WorksheetsInsurance Quiz 5
Total questions: 21
Worksheet time: 11mins
G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the Intoxicants and Narcotics exclusion in G’s policy, who is responsible for paying the medical bills?
The reinsurer
The insured
The insurer
The Guaranty Association
Select the appropriate response: Which of the following health insurance policy provisions specifies the health care services a policy will provide?
Insuring clause
Usual, Customary, and Reasonable clause
Consideration clause
Benefit clause
A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of application. How will the insurer handle this claim?
Claim will be paid and coverage will remain in force
Claim will be denied and coverage will remain in force
Claim will be denied and coverage will be cancelled
Claim will be denied, the coverage cancelled, and all premiums paid will be refunded
When does a Probationary Period provision become effective in a health insurance contract?
At the policy's inception
30 days after the policy's inception
When a claim is submitted
When a covered loss occurs
Agent J takes an application and initial premium from an applicant and sends the application and premium check to the insurance company. The insurance company returns the check back to J because the check is made out to J instead of the insurance company. What action should J take? Select the appropriate response.
Deposit the applicant's check into his account and make a personal check out to the insurance company from his personal account
Return to the customer, collect a new check made out to the insurance company, and send the new check out to the insurance company
Cross off his name on the 'pay to' portion of the check, write the name of the insurance company, and send the check back to the insurance company
Deposit the check in to his personal account, use the funds to purchase a cashiers check, and send the new cashiers check back to the insurance company
Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy?
Issue the policy with a diabetes exclusion
Issue the policy with an altered Time of Payment of Claims provision
Issue the policy with a rating
Decline the applicant
Which of the following correctly explains the actions an agent should take if a customer wants to apply for an insurance policy?
Have the customer sign a blank application, then take the application back to his office to complete prior to sending it off to the insurance company
Complete the application over the phone with the customer, sign the application for the customer, then send the application off to the insurance company
Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company
Have the customer fill out the application and send it to his office for him to sign, then send it off to the insurance company
T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable? Select the appropriate response.
Benefits are taxable to T
Benefits are tax-free to T
Benefits are partially taxable to T
Benefits are taxable to T's employer
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
Agent's report
MIB report
Inspection report
Attending physician's report
A prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take?
Send the initial premium back to the applicant
Send a notice to the applicant that the coverage was declined
Send a notice to the MIB that the applicant was declined
Send a notice to the agent that the applicant was declined
Which of the following BEST describes how pre-admission certification is used?
Used to assist in underwriting
Used to prevent nonessential medical costs
Used to minimize hospital lawsuits
Used to help process claims
Which of the following are NOT managed care organizations?
Point-of-Service plan (POS)
Preferred Provider Organization (PPO)
Medical Information Bureau (MIB)
Health Maintenance Organization (HMO)
Pre-hospitalization authorization is considered an example of:
managed care
PPO care
Medicaid
Major Medical insurance
Which of the following statements about the classification of applicants is INCORRECT?
Substandard applicants are never declined by underwriters
Substandard applicants are occasionally declined by underwriters
Preferred risk applicants typically have better premium rates than standard risk applicants
An applicant can be classified as substandard risk because of a hazardous job
Which type of plan normally includes hospice benefits?
Short-term disability plans
Group life plans
Workers' Compensation
Managed care plans
Select the appropriate response: An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to:
issue the policy only when the initial premium check has cleared
determine if the applicant is insurable by investigating family health history
issue the policy on a standard basis
determine if the applicant is an acceptable risk by completing standard underwriting procedures
P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?
$20,000
$14,000
$6,000
$0
Which mode of payment is NOT used by health insurance policies?
Monthly premium
Annual premium
Single premium
Semi-annual premium
When an insured changes to a more hazardous occupation, which disability policy provision allows an insurer to adjust policy benefits and rates?
Relation of earnings to insurance provision
Change of occupation provision
Conformity of state statutes provision
Entire contract provisions
Which of the following statements about a Guaranteed Renewable Health Insurance policy is CORRECT?
Premiums normally decrease at time of renewal
Premiums normally increase at time of renewal
Policy can be renewed at any time by the company
Policy can be cancelled at any time by the company
an insurance company receives E's application for an individual health policy E did not complete all of the medical history questions because she could not remember the exact dates E signed the policy and submitted it to the insurance company anyway a few weeks later E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium E is not insured which of the following causes the conditions that E did not meet
entire contract clause
MIB clause
insuring clause
Consideration clause
