WLAH - Wyoming Life & Accident and Health

Question 1: A health insurance policy guarantees that the insured may continue coverage by paying premiums on time, and the insurer cannot single that insured out for higher rates, though it may raise premiums for an entire class of similar policyholders. Which renewability classification matches this description?

Guaranteed renewable policy

Noncancelable policy

Cancelable policy

Conditionally renewable policy

Question 2: A benefits counselor compares managed care options, noting that one design has the tightest network and lowest cost sharing, another allows broad out of network access at higher cost, and a third sits between the two, permitting out of network choices at reduced benefits. Which plan occupies the middle position?

Health maintenance organization plan

Preferred provider organization plan

Point of service plan

Traditional fee for service plan

Question 3: An insurer issuing a large group health plan evaluates the overall characteristics of the entire employee group, such as its average age, occupation, and past claims history, rather than requiring each individual employee to complete a personal medical questionnaire before coverage begins. What underwriting approach does this illustrate?

Group underwriting of the whole

Individual medical underwriting

Guaranteed issue underwriting

Simplified issue underwriting

Question 4: A major medical policy requires the insured to pay a set amount of covered expenses out of pocket each year before the insurer begins paying, and after that point the insurer and the insured share most remaining covered costs by a fixed percentage split. Which two features does this describe?

Elimination period and waiver of premium

Coordination of benefits and subrogation

Preexisting condition and probationary period

Deductible and coinsurance provisions

Question 5: After receiving notice of a claim, an insurer fails to send the insured the paperwork normally used to document the loss within the timeframe the policy requires. Which provision then allows the insured to submit proof of loss using any reasonable written format instead?

Claim forms provision

Notice of claim provision

Proof of loss provision

Legal actions provision

Question 6: An insured dies during the days immediately following a missed premium due date, before the premium was ever paid, but still within the span the policy allows for late payment without lapse. What is the insurer's obligation regarding a death claim filed for that loss?

Deny the claim for nonpayment

Prorate the claim by days

Pay the claim as owed

Delay payment until reinstatement

Question 7: A disability claim arises directly from an insured's participation in an occupation that is illegal under the law, and the insurer wants to know whether the optional provision on this topic permits denying the claim on that basis. Which provision governs this denial?

Change of occupation provision

Exclusions and limitations provision

Relation of earnings provision

Illegal occupation provision

Question 8: A physician bills an amount noticeably higher than what most providers in the same area typically charge for an identical procedure, and the insurer pays only up to the amount it recognizes as consistent with prevailing local charges. Which standard did the insurer apply to limit its payment this way?

Usual reasonable and customary

Eligible expenses standard

Coinsurance percentage standard

Preexisting condition standard

Question 9: An individual enrolls in a health plan carrying a higher annual deductible than a major medical plan, which qualifies that person to open an individually owned savings account funded with pretax dollars that can be used tax free for qualified medical expenses and carried forward indefinitely. Which arrangement is described?

Flexible spending account alone

Health reimbursement arrangement alone

High deductible health plan with savings account

Basic hospital indemnity policy

Question 10: An insured is hospitalized after a covered accident and, once able, wants to satisfy the policy requirement that alerts the insurer a claim will be filed so the insurer can begin its file. Which provision sets this early notification duty and its outer time limit?

Proof of loss provision

Claim forms provision

Time of payment provision

Notice of claim provision

Question 11: A policy reimburses the cost of routine eye examinations, along with a scheduled allowance toward corrective lenses or frames, and it may also include a discount toward elective vision correction surgery, but it does not cover treatment of a diseased eye condition. Which category of coverage is this?

Vision insurance coverage

Dental insurance coverage

Major medical coverage

Disability income coverage

Question 12: A newly issued health policy states that a covered illness must first occur after a set number of days following the effective date before any related claim will be paid, even though the premium was paid on time. Which provision explains this waiting span at the very start of coverage?

Elimination period

Probationary period

Grace period

Preexisting conditions provision

Question 13: A consumer shopping for individual health coverage is comparing a cancelable policy against a guaranteed renewable policy with similar benefits, and notices the cancelable option carries a noticeably lower quoted premium. What best explains why the cancelable policy tends to cost less?

