Download Fundamentals of Insurance Contracts and Policies and more Exams Commercial Law in PDF only on Docsity!
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The stated amount or percent of liquid assets that an insurer must have on hand that will satisfy future obligations to its policyholders is called: - ✔✔Reserves An insurance applicant MUST be informed of an investigation regarding his/her reputation and character according to the: - ✔✔Fair Credit Reporting Act A nonprofit incorporated society that does not have capital stock and operates for the sole benefit of its members is known as: - ✔✔A fraternal benefit society What I the name of the law that requires insurers to disclose information gathering practices and where the information was obtained? - ✔✔Fair Credit Reporting Act Who elects the governing body of a mutual insurance company? - ✔✔Policyholders A group-owned insurance company that is formed to assume and spread the liability ricks of its members is known as a: - ✔✔Risk retention group What type of reinsurance contract involves two companies automatically sharing their risk exposure? - ✔✔treaty What year was the McCarran-Ferguson Act enacted? - ✔✔ 1945 Which of these describe a participating life insurance policy? - ✔✔Policy owners are entitled to receive dividends At what point must a life insurance applicant be informed of their rights that fall under the Fair Credit Reporting Act? - ✔✔Upon completion of the application
Which of the following requires insurers to disclose when an applicant's consumer or credit history is being investigated: - ✔✔ 1970 - Fair Credit Reporting Act What type of reinsurance contract involves two companies automatically sharing their risk exposure? - ✔✔Treaty A group-owned insurance company that is formed to assume and spread the liability risks of its members is known as a: - ✔✔risk retention group All of the following are considered to be typical characteristics describing the nature of an insurance contract, EXCEPT: - ✔✔Bilateral The part of a life insurance policy guaranteed to be true is called a(n) - ✔✔warranty Statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called - ✔✔representations Q purchases a $500,000 life insurance policy and pays $900 in premiums over the first six months. Q dies suddenly and the beneficiary is paid $500,000. This exchange of unequal values reflects which of the following insurance contract features? - ✔✔Aleatory When must insurable interest be present in order for a life insurance policy to be valid? - ✔✔When the application is made A life insurance arrangement which circumvents insurable interest statutes is called: - ✔✔Investor- Originated Life Insurance Stranger Originated Life Insurance (STOLI) has been found to be in violation of which of the following contractual elements? - ✔✔Legal Purpose (Insurable Interest) Who makes the legally enforceable promises in a unilateral contract? - ✔✔Insurance company
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 proceeds from E's life insurance policy be directed to? - ✔✔In this situation, the proceeds from E's life insurance policy will go to F. When must insurable interest exist for a life insurance contract to be valid? - ✔✔Inception of the contract Life and health insurance policies are: - ✔✔unilateral contracts A policy of adhesion can only be modified by whom? - ✔✔insurance company At what point does an informal contract become binding? - ✔✔When one party makes an offer and the other party accepts that offer What is the consideration given by an insurer in the Consideration clause of a life policy? - ✔✔Promise to pay a death benefit What is the consideration given by an insurer in the Consideration clause of life policy? - ✔✔Promise to pay a death benefit to a named beneficiary Insurance policies are considered aleatory contracts because: - ✔✔performance is conditioned upon a future occurrence Taking receipt of premiums and holding them for the insurance company is an example of - ✔✔fiduciary responsibility The Consideration clause in a life insurance contract contains what pertinent information? - ✔✔The schedule and amount of premium payments Which of the following consists of an offer, acceptance, and consideration? - ✔✔Contract
Which of the following consists of an offer, acceptance, and consideration? - ✔✔contract Which of these is NOT considered to be an element of an insurance company? - ✔✔Negotiating What is a warranty? - ✔✔is a statement guaranteed to be true A life insurance policy would be considered a wagering contract WITHOUT: - ✔✔insurable interest G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is - ✔✔Business Overhead Expense Which of the following claims are typically excluded from Medical expense policies? - ✔✔Intentionally self-inflicted injuries XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is - ✔✔100% A Business Overhead Expense policy: - ✔✔covers business expenses such as rent and utilities A Business Overhead Expense policy would cover which of the following if a business owner becomes disabled? - ✔✔Utilities and office rent What is issued to each employee of an employer health plan? - ✔✔certificate The benefits under a Disability Buy-Out policy are - ✔✔payable to the company or another shareholder A policy owner would like to change the beneficiary on a Life insurance policy and make the change permanent. Which type of designation would fulfill this need? - ✔✔irrevocable
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is - ✔✔Business Overhead Expense Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party? - ✔✔Subrogation S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? - ✔✔ 36 When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans? - ✔✔contributory Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business? - ✔✔Business owner becoming disabled An accident policy will most likely pay a benefit for a(n) - ✔✔off-the-job accident An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses? - ✔✔Loss of eyesight due to an accidental injury Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for: - ✔✔health information Under which of the following circumstances will the benefits under COBRA continuation coverage end? - ✔✔All group health plans are terminated by the employer 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 - ✔✔waiting period
Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition? - ✔✔Less restrictive Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy? - ✔✔reimbursement The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately described as: - ✔✔Employee's premiums paid by the employer is tax-deductible to the employer as a business expenditure P and Q are married and have three children. P is the primary beneficiary on Q's Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are killed instantly. The Accidental Death benefits will be paid to - ✔✔P only J has an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will receive from his policy? - ✔✔$25, Which of the following characteristics is associated with a large group disability income policy? - ✔✔No medical underwriting K has an Accidental Death and Dismemberment (AD&D) insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. Under the Common Disaster clause, if K and her husband are both killed in an automobile accident, where would the death proceeds be directed? - ✔✔daughter Which of the following statements does NOT accurately describe the tax treatment of premiums and benefits of individual Accident and Health insurance? - ✔✔Disability income policy premiums are tax- deductible coordination of benefits provision - ✔✔prevents an insured covered by two health plans from making a profit on a covered loss
What kind of Accidental Death and Dismemberment (AD&D) insurance beneficiary requires his/her consent when a change of beneficiary is made? - ✔✔Irrevocable beneficiary Which statement is TRUE regarding a group accident & health policy issued to an employer? - ✔✔The employer receives the policy and each employee is issued a certificate P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period? - ✔✔Sign an enrollment card M purchased an Accidental Death and Dismemberment (AD&D) policy and named his son as beneficiary. M has the right to change the beneficiary designation at anytime. What type of beneficiary is his son? - ✔✔Revocable T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary? - ✔✔Request of the change will be refused Which of these types of coverage is best described as a short term medical policy? - ✔✔interim coverage A Business Disability Buyout plan policy is designed: - ✔✔to pay benefits to the Corporation or other shareholders Group/voluntary long-term care policy premiums are typically deducted from the employee's income and - ✔✔are less costly as compared to individual long term care coverage B has a $100,000 Accidental Death and Dismemberment policy that pays triple indemnity for common carrier death. If B is killed from an accident on a commercial flight, what will the policy pay B's beneficiary? - ✔✔$300, A policyowner's rights are limited under which beneficiary designation? - ✔✔irrevocable
The reason for a business having a Business Overhead Expense Disability Plan is to cover - ✔✔fixed business expenses Which statement is true regarding a minor beneficiary? - ✔✔Normally, a guardian is required to be appointed in the Beneficiary clause of the contract T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision? - ✔✔Primary carrier Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? - ✔✔More physicians to choose from The health insurance program which is administered by each state and funded by both the federal and state governments is called: - ✔✔Medicaid Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured? - ✔✔PPO The individual who provides general medical care for a patient as well as the referral for specialized care is known as a - ✔✔primary care physician A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary?
- ✔✔Her group health plan Which of the following does Social Security NOT provide benefits for? - ✔✔dismemberment Medicaid was designed to assist individuals who are - ✔✔below a specific income limit What is the maximum Social Security Disability benefit amount an insured can receive? - ✔✔100% of the insured's Primary Insurance Amount
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to? - ✔✔health maintenance organization Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenses? - ✔✔Commercial insurer The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs? - ✔✔Social Security Disability Income Which type of provider is known for stressing preventative medical care? - ✔✔Health Maintenance Organizations (HMO's) Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges? - ✔✔The maximum amount considered eligible for reimbursement by an insurance company under a health plan Which of the following phrases refers to the fees charged by a healthcare professional? - ✔✔Usual, customary, and reasonable expenses Comprehensive Major Medical policies usually combine: - ✔✔Major Medical with Basic Hospital/Surgical coverage Which of these options can an individual use their medical flexible spending account to pay for? - ✔✔prescription drugs Which of the following BEST describes a Hospital Indemnity policy? - ✔✔Coverage that pays a stated amount per day of a covered hospitalization Which of the following is NOT a limited benefit plan? - ✔✔Life insurance policies An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance
clause, how much will the INSURED be responsible to pay with $11,000 in covered medical expenses? - ✔✔$3, Deductibles are used in health policies to lower: - ✔✔overuse of medical services All of the following statements about Major Medical benefits are true, EXCEPT: - ✔✔Benefits have no maximum limit Major Medical policies typically: - ✔✔contain a deductible and coinsurance In Major Medical Expense policies, what is the intent of a Stop Loss provision? - ✔✔Limits an insured's out-of-pocket medical expenses What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? - ✔✔Dread disease insurance Basic Hospital and Surgical policy benefits are: - ✔✔lower than the actual expenses incurred Basic Medical Expense insurance: - ✔✔has lower benefit limits than Major Medical insurance T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition? - ✔✔Insurer will likely treat as a pre-existing condition which may not be covered for one year Which of the following costs would a Basic Hospital/Surgical policy likely cover? - ✔✔Surgically removing a facial birthmark cosmetic surgery A characteristic of Preferred Provider Organizations (PPOs) would be: - ✔✔Discounted fees for the patient
Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of he current year's deductible? - ✔✔Carryover provision M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for? - ✔✔Determined by the terms of the policy N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as - ✔✔coinsurance With a Basic Medical Expense policy, what does the hospitalization expense cover? - ✔✔hospital room and board Which of the following individual health insurance policies will provide the broadest protection? - ✔✔major medical For which of the following expenses does a Basic Hospital policy pay? - ✔✔hospital room and board In order to establish a Health Reimbursement Arrangement (HRA), it MUST - ✔✔be established by the employer Which of the following health insurance coverages is BEST suited for meeting the expenses of catastrophic illness? - ✔✔major medical Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)? - ✔✔Employee funds the HRA entirely All of the following are limited benefit plans, EXCEPT: - ✔✔Life insurance policies The phrase "This policy will only pay for a semi-private room" is an example of a(n): - ✔✔Internal limit
M has a Major Medical insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim? - ✔✔$1, Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $ deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? - ✔✔$2, Which of the following types of health coverage frequently uses a deductible? - ✔✔Major Medical policy Which of the following statements about Health Reimbursement Areangements (HRA) is CORRECT? - ✔✔If the employee paid for qualified medical expenses, the reimbursements may be tax-free A Health Reimbursement Arrangement MUST be established: - ✔✔by the employer J's Major Medical policy has a $2,000 deductible and an 80/20 Coinsurance clause. If J is hospitalized and receives a bill for $10,000, J would pay: - ✔✔$3, The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the - ✔✔initial deductible S wants to open a tax-exempt Health Savings Account. To qualify for this type of account, Federal law dictates that S must be enrolled in a - ✔✔High Deductible Health Plan Which of the following services is NOT covered under a hospitalization expense policy? - ✔✔surgeon's fees Which of the following medical expenses does Cancer insurance NOT cover? - ✔✔arthritis A major medical policy typically: - ✔✔provides benefits for reasonable and necessary medical expenses, subject to policy limits
B is a teacher who was injured in a car accident and cannot work. She is now receiving monthly benefits as a result of this accident. Which type of policy does B have? - ✔✔Disability Income In a Disability Income policy, which of these clauses acts as a deductible? - ✔✔Elimination period When a person returns to work after a period of total disability but cannot earn as much as he or she did before the disability, this situation is called which of the following? - ✔✔Residual disability T has Disability Income policy that pays a monthly benefit of $5000. If T becomes partially disabled, what can he likely expect? - ✔✔Less than $5,000 per month benefit regardless of the cause Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase? - ✔✔Applicant's monthly income R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity? - ✔✔Residual disability With Disability Income insurance, an insurance company may limit the monthly benefit amount a prospective policy holder may obtain because of the insured's - ✔✔gross income at the time of purchase K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income? - ✔✔Disability Income D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits? - ✔✔Residual Benefit clause Non-occupational disability coverage is designed for: - ✔✔employees who suffer non-work related disabilities, since work-related disabilities are covered by Workers' Compensation
N is covered under an individual Disability policy with a 30-day Elimination period and a monthly benefit of $500. N is totally disabled for 3 1/2 months. N's total benefit received on this claim is - ✔✔$1, The provision in a health insurance policy that interrupts premiums being paid to the insurer while the insured is disabled is called the - ✔✔Waiver of Premium 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: - ✔✔Recurrent Disability provision When an insured has the same disability within a specified time period and the insurance company provides the same benefits without a new waiting period, the second disability is covered under which of the following benefits? - ✔✔Recurrent Disability P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as? - ✔✔Recurrent Disability A disability elimination period is best described as a - ✔✔time deductible Z owns a Disability Income policy with a 30-day Elimination period. Z contracts pneumonia that leaves him unable to work from January 1 until January 15. Z then becomes disabled from an accident on February 1 and the disability lasts until July 1 the same year. Z will become eligible to receive benefits starting on - ✔✔March 1 A CEO's personal assistant suffered injuries at home and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant? - ✔✔Disability income What is the primary factor that determines the benefits paid under a disability Income policy? - ✔✔wages T was insured under an individual Disability Income policy and was severely burned in a fire. As a result, T became totally disabled. The insurer began making monthly benefit payments, but later discovered
