Prepare with confidence for your Health and Accident Insurance licensing exam using this comprehensive study guide, updated for the 2024-2025 exam cycle. Designed for aspiring insurance professionals, this resource features accurate questions and detailed answers, ensuring a guaranteed pass with a proven track record of being graded A. The guide covers essential topics such as health insurance policies, accident insurance regulations, underwriting principles, claims processing, state-specific insurance laws, and ethical practices in the insurance industry. Each question is paired with a thorough explanation, providing clarity on complex concepts and helping you master the material needed to excel in your exam. Verified and updated to reflect the latest 2024-2025 standards, this study guide offers the most current and relevant content to align with industry requirements. Whether you’re aiming to obtain your insurance license or enhance your knowledge in health and accident insurance, this resource equips you with the tools to succeed. Study smarter, pass with ease, and launch your insurance career with this trusted, high-quality guide!
Preview
1. During the underwriting process for a group health policy, it was discovered that 15
out of 50 members of the group have major health issues. How would the insurer
handle this?
o a) Exclude the members with health issues
o b) Raise premiums for those with health issues
o c) Accept or reject the whole group
o d) Provide individual underwriting for each member
Answer: c) Accept or reject the whole group
o Rationale: In group health insurance, underwriting is based on the overall risk of
the group. The insurer can choose to accept or reject the group as a whole.
2. When a claim has coverage under more than one health plan, which group medical
plan provision applies?
o a) Coordination of benefits
o b) Waiver of premium
o c) Extension of benefits
o d) Coinsurance
Answer: a) Coordination of benefits
o Rationale: Coordination of benefits determines the order in which multiple
health plans will pay for claims to prevent over insurance.
3. What percentage of eligible employees must participate in a noncontributory group
health plan before it can be put in effect?
o a) 50%
o b) 75%
o c) 90%
o d) 100%
Answer: d) 100%
o Rationale: In a noncontributory plan, where the employer pays the full premium,
all eligible employees must participate.
4. Who is financially liable for the payment of covered claims in a fully insured group
health plan?
o a) The employer
o b) The employees
o c) The insurer
o d) A third-party administrator
Answer: c) The insurer
o Rationale: In a fully insured group health plan, the insurance company assumes
the financial responsibility for paying claims.
5. Buy-Sell Plans are typically funded by which two types of insurance?
o a) Life insurance and Health insurance
o b) Health insurance and Accident insurance
o c) Life insurance and Disability insurance
o d) Accident insurance and Disability insurance
Answer: c) Life insurance and Disability insurance
o Rationale: Buy-Sell Agreements are often funded by life insurance (in the event
of death) and disability insurance (in the event of a long-term disability).
out of 50 members of the group have major health issues. How would the insurer
handle this?
o a) Exclude the members with health issues
o b) Raise premiums for those with health issues
o c) Accept or reject the whole group
o d) Provide individual underwriting for each member
Answer: c) Accept or reject the whole group
o Rationale: In group health insurance, underwriting is based on the overall risk of
the group. The insurer can choose to accept or reject the group as a whole.
2. When a claim has coverage under more than one health plan, which group medical
plan provision applies?
o a) Coordination of benefits
o b) Waiver of premium
o c) Extension of benefits
o d) Coinsurance
Answer: a) Coordination of benefits
o Rationale: Coordination of benefits determines the order in which multiple
health plans will pay for claims to prevent over insurance.
3. What percentage of eligible employees must participate in a noncontributory group
health plan before it can be put in effect?
o a) 50%
o b) 75%
o c) 90%
o d) 100%
Answer: d) 100%
o Rationale: In a noncontributory plan, where the employer pays the full premium,
all eligible employees must participate.
4. Who is financially liable for the payment of covered claims in a fully insured group
health plan?
o a) The employer
o b) The employees
o c) The insurer
o d) A third-party administrator
Answer: c) The insurer
o Rationale: In a fully insured group health plan, the insurance company assumes
the financial responsibility for paying claims.
5. Buy-Sell Plans are typically funded by which two types of insurance?
o a) Life insurance and Health insurance
o b) Health insurance and Accident insurance
o c) Life insurance and Disability insurance
o d) Accident insurance and Disability insurance
Answer: c) Life insurance and Disability insurance
o Rationale: Buy-Sell Agreements are often funded by life insurance (in the event
of death) and disability insurance (in the event of a long-term disability).
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