TLAHI - Tennessee Life and Accident and Health Insurance Exam

Question 21: A Knoxville employer offers coverage to its workers under a single contract issued to the company, with each employee receiving a certificate rather than an individual policy. A producer names this arrangement for covering many people at once. Which arrangement is being described?

Group health insurance

An individual major medical policy

A hospital indemnity policy

A disability buyout policy

Question 22: A worker who leaves her job wants to keep her former employer's group health coverage for a limited time by paying the full premium herself, using a federal continuation right. A producer names this federal law. Which law provides this continuation?

HIPAA

The Fair Credit Reporting Act

COBRA

The USA PATRIOT Act

Question 23: A Memphis employee pairs a high-deductible health plan with a tax-advantaged account she owns, into which she can contribute pre-tax money to pay qualified medical costs, keeping unused funds year to year. A producer names this account. Which account is being described?

A flexible spending account

A health savings account

A health reimbursement account

A preferred provider account

Question 24: An employee funds an account through payroll to pay predictable out-of-pocket medical costs with pre-tax dollars, but she must use most of the money within the plan year or forfeit what remains. A producer names this employer account. Which account is being described?

A health savings account

A health reimbursement account

A preferred provider organization

A flexible spending account

Question 25: Under the Affordable Care Act, insurers generally cannot deny coverage or charge more because an applicant already has a medical condition. A producer names this consumer protection that changed how preexisting conditions are treated. Which protection is being described?

Guaranteed issue with no preexisting exclusions

A mandatory elimination period

Postclaim underwriting

A waiver of coverage

Question 26: A person covered under two health plans files a claim, and the plans follow rules to decide which pays first and which pays the balance, so the insured is not overpaid beyond the actual expense. A producer names this process. Which provision is being described?

Subrogation

The relation of earnings provision

Coordination of benefits

The time limit on defenses

Question 27: A Chattanooga family buys a limited policy that pays a fixed cash benefit only if a covered person is diagnosed with a specific serious illness such as cancer. A producer names this narrow type of coverage. Which coverage is being described?

Comprehensive major medical

A dread disease or specified illness policy

A disability income policy

A basic surgical policy

Question 28: An insured buys coverage that pays a set cash amount for each day she is confined to a hospital, regardless of her actual medical bills, to help with incidental costs. A producer names this supplemental policy. Which policy is being described?

Major medical insurance

A disability buyout policy

A dental plan

A hospital indemnity policy

Question 29: A federal law protects the privacy of individuals' health information and helps workers keep and transfer health coverage when they change jobs. A producer names this law known for its privacy and portability rules. Which law is being described?

HIPAA

COBRA

The USA PATRIOT Act

The Fair Credit Reporting Act

Question 30: A policy pays additional benefits if the insured dies or loses a limb or eyesight strictly as the result of an accident, separate from any sickness coverage. A producer names this common accident-based coverage. Which coverage is being described?

Disability income insurance

Major medical insurance

Accidental death and dismemberment

A dread disease policy

Question 31: A health policy will not cover a stated condition until the coverage has been in force for a set initial period after the effective date, applying only at the very start of the policy. A producer names this early exclusionary period. Which period is being described?

The elimination period

The grace period

The benefit period

The probationary period

Question 32: An employee covered by a group disability plan whose employer paid all the premiums becomes disabled and begins receiving benefits. A producer explains the general federal income tax treatment of those benefits. How are these employer-paid disability benefits generally taxed?

The benefits are taxable income

The benefits are always tax-free

Only half is ever taxable

They are taxed as capital gains

Question 33: An individual who buys her own disability income policy pays the premiums herself with money she has already paid income tax on. A producer explains how any benefits she later collects are generally taxed. How are these individually paid benefits generally treated?

Fully taxable as ordinary income

Taxed as long-term capital gains

Received income-tax-free

Subject to a ten percent penalty

Question 34: A managed care member must choose a primary care physician who coordinates all care and provides referrals to specialists, and staying within the network keeps costs lowest, though limited out-of-network care is allowed. A producer names this hybrid model. Which plan is being described?

A health maintenance organization

A point-of-service plan

An indemnity plan

An exclusive provider organization

Question 35: A health plan pays a small fixed dollar charge that the insured owes for each office visit or prescription, collected at the time of service. A producer names this specific fixed charge, distinct from percentage cost-sharing. Which feature is being described?

Coinsurance

A deductible

An out-of-pocket maximum

A copayment

Question 36: A Nashville family adds a plan that covers routine cleanings, fillings, extractions, and orthodontic work for their children, kept entirely separate from their major medical coverage. A producer names this specialized coverage. Which type of plan is being described?

A dental plan

A disability income policy

A hospital indemnity plan

A Medicare supplement policy

Question 37: A policy pays a lump sum upon the first diagnosis of a covered serious event such as a heart attack, stroke, or major organ failure, giving the insured cash to use however needed. A producer names this coverage. Which coverage is being described?

