TLAHI - Tennessee Life and Accident and Health Insurance Exam

Question 21: A Tennessee senior reviews the parts of Medicare and wants to know which part covers inpatient hospital stays, skilled nursing facility care, and some home health services after a qualifying stay. Which part of Medicare provides that hospital coverage?

Part A

Part B

Part C

Part D

Question 22: A Tennessee senior wants coverage for routine doctor visits, outpatient care, and preventive services under Medicare, kept separate from the hospital coverage he already understands from Part A. Which part of Medicare provides those physician and outpatient benefits?

Part A

Part D

Part B

A Medigap policy

Question 23: A Tennessee senior considers a private plan that bundles hospital and medical benefits together, often adding extras, and is offered by insurers approved by Medicare in place of Original Medicare. Which part of Medicare describes this private, all-in-one alternative?

Part A

Part B

Part D

Part C

Question 24: A Tennessee senior wants help paying for her prescription medications each month and learns that Medicare offers a specific benefit for this, delivered through private drug plans approved by Medicare. Which part of Medicare provides prescription drug coverage?

Part A

Part D

Part C only

A Medicare supplement policy

Question 25: A Tennessee senior with very limited income and assets may qualify for a joint federal and state program that helps with costs Medicare does not cover, including long-term care in a nursing facility. In Tennessee, what is that program called?

TennCare, the state Medicaid program

A Medicare Advantage plan

The state guaranty association

A health savings account

Question 26: A Tennessee senior compares long-term care policies and learns that care can be delivered at different intensities, ranging from occasional help with daily tasks to continuous skilled nursing. Which set best describes the recognized levels of long-term care?

Term, whole, and universal care

Primary, secondary, and excess care

Inpatient and outpatient care only

Skilled, intermediate, and custodial care

Question 27: A Tennessee long-term care policy begins paying benefits when the insured needs help with a set of basic self-care tasks such as bathing, dressing, eating, and transferring from a bed to a chair. What are these tasks commonly called in long-term care coverage?

Elimination periods

Coordination triggers

Activities of daily living

Preauthorization events

Question 28: A Tennessee study group maps long-term care insurance to the correct chapter of Title 56 for a citation review, and one member asks exactly where Tennessee places its long-term care insurance statutes. In which chapter of Title 56 does Tennessee locate long-term care insurance?

Chapter 42

Chapter 6

Chapter 8

Chapter 12

Question 29: A Tennessee producer who has sold insurance continuously since the early 1990s wants to add long-term care sales and asks about the special training, wondering whether a familiar Tennessee exemption might apply to someone with his long record. Who is exempt from the long-term care training requirement?

Producers over a certain age

Producers with any college degree

Producers who sell only to seniors

Producers continuously licensed since January 1, 1994

Question 30: Tennessee operates a program that pairs qualifying long-term care policies with expanded Medicaid asset protection, encouraging residents to insure privately so they can shelter more of their savings if they later need care. What is this kind of arrangement generally called?

A guaranteed issue pool

A long-term care partnership program

A high-risk assignment plan

A federal reinsurance backstop

Question 31: A Tennessee insured disagrees with a health plan's final denial of a covered service and wants an independent outside review of that decision by someone not employed by the insurer. Tennessee houses this external review process in a specific chapter of Title 56. Which chapter governs external review?

Chapter 26

Chapter 7

Chapter 61

Chapter 42

Question 32: A Tennessee insurer must make a certain coverage available for a policyholder to buy, but the policyholder is free to decline it, unlike another coverage that must always be included in the contract. How does a mandated offering differ from a mandated benefit in Tennessee?

Only the offering may be declined

Both must always be included

The offering is not a state mandate

There is no practical difference

Question 33: A Tennessee study group sorts accident-and-health topics by chapter and looks for where individual accident-and-sickness required provisions, cancellation, and renewal are located in the code. In which chapter of Title 56 does Tennessee place those individual health policy provisions?

Chapter 61

Chapter 26

Chapter 42

Chapter 8

Question 34: A Tennessee outline routes group and blanket contracts, school insurance, and many mandated benefits to a single chapter of Title 56, and a candidate wants to identify that chapter for her notes. Which chapter covers group and blanket contracts and school insurance in Tennessee?

Chapter 42

Chapter 26

Chapter 7

Chapter 61

Question 35: Tennessee gives unusual attention to insurance covering students, regulating both blanket and franchise school insurance and separate school accident coverage within the state insurance code. Under which part of Title 56, Chapter 7 does Tennessee regulate this school insurance?

Chapter 42, Part 1

Chapter 7, Part 23

Chapter 61, Part 2

Chapter 26, Part 5

Question 36: A Tennessee employee loses group hospitalization coverage when leaving a job and wants to convert to an individual policy, and Tennessee maintains a dedicated rule chapter covering exactly this conversion right in group hospitalization contracts. What does that chapter address?

Life insurance replacement

Annuity suitability standards

Medicare supplement loss ratios

Individual conversion privileges in group hospitalization

Question 37: A Tennessee employee studying continuation options confuses the federal law that lets workers keep group coverage after certain qualifying events with any separate Tennessee continuation rule that might also apply. Which statement best describes the federal continuation law by itself?

