ALAHI - Arizona Life Accident and Health Insurance Exam

Question 1: An actuary pricing an accident and health product relies on tables predicting how often insureds in a given group will become sick or injured, rather than tables predicting how often they will die. Which of the following terms describes that measure?

Mortality

Persistency

Adverse selection

Morbidity

Question 2: A health policy distinguishes between a loss arising from a sudden unforeseen external event and a loss arising from a disease that first manifests itself while coverage is in force. Which of the following terms describes those two categories?

Occupational and non occupational

Total and partial disability

Accidental injury and sickness

Presumptive and residual loss

Question 3: A newly issued health policy states that sickness first beginning during the thirty days after the effective date is not covered at all, although accidental injuries are covered from day one. Which of the following provisions creates that limitation?

Free look period

Elimination period

Grace period

Probationary period

Question 4: A disability income policyowner learns that benefits will not begin until the insured has been continuously disabled for ninety days, and that no benefit is ever paid for that initial stretch. Which of the following provisions describes this waiting requirement?

Elimination period

Benefit period

Grace period

Probationary period

Question 5: A major medical plan requires the insured to pay a stated dollar amount of covered expenses in each calendar year before the plan begins paying anything at all toward the remaining charges. Which of the following provisions describes this requirement?

A stop loss limit

A copayment schedule

A deductible

Coinsurance

Question 6: After a major medical deductible has been met, the insured and the plan divide the remaining covered charges according to a stated percentage split for the rest of the year. Which of the following provisions describes this arrangement?

Coinsurance

Preauthorization

Deductible

Stop loss provision

Question 7: A major medical plan provides that once the insured's out of pocket spending reaches a stated ceiling in a year, the plan pays covered charges in full for the rest of that year. Which of the following provisions produces this result?

The impairment rider

The deductible provision

The coinsurance provision

The stop loss provision

Question 8: A health policy states that the policy together with the attached application constitutes the whole agreement, and that no change is valid unless approved by an executive officer of the insurer. Which of the following uniform provisions is described?

Consideration clause

Legal actions provision

Entire contract provision

Time limit on certain defenses

Question 9: An insurer discovers four years after issue that a health insurance applicant misstated a medical history item, and wants to deny a claim on that basis. Which of the following uniform provisions blocks the insurer from doing so?

Notice of claim provision

Change of occupation provision

Physical examination and autopsy

Time limit on certain defenses

Question 10: A health policy provision directs the insured to inform the insurer of a loss within a stated number of days after it begins, or as soon afterward as is reasonably possible. Which of the following uniform provisions is described?

Notice of claim

Proof of loss

Claim forms

Time of payment of claims

Question 11: An insured reports a loss and the insurer fails to furnish the necessary forms within the period the policy allows, leaving the insured with no prescribed way to document the claim. Which of the following describes the insured's position?

The insured must wait indefinitely

The insured may submit written proof

The insured must sue to compel forms

The claim is automatically denied

Question 12: A health insurance provision requires the insured to submit written documentation of the extent of a loss within a stated period after the end of the period for which the insurer is liable. Which of the following provisions is described?

Proof of loss

Payment of claims

Legal actions

Notice of claim

Question 13: A health policy provision requires the insurer to pay benefits immediately upon receipt of acceptable written proof of loss, and to pay periodic indemnity benefits at the stated intervals. Which of the following uniform provisions does this describe?

Payment of claims

Grace period

Legal actions

Time of payment of claims

Question 14: A health policy bars an insured from suing the insurer until a stated period has passed after proof of loss is furnished, and also sets an outer deadline beyond which no suit may be brought. Which of the following provisions does this describe?

Time limit on certain defenses

Entire contract

Legal actions

Time of payment of claims

Question 15: A disability income insured moves from an office job to full time work as a roofer without telling the insurer, then files a claim. Which of the following describes how the change of occupation provision affects the benefit payable?

Benefits are paid in full as written

Benefits reduced to what premium purchased

The policy is rescinded from inception

The claim is denied outright

Question 16: An insurer discovers during a health claim that the insured's age was understated on the application, meaning the premium charged was lower than the correct rate. Which of the following describes the usual result under the optional misstatement of age provision?

Benefits adjusted to what premiums purchased

Benefits are paid without any adjustment

The insured pays the difference later

The policy is cancelled immediately

Question 17: A surgeon develops a hand tremor and can no longer operate, though the surgeon could still teach or consult for a living. Under one common definition the surgeon is considered totally disabled. Which of the following definitions produces that result?

