1.
What is required when an applicant reveals conditions that require more information?
Correct Answer
A. pHysical examination
Explanation
When an applicant reveals conditions that require more information, a physical examination is required. This is because a physical examination allows a healthcare professional to assess the applicant's overall health and determine if there are any underlying medical conditions that may affect their eligibility or coverage. By conducting a physical examination, the insurer can gather additional information to make an informed decision about the applicant's insurability and potential risk factors.
2.
Which risk classification carries the lowest premium?
Correct Answer
D. Preferred
Explanation
Preferred carries the lowest premium because it represents the lowest level of risk for the insurance company. Preferred individuals are considered to be in good health and have a low likelihood of making a claim. Therefore, the insurance company charges them a lower premium compared to other risk classifications such as Standard, Substandard, or Endowed, which indicate higher levels of risk and potential for claims.
3.
During the disability elimination period:
Correct Answer
C. No benefits are payable
Explanation
During the disability elimination period, no benefits are payable. This period is a waiting period before the insurance policy starts providing benefits. It is typically the initial period of disability where the insured individual must wait before receiving any benefits. This waiting period allows the insurance company to verify the disability and ensure that it meets the policy's criteria for benefits. Therefore, during this period, no benefits are payable to the insured individual.
4.
Which of the following statements defines partial disability?
Correct Answer
A. A disabled employee while he is working part-time and receiving lost income under their long-term disability benefit
5.
Which statement best describes a life insurance policy dividend?
Correct Answer
C. It is distribution of excess of funds accumulated by the insurer on participating policies
Explanation
A life insurance policy dividend is the distribution of excess funds accumulated by the insurer on participating policies. This means that when the insurance company collects more premiums than necessary to cover claims and expenses, they distribute the excess funds back to the policyholders who have a participating policy. This is different from a non-participating policy, where the policyholder does not receive a dividend. Therefore, the statement that best describes a life insurance policy dividend is that it is the distribution of excess funds accumulated by the insurer on participating policies.
6.
If a person was in violation of Section 770 of the CA Insurance Code, what action would the insurance Commissioner most likely take if the violation dealt with loans on the security of real or personal property?
Correct Answer
B. Issue a cease and desist order for a violation of more than one transaction
Explanation
If a person is in violation of Section 770 of the CA Insurance Code, the insurance Commissioner would most likely issue a cease and desist order for a violation of more than one transaction. This means that the violator would be ordered to stop engaging in the illegal activity of making loans on the security of real or personal property. This action is taken to prevent further violations and protect the interests of consumers.
7.
If no other method of payment is selected, which of the following is the automatic mode of settlement for life insurance proceeds?
Correct Answer
B. Lump-sum settlement in cash
Explanation
The automatic mode of settlement for life insurance proceeds, if no other method of payment is selected, is a lump-sum settlement in cash. This means that the beneficiary will receive the entire amount of the life insurance proceeds in a single payment, rather than receiving it in installments or through other methods such as extended term insurance, life income, or a paid-up policy.
8.
The process whereby a mutual insurer becomes a stock company is called:
Correct Answer
D. Demutualization
Explanation
Demutualization is the process by which a mutual insurer converts itself into a stock company. This involves the transformation of the company's ownership structure from being owned by policyholders to being owned by shareholders. Through demutualization, the company's policyholders receive shares in the newly formed stock company, allowing them to become shareholders and potentially benefit from any future profits. This process is often undertaken to increase the company's access to capital markets and improve its ability to compete in the industry.
9.
A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as:
Correct Answer
C. Hospital confinement indemnity
Explanation
A supplemental insurance policy that pays a set amount for each day that an individual is hospitalized is known as a hospital confinement indemnity. This type of policy provides additional coverage specifically for hospital stays, offering financial assistance to cover the costs associated with being hospitalized. It is designed to provide a fixed daily benefit to the policyholder during their hospital confinement, regardless of other medical expenses or treatments.
10.
Any situation that presents the possibility of a loss is known as:
Correct Answer
B. A loss exposure
Explanation
A loss exposure refers to any situation that presents the possibility of a loss. This could include events such as accidents, natural disasters, or financial downturns that could result in financial or other types of losses. By identifying and assessing these potential risks, individuals or organizations can take appropriate measures to mitigate or manage them effectively.
11.
A commonly used cost containment measure for emergency hospital care under a major medical expense plan is:
Correct Answer
B. Deductible
Explanation
A deductible is a commonly used cost containment measure for emergency hospital care under a major medical expense plan. It refers to the amount of money that the insured individual must pay out of pocket before the insurance coverage kicks in. By having a deductible, it helps to reduce the overall cost of healthcare by shifting a portion of the financial responsibility onto the insured individual. This encourages individuals to be more mindful of their healthcare expenses and helps to control unnecessary utilization of emergency hospital care.
