health q's Flashcards
(198 cards)
1
Q
Which situations would NOT potentially involve a prison sentence under federal law?
A
Selling insurance with a nonresidential license
2
Q
Every agent licensed in New York must notify the Superintendent within ____ days of any change of address
A
30 days
3
Q
Janice forgot to make her insurance premium payment by the due date. The specified period after the due date where she can still make payment and avoid discontinuance of her coverage is called the:
A
Grace Period
4
Q
What is an example of an agent’s fiduciary duty?
A
Collecting premiums and remitting them to the insurer
5
Q
In New York, an insurance agent cannot sell, solicit, or negotiate policies for an insurer unless there is an agreement in place between the agent and the insurer. This agreement is called a(n)
A
Appointment. [Before a licensed agent can legally transact insurance sales, they must first be appointed by an insurance company.]
6
Q
The superintendent MUST give a MINIMUM of how many days notice of a disciplinary hearing?
A
10 days
7
Q
The identity of the ____ must be made clear in every health insurance advertisement
A
Insurer- in all advertisements for health insurance, it should be made clear the identity of the insurer
8
Q
The right to examine period is ____ days for all long-term care policies solid in New York
A
30 days
9
Q
Security laws passed by congress are enforced by which federal agency?
A
Security and Exchange Commission
10
Q
As classified by the Affordable Care Act (ACA) a silver plan offers
A
70% actuarial level of coverage provided
11
Q
In New York, a long term care policy must be _____ renewable
A
Guaranteed renewable
12
Q
An agents license may only be suspended or revoked if the agent
A
Has been afforded a right to a hearing
13
Q
Who is required to notify the agent in the event of appointment termination?
A
Insurer
14
Q
If an agent is believed to be causing considerable harm, the superintendent
A
May issue a cease and desist order against the agent
15
Q
Which of the following provides affordable health insurance coverage to small employers?
A
Healthy New York Program
16
Q
What is required for an insurer to conduct business in this state?
A
Certificate of Authority
17
Q
If the cause of death appears to be accidental, an insurer may require an
A
Autopsy
18
Q
As of January 1st, 2014, an employer with up to 25 full time equivalent (FTEs) with average annual wages of less than $50,000 may be eligible for a tax credit of _____ of the premiums paid by the employers
A
50%
19
Q
According to the affordable care act, any plan in existence prior to which date is considered a grandfather plan?
A
March 23, 2010
20
Q
An example of misrepresentation is
A
Providing incorrect, misleading, incomplete, or materially untrue information in the license applicationAl
21
Q
All agents shall maintain full and correct transaction records of the business done by them for a period of at least
A
6 years
22
Q
An insurance consultant is BEST defined as a(n)
A
An insurance agent who charges fees for advice
23
Q
There’s many things that are a violation of the federal fraud and false statements act, but NOT
A
Claims reimbursement
24
Q
Which of the following is NOT covered by New York workers compensation laws?
A
On the job injury that was both intentional and self inflicted
25
What's a TRUE statement regarding the Fair Credit Reporting Act?
An insurer does NOT need to discuss any credit history, inconsistencies with the applicant
26
What would NOT be an eligible dependent on an Accident and Health Policy?
A 27 year old married child (would NOT be an eligible dependent)
27
Maria the insurance agent completes a sale by collecting the required signatures on the application and obtaining the initial premium. Afterwards, she deposits the check into her personal checking account. What crime has she committed?
Fraud.
28
The _____ is responsible for determining the appropriateness of a medicare supplement policy for an applicant
Agent
29
A common exclusion or limitation on a dental policy is
Endodontics (Endodontics is the branch of dentistry concerning dental pulp and tissues surrounding the roots of a tooth. Endodontic treatment, or root canal treatment, treats the soft pulp tissue inside the tooth.)
30
Long-term care policies solid in New York may exclude coverage related to
Substance addictions
31
The required grace period for an accident and health policy is ____ days for weekly premium policies
7 days
32
Jermaine's individual health policy had recently lapsed upon reinstatement, he must wait ____ days before coverage for illness is available
10 days
33
With a scheduled dental policy, how are covered expenses paid?
