LIFE HEALTH INSURANCE EXAM PREP

PDF Download LIFE & HEALTH INSURANCE EXAM PREP Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -100 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: Malingering

Answer:

Making the loss last longer than it has to.

Question 2: Miscellaneous Expense Benefits

Answer:

-Secondary benefits (inside benefits) because they occur inside the hospital for charges related to the stay. X-rays, prescriptions, MRI's, anesthesia and lab fees are usually separate fees incurred during a stay. Miscellaneous Expense Benefits have separate limits, referred to as Inside Limits. The are expressed usually as a multiple of the daily amount (UCR)

Question 3: LTC Coverage

Answer:

-At least12 consecutive months in the event the insured requires confinement in any care center environment, other than an acute unit of a hospital.

Question 4: Comprehensive major medical

Answer:

Major Medical and Basic Medical are written together.

Question 5: DI Insurability

Answer:

Only Disability Income Policies can be written as Guaranteed Renewable (G/R) and Non-Cancelable.

Question 6: Surgical Expense

Answer:

A schedule of procedures lists the amount allowable for each procedure. If a surgical procedure is not found in the schedule, it will still be payable. The amount payable for a procedure not listed is based on its relative value to a procedure of similar difficulty. There are usually no deductibles.

Question 7: Exclusions

Answer:

-War and Military Service -Intentionally self-inflicted injury, including attempted Suicide -Standard Aviation Exclusions -Losses occurring during the commission of a felony -Private Pilot Exclusions and Exclusions related to hazardous hobbies (sky diving, Race Car Driving etc.) -Pre-existing condition limitations -Impairment Riders (used to exclude specific named conditions from coverage)

Question 8: Disability Income Insurance

Answer:

-Designed to replace income lost due to a disability or illness of the insured wage earner. It never pays for the medical expenses; it only replaces lost income and must be paid no less frequently than monthly.Its to avoid Economic Death.-Can be group of individual policy

Question 9: Non-cancelable policy

Answer:

The premium may not be increased beyond what was originally expressed when the policy was issued.Graded premiums are usually used with this type of policy.

Question 10: Accidental bodily injury

Answer:

means the DAMAGE to the body is unexpected and unintended. A policy that uses the accidental bodily injury provision will provide more coverage than a policy that uses the accidental means provision.

Question 11: Custodial Care

Answer:

Provides assistance in areas such as eating, bathing and using bathroom facilities. These are not performed by medical personnel, but prescribed by a physician. These services can be performed in a nursing home or at the claimant's residence since it provides for the least severe cases.

Question 12: Disability Income (DI)

Answer:

Written specifically to cover accidents only or sickness only. These are usually short term policies designed to provide income on a per diem basis. Any policy that provides a flat dollar income benefit for each day of hospital confinement is referred to as a Hospital Indemnity Plan.

Question 13: LTC Benefit Period

Answer:

How long coverage applies after the Elimination Period (usually 30 or more days), in which the insured must be confined in a nursing home facility before benefits begins.-Benefit Period is usually 2 to 5 years

Question 14: Presumptive Disability

Answer:

Provision that is found in most DI policies which specifies the conditions that will automatically qualify the insured for full disability benefits. Some disability policies provide a benefit when people simply meet certain qualifications, regardless of their disability to work.

Question 15: Group Short Term Disability (STD)

Answer:

-Some Disability policies pay in conjunction with Workers Comp, such as STD -The benefit period for STD cannot be longer than 2 years.

Question 16: Stop Loss

Answer:

Max amount the insured is required to pay out of pocket: After the stop loss amount is reached by the insured, in a calendar year, the company will pay 100% of the remaining covered expenses.-calculated by adding both deductibles and coinsurance amounts.

Question 17: Sickness or illness

Answer:

Defined as either a sickness or disease contracted after the policy has been in force for at least 30 days, or a sickness or disease that first manifests itself after the policy is in force

Question 18: Taxation of LTC Premiums

Answer:

-Any premium paid by the employer is deductible as a business expenses.-Any premiums paid by the employee are only deductible to the extent that the employee's premiums, when added to all other un-reimbursed medical expenses, exceed 7.5% of the taxpayer's adjusted gross income, if the taxpayer itemizes deductions.

Question 19: Dread Dieses (Limited Risk)

Answer:

Policies provide a variety of benefits for a specific disease such as a cancer policy or a heart disease policy. Benefits are usually paid as a scheduled amount of indemnity for specified events or medical procedures, such as hospital confinement or chemotherapy.Question 20: Payment of AD&D Exceptions:

Answer:

-Be Purely Accidental -Occur within ninety days of the accident -Occur before the age of 70

Question 21: Short Term Vs Long Term

Answer:

benefit period of up to two years (24 months) are considered short term. Policies which have a Benefit Period of more than two years are considered long term.

Question 22: Morbidity Tables

Answer:

-Based on the law of large numbers.-Predict how many people are going to be disabled in a given year and the severity the disability.-Tables are important to an insurer because some insureds become more disabled than others.