FREE Life and Health Insurance Guide Exam Questions and Answers
A company is an "Applicable Large Employer (ALE)" if:
Applicable Large Employers (ALEs) must give their full-time and full-time equivalent employees health insurance. ALEs typically have 50 full-time and/or full-time equivalent workers in the year before the current reporting period.
When an insured person switches to a more dangerous employment, some individual health insurance policies have provisions that allow insurers to modify medical plan premiums. This provision is known as:
The "Relation of Earnings to Insurance" provision lets insurers tie the number of benefits to the insured person's average income over the last 24 months. Claims that arise from policyholders' participation in unlawful activities are not covered by their insurers under the "Illegal Occupation" provision. The "Conditionally Renewable" provision places limitations on how often the insurer may cancel policies when they are up for renewal.
The "Change of Occupation" provision is the right answer.
A health maintenance organization (HMO) pays people back for covered medical services by:
Medical services performed by HMO-owned clinics are reimbursed at a set rate that has been previously communicated to patients. These set amounts of money are called "flat fees."
Most short-term disability income benefits last between 6 months and:
Short-term disability income benefits are meant to help cover the insured's income for a limited time. Short-term disability income benefit periods should work with any long-term disability insurance that is available to reduce the chance of income gaps.
Different benefits and/or premium payments may be provided by employers to different employee groups as long as:
Employers can tailor benefit options and contributions depending on characteristics such as tenure, department, location, exempt/nonexempt status, and more.
Under Title VII, an employer can't make decisions about benefits based on race, color, sex, national origin, or religion.
Which of these is not usually covered by long-term care insurance?
Long-term assisted living care, nursing facility care, home health care services, adult daycare services, residential living care, and home health services are all covered by long-term care insurance policies, which pay policyholders a predetermined daily benefit amount.
Even though family care is normally not covered by long-term care insurance, it usually does offer respite care (temporary care provided in the absence of the primary caregiver).
Companies that offer an employer-sponsored medical insurance plan must cover all dependents under the age of:
Health insurance must be provided to all full-time and full-time equivalent workers, as well as dependents under the age of 26, by Applicable Large Employers in accordance with the Affordable Care Act (ACA). Most of the time, an employer is considered to be an "Applicable Large Employer" if it had an average of 50 full-time and/or full-time equivalent employees in the year before.
Which of the following legislation was made by the National Association of Insurance Commissioners (NAIC) to set up standard provisions for all individual health insurance policies?
The NAIC made the Uniform Individual Accident and Sickness Policy Provisions Law, which is a part of every individual health plan. All 50 states have signed on to this law. The wording changes from state to state, but the primary provisions of the legislation are the same everywhere.
Special Needs Plans (SNPs) are Medicare Advantage coordinated care plans for special needs patients, particularly those with chronic diseases. Which is not a chronic condition?
A chronic condition, for purposes of eligibility for a Special Needs Plan (SNP), is a disease or condition that typically lasts three months or more and may worsen over time.
Chronic diseases include long-term dependence on alcohol or other drugs, certain autoimmune diseases, cancer (not including pre-cancerous conditions), and some heart diseases. Chronic heart failure; dementia; diabetes mellitus; end-stage liver disease; end-stage renal disease (ESRD) requiring dialysis (any type of dialysis); certain severe hematologic disorders; HIV/AIDS; certain chronic lung disorders; certain chronic and disabling mental health conditions; certain neurologic disorders; and stroke.
Underwriting is required for most individual long-term care insurance, thus applicants with poor health may be denied or offered coverage:
Individuals applying for long-term care insurance coverage may frequently be asked about their health and lifestyle choices when filling out the application. Underwriters evaluate the information provided after applications are received to ascertain the level of risk involved in insuring each applicant. If an applicant's health poses an excessive risk, the insurer may refuse to provide coverage or may do so at a higher cost and/or with a lesser benefit level.
What qualifications do life and health insurance advisors need to market variable annuities?
Variable annuities are different from fixed annuities in that money is invested in the stock market to build wealth for retirement. In order to sell products that are linked to the stock market, life and health insurance advisors will need a Series 6 or Series 7 securities license.
Life insurance policy cash value withdrawals are normally non-taxable until:
Except for term life insurance, many types of life insurance can build cash value over time. Insured people can withdraw money tax-free until their withdrawals exceed their plan premiums. It is taxable to withdraw any additional funds from the plan.
What annuity guarantees a minimum interest rate?
Variable annuities have the biggest risk since rates might change. Index-linked annuities also go up and down, but buffers are built into these types of annuities to reduce risks. A fixed annuity is the only kind of annuity that guarantees a minimum rate of return.
A beneficiary of a life insurance policy can work with the insurance company to turn a death benefit payment into an annuity. The disadvantage of this payment method:
Converting a life insurance death benefit payout to an annuity is accurate in all three statements. Withdrawing the funds is costly and subject to taxation, and it may take years before the beneficiary receives the full death benefit.
The employer is financially liable for the payment of claims to covered persons under a self-funded health plan. Which of these would reduce financial risks associated with high plan utilization?
In this case, it is not cost-effective to reduce premiums or expand provider networks. Restricting coverage for common procedures might help keep costs down, but this is not in the best interest of those who are insured.
The greatest suggestion would be to get a stop-loss insurance policy that would help in covering excessive claims costs.
Health maintenance organization (HMO) insurers utilize this cost-controlling method:
Some HMO plans have large deductibles; however, this does not separate them from other medical insurance plans. Fixed premiums are lower than other medical insurance. HMOs save money by making insured people choose a primary care provider and see them for regular care and referrals to specialists.