Health and Accident
Insurance Exam
- During the underwriting process for a group health policy, it was discovered that 15
out of 50 members of the group have major health issues. How would the insurer
handle this?
Accept or reject the whole group - When a claim has coverage under more than one health plan, which group medical
plan provision applies?
Coordination of benefits - What percentage of eligible employees must participate in a noncontributory group
health plan before it can be put in effect?
100% - Who is financially liable for the payment of covered claims in a fully insured group
health plan?
Insurer - Buy-Sell Plans are typically funded by which two types of insurance?
Life insurance and Disability insurance - In regards to a group health insurance plan, which statement is CORRECT?
A non-contributory group health plan must cover all eligible members - Which of the following is NOT typically covered under vision care insurance?
Eye Surgery - An eligible individual who would like to obtain group health insurance without
providing evidence of insurability must?
Enroll within a specified eligibility period - Coverage is limited for vision and dental insurance in all of the following ways,
EXCEPT?
Specific dollar amount for examinations - The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to
employers who employ at least?
20 employees - The problem of over insurance is addressed in which health insurance provision?
Coordination of benefits - Minimum participation standards exist for group health insurance plans in order to
Prevent adverse selection - In an employer-sponsored group accident and health plan, a master contract is
issued to the?
Employer - Which of the following does Coordination of Benefits allow?
Health and Accident Exam
- An employer is issued a group medical insurance policy. This single contract is
known as a(n)
A. Entire contract
B. Master policy
C. .Certificate of coverage
D. Employer contract - What is issued to each employee of an employer health plan?
A. Provision
B. Receipt
C. Policy
D. Certificate - Which of the following decisions would a Health Savings Account (HSA) owner NOT
be able to make?
A. The amount contributed by the employer
B. The amount contributed by the owner
C. The underlying account investments used
D. The medical expenses paid for by the HSA - Which of the following is INELIGIBLE to participate in a Section 125 Plan?
A. Key Employee in a C-Corp
B. Highly Compensated Employee in an S-Corp
C. A C-Corp Owner with a greater than 2% share
D. An S-Corp Owner with a greater than 2% share - Under the subrogation clause, legal action can be taken by the insurer against the
A. Responsible third party
B. Beneficiary
C. Policy owner
D. State
- According to HIPAA, when an insured individual leaves an employer and immediately
begins working for a new company that offers group health insurance, the individual
A. Is eligible for coverage upon hire
B. Must wait 360 days to be eligible for coverage
C. Must continue coverage with the previous employer
D. Is eligible for only health insurance, not life or dental insurance - Justin is receiving disability income benefits from a group policy paid for by his
employer. How are these benefits treated for tax purposes?
A. Partially taxable income
B. Non-taxable income
C. Taxable income
D. Conditionally taxable income - When are group disability benefits considered to be tax-free to the insured?
A. When the recipient pays the premiums
B. When the employer pays the premiums
C. When both the employer and recipient pay the premiums
D. When benefits paid are equal to or lower than the recipient’s salary - Which type of business insurance is meant to cover the costs of continuing to do
business while the owner is disabled?
A. Disability overhead policy
B. Business continuation policy
C. Disability buy-sell policy
D. Business overhead expense policy - Sole proprietors are permitted tax deductions for health costs paid from their
earnings in the amount of
Health and Accident Insurance Exam
- Which of these circumstances is a Business Disability Buy-Sell policy designed to
help in the sale of a business?
Business owner becoming disabled
-A Business Disability Buy-Sell policy is designed to assist in the sale of a business
when one of the owners becomes disabled. - Accidental Death coverage is provided to commercial airline passengers in which of
the following types of policies?
Blanket Accident policy
A Blanket Accident policy provides Accidental Death coverage to airplane passengers. - The Health Insurance Portability and Accountability Act (HIPAA) gives privacy
protection for
The Health Insurance Portability and Accountability Act (HIPAA) provides privacy
protection for health information. - J has an Accidental Death and Dismemberment policy with a principal sum of
$50,000. While trimming the hedges, J cuts off one of his fingers. What is the
MAXIMUM J will receive from his policy?
The maximum sum payable would be the capital sum, or $25,000. - Which of these types of coverage is best described as a short term medical policy?
A short term medical policy is best described as interim coverage. - How would a contingent beneficiary receive the policy proceeds in an Accidental
Death and Dismemberment (AD&D) policy?
