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COLORADO HEALTH INSURANCE/ JURISPRUDENCE EXAM Bundle (Graded A)
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Jurisprudence Practice Exam Questions and Answers 2023
A doctorate is required for Technical Testing and Advanced Testing under CRS 12-43-228. True or False? - Answer- False The legal definition of psychothe... [Show More] rapy in CRS 12-43-201(9) includes testing, assessment, diagnosis, treatment, and counseling. True or False? - Answer- True HIPPA is state law not federal law. True or False? - Answer- False Two misdemeanor violations of a mental health law can result in a felony indictment. True or False? - Answer- True Supervisors will be held liable if the supervisee is NOT legally listed with DORA. True or False? - Answer- True Under CRS 27-65-103: Mandatory disclosure statements must be signed by the legal guardian or the parent of a child under 18 and the psychotherapist is NOT licensed. True or False? - Answer- True The legal definition of psychotherapy in CRS 12--43-201(9) includes understanding unconscious or conscious motivation. True or False? - Answer- True Under CRS 12-43-222 DORA regulatory boards can now sanction psychotherapists for NOT responding to a grievance. True or False? - Answer- True The 3 public and 4 professional DORA mental health board members are appointed by the Governor of Colorado. True or False? - Answer- True Both spouses or both partners must sign a waiver to release confidential information from couple therapy sessions. True or False? - Answer- True Because of what the ACA Code of Ethics says; HIV/AIDS, Hep C, and TB are exceptions to client confidentiality rules for psychotherapists listed in the Colorado Mental Health Statute (12-43-218). True or False? - Answer- False Confidentiality law does not apply after the client is dead. True or False? - Answer- False Duty to warn and duty to protect are: a) legal and ethical requirements b) voluntary requirements c) expired requirements d) renewable requirements - Answer- A The Colorado mental health regulatory boards can: a) appoint their own members b) revise statutes without the legislature c) require a psychotherapist to submit to an examinations or refer a psychotherapist to a peer assistant program d) issue court orders - Answer- c Prohibited activities DO NOT include: a) Not referring when a client fails to benefit from psychotherapy b) requiring a client to buy a book written by the psychotherapist c) Responding to a DORA complaint without a client release d) Sexual misconduct with a client or an ex-client - Answer- c Sanctions from a DORA regulatory board do NOT include: a) probation or practice monitoring b) a letter of admonition c) revocation, suspension, or a cease and desist order d) a public letter of confidential concern - Answer- d If you are grieved to DORA under CRS 12-43-222 you must: a) answer or be sanctioned b) not answer c) consider an answer d) none of the above - Answer- a Which is NOT a mandated reported requirement under Colorado law? a) Elder abuse and neglect b) domestic violence c) child abuse and neglect d) threats against a church, mall, school, workplace, or theatre - Answer- b What is the client's right to keep information confidential in court? a) privilege b) regulation c) commitment d) notification - Answer- a Which professionals are mandated child abuse reporters? a) dentists, veterinarians, and physicians b) religious ministers and pharmacists c) psychotherapists and optometrists d) All of the above - Answer- d What degree is required for technical testing under CRS 12-43-228? a) Associate b) Bachelor c) Masters d) Doctorate - Answer- c Generally accepted standards of practice are NOT determined by: a) Professional Organization Codes of Ethics b) State Government Policies c) Community Standards d) Court Decisions - Answer- b How many misdemeanors add up to a felony under Colorado law? a) Two b) Three c) Four d) Five - Answer- a Disciplines regulated by Colorado psychotherapy law do NOT include: a) professional counseling, school psychology, and marriage and family therapy b) registered psychotherapy and social work c) addiction counseling and psychology d) life coaching, psychiatric technicians, and religious ministry - Answer- d If a client's treatment issue is not benefiting from psychotherapy the counselor must: a) try harder b) terminate, consult, or refer c) make the sessions longer d) study a book on the issue - Answer- b A psychotherapist must have completed how many graduate classes to do Advanced Testing under CRS 12-43-228? a) 6 b) 11 c) 12 d) 13 - Answer- b DORA Regulatory Boards CANNOT: a) enjoin a psychotherapist as a court b) impose $5000 fine per mental health law violation c) Suspend, deny, or revoke licensure, certification, or registration d) Issue a Public Letter of Admonition - Answer- a DORA Board rules are: a) guidelines and policies for mental health professionals b) legally enforceable under Colorado Mental Health Law c) suggestions for psychotherapists d) policies to develop a private practice but not an agency - Answer- b Inappropriate court testimony includes: a) custody evaluations inconsistent with CRS 14-10-124 b) stating educational credentials c) referencing progress notes d) practicing testimony - Answer- a Who does NOT have the legal authority for authorization of emergency mental health holds under CRS 27-65? a) A police officer and a marriage and family therapist b) A medical assistant or a nurses aid c) a professional counselor and a psychologist d) a social worker and a licensed addiction counselor - Answer- b Expired DORA licensure requires__________________ for reinstatement. a) an application b) a reinstatement fee c) 20 hours of continuing education for every year of expiration d) All of the above - Answer- d State of Colorado Psychotherapists Record Keeping requirements include: a) A treatment plan b) a termination summary c) Progress notes d) All of the above - Answer- d When is a Mandatory Disclosure Statement not required under 12-43-214? a) court ordered clients b) forensic evaluations c) emergencies d) all of the above - Answer- d Colorado Law (CRS 13) requires that psychotherapists: a) restrain the client and keep them in the office b) notify law enforcement and the intended victim(s) of a threat by a client c) convince the client to surrender all weapons to the therapist d) contact the Ethics Office of the therapist's professional organization - Answer- b What may a DORA regulatory board NOT do? a) Conduct hearings b) Adopt rules or regulations c) maintain confidentiality of complainant and respondent d) Arbitrate or adjudicate fee disputes between psychotherapists - Answer- d [Show Less]
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Colorado Licensure Exam Questions with Verified Answers
Records required to be kept and record retention (DORA) - Answer- SW must retain record for 7 years from the date of termination. I Record information o... [Show More] n record - Answer- name, phi, referral reason, mandatory disclosure statement. (5) Dates of service including, but not limited to the date of each contact with client, the date on which services began, and the date of last contact with client; (6) Types of service; (7) Fees; (8) Any release of information; (9) The records must be prepared in a manner that allows any subsequent provider to reasonably conclude what occurred; (10) Name of any test administered, each date on which the test was administered, and the name(s) of the person(s) administering the testInformation on each referral made to and each consultation with another social worker or other health care provider. This information shall include the date of the referral or consultation, the name of the person to whom the client was referred, the name of the person with whom consultation was sought, the outcome (if known) of the referral, and the outcome (if known) of the consultation; (12) A final closing statement Record storage and transfer - Answer- Need clients consent to transfer and storage must be confidentail and secure Disposition of records - Answer- disability, illness, death, sale or transfer of practice, termination of practice Destroying records - Answer- Only after 7 years, all identifying information Record Keeping in an agency - Answer- A social worker need not create and maintain separate client records if the social worker practices in an agency or institutional setting and the social worker: (1) Sees the client in the usual course of that practice; (2) Keeps client records as required by the agency or institution; and (3) The agency or institution maintains client records. Reporting child abuse - Answer- reasonable cause to know or suspect that a child has been subjected to abuse or neglect or who has observed the child being subjected to circumstances or conditions that would reasonably result in abuse or neglect shall immediately upon receiving such information report or cause a report to be made of such fact to the county department, the local law enforcement agency, or through the child abuse reporting hotline system as set forth in section Exceptions to reporting abuse - Answer- Learn of the suspected abuse or neglect until after the alleged victim of the suspected abuse or neglect is eighteen years of age or older; and (II) Have reasonable cause to know or suspect that the perpetrator of the suspected abuse or neglect: (A) Has subjected any other child currently under eighteen years of age to abuse or neglect or to circumstances or conditions that would likely result in abuse or neglect; or (B) Is currently in a position of trust, as defined in section 18-3-401 (3.5), C.R.S., with regard to any child currently under eighteen years of age. Elderly abuse reporting - Answer- n and after July 1, 2016, a person specified in paragraph (b) of this subsection (1) who observes the mistreatment of an at-risk elder or an at-risk adult with IDD, or who has reasonable cause to believe that an at-risk elder or an at-risk adult with IDD has been mistreated or is at imminent risk of mistreatment, shall report such fact to a law enforcement agency not more than twenty-four hours after making the observation or discovery. Information to know in the report for elderly abuse - Answer- The name, age, address, and contact information of the at-risk elder or at-risk adult with IDD; (II) The name, age, address, and contact information of the person making the report; (III) The name, age, address, and contact information of the caretaker of the at-risk elder or at-risk adult with IDD, if any; (IV) The name of the alleged perpetrator; (V) The nature and extent of any injury, whether physical or financial, to the at-risk elder or at-risk adult with IDD; (VI) The nature and extent of the condition that required the report to be made; and (VII) Any other pertinent information. Consent for BH for minors - Answer- Notwithstanding any other provision of law, a minor who is fifteen years of age or older, whether with or without the consent of a parent or legal guardian, may consent to receive mental health services to be rendered by a facility or by a professional person or mental health professional licensed pursuant to part 3, 4, 5, 6, or 8 of article 43 of title 12, C.R.S., in any practice setting The need for continuing hospitalization of all voluntary patients who are minors shall be formally reviewed at least every two months. Imminent danger to self or others - Answer- the following persons may act as intervening professionals to effect a seventy-two-hour hold as provided in subsection (1)(a)(I) of this section: (A) A certified peace officer; (B) A professional person; (C) A registered professional nurse as defined in section 12-38-103 (11), C.R.S., who by reason of postgraduate education and additional nursing preparation has gained knowledge, judgment, and skill in psychiatric or mental health nursing; (D) A licensed marriage and family therapist, licensed professional counselor, or addiction counselor licensed under part 5, 6, or 8 of article 43 of title 12, C.R.S., who by reason of postgraduate education and additional preparation has gained knowledge, judgment, and skill in psychiatric or clinical mental health therapy, forensic psychotherapy, or the evaluation of mental disorders; or (E) A licensed clinical social worker licensed under the provisions of part 4 of article 43 of title 12, C.R.S. (I) When any person appears to have a mental health disorder and, as a result of such mental health disorder, appears to be an imminent danger to others or to himself or herself or appears to be gravely disabled, then an intervening professional, as specified in subsection (1)(a)(II) of this section, upon probable cause and with such assistance as may be required, may take the person into custody, or cause the person to be taken into custody, and placed in a facility designated or approved by the executive director for a seventy-two-hour treatment and evaluation. Electronic psychotherapy - Answer- It is recommended that the initial therapeutic contact be in person and adequate to provide a conclusive diagnosis and therapeutic treatment plan prior to implementing any psychotherapy through electronic means. The mental health professional is expected to establish an ongoing therapeutic relationship including face-to-face visits on a periodic basis thereafter Disclosure of Confidential information - Answer- A licensee, registrant, or certificate holder shall not disclose, without the consent of the client, any confidential communications made by the client, or advice given to the client, in the course of professional employment. A licensee's, registrant's, or certificate holder's employee or associate, whether clerical or professional, shall not disclose any knowledge of said communications acquired in such capacity. Any person who has participated in any therapy conducted under the supervision of a licensee, registrant, or certificate holder, including group therapy sessions, shall not disclose any knowledge gained during the course of such therapy without the consent of the person to whom the knowledge relates. Disclosure of confidential info part 2 - Answer- Subsection (1) of this section does not apply when: (a) A client or the heirs, executors, or administrators of a client file suit or a complaint against a licensee, registrant, or certificate holder on any cause of action arising out of or connected with the care or treatment of the client by the licensee, registrant, or certificate holder; (b) A licensee, registrant, or certificate holder was in consultation with a physician, registered professional nurse, licensee, registrant, or certificate holder against