SCLAHIP - South Carolina Life Accident and Health Insurance Producer Exam

Question 21: After a shoulder injury, a plumber returns to the shop and handles estimates and small repairs but cannot manage heavy pipe work, which had been a core part of his daily job. Which benefit describes this reduced level of working capacity?

Total disability

Presumptive disability

Partial disability

Recurrent disability

Question 22: Two applicants of the same age and health apply for identical individual disability income coverage; one is an accountant and the other is a roofer, and the roofer is quoted a far higher rate. Which underwriting factor drove that difference?

Marital status

Benefit period length

Elimination period length

Occupation

Question 23: A surgeon's disability policy pays full benefits whenever an injury keeps her from performing the duties of the specialty she was practicing when the disability began, even though she could still teach medicine. Which definition of total disability applies?

Own occupation

Any occupation

Presumptive disability

Residual disability

Question 24: An insured is hurt while committing a felony and hurt again on another day while working in an occupation the law forbids. Which optional uniform provision lets the insurer decline liability for both of those losses under an individual health policy?

Conformity with state statutes

Intoxicants and narcotics

Change of occupation

Illegal occupation

Question 25: An applicant for a health policy has a medical history and habits that place him well outside the range the company priced for average lives, yet the company is still willing to issue at a higher rate. Which risk classification has he received?

Preferred

Substandard

Standard

Declined

Question 26: An insured is injured while he is under the influence of a narcotic that no physician ever prescribed or advised for him. His policy carries the optional intoxicants and narcotics provision. How does that provision affect the insurer's liability for this loss?

Liability continues in full for the loss

Liability is cut in half

The policy is canceled that day

The insurer is not liable for it

Question 27: An insurer has just received acceptable written proof of loss on a claim that will be settled in a single sum. Under the time of payment of claims provision, when is that lump sum benefit due to be paid to the insured?

Immediately upon receipt of the proof

At the end of the policy year

Within one year of the loss

Only after the insurer completes an audit

Question 28: An insurer reviewing a claim finds an innocent error in answers the applicant gave three years earlier. Under the time limit on certain defenses provision of an individual accident and health policy, which period must pass before that kind of misstatement can no longer be used to void the policy?

Six months from the date of issue

Two years from the date of issue

One year from the date of issue

Five years from the date of issue

Question 29: Members of a certain health plan pay a fixed amount in advance each month, receive whatever covered care they need during the year at no additional charge beyond small co-payments, and are called subscribers rather than insureds. Which arrangement is this?

A fee-for-service indemnity plan

A preferred provider organization

A high deductible health plan

A prepaid health maintenance organization

Question 30: An insured completed treatment for a covered sickness and now needs to send the insurer documentation of what happened and what it cost. Under the proof of loss provision, what is the ordinary deadline measured from the date of the loss?

Twenty days

Sixty days

Ninety days

Two years

Question 31: A network of hospitals, physicians and laboratories agrees to serve a plan's members at fees below the usual rate for the area, and members who use that network pay less than they would elsewhere. Which type of managed care arrangement is described?

A preferred provider organization

A basic medical expense policy

A health reimbursement account

An indemnity plan with free choice

Question 32: After an insured meets the deductible under her health policy, the contract provides that the company pays eighty percent of the remaining covered charges and she pays the rest until her out-of-pocket limit is reached. Which feature is described?

The deductible

The copayment

The elimination period

Coinsurance

Question 33: A health contract gives the company the right to refuse renewal for any reason it chooses, but only on a premium due date or the policy anniversary, and to raise rates by class at those same points. Which classification fits?

Conditionally renewable

Guaranteed renewable

Optionally renewable

Noncancelable

Question 34: A producer is comparing plans for a client who wants a single policy covering everything from routine office visits through catastrophic hospital bills, subject to a deductible, coinsurance and a very high maximum benefit. Which category of medical expense coverage fits that description?

Major medical coverage

Basic hospital expense coverage

Basic surgical expense coverage

A flexible spending arrangement

Question 35: A policy promises that the insured may keep the coverage in force to age sixty-five by paying premiums, and that the company may raise the rate only if it raises the rate for everyone in the same class. Which classification is this?

Noncancelable

Guaranteed renewable

Optionally renewable

Cancelable

Question 36: An employer sponsors health coverage for its workers. The insurer issues one contract to the employer, and each covered worker receives only a document summarizing benefits and showing who is covered. Which term names the document the worker receives?

The master policy

An enrollment card

A certificate of coverage

A summary annual report

Question 37: A manufacturer buys key person disability coverage on its plant supervisor. The producer explains that after a waiting period of roughly thirty to ninety days, benefits will run for a limited stretch rather than for many years. How long does that stretch usually last?

One or two years

Three to six months

Five to ten years

To age sixty-five

Question 38: A policyowner files a covered claim at a moment when one premium payment is already overdue on the policy. Under the unpaid premium provision, how does the insurer handle the overdue amount when it settles the claim with the policyowner?

It bills the policyowner separately later

It cancels the policy before paying anything

It deducts the premium from the benefit

It ignores the overdue premium entirely

Question 39: A traveler buys a health contract written to cover him for a stated block of ninety days, after which the coverage simply ends and neither party may continue it. Which of the following descriptions fits this kind of policy?

Non-renewable, written for a set period

Guaranteed renewable to a stated age

Optionally renewable at each anniversary

Conditionally renewable on stated grounds

Question 40: A residual disability provision states that benefits are payable only when the insured's earnings drop by at least twenty percent because of the disability. An insured whose income has fallen slightly less than that files a claim. What is the outcome?

A reduced residual benefit is payable

The full total disability benefit applies

One-half of the benefit is payable

No residual benefit is payable

SCLAHIP South Carolina Life Accident and Health Insurance Producer Exam - Set 4 - Part 2