Kentucky Health Insurance Exam (New 2024/ 2025 Update) Questions and Verified Answers| 100 % Correct| Grade A
QUESTION
The Medical Information
... [Show More] Bureau (MIB) was created to protect
1. Insureds from unreasonable underwriting requirements by the insurance companies.
2. Medical examiners that perform insurance physical examinations.
3. Insurance companies from adverse selection by high risk persons.
4. Insurance departments from lawsuits by policyowners.
Answer:
Insurance compa- nies from adverse selection by high risk persons.
QUESTION
What term is used to describe when the medical caregiver provides ser- vices to only members or subscribers of a health organization, and contrac- tually is not allowed to treat other patients?
1. Closed panel
2. Corridor
3. Probationary
4. Open panel
Answer:
Closed panel
QUESTION
In insurance, an offer is usually made when
1. The insurer approves the application and receives the initial premium.
2. The agent hands the policy to the policyholder.
3. An agent explains a policy to a potential applicant.
4. An applicant submits an application to the insurer.
Answer:
An applicant submits an application to the insurer.
QUESTION
What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided?
1. Policy Request
2. Insurance Request Form
3. Request for Insurance
4. Application
Answer:
Application
QUESTION
All of the following are correct about the required provisions of a health insurance policy EXCEPT
1. A reinstated policy provides immediate coverage for an illness.
2. Proof-of-loss forms must be sent to the insured within 15 days of notice of claim.
3. A grace period of 31 days is found in an annual pay policy.
4. The entire contract clause means the signed application, policy, endorse- ments, and attachments constitute the entire contract.
Answer:
A reinstated policy provides immediate coverage for an illness.
QUESTION
A hearing may be held when requested in writing, when required by the
Insurance Code, or when
1. An insurance company feels it should be required.
2. A foreign insurance company is involved.
3. The Commissioner finds it necessary.
4. The Governor feels it would be beneficial.
Answer:
The Commissioner finds it neces- sary.
QUESTION
Most LTC plans have which of the following features?
1. Variable premiums
2. Open enrollment
3. Guaranteed renewability
4. No elimination period
Answer:
Guaranteed renewability
QUESTION
An insured has medical insurance coverage through 2 different providers, both covering the same expenses on an expense-incurred basis. Neither
company knows in advance that the insured has coverage through any other insurers. The insured submits a claim to both insurers. How should the claim be handled?
1. Each insurer should pay a proportionate share of the claim.
2. One of the insurers will pay fully, while the other will not pay any benefits.
3. Once the insurers discover the duplicate coverage, the policies would most likely be cancelled, and no claim paid.
4. The insured should receive full benefits from each insurer.
Answer:
Each insurer should pay a proportionate share of the claim.
QUESTION
What is the purpose of a conditional receipt?
1. It is given only to applicants who fully prepay the premium.
2. It is intended to provide coverage on a date prior to the policy issue.
3. It guarantees that a policy will be issued in the amount applied for.
4. It serves as proof that the applicant has been determined insurable.
Answer:
It is intended to provide coverage on a date prior to the policy issue.
QUESTION
Rose bought three policies from the same insurer. Her benefits have exceeded the maximum allowed by the insurer. Which of the following will happen?
1. Full distribution of each policy's benefit
2. Termination of two of the policies
3. Termination of all of the policies
4. Pro rata benefit reduction
Answer:
Pro rata benefit reduction
QUESTION
For an individual who is eligible for Medicare at age 65, and who is still employed and covered under the employer's plan, which of the following is true?
1. The employer plan is discontinued, and Medicare is primary coverage.
2. The employer plan continues, and Medicare is not available until the individ- ual is retired.
3. The employer plan is primary coverage, and Medicare is secondary cover- age.
4. The employer plan is secondary coverage, and Medicare is primary cover- age.
Answer:
The employer plan is primary coverage, and Medicare is secondary coverage.
QUESTION
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
1. A statement from the insured's employer showing that the insured was unable to work.
2. An estimate of the total amount of medical and hospital expense for the loss.
3. A complete physician's statement.
4. A statement that is sufficiently clear to identify the insured and the nature of the claim.
Answer:
A statement that is sufficiently clear to identify the insured and the nature of the claim.
QUESTION
Any occupation disability typically means that individuals are unable to perform the duties of the occupation for which they are suited by all of the following EXCEPT
1. Training.
2. Experience.
3. Preference.
4. Education [Show Less]