whom a suit or complaint was filed based on the case out of which said suit or complaint arises; (c) A review of services of a licensee, registrant, or certificate holder is conducted by any of the following: (I) A board or a person or group authorized by the board to make an investigation on its behalf; (II) The governing board of a hospital licensed pursuant to part 1 of article 3 of title 25, C.R.S., where the licensee, registrant, or certificate holder practices or the medical staff of such hospital if the medical staff operates pursuant to written bylaws approved by the governing board of the hospital; or (III) A professional review committee established pursuant to section 12-43-203 (11) if said person has signed a release authorizing such review; (d) (I) A client, regardless of age: (A) Makes an articulable and significant threat against a school or the occupants of a school; or (B) Exhibits behaviors that, in the reasonable judgment of the licensee, registrant, or certificate holder, create an articulable and significant threat to the health or safety of students, teachers, administrators, or other school personnel. (II) A licensee, registrant, or certificate holder who discloses information under this paragraph (d) shall limit the disclosure to appropriate school or school district personnel and law enforcement agencies. School or school district personnel to whom the information is disclosed shall maintain confidentiality of the disclosed information, regardless of whether the information constitutes an education record subject to FERPA, consistent with the requirements of FERPA and regulations and applicable guidelines adopted under FERPA, but may disclose information in accordance with section 1232g (b)(1) of FERPA and 34 CFR 99.36 if necessary to protect the health or safety of students or other persons. (III) A licensee, registrant, or certificate holder who discloses or fails to disclose a confidential communication with a client in accordance with this paragraph (d) is not liable for damages in any civil action for disclosing or not disclosing the communication. This subparagraph (III) does not rescind any statutory duty to warn and protect specified in, and does not eliminate any potential civil liability for failure to comply with, section 13-21-117, C.R.S. Mandatory Discloser - Answer- nitial client contact: (a) The name, business address, and business phone number of the licensee, registrant, or certificate holder; (b) (I) An explanation of the levels of regulation applicable to mental health professionals under this article and the differences between licensure, registration, and certification, including the educational, experience, and training requirements applicable to the particular level of regulation; and (II) A listing of any degrees, credentials, certifications, registrations, and licenses held or completed by the licensee, registrant, or certificate holder, including the education, experience, and training the licensee, registrant, or certificate holder was required to satisfy in order to complete the degree, credential, certification, registration, or license; (c) A statement indicating that the practice of licensed or registered persons in the field of psychotherapy is regulated by the division, and an address and telephone number for the board that regulates the licensee, registrant, or certificate holder; (d) A statement indicating that: (I) A client is entitled to receive information about the methods of therapy, the techniques used, the duration of therapy, if known, and the fee structure; (II) The client may seek a second opinion from another therapist or may terminate therapy at any time; (III) In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee, registrant, or certificate holder; (IV) The information provided by the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists, social workers, professional counselors, and psychologists; licensed or certified addiction counselors; and registered psychotherapists, except as provided in section 12-43-218 and except for certain legal exceptions that will be identified by the licensee, registrant, or certificate holder should any such situation arise during therapy; and (e) If the mental health professional is a registered psychotherapist, a statement indicating that a registered psychotherapist is a psychotherapist listed in the state's database and is authorized by law to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state. When mandatory discloser does not apply - Answer- (a) In an emergency; (b) Pursuant to a court order or involuntary procedures pursuant to sections 27-65-105 to 27-65-109, C.R.S.; (c) The sole purpose of the professional relationship is for forensic evaluation; (d) The client is in the physical custody of either the department of corrections or the department of human services and such department has developed an alternative program to provide similar information to such client and such program has been established through rule or regulation; (e) The client is incapable of understanding such disclosure and has no guardian to whom disclosure can be made; (f) By a social worker practicing in a hospital that is licensed or certified under section 25-1.5-103 (1)(a)(I) or (1)(a)(II), C.R.S.; (g) By a person licensed or certified pursuant to this article, or by a registered psychotherapist practicing in a hospital that is licensed or certified under section 25-1.5-103 (1)(a)(I) or (1)(a)(II), C.R.S. (5) If the client has no written language or is unable to read, an oral explanation shall accompany the written copy. (6) Unless the client, parent, or guardian is unable to write, or refuses or objects, the client, parent, or guardian shall sign the disclosure form required by this section not later than the second visit with the psychotherapist. Prohibited activites - Answer- (a) Has been convicted of or pled guilty or nolo contendere to a felony or received a deferred sentence to a felony charge. each board is governed by section 24-5-101, C.R.S. (b) Has violated or attempted to violate, directly or indirectly, or assisted or abetted the violation of, or conspired to violate any provision or term of this article or rule promulgated pursuant (c) Has used advertising that is misleading, deceptive, or false; (I) Has committed abuse of health insurance pursuant to section 18-13-119, C.R.S.; (II) Has advertised through newspapers, magazines, circulars, direct mail, directories, radio, television, or otherwise that the person will perform any act prohibited (e) Habitually or excessively uses or abuses alcohol, a habit-forming drug, or a controlled substance, (I) Fails to notify the board that regulates his or her profession of a physical illness; a physical condition; or a behavioral, mental health, or substance use disorder that affects the person's ability to treat clients with reasonable skill and safety or that may endanger the health or safety (II) Fails to act within the limitations created by a physical illness; a physical condition; or a behavioral, mental health, or substance use disorder that renders the person unable to treat clients with reasonable skill and safety or that may endanger the health or safety of persons under his or her care; or (III) Fails to comply with the limitations agreed to under a confidential agreement (g) (I) Has acted or failed to act in a manner that does not meet the generally accepted standards of the professional discipline under which the person practices. Generally accepted standards may include, at the board's discretion, the standards of practice (II) A certified copy of a malpractice judgment of a court of competent jurisdiction is conclusive evidence that the act or omission does not meet generally accepted standards (h) Has performed services outside of such person's area of training, (i) Has maintained relationships with clients that are likely to impair such person's professional judgment or increase the risk of client exploitation, (j) Has exercised undue influence on the client, including the promotion of the sale of services, goods, property, or drugs in such a manner as to exploit the client for the financial gain of the practitioner or a third party; (k) Has failed to terminate a relationship with a client when it was reasonably clear that the client was not benefitting from the relationship a (l) Has failed to refer a client to an appropriate practitioner when the problem of the client is beyond such person's training, (m) Has failed to obtain a consultation or perform a referral when such failure is not consistent with generally accepted (n) Has failed to render adequate professional supervision of persons practicing pursuant to this article under such person's supervision according to generally accepted standards of practice; (o) Has accepted commissions or rebates (p) Has failed to comply with any of the requirements pertaining to mandatory disclosure of information to clients (q) Has offered or given commissions, rebates, or other forms of remuneration for the referral of clients; except that a licensee, registrant, or certificate holder may pay an independent advertising or marketing agent compensation for advertising or marketing services rendered on the person's behalf by such agent, including compensation that is paid for the results of performance of such services on a per-patient basis; (r) Has engaged in sexual contact, sexual intrusion, or sexual penetration, with a client during the period of time in which a therapeutic relationship exists or for up to two years after the period in which such a relationship exists; (s) Has resorted to fraud, misrepresentation, or deception in applying for or in securing licensure (I) Repeated ordering or performing demonstrably unnecessary laboratory tests or studies without clinical justification for the tests or studies; (II) The administration, without clinical justification, of treatment that is demonstrably unnecessary; (III) Ordering or performing any service or treatment that is contrary to the generally accepted standards of the person's practice and is without clinical justification; (IV) Using or recommending rebirthing or any therapy technique that may be considered similar to rebirthing as a therapeutic treatment. "Rebirthing" means the reenactment of the birthing process through therapy techniques that involve any restraint that creates a situation in which a patient may suffer physical injury or death. For the purposes of this subparagraph (IV), a parent or legal guardian may not consent to physical, chemical, or mechanical restraint on behalf of a child or ward. (u) Has falsified or repeatedly made incorrect essential entries or repeatedly failed to make essential entries on patient records; (v) Has committed a fraudulent insurance act, as set forth in section 10-1-128, C.R.S.; (w) Has sold or fraudulently obtained or furnished a license, registration, or certification to practice as a psychologist, social worker, marriage and family therapist, licensed professional counselor, psychotherapist, or addiction counselor or has aided or abetted in such activities; or (x) Has failed to respond, in the manner required by the board, to a complaint filed with or by the board against the licensee, registrant, or certificate holder. (2) A disciplinary action relating to a license, registration, or certification to practice a profession licensed, registered, or certified under this article or any related occupation in any other state, territory, or country for disciplinary reasons constitutes prima facie evidence of grounds for disciplinary action, including denial of licensure, registration, or certification, by a board. This subsection board duties - Answer- (2) (a) (I) Each board shall annually hold a meeting and elect from its membership a chairperson and vice-chairperson. Each board shall meet at such times as it deems necessary or advisable or as deemed necessary and advisable by the chairperson or a majority of its members. Each board may conduct meetings by electronic means. Each board shall give reasonable notice of its meetings in the manner prescribed by law. A majority of each board constitutes a quorum at any meeting or hearing. (II) All meetings are open to the public, except when: (A) A board, or an administrative law judge acting on behalf of a board, specifically determines that the harm to a complainant or other recipient of services to keep such proceedings or related documents open to the public outweighs the public interest in observing the proceedings; or (B) The licensee, registrant, or certificate holder is participating in good faith in a program approved by the board designed to end a substance use disorder and the licensee, registrant, or certificate holder has not violated the board's order regarding the person's participation in the treatment program. (III) If the board determines that it is in the best interest of a complainant or other recipient of services to keep proceedings or related documents closed to the public, the final action of the board must be open to the public without disclosing the name of the client or other recipient. In all open meetings, the board shall take reasonable steps to keep the names of the recipients of services confidential. Board authorization - Answer- Each board is authorized to: (a) Adopt, and from time to time revise, such rules and regulations as may be necessary to carry out its powers and duties; (b) Adopt an examination; (c) Examine for, deny, withhold, or approve the license of an applicant, and renew licenses pursuant to section 12-43-212; (d) Appoint advisory committees to assist in the performance of its duties; (e) Conduct hearings as necessary to carry out its powers and duties. (3.5) In carrying out its duties related to the approval of applications for licensure, registration, or certification pursuant to this section, section 12-43-212, and this article, each board shall delegate the function of the preliminary review and approval of applications to the staff of the board, with approval of an application ratified by action of the board. Each board, in its sole discretion, may individually review any application requiring board consideration prior to the approval of the application pursuant to section 12-43-212 and this article. (4) Each board shall maintain current lists of the names of all licensees, registrants, and certificate holders and records of cases and decisions rendered by the board. In addition, each board shall keep an accurate record of the results of all examinations. More board - Answer- (7) (a) A member of a board or of a professional review committee authorized by a board, a member of staff to a board or committee, a person acting as a witness or consultant to a board or committee, a witness testifying in a proceeding authorized under this article, and a person who lodges a complaint pursuant to this article is immune from liability in a civil action brought against him or her for acts occurring while acting in his or her capacity as a board or committee member, staff, consultant, or witness, respectively, if the individual was acting in good faith within the scope of his or her respective capacity, made a reasonable effort to obtain the facts of the matter as to which he or she acted, and acted in the reasonable belief that the action taken by him or her was warranted by the facts. A person participating in good faith in lodging a complaint or participating in an investigative or administrative proceeding pursuant to this article is immune from any civil or criminal liability that may result from such participation. (b) A person participating in good faith in the making of a complaint or report or participating in any investigative or administrative proceeding before the board pursuant to this article is immune from any civil or criminal liability that might result by reason of the action. (9) Any board member having an immediate personal, private, or financial interest in any matter pending before the board shall disclose the fact and shall not vote upon such matter. (10) The governor may remove any board member for misconduct, incompetence, or neglect of duty. Actions constituting neglect o [Show Less]