12.
Which settlement option allows only the death benefit earnings to be paid to the beneficiary?
Correct Answer
C. Interest option
Explanation
The interest option allows only the death benefit earnings to be paid to the beneficiary. This means that the beneficiary will receive the interest earned on the death benefit amount, but not the principal amount itself. This option is often chosen by individuals who want to ensure a steady stream of income for their beneficiaries without depleting the principal amount.
13.
An agent acting as an insurance agent, broker, solicitor, life agent, or bail agent acts in which capacity when handling premiums or return premiums for an insured?
Correct Answer
B. Fiduciary
Explanation
An agent acting as an insurance agent, broker, solicitor, life agent, or bail agent acts in the capacity of a fiduciary when handling premiums or return premiums for an insured. A fiduciary is a person who is entrusted with the responsibility to act in the best interest of another party. In this case, the agent is entrusted with handling the funds of the insured, and therefore, has a legal and ethical duty to act in the insured's best interest. This includes ensuring that the premiums are handled properly and returned if necessary.
14.
Which statement is true regarding participating in a group health insurance plan?
Correct Answer
B. A non-contributory group health plan must cover all eligible members
Explanation
A non-contributory group health plan must cover all eligible members means that every eligible member of the group must be included in the plan without having to pay any premiums or contributions. This type of plan is fully funded by the employer or the group sponsor, and the members do not have to make any financial contributions towards the coverage.
15.
According to state law, what size print must be used for the licensee's license number on all price quotes, business cards, and printed material?
Correct Answer
C. The same size print as the licensee's pHone number, fax number or address
Explanation
According to state law, the licensee's license number must be printed in the same size as their phone number, fax number, or address. This means that the license number should not be larger or smaller than any other contact information on the material.
16.
Social Security disability benefits are paid to persons expected to die or be disabled at least:
Correct Answer
C. 12 months
Explanation
Social Security disability benefits are paid to persons who are expected to be disabled for at least 12 months. This means that the individual must have a medical condition that prevents them from working and is expected to last for at least a year or result in death. The 12-month requirement ensures that the benefits are provided to individuals with long-term disabilities, rather than those with short-term or temporary conditions.
17.
Which non-forfeiture option uses cash surrender values to purchase paid-up term insurance for the full face amount of the policy?
Correct Answer
C. Extended term insurance
Explanation
Extended term insurance is a non-forfeiture option that uses the cash surrender values of a policy to purchase paid-up term insurance for the full face amount of the policy. This means that the policyholder can use the accumulated cash value to continue the coverage without paying additional premiums, but instead, the policy is converted into a term insurance policy for the same face amount. This option allows the policyholder to maintain coverage while utilizing the cash value of the policy.
18.
The group medical plan provision that applies when a claimant has coverage under more than one plan is knows as?
Correct Answer
C. Coordination of benefits
Explanation
Coordination of benefits is the group medical plan provision that applies when a claimant has coverage under more than one plan. This provision ensures that the total benefits received by the claimant do not exceed the actual cost of the medical expenses. It helps in determining the primary and secondary payer for the claim, avoiding duplicate payments, and ensuring fair distribution of benefits among multiple insurance plans.
19.
All of the following statements about the gatekeeper system are true, except:
Correct Answer
A. Specialists can choose to be gatekeepers for their patients
Explanation
The gatekeeper system is a common feature of Health Maintenance Organization (HMO) plans, where insured individuals are required to choose a primary care physician (PCP) as their gatekeeper. The PCP authorizes and coordinates all medical care, including referrals to specialists when necessary. This system ensures that insured individuals must seek initial care through their PCP, who plays a central role in managing their healthcare. Specialists themselves do not typically serve as gatekeepers in this system.
20.
Which coverage is available at no cost to persons at age 65?
Correct Answer
A. Medicare Part A
Explanation
Medicare Part A is available at no cost to persons at age 65. Medicare Part A is the hospital insurance portion of Medicare, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. While Medicare Part B and Social Security retirement benefits are also available to persons at age 65, they may come with costs such as monthly premiums. Long term care insurance is a separate insurance policy that individuals can purchase to cover long-term care services, but it is not available at no cost.
21.
Which optional program is only for individuals age 65 or older?
