SS- Georgia accident and sickness

78 flash cards

1.     Which type of policy is designed to cover business expenses during a key employee's disability?
A. Individual Disability Income
B. Key Employee Policy
C. Business Overhead Expense
D. Disability Buy-Sell Agreement

c. Business Overhead Expense

2.       A Business Disability Buyout policy is typically purchased to:
A. Replace income lost by an employee’s disability
B. Cover medical expenses for employees
C. Fund a buy-sell agreement in case an owner becomes disabled
D. Pay key employees extra income

C. Fund a buy-sell agreement in case an owner becomes disabled

3.       Which policy provides a lump-sum benefit for loss of sight or accidental death?
A. Disability Income Insurance
B. Medicare Supplement
C. Accidental Death and Dismemberment
D. Major Medical

C. Accidental Death and Dismemberment

4.     What distinguishes a Basic Medical Expense Policy?
A. Covers only dental expenses
B. Offers high coverage limits
C. Low coverage limits and no deductible
D. Requires enrollment in Medicare

C. Low coverage limits and often no deductible, providing coverage for essential medical services such as hospital stays and physician visits.

5.     Major Medical policies are different from Basic policies in that they:
A. Are always issued by HMOs
B. Offer broader coverage with high limits
C. Are only available through employers
D. Do not cover surgical costs

B. Offer broader coverage with high limits, often including a variety of medical services beyond basic care.

6.     What is the primary purpose of an HMO?
A. Reimburse expenses
B. Pay for all services out of pocket
C. Offer managed care with an emphasis on prevention
D. Provide indemnity-style reimbursement

C. Offer managed care with an emphasis on prevention, focusing on health maintenance and reducing costs through preventive care.

7.     PPOs differ from HMOs because:
A. PPOs require a primary care physician referral
B. PPOs do not allow out-of-network coverage
C. PPOs offer greater flexibility in choosing providers
D. PPOs are government funded

C. PPOs offer greater flexibility in choosing providers, allowing members to see specialists without referrals and accessing a wider network of healthcare professionals.

8. A Point of Service (POS) plan is:
   A. A type of HMO that doesn't use a network
   B. A hybrid between HMO and PPO
   C. A short-term plan
   D. Only available to those on Medicare

B. A hybrid between HMO and PPO, allowing members to choose between receiving care within a network or out-of-network at a higher cost.

9.     What is an FSA used for?
A. Buying long-term care insurance
B. Paying qualified medical expenses with pre-tax dollars
C. Covering dental premiums only
D. Investing in retirement plans

B. An FSA, or Flexible Spending Account, is used for paying qualified medical expenses with pre-tax dollars, allowing individuals to save on taxes while covering various healthcare costs.

10.     A High Deductible Health Plan must be paired with what to receive tax advantages?
A. PPO
B. Medicare
C. HSA
D. FSA

C. A Health Savings Account (HSA) is required to receive tax advantages when paired with a High Deductible Health Plan, allowing individuals to save for qualified medical expenses.

HRAs are funded by:
A. The employee
B. Medicare
C. The employer
D. Medicaid

C. The employer is responsible for funding Health Reimbursement Arrangements (HRAs), which are designed to reimburse employees for qualified medical expenses.

12.       A Medicare Supplement policy is also known as:
A. Part B
B. Medigap
C. Medicaid
D. Advantage Plan

B. A Medicare Supplement policy, commonly referred to as Medigap, is designed to cover additional healthcare costs that Original Medicare does not pay, such as copayments and deductibles.

13.     What does COBRA allow?
A. Permanent Medicare coverage
B. Coverage for employees with cancer
C. Continued group coverage after job loss
D. Free health care for children

C. The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees to continue their group health insurance coverage for a limited time after losing their job or experiencing other qualifying events.

14.       A contributory group health plan requires:
A. No employee contributions
B. The employer to pay 100%
C. Employees to contribute to premiums
D. No underwriting

C. A contributory group health plan requires that employees contribute to premiums, which can lower the overall cost for employers while providing coverage.

