Montana Health Insurance Practice Exam

These questions are part of the practice quiz. Start practicing

• Under what circumstance may a Montana insurer limit payment for health care services?
• What is the primary role of a gatekeeper in a health maintenance organization (HMO)?
• Who is responsible for premium payments under a key person disability income policy?
• What must an insurer provide to an insured when a claim for benefits is denied?
• What happens if a non-member physician is utilized under a POS plan?
• Under a point of service (POS) plan, how does the cost-sharing mechanism work with non-member physicians?
• What is the maximum allowed percentage for payment differences in a health benefit plan where the network is inadequate?
• Which type of long-term care is NOT provided in an institutional setting?
• What type of health insurance policy provides a lump sum payment for a heart attack or stroke?
• Which type of insurance producer is specifically known for providing financial advice in addition to selling policies?
• What is the amount a physician or supplier bills for a particular service or supply referred to as?
• How do managed care plans typically limit expenses?
• Under which organization type are practicing providers compensated on a fee-for-service basis?
• What is the primary purpose of COBRA?
• What type of coverage is written in conjunction with hospital expense policies to cover surgeons' fees, anesthesiologist, and the operating room?
• What is the objective of Montana's Insurance Information and Privacy Protection Act?
• What type of organization is established primarily for the purpose of offering prepaid hospital care and other health services?
• When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
• Which statement accurately describes group disability income insurance?
• What is the unlawful practice of offering inducements to the insured that are not specified in the insurance policy called?
• If an individual is insured under an employer's group disability income policy and suffers an accident that leaves them unable to work, what is true about the benefits?
• Which provision mandates that medical expense claims must be paid immediately?
• Does Medicare cover long-term care (LTC) services?
• Which definition provides broader coverage in an insurance policy?
• What is a primary eligibility requirement for Social Security disability income benefits?
• What factor determines whether disability insurance benefits are taxed?
• The definition of a primary care physician includes which of the following roles?
• What is the primary purpose of a hospital indemnity policy?
• Under a guaranteed renewable health insurance policy, which factor may insurers change?
• How soon from the reinstatement of a health insurance policy would a loss be covered?
• Which health insurance provision describes the insured's right to cancel coverage?
• How does a longer benefit period affect the premium of a disability policy?
• Benefits will be coordinated when individuals are covered under what situation?
• What benefit does a guaranteed renewable policy provide to the insured?
• What is the typical deductible for basic surgical expense insurance?
• In a replacement situation, what must be considered?
• In health insurance, what does "consideration" refer to?
• How often must an insurance commissioner examine the transactions of an insurer?
• How many days of skilled nursing facility care will Medicare pay for?
• Under which of the following organizations are practicing providers compensated on a fee-for-service basis?
• What is the legal process that gives an insurer the right to seek recovery from a third party after paying a loss?
• What provision describes the insured's right to cancel their coverage?
• What does the term "first dollar coverage" imply in health insurance?
• When do Health Maintenance Organizations (HMOs) prefer members to receive care?
• For Medicare Part A benefits in a skilled nursing facility, what condition must be met?
• The gatekeeper of an HMO helps to:
• What is considered a continuous period of creditable coverage?
• Which characteristic is NOT typically associated with an HMO plan?
• What is the required initial training for producers who want to sell long-term care insurance?
• What is Medicare Advantage also known as?
• Which type of insurance provides benefits to cover caregiving in the event of chronic illness?
• What is true about the taxation of Business Overhead policies?
• Which of the following is NOT a type of insurance policy generally issued in Montana?
• What type of care is provided under intermediate care in Long-Term Care (LTC) insurance?
• What type of benefit is determined by the person's primary insurance amount?
• What type of insurance pays for hiring a replacement for an important employee who becomes disabled?
• What document describes an insured's medical history, including diagnoses and treatments?
• What amount will a disability income policy pay if the insured is hospitalized for 2 weeks after purchasing the policy with a 20-day probationary period?
• Which type of benefits include compensations for medical costs and lost wages?
• What is another name for a primary care physician in an HMO?