Correct Answer
D. Medicare Part B
Explanation
Medicare Part B is the correct answer because it is a program specifically designed for individuals age 65 or older. Medicare Part B provides medical insurance coverage, including doctor visits, outpatient care, and preventive services. It is an optional program that individuals can choose to enroll in, in addition to Medicare Part A, which covers hospital insurance. Long term care insurance is not age-restricted and can be purchased by individuals of any age. Social Security survivor benefits are available to eligible individuals regardless of age.
22.
Traditional comprehensive major medical plans include all of the following, except:
Correct Answer
D. First-dollar coverage
Explanation
Traditional comprehensive major medical plans include deductibles, co-insurance, and out-of-pocket maximums. These features require the policyholder to pay a certain amount of expenses before the insurance coverage kicks in, share a percentage of costs with the insurance company, and limit the maximum amount the policyholder has to pay out of pocket, respectively. However, first-dollar coverage is not included in these plans. First-dollar coverage means that the insurance starts paying for medical expenses from the first dollar spent, without any deductibles or co-insurance requirements. Therefore, it is not a part of traditional comprehensive major medical plans.
23.
According to Employee Retirement Income Security Act of 1974 (ERISA) fiduciary standards, benefit plans are operated for:
Correct Answer
D. Plan participants and beneficiaries
Explanation
The correct answer is plan participants and beneficiaries. According to the Employee Retirement Income Security Act of 1974 (ERISA) fiduciary standards, benefit plans are operated for the benefit of the plan participants and beneficiaries. This means that the fiduciaries of the plan have a legal duty to act in the best interests of the participants and beneficiaries, ensuring that the plan is managed and administered in a way that maximizes their benefits and protects their rights. The plan sponsors and employees may also benefit from the plan, but the primary focus is on the participants and beneficiaries.
24.
After the deductible is paid, what percentage of the balance of approved charges does Medicare Part B pay?
Correct Answer
C. 80%
Explanation
Medicare Part B pays 80% of the balance of approved charges after the deductible is paid. This means that once the deductible is met, Medicare will cover 80% of the remaining approved charges, while the individual is responsible for the remaining 20%.
25.
With Medicare coverage:
Correct Answer
C. Part B provides benefits for diagnostic tests and x-rays performed on an out-patient basis
Explanation
Part B provides benefits for diagnostic tests and x-rays performed on an out-patient basis. This means that individuals covered by Medicare can receive coverage for these types of medical procedures without being admitted to a hospital or other in-patient facility. Part B coverage is specifically designed to provide outpatient services, including diagnostic tests and x-rays, which can be crucial for diagnosing and monitoring various medical conditions. This coverage is separate from Part A, which focuses on in-patient hospital care.
26.
Life insurance settlement options include all of the following, except:
Correct Answer
B. Extended term option
Explanation
The extended term option is not a life insurance settlement option. This option allows the policyholder to use the cash value of the policy to purchase a term insurance policy with the same death benefit as the original policy. The other options mentioned, such as the interest option, fixed amount option, and fixed period option, are all valid settlement options that allow the policyholder to receive the policy's cash value in different ways.
27.
All of the following are features of a preferred provider organization (PPO), except:
Correct Answer
D. Primary care pHysicians act as gatekeepers
Explanation
A preferred provider organization (PPO) is a type of healthcare plan that allows individuals to choose their healthcare providers from a network of preferred providers. The providers are paid on a fee-for-service basis, meaning they are paid for each service they provide. Employees have the freedom to choose their practitioners without the need for referrals. However, in a PPO, primary care physicians do not act as gatekeepers. This means that individuals do not need to obtain a referral from their primary care physician in order to see a specialist.
28.
What must a life agent do in order to be able to sell 24-hour care coverage?
Correct Answer
B. Nothing; they are already authorized to sell this coverage with a life license
Explanation
Life agents are already authorized to sell 24-hour care coverage with a life license. This means they do not need to complete any additional courses or applications to sell this type of coverage.
29.
A life insurance application is important for all of the following reasons, except:
Correct Answer
B. The beneficiary must sign the application before the insurer will issue the policy
Explanation
The correct answer is that the beneficiary must sign the application before the insurer will issue the policy. This is because the beneficiary's signature is not a requirement for the issuance of a life insurance policy. The application is important for all the other reasons mentioned, such as requiring truthful statements, containing essential information about the applicant, and becoming a part of the policy if a copy is attached.
30.
The price of insurance for each exposure unit is called the:
Correct Answer
B. Rate
Explanation
The price of insurance for each exposure unit is called the rate. This rate is determined based on various factors such as the level of risk associated with the exposure unit and the coverage provided by the insurance policy. It represents the cost of the insurance coverage for a specific unit of exposure, such as a person or property. The rate is typically calculated by insurance companies to ensure that they are charging an appropriate amount to cover potential claims and expenses.