     What is a key requirement for Long-Term Care Insurance eligibility?
A. Must be under age 30
B. Must be on Medicaid
C. Must be unable to perform 2 or more ADLs
D. Must have had cancer

C. A key requirement for Long-Term Care Insurance eligibility is that the individual must be unable to perform 2 or more Activities of Daily Living (ADLs), such as bathing, dressing, or eating.

Which of the following provides indemnity benefits for a fixed dollar amount per day?
A. Cancer insurance
B. Hospital indemnity plan
C. HMO
D. Major medical

B. A hospital indemnity plan provides indemnity benefits for a fixed dollar amount per day for hospital stays or other medical services.

Which is NOT considered a specified disease policy?
A. Critical illness insurance
B. Dental
C. Cancer insurance
D. Heart attack policy

B. Dental insurance is not considered a specified disease policy, as it primarily covers dental care rather than specific illnesses or diseases.

Short-term medical policies are typically:
A. Permanent coverage
B. Employer-funded only
C. Temporary coverage for gaps in insurance
D. Medicare-based

C. Temporary coverage for gaps in insurance, designed to bridge periods when an individual is without health insurance.

19. What does the entire contract provision in a health policy state?
    A. The insurer can change terms at any time
    B. Only the agent can amend the policy
    C. The policy, application, and endorsements make up the contract
    D. The agent’s verbal promises are binding

C. The entire contract provision in a health policy states that the policy, application, and endorsements make up the contract, ensuring that all terms are documented and agreed upon.

The Time Limit on Certain Defenses provision is similar to:
A. Free look
B. Grace period
C. Incontestability
D. Probationary period

C. Incontestability, which prevents insurers from denying claims based on misstatements after a specified period, usually two years.

  The grace period in a health policy refers to:
A. Time allowed for payment after the due date without lapse
B. Time for beneficiary to file a claim
C. Time for agent to deliver the policy
D. Time the insured is ineligible for benefits

A. Time allowed for payment after the due date without lapse, ensuring the policy remains in force during this period.

Which provision allows a policyholder to reinstate a lapsed policy after non-payment?
A. Notice of claim
B. Reinstatement
C. Consideration
D. Waiver of premium

B. The reinstatement provision allows a policyholder to reinstate a lapsed policy after non-payment, often requiring evidence of insurability and payment of past due premiums.

What must the insured do to initiate the claims process?
A. Submit proof of loss within 30 days
B. Notify their employer
C. Submit a reinstatement application
D. Provide notice of claim within the time required by the policy

D. Provide notice of claim within the time required by the policy, which ensures that the insurer is informed timely about the incident leading to the claim.

  If the insurer does not provide claim forms within the specified time:
A. The claim is void
B. The insured must write a statement of claim in any form
C. The insured forfeits coverage
D. The state insurance department will pay

B. The insured must write a statement of claim in any form, ensuring that the insurer can still process the claim despite the absence of official forms.

25.  What is the standard time limit to provide proof of loss?
A. 10 days
B. 20 days
C. 60 days
D. 90 days

D. 90 days

26.  Under the payment of claims provision, claims for medical expenses are usually paid to:
A. The insured
B. The physician or hospital
C. The agent
D. The insurer

B. The physician or hospital, as they are typically the parties directly responsible for providing medical care and services.

27.  Which provision allows the insurer to request an autopsy?
A. Physical exam and autopsy
B. Proof of loss
C. Legal actions
D. Waiver of premium

A. Physical exam and autopsy, which enables the insurer to verify the cause of death or injury when necessary for claim assessment.

28.  The legal actions provision states a claim cannot be pursued legally until:
A. 30 days after the date of loss
B. 60 days after proof of loss
C. After one year
D. After policy delivery

B. 60 days after proof of loss, which gives the insurer time to properly review the claim before any legal action can be taken.