• What does the term 'capital' refer to in the context of disability benefits?
• How are HMO territories typically divided?
• Which of the following best describes the nature of health insurance?
• Under workers' compensation, which of the following benefits is typically not included?
• What is the main purpose of long-term care insurance?
• Which provision prevents insurers from using misstatements made on a health insurance application to deny claims after a policy has been in force for a specified period?
• What does a Preferred Provider Organization (PPO) primarily offer to its members?
• What occurs to producer appointments when an insurer's authority is terminated?
• In a guaranteed renewable policy, what change can insurers make compared to other types of policies?
• Regarding cancellable policies, which statement is NOT correct about the cancellation of an individual insurance policy?
• What provision in an insurance policy prevents denial of a claim due to misstatements after two years?
• Which statement is true regarding Long-Term Care (LTC) insurance policies?
• If an employee reduces his working hours, what happens to his group health insurance coverage?
• How can employers effectively reduce health plan costs?
• In regard to health insurance applications, what must be insured to protect consumers?
• What document provides an insured's medical history, including diagnoses and treatments?
• When must both parties to a contract perform certain duties for the contract to be enforceable?
• Once an irrevocable beneficiary is named for the policy, changes of beneficiaries require what?
• What generally happens if an insured fails to provide proof of loss within the specified time frame?
• What is the initial waiting period specified in a disability income policy before a loss can be covered?
• A hospital indemnity policy provides which of the following?
• Credit disability policies can be issued in all of the following forms except which?
• Before an application for a resident producer license is approved, what must the commissioner verify?
• Which factor is NOT typically a consideration in a replacement insurance situation?
• For how long must insurance transaction records be maintained?
• Which of the following elements does not directly influence health insurance premiums?
• Buy-sell coverage benefits are considered?
• Who is authorized to write blanket disability insurance?
• If a health policy lapses due to nonpayment of premium, within how many days can it be automatically reinstated once the outstanding premium is paid?
• Under the partially contributory group disability plan, how is the taxable portion of monthly benefits determined?
• Which best describes the unfair trade practice of defamation?
• Which organization is comprised of insurers that gather medical information?
• Regarding Business Overhead Expense insurance, which statement is correct?
• What is the tax status of premiums paid by self-employed sole proprietors or partners for medical expense insurance?
• According to the Affordable Care Act, what percentage of preventive care must be covered without cost sharing?
• What term refers to the specified dollar amount beyond which the insured no longer participates in expense sharing?
• How many pints of blood will Medicare cover under core benefits?
• How do employer contributions to a Health Savings Account (HSA) affect taxes for the insured?
• Which of the following best describes a feature common in flexible spending accounts?
• How long does an individual have to examine a Medicare supplement policy after receiving it?
• Which of the following describes the taxation of individual disability income insurance premiums and benefits?
• How many hours of continuing education in ethics are required every licensing period for insurers?
• Under which employer-provided plan are the benefits taxable to an employee based on the employer's premium payment?
• What is the primary goal of a Preferred Provider Organization (PPO)?
• What term is used for the circumstances under which a health insurance policy will pay benefits?
• What term describes when one state grants the same privileges to residents of another state, including insurance coverage?
• While a claim is pending, what may an insurance company require?
• How do employer contributions to a health savings account affect the insured's taxes?
• Which of the following is a characteristic of health savings accounts?
• Long-term care (LTC) policies can be purchased in which manner?
• What is the minimum schedule of time in which claim payments must be made to an insured under an individual disability income policy?
• What is typically included in a critical illness insurance policy?
• How is emergency care covered for a member of a Health Maintenance Organization (HMO)?
• In a disability policy, what does the probationary period indicate?
• How many days of skilled nursing facility care will Medicare cover benefits?
• In the context of health insurance, what is generally true about deductibles?
• Which term refers to a person who solicits, negotiates, or delivers policies of insurance?
• When must an insurer provide notice of information practices to the insured?
• An insured is in a car accident and permanently loses the use of his leg and becomes blind. To what extent will the insured receive Presumptive Disability benefits if the blindness improves after a month?