Presumptive disability definition

Residual disability definition

Own occupation definition

Any occupation definition

Question 18: A disability income policy provides that total disability is automatically established, with no further proof of inability to work, upon the loss of sight in both eyes or the loss of two limbs. Which of the following provisions is described?

Residual disability

Recurrent disability

Partial disability

Presumptive disability

Question 19: A disabled insured returns to work part time and earns substantially less each month than before the disability began, and the policy pays a benefit proportionate to the earnings actually lost. Which of the following provisions produces that benefit?

Residual disability

Presumptive disability

Recurrent disability

Rehabilitation benefit

Question 20: An insured returns to work after a disability claim, then becomes disabled again from the same cause a few weeks later, and the insurer treats the second period as a continuation of the first. Which of the following provisions explains this?

Waiver of premium provision

Probationary period provision

Recurrent disability provision

Change of occupation provision

ALAHI Arizona Life Accident and Health Insurance Exam - Set 5 - Part 1

Question 1: An actuary pricing an accident and health product relies on tables predicting how often insureds in a given group will become sick or injured, rather than tables predicting how often they will die. Which of the following terms describes that measure?

Question 2: A health policy distinguishes between a loss arising from a sudden unforeseen external event and a loss arising from a disease that first manifests itself while coverage is in force. Which of the following terms describes those two categories?

Question 3: A newly issued health policy states that sickness first beginning during the thirty days after the effective date is not covered at all, although accidental injuries are covered from day one. Which of the following provisions creates that limitation?

Question 4: A disability income policyowner learns that benefits will not begin until the insured has been continuously disabled for ninety days, and that no benefit is ever paid for that initial stretch. Which of the following provisions describes this waiting requirement?

Question 5: A major medical plan requires the insured to pay a stated dollar amount of covered expenses in each calendar year before the plan begins paying anything at all toward the remaining charges. Which of the following provisions describes this requirement?

Question 6: After a major medical deductible has been met, the insured and the plan divide the remaining covered charges according to a stated percentage split for the rest of the year. Which of the following provisions describes this arrangement?

Question 7: A major medical plan provides that once the insured's out of pocket spending reaches a stated ceiling in a year, the plan pays covered charges in full for the rest of that year. Which of the following provisions produces this result?

Question 8: A health policy states that the policy together with the attached application constitutes the whole agreement, and that no change is valid unless approved by an executive officer of the insurer. Which of the following uniform provisions is described?

Question 9: An insurer discovers four years after issue that a health insurance applicant misstated a medical history item, and wants to deny a claim on that basis. Which of the following uniform provisions blocks the insurer from doing so?

Question 10: A health policy provision directs the insured to inform the insurer of a loss within a stated number of days after it begins, or as soon afterward as is reasonably possible. Which of the following uniform provisions is described?

Question 11: An insured reports a loss and the insurer fails to furnish the necessary forms within the period the policy allows, leaving the insured with no prescribed way to document the claim. Which of the following describes the insured's position?

Question 12: A health insurance provision requires the insured to submit written documentation of the extent of a loss within a stated period after the end of the period for which the insurer is liable. Which of the following provisions is described?

Question 13: A health policy provision requires the insurer to pay benefits immediately upon receipt of acceptable written proof of loss, and to pay periodic indemnity benefits at the stated intervals. Which of the following uniform provisions does this describe?

Question 14: A health policy bars an insured from suing the insurer until a stated period has passed after proof of loss is furnished, and also sets an outer deadline beyond which no suit may be brought. Which of the following provisions does this describe?

Question 15: A disability income insured moves from an office job to full time work as a roofer without telling the insurer, then files a claim. Which of the following describes how the change of occupation provision affects the benefit payable?

Question 16: An insurer discovers during a health claim that the insured's age was understated on the application, meaning the premium charged was lower than the correct rate. Which of the following describes the usual result under the optional misstatement of age provision?

Question 17: A surgeon develops a hand tremor and can no longer operate, though the surgeon could still teach or consult for a living. Under one common definition the surgeon is considered totally disabled. Which of the following definitions produces that result?

Question 18: A disability income policy provides that total disability is automatically established, with no further proof of inability to work, upon the loss of sight in both eyes or the loss of two limbs. Which of the following provisions is described?

Question 19: A disabled insured returns to work part time and earns substantially less each month than before the disability began, and the policy pays a benefit proportionate to the earnings actually lost. Which of the following provisions produces that benefit?

Question 20: An insured returns to work after a disability claim, then becomes disabled again from the same cause a few weeks later, and the insurer treats the second period as a continuation of the first. Which of the following provisions explains this?

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