Benefits are limited to a specific maximum dollar amount per procedure
34
Insurance agent Kelly offers a prospect a $1,000 shopping card if an insurance policy is purchased through her. What illegal activity is this an example of?
Rebating (offering valuable consideration or inducement to a prospective insured that is not specified in the contract)
35
An alien insurer
Is an insurer operating in the US but headquartered outside the US
36
According to the affordable care act, what metal tier is required to have an actuarial value of 70%, with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features?
Silver. (Bronze- 60/40, Gold-80/20, Platinum 90/10)
37
A hospital or medical expense policy will typically cover dental treatment expenses under which circumstance
Dental treatment is needed to repair an injury
38
In most dental plans, a deductible typically is NOT applied to
Preventative and diagnostic services
39
In New York, an agent may have his or her license revoked for what act?
Failure to pay state income tax
40
Within ____ days after policy delivery, both medicare supplement and long-term care policies can be returned for a 100% premium or refund
30 days
41
An insurer is REQUIRED to offer which of the following to each long term care applicant at the time of purchase?
Inflation protection
42
Violations of US Code Title 18 section 1033 may result in
A fine of up to $50,000 per violation and/or incarceration of up to a maximum of 15 years
43
The renewability provision for an individual long term care insurance policy must be located on the policy form's
First page
44
An agent's commission for the sale of a Medicare supplement policy in the first year following its effective date cannot exceed ____ of the commission paid for selling or servicing the policy in the second year.
200%
45
Long term care insurance provides
One or more diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital
46
A(n) ___ company is owned by its shareholders
A stock insurance company
47
Which of these is NOT a characteristic of a Fraternal Benefit Society
Existing for profit
48
Twisting is defined in the context of medical insurance as
Replacing an insurance policy from one insurer to another based on misrepresentation
49
What is NOT considered to be an act of fraud?
Collecting a charge for insurance that is less than the charge that is applicable to that insurance
50
What are the levels of coverage as defined by the Affordable Care Act (ACA)?
Bronze, Silver, Gold, and Platinum
51
An advertisement for an insurance product must contain
The insurer's name
52
An employer may qualify for health care tax credits through SHOP marketplace if that employer has fewer than how many employees?
25 employees
53
Benefits for a Medicare Supplement Policy
must not duplicate medicare benefits
54
New York Disability Benefits Law provides cash payments to workers unable to work because of
Injury or illness that occurred on the job
55
An insurance agent agrees to pay the first monthly premium for an insurance applicant. This is called a(n)
Rebate
56
An agent may be disciplined by the superintendent for which of the following actions?
Misappropriation of premium funds
57
After ____ years from date of issue, an individual health insurance policy can no longer be canceled by the insurer for misstatements (except for fraud)
2 years- policy terms shall be incontestable
58
When does a family health plan coverage for a newborn baby begin?
At the moment of birth
59
What does shop stand for in SHOP exchange?
Small Business Health Option Program
60
When a medicare supplement insurance policy is being replaced, who must sign the notice of replacement?
The agent AND the applicant
61
An agent does NOT have a fiduciary responsibility to
The New York Guaranty Association (also known as the Life and Health Insurance Company Guaranty Corporation of New York)
62
Which of the following is NOT a circumstance to which a temporary agent license can be issued?
Prospective agent who is waiting to take the state licensing examination
63
What's NOT a responsibility of the superintedent?
Endorsing insurers
64
A domestic insurance company in New York must
Be formed under the laws of NY
65
An agent license is NOT required when
Referring insurance
66
What is NOT an Unfair Claims Settlement Practice
Providing claim payments to insureds under the guidelines of the insurance contract
67
Employees are required to work at least ____ hours per week to become eligible for a small employer health plan
20 hours
68
An agent has committed an insurance crime that violates US code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime?
US Attorney General
69
Failing to promptly provide reasonable explanations for the denial of claims is considered a(n)
Unfair claim settlement practice
70
An example of an endodontic treatment is a
Root canal
71
An insurer may exclude preexisting conditions on a medicare supplement policy for _____ months
6 months
72
An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called
Co-insurance
73
A license who is required to take continuing education must complete ____ hours of continuing coursework
15
74
A temporary license is valid for a maximum of ____ days
90
75
An example of misrepresentation is
Providing incorrect, misleading, incomplete, or materially untrue information in the license application is misrepresentation
76
Which of the following is included in the entire contract according to the entire contract provision?