If the primary beneficiary dies before the insured
-A contingent beneficiary will receive the policy proceeds if the primary beneficiary dies
before the insured’s death.
- Under which of the following circumstances will the benefits under COBRA
continuation coverage end?
All group health plans are terminated by the employer
-One of the disqualifying events that can result in the termination of continuing coverage
under COBRA is when the employer terminates all group health plans. - The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and
their families) whose employment has been terminated the right to
Continue group health benefits - When an employee is required to pay a portion of the premium for an
employer/employee group health plan, the employee is covered under which of the
following plans?
Contributory
-Group plans where employees pay a portion of the premiums are called contributory
plans. - On an Accidental Death and Dismemberment (AD&D) insurance policy, who is
qualified to change the beneficiary designation?
Policy owner
-The policy owner has the right to change the beneficiary designation. However,
consent may needed by the current beneficiary if designated as irrevocable. - Which contract permits the remaining partners to buy-out the interest of a disabled
business partner?
Accident and Health Insurance
Agent/Broker Practice Exam
- Sally is considering her Medicare options. She understands that to enroll in Medicare
Part B, she will have to pay a monthly premium. Since she is healthy, she is considering
delaying her enrollment until later. Will she be able to enroll at a later date?
A. Yes, she can enroll at anytime in the future
B. Yes, however; she would have a permanent premium penalty when she does enroll
C. No, this is a take or leave it situation
D. Yes, but she would have to show evidence of good health.
Yes, however; she would have a permanent premium penalty when she does enroll - Under Medicare Part A, a spell of illness begins again and is subject to a new
deductible for another admission when: - The patient has been discharged from a prior stay and 45 days have elapsed
- The patient has been discharged from a prior stay and 30 days have elapsed
- The patient has been discharged from a prior stay and 60 days have elapsed
- The patient has been discharged from a prior stay and 90 days have elapsed
- What type of insurer retains risk?
- Government insurance.
- Reinsurers.
- Self -insurers.
- Assessment insurers.
- A variety of types of care are provided under a long-term care policy. All of the
following are types of care generally provided EXCEPT: - Home health care
- Intensive care
- Custodial care
- Skilled care
- Melvin has a long-term care policy with a 30-day elimination period. The policy has a
daily benefit of $100/day. The policy has a 3-year benefit period. If Melvin is confined to
a nursing home for 9 months, how much in benefits will his policy pay? - $27,000
- $18,000
- $24,000
- $17,000
- Martin and his friends were at a local tavern celebrating his birthday. Martin left the
bar to drive home, but unfortunately, he was involved in a fatal accident, killing himself
and two other individuals. An autopsy reveals that Martin was well above the legal limit
on his blood alcohol test. Martin’s family will receive the following from his Accidental
Death and Dismemberment policy: - His family will receive reduced benefits since other deaths were involved.
- His family will receive the principal sum since this was death
- His family will receive no benefits, since he was in the act of committing a felony
- His family will receive no benefits since there was no dismemberment involved.
- An exclusion that always appears in a health policy is:
- No coverage for drug or alcohol related illness
- Hernia from an accident
- Travel outside of the USA
- Injury in the act of committing a felony
- Bruce owns a plan that pays $100 daily benefit for a hospital stay with no deductible.
This kind of policy is known as a (an): - Major medical plan
- Basic plan
- Indemnity plan
- Reimbursement plan
- Under what conditions is the death benefit (principal sum) payable under an
Accidental Death and Dismemberment (AD&D) policy? - The insured dies from a grave illness
- The insured dies from natural causes
- The insured dies from an accident
- All of the above
- An insurance agent told a member of his church who had recently experienced
several personal and financial losses that he could see that she got a more favorable
rate on her insurance policies than her health and general circumstances would
warrant. The woman had been his kindergarten teacher and was a pillar in the
community’s life. He wanted to help her. Which of the following is FALSE? - The agent was breaking the law.
- The agent is compassionate.
- The agent was engaging in unfair discrimination.
- The agent was engaging in twisting.
Chapter 12 – Health and
Accident Insurance Exam
- Jill has a group health plan with an employer that covers employees in more than one
state. Which of the following aspects is NOT affected by the state regulatory jurisdiction
established for this plan?
