Life and Health Insurance Assessment Flashcards
16 cards from real Life & Health Insurance Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 16 Life and Health Insurance Assessment flashcards as text
What is the MOST important thing for an insurance agent to think about when talking to a client about who should be the beneficiary of their life insurance plan?
Answer: Whether the insurance policy is court-ordered
When discussing beneficiaries, the most critical factor for an agent to consider is whether there's a court order, such as a divorce decree or child support order, mandating specific beneficiaries. Such orders legally supersede the policy owner's wishes and must be adhered to. Failure to comply could result in legal repercussions for the insured and the agent, making it the most important consideration.
At the moment, the Federal Insurance Office (FIO) of the U.S. Department of the Treasury has the power to:
Answer: Both United States and international insurance matters
The Federal Insurance Office (FIO) was established by the Dodd-Frank Act to monitor all aspects of the insurance industry, identify gaps in regulation, and represent the U.S. on international insurance matters. While it doesn't directly regulate insurance, it plays a significant role in both domestic and global insurance policy and oversight. Therefore, its power extends to both United States and international insurance matters.
Insurance is governed by:
Answer: States
In the United States, the insurance industry is primarily regulated at the state level, not by the federal government. Each state has its own Department of Insurance or similar regulatory body that licenses insurers and agents, approves policy forms and rates, and enforces insurance laws to protect consumers. This system is a result of the McCarran-Ferguson Act of 1945.
The legislation that rules and regulates the insurance business is known as:
Answer: Insurance Regulatory Law
The body of laws and regulations that govern the insurance business is broadly known as Insurance Regulatory Law. This encompasses statutes, administrative rules, and judicial decisions that dictate how insurance companies operate, how policies are sold, and how claims are handled, all primarily at the state level. It ensures fair practices and consumer protection within the industry.
Which of the following concerns is NOT a life insurance plan rider example?
Answer: Delayed acceptance rider
A 'delayed acceptance rider' is not a recognized life insurance plan rider. Riders are additional provisions that can be added to a life insurance policy to provide extra benefits or modify coverage, such as a waiver of premium for disability, return-of-premium, or child insurance riders. Delayed acceptance typically refers to a condition during the underwriting process, not an optional policy feature.
Which division of an insurance firm approves or denies applications and assigns risk categories?
Answer: Underwriting department
The underwriting department is responsible for evaluating insurance applications, assessing the risk presented by the applicant, and deciding whether to accept or decline coverage. They also assign risk classifications (e.g., standard, preferred, substandard) which determine the premium rates. This department ensures the insurer takes on acceptable risks and maintains financial solvency.
The 11 extra provisions that can be added to life insurance contracts are mostly restrictions on:
Answer: Insured
The '11 extra provisions' (often referring to optional provisions or riders) in life insurance contracts are primarily designed to place restrictions or conditions on the *insured* or to provide additional benefits related to the insured's circumstances. These provisions might limit coverage in certain situations (e.g., aviation exclusion) or require specific actions from the insured to maintain coverage.
Who decides which of the 11 optional life insurance provisions will be part of an insurance contract?
Answer: Insurers
While state regulations dictate what types of provisions are permissible, it is the *insurers* (insurance companies) that decide which specific optional provisions or riders they will offer as part of their life insurance contracts. They design and market these options to meet various consumer needs and competitive pressures, within the framework of state law.
A Qualified Health Plan is considered "affordable" as of January 2025 if the individual's premium contribution for the lowest priced plan does not exceed:
Answer: 9.12% of the employee’s household income
Under the Affordable Care Act (ACA), a Qualified Health Plan (QHP) is considered 'affordable' if the employee's required contribution for self-only coverage does not exceed a certain percentage of their household income. This percentage is adjusted annually. For 2025, the affordability threshold is set at 9.12% of the employee's household income, meaning if the premium exceeds this, the coverage is deemed unaffordable.
Which of the following is not one of the Affordable Care Act's 10 categories of "minimum essential coverage (MEC)":
Answer: Cosmetic surgery
The Affordable Care Act (ACA) mandates that health insurance plans cover 10 essential health benefits (EHB) to ensure comprehensive coverage, which include services like emergency care, outpatient care, and maternity care. Cosmetic surgery, however, is generally considered an elective procedure not medically necessary for basic health. Therefore, it is explicitly excluded from the ACA's essential health benefits categories.
Co-insurance is the proportion of the cost of healthcare that an insured person pays after the insured:
Answer: Meets the plan’s deductible
Co-insurance is a cost-sharing mechanism in health insurance where the insured person pays a specified percentage of the medical costs. This payment responsibility only begins after the insured has first met their plan's deductible. Before the deductible is satisfied, the insured typically pays 100% of the costs (or a co-payment for certain services), and then co-insurance applies to the remaining eligible expenses.
A person with insurance can only make changes to their plan outside of the initial enrollment period or the annual enrollment period when:
Answer: A qualifying event occurs, such as marriage, divorce, birth of child, or employment status change
Health insurance plans have specific enrollment periods (initial and annual) for making changes. Outside of these periods, individuals can only modify their plans if they experience a 'qualifying life event.' These significant life changes, such as marriage, divorce, birth of a child, or a change in employment status affecting coverage, trigger a special enrollment period, allowing for necessary adjustments to their insurance.
Which of the following suggestions would be the LEAST useful when advising customers on choosing a medical insurance plan?
Answer: Identify the insurer’s stop-loss coverage provider
When choosing a medical insurance plan, customers should prioritize factors directly impacting their out-of-pocket costs and access to care, such as deductibles, prescription coverage, and in-network providers. Identifying the insurer's stop-loss coverage provider is generally irrelevant to an individual policyholder. Stop-loss coverage is a type of insurance purchased by self-funded employers to protect themselves from catastrophic claims, not a concern for individual consumers selecting a plan.
With a high-deductible health plan (HDHP), which savings plan is most often offered?
Answer: Health Savings Account
High-deductible health plans (HDHPs) are specifically designed to be paired with Health Savings Accounts (HSAs). HSAs are tax-advantaged savings accounts that allow individuals to save and pay for qualified medical expenses. This combination enables lower monthly premiums with the benefit of tax-free contributions, growth, and withdrawals for healthcare, making them a complementary and popular choice.
Catastrophic losses are covered by major medical expense insurance if:
Answer: Basic insurance runs out
Major medical expense insurance is designed to provide coverage for significant, high-cost medical events, often referred to as catastrophic losses. This type of insurance typically acts as a secondary layer of coverage. It kicks in and begins to cover expenses only after an individual's basic health insurance benefits, which cover routine and less severe medical expenses, have been exhausted.
The deductible for John's major medical plan is $2500, and the coinsurance is divided 80/20. John gets a bill for $1000 from a provider. How much will he need to pay the provider directly?
Answer: $1,000
John's major medical plan has a deductible of $2500. A deductible is the amount an insured person must pay out-of-pocket for covered services before their insurance company starts to pay. Since John's bill for $1000 is less than his $2500 deductible, he is responsible for paying the entire $1000 directly to the provider. The co-insurance only applies to costs incurred after the deductible has been fully met.