Application
77
What is NOT a duty of the superintendent?
Establishing rates for the insurer
78
Replacement regulation is designed to protect the interests of
Policy owners- the primary purpose of replacement regulation is to protect policy owners from misrepresentations and loss of benefits
79
If an insurer refuses to pay a claim, how many days must the insured wait to take legal action against a health insurer after submitting written proof of loss?
60 days
80
A form of medial health insurance covering the treatment and care of gum disease is called
Dental expense insurance
81
All health benefit plans issued after January 1, 2014 must provide
Preventative health services
82
A foreign insurance company doing business in New York
Is a company that was formed under the laws of another state
83
An agent is legally permitted to share his/her commissions
With another licensed agent
84
Under Federal Law, what action may result in a producer becoming imprisoned?
Producer embezzling funds from an insurer
85
Tom the agent replaced a client's insurance policy when it was not in the client's best interest. Tom could be found guilty of:
Twisting
86
Group accident and health insurance policies issued in New York must generally include unmarried dependent child who is ____ years or younger
19
87
Long term care policies solid in New York may NOT exclude coverage for
Senile dementia
88
Insurance crimes which affect interstate commerce are prosecuted by the
US Attorney General
89
How often must the superintendent examine each admitted insurance company?
Ever 6 years
90
The superintendent serves a term of ____ years
4 years
91
Which does restorative dental treatment cover?
Crowns
92
The entire contract provision includes all of the following EXCEPT the
Changes made by the agent
93
According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation?
Making false entries in a company's books
94
An individual who has a contract with an insurance company to represent it is called a(n)
Agent
95
The health plans according to the ACA are classified as
Bronze- 60/40, Silver- 70/30, Gold- 80/20, Platinum-90/10
96
Under the affordable care act, a large employer that does not provide health insurance and owes an employer mandate penalty MUST pay an annual penalty, which is calculated by multiplying $12,000 by
The number of full time employees MINUS 30
97
An insurer would be committing unfair discrimination if coverage was denied based upon
Marital status
98
The maximum prison sentence given under federal law for unfair and deceptive insurance practices is
15 years
99
Which of the following unfair trade practices involves an agent who made public, malicious statements about an insurer's financial condition?
Defamation
100
Which of the following is not covered under workers compensation?
Pain and suffering
101
A client told an intentional lie to an insurer in order to receive a favorable premium. This is an example of
Fraud
102
An agent's secretary who solicits prospects on the telephone
Must be licensed as an agent
103
If an insurer terminates an agent's appointment, it must notify the superintendent within _____ days of the termination
30 days
104
The branch of dentistry which deals with the replacement of missing parts is called
Prosthodontics
105
During the examination of an insurer's books and records by the superintendent, the insurer
Must not impede the examination
106
A carrier for a small group health plan may refuse to renew the plan if the employer
Fails to pay the premium
107
Under workers compensation laws, a permanent disability would be most likely caused by a
Loss of a foot
108
An example of an unfair claims settlement practice is
Failing to promptly provide reasonable explanations for the denial of claims
109
To be classified as a small employer in New York, an employer must employ
2-50 employees
110
An outline of _____ is required for long-term care policies and provides a brief description of the important failures of the policy.
Coverage
111
XYZ Corp was issued a group health policy for its employees. Under this plan a
Policy must be issued to XYZ and a certificate for each employee.
112
John has a criminal record in which he was convicted of a felony that involved dishonesty. Under federal laws, how would John be able to engage in insurance transactions?
Given written consent by the state insurance regulatory agency.
113
Under which circumstance may a commission be shared between two agents?
When they are both licensed in the same line of business.
114
According to the affordable care act, what is the maximum amount an individual can contribute to a flexible savings account?
$2,500
115
Group dental plans will frequently place a limit on annual benefits in order to minimize
Adverse selection
116
A type of policy that would help pay for uncovered medicare claims is called
Medicare supplement
117
One role of the superintendent is to
Enforce state insurance laws
118
No insurance company may transact business in New York without a certificate of
Authority
119
In NY, a medicare supplement policy must be _____ renewable
Guaranteed
120
According to federal fraud and false statements regulation, what is required for a prohibited person to transact insurance business in this state?
