CALIFORNIA LIFE AND HEALTH FINAL EXAM
(ACTUAL 2024 EXAM) QUESTIONS AND CORRECT
DETAILED ANSWERS AGRADE
RATED
Which of the following is an example of a third-party administrator? - ANSWER✔✔ Outside organization that processes claims for an employer's self-funded group plan Bruce is involved in an accident and becomes totally and permanently disabled. His insurance policy continues in force without payment of further premiums. Which policy provision is responsible for this? - ANSWER✔✔Waiver of premium provision A unilateral contract is one in which - ANSWER✔✔only one party (the insurer) makes any kind of legally enforceable promise The problem of overinsurance is addressed in which health insurance provision? - ANSWER✔✔Coordination of benefits What prevents a life insurance policy from being rescinded by the insurer after being in force for two years? - ANSWER✔✔Incontestability clause Which of the following is NOT included under long-term care insurance? - ANSWER✔ ✔Hospital acute care Which of the following could lower the premium of a proposed disability income policy? - ANSWER✔✔Increase in the elimination period 1 / 2
The misstatement of age provision in a health policy states that if an insured gives the wrong age at the time of application, what action can the insurance company take? - ANSWER✔✔Benefits can be adjusted Which of the following is NOT a risk classification that an underwriter would use? - ANSWER✔✔Dividend risk Pete is a life agent who has misappropriated fiduciary funds to his own use. What is Pete guilty of? - ANSWER✔✔Theft An insurer that has been found using higher rates based on race, religion, or ethnicity is said to be engaging in - ANSWER✔✔unfair discrimination During the underwriting process for a group health policy, it was discovered that 15 out of 50 members of the group have major health issues. How would the insurer handle this? - ANSWER✔✔Accept or reject the whole group When a life insurance policy is surrendered, how does the cost recovery rule apply? - ANSWER✔✔The policy's cost basis is exempt from taxation When calculating life insurance premium rates, which component is affected by an insured's age and gender? - ANSWER✔✔Mortality An applicant has revealed conditions that require more information. Which of the following is needed next? - ANSWER✔✔Attending physician's statement Which of the following healthcare providers provides both the healthcare services and healthcare coverage? - ANSWER✔✔Health Maintenance Organization (HMO) After the annual deductible is met, a Medicare Part B patient will pay ___ of the remaining covered expenses. - ANSWER✔✔20% When an insurer has met the qualifications necessary to transact business in California, it is said to be - ANSWER✔✔admitted
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