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Jurisprudence Exam 2023 with complete solutions
1. Licensees shall retain medical records for ________ to serve and protect clients/patients, but also to protect themselves against adverse actions - Answ... [Show More] er- As long as needed 2. Each licensee shall ensure that client/patient records are maintained and may be obtained by the client/patient for a minimum of _______after the termination or relocation of practice. - Answer- 2 years 3. All client/patient records shall be disposed of - Answer- In a manner that will secure the permanent confidentiality of records 4. Each licensee engaged in practice, who maintains the responsibility for client/patient medical records, shall, when terminating or relocating the practice, notify ______ of such termination or relocation. - Answer- All of the client/patients 5. Any person required to release records must adhere to the following costs: - Answer- A. For the first 25 pages, the cost shall be $1.00 per page. For each page in excess of 25 pages, the cost shall be $.25 per page 1) The primary concern of the Physical Therapist and Physical Therapist Assistant is: - Answer- b. Safety, well-being, and best interest of the patient 2) ___________ Supportive Personnel may be utilized to help in the treatment being provided by a licensed physical therapist or licensed physical therapist assistant under direct supervision. - Answer- Unlicensed 3) A Physical Therapist Assistant should not provide services to a patient in which setting unless the Physical Therapist is readily and physically available to provide consultation? - Answer- c. Inpatient or Acute Phase of Injury 4) A Physical Therapist Assistant _______ initiate treatment without the prior assessment and approval of the Physical Therapist. - Answer- Cannot 5) Conditions and performances which are essential for quality physical therapy service and patient care are considered: - Answer- standards 6) It is lawful for any health care provider or any provider of health care services to offer, - Answer- A thank you for referring patients 7) When are kick backs acceptable for referring and soliciting patients - Answer- Never 8) Florida statue 456.053 is short titled "Patient self referral act of ____" - Answer- 1992 9) Violation of law 456.052 will result in - Answer- misdemeanor 1. Who can a PTA perform patient-related activities for other than a PT, that does NOT require onsite supervision by a PT? - Answer- orthopeadic physician 2. "Physical Therapist" means a person who is licensed and who practiced physical therapy in accordance with the provisions of: - Answer- this chapters definition of the law 3. Who can a PTA perform patient-related activities for other than a PT, that DOES require onsite supervision by a PT? - Answer- general physician 4. Are PTA's defined as "physical therapy practitioners"? - Answer- yes, just like PTs are 5. What legally defines someone as a PTA? - Answer- a license in good standing 1. The sole legislative purpose in enacting this chapter is that every practicing physical therapist in Florida meets _______ requirements for safe practice. - Answer- minimum 2. It is the legislative intent that physical therapist who fall below the minimum requirements of competency or pose a danger to the public are _______ from practicing in this state. - Answer- prohibited 3. A temporary permit is not renewable and is ______ until a license is granted by the board. - Answer- valid 4. Each licensee must complete one hour of what kind of education - Answer- HIV/aids 5. Which is not a reason a board member can miss a meeting? - Answer- vacation 1. How many members are there on the Board of Physical Therapy Practice - Answer- 5 2. Who appoints Board Members to the Board of Physical Therapy Practice? - Answer- governor of florida 3. What is the length of time allowed for a patient referral to a Physical Therapist before the patient needs to be reexamined by a doctor, and a new referral issued? - Answer- d. A length of 30 days is allowed before a new referral needs to be issued to the patient. 4. According to chapter 486 Florida Law, "Physical Therapy Practitioner" refers to: - Answer- b. A Physical therapist, Physical therapy asissitant, a physical therapy aide, or any person who provides care in the form physical therapy or physiotherapy services 5. According to Chapter 486 of Florida Law, "Department" means. - Answer- c. Florida Department of Health 1. Which of the questions is false? The role of the PTA includes: - Answer- a) Communicating poorly to the patient the treatment evaluation and process? 2. When participating in student programs, ensure that the academic programs are _____ or in candidacy by the appropriate accrediting agency recognized by statute and that the physical therapist provides direct supervision when students are performing patient care activities. - Answer- accredited 3. Unlicensed personnel may be utilized to assist in the delivery of patient care treatment by the physical therapist, with ______ supervision by the physical therapist or the physical therapist assistant. - Answer- direct 4. Supervision of unlicensed personnel is the provision of ________ or oversight by qualified physical therapists or physical therapist assistants for the accomplishment of any delegated tasks - Answer- guidance 5. Education entails a technical or _________ degree or certification in a specific practice area providing for background and experience. - Answer- professional 1) Practitioner will not be civilly or criminally liable for failure to disclose information relating to a positive test result for of a patient to a sexual partner or a needle-sharing partner. - Answer- HIV 2) A practitioner regulated through the Division of Medical Quality Assurance of the department shall not be civilly or criminally liable for the disclosure of otherwise confidential information to a sexual partner or a needle-sharing partner under the following circumstances: - Answer- d. Patient who has tested positive for human immunodeficiency virus discloses to the practitioner the identity of a sexual partner or a needle-sharing partner 3) If practitioner's patient test positive for HIV, the practitioner may: - Answer- a. Practitioner may inform patient's sexual or needle sharing partner if patient refuses 4) Health practitioner may NOT advise HIV positive patient to: - Answer- tell current family and friends of positive test 5) Practitioner can be civilly or criminally liable if they disclose: - Answer- c. Results from treatment to current friend of the family 1. Physical therapy and _____ are terms deemed identical and interchangeable with each other, meaning a health care profession. - Answer- physiotherapy 2. _______ of physical therapy means the performance of physical therapy assessments and the treatment of any disability, injury, disease, or other health condition of human beings. - Answer- practice 3. The board of _____ sets forth the criteria of compliance for physical therapists. - Answer- medicine 4. The practice of physical therapy does not authorize a physical therapy practitioner to practice _____ medicine as defined in chapter 460, including specific spinal manipulation. - Answer- A. Chiropractic 5. A physical therapist may implement a plan of treatment developed by the physical therapist for a patient or provided for a patient by a practitioner of record or by an advanced registered nurse practitioner licensed under _____. - Answer- A. s. 464.012. 1. A licensed Physical Therapy Assistant (PTA) is working in a facility where the supervising PT can be reached by phone or email. This is an example of ____________ supervision. - Answer- general supervision 2. A recent PTA school graduate has acquired a temporary license. What level of supervision must be provided? - Answer- direct supervision 3. The physical therapist is physically present and immediately available for direction and supervision. - Answer- direct personal supervision 4. _______________ is the type of supervision given to student PTAs. - Answer- direct personal supervision 5. General supervision requires that the supervising PT be available at least by _________ for direction and supervision. - Answer- telecommunication 1. The board requires licensees to demonstrate their ability by completing 24 hours of continuing education how often? - Answer- biannially 2. The board will only approve courses sponsored by a college or university which is under the same curriculum for physical therapists or physical therapist assistants approved by who? - Answer- a. The Florida Physical Therapy Association or The American Physical Therapy Association 3. Under which rule will the board make an exception from the requirements of this section in an emergency or hardship case? - Answer- rule 13 4. What does each licensee have to maintain to demonstrate compliance with this section? - Answer- sufficient records 5. Who has the authority to adopt rules within the requirements of this section that are necessary for its implementation? - Answer- the board 1. What is the physical therapist - patient relationship founded on? - Answer- mutal trust 2. Sexual misconduct in the practice of physical therapy is? - Answer- prohibited 3. What department can order a licensed PT or PTA to a mental or physical examination when they believe one is no longer able to practice under proper standards? - Answer- state surgeon general 4. A PT or PTA can forfeit their license if one violates a ____order given by the department or the board. - Answer- lawful 5. One can surrender their license if they fail to comply with the educational course requirement for ______________? - Answer- domestic violence 1. The department shall renew a license upon reciept of the renewal application and the fee set by he board not to exceed? - Answer- $150 [Show Less]
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Colorado Health Insurance Exam Questions with correct Answers
Mandatory Uniform Provisions - Answer- Must be included in every individual accident policy, no additional provisions may be included which otherwise restr... [Show More] ict or modify a uniform provision, designed to protect the insured's interest Entire Contract Clause- Mandatory Uniform - Answer- Includes the policy and provisions, c a copy of the application and any riders, waivers, or endorsements Time Limit on Certain Defenses-Mandatory Uniform - Answer- No statement or misstatement may be contested after 2 years, no time limit for fraud Grace Period-Mandatory Uniform - Answer- Period after premium due date before policy lapse, (7-10-31) 7 days for weekly premium; 10 days for a monthly premium; 31 days of every thing else Reinstatement Provision- Mandatory Uniform - Answer- Applies to the time frame that an insurer hasn't paid premium but wants the policy back, allows insured to reinstate by paying past due premiums, proof of insurability may be required, sickness begins after 10 days, accidents are covered immediately - If you haven't heard back in 45 days, then the policy has been reinstated Notice of Claim provision-Mandatory Uniform - Answer- Policy owner must notify Insurer of loss either in writing, in person or by phone w/in 20 days. claim forms provision-Mandatory Uniform - Answer- The insurer is required to send the insured a claim form within 15 days after notice is received Proof of Loss provision-Mandatory Uniform - Answer- Policy owner has 90 days from date of loss to submit proof of loss to Insurer; valid claim must be paid immediately upon receipt. Time of Payment of Claims-Mandatory Uniform - Answer- Provides for immediate payment of the claim after the insurer receives notification and proof of loss. Payment of Claims Provision-Mandatory Uniform - Answer- Payment of claims to the policyowner unless otherwise specified or there is an assignment of benefits(required) defines how proceeds are to be paid out + requirements to initiate death benefit claim Physical Exam and Autopsy-Mandatory Uniform - Answer- A provision that allows an insurer, at its own expense, to have an insured physically examined when a claim is pending or to have an autopsy performed where not prohibited by law. legal action - Answer- Insured must wait 60 days but no later than 3 years after proof of loss (POL) before legal action may be brought against the isurer Change of Beneficiary Provision-Mandatory Uniform - Answer- Stipulates that the policy owner may change the beneficiary at any time by providing a written request to the insurer, unless the beneficiary is designated as irrevocable. Optional Uniform Provisions - Answer- These provisions are included at the insurer's option; however, if used they must conform to the state's insurance code. These provisions are designed to protect the insurer. Change of Occupation Provision-Optional - Answer- If Insured changes to: more hazardous job - benefits reduced; less hazardous job - premiums reduce. Misstatement of Age-Optioanl - Answer- This clause protects the insurance company against an applicant who lies about his age The insurance company has the right to adjust your face amount up or down to coincide with the face amount or policy limit