Written consent from the state insurance regulatory agency
121
When a medicare supplement policy is replaced, the policy owner will have a free look period of ____ days
30 days
122
Which is considered to be an act of misrepresentation?
Falsifying the terms, benefits, advantages, or conditions of an insurance policy
123
An agent has ____ days to report a felony conviction to a superintendent
30 days
124
Which is NOT considered a federal punishment for unfair and deceptive insurance practices?
Community service- its more like prison time and massive fines
125
How often must an insurance agents license in NY be renewed?
Every two years
126
The free look period in NY for individual health insurance policies is ____ days
10 days
127
A licensed agent must report any administrative action taken against the licensee in another jurisdiction or by another agency department in NY within ____ days of the final disposition
30 days
128
An insurance company may only pay commissions to a(n)
Licensed agent appointed by the insurer
129
What is the minimum benefit period that must be offered by a Long-Term care policy?
12 months
130
Which of these individuals would require continuing education?
Resident agent
131
Which of the following is required for the renewal of an agents insurance license?
Continuing education- license is renewed by playing the applicable renewal fee and completing 15 hours of continuing education every 2 years
132
All medicare supplement policies must contain which provision?
Pre-existing conditions may be excluded from coverage for a maximum of 6 months
133
An agent has recently died and leaves behind a spouse. In order for the agents insurance business to continue, the superintendent may issue to the agent's spouse a(n)
Temporary insurance license
134
If an agent would like to start using an assumed name, at what point must the superintendent be notified?
Before using the assumed name
135
When a health policy requires payment of an additional premium to provide coverage for a newborn, how many days after the birth is the first payment due?
30 days
136
The Fair Credit Reporting Act protects consumers
With guidelines regarding credit reporting and distribution
137
Under the Affordable Care Act (ACA) how would a grandfathered health plan lose its grandfathered status?
The insurer significantly raises co-insurance charges, deductibles, or co-payment charges
138
Proof of loss on health insurance claims must be submitted to an insurer within ____ days after the insured's date of loss
90 days
139
After a disability policy has been in force for ____ years, it is considered incontestable
2 years
140
Which of these may NOT be used in a health insurance ad?
An insurance company's trademark instead of the company's actual name
141
Charles is an agent who is licensed in NY but resides in NJ. Charles is considered to be a(n)
Non-resident agent
142
What is considered interstate travel under the Federal Fraud and False Statements Act?
Puerto Rico
143
Agents must complete ______ of continued education biannually
15
144
If a new enrollee to a group health plan has had previous creditable coverage for up to ____ days prior to enrollment, the pre-existing condition provision will apply.
63 days (weird number)
145
A disability policy where the premiums are due monthly require a grace period of
10 days
146
An insurer may pay comission in which of the following scenarios?
To a licensed producer who is appointed with the insurer
147
Coverage for newborns under an accident and health plan must include coverage for
Birth abnormalities
148
Written notice of a health insurance claim should be given to the insurer within _____ days after the occurrence of any loss covered by the policy
20 days
149
John the agent made public statements that falsely portrayed an insurer as insolvent. John would likely be found guilty of
Defamation
150
CH 10 XYZ Corp pays the tax-deductible insurance premiums for a key employee disability policy. Which would be an appropriate tax consequence?
Benefits are fully taxable
151
Tara the producer is delivering a specified disease insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT a(n)
Modified application with a new signature
152
An insured was injured as an innocent bystander when someone committed a felony. The insurer is
Liable for the loss
153
Which of these characteristics of an applicant is NOT taken into consideration when assessing risk for disability coverage?
Number of children
154
One of the most important considerations when replacing health insurance would be
Exclusions on a new policy
155
The gatekeepers role when used by an HMO is
Obtaining referrals to specialists from primary care physicians
156
The IRS allows taxpayers to deduct medical expenses that exceed 75% of their AGI. Which of the following is considered to be a tax deductible medical expense under this rule?
Long term care insurance premiums
157
In which of the following processes will the insurer oversee the insured's hospital stay to confirm everything is going according to schedule and that the insured will be released as planned?
