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HEALTH INSURANCE EXAM QUESTIONS
Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -48 Questions and Answers
-Format: Multiple-choice / Flashcard
Question 1: Suicide, pre-existing conditions and self-inflicted injuries are dealt with in which of the following policy features?
A: Extensions of coverage
B: Benefits clause
C: Riders
D: Exclusions
Answer:
D: Exclusions
Question 2: 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
Answer:
B: At the inception of the policy
Question 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
Answer:
B: 20
Question 4: 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
Answer:
D: Contracts of Adhesion
Question 5: 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
Answer:
B: Disability Buy-Out
Question 6: 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 exlcusions 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
Answer:
C: keep the policy in the producer's office for safe-keeping on behalf of the client
Question 7: Which of the following statements is CORRECT about coinsurance?
A: It applies to deductibles as well as to claim payments.
B: It helps control overutilization of benefits.
C: It if effective for the first claim payment and waived for future claims.
D: Insurance companies may adjust the coinsurance ratio after issuing this policy.
Answer:
B: It helps control overutilization of benefits.
Question 8: Under a group health plan, an employer may offer additional benefits to classes of
employees on the basis of all of the following factors EXCEPT:
A: length of employment
B: gender
C: salary grade
D: job category
Answer:
B: gender
Question 9: 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 material misrepresentation on the application
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
Answer:
D: Adjust the benefits downward according to the benefits that X would have been entitled to based on the premiums Question 10: Medicare Supplement policies are primarily designed to:
A: offset the high cost of Medicare
B: provide additional retirement income to supplemental 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
Answer:
C: provide additional benefits beyond those provided by Medicare
Question 11: The PRIMARY purpose of Medicaid is to:
A: pay for expenses not covered by Medicare
B: provide Disability Income benefits to people on Medicare
C: provide Medical Expense coverage to persons meeting certain minimum income
requirements
D: provide funds for people injured in natural disasters
Answer:
C: provide Medical Expense coverage to persons meeting certain minimum income requirements
Question 12: 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
Answer:
D: Payment of Claims
Question 13: Which of the following laws requires an insurer to notify an applicant in writing that an investigative consumer report may be made on the applicant?
A: Uniform Provisions Law
B: Freedom of Information Act
C: Medical Information Bureau Disclosure Act
D: Fair Credit Reporting Act (Insurance Information and Privacy Protection Act
Answer:
D: Fair Credit Reporting Act (Insurance Information and Privacy Protection Act
Question 14: The Coordination of Benefits clause found in group health master contracts is
used to:
A: integrate Disability benefits with Major Medical benefits
B: avoid double payment of benefits to an insured who has duplicate group coverages
C: investigate the claims history of an insured
D: avoid duplicate claims to an employer for the same employee
Answer:
B: avoid double payment of benefits to an insured who has duplicate group coverages Question 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
Answer:
C: Residual disability
Question 16: A health care plan that reimburses a flat fee for medical care it provides at a clinic
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