TLAHI - Tennessee Life and Accident and Health Insurance Exam

Question 1: A Nashville worker buys a policy that replaces part of his paycheck with monthly income if an illness or injury keeps him from working. A producer names the type of health coverage designed to protect earnings during a disability. Which coverage is being described?

Major medical insurance

A dental plan

A hospital indemnity plan

Disability income insurance

Question 2: A Memphis surgeon buys disability coverage that will pay benefits if she cannot perform the specific duties of her own profession, even if she could work at some other job. A producer names this definition of disability. Which definition is being described?

Any-occupation disability

Own-occupation disability

Presumptive disability

Partial disability

Question 3: A disability policy will not begin paying benefits until the insured has been disabled for a waiting stretch of ninety days, during which no benefits are due. A producer names this initial waiting stretch. Which provision is being described?

The elimination period

The benefit period

The probationary period

The grace period

Question 4: An insured recovering from a disability returns to work part-time at reduced pay, and his policy continues a reduced benefit that reflects his lost earnings. A producer names this feature that pays for a lingering income loss. Which type of benefit is being described?

Presumptive disability

Total disability

Residual disability

An elimination period

Question 5: A disability policy states that if the insured loses sight in both eyes, or loses the use of two limbs, benefits are payable as if totally disabled even if the insured can still perform some work. A producer names this provision. Which provision is being described?

Residual disability

Partial disability

The elimination period

Presumptive disability

Question 6: A Knoxville family buys a health plan that pays a large share of major hospital and physician bills after they meet a yearly deductible and then split costs through coinsurance up to a stop-loss. A producer names this broad coverage. Which coverage is being described?

Major medical insurance

A hospital indemnity plan

A dental plan

A disability income policy

Question 7: A Chattanooga member enrolls in a plan that provides care through a network of contracted providers, requires a primary physician to coordinate and refer, and generally pays nothing outside the network. A producer names this managed care model. Which plan is being described?

A preferred provider organization

An indemnity plan

A health maintenance organization

A point-of-service plan

Question 8: A member wants a plan with a provider network but also the freedom to see specialists out of network at a higher cost, without needing a primary physician's referral. A producer names the managed care model offering this flexibility. Which plan is being described?

A health maintenance organization

A preferred provider organization

An exclusive provider organization

A basic surgical plan

Question 9: A health plan requires the insured to pay the first amount of covered expenses each year out of pocket before the insurer begins paying its share. A producer names this fixed annual threshold the insured must satisfy first. Which cost-sharing feature is being described?

Coinsurance

A copayment

The out-of-pocket maximum

The deductible

Question 10: After a Nashville insured meets her deductible, her plan splits further covered costs so the insurer pays eighty percent and she pays twenty percent until she reaches her yearly limit. A producer names this percentage sharing of costs. Which feature is being described?

Coinsurance

A deductible

A copayment

A premium

Question 11: A health plan limits how much an insured must pay in a year, so that once the insured's own spending reaches a set ceiling, the plan pays the remaining covered costs in full. A producer names this protective ceiling. Which feature is being described?

The deductible

The elimination period

The out-of-pocket maximum

The coinsurance rate

Question 12: A health policy provides that after two years, the insurer generally cannot contest the policy or deny a claim based on misstatements in the application. A producer names the health policy provision creating this cutoff. Which mandatory provision is being described?

The grace period

The time limit on certain defenses

The reinstatement provision

The physical examination provision

Question 13: A health insured must send the company written notice of a claim within a standard number of days after a loss begins, commonly twenty days, so the insurer can start the claim process. A producer names this uniform provision. Which provision is being described?

Proof of loss

Legal actions

Time of payment of claims

Notice of claim

Question 14: After giving notice of a claim, a health insured must submit written proof documenting the loss, commonly within ninety days, so the insurer can evaluate what it owes. A producer names this uniform provision. Which provision is being described?

Proof of loss

Notice of claim

The grace period

Change of occupation

Question 15: A health insured wants to know how soon after proof of loss the insurer must pay benefits that are due, and how long she must wait before she could take the insurer to court. Which pair of uniform provisions governs these two timing questions?

Grace period and reinstatement

Notice of claim and proof of loss

Time of payment and legal actions

Entire contract and change of occupation

Question 16: A health insured takes a much riskier job, and his policy adjusts the benefits the insurer will pay to what the premium would have purchased at the more hazardous classification. A producer names this optional provision. Which provision is being described?

Misstatement of age

Change of occupation

Relation of earnings to insurance

The illegal occupation provision

Question 17: A Memphis insured wants a health policy the insurer can never cancel and whose premiums are guaranteed not to increase, giving the strongest possible continuation rights available. A producer names this renewability classification. Which classification is being described?

Conditionally renewable

Cancelable

Optionally renewable

Noncancelable

Question 18: A Nashville insured wants a policy the insurer must always renew but understands the insurer may raise premiums for an entire class of policyholders, not just for her. A producer names this middle-ground renewability classification. Which classification is being described?

