SCLAHIP - South Carolina Life Accident and Health Insurance Producer Exam

Question 1: A beneficiary enrolled in Parts A and B wants outpatient prescription coverage. Her producer explains that she signs up with a private company, Medicare pays that company, and the company pays the pharmacy. Which arrangement has the producer described?

A federal drug purchasing program

An expansion of Part B coverage

A state pharmacy assistance requirement

A stand-alone prescription drug plan

Question 2: A worker's Social Security disability claim is approved. He assumes his first check will cover the month his disability began. His producer corrects him about the delay built into the program. Which statement about the waiting period is correct?

Five months pass, with no retroactive pay

Benefits start immediately with no waiting

A thirty-day wait applies, then retroactive pay

A twelve-month wait applies with back pay

Question 3: A long-term care policy pays for a visiting nurse and a physical therapist who come to the insured's house several times a week to provide skilled services there, rather than in any facility. Which type of care is being paid for?

Adult day care

Assisted living care

Custodial nursing home care

Home health care

Question 4: A forty-eight-year-old man has been collecting Social Security disability benefits for the past twenty-six months and has no kidney disease. His producer reviews federal program rules to see whether he already qualifies for Medicare. Which statement about his situation is correct?

He must wait until age sixty-five

He qualifies after twenty-four months of benefits

Only kidney failure allows early Medicare entry

Disability recipients never receive Medicare before retirement

Question 5: An eighty-year-old man qualifies for Medicare because of his age and also meets his state's income and resource limits for Medicaid. His daughter asks how the two programs interact for him from month to month. Which statement about his situation is accurate?

Medicaid pays his Medicare cost sharing

He must choose one program only

Medicare ends once Medicaid begins paying

Medicaid refuses anyone already holding Medicare

Question 6: A dental plan lists seven categories of treatment. One of them covers work on the soft pulp tissue at the center of a tooth, the category under which a root canal is paid. Which category of dental treatment is that?

Periodontics

Prosthodontics

Endodontics

Orthodontics

Question 7: Among the several levels of care named in long-term care policies, one is furnished continuously, day and night, and may be performed only by licensed nurses who are acting on a physician's written orders. Which level of care carries that description?

Custodial care

Home health care

Intermediate care

Skilled nursing care

Question 8: A prospect tells a producer that she is enrolled in a Medicare Advantage plan and asks the producer to write her a Medicare supplement policy as well. How should the producer respond to that request under the rules governing these products?

Sell it with a written waiver

Sell only Plan A to her

Decline; the sale would be illegal

Sell it after a medical examination

Question 9: Federal law separates minimum essential coverage from excepted benefits, and several products count as excepted only when they are issued as a separate policy rather than bundled into a medical plan. Which group of products below is made up entirely of coverages treated that way?

Major medical, hospital and surgical plans

Employer group plans and individual market plans

Grandfathered plans and qualified health plans

Dental, vision, long-term care, Medicare supplement

Question 10: A fifty-five-year-old buys a long-term care policy expecting to use it decades from now. She adds a feature that raises the daily benefit automatically each year by a stated percentage so the coverage keeps pace with rising costs. Which option has she added?

Nonforfeiture benefit

Guaranteed insurability option

Inflation protection

Waiver of elimination period

Question 11: A newly eligible beneficiary asks how Medicare medical insurance differs from hospital insurance in cost and in what it pays for. Her producer explains the basic structure of Part B for her. Which description of Part B is correct?

Optional coverage of physician services, requiring premiums

Free coverage for inpatient hospital room charges

Premium-free coverage of prescription drugs at pharmacies

Mandatory coverage paid for by payroll taxes

Question 12: A young roofer buys inexpensive coverage that pays benefits when he is injured by an unforeseen mishap but pays nothing at all if he is laid up by influenza, appendicitis or any other disease. Which limited benefit policy has he bought?

A dread disease policy

A hospital indemnity policy

An accident-only policy

A vision care policy

Question 13: A claimant applies for Social Security disability benefits after a back injury that prevents him from returning to his former trade, though he could handle lighter work. Which standard does Social Security apply when deciding his claim for benefits?

Inability to perform his own occupation

Inability to earn his former wage

Inability to work for thirty days

Inability to perform any occupation

Question 14: A daughter has cared for her mother at home for two years without a break. The mother's long-term care policy will pay professionals to take over the caregiving for several days so the daughter can travel. Which benefit is being used?

Respite care

Guaranteed insurability benefit

Adult day care

Intermediate nursing care

Question 15: A retiree turned down Part B when he first became eligible and now, two years later, wants medical insurance. He has no employer coverage. Which statement correctly gives the annual window for signing up and the date his coverage would start?

October through December; coverage begins immediately

Any month he chooses; coverage begins instantly

April through June; coverage starts in December

January through March; coverage starts next month

Question 16: A beneficiary is considering leaving Original Medicare for a Medicare Advantage plan offered by a local insurer this year. She wants to know what she must keep and what she must pay once she moves. Which statement is accurate?

Drop Part B and its premium

Keep Part A only, premium-free

Retain Parts A and B, paying premiums

Neither Part B nor plan premiums apply

Question 17: Part A will help pay for care in a skilled nursing facility only when specific conditions are met, and its coverage of that care is finite. Which pairing correctly states the entry requirement and the outer limit on covered days?

No prior hospital stay; sixty covered days

A one-day hospital stay; unlimited covered days

A seven-day hospital stay; sixty covered days

A three-day hospital stay; one hundred days

Question 18: Social Security measures a worker's insured status in units earned by working and paying payroll taxes, and no worker can earn more than four of them in a single calendar year no matter how much is earned. Which term names these units?

Quarters of coverage

Elimination periods

Exclusion ratios

Benefit periods

Question 19: A sixty-eight-year-old woman kept working and stayed on her employer's group health plan, so she skipped Part B at sixty-five. She retires this month and loses that plan. Which enrollment route lets her take Part B without a late penalty?

The general enrollment period each January

A second initial enrollment period

A special enrollment period tied to employment

No route; the penalty always applies

Question 20: A family learns that Medicare will not pay for their mother's ongoing help with bathing, dressing, and eating in a nursing home once her skilled care benefit ends. Which program may pay for that custodial care if she qualifies financially?

Medicare Part B medical insurance

Social Security retirement benefits

Medicare Part D drug coverage

Medicaid

SCLAHIP South Carolina Life Accident and Health Insurance Producer Exam - Set 5 - Part 1