Benefits are always smaller overall

Deductibles are always much higher

Insurer bears less renewal risk

Claims are paid more slowly

Question 14: A health policy pays a limited, scheduled amount toward hospital room and board, miscellaneous hospital charges, and a surgeon's fee, but it carries no overall major medical style deductible and stops paying once the modest scheduled limits are reached. Which category of coverage does this describe?

Comprehensive major medical coverage

Long term care coverage

Medicare supplement coverage

Basic hospital, medical, and surgical coverage

Question 15: A recent college graduate needs temporary health coverage to bridge a gap of a few months between finishing a parent's plan and starting a new employer's group plan, so the graduate buys a policy providing major medical style benefits for a short, clearly limited period. Which product fits this need?

Short term medical policy

Group long term disability policy

Medicare supplement policy

Long term care policy

Question 16: A policyholder under an optionally renewable health policy receives written notice that the insurer will not renew coverage at the upcoming policy anniversary, even though the policyholder has paid every premium on time and filed no claims. Is the insurer permitted to take this action under this renewability classification?

No, timely payment guarantees renewal

Yes, nonrenewal is allowed then

No, without cause is prohibited

Only with regulatory approval first

Question 17: A disability income policyowner's earnings have grown steadily since the policy was issued, and at a scheduled option date the owner wants to raise the monthly benefit to better match current income without undergoing a fresh medical evaluation. What must the owner typically show the insurer to exercise this option?

Evidence of continued good health

A brand new medical exam

Evidence of increased earned income

Proof of a new occupation

Question 18: A claimant whose disability claim was denied wants to file a lawsuit against the insurer almost immediately after submitting proof of loss, without waiting any further. Which provision sets the earliest point at which a covered person may bring legal action against the insurer?

Proof of loss provision

Time of payment provision

Notice of claim provision

Legal actions provision

Question 19: A disability income policy states that benefits will not begin until a certain number of days of continuous disability have passed, functioning much like a deductible measured in time rather than money. Which term names this waiting span between the onset of disability and the start of benefits?

Elimination period

Probationary period

Grace period

Free look period

Question 20: An insured stops paying premiums on a disability income policy after becoming totally disabled and satisfying the required waiting period, yet the insurer continues the coverage in force at no premium cost for as long as the disability continues. Which provision produces this result?

Cost of living adjustment rider

Waiver of premium provision

Future increase option rider

Return of premium provision

WLAH Wyoming Life & Accident and Health - Set 3 - Part 1

Question 5: After receiving notice of a claim, an insurer fails to send the insured the paperwork normally used to document the loss within the timeframe the policy requires. Which provision then allows the insured to submit proof of loss using any reasonable written format instead?

Question 6: An insured dies during the days immediately following a missed premium due date, before the premium was ever paid, but still within the span the policy allows for late payment without lapse. What is the insurer's obligation regarding a death claim filed for that loss?

Question 7: A disability claim arises directly from an insured's participation in an occupation that is illegal under the law, and the insurer wants to know whether the optional provision on this topic permits denying the claim on that basis. Which provision governs this denial?

Question 10: An insured is hospitalized after a covered accident and, once able, wants to satisfy the policy requirement that alerts the insurer a claim will be filed so the insurer can begin its file. Which provision sets this early notification duty and its outer time limit?

Question 12: A newly issued health policy states that a covered illness must first occur after a set number of days following the effective date before any related claim will be paid, even though the premium was paid on time. Which provision explains this waiting span at the very start of coverage?

Question 13: A consumer shopping for individual health coverage is comparing a cancelable policy against a guaranteed renewable policy with similar benefits, and notices the cancelable option carries a noticeably lower quoted premium. What best explains why the cancelable policy tends to cost less?

Question 18: A claimant whose disability claim was denied wants to file a lawsuit against the insurer almost immediately after submitting proof of loss, without waiting any further. Which provision sets the earliest point at which a covered person may bring legal action against the insurer?

Question 20: An insured stops paying premiums on a disability income policy after becoming totally disabled and satisfying the required waiting period, yet the insurer continues the coverage in force at no premium cost for as long as the disability continues. Which provision produces this result?

Need Guaranteed Results?