31.
By adopting a self-funded health plan, an employer will have greater flexibility in all areas of the planning, except:
Correct Answer
A. Claims severity
Explanation
By adopting a self-funded health plan, an employer will have greater flexibility in all areas of the planning, except claims severity. This means that while the employer can have more control and flexibility over the group size, benefits provided, and cost of the plan, they may not have the same level of control over the severity of the claims made by employees. Claims severity refers to the extent or seriousness of the medical conditions or treatments required, and this may be influenced by factors beyond the employer's control, such as the health status and needs of the employees.
32.
To authorize the release of an attending physician's report, the applicant must:
Correct Answer
A. Sign a consent form
Explanation
To authorize the release of an attending physician's report, the applicant is required to sign a consent form. This form serves as a legal document granting permission for the release of the report to the relevant parties. By signing the consent form, the applicant acknowledges their understanding and agreement to allow the physician to disclose their medical information. This ensures that the release of the report is done in compliance with privacy laws and regulations.
33.
Yearly probabilities of death are shown in:
Correct Answer
A. Mortality tables
Explanation
Mortality tables provide yearly probabilities of death for different age groups. These tables are used by insurance companies to calculate premiums and assess the risk of insuring individuals. They provide valuable information on the likelihood of death at different ages, which is essential for determining life insurance rates and payouts. Morbidity tables, on the other hand, focus on the probability of illness or disability rather than death. Policy illustrations and summaries are documents that provide an overview of the terms and conditions of an insurance policy, but they do not contain specific mortality data.
34.
Members of the Medical information Bureau are required to report:
Correct Answer
C. Medical impairments found during the underwriting process
Explanation
Members of the Medical Information Bureau are required to report medical impairments found during the underwriting process. This means that if a member physician identifies any medical conditions or impairments while evaluating an applicant's eligibility for insurance coverage, they must report this information to the Medical Information Bureau. This reporting helps insurance companies assess the risk associated with insuring individuals with specific medical conditions and make informed decisions about coverage and premiums.
35.
When referring to an insurance contract, when must a representation be made?
Correct Answer
D. Either at the time of or before policy issuance
Explanation
In the context of an insurance contract, a representation must be made either at the time of or before policy issuance. This means that the representation can be made during the application process when applying for the insurance policy, or it can be made after the policy has been issued but before it takes effect. In both cases, the insured individual is required to provide accurate and truthful information about themselves and the subject matter of the insurance policy. The representation helps the insurer assess the risk and determine the terms and conditions of the policy.
36.
Frank and Ernest are 25 year old identical twins. They are both in excellent health. Both buy life policies that have $500 annual premiums. Frank buys a 5-year renewable term policy. Ernest buys a whole life policy. Which statement is no true ?
Correct Answer
D. Ernest's whole life premium will remain the same. Frank's premium will increase every 5 yeas.
37.
The request for an attending physician's report must be accompanied by a copy of the:
Correct Answer
D. Signed authorization
Explanation
When requesting an attending physician's report, it is necessary to include a signed authorization. This authorization allows the insurance company to access the individual's medical records and obtain the necessary information from the attending physician. Without a signed authorization, the insurance company would not have the legal permission to request and obtain the required medical information. Therefore, a signed authorization is a crucial document that must accompany the request for an attending physician's report.
38.
A provision stating that health insureds and their insurers will share covered losses in an agreed proportion is called:
Correct Answer
C. Co-insurance
Explanation
Co-insurance is a provision in health insurance where the insured individual and the insurance company share the covered losses in an agreed proportion. This means that the insured person is responsible for paying a certain percentage of the covered expenses, while the insurance company covers the remaining portion. Co-insurance helps to distribute the financial risk between the insured individual and the insurer, ensuring that both parties contribute to the cost of healthcare services.
39.
Which life insurance classification carries the highest premium?
Correct Answer
A. Substandard
Explanation
Substandard life insurance classification carries the highest premium because it is offered to individuals who pose a higher risk to the insurance company due to their health conditions, lifestyle choices, or occupation. These individuals may have pre-existing medical conditions, engage in risky activities, or have a history of health issues. As a result, the insurance company charges higher premiums to compensate for the increased likelihood of having to pay out a claim.
40.
A group insurance plan is contributory when the:
Correct Answer
C. Employee pays part of the premium
Explanation
In a contributory group insurance plan, the employee is required to pay a portion of the premium. This means that the cost of the insurance coverage is shared between the employer and the employee. The employer may still contribute to the premium, but the employee is responsible for paying a portion as well. This arrangement helps to distribute the financial burden of the insurance coverage and encourages employees to have a stake in their own coverage.
