PLAHI - Pennsylvania Life Accident and Health Insurance Exam

Question 1: A Pennsylvania individual health policyholder in Erie argues that a benefit her producer described over the telephone should be covered, even though it appears in no document. Which of the following required provisions determines what actually forms her contract?

Entire contract; changes

Conformity with state statutes

Consideration clause

Time limit on certain defenses

Question 2: A Pennsylvania insurer discovers a nonfraudulent misstatement on an individual health application forty months after the policy was issued and wants to deny a claim on that basis. Which of the following describes the insurer's position under Pennsylvania law?

It may deny; health policies never incontestable

It may deny for another two years

It may not deny; three years passed

It may deny with Commissioner approval

Question 3: Three Pennsylvania individual health policyholders pay premium on different schedules. One pays weekly, one pays monthly, and one pays quarterly, and each policy is in force. Which of the following correctly states the grace period Pennsylvania gives each of them, in that order?

Ten, twenty, and thirty days

Thirty-one days for all three

Seven, seven, and seven days

Seven, ten, and thirty-one days

Question 4: A Pennsylvania insurer requires an application and issues a conditional receipt when a lapsed health policy owner tries to reinstate the coverage. The insurer never disapproves that application in writing. Which of the following describes when reinstatement actually occurs?

Never, without written approval

Immediately upon payment of premium

Automatically on the forty-fifth day

On the next policy month's first day

Question 5: A Pennsylvania health policy is reinstated after a lapse, and the insured is injured in a fall two days later and then develops an illness eight days after that. Which of the following describes coverage for these two events?

Both are covered immediately

Neither is covered for thirty days

Only the sickness is covered

The injury is covered, not the sickness

Question 6: An insured in Lancaster suffers a covered loss under her individual health policy and wants to know how quickly she must tell the insurer that a claim is coming. Which of the following states Pennsylvania's notice of claim requirement?

Within twenty days of the loss

Within ninety days of the loss

Within one year of the loss

Before any treatment is received

Question 7: A Pennsylvania insured has given timely notice of a claim under her individual health policy and now must document the extent of her loss to the insurer. Which of the following states the period Pennsylvania allows for furnishing proof of loss?

Twenty days after the loss

Thirty days after the loss

Sixty days after the loss

Ninety days after the loss

Question 8: A Pennsylvania disability income insured furnishes acceptable written proof of a continuing disability, and the insurer reviews it and begins paying benefits. Which of the following describes how often Pennsylvania requires those periodic benefits to be paid to him?

Only at the end of the disability

At least once each calendar quarter

At least monthly

Whenever the insurer completes its review

Question 9: An individual health policy in Pennsylvania provides a death benefit, and the insured has died without any surviving named beneficiary on record with the insurer. Which of the following describes where the required provisions direct those policy proceeds?

To the insured's estate

To the Insurance Department

To the attending physician

To the producer of record

Question 10: A Pennsylvania insurer wants to have an independent physician examine a claimant while a disability claim is pending, and it also wants an autopsy in a separate fatal claim. Which of the following describes the insurer's rights and who pays?

Both permitted, with the claimant paying

Neither is permitted in Pennsylvania

Examinations only, never an autopsy

Both permitted at the insurer's own expense

Question 11: A Pennsylvania insured is dissatisfied with a health claim decision and consults an attorney about suing the insurer. Which of the following correctly states the earliest and latest points at which Pennsylvania permits that action to be brought?

Immediately; within one year of denial

After thirty days; within two years

After sixty days; within three years

After ninety days; within five years

Question 12: An insured under a Pennsylvania individual health policy wants to name a different person to receive any death benefit, and the existing designation was never made irrevocable. Which of the following describes his ability to make that change?

He may change it only at renewal

He may change it at any time

He needs the insurer's written consent

He needs the current beneficiary's consent

Question 13: A Pennsylvania disability insured leaves office work for a substantially more hazardous job and does not tell the insurer. He is later injured. Which of the following describes how the optional change of occupation provision treats his claim?

Benefits scale to what the premium bought

Benefits are paid without adjustment

The policy is rescinded from inception

The claim is denied in full

Question 14: A Pennsylvania insurer learns after a claim is filed that a health insured misstated her age on the application and paid less premium than her true age required. Which of the following describes how the optional provision resolves that situation?

The policy is void from inception

The insured must pay the past shortfall

Benefits adjust to what the premium bought

The claim is paid in full anyway

Question 15: A Pennsylvania insured holds two individual health policies with the same insurer, and their combined benefits exceed the maximum that the insurer states it will carry on any one person. Which of the following describes the effect of the optional provision?

Both policies are canceled immediately

The insurer pays both without limitation

The newer policy alone remains in force

Excess benefits void, excess premium returned

Question 16: A Pennsylvania disability insured's earnings have fallen sharply since he bought his policy, and his total monthly disability benefits from all coverage now exceed what he was actually earning. Which of the following optional provisions addresses that situation?

Conformity with state statutes

Relation of earnings to insurance

Illegal occupation

Unpaid premium

Question 17: A Pennsylvania health insured files a valid claim at a time when one month of premium remains due and unpaid on the policy. Which of the following describes what the optional unpaid premium provision permits the insurer to do?

