Health - Pearson Practice

50 Questions | By Gohealth | Last updated: Mar 22, 2022 | Total Attempts: 473

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Pearson Vue Practice

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1.

The Coordination of Benefits clause found in group health Master Contracts is used to:
- A.
  
  Avoid double payment of benefits to an insured who has duplicate group coverages
- B.
  
  Integrate Disability income benefits with Major Medical benefits
- C.
  
  Investigate the claims history of an insured
- D.
  
  Avoid duplicate claims to an employer for the same employee
2.

In which of the following health policies are both the renewability and the premiums guaranteed?
- A.
  
  Optionally Renewable
- B.
  
  Noncancellable
- C.
  
  Guaranteed Renewable
- D.
  
  Conditionally Renewable
3.

An Accident and Health policy Notice of Claim provision requires that an insured give written notice to the insurer within a MAXIMUM of how many days after a loss?
- A.
  
  15
- B.
  
  20
- C.
  
  30
- D.
  
  45
4.

An applicant for insurance submits an application to an insurer for underwriting but does not forward any premium payment with the application. Legally, the applicant is making:
- A.
  
  An inquiry for an offer
- B.
  
  An offer
- C.
  
  A counteroffer
- D.
  
  An acceptance
5.

In an Accidential Death and Dismemberment (AD&D) policy, the term "capital sum" refers to:
- 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 sigh in one eye
- 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
6.

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
7.

Which of the following statements is CORRECT about a Disability Income policy with a Guaranteed Insurability rider?
- A.
  
  The insured may periodically increase the amount of benefits payable under the policy.
- B.
  
  The insured may assign the policy to a member of the insured's family.
- C.
  
  The insurer is not permitted to cancel the policy.
- D.
  
  The insurer will issue the policy without a medical examination.
8.

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 actons?
- 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
9.

A married insured has an Accidental Death and Dismemberment (AD&D) policy that names his brother as the primary beneficiary and his son as the contingent beneficiary. If the insured and his brother are both killed instantly in a train accident, the policy would be paid to the following?
- A.
  
  The insured's estate
- B.
  
  The brother's estate
- C.
  
  The insured's son
- D.
  
  The insured's spouse
10.

Health insurance policies are offered on a "take it or leave it" basis and referred to as which of the following types of contracts?
- A.
  
  Aleatory Contracts
- B.
  
  Valued Contracts
- C.
  
  Unilateral Contracts
- D.
  
  Contracts of Adhesion
11.

The Consideration clause in an accident and health policy states the:
- A.
  
  The applicant pays the initial premium
- B.
  
  Conditions under which benefits are paid
- C.
  
  Premiums will be refunded during the free look period
- D.
  
  Certain claims will be excluded under the policy
12.

Under an Accidental Death and Dismemberment (AD&D) policy, insurable interest must exist at which of the following times?
- A.
  
  When a change of beneficiary is requested
- B.
  
  At the inception of the policy
- C.
  
  When a beneficiary other than a relative is named
- D.
  
  At the time a claim is submitted
13.

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
14.

An individual who has had a heart murmur since birth is likely to be issued an individual health policy that includes:
- A.
  
  A Guaranteed Insurability rider
- B.
  
  An Exclusionary/Impairment rider
- C.
  
  A Waiver of Premium rider
- D.
  
  A Double Indemnity rider
15.

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
16.

Medicare Supplement policies are primarily designed to:
- 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
17.

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.
  
  A Health Maintenance Organization (HMO)
- B.
  
  Medicaid
- C.
  
  Meicare
- D.
  
  A Multiple Employer Trust (MET)
18.

Which of the following reports may include information obtained by a telephone call to the proposed insured?
- A.
  
  Medical Information Bureau (MIB) report
- B.
  
  Attending physician's report
- C.
  
  Inspection report
- D.
  
  Precertification Review
19.

Which of the following definitions MOST accurately describes the Probationary Period?
- A.
  
  The period of time from the date of the loss until the benefits begin
- B.
  
  The period of time from the date of the loss until benefits are actually received by the policyowner
- C.
  
  The waiting period a new hire must satisfy prior to becoming eligible for group health coverage
- D.
  
  The period of time once a claim is received by the insurance company before it pays benefits to the policyowner
20.

Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the following features?
- A.
  
  Extension of coverage
- B.
  
  Benefits clause
- C.
  
  Riders
- D.
  
  Exclusions
21.

When delivering a policy to a client, a producer should take all of the following actions EXCEPT:
- A.
  
  Collect any premiums due
- B.
  
  Fully explain all exclusions and/or riders
- C.
  
  Keep the policy in the producer's office for safe-keeping on behalf of the client
- D.
  
  Review all benefits provided by the policy
22.

Which of the following health policies requires a beneficiary designation?
- A.
  
  Travel Accident
- B.
  
  Medicare Supplement
- C.
  
  Blanket
- D.
  
  Long Term Care
23.

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.
24.

Five years ago, at age forty-five, X stated that he was forty years old on a disability income insurance application. X now submits a claim and the insurer discovers X's true age. The insurer will most likely take which of the following actions?
- A.
  
  Deny the claim due to the material misrepresentation on the applicaton
- B.
  
  Pay the claim as filed because the policy becomes incontestable after two years
- C.
  
  Pay the claim and cancel the policy
- D.
  
  Adjust the benefits downward according to the benefits that X would have been entitled to based on the premiums
25.

Which of the following provisions designates to whom claim payments are made?
- A.
  
  Time of Payment of Claims
- B.
  
  Claim Forms
- C.
  
  Notice of Claim
- D.
  
  Payment of Claims