MLAHP - Minnesota Life Accident and Health Producer Exam

Question 1: An insured with accidental death and dismemberment coverage loses the sight of one eye in a car accident and survives with no other injury. Compared with the amount payable for death, what will the insurer pay for this loss?

The full principal sum

Nothing, since the insured survived

One half of it, the capital sum

Twice the monthly disability indemnity

Question 2: An HMO pays each contracted medical group a fixed monthly amount for every member assigned to it, regardless of how many office visits those members actually make during the month. Which payment method is the HMO using to compensate the group?

Capitation

Fee-for-service reimbursement

Usual, customary and reasonable payment

Scheduled benefit reimbursement

Question 3: An insured with a tax qualified long term care policy files a claim after a stroke leaves her needing daily help. Benefits generally begin once she can no longer perform how many of the six activities of daily living?

One of the six listed tasks

Four of the six listed tasks

All six of the listed tasks

Two of the six listed tasks

Question 4: A physician who owns a small practice asks how quickly a business overhead expense policy starts reimbursing continuing office costs after she becomes disabled. Which waiting time is typical for this coverage, given that fixed bills arrive within weeks of a disability?

Fifteen or thirty days

Ninety or one hundred eighty days

One or two years

Twelve months

Question 5: A worker's employer provides a basic plan with first-dollar benefits and modest limits, plus a second layer of coverage that begins paying only after those basic limits run out. Which of the following descriptions fits that second layer of protection?

Comprehensive major medical, issued stand-alone

A basic surgical expense policy

Supplemental major medical layered over basic

An exclusive provider organization arrangement

Question 6: An employee's dental plan groups covered treatments into categories, and her dentist tells her the procedure she needs treats the soft pulp at the center of a tooth. Under which category of dental treatment does a root canal fall?

Endodontics

Periodontics

Prosthodontics

Orthodontics

Question 7: An employer decides to pay the entire cost of its group health plan, so employees contribute nothing at all toward the premium. Which statement correctly describes the participation requirement that an insurer applies to a plan funded in this manner?

Seventy-five percent of eligible employees must participate

Half of eligible employees must enroll

No minimum participation level is required

All eligible employees must be covered

Question 8: After hip surgery an insured returns to his house and a visiting aide comes several times a week to change dressings and run through physical therapy exercises. Which long term care benefit is most likely paying for these visits?

Adult day care benefit

Respite care benefit

Home health care benefit

Intermediate care benefit

Question 9: An employer comparing business disability products notes that its key person contract begins paying sooner than a buyout policy but not as quickly as an overhead expense policy. Which waiting time is customary for key person disability income coverage?

Fifteen or thirty days

Thirty to ninety days

One or two years

Five months

Question 10: An applicant compares two long term care quotes that are identical except that one requires him to receive care for ninety days before payments start and the other for thirty. Which statement about the longer waiting period is correct?

It raises the annual premium sharply

It shortens the total benefit period

It lowers the premium he will pay

It removes the need for underwriting

Question 11: An employee compares her employer's group long term disability certificate with an individual policy quoted by a producer and notices the group coverage costs far less per dollar of monthly benefit. Which pair of factors explains that difference in cost?

Government subsidies and mandatory employer contributions

Guaranteed issue and lifetime benefit periods

Higher benefit amounts and shorter waits

Spread risk and generally smaller benefits

Question 12: An underwriter reviewing an application for individual disability income coverage will not issue a monthly benefit equal to the applicant's full take home pay. Which reason best explains why insurers cap the benefit at roughly 65 or 70 percent of net income?

Benefits above that level are taxable

Full income replacement encourages malingering

Elimination periods would have to lengthen

Group coverage always pays the remainder

Question 13: A producer explains to a client that her employer's disability plan states benefits one way while the individual policy she is considering states them another way. Which description correctly contrasts how group and individual disability benefits are usually expressed?

Both state a flat daily amount

Group states dollars; individual states a percentage

Group states a percentage; individual states dollars

Both are tied to net worth

Question 14: An employer offers both short term and long term disability coverage and wants the two to fit together without a gap in income for a worker who stays disabled. Which rule governs the waiting time built into the long term plan?

It matches the short term benefit period

It equals thirty days in every plan

It is waived for covered accidents

It runs one year after hire

Question 15: A policyholder with Alzheimer's disease can still bathe and dress himself but wanders from the house at night and cannot be left alone safely. Under a long term care contract, which of the following findings would allow his benefits to begin?

Loss of four activities of daily living

A prior hospital stay of three days

A physician's order for skilled nursing care

Cognitive impairment requiring supervision for his safety

Question 16: An insurer sets the renewal premium for a large employer's health plan by looking at the claims that this particular employer's covered workers actually generated over the past year. Which rating method is the insurer applying to that renewal?

Community rating

Capitation rating

Experience rating

Blanket rating

Question 17: A graduate accepts a job whose group health plan will not start for four months, so she buys a policy written to fill that gap and expects it to end on its own. Which statement correctly describes this temporary medical coverage?

It renews automatically each year thereafter

It is not renewable at term end

It must be issued without underwriting

It provides the ten essential health benefits

Question 18: An insured needs nursing services from a licensed nurse under a physician's orders, but only on an occasional basis rather than continuously through the day and night. Which level of long term care does this insured most likely require?

Intermediate care

Skilled nursing care

Respite care

Custodial care

Question 19: A daughter has cared for her mother at home for two years without a break and wants to take a week's vacation. Her mother's policy will pay for a temporary stay in a facility. Which long term care benefit applies to that stay?

Adult day care