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Final Exam - South Carolina Life and
Health solution 2024
A closed network plan offers a primary physician copay of $25. If a subscriber chooses a primary care physician outside of the network, the subscriber will likely pay - ANS>> 100% of the billed amount What does Coordination of Benefits allow? - ANS>> Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid A waiver of premium rider allows an insured to waive premium payments if the insured is - ANS>> completely and permanently disabled Under the Time Limit of Certain Defenses Provision, a disability policy is incontestable after it has been in force for a period of - ANS>> 2 years In what part of an insurance policy are policy benefits found? - ANS>> Declarations What type of annuity stops all payments upon the death of the annuitant? - ANS>> Life annuity A guaranteed issue insurance policy has no - ANS>> medical underwriting What is NOT a qualifying event for Medicare? - ANS>> Falling below the federal poverty level 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 - ANS>> benefit schedule Craig purchased a life insurance policy for enabling his heirs to pay estate taxes. What is this called? - ANS>> Estate conservation Ownership of a life insurance policy may be temporarily transferred with a(n) - ANS>> collateral assignment Respite care is able to provide - ANS>> temporary relief to the patient's primary caregiver What are employers is required to follow ERISA regulations? - ANS>> A local electrical supply company with 12 employees A policy illustration given at time of sale does NOT typically include the - ANS>> names of the beneficiary
How are contributions made to a Roth IRA handled for tax purposes? - ANS>> Not tax deductible With respect to small group health benefit plans, a carrier may discontinue coverage or may refuse to renew such a plan if the employer - ANS>> fails to pay the premium prior to the end of the grace period What is an insurance policy's grace period? - ANS>> period of time after premium is due but the policy remains in force What isn't considered to be nonforfeiture options available to policyowner - ANS>> Reduction of Premium An insured MUST submit a proof of loss on a health insurance claim within how many days after the date of loss? - ANS>> 90 What dividend option is taxable? - ANS>> Accumulation at interest When calculating the amount of life insurance needed for an income earner, what has to be determined when using the Needs Approach? - ANS>> The family's financial objectives if the income earner were to die or become disabled What statement best describes the relationship between the premiums of a whole life policy and the premium payment period? - ANS>> The shorter the payment period, the higher the premium Dorian exercised a nonforfeiture option by using his life policy's cash value to purchase an extended term insurance option. When the term insurance expires, - ANS>> the protection ends What are an applicant's statements concerning occupation, hobbies, and personal health history regraded as? - ANS>> representation Joe has a life insurance policy that has a face amount of $300,000. After a number of years, the policy's cash value accumulates to $50,000 and the face amount becomes a $350,000. What kind of policy is this? - ANS>> Universal Life policy In most dental plans, a deductible typically is NOT applied to - ANS>> preventative and diagnostic services What is considered to be a point of service (POS) plan? - ANS>> Managed care plan What is a corridor in relation to a Universal Life insurance policy? - ANS>> The gap between the total death benefit and the policy's cash value.
waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan. The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as - ANS>> twisting Tyler purchased a disability policy with a waiver of premium rider on April 1. He is disabled on May 1. On June 1, he receives proof of permanent and total disability, and submits a claim. He begins receiving benefits on June 15. When are his premiums waived? - ANS>> May 1 Without a Section 125 Plan in place, what would happen to an employee's payroll contribution to an HSA? - ANS>> It would be considered taxable income to the employee Joanne has a $100,00 whole life policy with an accumulated $25,000 of cash value. She would like to borrow $15,000 against the cash value. Which of the following statements is TRUE? - ANS>> Net death benefit will be reduced if the loan is not repaid What situation would qualify an individual for receiving benefits from a qualified long- term care policy? - ANS>> Becoming cognitively impared A long-term care policy typically provides all of the following levels of care EXCEPT - ANS>> acute care What isn't considered a source of information that can assist an underwriter in determining whether or not to accept a risk - ANS>> National Association of Insurance Underwriters What is typically not a source of underwriting information for life or health insurance - ANS>> Disclosure authorization response Claims payable to a disability income insured, even when the insured can continue to work, are the result of a - ANS>> presumptive disability the free-look provision gives the policyowner - ANS>> the right to return the policy for a full refund within a specified number of days An insured individual and the policy's beneficiary die from the same accident. The common disaster provision states the insurer will continue as if - ANS>> the insured outlived the beneficiary An insurer will accept a premium from the insured and continue the coverage in full force as though it was NOT late during which time period - ANS>> grace period
When can a policy no longer be cancelled for nonfraudulent misstatements after its date of issue? - ANS>> 2 years Kathy pays a monthly premium on her health insurance policy. How long is her grace period? - ANS>> 10 days Jonas has disability insurance through his employer. The employer pays 75% of the premium, and Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? - ANS>> Taxes must be paid on 25% of the benefits received The MAXIMUM time period that an eligible employee can be excluded from coverage under a group health policy as a late enrollee is - ANS>> 18 months What would be considered a possible applicant and contract policyholder for group health benefits? - ANS>> Employer The legal action provision in a health contract is limited to no more than ___ years - ANS>> 5 As of January 1, 2004, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of what percentage of the premiums paid by the employer - ANS>> 50% Which type of plan would be most appropriate for an individual on Medicare and is concerned that Medicare will NOT pay for chargers exceeding the approved amount? - ANS>> Medicare supplement Plan F To qualify as a small employer, an employer must employ no more than - ANS>> 50 eligible employees The deeds and actions of a producer indicate what kind of authority? - ANS>> Apparent What is known as the immediate specific event causing loss and giving rise to risk? - ANS>> Peril People with higher loss exposure have the tendency to purchase insurance more often than those at average risk. What is this called? - ANS>> adverse selection A temporary producer license can be issued in any of the following circumstances EXCEPT - ANS>> a prospective producer who is enrolled in an insurance pre-license class