Guaranteed renewable

Noncancelable

Cancelable

Conditionally renewable

Question 19: A business owner buys coverage that reimburses the fixed expenses of running his office, such as rent, utilities, and staff salaries, if he becomes disabled and cannot operate the business. A producer names this specialized policy. Which policy is being described?

Key person disability

Disability buyout

Business overhead expense

Group disability income

Question 20: Two partners want a way to fund the buyout of a co-owner's share if that owner becomes totally disabled and can no longer contribute to the business. A producer names the policy designed to provide those purchase funds. Which policy is being described?

Business overhead expense

Key person disability

Group disability income

A disability buyout policy

TLAHI Tennessee Life and Accident and Health Insurance Exam - Set 4 - Part 1

Question 1: A Nashville worker buys a policy that replaces part of his paycheck with monthly income if an illness or injury keeps him from working. A producer names the type of health coverage designed to protect earnings during a disability. Which coverage is being described?

Question 2: A Memphis surgeon buys disability coverage that will pay benefits if she cannot perform the specific duties of her own profession, even if she could work at some other job. A producer names this definition of disability. Which definition is being described?

Question 3: A disability policy will not begin paying benefits until the insured has been disabled for a waiting stretch of ninety days, during which no benefits are due. A producer names this initial waiting stretch. Which provision is being described?

Question 4: An insured recovering from a disability returns to work part-time at reduced pay, and his policy continues a reduced benefit that reflects his lost earnings. A producer names this feature that pays for a lingering income loss. Which type of benefit is being described?

Question 5: A disability policy states that if the insured loses sight in both eyes, or loses the use of two limbs, benefits are payable as if totally disabled even if the insured can still perform some work. A producer names this provision. Which provision is being described?

Question 6: A Knoxville family buys a health plan that pays a large share of major hospital and physician bills after they meet a yearly deductible and then split costs through coinsurance up to a stop-loss. A producer names this broad coverage. Which coverage is being described?

Question 7: A Chattanooga member enrolls in a plan that provides care through a network of contracted providers, requires a primary physician to coordinate and refer, and generally pays nothing outside the network. A producer names this managed care model. Which plan is being described?

Question 8: A member wants a plan with a provider network but also the freedom to see specialists out of network at a higher cost, without needing a primary physician's referral. A producer names the managed care model offering this flexibility. Which plan is being described?

Question 9: A health plan requires the insured to pay the first amount of covered expenses each year out of pocket before the insurer begins paying its share. A producer names this fixed annual threshold the insured must satisfy first. Which cost-sharing feature is being described?

Question 10: After a Nashville insured meets her deductible, her plan splits further covered costs so the insurer pays eighty percent and she pays twenty percent until she reaches her yearly limit. A producer names this percentage sharing of costs. Which feature is being described?

Question 11: A health plan limits how much an insured must pay in a year, so that once the insured's own spending reaches a set ceiling, the plan pays the remaining covered costs in full. A producer names this protective ceiling. Which feature is being described?

Question 12: A health policy provides that after two years, the insurer generally cannot contest the policy or deny a claim based on misstatements in the application. A producer names the health policy provision creating this cutoff. Which mandatory provision is being described?

Question 13: A health insured must send the company written notice of a claim within a standard number of days after a loss begins, commonly twenty days, so the insurer can start the claim process. A producer names this uniform provision. Which provision is being described?

Question 14: After giving notice of a claim, a health insured must submit written proof documenting the loss, commonly within ninety days, so the insurer can evaluate what it owes. A producer names this uniform provision. Which provision is being described?

Question 15: A health insured wants to know how soon after proof of loss the insurer must pay benefits that are due, and how long she must wait before she could take the insurer to court. Which pair of uniform provisions governs these two timing questions?

Question 16: A health insured takes a much riskier job, and his policy adjusts the benefits the insurer will pay to what the premium would have purchased at the more hazardous classification. A producer names this optional provision. Which provision is being described?

Question 17: A Memphis insured wants a health policy the insurer can never cancel and whose premiums are guaranteed not to increase, giving the strongest possible continuation rights available. A producer names this renewability classification. Which classification is being described?

Question 18: A Nashville insured wants a policy the insurer must always renew but understands the insurer may raise premiums for an entire class of policyholders, not just for her. A producer names this middle-ground renewability classification. Which classification is being described?

Question 19: A business owner buys coverage that reimburses the fixed expenses of running his office, such as rent, utilities, and staff salaries, if he becomes disabled and cannot operate the business. A producer names this specialized policy. Which policy is being described?

Question 20: Two partners want a way to fund the buyout of a co-owner's share if that owner becomes totally disabled and can no longer contribute to the business. A producer names the policy designed to provide those purchase funds. Which policy is being described?

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