Continuation of coverage under COBRA - Group accident and health insurance may be offered by an insurer when the
sponsoring group
Provides an employer-employee relationship - Which of the following statements BEST describes a double indemnity provision in
travel accident insurance?
Benefits are doubled under certain circumstances stated in the policy - What action can an insurer take to discourage malingering and false disability
claims?
Limit the amount of benefits an insured can receive from two disability policies with the
same insurer - What type of employee welfare plans are not subject to ERISA regulations?
Church Plans - Which of the following statements BEST describes disability buy-sell insurance
policies?
Policy proceeds are typically received income tax-free - Darrell has a group long-term disability income policy paid by his employer. Which of
these statements is true?
The specified benefit amount is a percentage of his wages - For employees covered in multiple states under a group health plan, jurisdiction rules
cannot alter
COBRA Laws - How many employees must an employer have for the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA) to apply?
20 or more - A certificate of coverage for a group health policy is best described as
Proof of coverage for the employee - When disability buy-sell insurance benefits exceed a partner’s cost basis, which of
the following is correct?
The full amount is non-taxable to the partner - Which of the following is NOT a function of accident and health insurance?
Pays a death benefit as a result of natural causes - A comprehensive group policy also covers expenses related to vision care. Which of
the following is not typically covered under a vision plan?
Cataract Surgery
Life, Accident and Health
Insurance Exam
- If only one party to an insurance contract has made a legally enforceable promise,
what kind of contract is it?
A. Conditional
B. A legal, but unethical contract
C. Unilateral
D. Adhesion - Which services are associated with Standard & Poor’s and AM Best?
A. Investigating violation of The Fair Credit Reporting Act
B. Providing employment histories for investigative consumer reports
C. Storing medical information collected by insurance companies
D. Rating the financial strength of insurance companies - Which insurance principle states that if a policy allows for greater compensation than
the financial loss incurred, the insured may only receive benefits for the amount lost?
A. Consideration
B. Indemnity
C. Stop-loss
D. Limited Benefits - If an insurer meets the state’s finical requirements and is approved to transact
business in the state, it is considered to be..
A. Domestic
B. Authorized
C. Qualified
D. Certified - Which of the following is an example of apparent authority?
A. The agent puts up a sign with the logo of the insurance company without express
permission
B. The agent accepts a premium payment after the end of the grace period
C. The agent accepts a premium during the grace period
D. The agent has business cards and stationery printed
- Which statement regarding insurable risks is NOT correct?
A. Insurance cannot be mandatory
B. The insurable risk needs to be statistically predictable
C. Losses must be measurable
D. Insureds cannot be randomly selected - All of the following are examples of risk retention EXCEPT…
A. Deductibles
B. Copayments
C. Self-insurance
D. Premiums - Because an insurance policy is a legal contract, it must conform to the laws
governing contracts which require all of the following elements EXCEPT…
A. Offer and acceptance
B. Conditions
C. Legal purpose
D. Consideration - In insurance transactions, fiduciary responsibility means…
A. Commingling premiums with agent’s personal funds
B. Handling insurer’s funds in a trust capacity
C. Maintaining a good credit record
D. Being liable with respect to payment of claims - Which of the following types of insurers issues participating policies?
A. A fraternal insurer
B. A stock insurer
C. A mutual insurer
D. An authorized insurer
- Which of the following is the foundation of the statistical prediction of loss upon
which rates for insurance are calculated?