COBRA is federal continuation of group coverage

COBRA is a Tennessee-only statute

COBRA replaces Medicare for retirees

COBRA is a long-term care benefit

Question 38: Tennessee regulates a uniform claims process for the managed care organizations that serve its Medicaid population, an arrangement that also confirms the branded state name Tennessee uses for its Medicaid program. Which program do these managed care organizations serve?

Medicare Advantage

The federal marketplace

TennCare, Tennessee's Medicaid program

The guaranty association

Question 39: A Tennessee employer sponsors group health coverage for its workers, and one employee notices the arrangement works differently from an individual policy she once bought on her own. Which feature is characteristic of group health insurance compared with individual coverage?

Each member is individually underwritten

The employee owns the master contract

Coverage always costs more than individual

One master contract covers many members

Question 40: A Tennessee worker at a large company loses her job and expects to keep the group health plan temporarily under federal law, and she recalls that federal COBRA generally applies only to employers above a certain size. Which employer size does federal COBRA generally reach?

Employers with at least five employees

Employers with twenty or more employees

Employers with any number of employees

Only government employers

TLAHI Tennessee Life and Accident and Health Insurance Exam - Set 5 - Part 2

Question 21: A Tennessee senior reviews the parts of Medicare and wants to know which part covers inpatient hospital stays, skilled nursing facility care, and some home health services after a qualifying stay. Which part of Medicare provides that hospital coverage?

Question 22: A Tennessee senior wants coverage for routine doctor visits, outpatient care, and preventive services under Medicare, kept separate from the hospital coverage he already understands from Part A. Which part of Medicare provides those physician and outpatient benefits?

Question 23: A Tennessee senior considers a private plan that bundles hospital and medical benefits together, often adding extras, and is offered by insurers approved by Medicare in place of Original Medicare. Which part of Medicare describes this private, all-in-one alternative?

Question 24: A Tennessee senior wants help paying for her prescription medications each month and learns that Medicare offers a specific benefit for this, delivered through private drug plans approved by Medicare. Which part of Medicare provides prescription drug coverage?

Question 25: A Tennessee senior with very limited income and assets may qualify for a joint federal and state program that helps with costs Medicare does not cover, including long-term care in a nursing facility. In Tennessee, what is that program called?

Question 26: A Tennessee senior compares long-term care policies and learns that care can be delivered at different intensities, ranging from occasional help with daily tasks to continuous skilled nursing. Which set best describes the recognized levels of long-term care?

Question 27: A Tennessee long-term care policy begins paying benefits when the insured needs help with a set of basic self-care tasks such as bathing, dressing, eating, and transferring from a bed to a chair. What are these tasks commonly called in long-term care coverage?

Question 28: A Tennessee study group maps long-term care insurance to the correct chapter of Title 56 for a citation review, and one member asks exactly where Tennessee places its long-term care insurance statutes. In which chapter of Title 56 does Tennessee locate long-term care insurance?

Question 30: Tennessee operates a program that pairs qualifying long-term care policies with expanded Medicaid asset protection, encouraging residents to insure privately so they can shelter more of their savings if they later need care. What is this kind of arrangement generally called?

Question 32: A Tennessee insurer must make a certain coverage available for a policyholder to buy, but the policyholder is free to decline it, unlike another coverage that must always be included in the contract. How does a mandated offering differ from a mandated benefit in Tennessee?

Question 33: A Tennessee study group sorts accident-and-health topics by chapter and looks for where individual accident-and-sickness required provisions, cancellation, and renewal are located in the code. In which chapter of Title 56 does Tennessee place those individual health policy provisions?

Question 34: A Tennessee outline routes group and blanket contracts, school insurance, and many mandated benefits to a single chapter of Title 56, and a candidate wants to identify that chapter for her notes. Which chapter covers group and blanket contracts and school insurance in Tennessee?

Question 35: Tennessee gives unusual attention to insurance covering students, regulating both blanket and franchise school insurance and separate school accident coverage within the state insurance code. Under which part of Title 56, Chapter 7 does Tennessee regulate this school insurance?

Question 36: A Tennessee employee loses group hospitalization coverage when leaving a job and wants to convert to an individual policy, and Tennessee maintains a dedicated rule chapter covering exactly this conversion right in group hospitalization contracts. What does that chapter address?

Question 37: A Tennessee employee studying continuation options confuses the federal law that lets workers keep group coverage after certain qualifying events with any separate Tennessee continuation rule that might also apply. Which statement best describes the federal continuation law by itself?

Question 38: Tennessee regulates a uniform claims process for the managed care organizations that serve its Medicaid population, an arrangement that also confirms the branded state name Tennessee uses for its Medicaid program. Which program do these managed care organizations serve?

Question 39: A Tennessee employer sponsors group health coverage for its workers, and one employee notices the arrangement works differently from an individual policy she once bought on her own. Which feature is characteristic of group health insurance compared with individual coverage?

Question 40: A Tennessee worker at a large company loses her job and expects to keep the group health plan temporarily under federal law, and she recalls that federal COBRA generally applies only to employers above a certain size. Which employer size does federal COBRA generally reach?

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