Major medical insurance

A dental plan

Critical illness insurance

Disability income insurance

Question 38: Under the Affordable Care Act, plans must let young adults stay on a parent's health coverage until a certain age, broadening coverage for that group. A producer states the age up to which this dependent coverage generally continues. To what age does it generally extend?

Age eighteen

Age twenty-six

Age twenty-one

Age sixty-five

Question 39: A disability policyowner adds a feature that increases his monthly benefit over a long claim to help the ongoing payments keep pace with steadily rising living costs. A producer names this optional rider. Which rider is being described?

The guaranteed insurability rider

The waiver of premium rider

The presumptive disability provision

The cost of living adjustment rider

Question 40: A basic medical plan pays covered charges from the first dollar with no deductible, but lists a separate scheduled payment limit for each hospital, surgical, and physician service and covers nothing off that list. A producer names this older coverage. Which coverage is described?

Basic hospital, surgical, and medical coverage

Comprehensive major medical

A health maintenance organization

A disability income policy

TLAHI Tennessee Life and Accident and Health Insurance Exam - Set 4 - Part 2

Question 21: A Knoxville employer offers coverage to its workers under a single contract issued to the company, with each employee receiving a certificate rather than an individual policy. A producer names this arrangement for covering many people at once. Which arrangement is being described?

Question 22: A worker who leaves her job wants to keep her former employer's group health coverage for a limited time by paying the full premium herself, using a federal continuation right. A producer names this federal law. Which law provides this continuation?

Question 23: A Memphis employee pairs a high-deductible health plan with a tax-advantaged account she owns, into which she can contribute pre-tax money to pay qualified medical costs, keeping unused funds year to year. A producer names this account. Which account is being described?

Question 24: An employee funds an account through payroll to pay predictable out-of-pocket medical costs with pre-tax dollars, but she must use most of the money within the plan year or forfeit what remains. A producer names this employer account. Which account is being described?

Question 25: Under the Affordable Care Act, insurers generally cannot deny coverage or charge more because an applicant already has a medical condition. A producer names this consumer protection that changed how preexisting conditions are treated. Which protection is being described?

Question 26: A person covered under two health plans files a claim, and the plans follow rules to decide which pays first and which pays the balance, so the insured is not overpaid beyond the actual expense. A producer names this process. Which provision is being described?

Question 27: A Chattanooga family buys a limited policy that pays a fixed cash benefit only if a covered person is diagnosed with a specific serious illness such as cancer. A producer names this narrow type of coverage. Which coverage is being described?

Question 28: An insured buys coverage that pays a set cash amount for each day she is confined to a hospital, regardless of her actual medical bills, to help with incidental costs. A producer names this supplemental policy. Which policy is being described?

Question 29: A federal law protects the privacy of individuals' health information and helps workers keep and transfer health coverage when they change jobs. A producer names this law known for its privacy and portability rules. Which law is being described?

Question 30: A policy pays additional benefits if the insured dies or loses a limb or eyesight strictly as the result of an accident, separate from any sickness coverage. A producer names this common accident-based coverage. Which coverage is being described?

Question 31: A health policy will not cover a stated condition until the coverage has been in force for a set initial period after the effective date, applying only at the very start of the policy. A producer names this early exclusionary period. Which period is being described?

Question 32: An employee covered by a group disability plan whose employer paid all the premiums becomes disabled and begins receiving benefits. A producer explains the general federal income tax treatment of those benefits. How are these employer-paid disability benefits generally taxed?

Question 33: An individual who buys her own disability income policy pays the premiums herself with money she has already paid income tax on. A producer explains how any benefits she later collects are generally taxed. How are these individually paid benefits generally treated?

Question 34: A managed care member must choose a primary care physician who coordinates all care and provides referrals to specialists, and staying within the network keeps costs lowest, though limited out-of-network care is allowed. A producer names this hybrid model. Which plan is being described?

Question 35: A health plan pays a small fixed dollar charge that the insured owes for each office visit or prescription, collected at the time of service. A producer names this specific fixed charge, distinct from percentage cost-sharing. Which feature is being described?

Question 36: A Nashville family adds a plan that covers routine cleanings, fillings, extractions, and orthodontic work for their children, kept entirely separate from their major medical coverage. A producer names this specialized coverage. Which type of plan is being described?

Question 37: A policy pays a lump sum upon the first diagnosis of a covered serious event such as a heart attack, stroke, or major organ failure, giving the insured cash to use however needed. A producer names this coverage. Which coverage is being described?

Question 38: Under the Affordable Care Act, plans must let young adults stay on a parent's health coverage until a certain age, broadening coverage for that group. A producer states the age up to which this dependent coverage generally continues. To what age does it generally extend?

Question 39: A disability policyowner adds a feature that increases his monthly benefit over a long claim to help the ongoing payments keep pace with steadily rising living costs. A producer names this optional rider. Which rider is being described?

Question 40: A basic medical plan pays covered charges from the first dollar with no deductible, but lists a separate scheduled payment limit for each hospital, surgical, and physician service and covers nothing off that list. A producer names this older coverage. Which coverage is described?

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