PSI PRACTICE HEALTH AND ACCIDENT
EXAM QUESTIONS WITH COMPLETE
ANSWERS
Which oft he following is a characteristic of preferred provider org (PPO)
A: prearranged costs for services rendered
B: providers receive a flat montlyh amount for each user
C: ability to receive care at the same cost from any provider
D: emergency treatment is restricted to pre-select hospitals - Answer-A: prearranged
costs for services rendered
How do most disability policies handle the case of a recurrent disability at least 90 days
after the first claim:
A: it is handled as a continuation of existing claim
B: it is excluded from coverage because the benefits have already been paid out
C: it must be handled as a new claim for a new period of disability, requiring a new
elimination period
D: it must be handles as a new claim for a new period of disability, without requiring a
new elimination period. - Answer-D: it must be handles as a new claim for a new period
of disability, without requiring a new elimination period.
How are issues of amigity usually resolved because insurance contracts are contracts
of adhesion:
A: in favor of the insured because the insurance company drafts language in the
contract
B: in favor of the insured bec insurance companies often do not adhere to the more
specific contract principles
C: in favor of the insurer because most issues arise from misrepresentation on the part
of the insured
D: in favor of the insurer bec the insured frequently does not adhere to the requirements
of the contract - Answer-C: in favor of the insurer because most issues arise from
misrepresentation on the part of the insured
What is the difference between copayment and coinsurance:
A: a copayment is a set percentage, while coin insurance is a set dollar amount
B: a copayment is a set dollar amount, while coininsurance is a percentage
C: a copayment is an amount of money that must be paid up front anually before
benefits begin
D: coin insurance is an amount of money that must be paid up front anually before
benefits begin - Answer-B: a copayment is a set dollar amount, while coininsurance is a
percentage
, Which policy provision permits the policyowner to take a specified number of days to
examine the contract, and all the cancellation and a full refund if the policyowner rejects
the terms or costs:
A: exclusions
B: free look
C: grace period
D: insuring clause - Answer-B: free look
According to the time of payment of claims provision, the insurer must make the
payment immediately after receiving proof of loss EXCEPT:
A: for claims involving periodic payments
B: if the death is a suicide or due to pre existing conditions
C: when the policy is in the incontestability period
D: if the insured is able to eventually return to work - Answer-C: when the policy is in the
incontestability period
A group conversion option may be used in all the following instances EXCEPT
1. The termination of the master policy
2. Loss of coverage due to loss of employment.
3. Loss of eligibility on the part of a class of insureds.
4. A life-changing event, such as marriage, divorce, or childbirth. - Answer-1. The
termination of the master policy
How do warranties differ from representations?
1. A warranty is guaranteed to be true, a representation is believed to be true to the best
of one's knowledge.
2. A representation is guaranteed to be true, a waranty is believed to be true to the best
of one's knowledge.
3. A warranty is issued by the insurer, a representation is a statement provided by the
applicant.
4. An incorrect representation automatically voids a contract, whereas an incorrect
waranty must be proven. - Answer-1. A warranty is guaranteed to be true, a
representation is believed to be true to the best of one's knowledge.
Which of the following is considered the major advantage of HIPAA?
1. Portability
2. Increased coverage
3. Qualified beneficiaries
4. Tax deductibility of certain medical expenses - Answer-4. Tax deductibility of certain
medical expenses
During which period of a Disability Income Policy is coverage effective but during which
no benefits will be paid under the policy?
1. Benefit period
2. Elimination period
3. Grace period
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