A. Law of averages
B. Law of large numbers
C. Adverse selection
D. Field underwriting - The authority granted to an agent through the agent’ contract is referred to as…
A. Apparent authority
B. Implied authority
C. Absolute authority
D. Express authority - Which of the following is NOT consideration not he part of an insured?
A. Premium payment
B. Promise to submit timely claims
C. Representations on the application
D. Submitting a Statement of Good Health - Events or conditions that increase the chances of an insured loss occurring are
referred to as…
A. Risks
B. Perils
C. Hazards
D. Exposures - Events in which the principal has both the chance of winning or losing are classified
as…
A. Retained risk
B. Speculative risk
Accident and Health
Insurance Final Exam
- Your license will be considered to be inactive when you:
No longer have any appointments - On a “participating” health insurance policy issued by a mutual insurance company,
dividends paid to policy holders are:
Not taxable since the IRS treats them as a refund of a portion of the premium paid - All of the following are true regarding a non-contributory employer group medical
expense insurance policy EXCEPT:
Premiums must be paid entirely by the employees - Which two of the following are considered to be activities of daily living in most longterm care policies:
Eating and dressing - The Employee Retirement Income Security Act (ERISA) requires that employee
benefit plans be managed for the benefit of:
Participants and beneficiaries - Which of the following must be printed on every licensee’s business cards, written
price quotations and printed advertisements:
Their insurance license number - At age 65, an individual would be eligible for which of the following at no charge
Part A of Medicare - Under the California Insurance Code (CIC), neither party to a contract of insurance is
bound to communicate any of the following EXCEPT:
Information known to be material - The enrollee pays what percentage of the premium for Medicare Part B?
100% - When an insurer voids an insurance contract due to an intentionally fraudulent
omission by the insured of a material fact, it is known as:
Rescission - When can a representation be altered or withdrawn?
Before the insurance is effected, but not afterwards - Under the Patient Protection and Affordable Care Act (PPACA), health plans cannot
limit or deny benefits or deny coverage for a child younger than age __ because the
child has a pre-existing condition that developed before the child applied to join the
plan:
19 - Which of the following is not covered in a long-term care policy?
Acute care in the hospital
Chapter 12: Health and
Accident Insurance Exam
- What is issued to each employee of an employer health plan?
A) Provision
B) Receipt
C) Policy
D) Certificate - The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers
who employ at least
A) 10 employees
B) 20 employees
C) 30 employees
D) 40 employees - An employer is issued a group medical insurance policy. This single contract is
known as a(n)
A) entire contract
B) master policy
C) certificate of coverage
D) employer contract - A master contract and certificate of coverage can be found in which type of policy?
A) Long-term
B) Medicaid
C) Group
D) Medicare
- The election of COBRA for continuation of health coverage will
A) increase the coverage and lower premium
B) maintain the same coverage and increase premium
C) increase out-of-pocket costs and lower premium
D) decrease out-of-pocket costs and maintain same premium - An insurer has the right to recover payment made to the insured from the negligent
party. These rights are called
A) contributory
B) indemnity
C)estoppel
D) subrogation - Without a Section 125 Plan in place, what would happen to an employee’s payroll
contribution to an HSA?
A) It would be considered taxable income to the employee
B) The employee would not be allowed to an HSA
C) The employer would pay payroll tax and FICA on the contribution amount
D) The employer would not be allowed to deduct the contribution from the employee’s
pay - According to the Health Insurance Portability and Accountability Act (HIPAA), when
can a group health policy renewal be denied?
A) There have been too many claims in the previous year
B) The size of the group has increased by more than 10%
C) Participation or contribution rules have been violated
D) Participation or contribution rules have been changed
- A group Disability Income plan that pays tax-free benefits to covered employees is
considered
A) non-contributory
B) partially contributory
C) group contributory
D) fully contributory - The purpose of the Coordination of Benefits provision in group accident and health
plans is to
A) avoid overpayment of claims
B) reduce out-of-pocket costs
C) reduce adverse selection
D) lower the cost of premiums - Continued coverage under COBRA would be provided to all of the following
EXCEPT:
A) former dependent of employee no longer of dependent status
B) terminated employee
C) divorced spouse of employee
D) a covered employee is terminated for gross misconduct
Chapter 1 Health and Accident Insurance
- Which of the following is NOT a function of accident and health insurance?
Pays a death benefit as a result of natural causes - Which of the following incidents would NOT be covered by an Accidental Death and
Dismemberment policy?
Suicide - An accident and health insurance policy defines an injury as “bodily injury by
accidental means”. For an injury to be covered on this policy, what is required?
Both the cause and resultant injury must be accidental - Kate received a group accident and health termination notice. How many days does
she have to apply for a converted policy?
31 - Which of the following statements BEST describes a double indemnity provision in
travel accident insurance?
Benefits are doubled under certain circumstances stated in the policy - What type of employee welfare plans are not subject to ERISA regulations?
Church plans - Individuals covered with employer-paid group health plans will normally receive taxfree benefits under all of these plans EXCEPT
Disability income - How are benefit payments from individually-owned medical expense policies treated
for tax purposes?
Exempt from income taxes - What is the name of the period of time during which a new employee is ineligible for
group Health insurance coverage?
