminate the policy except for nonpayment of premium B: may not cancel before the insured reaches age 50 C: may pay limited benefits and cannot c ancel all benefits D: can only terminate coverage if the insured switches occupations - answer✔✔A: may not raise the premium or terminate the policy except for nonpayment of premium The maximum number of in -hospital days coverage provided by an individual policy under minimum standards is: A: 30 days B: 45 days C: 90 days D: 180 days - answer✔✔D: 180 days If there is a dispute on medical necessity under a HMO, there must be a system in place for a second opinion. If the second opinion determines that a cove red service is in fact medically necessary, the HMO must provide service. The only way that benefits are paid for an out -of-
network physician is: A: if a referral is given
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