SDLAHP - South Dakota Life Accident and Health Producer

Question 21: An applicant with a documented prior injury to one knee is offered a policy that permanently excludes coverage for any future loss connected to that specific knee, while the rest of the body remains normally covered. Which rider correctly describes that kind of arrangement?

a guaranteed insurability rider

a future increase option rider

an impairment or exclusion rider

a waiver of premium rider

Question 22: An insured is injured in a car accident four days after his disability income policy takes effect and promptly files a claim, while a coworker who falls ill from a cold on the same day is denied coverage under the probationary period rule. Which principle explains the different outcomes?

injuries always require a longer waiting period

sickness claims are permanently excluded from coverage

accidents are excluded until underwriting is complete

the probationary period excludes sickness, not accidents

Question 23: An employer sponsoring a self-funded group health plan wants protection against a single catastrophic claim or an unusually high total of claims in one year, shifting responsibility for costs above a set point to an outside insurer. Which cost-sharing concept correctly names that protective arrangement?

stop-loss coverage

the deductible

coordination of benefits

the out-of-pocket maximum

Question 24: A young professional buys a disability income policy today but expects her earnings to grow substantially over the next decade as her career advances. Which rider would let her purchase additional disability coverage at specified future dates without having to prove continued good health at that time?

a cost of living adjustment rider

a future increase option rider

an accidental death and dismemberment rider

a waiver of premium rider

Question 25: One disability income applicant selects a benefit period that runs to a stated retirement age, while a coworker with a similar policy instead selects a benefit period of a fixed number of years regardless of age at disablement. Which statement correctly compares these two available benefit period structures?

only the fixed-year form is ever offered

only the to-age form satisfies underwriting rules

both validly define maximum benefit duration

the two structures must always match exactly

Question 26: A disability income applicant selects a rider guaranteeing that if she files few or no claims over a stated period, the insurer will refund a portion of premiums paid during that span. Which rider provides this kind of refund based on a low claims experience?

a waiver of premium rider

a hospital confinement rider

a future increase option rider

a return of premium rider

Question 27: A rider attached to a policy lets the insured purchase additional amounts of coverage at specified future option dates or life events without submitting new evidence of health, regardless of any medical changes since the policy was issued. Which rider correctly matches that description?

a guaranteed insurability rider

an impairment rider

a waiver of premium rider

a coordination of benefits rider

Question 28: A business applies for, pays the premium on, and is named as both owner and beneficiary of a disability income policy covering one of its most valuable employees. Which party receives the monthly disability benefit if that key employee later becomes disabled and a claim is approved?

the disabled employee directly

the business itself

the employee's designated family member

a court-appointed trustee for the funds

Question 29: Two business partners fund a written agreement requiring the healthy partner to purchase the disabled partner's ownership share if that partner remains totally disabled beyond a stated waiting period, using proceeds from a dedicated disability policy. Which type of coverage funds this kind of ownership transfer?

business overhead expense insurance

key person disability insurance

disability buy-sell insurance

a hospital confinement rider

Question 30: An insurer's claims manual states that an insured is not totally disabled under the any-occupation test merely because she cannot find work, but only if she remains able to perform an occupation reasonably suited to her background. Which phrase captures the qualifier that limits this any-occupation standard?

any job that exists anywhere

any job paying minimum wage

any occupation the insurer selects

reasonably suited to training and experience

Question 31: A disability income contract pays a stated partial disability benefit equal to half the total disability amount whenever the insured can perform some but not all occupational duties, without requiring proof of any specific dollar amount of lost income. Which feature distinguishes this partial benefit from a residual disability benefit?

a flat amount, not proportionate to loss

it requires a longer elimination period

it equals the full total disability benefit

it excludes sickness-caused disabilities

Question 32: A health policy pays benefits for a covered hospitalization only for a defined span of time, after which no further benefits are paid for that same confinement even if the insured remains hospitalized. Which cost-sharing term correctly names that defined span of time?

the elimination period

the benefit period

the probationary period

the grace period

Question 33: An insurer receives timely notice of a claim from an insured but fails to send the required claim forms within the period the policy specifies for doing so. Which statement correctly describes what the insured may then do to satisfy the proof of loss requirement?

