WLAH - Wyoming Life & Accident and Health

Question 21: An applicant had received treatment for a chronic condition in the months before applying for an individual health policy, and the policy contains language limiting how soon claims tied to that earlier condition become payable. Which term describes a health condition that existed before the policy's effective date?

Illegal occupation

Elimination period

Preexisting condition

Impairment rider

Question 22: A health policy has stayed in force for three full years when the insurer discovers the insured concealed a serious diagnosis at application, yet cannot now void coverage for that concealment alone. Which provision explains why the passage of time defeats this defense?

Waiver of premium provision

Change of occupation provision

Physical examination provision

Time limit on certain defenses

Question 23: An insurer issues an individual health policy and later argues that a statement made by the applicant on a separate document, never attached to the policy at delivery, should still limit coverage. Which uniform provision determines whether that outside statement can be used against the insured?

Entire contract provision

Time limit on defenses

Consideration clause

Insuring clause

Question 24: A medical expense policy applies a flat deductible first, then splits remaining covered charges between insurer and insured by percentage up to a stated out of pocket ceiling, after which the insurer pays the full remaining balance for that year. Which feature caps the insured's total percentage cost sharing here?

Deductible carryover provision

Coinsurance out of pocket maximum

Lifetime maximum limit

Usual reasonable customary limit

Question 25: While a disability claim is pending, an insurer wants an independent physician to examine the claimant as often as reasonably needed, and, if the insured dies, wants the option to request an autopsy where law permits. Which provision grants the insurer these investigative rights?

Legal actions provision

Proof of loss provision

Physical examination and autopsy

Notice of claim provision

Question 26: A policyowner who named a revocable beneficiary on a health policy later decides to name a different person to receive any death benefit and asks the insurer how to make that change. Which provision addresses the owner's right to name a new beneficiary?

Payment of claims provision

Misstatement of age provision

Entire contract provision

Change of beneficiary provision

Question 27: A policy pays a stated benefit toward routine cleanings and checkups, fillings, and more complex procedures such as crowns or root canals, though it typically pays a smaller share toward major procedures than toward basic preventive services. Which category of coverage is this?

Dental insurance coverage

Vision insurance coverage

Basic hospital indemnity coverage

Critical illness coverage

Question 28: A sole proprietor buys a disability policy that reimburses fixed business costs, such as rent, utilities, and employee salaries, while the proprietor is disabled and unable to generate income, but the policy does not replace the proprietor's own lost personal income. Which policy type is this?

Individual disability income policy

Business overhead expense policy

Key employee disability policy

Disability buyout policy

Question 29: A policy is issued with an attached rider permanently excluding benefits for any loss connected to one named preexisting condition, and years later the insured is hospitalized for a completely unrelated illness never mentioned in that rider. How should the insurer treat this new, unrelated claim?

Deny it under the rider

Reduce it under the rider

Pay it like any other claim

Require a new application first

Question 30: A patient recovering from major surgery requires daily care delivered or supervised by a licensed nurse or therapist, following a physician's specific written treatment plan, and this intensive level of care is provided around the clock under professional medical supervision. Which level of long term care does this describe?

Intermediate nursing care

Custodial care

Adult day care

Skilled nursing care

Question 31: An individual disability income policy guarantees the insured the right to continue coverage by paying premiums as scheduled, and further guarantees that the insurer can never raise the premium rate above what was stated in the original contract. Which renewability classification offers both of these strong guarantees together?

Noncancelable policy

Guaranteed renewable policy

Conditionally renewable policy

Cancelable policy

Question 32: An accidental death and dismemberment policy lists specific dollar amounts payable for the loss of one hand, one foot, or the sight of one eye, and a larger amount payable when an insured loses any combination of two such losses in the same accident. What is this list called?

Table of surrender values

Schedule of dismemberment benefits

Table of nonforfeiture options

Schedule of settlement options

Question 33: An elderly individual living at home needs regular help with bathing, dressing, and eating because of a chronic condition, but this assistance can be provided safely by a trained aide or even a family member and does not require any licensed nursing skill. Which level of care is this?

Skilled nursing care

Intermediate nursing care

Custodial care

Respite care

Question 34: A health insurance policy allows the insurer to terminate coverage at any premium due date, or sometimes with advance written notice, for almost any reason the insurer chooses, without needing the insured's consent. Which renewability classification gives the insurer this broad right to end coverage?

Noncancelable policy

Guaranteed renewable policy

Optionally renewable policy

Cancelable policy

Question 35: An insurance regulator requires every company selling Medicare supplement policies within its jurisdiction to offer only from a standardized menu of benefit packages, so that a given package labeled the same way provides identical benefits no matter which insurer issues it. What does this standardization primarily accomplish?

Easier comparison shopping across insurers

Guaranteed lower premiums for everyone

Automatic enrollment for all retirees

Elimination of medical underwriting entirely

Question 36: A small business owner wants a policy that will pay the office lease, the phone and utility bills, and the salaries of two administrative staff members if the owner becomes disabled, while explicitly excluding the owner's own salary from covered expenses. Which feature is characteristic of this coverage?

Benefits based on prior net income

Benefits limited to normal overhead only

Benefits payable as a single lump sum

Benefits continuing for the insured's lifetime

Question 37: A lapsed policyowner submits an overdue premium and a written reinstatement application, and the insurer issues a conditional receipt but never approves or denies the application in writing before a covered accident occurs. Under the standard reinstatement provision, when does the policy become reinstated?

Only after written approval issued

Never without a new application

Automatically after the stated period

Only at the next anniversary

Question 38: A long term care insurer decides whether a policyholder qualifies for benefits by measuring the ability to perform basic self care tasks such as bathing, dressing, eating, toileting, transferring, and maintaining continence, with benefits beginning once help is needed with several of these tasks. What are these basic tasks called?

Instrumental activities of daily living

Cognitive impairment indicators

Medical necessity standards

Activities of daily living

Question 39: An insured carries disability income coverage from several insurers whose combined monthly benefits would exceed the insured's actual average earnings before becoming disabled, and one insurer wants to limit its own payout accordingly. Which optional provision lets an insurer reduce benefits so total coverage does not exceed actual earned income?

Relation of earnings to insurance

Coordination of benefits provision

Change of occupation provision

Physical examination provision

Question 40: A worker who changes employers keeps full ownership and control of the balance already accumulated in a tax advantaged medical savings account tied to a qualifying high deductible plan, since that account belongs to the individual rather than to any particular employer. Which feature does this situation best illustrate?

Employer forfeiture at plan year end

Full portability of health savings account funds

Coordination of benefits between employers

Automatic conversion to group term coverage