29.  What happens if the insured misstated their age on the application?
A. Coverage is voided
B. Premiums are refunded
C. Benefits are adjusted
D. Insurer pays interest

C. Benefits are adjusted, meaning that the insurer will alter the policy benefits based on the correct age of the insured.

30.  What is the purpose of the change of occupation provision?
A. To allow coverage for hobbies
B. To avoid overinsurance for riskier jobs
C. To reduce copays
D. To extend coverage beyond age 65

B. To avoid overinsurance for riskier jobs, which ensures that policy benefits align with the level of risk associated with the insured's occupation.

31.  The illegal occupation provision means the insurer can:
A. Increase premiums
B. Deny claims from illegal activity
C. Change the contract
D. Report to the IRS

B. Deny claims from illegal activity, meaning the insurer is not liable for any claims resulting from such activities.

32.  A waiver of premium rider:
A. Pays benefits when the insured becomes unemployed
B. Cancels future premiums when the insured is disabled
C. Waives taxes on proceeds
D. Ends the policy early

B. Cancels future premiums when the insured is disabled, ensuring that the policy remains in force without the financial burden of premium payments during a period of disability.

33.  What does a guaranteed insurability rider allow?
A. Increase benefits without evidence of insurability
B. Cancel the policy at any time
C. File a claim early
D. Pay lower premiums automatically

A. Increase benefits without evidence of insurability, allowing the insured to obtain additional coverage without undergoing medical underwriting.

34. Medicare Part A primarily covers:
    A. Outpatient care
    B. Physician services
    C. Prescription drugs
    D. Hospitalization

D. Hospitalization, providing coverage for inpatient stays, including costs associated with a patient's room, nursing care, and meals during their hospital stay.

35. Medicare Part B covers which of the following?
    A. Private hospital room
    B. Dental and vision
    C. Doctor visits and outpatient services
    D. Prescription drugs

C. Doctor visits and outpatient services, offering coverage for physician services, preventive care, and various outpatient treatments.

36. What is Medicare Part C also known as?
    A. Medicaid
    B. Medigap
    C. Advantage Plans
    D. Long-Term Care

C. Advantage Plans, which offer an alternative way to receive Medicare benefits through private insurance companies that contract with Medicare.

37. What is the main purpose of Medicare Part D?
    A. Preventative care
    B. Prescription drug coverage
    C. Home healthcare
    D. Skilled nursing facilities

B. Prescription drug coverage, designed to help Medicare beneficiaries pay for prescription medications and related costs.

38. Which of the following is not true about Medicaid?
    A. It is funded jointly by state and federal governments
    B. It is available to those age 65+ regardless of income
    C. It covers long-term care for eligible low-income individuals
    D. Eligibility is based on income and assets

B. It is available to those age 65+ regardless of income, as Medicaid primarily assists low-income individuals and families, regardless of age.

39. Social Security Disability Benefits require the disability to:
    A. Be caused by a work-related injury
    B. Be expected to last at least 12 months or result in death
    C. Be temporary in nature
    D. Be treated by a specific physician.

B. Be expected to last at least 12 months or result in death, which is a requirement to qualify for Social Security Disability Benefits.

40. A residual disability benefit is paid when the insured:
    A. Is totally disabled
    B. Has returned to work but with reduced earnings
    C. Dies from their injury
    D. Cannot perform any work ever again

B. Has returned to work but with reduced earnings; this benefit provides financial support to individuals who are partially disabled but still able to engage in some form of employment.

41. Who has ownership rights in a health insurance policy?
    A. The insured
    B. The beneficiary
    C. The applicant
    D. The policy-owner

D. The policy-owner has the ownership rights in a health insurance policy, allowing them to make changes and decisions regarding the policy.

42. Which of the following is a qualified dependent for health coverage?
    A. A live-in partner
    B. A child over age 30
    C. A 24-year-old full-time student
    D. A co-worker

C. A 24-year-old full-time student; qualified dependents for health coverage typically include children who are full-time students and under a certain age.