In SC what is the MAXIMUM length of time an insurer can defer payment of a cash surrender value of an annuity? - ANS>> 6 months How long can an insurer exclude coverage for a preexisiting condition on a Medicare Supplement Policy? - ANS>> 6 months Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him? - ANS>> assisted living In SC, within how many days does the free-look provision allow the insured the right to return an individual insurance policy for full premium? - ANS>> 10 days What % of participant's income are group long-term disability benefit amounts typically limited to? - ANS>> 60% The authority granted to a licensed producer is provided via the - ANS>> Law of Agency One of the most important considerations when replacing health insurance would be the - ANS>> exclusions on a new policy The role of the federal government was expanded when Medicaid was established by allowing the state to - ANS>> receive matching funds to expand public assistance programs When a life insurance policy is issued to replace another life insurance policy, which of the following does NOT need to be provided to the purchaser at or before the time the policy is delivered? - ANS>> The replacing insurer's financial statements Which of these premium payment frequencies is not typically available to a policyowner? - ANS>> bi-weekly Which disability policy provision would address any concerns of the value of the benefits decreasing over time? - ANS>> cost of living benefit The PRIMARY purpose of the Fair Credit and Reporting Act is to - ANS>> protect consumers with guidelines regarding credit reporting and distribution An example of endodontic treatment is a - ANS>> root canal The monthly benefit for an individual disability income policy is usually limited to a percentage of the insured's income in order to avoid - ANS>> over insurance According to SC insurance code, which of the following MUST a producer do when replacing Life Insurance policy? - ANS>> Submit to the replacing insurer a list of all Life Insurance policies or annuity contracts proposed to be replaced.
Under the Affordable Care ACT, which of these plans if designed to provide coverage that is actually equivalent to 80% of the full actuarial value of the benefits provided under the plan? - ANS>> gold Yes - ANS>> yes Pat owns a 20-pay life policy with a paid-up dividend option. Which of the following statements is true? - ANS>> the policy may be paid up early by using policy dividends What type of long term care benefit would be most appropriate for a stroke victim who requires speech therapy administered at her home? - ANS>> Home health care Disability income plans which require that the insurer can NEVER change or alter premium rates are usually considered - ANS>> noncancellable yeah - ANS>> yeah Tom has a rider on his disability income policy that guarantees the right to increase his benefits without a medical exam. What kind of rider is this? - ANS>> guaranteed insurability rider If an insured's age on a life insurance policy has been missated, what is the insurer's liability if the insured dies? - ANS>> a proprated death benefit based on the amount of insurance the insured's premiums would have been if purchased at the correct age under SC law, the buyer's guide and policy summary MUST be delivered - ANS>> with or prior to the policy delivery mhm - ANS>> mhm in group health care, what is the purpose of the coordination of benefits provision? - ANS>> determines what is paid by the primary and secondary insurers in the event of a claim. When is the accumulated value in an annuity paid out - ANS>> annuitization phase How does one become eligible for Part D: Prescription Drug coverage? - ANS>> Must have medicare coverage tired - ANS>> tired Lisa has recently bought a fixed annuity. Which of these is considered to be a disadvantage of owning this type of annuity? - ANS>> During periods of inflation, annuitants will experience a decrease in purchasing power of their payments.
fck - ANS>> fck The gatekeeper's role when used by an HMO is - ANS>> obtaining referrals to specialists from primary care physicians Which settlement option pays a stated amount to an annuitant, but no residual value to a beneficiary? - ANS>> life income When an insured has a major medical plan with first dollar coverage, how does this impact the benefits paid? - ANS>> No deductible payment is required yess - ANS>> yess When life insurance is not sold by mail the grace period is - ANS>> 10 days talking - ANS>> talking foreign - ANS>> foreign Which clause defines total disability as being unable to perform the major duties of the insured's regular occupation? - ANS>> own occupation clause 63 days - ANS>> 63 days SC - ANS>> SC Which of the following is considered to be an alternative to a life settlement? - ANS>> accelerated death benefit rider hangec - ANS>> change the term which describes the fact that both parties of a contract may NOT receive the same value is referred to as - ANS>> aleatory Addy - ANS>> addy What is medicare part b also known as? - ANS>> medical insurance A deliberate lie by an insured to the insurer to obtain a lower premium is an example of
- ANS>> fraud 65 - ANS>> 65 retirement - ANS>> please
When must a claim on a life insurance policy be paid after proof of loss has been received by the insurer? - ANS>> within 30 days which of the following does medicare part d cover - ANS>> prescription drugs under a group life policy, the insurer will issue an individual _______ to the policyowner for delivery to each person insured - ANS>> certificate Legal purpose is a term used in contract law meaning - ANS>> there must be legal reasons for entering into the contract What is the primary purpose of a rating service company such as A.M Best? - ANS>> Determine the financial strength of a company Which type of life insurance policy pays the face amount at the end of the specified period if the insured is still alive? - ANS>> Endowment policy Which of these is NOT subject to income taxation under a Modified Endowment Contract? (MEC)? - ANS>> Death benefit What is the primary reason for buying an annuity? - ANS>> Provide future economic security In conjunction with a South Carolina insurance license renewal, which one of the following is the continuing education REQUIREMENT? - ANS>> 24 hours every 2 years How are health plans classified according to the Affordable Care Act? - ANS>> Bronze, Silver, Gold, Platinum Victoria's producer license was initially issued on July 18, 2017. Her birthday is June 9,
- When will her license renew? - ANS>> June 30th, 2019