the correct premium would have purchased if you had not lied about your age This is a separate clause from the Incontestability Clause and will not ever cause the policy to be voided Relation of Earnings to Insurance-Optional - Answer- Amount of monies from premium payments the insurer received versus the loss the insurer suffered through claims payments Illegal Occupation-Optional - Answer- If the insured is connected with a felony or has an illegal occupation and incurs injury, the insurance company is not held responsible Free Look Provision( Right to Examine )-other - Answer- Generally 10 days after policy delivery to cancel policy w/ full refund, except 30 days for seniors or for replacement policies. Insuring Clause-other - Answer- Appears on first page of contract has a summary of all the main points of the contract like the "promise to pay" death benefit Consideration Clause-other - Answer- Payments and promise Preexisting condition-other - Answer- A health problem that existed before the date your insurance coverage became effective. Prior Conditions which insured should have received medical advice or treatment. Probationary period-other - Answer- Number of days at the start of the policy with no coverage for loss due to sickness Elimination Period (Waiting Period)-other - Answer- A period of days (time) that must pass after the onset of an illness or occurrence of an accident before benefits will be payable. Waiver of Premium-other - Answer- Premiums waved after stated period of time of disability First dollar coverage-other - Answer- Provides that no out of pocket charges ( deductibles or co payments) will be paid by the insured before benefits are payable by the plan Coordination of benefits-other - Answer- A provision that determines the method of reimbursement when more than one insurer is responsible for the loss Policy Renewal Provisions - Answer- Each health policy must express conditions and provisions for coverage continuation. Noncancellable-PRP - Answer- Most favorable to insured, only owner can terminate, rates never increase, benefits cannot be changed and premiums cannot be altered Guaranteed Renewable-PRP - Answer- A clause in an insurance policy that means the insurance company must renew the policy as long as premium payments are made. However, the premium may be increased when it is renewed. Conditionally Renewable-PRP - Answer- Renew unless insurer gives notice to not renew Optionally Renewable-PRP - Answer- At insurer's option- retired Cancellable-PRP - Answer- A policy allowing the insurer to cancel the policy at any time with notice, 5 days, provided the insurer return all unearned premiums. cost containment (managed care provisions) - Answer- procedures used to control costs or expenses Mandatory Second Surgical Opinion - Answer- This requirement may be included in policies that offer surgical expense benefits, requiring the insured to consult a physician, other than the attending physician, to determine the necessity of surgery and/or alternate methods of treatment. If the insured should fail to obtain the second opinion, benefits are greatly reduced. utilization review - Answer- a process in which an insurer reviews decisions by physicians and other providers about how much care to provide, length of hospital stay is monitored, "before, during, and after" Prospective Review - Answer- A method of reviewing possible hospitalization befConore admission to determine necessity and estimated length of stay. Concurrent review - Answer- Determines whether length of time and scope of inpatient stay is justified, to determine medical necessity Pre-authorization - Answer- Requirement for some health ins plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed "medical necessary" (not an emergency) Impairment Rider - Answer- Excludes coverage for a specific ailment or condition that otherwise would be covered (e.g., previous back injury) Guaranteed Insurability Rider - Answer- Optional rider that enables the policyowner to purchase additional amounts of coverage at predetermined times without proof of insurability. Multiple Indemnity Rider - Answer- If someone dies under certain specified circumstances, AD&D policies with this rider will pay double (double indemnity) or triple (triple indemnity) the principal sum amount. Master Policy - Answer- The policy contract issued to the employer under a Group insurance plan. Remember, the employees covered by a group plan are considered to be insureds, but they only receive certificates. Certificate of Insurance and Summary of Benefits - Answer- A document provided to the individual employees of a group insurance contract. Experience Rating - Answer- Rating system that bases insurance rates on claims history community rating - Answer- Determines premiums by examining the claims history of a particular geographic region Contributory - Answer- A group insurance plan that requires the employees to pay part of the premium. Usually 75% of eligible employees Non-contributory - Answer- Group Plan requires 100% of participation of eligible employees, employer pays entire amount Eligibility for Coverage - Answer- Minimum of 30 hour week, empolyer can not discriminate when determining eligibility and employee benefit Conversion Privilege - Answer- Clause in a group insurance policy that allows the insured to continue the same or lesser coverage under an individual policy without proof of insurability, request to convert and payment of premium must be submitted within 31 day grace period. self-employed person - Answer- May deduct up to 100% of the cost of health insurance for themselves and their dependents Benefits Received - Answer- Benefits received under any medical expense and dental plan, regardless of the premium payer, are not taxable Continuation of Coverage COBRA - Answer- Act states that employers with 20 or more employees must provide health continuation coverage to all covered employees and dependents up to 18 months in event of :Termination of employee :Reduction of hours as they no longer qualify for full time :Coverage may continue up to 29 months if an employee(or dependent) is totally disabled Continuation (COBRA) - Answer- Coverage may also continue for dependents up to 36 months if certain qualifying events happen :Death of employee :Divorce or legal separation :Empolyees entitlement to Medicare benefits :A child ages out of group plan as a dependent at age 26 Any substantial gainful activity - Answer- Social Security uses which definition to determine total disability? An insured with a cognitive impairment has how many days to reinstate the LTC policy that was cancelled for nonpayment of premium? - Answer- 90 days Insured - Answer- Before a policy will be issued, an insurable interest must exist between the owner (applicant) and th If a policy is issued with a surcharge, this means that the policy - Answer- Policy was issued with a higher premium due to the increased risk. Overinsurance - Answer- When an individual carries more accident and health insurance than he/she would need for a loss, it is called: Coordination of Benefits - Answer- Which provision in a health insurance plan is used to avoid overinsurance when a person is covered by more than one plan? Which of the following is true concerning the Benefit Period of a LTC Policy - Answer- Once the elimination period has been satisfied, it is how long benefits will be payable When the insurer issues a policy - Answer- An applicant completes the application and submits it to the insurer along with a premium check. When is the applicant's offer considered accepted? The Guaranteed Renewable Provision states that the policy is: - Answer- Renewable with premiums that may be increased for entire classes of insureds What do ADLs trigger? - Answer- Long-Term Care Insurance, Activities of Daily Living (ADLs) are triggers used to begin Long-Term Care Insurance benefits. Social Security Disability - Answer- Medicare is available to individuals who have been receiving ______________ benefits for 24 months. Medicare is available to individuals regardless of age if they have received Social Security disability benefits for 24 months. Supplementary Major Medical - Answer- A policy which utilizes a Corridor Deductible after Basic Medical Expense Coverage benefits have been exhausted and before Major Medical benefits begin? Utilization Review - Answer- Is a set of formal techniques for monitoring the use or clinical necessity of health care, or for determining if an exclusion applies or a treatment is medically necessary. Unauthorized entities - Answer- Every person acting as an advisor, counselor, or analyst must report every unauthorized policy or contract to the Commissioner. $750,000 - Answer- The maximum penalty for a knowing violation of Unfair Trade Practices law is: Misrepresentation - Answer- Making a statement that is misleading about a policy, its dividends, or its share of surplus receivable or paid in the past, or about a person's financial condition or a life insurer's legal reserve system. Free Look Period = - Answer- Right to Examine is the same as A small employer insurers must - Answer- Offer a basic and a standard health plan Unfair Claims Practices - Answer- Compelling insureds to sue by offering substantially less than what a lawsuit would award is an example of Unfair Claims Practices - Answer- Misrepresenting pertinent facts or insurance policy provisions relating to coverage at issue Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies Failing to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies Refusing to pay claims without conducting a reasonable investigation based on all available information Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements have been completed Not attempting in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear Compelling insureds to institute litigation to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in actions brought by such insureds Attempting to settle a claim for less than the amount to which a reasonable person would have believed he was entitled by reference to written or principal advertising material accompanying or made part of an application Attempting to settle claims on the basis of an application that was altered without notice, knowledge, or consent of the insured Making claims payments to insureds or beneficiaries not accompanied by statements setting forth the coverage under which the payments are being made Making known to insureds or claimants a policy of appealing arbitration awards in favor of insureds or claimants for the purpose of compelling them to accept settlements or compromises less than the amount awarded in arbitration [Show Less]
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Colorado Health Insurance Exam Questions and Answers (Graded A)
Agent - Answer- Agents are the agents of the insurer Producer - Answer- Usually includes agents and brokers Applicant or proposed insured - Answer- A... [Show More] person applying for insurance Consent - Answer- permission to do something Insurable Interest - Answer- The policy owner must face the possibility of losing money or something of value in the event of loss insurance policy - Answer- a contract between a policyowner (and/or insured) and an insurance company which agrees to pay the insured or the beneficiary for loss caused by specific events Insured - Answer- Person covered by the insurance policy, may or may not be the policy holder. Insurer (principal) - Answer- the company who issues an insurance policy Policyowner - Answer- the person entitled to exercise the rights and privileges in the policy Premium - Answer- the money paid to the insurance company for the insurance policy Contracts to be legally binding: - Answer- Agreement- Offer and acceptance Consideration Competent parties Legal Purpose Offer - Answer- needs to be by one party and the other party accepts offer in exact terms. Applicant - Answer- usually makes the offer when submitting the application. Acceptance - Answer- takes place when an insurer's underwriter approves the application and issues a policy Consideration - Answer- Is the value that each party gives each other. Insured - Answer- person who makes payment of premium and rpresents made in the application Insurer - Answer- Promise to pay in the event of a loss T/F Insurers considerations is the promise to pay for losses, insureds consideration is the premium and statements on the application - Answer- True Parties to a contract - Answer- Must be capable of entering into a contract in the eyes of the law. Both parties need to be legal age, mentally competent and not under the influence of drugs/alcohol. Legal - Answer- Must have both insurable interest and consent. Insurable interest - Answer- Proven by love and affection, economic or financial loss required at the time of policy insurance. Must experience financial loss due to an accident or sickness that befalls the insured. Warranty - Answer- True statements of validity of the insurance policy depend. Breach of Warranty - Answer- can be considered grounds for voiding policy or a return of premium. Representations - Answer- statements believed to be true to the best of one's knowledge, but they are not guaranteed to be true Untrue statements - Answer- statements on an application that are considered misrepresentations and could void contract. Material Misrepresentation - Answer- Discovered after underwriting decision of the insurance company. If material misrepresentations are intentional - Answer- They are considered fraud. Conditional Contract - Answer- Requires that certain conditions must be met by the policyowner and the company in order for the contract to be executed, and before each party fulfills its obligations. Unilateral Contract - Answer- only one of the parties to the contract is legally bound to do anything. Insured makes no legally binding promises, insurer is legally bound to pay losses covered by policy to force. No legal actions for cancellation - Answer- When someone loses job, unemployment and premiums are current insure can't refuse to pay death benefit. Contract of adhesion - Answer- prepared by one of the parties (insurer) and accepted or rejected by the other party (insured) Insurance policies are - Answer- drawn up as take it or leave it Aleatory exchange - Answer- unequal amounts or values and uneven exchange of values. Insurance contracts are? - Answer- aleatory T/F If Jons paid $100 of his 100,000 life insurance policy and he dies his beneficiary will receive the total 100,000? - Answer- True T/F if a mistake occurs on application have client draw line and initial the correct answer. - Answer- True An application is. form completed