NMLAHIP - New Mexico Life Accident and Health Insurance Producer

Question 21: A health policy includes a rider excusing the policyowner from paying further premiums once the insured has remained totally disabled beyond a stated qualifying period, keeping the coverage fully in force without requiring any payment while the qualifying disability continues. Which rider does this describe?

The guaranteed insurability rider

The future increase option rider

The waiver of premium rider

The impairment rider

Question 22: A closely held corporation applies for a disability income policy insuring one of its founding partners, pays every premium itself, and names itself as the sole beneficiary of any benefit paid. From whose insurable interest is this policy properly underwritten?

The partner's own personal insurable interest

The partner's spouse's insurable interest

A creditor's interest in the corporation's assets

The corporation's interest in the partner's skills

Question 23: A health policy contains a provision stating that any term conflicting with the minimum legal requirements of the state where the insured resides on the policy's effective date is automatically amended to meet those minimum standards, without the policyowner needing to request any change. Which provision describes this automatic amendment?

Conformity with state statutes

The entire contract provision

The legal actions provision

The illegal occupation provision

Question 24: An insurer calculates the maximum disability benefit it will issue to an applicant by adding the benefits in force under other individual policies and any group or government disability benefits the applicant could receive, then compares that total against a percentage of income. What is this practice designed to prevent?

Fraudulent misstatement of the applicant's occupation

The insured profiting more disabled than working

Lapses caused by missed premium payments

Adverse selection against nonsmoker premium rates

Question 25: A disability income policy specifies that once an insured becomes totally disabled, a stretch of consecutive days must pass with the disability continuing before any benefit payments begin, functioning much like a deductible measured in time rather than dollars. Which feature does this describe?

The probationary period

The benefit period

The elimination period

The grace period

Question 26: A disability income policy pays benefits under the own occupation standard for the first two years of a claim, then requires the insured to satisfy the stricter any occupation standard for benefits to continue for the remainder of the claim. Which type of total disability definition does this describe?

A pure own occupation definition

A pure any occupation definition

A residual disability definition

A modified, split total disability definition

Question 27: A health policy sets a minimum waiting period after proof of loss is furnished before a claimant may sue the insurer over a disputed claim, and sets an outer deadline, measured from when proof was required, after which no such lawsuit may be started. Which provision creates both limits?

The legal actions provision

The proof of loss provision

The time limit on certain defenses

The conformity with statutes provision

Question 28: A health insurance policy specifies how quickly the insurer must pay benefits once it has received written proof of loss, requiring immediate payment for most claims and at least monthly payment for claims involving ongoing periodic benefits. Which mandatory provision sets this payment timing standard?

The payment of claims provision

The time of payment of claims provision

The proof of loss provision

The legal actions provision

Question 29: Following an injury, an insured returns to work but can perform only some of the important duties of the regular occupation, resulting in reduced but not eliminated work capacity. Which disability classification best fits this insured's situation under a typical individual disability income policy?

Total disability under any occupation

Presumptive disability from dismemberment

Partial disability

Recurrent disability from the same cause

Question 30: An accidental death and dismemberment policy pays the principal sum if the insured dies in a covered accident, but pays only a stated fraction, called the capital sum, if the insured survives but loses a hand, a foot, or the sight of one eye. What does the capital sum represent?

The same full amount paid on death

A monthly income replacement benefit

A refund of premiums already paid

A scheduled fraction of the principal sum

Question 31: A producer explains to an applicant that choosing the own occupation definition of total disability, rather than the any occupation definition, will make the policy more expensive for a comparable benefit amount. Why does the own occupation standard typically cost more?

It is easier for insureds to satisfy

It requires a longer elimination period

It excludes sickness claims entirely

It pays a smaller monthly benefit

Question 32: After returning to work in a reduced capacity following a covered illness, an insured continues to earn less than before becoming disabled, and the policy pays a benefit proportional to the percentage of income actually lost rather than a flat amount. Which disability benefit design does this describe?

Partial disability benefit

Residual disability benefit

Presumptive disability benefit

Waiver of premium benefit

Question 33: An insured unknowingly holds two overlapping health policies issued by the very same insurer, and once the duplication is discovered, the insurer caps its total liability at a stated maximum amount rather than paying the full benefit under each policy, refunding any excess premium collected. Which optional provision applies here?

Insurance with other insurers

Coordination of benefits

Other insurance in this insurer

Relation of earnings to insurance

Question 34: An insured's total disability income benefits across several policies would, if fully paid, exceed the actual monthly earnings the insured received before becoming disabled, so the insurer invokes a provision to reduce benefits proportionally and refund the excess premium rather than allow a profit from disability. Which provision is this?

Other insurance in this insurer

Coordination of benefits

Time limit on certain defenses

Relation of earnings to insurance

Question 35: Before a disability income policy will begin paying any benefit, the insured must satisfy a defined event, such as meeting the policy's definition of total disability and completing the required waiting period, and only then does the insurer's payment obligation actually activate. Which concept describes this activating requirement?

The benefit trigger

The consideration clause

The insuring clause

The free look provision

Question 36: An insured who works a desk job at issue later takes a more hazardous occupation, and the disability income policy allows the insurer to adjust the premium or the benefit amount to reflect the new occupational risk rather than voiding the contract outright. Which provision permits this adjustment?

The waiver of premium provision

The change of occupation clause

The probationary period provision

The presumptive disability provision

Question 37: A disability income policy contains a provision reducing its monthly benefit, dollar for dollar up to a stated limit, by any monthly Social Security disability benefit the insured also receives for the same disability. What is this coordination provision commonly called?

An elimination period provision

A probationary period provision

A Social Security offset, or integration, provision

A future increase option provision

Question 38: A major medical plan limits how much an insured must contribute under coinsurance to a specified dollar figure, and once the insured's coinsurance payments reach that figure, the insurer begins paying covered expenses at a higher percentage or in full for the remainder. Which feature does this describe?

The deductible

The copayment

The elimination period

The stop-loss limit

Question 39: An insured who suffers a job related injury already receives weekly indemnity payments through a workers compensation claim, and the disability income policy reduces its own monthly benefit by the amount of those workers compensation payments. What is the purpose of this reduction?

To prevent duplicate payment for one disability

To punish the insured for claiming

To shorten the policy's elimination period

To convert the claim to group

Question 40: While a disability claim remains open, a health insurer wants the right, at its own expense, to have the insured examined by a physician as often as reasonably necessary, and in the event of death, to request an autopsy where law permits it. Which mandatory provision grants these rights?

The proof of loss provision

The physical examination and autopsy provision

The notice of claim provision

The legal actions provision

NMLAHIP New Mexico Life Accident and Health Insurance Producer - Set 4 - Part 2

Question 22: A closely held corporation applies for a disability income policy insuring one of its founding partners, pays every premium itself, and names itself as the sole beneficiary of any benefit paid. From whose insurable interest is this policy properly underwritten?

Question 27: A health policy sets a minimum waiting period after proof of loss is furnished before a claimant may sue the insurer over a disputed claim, and sets an outer deadline, measured from when proof was required, after which no such lawsuit may be started. Which provision creates both limits?

Question 30: An accidental death and dismemberment policy pays the principal sum if the insured dies in a covered accident, but pays only a stated fraction, called the capital sum, if the insured survives but loses a hand, a foot, or the sight of one eye. What does the capital sum represent?

Question 31: A producer explains to an applicant that choosing the own occupation definition of total disability, rather than the any occupation definition, will make the policy more expensive for a comparable benefit amount. Why does the own occupation standard typically cost more?

Question 37: A disability income policy contains a provision reducing its monthly benefit, dollar for dollar up to a stated limit, by any monthly Social Security disability benefit the insured also receives for the same disability. What is this coordination provision commonly called?

Question 39: An insured who suffers a job related injury already receives weekly indemnity payments through a workers compensation claim, and the disability income policy reduces its own monthly benefit by the amount of those workers compensation payments. What is the purpose of this reduction?

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