Concurrent review
158
Which of the following typically does NOT provide a form of managed care?
Major Medical Indemnity Plan
159
A 10% excise tax is normally applied to an early withdrawal from the IRA. According to HIPPA, this tax will not be applied if the withdrawal is used for medical expenses that exceed ____ of the individuals adjusted gross income.
75%
160
XYZ Company has applied for group health insurance for its employees. What information would insurer underwriters likely use to determine the appropriate coverage and final premium rate given to the group?
An experienced rating system is used to estimate how much a specific group will have to spend on medical care
161
How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?
Not tax deductible- the premiums paid for personal disability income insurance are not deductible by the individual insured, but the disability benefits are tax-free to the recipient
162
Which is considered to be a point of service (POS) plan?
Managed Care Plan
163
Pierre is covered by his employer's group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 be taxable as income under this plan?
$0- benefits that fall under a major medical plan are considered to be a reimbursement for a loss, and is not taxable as income.
164
Premium mode is a term used to describe the
Frequency of the premium payment
165
The difference between pre-certification and concurrent reviews is that pre-certification
Occurs before the treatment is provided
166
Lorenzo is self employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year?
100% of his health insurance costs can be deducted from his gross income
167
What happens when an insurance policy is backdated?
The policy's effective date is earlier than the present
168
Which of the following is NOT an example of utilization review?
"Ongoing inspection of an accident prone individual"
169
Which of the following IS a requirement for ANY change in an insurance application?
Change must be initiated by the applicant
170
Bill the producer is collecting the initial premium on a health policy. Which of the following statements is true?
The contract is not in force without the initial premium being paid.
171
An example of a primary care physician would be a(n)
Internist
172
A field underwriters main task is
To ensure an applicants medical information is accurate and complete
173
States that have "no loss no gain" laws require a replacing policy to
Pay for ongoing claims under the policy it replaces
174
Employees are required to work at least ____ hours per week to become eligible for a "small" employer health plan
20 hours
175
All of these are typically sources of underwriting information for life or health insurance EXCEPT
Disclosure Authorization Response
176
XYZ Corp pays the tax-deductible insurance premiums for key employees disability policy. Which would be the appropriate tax consequence?
Benefits are fully taxable
177
Which of the following does restorative dental treatment cover?
Crowns
178
How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes?
Not tax deductible- but disability benefits are tax-free
179
Field underwriting performed by the producer involves
Completing the application and collecting initial premium
180
Without a section 125 plan in place, what would happen to an employees payroll attribution to an HSA?
It would be considered taxable income to the employee
181
The time limit for filing claim disputes is addressed in which provision of an accident and health policy?
Legal actions
182
Tara the producer is delivering a specified insurance policy to a new policyowner. Upon delivery, she may be expected to collect all of the following EXCEPT
Modified application with a new signature
183
A dread disease policy is considered to be a type of
Limited health insurance policy
184
The waiting period for a disability insurance policy
Excludes payments for a short term illness or injury
185
The waiver of premium does NOT include which provision?
All future premiums are waived if the insured recovers from the disability
186
A nonparticipating company is sometimes called a(n)
Stock insurer
187
What guarantees the statements supplied by an insurance applicant are true?
Warranty
188
Upon policy delivery, which of the following must a producer have an applicant sign if no initial premium was collected with the health insurance application?
A good health statement
189
What is the required action to be taken by a New York licensee before operating under an assumed business name?
Notifying the superintendent
190
Joe is a medicare participant who receives his benefits through a managed health care plan. Which medicare plan does he have?
Part C
191
When does a health insurance policy typically become effective?
When initial premium is collected and policy is issued
192
An example of a primary care physician would be a(n)
Internist
193
What kind of life insurance policy issued by a mutual insurer provides a return of divisible surplus?
Participating life insurance policy
194
All of these are examples of pure risk EXCEPT
Losing money at a casino- pure risk-loss is only possible outcome.
195
Bill requires some nursing care and supervision, but NOT full time care. Which of these nursing home options would best serve him?
Assisted living
196
Within _____ days after policy delivery, both medicare supplement and long-term care policies can be returned for a 100% premium refund.
30 days
197
A type of insurer that is owned by its policy owners is called
A mutual insurer
198