by the agent as questions are asked of the applicant, responses are recorded. It then submitted to insurance company for approval or rejection. If policy is issued a copy of application will be stapled on the back of the policy. It then becomes apart of the? - Answer- Entire contract Notice to applicant - Answer- must be issued to all applicants for life or health insurance coverage. This notice informs the applicant that a report will be ordered concerning their past credit history and any other life or health insurance for which they have previously applied. The agent must leave this notice with the applicant along with the receipt. Application process - Answer- Completeness and accuracy Signatures Changes in the application premiums with application submitting application to company for underwriting. Completness and accuracy - Answer- Agent need to be accurate with interest of company and insured. Main source of under writing information. Agent responsible for application and correctly filled out. Changes in application requires - Answer- Ink, if mistake occurs use new app, if not practical draw a line through the incorrect answer. Applicant needs to be informed. Premiums with the Application - Answer- Agents attempt to collect the initial premium and submit to insurer. Collecting initial premium at the time of the application increases the chance that the applicant will accept the policy once issued. No initial premium with application - Answer- in case where premiums didn't accompany the application upon delivery the agent must collect premium and obtain statement of good health before releasing the policy. Submitting Application to Company for Underwriting - Answer- The agent is obligated to check the application to make certain that all questions have been answered and all necessary signatures have been collected. The agent then sends the application to the insurer. Medical Information Bureau (MIB) - Answer- A nonprofit association that maintains medical data on applicants for life insurance. Used for underwriting proposes. Applicant must be aware of - Answer- sources being used and how all the information is gathered up. Due to fair credit reporting act. Attending Physical report - Answer- Under writer deems its necessary (APS) will be sent to applicant doctor to be completed. Best for accurate information on medical history. can explain what applicant was treated for treatment, recovery and outcome. Medical Information and consumer reports - Answer- For policies with higher amounts of coverage or if the application raised additional questions concerning the prospective insured' health, the underwriter may require a medical examination of the insured. 2 reasons for medical examination - Answer- Paramedical report or Attending physical statement (will require MIB report) Insurers can't - Answer- refuse coverage solely on the basis of adverse information on a MIB report. Medical Exam Report - Answer- Conducted by physicians or paramedics.Expense paid by insurance company. More common with life insurance and underwriting. Written consent form T/F Insurance companies must maintain strict confidential regarding HIV related test results - Answer- True Fair Credit Reporting Act - Answer- Regulate consumer reports. Act that protects privacy of background information and ensures that information supplied is accurate. Law used to protect consumers. Acceptability of Risk - Answer- is determined by checking individual risk from factors directly related to risk potential for loss. Consumer Reports - Answer- Include written and/or oral information regarding a consumer's credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources. Investigative Consumer Report - Answer- information on a consumer's character, general reputation, personal habits, and mode of living that is obtained through investigation. Advise in writting in 3 days and 5 days to provide consumer with additional information. When you run a ICR you would need to know the consumer has been - Answer- truthful and next day notify. HIPPA Privacy - Answer- Individually insatiable health information, held or transmitted by covered entity to business associate, any form or media, rather electric, paper or oral. Protected health information. Individually indentifiable health information - Answer- Demo data the relates to past, present or future physical or mental health or condition or payment info that could easily identify individual. Policy delivery - Answer- Can be accomplished without physically delivering in policy owner possession an agent should personally deliver whenever possible. Explaining policy and its provision, riders elusions and ratings - Answer- Agent is responsible to provide insured with explanation of policy principal benefits and provisions. Policy is issued with any changes or adenments, agent require to explain changes and obtain insured signature acknowledge and amendments. Replacement - Answer- Agent attempt to replace insured currant health policy with a new one, agent needs to be careful not to mislead insured or provide coverages to insured determine its agent responsibility to compare benefits. Limitations and exclusions. T/F Agent also must make sure that the current policy is not cancelled before new policy is issued. - Answer- True Pre-Exisitng Condition - Answer- Medical condition insured sought medical advise or treatment within a specific period or time, prior to policy issued. Health condition covered by currant policy may not be covered by new policy due to limited pre existing conditions. underwritting - Answer- The process of reviewing, accepting or rejecting applications for insurance. Exclusions - Answer- War or military service self-inflicted injuries elective cosmetic conditions covered by workers comp conditions covered by government plans Participation in criminal activities and cremating crime/ shot cost sharing - Answer- Provision of a healthcare insurance policy that requires policyholders to pay for a portion of their healthcare services; a cost-control mechanism. Deductible and coinsurance. Accidental bodily injury - Answer- Unplanned, unforeseen traumatic injury to the body. cafeteria plan - Answer- A selection of health care benefits from which an employee may choose the ones that he/she needs. Cancellation - Answer- The termination of an in-force insurance policy by either the insured or the insurer prior to the expiration date shown in the policy. Comprehensive coverage - Answer- health insurance that provides coverage for most types of medical expenses Deductible - Answer- A specific dollar amount that must be paid by the insured before a medical insurance plan or government program begins covering health care costs. Lump sum - Answer- a payout method that pays the beneficiary the entire benefit in one payment non-renewable - Answer- termination of an insurance policy at its expiration date by not offering a continuation of the existing policy replacement. Riders - Answer- added to the basic insurance policy to add, modify or delete policy provisions Sickness - Answer- an illness, which manifest its while policy is in force. Tax Except - Answer- not subject to taxes taxable - Answer- subject to taxation Underwriting Risk - Answer- Selection and classification process. HMO - Answer- health maintenance organization PPO - Answer- preferred provider organization Medical expense insurance - Answer- More limited! Basic hospital, surgical and medical polices and major medical polices. cover three basic coverages hospital, surgical and medical. KNOWN AS FIRST DOLLAR COVERAGE. First dollar coverage - Answer- doesn't require insured to pay a deductible Basic Hospital Expense Coverage - Answer- Covers hospital room and board, and miscellaneous expenses, such as lab and x-ray charges and medicines while insured is confined to a hospital. Miscellaneous hospital expenses - Answer- Separate limit specific amount. may not pay for full amount needed by insured in event of long stay. Basic medical expense coverage - Answer- Non surgical expense coverage. Limited to visits, and limited to number of stays in hospitals and doctor visits. appoints may be paid for no deductible with benefits. can be purchased to cover emergency benefits, maternity, mental. nervous disorder, hospice, home care, outpatient and nurse expense. Basic Surgical Expense Coverage - Answer- Covers costs of surgeons' services, whether the surgery is performed in or out of the hospital Surgical Schedule - Answer- list types of operations co [Show Less]
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Life & Health Insurance Exam Colorado Questions with correct Answers 2023
Traditional Whole Life - Answer- -Ordinary (Straight) Life -Limited-Pay & Single-Premium Whole Life -Adjustable Whole Life Ordinary (Straight) Life - ... [Show More] Answer- -Until 100 or Death, whichever comes first -Permanent Protection -Rates & benefits based on law of large numbers (Mortality Rate) -Guaranteed, tax-deferred interest rate -Premium level, company's risk goes down as cash value goes up -Insurer keeps the cash value if death to offset risk -Lowest net cost in long run -Client has access to cash through cash surrender or policy loan -Rates are per unit of protection (1,000 is 1 unit)---TEST -Cash value is guaranteed -Cash value will equal face amount at policy maturity Limited-Pay & Single-Premium Whole Life - Answer- -Premium paying period is shorter -Cash value still equals face amount at age 100 -20 pay life will be paid up in 20 years PL -Life Paid up at age 65, will be paid up at 65 LP -A single premium policy will have an immediate cash value (1-pay life)---TEST Adjustable Whole Life----TEST - Answer- -Sold to clients with fluctuating incomes----TEST -Combination of term and whole life----TEST -Coverage may not be increased without physical exam---TEST Interest/Market Sensitive Whole Life Products - Answer- -Universal Whole life -Variable Whole life -Variable/Universal Whole life -Equity-Indexed Life Universal Whole life - Answer- -Guaranteed minimum interest rates -Extreme flexibility regarding premium PMTs----TEST -Most flexible product -Target premium based on projected earnings -Option A UL has level death benefits -Option B UL will pay beneficiary both face amount + cash value Variable Whole life - Answer- -Cash value deposited into a separate account -Requires FINRA series 6 or 7 to sell -Used to be called NASD -Regulated by SEC -Regulated by FINRA (Financial Industry Regulatory Authority) -NYSE license not required -Minimum death benefit (face amount) is guaranteed---TEST -Has fixed premium---TEST Variable/Universal Whole life - Answer- -Requires Finra(series 6 or 7) licenses to sell -Allows client to self-direct cash values into sub-account---TEST -Flexible premium Equity-Indexed Life - Answer- -cash value, where minimum death benefit is guaranteed as well as the minimum earning on the cash value in the general account -Securities license is not required -Fixed Premium Term Life - Answer- -Level Term -Decreasing Term -Increasing Term General Features of Term Insurance - Answer- -Premium goes up every year -May be converted to whole life at current attained age regardless of health -May be renewable up to certain age without physical Level Term - Answer- Both premium and face amount are level for period of time Decreasing Term - Answer- -Face amount goes down but premium remains the same -Usually convertible to whole life regardless of health -Premium stays the same but cost increases as face amount decreases Increasing Term - Answer- -Face amount goes up instead of down -Allows beneficiary to receive the face amount + premiums or cash values -Also known as Universal Life option B Special features of Term Insurance - Answer- -Renewable/Convertible to whole up to certain date or age regardless of health -Conversion based on current age -May only convert to more expensive option -Cannot convert to term -Cannot convert to more coverage than you have Return of Premium under Term - Answer- The premium for a return of premium policy is generally more than that for a term policy, but less than that of a traditional whole life policy General Features of Annuities - Answer- -Always have beneficiary during the pay-in or accumulation period -May or may not have a beneficiary during the pay-out or annuity period -During pay-out period all Pmt's are for the life of the annuitant -Long-term investments subject to 10% early withdrawal penalties on withdrawals taken prior to 59.5 -Immediate annuities have no pay-in or accumulation period--single premium -Variable annuities use a separate account (Like Mutual fund) -Have 30-day grace period Annuity Pay-Out Options - Answer- -Contractual; cannot be changed once selected -Amount received in excess of cost are taxable as ordinary income -For life -Cash surrender under age 59.5 subject to IRS 10% penalty -Non-qualified=Funded with after tax dollars Specific Annuity Pay-Out Options (Annuitization) - Answer- -Life Income -Life Income with period certain -Life Income with refund -Joint life annuity -Joint survivor annuity Life Income - Answer- -Type of Annuity pay out-option -Also known as straight life option -Has no beneficiary, considered risky -Highest monthly pay out---because of risk Life Income with Period Certain - Answer- -Type of ---Annuity Pay out-option -5,10,15, or 20 years-----TEST -Guarantees PMT's -Longer the period certain, the lower the monthly PMT -Has beneficiary during the period certain only -Less risk than life income option, payout lower -Doesn't guarantee all monies, just those that would have been paid out during the certain period Life Income with Refund - Answer- -Type of Annuity pay-out option -If annuitant dies before recovering all monies, refund goes to beneficiary -Beneficiary may choose cash refund or installment refund -Will pay as long as annuitant lives Joint Life Annuity - Answer- -Type of Annuity Pay-out option -Pays only until first annuitant dies Joint and Survivor Annuity - Answer- -Pays until the last party dies -Payment often adjusted upon the death of the first party because of age difference Types of Annuities - Answer- -Single Premium Deferred Annuity (SPDA) -Level Premium Annuity -Flexible Premium Annuity -Immediate Annuity -Fixed Annuity -Regular -Variable Annuity -Indexed Annuity Immediate Annuity - Answer- -No accumulation period -Pays in single premium -Annuitizes right away Variable Annuity - Answer- -Goes into separate accounts -Valued in annuity units---TEST -Buyer bears risk -Need FINRA/securities license and annuity course -Subject to state and federal regulation -Insurance under state law Indexed Annuity - Answer- -Pays 2% on cash value -Securities license not