SCLAHIP - South Carolina Life Accident and Health Insurance Producer Exam

Question 21: A long-term care policy defines one level of care as help with bathing, dressing and eating that can be given by a person with no medical training at all, under no physician's order. Which level of care is being described?

Custodial care

Skilled nursing care

Intermediate nursing care

Respite care

Question 22: An elderly widower lives with his daughter, who works weekdays. His long-term care policy pays for a community program that supervises him during working hours and provides company, meals and recreation before he returns home each evening. Which service is this?

Skilled nursing facility care

Adult day care

Assisted living facility care

Respite care

Question 23: A man turning sixty-five next month has worked and paid Social Security taxes for thirty years. He asks his producer what he must do, and what he must pay, to obtain Medicare hospital insurance. Which answer describes his Part A situation?

He must apply and pay a premium

He must apply but owes no premium

Enrollment is automatic and costs him nothing

Enrollment is automatic but a premium applies

Question 24: In a typical group dental plan, one category of treatment is paid in full with no deductible and no coinsurance, while fillings carry coinsurance and root canals carry a higher share still. Which category receives that full payment, and why?

Orthodontia, because braces are costly

Oral surgery, because it prevents infection

Prosthodontics, because implants restore function

Diagnostic and preventive, to encourage early care

Question 25: A fully insured worker dies, leaving a surviving spouse who cares for their nine-year-old child. The family asks what Social Security provides for them now. Which benefit does the program pay to a surviving caretaker spouse in this situation?

A monthly survivor benefit based on PIA

A lump sum equal to lifetime earnings

A refund of all payroll taxes paid

Nothing until the spouse reaches sixty-five

Question 26: A program provides health coverage for people of all ages whose income and resources fall short, draws money from both federal and state treasuries, and lets each state set its own eligibility guidelines within federal rules. Which program operates that way?

Medicare

Social Security disability insurance

Medicaid

Workers compensation

Question 27: A comprehensive medical expense plan pays for treatment of an eye injury or eye disease but will not pay for a routine sight test, spectacle lenses or frames. A separate policy is bought to fill that gap. Which policy is it?

A vision care policy

A hearing benefit policy

A dental expense policy

A hospital indemnity policy

Question 28: Some Medicare beneficiaries choose to receive their hospital and medical benefits through a private company under contract with Medicare, rather than directly from the federal fee-for-service program that began in 1965. Which part of Medicare houses these privately administered plans?

Part A, hospital insurance

Part B, medical insurance

Part C, Medicare Advantage

Part D, prescription drug coverage

Question 29: A producer meets a prospect in Conway to discuss long term care insurance for the first time. South Carolina fixes the moment at which the outline of coverage must reach that prospective applicant. At which point must the producer deliver it?

At the time of initial solicitation

When the policy is delivered

When the application is signed

Within thirty days after policy issue

Question 30: A Charleston employee's group life coverage ends when he is laid off. He never applies for an individual policy, and he dies eleven days later, still inside the conversion window. His widow files a claim. How does South Carolina Code section 38-65-210 resolve it?

No benefit, since coverage had terminated

The death benefit is payable to her

Only the premiums paid are refunded

Benefits depend on the employer's written consent

Question 31: Eighteen months after issue, a South Carolina life insurer believes the insured lied about his health on the application and wants to rescind by mutual agreement. Section 38-63-230 sets what the insurer must have and how it must communicate. Which statement is correct?

Certified letters and clear, convincing evidence

A telephone call to the insured suffices

Rescission is barred at any time

Only the Director may order rescission

Question 32: A producer in Spartanburg urges an annuity owner to surrender her existing contract and buy a new one from another insurer, describing the older contract's benefits in terms she knows to be false. Which South Carolina annuity rule does this conduct violate?

The annuity grace period requirement

Misrepresentation to induce annuity termination or conversion

The nonforfeiture benefit requirement

The right to examine requirement

Question 33: At the death of an insured in Beaufort, the insurer discovers the application understated the insured's age by four years. Nothing was fraudulent, and the contestable period has passed. Under South Carolina's required life policy provisions, how must the insurer handle the claim?

Deny the claim and refund premiums

Pay the full face amount anyway

Rescind the policy for misrepresentation

Adjust the benefit to the correct age

Question 34: An insured in Aiken dies owing substantial debts to several creditors. His life insurance policy names his adult daughter as beneficiary rather than his estate. Under South Carolina Code section 38-63-40, what happens when those creditors try to reach the death proceeds?

Only a limited dollar amount is exempt

Creditors reach the proceeds before the beneficiary

The proceeds are exempt from those claims

Exemption depends on the beneficiary's own debts

Question 35: A patient in Greenwood is midway through a course of treatment when her physician's contract with the health insurer ends and he leaves the network. South Carolina addresses this situation in a dedicated group of sections. Which subject do those continuation of care sections govern?

Keeping group coverage after employment ends

Continuity of treatment when a provider leaves

Converting group coverage to an individual policy

Extending benefits after the policy terminates

Question 36: A producer in Seneca wants to begin selling long term care coverage in South Carolina. Section 38-72-69 sets both an initial training obligation and an ongoing one. Which pairing correctly states the minimum hours South Carolina requires of that producer?

Four hours once, then eight yearly

Eight hours once, then eight yearly

Four hours once, then four biennially

Eight hours once, then four biennially

Question 37: A buyer in Myrtle Beach returns a direct response health policy. She mails the policy back on Monday and hands the insurer's agent a signed written refusal on Wednesday. South Carolina says which of these two acts fixes the effective date of the return?

The later of the two dates

The earlier of the two dates

Only the written notice to the agent

Only the date the insurer receives it

Question 38: A South Carolina employer terminates its group life policy entirely, and an employee covered under it for years wants to convert to an individual contract. Section 38-65-210 caps the amount he may convert in that situation. Which limit does the statute impose?

The full amount of coverage lost

Half of the coverage lost

Coverage lost, capped at ten thousand dollars

Fifty thousand dollars in every case

Question 39: A family court in Camden enters a divorce decree. The former spouse had been covered as a dependent under the other spouse's accident and health policy and now wants comparable individual coverage. South Carolina gives her a right to it. Which condition governs that right?

Apply within thirty-one days and prove insurability

Apply within sixty days of the decree

Apply within one year with medical underwriting

Apply at the next policy anniversary date

Question 40: A Florence consumer answers a mailed advertisement and buys an individual health policy without ever meeting a producer. The insurer mails the contract directly to her home. South Carolina lengthens the examination period for a sale made this way. Which period governs her policy?

Ten days

Twenty days

Thirty days

Sixty days

SCLAHIP South Carolina Life Accident and Health Insurance Producer Exam - Set 5 - Part 2