excel - pdf

Which of the following reimburses its insureds for covered medical expenses?

Health maintenance organizations

Preferred provider organizations

Commercial insurers

Service providers

Commercial insurers

The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the

Grace Period

Waiting Period

Postponement Period

Elimination Period

Waiting Period

Which of the following statements is NOT CORRECT about the Commissioner of Insurance?

The Commissioner must be elected in a general election

The Commissioner is authorized to conduct the activities of the Texas Department of Insurance (TDI)

The Commissioner may be a former employee of the Texas Department of Insurance (TDI)

The Commissioner must serve as chief executive and administrator officer of the Texas Department of Insurance

The Commissioner must be elected in a general election

The automatic premium loan provision is designed to

provide a source of revenue to the insurance company

avoid a policy lapse

allow a policyowner to request a policy loan

allow a policyowner to take out additional coverage without evidence of insurability

Avoid a policy lapse

T and S are named co-primary beneficiaries on a $500,000 Accidental Death and Dismemberment policy insuring their father. Their mother was named contingent beneficiary. Five years later, S dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother receive?

$1,000,000

$500,000

$250,000

$0

The mother receives $0 because T is still alive and the sole primary beneficiary, while the mother is still the contingent beneficiary.

According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?

Annually

Semiannually

Quarterly

Monthly

Monthly

In Texas, a domestic insurance company is defined as a company that

employs Texas residents agents only

maintains a full service branch office in Texas

is incorporated and formed in Texas

is licensed to issue Homeowners policies only

is incorporated and formed in Texas

A life insurance illustration is NOT required to include the

name of the insurer

underwriting or rating classification upon which the illustration is based initial death benefit

company's mortality table

company's mortality table

A Health Maintenance Organization (HMO) may issue an Evidence of Coverage form after it has been approved by the

State Board of Health

HMO's Board of Directors

Commissioner of Insurance State

HMO Association

Commissioner of Insurance

E and F are business partners. Each takes out a $500,000 life insurance policy on the other, naming himself as primary beneficiary. E and F eventually terminate their business, and four months later E dies. Although E was married with three children at the time of death, the primary beneficiary is still F. However, an insurable interest no longer exists. Where will the s from E's life insurance policy be directed to?

F

The dissolved partnership

E's family

E's estate

F

Which Long Term Care insurance statement is true?

Inflation protection is usually not offered

Benefits are usually payable for alcohol rehabilitation

Can only be offered to individuals under the age of 70

Pre-existing conditions must be covered after the coverage has been in force for six months

Pre-existing conditions must be covered after the coverage has been in force for six months

If an individual has an Accidental Death and Dismemberment policy and dies, an autopsy can be performed in all these situations EXCEPT

When the cause of death is unknown

When the state prohibits this by law

When consent for the autopsy is not obtained

When foul play was a contributing factor

When the state prohibits this by law

A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered EXCEPT for

hospital charges

physician fees

experimental and investigative services

nursing services

experimental and investigative services

After the initial enrollment period, an HMO must hold an open enrollment period of how many days at LEAST once in every 12-month period?

15

31

45

90

31

F needs life insurance that provides coverage for only a limited amount of time with a death benefit that changes regularly according to a schedule. What kind of policy is needed?

Level term policy

Whole life policy

Limited-pay policy

Decreasing term policy

Decreasing term policy

J would like to maintain the right to change beneficiaries. Which beneficiary designation should be used?

Irrevocable

Contingent

Primary

Revocable

Revocable

What is the underlying concept regarding level premiums?

Level premiums build cash value quicker in the early years

The early years are charged more than what is needed

The early years are charged less than what is needed

Level premiums can only be paid annually

The early years are charged more than what is needed

If an insured sustains a loss on a policy sold by an agent through an insurance company that is not authorized to do business in Texas, which of the following would be liable?

The agent only

The company only

The agent and the company

The Life, Accident, Health and Hospital Insurance Guaranty Association

The agent and the company

A Disability Income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insurer may cover the second disability without a new elimination period under the

Residual Disability provision

Presumptive Disability provision

Recurrent Disability provision

Partial Disability provision

Recurrent Disability provision

Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party?

Indemnity

Subrogation

Legal action

Consideration

Subrogation

An organization that solicits insurance only among its members is known as a

specific order

specialized company

limited insurance company

fraternal benefit society

fraternal benefit society

Insurance policies offered on a "take it or leave it" basis are considered what?

Conditional Contracts

Aleatory Contracts

Unilateral Contracts

Contracts of Adhesion

Contracts of Adhesion

With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period?

Gives the policyowner additional time to pay past due premiums

Gives the policyowner additional time to file a lawsuit

Gives the policyowner additional time to file a claim

Gives the policyowner additional time to provide proof of loss

Gives the policyowner additional time to pay past due premiums

Group life policies MUST include all of the following provisions EXCEPT

Ownership

Beneficiary Designation

Conversion Privilege

Right to Loans

Right to Loans

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

Claim will be paid and coverage will remain in force

Which statement regarding the Change of Beneficiary provision is true?

The beneficiary can only be changed with the consent of the insurer

The policyowner can change the beneficiary

The insured can change the beneficiary

A beneficiary change is subject to underwriting procedures

The policyowner can change the beneficiary

A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013?

$500

$1,000

$1,500

$2,000

$1,000

Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?

Employer funds the HRA entirely

HRA's can be offered with other health plans

HRA's allow reimbursement for eligible medical expenses

Employee funds the HRA entirely

Which plan is intended to be used by a sole proprietor and the employees of that business?

SEP Plan

Keogh Plan

Individual Retirement Account (IRA)

SIMPLE Plan

Keogh Plan

Upon delivery of a rated life insurance policy, the Producer must obtain each of the following EXCEPT

Signed HIPAA disclosure

Signed amendment

Signed statement of Good Health

The required premium

Signed HIPAA disclosure

What is the purpose of the U.S.A. Patriot Act?

detect and deter fraud

detect and deter alien insurance companies

detect and deter terrorism

detect and deter misrepresentations

detect and deter terrorism

All of these are considered sources of underwriting information about an applicant EXCEPT

Inspection Report

Credit Report

Rating Services

Medical Information Bureau

Rating Services

A newly licensed General Lines agent must complete a MINIMUM of how many hours of continuing education within 24 months after initial license?

10

15

20

24

24 hours

M completes an application for life insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect EXCEPT

policy is delivered

free-look period has expired

insurance company issues policy

initial premium is collected

free-look period has expired

All of these statements about Equity Indexed Life Insurance are correct EXCEPT

Cash value has a minimum rate of accumulation

If the gain on the index goes beyond the policy's minimum rate of return, the cash value will mirror that of the index

The premiums can be lowered or raised, based on investment performance

Tied to an equity index such as the S&P 500