required -Cash accumulation usually linked to an index (S&P) -If index outperforms guaranteed interest rate, difference credited to cash value -Premiums do not change Combination Plans & Life Insurance Policy Variations - Answer- -Joint Life Policy -Survivorship Life Policy Joint Life Policy (First to Die) - Answer- -Type of Combination Plans & Life Insurance Policy Variations -Covers 2+ on same policy -No further coverage for remaining party Survivorship Life Policy (Last to Die) - Answer- -Usually used to pay estate taxes -Used in estate planning--TEST Life Insurance Policy Riders - Answer- -Waiver of Premium & Waiver of Premium with Disability Income(WP) -Guaranteed Insurability Rider(GIR) -Payor Benefit Rider -Accidental Death Benefit Rider -Term Insurance Rider -Long-Term Care Rider -Other Insured Rider -Return of Premium Rider Waiver of Premium & Waiver of Premium with Disability Income (WP) - Answer- -Type of Insurance Rider=Add on to coverage -Disability income insurance added to a life policy -6-month waiting period; if satisfy waiting period insurer will reimburse insured for paid premiums within that period -Premiums waived, and policy still enforced as long as insured is disable -If added with disability income, policy pays insured's net income during disability Guaranteed Insurability Rider(GIR) - Answer- -Type of Insurance Rider -Enables insured to increase coverage later regardless of health -Option dates usually occur at 2 or 3 year intervals, if skipped the date is lost -At each increase, rates are based upon current age Payor Benefit Rider - Answer- -Type of Insurance Rider -Added to policy on child -Waives premium if payor dies or becomes disabled -Expires when child reaches age 18-----TEST Accidental Death Benefit Rider - Answer- -Type of Insurance Rider -Death must occur within 90 days of accident or it is assumed to be form of natural causes -Doesn't cover death due to sickness only accidents Term Insurance Rider - Answer- -Type of Insurance Rider -Often added to whole life policy to increase coverage -Some whole, some term -Term portion will not cover unless insured dies within the term period Other Insured Rider---TEST - Answer- -Type of Insurance Rider -Added to whole life policy under certain circumstances -Adds coverage for new spouse on whole life -Subject to insurability (Physical Exam) -Could be used to add coverage on newborn, on current policy, term insurance rider on child Long-Term Care Rider - Answer- -Type of Insurance Rider -Costs extra and may be added to a cash value policy -Allows policy owner to take money out of policy's cash value to pay for qualifying nursing home or home health care Return of Premium Rider - Answer- -Type of Insurance Rider -Same as term -Could be added to term depending upon company -Also called return of premium term insurance (ROPT) -If insured should live to end of term, premium is returned tax-free Life Insurance Policy Provisions & Options - Answer- -Entire Contract Clause -Insuring Clause or Agreement -Free Look -Consideration Clause -Owner's Rights -Beneficiary Designations -Premium Payment Provisions -Reinstatement Provision -Policy Loan Provisions -Nonforfeiture Provisions or Options -Dividend and Dividend Options -Incontestability Clause -Assignments -Suicide Exclusion -Misstatement of Age & Gender Clause -Settlement (Pay-out) Options -Accelerated Death Benefits Entire Contract Clause - Answer- -Defines what is admissible in court -Only policy, endorsements & attached papers if any -Prevents company from changing the policy after policy delivery Insuring Clause or Agreement - Answer- -Promise to pay -States that coverage is provided in accordance with the terms of the policy -Located on first page -States coverage, effective date, and parties -Promise can be legally enforced Free Look - Answer- -Enables insured to examine policy after delivery -May return policy and get full refund if not satisfied---TEST -15 days to do so Consideration Clause - Answer- -An exchange of values -Pays first premium then answers questions on application -Representation is truth to the best of your knowledge -Company agrees to provide coverage in exchange -No coverage unless premium is paid Owner's Rights---TEST - Answer- -Must pay premium-usually -May designate beneficiary, may also change beneficiary -Can assign ownership rights to others -May select dividend options and nonforfeiture options Beneficiary Designations - Answer- -Primary beneficiary receives proceeds when insured dies -Can have as many primaries as wanted -Guardian must be appointed for children -Company may designate irrevocable beneficiary -Common disaster clause -Applies if insured and primary beneficiary both day as a result of the same accident -Insured always dies last even if not the case -Primary beneficiary must die within 10 days for clause to be enacted Premium Payment Provisions - Answer- -Mode of payment -The more frequent the mode, the higher the premium -Annual mode of payment has lowest cost -Grace periods -30 day grace period for individual life insurance -31 day grace period for group life -Automatic Premium loan rider -Will automatically borrow the amount of the premium if insured does not pay by end of grace period -Creates a policy loan Policies with Level Premiums - Answer- -Ordinary whole life -Limited-pay whole life -Single premium whole life -Variable whole life -Equity indexed whole life -Term insurance -could be 1 year or more Policies with Flexible Premiums - Answer- -Adjustable whole life -Universal whole life-Target premium -Variable/universal whole life -Interest sensitive whole life Reinstatement Provision - Answer- -Applies when a policy lapses at the end of the grace period -Allows insured to apply for reinstatement for up to 5 years after lapse -Insured maintains original age -A policy surrendered for cash may not be reinstated Policy Loan Provisions - Answer- -Applies only to polices with cash value-not term -Maximum fixed interest rate usually 8% might have dropped -Loans need to be paid back while insured is still alive -Interest will accrue if loan is not paid---TEST Nonforfeiture Provisions or Options - Answer- -3 options -Cash Surrender; most up front---TEST -Tax on profit only -Amount received in excess of premiums paid is [Show Less]
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Colorado Accident & health laws state Exam simulator Questions and Answers
Which of the following is an example of defamation? A brochure including an untrue statement regarding a competitor's ability to pay claims A truthful ... [Show More] estimate of the dividends A pamphlet listing a competitor's financial rating A verbal statement of a competitor's complaint ratio - Answer- A brochure including an untrue statement regarding a competitor's ability to pay claims Which of the following is an example of rebating? offer of temporary insurance coverage cancellation of an insurance policy without cause sale of mass-marketed insurance products returning a portion of a premium as inducement to purchase insurance - Answer- returning a portion of a premium as inducement to purchase insurance Which of the following is a duty of the Commissioner? Setting insurance rates Writing insurance laws Setting sales quotas Reviewing and approving license applications - Answer- reviewing and approving license applications A license is deemed to be used for controlled business if during any 12-month period the licensee wrote more than 10 policies on controlled business the licensee wrote policies totaling more than $25,000 on controlled business the licensee's total premiums on controlled business made up more than 25% of his total premiums the licensee's total premiums on controlled business exceeded the total premiums on all other business - Answer- the licensee's total premiums on controlled business exceeded the total premiums on all other business In Colorado, which of the following is true regarding the commingling of an insured's funds with the funds of the producer? It is never okay It is okay with the insurer's written approval It is okay if records are kept on the transaction It is okay with the insured's written approval - Answer- it is never okay Who is not eligible to receive commissions from the sale of an insurance product? Corporate executive General agent Licensed home office employee Personal producer - Answer- corporate executive Which of the following is an example of a misrepresentation? Making malicious statements about an insurer Describing a universal life policy as a security Returning a portion of a premium as inducement to purchase insurance Failing to affirm or deny coverage of claims within a reasonable time - Answer- describing a universal life policy as a security An insurer that terminates a producer's appointment must inform the Commissioner within how many days? 45 55 15 30 - Answer- 30 In Colorado, all of the following are considered unfair trade practices EXCEPT coercion rebating replacement misrepresentation - Answer- replacement A fiduciary responsibility is defined as a relationship of special trust and confidence when a person is entrusted with another's funds the responsibility of the insured to pay premiums in a timely fashion the responsibility the producer has to the appointing insurer the relationship between the broker and the insurer whose products are sold - Answer- a relationship of special trust and confidence when a person is entrusted with another's funds Circulation of a maliciously critical statement about an insurer's financial condition meant to damage the insurer's reputation or business is called defamation unfair discrimination conservation coercion - Answer- defamation Which information is NOT included in the Colorado Supplement to the Summary of Benefits and Coverage form? Covered cancer screenings Deductibles Insurer's prior year financials Balanced billing - Answer- insurer's prior year financials How long must a replacing insurer maintain the records of a replacement transaction? 5 years 4 years 2 years 3 years - Answer- 5 years From what point must the insurer pay interest on the proceeds of a death claim? Date claim is postmarked Date of death Date insurer is notified of the death claim Date claim is received by insurer - Answer- date of death Ultimately, who is responsible for a producer-generated advertisement? The Department of Insurance Producer Insurer Life and Health Guaranty Association - Answer- insurer If an insurance company wishes to discriminate rates based on gender, it must receive prior approval from the Department of Insurance be justified by actuarial statistics allow for no more than a 10% rate difference disclose the rate difference on the application - Answer- be justified by actuarial statistics As a condition to be approved for a loan, a creditor may require the borrower to obtain an insurance policy through the lender obtain an insurance policy for more than the loan amount obtain an insurance policy through an insurer of lender's preference obtain an insurance policy through an insurer of the borrower's preference - Answer- obtain an insurance policy through an insurer of the borrower's preference All of the following penalties apply to anyone giving intentional false testimony during an insurance examination EXCEPT imprisonment up to three months guilty of a misdemeanor guilty of a felony fine of up to $5,000 - Answer- guilty of a felony All of the following are considered a form of advertisement EXCEPT newspapers communication or materials used within an insurer's own organization free lunch seminars telemarketing scripts - Answer- communication or materials used within an insurer's own organization If a producer completes an insurance application, collects the initial premium, and issues the appropriate receipt, coverage will be contingent upon the insurer's underwriting policies coverage will begin 14 days after the free-look period coverage will begin when the policy is delivered coverage will begin the day of application - Answer- coverage will be contingent upon the insurer's underwriting policies When a claim has been denied, the insurer must issue a statement to the policyowner explaining the coverage, provision, or laws on which denial was based cancel the policy notify the producer refund all paid premiums - Answer- issue a statement to the policyowner explaining the coverage, provision, or laws on which denial was based A producer that only sells insurance to family members is said to be engaging in personal business domestic business family business controlled business - Answer- controlled business Renewing a producer's license requires __ hours of continued education every 2 years. 24 36 12 18 - Answer- 24 Which of the following offers an insurance applicant the right to review the contract and receive a full refund? Elimination period Refund period Free-look period Probation period - Answer- free-look period An producer who violates a cease and desist order may, after a hearing, be fined up to $750 $1000 $500 $250 - Answer- 500 A producer license may be suspended or revoked if the producer is found to be engaging in replacement converting a term life policy to a whole life policy selling with a nonresident license misrepresentation - Answer- misrepresentation If a producer chooses to conduct business under an assumed name, when must notification be given to the Commissioner? No notice is required At the time of license renewal No later than 30 days after using the assumed name Prior to using the assumed name - Answer- prior to using the assumed name Paying insurance premiums on a more frequent basis will cause the policy to have lower premiums graded premiums average premiums higher premiums - Answer- higher premiums A verbal or written statement which misleads a policy's features, benefits, or coverage is considered coercion rebating misrepresentation defamation - Answer- misrepresentation Upon request, when must the Colorado Supplement to the Summary of Benefits and Coverage Form be provided? Within 30 business days Within 7 business days Within 15 business days Within 10 business days - Answer- within 7 business days Which of the following is NOT required to be disclosed to an applicant for health insurance? Any change to the standard compensation Standard compensation schedule for the product being sold Any contingent compensation received The insurance producer will receive a commission from the carrier - Answer- Any contingent compensation received In regards to maternity care, which of the following is not required to be covered in the State of Colorado? Standard newborn circumcision Injuries or sickness Congenital defects Birth abnormalities - Answer- standard newborn circumcision In Colorado, what is required to be covered in individual and group medical expense policies? Epilepsy Accidental death In vitro fertilization Diabetes - Answer- diabetes Which of the following is NOT a required provision for an accident and health policy? Insurance with other insurers Reinstatement Grace period Incontestable - Answer- insurance with other insurers A health insurer may exclude medical coverage for any claims that result from skydiving snow-skiing off-highway vehicle riding snowmobiling - Answer- skydiving T calls to file a claim on his health insurance policy. Within how many days must the insurer provide T's proof of loss forms? 15 days 20 days 10 days 30 days - Answer- 15 days When an employee's coverage terminates under a group health policy, the employee must be offered continuation coverage for 18 months 180 days 60 days 365 days - Answer- 18 months Which of the following coverage exclusions or limitations is permitted under a long-term care policy issued in Colorado? Alzheimer's disease Preexisting conditions Senile dementia Parkinson's disease - Answer- pre-existing conditions All accident and health policies issued in Colorado that provide major medical services must offer policyholders the opportunity to purchase supplemental coverage home health care coverage double indemnity coverage disability coverage - Answer- home health care coverage The primary difference between the Colorado Partnership LTC policy and other LTC policies is longer lifetime benefits Medicaid asset protection higher daily benefits optional inflation protection - Answer- medical asset protection An insurer can deny a claim under a long-term care insurance policy for any material misrepresentation made by the insured if it has been in effect for fewer than 6 months no more than 2 years at least 1 year more than 6 months - Answer- fewer than 6 months Which of the following documents are NOT required to mention the Colorado Fraud Statute? Claim forms Certificates of authority Policies Applications - Answer- certificates of authority If an insurer is authorized to conduct busines [Show Less]
