WISCONSIN ACCIDENT AND HEALTH INSURANCE EXAM

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WISCONSIN ACCIDENT AND HEALTH INSURANCE EXAM

Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -99 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: Which of these is NOT a factor that influences group health insurance underwriting?Physical exams of group members Number of individuals in the group Group's claims experience Type of occupation group is involved in

Answer:

Physical exams of group members

Question 2: Presumptive total disability

Answer:

An insured currently has group coverage issued by different health insurance companies. How will payment for medical expenses typically be handled when both group policies provide coverage?The policy under which the individual was first insured will pay for the expenses.Payment will be made in accordance with the policies' coordination of benefits provisions.The insured will collect the full amount of expenses from each of the two insurers.Payment of expenses will be made in accordance with the policies' uniform provisions.

Question 3: The law of large numbers enables an insurer to

Predict losses Avoid adverse selection Classify rates Assure company profiles

Answer:

Predict losses

Question 4: A stock insurance company is owned by its

Officers Board directors Policyowners Shareholders

Answer:

Policyowners

Question 5: Higher total health plan costs for an employer

Answer:

Under the waiver of premium provision of a disability income policy, when does the insured resume paying premiums?At the end of the grace period At the end of the stated period in the policy, normally 90 days When the insured returns to work and is no longer disabled When the elimination period ends Question 6: Concurrent review is a form of utilization review that is performed: After the patient has recovered After hospital bills have been paid Before pre-certification of hospital admission During the course of the patient's treatment

Answer:

During the course of the patient's treatment

Question 7: Which of the following is Not an example of risk retention?

Becoming aware of a risk and taking no action Self-insuring a given risk Deciding a business deal is risky but going through with it anyways Not doing a business deal after deciding it would be too risky

Answer:

Not doing a business deal after deciding it would be too risky Question 8: Which of the following guidelines does NOT apply under the pregnancy provision of the Civil Rights Act?A pregnant woman is entitled to sick-leave under the same guidelines as any other type of disability Pregnancy must be covered under medical benefits the same as any other illness Post-termination extensions of medical benefits must apply equally to pregnancy Abortion complications are covered if the woman's life is in danger

Answer:

Post-termination extensions of medical benefits must apply equally to pregnancy

Question 9: Hobbies of the insured

Answer:

Which statement about group health insurance is true?The insurer's contract is with the organization sponsoring the group plan.The insurer issues a policy to each insured member in the group.A medical questionnaire is required of each individual to be covered by the contract.Group policies are more expensive than individual policies because they provide broader benefits.Question 10: An insured is entitled to coverage under a policy that a prudent person would expect it to provide. This principle is called Adhesion Reasonable sensibility Reasonable expectations Insurable interest

Answer:

Reasonable expectations Question 11: Ambiguities in insurance contracts are typically interpreted in favor of the insured.This rule is referred to as Subrogation Reasonable expectations Insurable interest Adhesion

Answer:

Reasonable expectations Question 12: XYZ Insurance Company gives direct authority to its producers to sell insurance through an agency contract, but nothing is stated regarding the collection of premiums. Which authority grants the producer the right to collect premiums?Implied authority Apparent authority Express authority Assumed authority

Answer:

Implied authority

Question 13: A certificate of coverage for a group health policy is best described as A contract between the employer and employee A contract between the employer and insurer Proof of coverage for the employee Proof of coverage for the employer

Answer:

Proof of coverage for the employee Question 14: Payment will be made in accordance with the policies' coordination of benefits provisions.

Answer:

In health insurance, initial notice about a potential claim:

May be required within a short time period Usually results in rejection of the claim Is sent to the attending physician's office Must be submitted by the provider of services Question 15: The insurer's contract is with the organization sponsoring the group plan.

Answer:

Periodontics includes all of the following EXCEPT:

Bone surgery Guided tissue regeneration Gum disease treatment Dentures

Question 16: Dividends from a mutual insurance company are paid to whom?

Policyholders Beneficiaries Preferred stockholders Stockholders

Answer:

Policyholders Question 17: Which of these is true regarding the exchange of consideration among parties involved in an insurance contract?Required to be in currency Must be equal Can be unequal Must be certified by the state where transaction takes place

Answer: