PLAHI - Pennsylvania Life Accident and Health Insurance Exam

Question 21: A Pennsylvania consumer receives an individual accident and health policy that is not a single premium nonrenewable contract, and after reading it she decides she does not want it. Which of the following describes the return right Pennsylvania gives her?

Ten days from delivery, with full refund

Thirty days from delivery, with partial refund

Forty-five days from application

No return right for health coverage

Question 22: A Pennsylvania family's health policy is about to drop a child who has reached the limiting age but cannot support himself because of a physical handicap and depends chiefly on his parents. Which of the following describes the insurer's obligation?

Coverage ends at the limiting age regardless

Coverage continues; proof within thirty-one days

Coverage continues only until age twenty-six

Coverage continues only if premiums double

Question 23: One Pennsylvania disability policy pays when the insured cannot perform the duties of his own occupation, and another pays only when he cannot perform any occupation for which he is suited. Which of the following describes these definitions?

The first is more liberal

The second is more liberal

Both definitions are identical in effect

Neither definition is used in practice

Question 24: A Pennsylvania disability policyholder loses the sight in both eyes in an industrial accident, and the insurer begins paying total disability benefits without requiring him to prove he cannot work. Which of the following provisions produced that outcome?

Residual disability

Presumptive disability

Recurrent disability

Partial disability

Question 25: One Pennsylvania insured returns to work in a reduced capacity and receives a flat percentage of his total benefit for a limited period. Another receives a benefit calculated from his actual income loss for as long as it lasts. Which describes them?

Partial disability and residual disability

Residual disability and partial disability

Presumptive disability and recurrent disability

Recurrent disability and presumptive disability

Question 26: A Pennsylvania insured recovers from a disabling back injury, returns to full-time work for three weeks, and then the same condition disables him again. His benefits resume without a new waiting period. Which of the following provisions produced that result?

Presumptive disability

Partial disability

Recurrent disability

Residual disability

Question 27: A Pennsylvania disability applicant compares two identical policies, and the only difference is that one begins paying benefits after thirty days of disability while the other waits ninety days. Which of the following describes the effect on premium?

The ninety-day policy costs less

The thirty-day policy costs less

The two policies cost the same

Premium depends only on benefit period

Question 28: A Pennsylvania producer explains that one feature of a disability income policy answers the question of how long payments will continue once they begin, rather than how long the insured must wait. Which of the following features is she describing?

The elimination period

The probationary period

The benefit period

The grace period

Question 29: A Pennsylvania disability insured remains totally disabled beyond the waiting period stated in her policy, and the insurer stops requiring premium payments and refunds the premiums she paid during that waiting period. Which of the following provisions produced that outcome?

The relation of earnings provision

The future increase option

The rehabilitation benefit

The waiver of premium provision

Question 30: A Pennsylvania insured has been receiving disability benefits for several years now, and each year the monthly payment rises in step with a published measure of consumer prices. Which of the following riders is responsible for that annual increase?

The cost of living rider

The guaranteed insurability rider

The social insurance supplement

The additional monthly benefit rider

Question 31: One rider pays an extra amount during the first year of disability whether or not the insured receives government benefits. Another pays only when those benefits are not being received and makes up the difference. Which of the following names them in order?

Social insurance supplement and cost of living

Cost of living rider and rehabilitation benefit

Guaranteed insurability and presumptive disability

Additional monthly benefit and social insurance supplement

Question 32: A disabled dentist in Bethlehem continues to owe rent, staff salaries and utilities for her practice while she cannot work, and her policy reimburses those specific expenses rather than replacing her income. Which of the following coverages does she hold?

A disability buy-sell policy

A business overhead expense policy

A key employee disability policy

An individual disability income policy

Question 33: Three owners of a Pittsburgh engineering firm want funding arranged in advance so that if one of them becomes permanently disabled the others can buy that owner's interest at an agreed price. Which of the following arrangements meets their objective?

Business overhead expense coverage

Group long-term disability coverage

A disability buy-sell policy

A key employee disability policy

Question 34: A Harrisburg manufacturer buys a policy that pays the company itself when its top salesperson is disabled, offsetting lost revenue and the cost of finding a replacement. Which of the following describes who owns the policy and receives the benefit?

The employee owns it and collects

The employer owns it and collects

The employee owns it, the employer collects

A trustee owns it for both parties

Question 35: A Pennsylvania worker applies for Social Security disability benefits after a serious injury, and her representative explains how long she must wait and how long the disability must be expected to last. Which of the following states both correctly?

Two-month wait; must last six months

No wait; must last six months

Five-month wait; must last twelve months

Twelve-month wait; must last two years

Question 36: One Pennsylvania plan pays providers as services are rendered and calls its customers insureds. A second plan pays providers a set amount in advance and calls its customers subscribers. Which of the following correctly identifies these two arrangements?

Fee-for-service and prepaid

Prepaid and fee-for-service

Indemnity and reimbursement

Scheduled and nonscheduled

Question 37: A Pennsylvania major medical policyholder must satisfy a set dollar amount of covered expenses out of her own pocket each calendar year before the insurer begins paying anything at all. Which of the following provisions describes that requirement?

The coinsurance provision

The stop-loss provision

The elimination period

The deductible

Question 38: After meeting her annual deductible, a Pennsylvania insured continues to pay one fifth of each covered charge while her insurer pays the remaining four fifths of it. Which of the following provisions describes that continued sharing of cost?

Coinsurance

The stop-loss limit

The impairment rider