41.
The CA Insurance Code states that policies or certificates may be called comprehensive long term care insurance if they provide benefits for:
Correct Answer
A. Institutional (nursing facilities) and home care
Explanation
The correct answer is Institutional (nursing facilities) and home care. According to the CA Insurance Code, policies or certificates can be called comprehensive long term care insurance if they provide benefits for both institutional care (nursing facilities) and home care. This means that the insurance coverage includes both types of care settings, allowing individuals to receive care either in a nursing facility or in their own homes.
42.
Whose benefits are affected by the blackout period?
Correct Answer
B. The surviving spouse
Explanation
The blackout period refers to the period of time after the death of a fully insured worker when the surviving spouse is not yet eligible to receive Social Security benefits. During this period, the surviving spouse's benefits are affected as they are not able to receive any financial support from Social Security. Therefore, the correct answer is the surviving spouse.
43.
Which of the following is not an option for the use of the policy dividends?
Correct Answer
A. Fund the addition of monthly income payments
Explanation
The policy dividends cannot be used to fund the addition of monthly income payments. Policy dividends are typically used to purchase additional insurance coverage or reduce premiums. Monthly income payments are not typically considered as an option for the use of policy dividends.
44.
Who are members of the Medical Information Bureau?
Correct Answer
A. Life insurance companies
Explanation
The Medical Information Bureau (MIB) is a specialized organization that collects and maintains medical information on individuals. This information is primarily used by life insurance companies to assess the risk associated with insuring an individual. Therefore, the members of the MIB are life insurance companies who have access to the information stored in the database. Physicians, hospitals, and health insurance companies are not members of the MIB as they do not have direct access to the information or utilize it for insurance purposes.
45.
After the deductible, what portion does a patient pay for covered expenses under Medicare Part B?
Correct Answer
A. 20%
Explanation
After the deductible, a patient is responsible for paying 20% of the covered expenses under Medicare Part B. This means that Medicare will cover 80% of the costs, while the patient will be responsible for the remaining 20%. This system helps to ensure that patients have some financial responsibility for their healthcare expenses while still providing them with a significant amount of coverage.
46.
Which of the following functions is best defined as an insurance company's identifying and selling to potential customers?
Correct Answer
D. Marketing
Explanation
Marketing is the best defined function as an insurance company's identifying and selling to potential customers. Marketing involves activities such as market research, advertising, and promotion, which are aimed at identifying potential customers and persuading them to purchase insurance products. It focuses on creating brand awareness, developing marketing strategies, and implementing tactics to attract and retain customers. Marketing plays a crucial role in understanding customer needs, positioning insurance products, and effectively communicating their value to potential customers.
47.
What is it called when an insurer uses higher rates based solely on religion, race, or ethnic group?
Correct Answer
B. Unfair discrimination
Explanation
Unfair discrimination is the correct answer because it refers to the practice of an insurer using higher rates based solely on religion, race, or ethnic group. This practice is considered unfair as it violates the principles of equality and fairness, and it is illegal in many jurisdictions. It is important for insurers to assess risk based on relevant factors such as individual characteristics and behavior, rather than discriminatory factors like religion, race, or ethnicity.
48.
A policy owner has the right to change all of the following, except:
Correct Answer
C. The dividend schedule
Explanation
A policy owner has the right to change the beneficiary, the payment mode, and the dividend option. However, the dividend schedule refers to the timing and frequency of dividend payments, which is determined by the insurance company. Therefore, the policy owner does not have the right to change the dividend schedule.
49.
Long term care policies can be replaced for all of the following reasons, except:
Correct Answer
D. The new policy has fewer benefits and a higher premium
Explanation
Long term care policies can be replaced for various reasons, such as if the new policy has a lower premium or greater benefits. Additionally, if the insured's condition has significantly improved, they may choose to replace their policy. However, the given answer states that the new policy has fewer benefits and a higher premium, which is not a valid reason for replacing a long term care policy.
50.
When must insurance records for insurance agents and insurance brokers be made available to the insurance commissioner?
Correct Answer
B. At all times
Explanation
Insurance records for insurance agents and insurance brokers must be made available to the insurance commissioner at all times. This means that the records should be accessible and ready for inspection whenever the commissioner requires them, without any specific time limit or condition. This ensures transparency and accountability in the insurance industry, allowing the commissioner to monitor and regulate the activities of agents and brokers effectively.