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Colorado Accident and Health General State Exam Simulator Questions and Answers 2023
Which of the following statements about Health Reimbursement Arrangements (HRA) is correct? - Answer- If the employee paid for qualified medical expenses, ... [Show More] the reimbursements may be tax free. Which parts of a health insurance policy are guaranteed to be true? - Answer- warranty What is usually excluded from medical expense policies? - Answer- Intentionally self-inflicted injuries insurable interest only needs to exist at the time of application. - Answer- F Blue Cross/Blue Shield - Answer- non-profit organizations reimbursement of benefits for the treatment of a beneficiary's injures caused by a third party? - Answer- subrogation is the right for an insurer to purse a third party the caused an insurance loss to the insured accident policy will most likely pay a benefit for an - Answer- off-the-job-accident deductibles are used in health policies to lower - Answer- coinsurance amount must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds - Answer- guaranteed renewable dental care indemnity coverage - Answer- services are reimbursed after insurer receives the invoice agent authority - Answer- express, implied, and apparent document NOT required to mention the Colorado fraud statute - Answer- certificates of authority which of these arrangements allows one to bypass insurable interest laws? - Answer- investor-originated life insurance sometimes called stranger originated life insurance is used to circumvent state insurable interest statutes. all of the following are considered to be typical characteristics describing nature of an insurance contract except - Answer- bilateral (unilateral, aleatory, and adhesion are all characteristics of insurance contract) surgeon's fees are not - Answer- covered under hospitalization expense policy after an insured gives notice of loss what must be done if the insurer does not furnish forms? - Answer- file written proof of loss medicare is interned for all of the following groups except - Answer- those enrolled as full-time students disability income policy the ___ acts as a deductible clause - Answer- deductible period the elimination period serves as the deductible - Answer- in a disability income policy a characteristic of preferred provider organizations (PPOs) - Answer- discounted fees for the patient. feed are discounted in return for using listed providers the primary difference between the Colorado partnership LTC policy and the other LTC policies are - Answer- medicaid assest protection single premium is not used by - Answer- health insurance policies 45 days from the reinstatement application date the insurance comply has to notify the person - Answer- of the denial before the policy will be automatically placed back in force t. became disabled due to a fire t set insurer found out after the company began making monthly benefit payments the insurer will then - Answer- rescind the policy, deny the claim, and recover all payments made accidental death and dismemberment insurance beneficiary requires consent when a change of beneficiary is made? - Answer- irrevocable beneficiary an insured should submit the claim in any form if the insurer - Answer- does not send the claims forms within the time period set forth in a health policy's claims forms provision reinstatement - Answer- coverage may be restored under the reinstatement provision a policy owners rights are limited under which beneficiary designation? - Answer- irrevocable irrevocable - Answer- beneficiary designation requires that consent and signature of that named beneficiary before a change of beneficiary occurs 2 years to contest information provided on an A&H app beings on the date - Answer- insurer dates the policy grace period provision minimum days is - Answer- 31 pre-exisiting condition - Answer- 6 months the intent of a coinsurance clause in a major medical policy is - Answer- discourages over utilization of the insurance coverage the premiums may increase at time of renewal - Answer- conditionally renewable health insurance policy information obtained from a phone conversation to the proposed insured can be found on the - Answer- inspection reports irrevocable designation may not be changed without the - Answer- written consent of the beneficiary insuring clause - Answer- identifies which losses resulting from an accident or sickness are insured by the policy Guaranteed Renewable - Answer- policy must be renewed as long as the premiums are paid until the insured reaches a specified age Medicare - Answer- part A covers hospitalization , part B covers doctor's services coverage will be contingent upon the insurer's underwriting policies - Answer- if the producer completes app social security does not provide benefits for - Answer- dismemberment a health insurance contract is valid only if the insured provides - Answer- consideration Accidental Bodily Injury - Answer- less restrictive Accidental means - Answer- more restrictive internal limit - Answer- this policy will only pay for a semi-private room insurer must wait 60 days after written proof of loss before - Answer- legal action can be brought against the company an insurer can deny a claim under a long-term care insurance policy for any material misrepresentation made by the insured if it has been in effect for less than - Answer- 6 months major medical expense plans have a - Answer- one year benefit period Benefits Payable under disability buy-out policy are paid to the - Answer- company or another shareholder common accident deductible provision states - Answer- that should more than one family member be involved in a common accident, or suffer the same illness, only one individual deductible amount shall be applied if a policy-owner covered under a A&H policy wanted to ensure the policy will continue if the ever become totally disabled, they would want to add a - Answer- waiver of premium rider the waiver of premium provision in a health insurance contract suspends the insurer's right to - Answer- receive premiums during a covered period of disability residual disability benefit - Answer- is usually a percentage of the total disability benefit for periods when the insured is unable to perform some of the duties of occupation. health reimbursement arrangement - Answer- are employer established benefit plans that must be funded by the employer payment of claims is considered a mandatory pr [Show Less]
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Life Insurance Ch. 3 - Life Policies & Life Provisions Questions and Answers
When a life insurance policy exceeds certain IRS table values, the result would create which of the following? A. 1035 Exchange B. An investment C. M... [Show More] odified Endowment Contract (MEC) D. Endowment - Answer- C. Modified Endowment Contract (MEC) What kind of life insurance product covers children under their parent's policy? A. Family Maintenance rider B. Term rider C. Family Income rider D. Payor benefit - Answer- B. Term Rider Variable Whole Life Insurance can be described as A. both an insurance and securities product B. an insurance product only C. a securities product only D. the insurance company assumes the investment risk - Answer- A. both an insurance and securities product When is the face amount paid under a Joint Life and Survivor policy? A. when policy reaches maturation B. upon death of the first insured C. upon death of the last insured D. when one of the insureds becomes disabled and no longer able to make premium payments - Answer- C. upon death of last insured K is looking to purchase Renewable Term insurance. Which of these types of Term insurance may be renewable?. A. Increasing B. Decreasing C. Adjustable D. Level - Answer- D. Level F needs life insurance that provides coverage for only a limited amount of time with a death benefit that changes regularly according to a schedule. What kind of policy is needed? A. Level term policy B. Whole life policy C. Limited-pay policy D. Decreasing term policy - Answer- D. Decreasing term policy What type of policy would offer a 40-year old the quickest accumulation of cash value? A. Paid-up at 65 B. 20-pay life C. 30-pay life D. Straight whole life - Answer- B. 20-pay life Which type of life policy contains a monthly mortality charge as well as self-directed investment choices? A. Joint Life B. Adjustable Life C. Variable Universal Life D. Universal Life - Answer- C. Variable Universal Life Which of these types of life insurance allows the policyowner to have level premiums and to also choose from a selection of investment options? A. Modified Whole Life B. Variable Life C. Universal Life D. Adjustable Life - Answer- B. Variable Life A Family Income Policy is a combination of Whole Life and A. Decreasing Term insurance B. Level Term insurance C. Deposit Term insurance D. Increasing Term insurance - Answer- A. Decreasing Term insurance Life insurance that covers an insured's whole life with level premiums paid over a limited time is called A. Adjustable Life B. Renewable Term C. Limited Pay Life D. Joint Life - Answer- C. Limited Pay Life What type of life policy covers two people and pays upon the death of the last insured? A. Shared B. Survivorship C. Adjustable D. Joint - Answer- B. Survivorship What kind of life insurance starts out as temporary coverage but can be later modified to permanent coverage without evidence of insurability? A. Endowment policy B. Limited-Pay Whole life C. Convertible Term D. Decreasing Term - Answer- C. Convertible Term L, aged 50, and L's spouse, 48, have one natural child and one adopted child. They purchase a Family Policy that covers L's spouse to age 65. A death benefit will NOT be paid in which of the following circumstances? A. L's spouse dies at age 62. B. L's spouse dies at age 66. C. Their natural child dies at age 18. D. Their adopted child dies at age 18. - Answer- B. L's spouse dies at age 66 When a policyowner exchanges a term policy for a whole life policy without providing proof of good health, which of these apply? A. Extended term option B. Conversion provision C. 1035 Exchange D. Incontestable period - Answer- B. Conversion provision A life policy with a death benefit that can fluctuate according to the performance of its underlying investment portfolio is referred to as A. Adjustable Life B. Graded-Premium Life C. Variable Life D. Modified Whole Life - Answer- C. Variable Life S is close to retiring and would like to purchase a policy that will yield greater gains than bonds, but will still protect the principal with a minimum level or risk. Which product would S be advised to purchase? A. Equity index insurance B. Endowment C. Graded whole life policy D. Return of premium policy - Answer- A. Equity index insurance A potential client, age 40, would like to purchase a Whole Life policy that will accumulate cash value at a faster rate in the early years of the policy. Which of these statements made by the producer would be correct? A. Straight life accumulates faster than Limited-pay Life B. 20-Pay Life accumulates cash value faster than Straight Life C. Cash value accumulation of both 20-Pay Life and Straight Life depend on the insurer's financial rating D. 20-Pay Life and Straight Life accumulate cash value at the same rate - Answer- B. 20-Pay Life accumulates cash value faster than Straight Life Which policy requires an agent to register with the National Association of Securities Dealers (NASD) before selling? A. Variable Life B. Credit Life C. Universal Life D. Interest-Sensitive Whole Life - Answer- A. Variable Life A variable insurance policy A. guarantees a minimum rate of return B. does not allow the policyowner to assume the investment risk C. does not guarantee a return on its investment accounts D. does not guarantee an assignment provision - Answer- C. does not guarantee a return on its investment accounts What type of life insurance incorporates flexible premiums and an adjustable death benefit? A. Endowment Policy B. Modified Whole Life C. Decreasing Term D. Universal Life - Answer- D. Universal Life P is looking to purchase a life insurance policy that will pay a stated monthly income to his beneficiaries for 20 years after he dies and a lump sum of $20,000 at the end of that 20 year period. What type of policy should P purchase? A. Family Benefit policy B. Family Maintenance policy C. Family Income policy D. Family Survivor policy - Answer- B. Family Maintenance policy K pays on a $20,000 20-Year Endowment policy for 10 years and dies from an