Xcel Final Exam Comprehensive of Life and Health Insurance Questions with Complete Solutions 2023/2024 Typically, Long-Term Disability benefits are coordinated with which benefit plan? - Correct Answer Social Security The focus of major medical insurance is providing coverage for - Correct Answer medical and hospitalization expenses An insured under a Major Medical expense plan with a zero deductible and 80/20 coinsurance provision files a $1,000 claim. How much of this claim is the insured responsible for? - Correct Answer $200 because this policy has a zero deductible, the insures is only responsible for the 20% coinsurance on this claim, or $200 An insured has a stop-loss limit of $5,000 and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured pay? - Correct Answer $5,000 Which type of plan would be the most appropriate for an individual on Medicare and concerned that Medicare will NOT pay for charges exceeding the approved amount? - Correct Answer Medicare supplement Plan F When can a group health policy renewal be denied according to the Health Insurance Portability and Accountability Act (HIPAA)? - Correct Answer when contribution or participation rules have been violated What does the word "level: in Level Term describe? - Correct Answer the face amount A non-contributory health insurance plan helps the insurer avoid - Correct Answer adverse selection because all eligible employees are usually covered, non-contributory plans are desirable from an underwriting standpoint because adverse selection is minimized.To qualify for a resident producer license in the state of Michigan, an individual - Correct Answer must complete the required pre-licensing education within 12 months of license application Under an expense-incurred individual health policy, what is the MAXIMUM length of time after issuance of the policy that an insurer can exclude coverage for a pre-existing condition? - Correct Answer 12 months 1 / 3
pre-existing conditions may be excluded for a maximum of 12 months from the date of enrollment.An insured has a health plan that pays established amounts in accordance with a list of injuries, surgical procedures, or other losses. This list is called a - Correct Answer benefit schedule benefits schedule set predetermined limits or maximums on how much money and insured can be reimbursed for a covered loss.Who is the individual paid on a fee-for-service basis? - Correct Answer Provider Which of the following is NOT an illegal inducement? - Correct Answer Giving the insured an article of merchandise printed with the producer's name costing $5 $5 or less of tokens or merchandise to applicants is allowed.Making a statement that is false or maliciously critical of the financial condition of an insurer is known as - Correct Answer defamation Which of the following is NOT a required provision in an accident and health insurance policy? - Correct Answer change of occupation the change of occupation provision is considered an OPTIONAL provision Which of these statements about Medicaid is CORRECT? - Correct Answer Funded by federal, sate, and local taxes Medicaid is funded by federal, state, and local taxes but is administered by each state.All of these are considered key factors in underwriting life insurance EXCEPT - Correct Answer Marital Status
Correct: tobacco use, health history, age
The time limit for filing claim disputes is addressed in which provision of an accident and health policy? - Correct Answer legal actions All of the following plans allow for employee contributions to be taken on a pre-tax basis EXCEPT - Correct Answer Health reimbursement Arrangement plan employers contribute to health reimbursement Arrangement planz (HRA's), not employees.Which of the following gifts from a producer would NOT be considered rebating? - Correct Answer $5 pen 2 / 3
A producer quoting life insurance may give an applicant an article of merchandise having an invoice value of $5.00 or less.Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. - Correct Answer 20 Chris is an insured bricklayer who severed his left hand in an automobile accident.Although his primary duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability income check every month. How does his policy define total disability? - Correct Answer own occupation the "own occupation" definition of total disability requires that the insured be unable to perform the insured's current occupation as a result of an accident or sickness.Which approach predicts a person's earning potential and determines how much of that amount would be devoted to dependents? - Correct Answer Human life value approach The human life value approach predicts an individual's future earning potential and determines how much of that amount would be devoted to dependents.Index whole life insurance contains a securities component that acts as a(n) - Correct Answer hedge against inflation Phil is shopping for an annuity that guarantees he CANNOT outlive the benefits. Which of these benefit options would he choose? - Correct Answer Guaranteed lifetime withdrawal benefit The guaranteed lifetime withdrawal benefit normally requires a fee, but it ensures that the income benefit will be paid for life without actually annuitizing the contract.Which of these factors would an insurer consider when determining whether to accept a group life plan? - Correct Answer average age and insurer would consider the average age when determining whether to accept a group Life Plan.This MANDATORY health policy provision states that the policy, including endorsements and attached papers, constitutes - Correct Answer the entire insurance contract between the parties The monthly benefit for an individual disability income policy is usually limited to a percentage of the insured's income in order to avoid - Correct Answer over insurance
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