43. What is the role of the primary beneficiary?
    A. Pays the premiums
    B. Receives the benefits upon the insured’s death
    C. Delivers the policy
    D. Files tax forms

B. Receives the benefits upon the insured’s death; the primary beneficiary is designated to receive the death benefit from a life insurance policy.

44. What is the purpose of coordination of benefits?
    A. To increase out-of-pocket costs
    B. To avoid duplicate payments from multiple policies
    C. To allow early retirement
    D. To eliminate deductibles

B. to avoid duplicate payments from multiple policies

45. The difference between occupational and nonoccupational coverage is:
    A. Who pays the premium
    B. Whether coverage includes work-related injuries
    C. Whether the coverage is temporary
    D. If the coverage includes life insurance

B. Whether coverage includes work-related injuries

46. What is the first step in the field underwriting process?
    A. Collecting the premium
    B. Completing the application
    C. Submitting to underwriting
    D. Delivering the policy

B. Completing the application

47. If an applicant makes an error on the application, the agent should:
    A. White it out and correct it
    B. Start a new application
    C. Have the applicant initial the change
    D. Sign the change themselves

C. Have the applicant initial the change

48. The HIPAA Privacy Rule protects:
    A. Agent’s licensing rights
    B. Insurer’s pricing
    C. Personal health information
    D. Tax documents

C. personal health information

49. What does the MIB (Medical Information Bureau) do?
    A. Approves claims
    B. Maintains health info on applicants for member companies
    C. Pays disability benefits
    D. Provides Medicare coverage

B. Maintains health info on applicants for member companies

50. If the premium is not collected with the application:
    A. The policy is void
    B. No underwriting is needed
    C. The agent must collect it upon delivery
    D. The insurer cannot issue a policy

c. The agent must collect it upon delivery

51. A conditional receipt means:
    A. Coverage begins once premium is paid and conditions are met
    B. The policy is guaranteed
    C. The agent accepts liability
    D. The policyholder has 30 days to cancel

A. Coverage begins once premium is paid and conditions are met

52. When an agent delivers a policy, they must also:
    A. Leave immediately
    B. Explain policy provisions, riders, and ratings
    C. Collect tax ID info
    D. Re-underwrite the applicant

B. Explain policy provisions, riders, and ratings

53. A contract must contain all of the following except:
    A. Consideration
    B. Legal purpose
    C. Competent parties
    D. A notary public

D. A notary public

54. Who enforces insurance laws in Georgia?
    A. The Governor
    B. State Attorney General
    C. Commissioner of Insurance
    D. Federal Insurance Office

C. Commissioner of Insurance

55. The Commissioner of Insurance is elected for a term of:
    A. 2 years
    B. 4 years
    C. 6 years
    D. Appointed indefinitely

B. 4 years

56. The Commissioner’s power to examine records applies to:
    A. All licensed producers and insurers
    B. Federal agencies only
    C. Group policyholders
    D. Adjusters only

A. All licensed producers and insurers

57. An insurer found violating Georgia law can be penalized by:
    A. Fines, license revocation, or imprisonment
    B. A refund of premiums only
    C. A tax audit
    D. Automatic cancellation

A. Fines, license revocation, or imprisonment

58. A domestic insurer is one:
    A. Based outside the U.S.
    B. Operating only online
    C. Formed under Georgia law
    D. Licensed in any state

c. Formed under Georgia law

59. An alien insurer is:
    A. From another U.S. state
    B. A surplus lines broker
    C. Formed under laws of another country
    D. Unlicensed in Georgia

C. Formed under laws of another country

60. A certificate of authority gives an insurer:
    A. Permission to sell policies in another country
    B. Licensing to operate in the state
    C. Power to sell annuities only
    D. A guarantee fund