automobile accident. How much will the insurance company pay the beneficiary? A. Return of premiums paid B. Cash value plus interest C. $20,000 death benefit D. Face amount plus interest - Answer- C. $20,000 death benefit Which of these statements describe a Modified Endowment Contract (MEC)? A. Falls below the minimum amount of premium that can be paid into a policy and still have it recognized as a life insurance contract B. Exceeds the maximum amount of premium that can be paid into a policy and still have it recognized as a life insurance contract C. The 7-pay test is used to determine the minimum death benefit of the policy D. The 7-pay test is used to determine the maximum death benefit of the policy - Answer- B. Exceeds the maximum amount of premium that can be paid into a policy and still have it recognized as a life insurance contract What type of life insurance are credit policies issued as? A. Whole B. Variable C. Term D. Universal - Answer- C. Term Which provision allows the policyowner to change a term life policy to a permanent one without providing proof of good health? A. Modification B. Conversion C. Exchange D. Adjustable - Answer- B. Conversion What kind of life policy either pays the face value upon the death of the insured or when the insured reaches age 100? A. Term Life B. Whole Life C. Credit Life D. Universal Life - Answer- B. Whole Life D needs life insurance that provides coverage for only a limited amount of time while also paying the lowest possible premium. What kind of policy is needed? A. Limited-pay life B. Graded Premium C. Level term D. Endowment - Answer- C. Level Term Which statement is correct regarding the premium payment schedule for whole life policies? A. Premiums are payable throughout the insured's lifetime/ coverage lasts until death of the insured B. Premiums are payable for a set period/ coverage expires at that point C. Premiums are payable until age 65/ coverage lasts a lifetime D. A single premium is paid at time of application/ coverage lasts until retirement - Answer- A. Premiums are payable throughout the insured's lifetime/ coverage lasts until death of the insured Which type of policy is considered to be overfunded, as stated by IRS guidelines? A. Modified Whole Life B. Modified Endowment Contract C. Variable Universal Life D. Interest-Sensitive Whole Life - Answer- B. Modified Endowment Contract Under a Renewable Term policy, A. the face amount is automatically adjusted at the time of renewal B. evidence of insurability must be provided at each renewal C. the renewal premium is calculated on the basis of the insured's attained age D. a new application must be completed at each renewal - Answer- C. the renewal premium is calculated on the basis of the insured's attained age Which is true concerning a Variable Universal Life policy? A. Policyowner controls where the investment will go and selects the amount of the premium payment B. Policyowner has no say where the investment will go but can choose the premium mode C. The investment vehicle for this type of policy is held in the insurer's general portfolio D. The death benefit can vary but the policyowner has no say in the premium amount paid - Answer- A. Policyowner controls where the investment will go and selects the amount of the premium payment When is the face amount of a Whole Life policy paid? A. At the policy's maturity date only B. When the insured dies or at the policy's maturity date, whichever happens first C. Only when the insured dies D. When the policy is surrendered - Answer- B. When the insured dies or at the policy's maturity date, whichever happens first Which of these would be considered a Limited-Pay Life policy? A. 10-year Renewable and Convertible Term B. Life Paid-Up at Age 70 C. Straight Whole Life D. Renewable Term to Age 100 - Answer- B. Life Paid-Up at Age 70 A Limited-Pay Life policy has A. graded death benefits B. no cash value C. premium payments limited to a specified number of years D. premium payments that are paid to age 100 - Answer- C. premium payments limited to a specified number of years The Consideration clause in a life insurance contract contains what pertinent information? A. Summary of benefits B. Offer and acceptance C. Entire Contract D. Amount of premium payments and when they are due - Answer- D. Amount of premium payments and when they are due Whose life is covered on a life insurance policy that contains a payor benefit clause? A. Parent B. Beneficiary C. Child D. Spouse - Answer- C. Child The Accidental Death and Dismemberment (AD&D) provision in a life insurance policy would pay additional b [Show Less]
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Colorado Life & Health Insurance State Law Supplement Practice Exam with complete solutions
What is the maximum amount the commissioner can fine an insurer for each violation of a cease-and-desist order? - Answer- $10,000 When appropriate the c... [Show More] ommissioner reports a violation of insurance law to - Answer- The district attorney A company that has not been authorized to operate in Colorado is known as - Answer- A nonadmitted insurer An insurer that terminates the producers appointment must inform the commissioner within how many days? - Answer- 30 All of the following are duties of the commissioner except: a. keeping records of the insurers that he has examined b. adopting rules and regulations c. writing insurance laws d. submitting an annual report to the General assembly - Answer- See. Writing insurance laws When an insurer terminates a producer's appointment, the insurer must notify - Answer- The commissioner and producer An insurance producer who solicits insurance on behalf of an insurer represents the - Answer- Insurer The commissioner may... - Answer- Conduct investigations and subpoena witnesses whenever he deems it necessary The commissioner gives approval to an insurer to do business in Colorado in a certificate of - Answer- Authority In Colorado all of the following are considered unfair trade practices except: a. Misrepresentation b. Rebating c.. Replacement D. Coercion - Answer- C. Replacement All of the following are violations of Colorado insurance law except: a. Charging individuals of the same class different premium rates b. Offering tickets to a football game as an incentive to purchase a policy c. In forming a new policy holder that his new policy, if lapsed for nonpayment of premium, could be reinstated upon reapplication d. Having an arrangement to sell stock to a person contingent upon the purchase of an annuity - Answer- C. In forming a new policy holder that his new policy, if lapsed for nonpayment of premium, could be reinstated upon reapplication All of the following insurance practices are illegal in Colorado except: A. Soliciting or procuring insurance without a license B. Paying a fee for services as an insurance producer to anyone who is not properly licensed C. Inquiring about an applicant sexual orientation in connection with an application D. Replacing one life insurance policy with another - Answer- D. Replacing one life insurance policy with another How many hours of continuing education must be in courses associated with the lines of insurance for which the producer is licensed? - Answer- 18 All of the following are examples of unfair claims settlement practices except: A. Paying the claim without conducting an investigation B. Denying a claim promptly but without explaining the coverage or laws on which the denial is based C. Paying a claim promptly but without explaining the coverage or laws on which the payment is based D. Denying the claim without making an investigation - Answer- A. Paying a claim without conducting an investigation A producer has how many days to file a written appeal to the commissioner after he has been terminated by his appointing insurer? - Answer- 30 A fraternal benefit society representative need not be licensed as a producer if he sells life insurance with the face amount equal to or less than: - Answer- 50,000 To be licensed to sell life, accident and health insurance in Colorado, and applicant must complete: - Answer- 100 hours of pre-licensing education A fiduciary responsibility is defined as: - Answer- A relationship of special trust and confidence when a person is entrusted with another's funds A producer who has to write a majority of his insurance business on the employees and officers of a restaurant owned by his wife is transacting: - Answer- Controlled business Circulation of a maliciously critical statement about an insurer's financial condition to damage the insurer's reputation or business is called: - Answer- Defamation In general, people who represent fraternal benefit society's to solicit insurance are: - Answer- Considered insurance producers and must meet all licensing requirements How must insurance producers account for each insurance policy and the premiums they receive on it? - Answer- As a separate account of the insured Suppose a producer helps a client set up an estate plan, which is not part of the producers usual service. The producer can charge a fee for this service if all of the following circumstances are in place except: A. When it is clear from the beginning that no sale of an insurance product is related to the service B. When the client signs the disclosure statement which stipulates that he is not obligated to buy insurance from the producer in exchange for the service C. When the producer always planned to sell insurance to the client D. When the financial service is beyond the producers normal duties - Answer- C. When the producer always planned to sell insurance to the client Which of the following policy holders may request that the commissioner examine an insurer because they fear the insurer is unsound or insolvent? - Answer- At least five policyholders that have at least $100,000 insurance in force and to have specified their concerns in writing To be valid, a group life insurance policy: - Answer- May not be issued to a group formed solely for the purpose of obtaining insurance. The usual free look period For life insurance policy that is not delivered as a replacement policy is how many days? - Answer- 15 A group life policy is incontestable (except for nonpayment of premium) once it has been in effect for: - Answer- 2 Years A group life insurance policy holder must be given a grace period for premium payment of how many days? - Answer- 31 Which of the following statements regarding the notice regarding replacement of life insurance is correct: - Answer- C. A copy of the notice must be signed by the applicant and submitted with the application. Which of the following potential insurance sales would be subject to replacement regulations? - Answer- B. A new policy that causes an existing life insurance policy to be surrendered. If the producer office to refund part of a prospects premium in exchange for the purchase of a life insurance policy, the producer is committing the illegal act of: - Answer- Rebating Which of the following is not a problem when existing life insurance is replaced with new coverage? - Answer- B. Comprehensive coverage may increase under the new policy. When an employee's coverage terminates under a group health policy, the employee must be offered continuation coverage for: - Answer- 18 months Accident and health policies that provide coverage on an expense incurred basis for a family member of the insured: - Answer- Must cover a newborn child from the moment of birth An individual accident and health policy whose premiums are paid on a quarterly basis, without any subsidy assistance, must contain a grace period of at least how many days? - Answer- 31 Which of the following coverage exclusions or limitations is permitted under a long-term care policy issued in Colorado? A. Pre-existing conditions B. Alzheimer's disease C. Senile dementia D. Parkinson's disease - Answer- Pre-existing conditions All accident and health policies issued in Colorado they provide a major medical services must offer policyholders the opportunity to purchase: a. Disability coverage B. Double indemnity coverage C. Home health care coverage D. Supplemental coverage - Answer- C. Home health care coverage Which of the following is not considered an essential health benefit? A. Emergency services B. Long term care services C. Maternity and newborn care D. Prescription drugs - Answer- B. Long-term care services An insurer providing group health coverage may not be required to issue a converted policy to: - Answer- Anyone covered by Medicare Which of the following statements about a Medicare supplement policy is correct: a. The insurer may cancel it on the grounds of the insured's health status alone. B. The insurer may cancel it because the insured has not paid the premiums C. It can indemnify against losses resulting from sickness on a different bases from claims resulting from accidents D. The insurer may cancel it on the grounds of the insured's geographic location - Answer- B. The insurer may cancel it because the insured has not paid the premiums An insurance policy that increases benefits to keep up with anticipated cost increases for long-term care services is said to have: - Answer- Inflation protection How often must an individual accident and health insurance policy pay for the mammograms of a 56-year-old Colorado woman? - Answer- Once every year Suppose that an insurance producer urges an elderly applicant to buy a second Medicare supplement policy just to be sure our potential medical expenses are covered. This sale is: - Answer- Prohibited because the sale of a supplement which will provide a person with more than one Medicare supplement is illegal Long-term care policies can limit or exclude coverage for all of the following circumstances except: A. Pre-existing conditions or diseases B. Family history of heart condition before the effective date of coverage C. Treatment provided in a government facility which is not required by law D. Services provided by a member of the insured's family - Answer- Family history of heart condition before the effective date of coverage What accident and health insurance renewability clause means the insurer cannot unilaterally change any provision what the policy is in force that can change premium rate my class? - Answer- Guaranteed renewable The primary difference between the Colorado partnership LTC policy and other LTC policy is is: - Answer- Medicaid asset protection If an individual collected $100,000 in benefits from her Colorado partnership LTC policy, how much asset protection will she receive? - Answer- $100,000 or 100% How many days is the free look period For a p [Show Less]
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