Tennessee Health Insurance Exam Questions With Explanations Of Answers/2024.

Under a health insurance policy, benefits, other than death benefits, that have not otherwise been assigned, will be paid to - correct answer The insured. Items stipulated in the contract that the insurer will not provide coverage for are found in the________________. - correct answer Exclusions The insurance policy, together with the policy application and any added riders form what is known as - correct answer Entire contract Which of the following would basic medical expense coverage NOT cover? - correct answer Surgeon's Services An insurance producer is defined as - correct answer A person licensed to sell insurance In terms of parties to a contract, which of the following does NOT describe a competent party? - correct answer The person must have at least completed secondary education How does a member of an HMO see a specialist? - correct answer The primary care physician refers the member. A 63-year-old man is planning to be employed until age 68.When will he be eligible for Medicare? - correct answer Age 65, regardless of his employment status The mode of premium payment - correct answer is defined as the frequency and the amount of the premium payment Which of the following provisions is mandatory for health insurance policies? - correct answer Physical examination and autopsy. Alexander has a policy with his ex-wife as its beneficiary. What provision allows him to change the beneficiary to his new wife? - correct answer Change of beneficiary The insured's health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have? - correct answer Accident-only Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? - correct answer Free Look Period Which of the following statements regarding the Change of Beneficiaries Provision is false? - correct answer The policyowner has the right to change beneficiaries in any case. A policyowner has a health insurance policy with his wife listed as the primary beneficiary. He would like to change the primary beneficiary to his sister. Which of the following is true? - correct answer Unless the policy designated the current beneficiary as irrevocable, the policyowner can make the change at any time. Candidates for either a Property license or a causalty license must complete how many hours of prelicensing education? - correct answer 20 An insurance producer license may be renewed if the producer has paid the applicable fees, submitted the renewal form to the Commissioner, and - correct answer Completed all continuing education requirements Which of the following statements pertaining to Medicare Part A is correct? - correct answer Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65. All of the following are TRUE regarding key person disability income insurance EXCEPT - correct answer Premiums are tax deductible as a business expense. In key person disability insurance, the contract is owned by the business, the premium is paid by the business, and the business is the beneficiary. The key person is the insured, and the business must have the key person's consent to be insured in writing. What percentage of individually-owned disability income benefits is taxable? - correct answer 0% In a relative value system of determining coverage for a given procedure, what term describes the total amount payable per point? - correct answer Conversion factor Note:In order to determine the amount payable for a given procedure, the assigned points (relative value) of 200 are multiplied by a conversion factor. This conversion factor represents the total amount payable per point. For example, if the conversion factor is $10 and the point value is 200, the policy would pay $2,000 for the procedure (200 x 10). In insurance an offer is usually made when - correct answer The completed application is submitted Which of the following does the Insuring Clause NOT specify? - correct answer A list of available doctors Which of the following best describes the Aleatory nature of an insurance contract? - correct answer Exchange of unequal values How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company? - correct answer Within 90 days or as soon as reasonably possible, but not to exceed 1 year Note: The "proof of loss" provision states the claimant must submit a proof of loss within 90 days; however, if it is not possible to comply, the time parameter is extended to 1 year. The one-year limit does not apply if the claimant is not legally competent to comply with this provision Am insurance company has published a brochure that inaccurately portrays the advantages of a particular insurance policy. What is this an example of? - correct answer False advertising Note:False advertising is the illegal practice of advertising or circulating materials that are untrue, deceptive, or misleading. Hospital indemnity/hospital confinement indemnity policy will provide payment based on - correct answer The number of days confined in a hospital According to the PPACA rules, what percentage of health care costs will be covered under a bronze plan? - correct answer 60% If a producer was licensed at the time he sold an insurance policy but no longer holds a valid license, what happens to the commission earned for the sale? - correct answer It will be paid to the producer since he was licensed at the time of the sale. Which of the following statements is correct? A) HMOs may pay for services not covered by Medicare B) HMOs do not pay for services covered by Medicare C) Medicare Advantage is Medicare provided by an approved Health Maintenance Organization only D) All HMOs and PPOs charge premiums beyond what is paid by Medicare - correct answer HMOs may pay for services not covered by Medicare Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within a) 90 days of a loss. b) 20 days of a loss. c) 30 days of a loss.