MLAHP - Minnesota Life Accident and Health Producer Exam

Question 21: A worker leaves a company that employs forty people and elects to stay on the employer's group health plan. Which statement correctly describes what he must pay and how long the continued coverage may last for this qualifying event?

Half the premium, up to thirty-six months

Employer share only, up to twelve months

Entire premium, up to eighteen months

Entire premium, for life

Question 22: A department manager is dismissed after the company documents repeated theft from its warehouse. He asks the human resources office to let him continue his group health coverage under the federal continuation law. Which statement correctly describes his position?

He may continue for thirty-six months

He may continue only his dental benefits

He may continue his group life insurance

Termination for gross misconduct ends the right

Question 23: An employee joins a managed care plan built around a defined network. Except for true emergencies, the plan pays nothing at all when the employee obtains care from a provider outside that network. Which type of managed care plan is this?

An exclusive provider organization

A preferred provider organization

A point-of-service plan

A comprehensive major medical policy

Question 24: The monthly amount payable under a business overhead expense policy is not chosen freely by the owner the way an individual disability benefit is. Which of the following determines how much a business overhead expense policy will pay each month?

The owner's average monthly net income

A fixed multiple of the elimination period

Sixty percent of gross business revenue

The average eligible overhead expenses incurred

Question 25: A network plan contracts with hospitals and doctors who agree to discounted fees. Members may use any provider they wish, but they pay a noticeably larger share of the bill when they go outside the network. Which arrangement is described?

A closed-panel health maintenance organization

A preferred provider organization

A flexible spending arrangement

A health reimbursement account

Question 26: During the enrollment window that follows the waiting period at her new job, an employee signs up for the group medical plan. She answers no medical questions and takes no examination, yet her coverage is issued. Which principle explains this?

Individual underwriting is merely postponed here

Coordination of benefits removes medical questions

Community rating requires accepting every applicant

Group underwriting evaluates the whole group

Question 27: Two insureds compare contracts. The first is told her rate may rise if the company raises rates for her entire class; the second is told his rate can never change. Both are told renewal is assured. Which pairing is correct?

Hers is guaranteed renewable, his noncancelable

Both hold noncancelable contracts

Hers is noncancelable, his guaranteed renewable

Both hold conditionally renewable contracts

Question 28: One paragraph near the front of a health insurance policy sets out the insurer's promise to pay benefits and identifies the type of loss that the contract will cover. Which policy provision is being described in that paragraph?

The consideration clause

The insuring clause

The free look provision

The probationary period provision

Question 29: An applicant with a chronic knee condition is otherwise a good risk. The insurer issues the policy but attaches a form removing coverage for any loss arising from that knee. Which name is given to that attached form?

A guaranteed insurability rider

A conditionally renewable clause

A future increase option

An impairment rider

Question 30: A lapsed individual health policy is put back in force under the reinstatement provision. Four days later the insured fractures a wrist in a fall and, that same afternoon, is diagnosed with a sickness that began after reinstatement. How does the reinstated contract respond to these two losses?

Both losses are covered right away

Sickness covered; injury excluded for ten days

Injury covered; sickness excluded for ten days

Neither loss is covered for ten days

Question 31: A policyowner insured under a disability income contract moves from tree trimming to an office role and notifies her insurer. She asks what the change of occupation provision does for her now that her work carries less risk. Which answer is correct?

Her rate drops and excess premium returns

Her monthly benefit is automatically increased

Her elimination period is shortened

Nothing changes until the next renewal

Question 32: A subscriber hands the receptionist fifteen dollars at every office visit, the same amount whether the doctor spends five minutes or an hour, and the plan covers the rest of the charge. Which cost-sharing item did the subscriber just pay?

The calendar year deductible

The coinsurance share

The stop-loss amount

The copayment

Question 33: A medical expense policy lists several situations in which no benefits at all will be paid, among them injuries the insured deliberately inflicts and losses arising from an act of war. Which term names this category of policy language?

Policy coinsurance terms

Eligible expense definitions

Policy exclusions

Policy copayment requirements

Question 34: After a comprehensive major medical insured satisfies her deductible, the plan pays eighty percent of each additional covered charge and she pays the remaining twenty percent until her out-of-pocket total reaches a stated ceiling. Which cost-sharing feature is this?

Coinsurance

A per cause deductible

A flat copayment

A pre-authorization requirement

Question 35: A newly hired employee's group health certificate states that sickness benefits will not be payable for any illness that first appears during the first thirty days after her coverage takes effect. Which policy feature imposes that initial delay?

The elimination period

The probationary period

The grace period

The corridor deductible

Question 36: A comprehensive plan pays for treatment of mental illness but caps the number of covered visits each year, while it refuses any payment for care received in a government facility. Which pairing correctly labels these two pieces of policy language?

Mental illness exclusion; government facility limitation

Both are exclusions from coverage

Mental illness limitation; government facility exclusion

Both are limitations on coverage

Question 37: An insured has a policy the company must renew as long as premiums are paid, although the company may raise the rate for everyone who owns that same form. Which renewal classification does this policy most likely carry?

Guaranteed renewable

Cancelable

Optionally renewable

Noncancelable

Question 38: A rider on a health policy lets the insured purchase additional amounts of coverage on stated future dates and bars the insurer from asking any medical questions at those times. Which of the following riders carries that right for the insured?

Impairment rider

Waiver of premium rider

Guaranteed insurability rider

Return of premium rider

Question 39: An older major medical contract states one ceiling on all benefits payable during the insured's lifetime, another that resets each year and a third that applies separately to each accident or sickness. Which set of terms names those three ceilings in order?

Lifetime, annual and per cause maximums

Corridor, carryover and flat maximums

Stop-loss, copayment and coinsurance maximums

Annual, lifetime and per cause maximums

Question 40: An insured is injured on June 1 and wants to start a claim under her individual health policy. The mandatory notice of claim provision sets the outside period for giving the insurer written notice of the loss. How long does she have?

Ten days

Fifteen days

Ninety days

Twenty days

MLAHP Minnesota Life Accident and Health Producer Exam - Set 4 - Part 2