Deduct the unpaid premium from the claim

Deny the claim in its entirety

Cancel the policy retroactively

Report the insured to the Department

Question 18: A Pennsylvania individual health policy contains an optional cancellation clause, and the insurer decides to end the coverage before the term expires. Which of the following describes how any unearned premium must be handled when the insurer cancels?

It is forfeited by the insured

It is refunded pro rata

It is refunded at short rates

It is applied to future coverage

Question 19: A Pennsylvania individual health policy contains language that provides less protection than the Commonwealth's law requires for residents of this state. Which of the following optional provisions resolves that conflict without the insured having to go to court?

Entire contract; changes

Legal actions

Change of occupation

Conformity with state statutes

Question 20: A Pennsylvania health insured is injured in a fall that occurs while he is intoxicated, and no physician had prescribed or administered anything he consumed that evening. Which of the following describes the effect of the optional intoxicants and narcotics provision?

The insurer must pay in full

The insured may appeal to the Commissioner

The insurer is not liable

Benefits are reduced by half

PLAHI Pennsylvania Life Accident and Health Insurance Exam - Set 4 - Part 1

Question 1: A Pennsylvania individual health policyholder in Erie argues that a benefit her producer described over the telephone should be covered, even though it appears in no document. Which of the following required provisions determines what actually forms her contract?

Question 2: A Pennsylvania insurer discovers a nonfraudulent misstatement on an individual health application forty months after the policy was issued and wants to deny a claim on that basis. Which of the following describes the insurer's position under Pennsylvania law?

Question 3: Three Pennsylvania individual health policyholders pay premium on different schedules. One pays weekly, one pays monthly, and one pays quarterly, and each policy is in force. Which of the following correctly states the grace period Pennsylvania gives each of them, in that order?

Question 4: A Pennsylvania insurer requires an application and issues a conditional receipt when a lapsed health policy owner tries to reinstate the coverage. The insurer never disapproves that application in writing. Which of the following describes when reinstatement actually occurs?

Question 5: A Pennsylvania health policy is reinstated after a lapse, and the insured is injured in a fall two days later and then develops an illness eight days after that. Which of the following describes coverage for these two events?

Question 6: An insured in Lancaster suffers a covered loss under her individual health policy and wants to know how quickly she must tell the insurer that a claim is coming. Which of the following states Pennsylvania's notice of claim requirement?

Question 7: A Pennsylvania insured has given timely notice of a claim under her individual health policy and now must document the extent of her loss to the insurer. Which of the following states the period Pennsylvania allows for furnishing proof of loss?

Question 8: A Pennsylvania disability income insured furnishes acceptable written proof of a continuing disability, and the insurer reviews it and begins paying benefits. Which of the following describes how often Pennsylvania requires those periodic benefits to be paid to him?

Question 9: An individual health policy in Pennsylvania provides a death benefit, and the insured has died without any surviving named beneficiary on record with the insurer. Which of the following describes where the required provisions direct those policy proceeds?

Question 10: A Pennsylvania insurer wants to have an independent physician examine a claimant while a disability claim is pending, and it also wants an autopsy in a separate fatal claim. Which of the following describes the insurer's rights and who pays?

Question 11: A Pennsylvania insured is dissatisfied with a health claim decision and consults an attorney about suing the insurer. Which of the following correctly states the earliest and latest points at which Pennsylvania permits that action to be brought?

Question 12: An insured under a Pennsylvania individual health policy wants to name a different person to receive any death benefit, and the existing designation was never made irrevocable. Which of the following describes his ability to make that change?

Question 13: A Pennsylvania disability insured leaves office work for a substantially more hazardous job and does not tell the insurer. He is later injured. Which of the following describes how the optional change of occupation provision treats his claim?

Question 14: A Pennsylvania insurer learns after a claim is filed that a health insured misstated her age on the application and paid less premium than her true age required. Which of the following describes how the optional provision resolves that situation?

Question 15: A Pennsylvania insured holds two individual health policies with the same insurer, and their combined benefits exceed the maximum that the insurer states it will carry on any one person. Which of the following describes the effect of the optional provision?

Question 16: A Pennsylvania disability insured's earnings have fallen sharply since he bought his policy, and his total monthly disability benefits from all coverage now exceed what he was actually earning. Which of the following optional provisions addresses that situation?

Question 17: A Pennsylvania health insured files a valid claim at a time when one month of premium remains due and unpaid on the policy. Which of the following describes what the optional unpaid premium provision permits the insurer to do?

Question 18: A Pennsylvania individual health policy contains an optional cancellation clause, and the insurer decides to end the coverage before the term expires. Which of the following describes how any unearned premium must be handled when the insurer cancels?

Question 19: A Pennsylvania individual health policy contains language that provides less protection than the Commonwealth's law requires for residents of this state. Which of the following optional provisions resolves that conflict without the insured having to go to court?

Question 20: A Pennsylvania health insured is injured in a fall that occurs while he is intoxicated, and no physician had prescribed or administered anything he consumed that evening. Which of the following describes the effect of the optional intoxicants and narcotics provision?

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