QUIZ CA-LIFE-ACCIDENT-AND-HEALTH - PROFESSIONAL VALID CA LIFE, ACCIDENT AND HEALTH OR SICKNESS EXAMINATION STUDY MATERIALS

Quiz CA-Life-Accident-and-Health - Professional Valid CA Life, Accident and Health or Sickness Examination Study Materials

Quiz CA-Life-Accident-and-Health - Professional Valid CA Life, Accident and Health or Sickness Examination Study Materials

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California Department of Insurance CA Life, Accident and Health or Sickness Examination Sample Questions (Q32-Q37):

NEW QUESTION # 32
Which contract provision forgives the payment of all health or disability insurance premiums whilethe insured is disabled?

  • A. guaranteed insurability
  • B. waiver of premium
  • C. cost of living
  • D. family leave

Answer: B

Explanation:
Waiver of Premium Provision: This provision is designed to help policyholders maintain their health or disability insurance coverage even if they become disabled and unable to work.
Function: When the insured is disabled, the waiver of premium provision forgives the payment of premiums, allowing the policy to remain in force without the insured having to make further payments.
Relevance: This provision is crucial for policyholders who might otherwise lose their insurance coverage due to an inability to pay premiums during a period of disability.References: California Insurance Code Section
10271 outlines the provisions related to the waiver of premium in health and disability insurance policies.


NEW QUESTION # 33
All of the following are characteristics of adverse selection EXCEPT

  • A. insurance companies cannot discriminate against applicants who have a higher probability of loss.
  • B. people with the greatest probability of loss are the ones most likely to buy insurance.
  • C. it normally occurs if the premium is low relative to the loss exposure.
  • D. poor underwriting results may occur if too many of the applicants accepted for insurance are those most likely to incur serious losses.

Answer: A

Explanation:
Adverse selection refers to a situation where those most likely to file claims are the ones most eager to purchase insurance, which can lead to higher-than-expected loss ratios for insurers. Characteristics of adverse selection include:
* Occurring when premiums are low relative to the risk (A).
* Attracting individuals with the greatest probability of loss (B).
* Leading to poor underwriting results if many high-risk applicants are accepted (D).However, insurance companies can and do use underwriting criteria to assess and mitigate risks, meaning they can discriminate based on the probability of loss, which makes option C incorrect.


NEW QUESTION # 34
What happens if an insurer violates the Medical Loss Ratio rule and spends too much money on administrative costs?

  • A. Insurers that do not meet the Medical Loss Ratio standard will only be required to reduce their spending on administrative costs.
  • B. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Federal government, n
  • C. Insurers that do not meet the Medical Loss Ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs.
  • D. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Health Benefits Exchange.

Answer: C

Explanation:
The Medical Loss Ratio (MLR) rule requires insurers to spend a minimum percentage of premium dollars on medical care and healthcare quality improvement, rather than on administrative costs and profits. For individual and small group markets, this threshold is 80%, and for large group markets, it is 85%. If insurers fail to meet this requirement, they must provide rebates to their policyholders to ensure compliance. This ensures that a significant portion of premiums is spent on actual medical care.


NEW QUESTION # 35
For Social Security purposes, a person with 40 quarters of coverage is considered

  • A. partially insured.
  • B. conditionally insured.
  • C. fully insured.
  • D. currently insured.

Answer: C

Explanation:
For Social Security purposes, a person with 40 quarters of coverage is considered "fully insured." This status qualifies them for a range of Social Security benefits, including retirement and disability benefits, as well as survivor benefits for their dependents.


NEW QUESTION # 36
California long-term care policies may be identified as any of the following EXCEPT

  • A. Nursing Facility and Residential Care Facility only.
  • B. Acute Hospital Care only.
  • C. Comprehensive Long-Term Care.
  • D. Home Care only.

Answer: B


NEW QUESTION # 37
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