Probationary period - Typically, working individuals age 65 or over must be
Offered the same Health benefits as the younger employees - Under a key person disability income policy, benefits will be received as
Tax-free income to the business - Which of the following statements is NOT true concerning the relationship between
group health insurance plans and Medicare? (assuming the business has more than 20
employees)
Group health coverage is NOT available for workers over the age of 65 - Darrell has a group long-term disability income policy paid by his employer. Which
of these statements is true?
The specified benefit amount is a percentage of his wages - Notice of information practices must be given to a policyholder at least
Every three years
Chapter 3 – Health and Accident Insurance
- J has an Accidental Death and Dismemberment policy with a principal sum of
$50,000. While trimming his hedges, J cuts off one of his fingers. What is the
MAXIMUM J will receive from his policy?
$25,000 - An insurance company would MOST likely pay benefits under an Accidental Death
and Dismemberment policy for which of the following?
Loss of eyesight due to an accidental injury - B has a $100,000 Accidental Death and Dismemberment policy that pays triple
indemnity for common carrier death. If B is killed from an accident on a commercial
flight, what will the policy pay B’s beneficiary?
$300,000 - Which of the following statements BEST describes how a policy that uses the
“accidental bodily injury” definition of an accident differs from one that uses the
“accidental means injury”?
Less restrictive - With Disability Income insurance, an insurance company may limit the monthly
benefit amount a prospective policy holder may obtain because of the insured’s…
Gross income at the time of purchase - Which of the following is the MOST important factor when deciding how much
Disability income coverage an applicant should purchase?
Applicant’s monthly income - An individual Disability Income insurance applicant may be required to submit all of
the following information EXCEPT
Spouse’s occupation - M becomes disabled and is unable to work for six months. M dies soon after from
complications arising from this disability. M has a Disability Income policy that pays
$2,000 a month. Which of the following statements BEST describes what is owed to her
estate?
Earned, but unpaid benefits - Disability policies do NOT normally pay for disabilities arising from which of the
following?
War - B is a teacher who was injured in a car accident and cannot work. She is now
receiving monthly benefits as a result of this accident. Which type of policy does B
have?
Disability Income - Which of these statements concerning an individual Disability Income policy is
TRUE?
Normally includes an elimination period - J has a Disability Income policy that does NOT provide benefits for losses occurring
as the result of his employment. What kind of coverage is this?
Non-occupational coverage
Chapter 4 – Health and Accident Insurance
- If an employee contributes 50% toward the disability plan premium provided by an
employer, what would be considered the taxable income of a $1,000 monthly disability
benefit?
- $100
- $250
- $500
- $1,000
- Which of the following would evidence ownership in a participating health insurance
contract?
- Stock ownership
- Irrevocable beneficiary status
- Policy ownership
- Collateral assignment
- Mark continues working after the age of 65 and is covered through his employer’s
group health plan. Which of the following statements is TRUE?
- He’s not eligible for Medicare
- His group health plan and Medicare pay 50/50
- Medicare is the secondary payer
- Medicare is the primary payer
- Which of the following would be considered a possible applicant and contract
policyholder for group health benefits?
- Human resource department
- Employer
- Insured employee
- Insurance company
- What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985
allow an employee to do?
- In the event of the employment termination, group health insurance can be kept if the
employee pays the premiums - Receive a tax credit to help offset the cost of health insurance
- Remain on their current coverage for 30 months
- In the event of employment termination, group health insurance can be kept if the
employer pays the premiums
- Key Person Disability Insurance pays benefits to the
- Hospital
- Employee
- Employer
- Employee’s creditors
- When are group disability benefits considered to be tax-free to the insured?
- When the recipient pays the premiums
- When the employer pays the premiums
- When both the employer and recipients pay the premiums
- When benefits paid are equal to or lower than the recipient’s salary
- Justin receiving disability income benefits from a group policy paid for by his
employer. How are these benefits treated for tax purposes?
- Partially taxable income
- Non-taxable income
- Taxable income
- Conditionally taxable income
- In an employer-sponsored contributory group Disability Income plan, the employer
pays 60% of the premium and each employee pays 40% of the premium. Any income
benefits paid are taxed to the employee at
- Employee has no tax liability
- 40% of the benefit
- 60% of the benefit
- 100% of the benefit
- Continued coverage under COBRA would be provided to all of the following
EXCEPT: