Health - Pearson Practice

50 Questions | Total Attempts: 473

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Healthcare Quizzes & Trivia

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Questions and Answers
  • 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

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