B. Licensing to operate in the state

61. A licensed agent is allowed to:
    A. Issue policies directly
    B. Appoint other agents
    C. Transact insurance on behalf of an insurer
    D. Set premium rates

c. transact insurance on behalf of an insurer

62. Which of the following would NOT be considered transacting insurance?
    A. Selling a policy
    B. Negotiating a claim
    C. Collecting premiums
    D. Shopping for personal coverage

D. Shopping for personal coverage

63. What is controlled business?
    A. Selling insurance only online
    B. Insuring mostly relatives and business associates
    C. Group insurance plans
    D. Out-of-state underwriting

B. Insuring mostly relatives and business associates

64. Rebating refers to:
    A. Refunding unused premiums
    B. Sharing commissions with another agent
    C. Offering a client part of your commission as an incentive to buy
    D. Charging reduced rates

c. offering a client part of your commission as an incentive to buy

65. Which of the following is defamation in insurance?
    A. Comparing prices
    B. Publishing false statements about another insurer
    C. Misquoting coverage
    D. Explaining a competitor's policy

B. Publishing false statements about another insurer

66. Twisting and churning both involve:
    A. Improperly replacing policies
    B. Proper policy upgrades
    C. Refunding client payments
    D. Canceling group plans

A. Improperly replacing policies

67. It is unfair discrimination to base rates on:
    A. Medical history
    B. Gender
    C. Occupation
    D. Race or religion

D. Race or religion

68. Misrepresentation is:
    A. A required sales technique
    B. Giving false information about a policy’s terms
    C. A type of premium payment
    D. An accidental underpayment

B. Giving false information about a policy’s terms

69. Fiduciary responsibility means an agent must:
    A. Reinvest client funds
    B. Deposit premium funds in a personal account
    C. Keep client funds separate and account for them
    D. Adjust claims immediately

C. Keep client funds separate and account for them

70. Commingling occurs when an agent:
    A. Mixes their own money with a client’s premium
    B. Pays bills with agency funds
    C. Refers to multiple insurers
    D. Sells two types of coverage

A. Mixes their own money with a client’s premium

71. The Georgia Life and Health Insurance Guaranty Association protects:
    A. Employers from lawsuits
    B. Policyholders if an insurer becomes insolvent
    C. Agents from errors and omissions
    D. Only Medicare recipients

B. Policyholders if an insurer becomes insolvent

72. Which license is required to give advice for a fee in Georgia?
    A. Adjuster license
    B. Producer license
    C. Counselor license
    D. Temporary license

C. Counselor license

73. Georgia law requires individual accident and sickness policies to:
    A. Be renewable only by the insurer
    B. Include a 30-day free look
    C. Clearly define benefits and limitations
    D. Be sold only through employers

C. Clearly define benefits and limitations

74. Which regulation governs group accident and sickness insurance in Georgia?
    A. Reg. 120-2-8
    B. Reg. 33-3-1
    C. Reg. 100-2-10 through 12
    D. Reg. 33-14-2

C. Reg. 100-2-10 through 12

75. What must be disclosed in a Medicare Supplement policy?
    A. Coinsurance caps
    B. That it is not part of Medicare
    C. Cost-sharing with Medicaid
    D. Premium refund options

B. That it is not part of medicare

76. A Medicare Supplement policy cannot:
    A. Include preexisting condition exclusions
    B. Duplicate existing Medicare coverage
    C. Be canceled for health reasons
    D. Cover hospital room charges

B. duplicate existing medicare coverage

77. Long Term Care policies in Georgia must include:
    A. Coverage for cosmetic surgery
    B. Benefits for only skilled nursing care
    C. A 30-day free look period
    D. Prescription drug coverage

C. 30-day free look period

78. Georgia’s LTC Partnership Program allows:
    A. An agent to underwrite policies independently
    B. Individuals to protect assets if they apply for Medicaid
    C. Group plans to be funded by Medicare
    D. Employers to purchase LTC plans for free

B. Individuals to protect assets if they apply for Medicaid