wait indefinitely until the insurer sends forms

the claim is automatically forfeited entirely

submit proof in any reasonable written form

hire an attorney before filing proof

Question 34: An applicant was treated for a chronic condition shortly before applying for an accident and health policy, and the insurer wants to limit its exposure for that specific condition for a defined period after issue. Which concept correctly describes that limited exclusion?

the probationary period

the coordination of benefits provision

the free look provision

a preexisting condition limitation

Question 35: An insured's combined deductible, coinsurance, and copayment spending during a benefit period reaches the ceiling stated in the health plan, after which the insurer pays the full amount of further covered expenses for the rest of that period. Which cost-sharing term correctly names that ceiling?

the out-of-pocket maximum

the deductible

the elimination period

usual, reasonable, and customary charges

Question 36: An insured moves from a warehouse loading job into a lower-risk clerical position and reports the change to the insurer as required by the policy. Under a typical change of occupation clause, which adjustment might the insured reasonably expect the insurer to make going forward?

an automatic increase in benefit period

a reduction in the premium charged

a mandatory new medical examination

a switch to an any-occupation definition

Question 37: A disability income policy includes a rider letting the insured raise the monthly benefit amount at set future option dates without submitting new proof of insurability, helping the benefit keep pace with rising income and living costs over time. Which rider correctly matches that description?

a return of premium rider

an impairment or exclusion rider

a future increase option rider

a waiver of premium rider

Question 38: A claims examiner reviewing a presumptive disability claim confirms the insured suffered total and permanent loss of hearing in both ears from a covered accident. Which additional element, ordinarily required for an ordinary total disability claim, does the presumptive provision specifically excuse the insured from proving?

the accidental cause of the injury

timely notice of the claim itself

the existence of a valid policy

actual inability to perform occupational duties

Question 39: An insurer issues an individual accident and health policy along with the signed application and one attached rider. Under the mandatory uniform provisions, which statement correctly identifies what forms the whole agreement between the insurer and the policyowner once the policy is delivered?

the policy, application, and any riders

only the insurer's printed policy form

any verbal statements made by the producer

the application by itself, unattached

Question 40: An insurer retains the right to decline renewal of an accident and health policy on any premium due date, entirely at the insurer's own discretion, without needing to cite any specific reason tied to that particular insured. Which renewability classification correctly matches this arrangement?

guaranteed renewable

optionally renewable

noncancelable

conditionally renewable

SDLAHP South Dakota Life Accident and Health Producer - Set 4 - Part 2

Question 21: An applicant with a documented prior injury to one knee is offered a policy that permanently excludes coverage for any future loss connected to that specific knee, while the rest of the body remains normally covered. Which rider correctly describes that kind of arrangement?

Question 26: A disability income applicant selects a rider guaranteeing that if she files few or no claims over a stated period, the insurer will refund a portion of premiums paid during that span. Which rider provides this kind of refund based on a low claims experience?

Question 27: A rider attached to a policy lets the insured purchase additional amounts of coverage at specified future option dates or life events without submitting new evidence of health, regardless of any medical changes since the policy was issued. Which rider correctly matches that description?

Question 28: A business applies for, pays the premium on, and is named as both owner and beneficiary of a disability income policy covering one of its most valuable employees. Which party receives the monthly disability benefit if that key employee later becomes disabled and a claim is approved?

Question 32: A health policy pays benefits for a covered hospitalization only for a defined span of time, after which no further benefits are paid for that same confinement even if the insured remains hospitalized. Which cost-sharing term correctly names that defined span of time?

Question 33: An insurer receives timely notice of a claim from an insured but fails to send the required claim forms within the period the policy specifies for doing so. Which statement correctly describes what the insured may then do to satisfy the proof of loss requirement?

Question 34: An applicant was treated for a chronic condition shortly before applying for an accident and health policy, and the insurer wants to limit its exposure for that specific condition for a defined period after issue. Which concept correctly describes that limited exclusion?

Question 36: An insured moves from a warehouse loading job into a lower-risk clerical position and reports the change to the insurer as required by the policy. Under a typical change of occupation clause, which adjustment might the insured reasonably expect the insurer to make going forward?

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