• What is the specific dollar amount required from an HMO member for a service called?
• COBRA applies to employers with how many employees at a minimum?
• What is a primary purpose of a general disability policy?
• Workers' compensation benefits are regulated by which entity?
• Which plan provides employees with the option to use both HMO and non-HMO doctors?
• What occurs when an individual member fails to make a premium payment within the specified time frame?
• What type of care is provided by Respite care?
• If an insured under a Preferred Provider Organization (PPO) plan chooses a physician who is not a PPO provider, what will occur?
• What provision allows for the sharing of expenses between the insured and the insurance company?
• Which option accurately describes the coverage under a standardized Medicare Supplement plan?
• In the context of Medicare Supplement Benefit Plans, what does the term "standard" refer to?
• What are the four essential elements of all legal contracts?
• How many days will Medicare pay full benefits in a skilled nursing facility after hospitalization due to an accident?
• What exemplifies a producer's fiduciary duty?
• Benefit periods for individual short-term disability policies typically last for how long?
• What does the elimination period refer to in the context of disability insurance?
• What action should an employee take if their group disability insurance is eliminated?
• Long-term care policies may exclude coverage for pre-existing conditions if the loss occurs within how many months of the effective date?
• A policy with a 31-day grace period implies what regarding premium payment?
• An insurance company must notify the commissioner whenever it terminates a producer's appointment within how many days?
• What does the term "co-payment" in health insurance plans refer to?
• How are state insurance guaranty associations primarily funded?
• What are "mistatement of age", "change of occupation", and "illegal occupation" examples of?
• Health savings accounts are designed to do what?
• The benefits received by a business in a disability buy-sell policy are:
• What does the term "rebating" refer to in insurance practices?
• If a man is laid off from his job, how long does he have to apply for an individual policy under his group health insurance?
• In relation to disability income policies, what is the relationship between waiting periods and premiums?
• How soon after reinstatement of a health insurance policy does coverage for a loss typically begin?
• Who chooses a primary care physician in a Health Maintenance Organization (HMO)?
• On what basis are benefits for individual disability insurance typically determined?
• If an employee is enrolled in a noncontributory group disability income plan with a 30-day elimination period and suffers a covered disability lasting 7 months, how much will they receive?
• What factor determines the premiums an insured may pay?
• What type of insurance is designed to provide funds for a business to purchase the interest of a disabled partner?
• What type of account must all premiums received by an insurance producer be held in until they are remitted to the insurer?
• What type of reimbursement is not provided by an HMO?
• What does a POS plan allow employees to do regarding healthcare providers?
• How many days in advance must every form be filed with the Commissioner in Montana before its use?
• If a nonresident is applying for a license in Montana and their home state does not require continuing education, what happens?
• What characteristic of an insurance contract is described when an insured pays a $100 premium for coverage of $10,000?
• What is typically required before a health insurance claim is processed?
• What type of health insurance covers insured individuals at both home and work?
• What type of contract does not allow negotiations and is prepared solely by the insurer?
• The premium for exercising the guaranteed insurability rider is based on what factor?
• Which statement is true regarding coinsurance?
• According to the Preferred Provider Agreement Act, what is the maximum payment difference percentage allowed for a health benefit plan with inadequate provider networks?
• Group medical expense premiums are _____ and benefits are _____.
• How does the relation of earnings to insurance provision influence an insured's benefits?
• If an insured reports a loss to their agent within 12 days, but the agent notifies the insurer after 60 days, how is the claim processed?
• In the context of health insurance, what does the term 'exclusion' refer to?
• If an insured makes regular contributions to his health savings account, how are those contributions treated in regard to taxation?
• What is a typical benefit period for long-term care insurance policies?
• Why are the basic types of coverage (medical, surgical, hospital) referred to as first dollar coverage?
• What term is used when healthcare insurers negotiate contracts with providers to offer services at a favorable cost?
• Under what condition are group disability income benefits received by an employee not taxable as income?
• In elderly care, as the elimination period becomes shorter, what happens to the premium?
• What might happen if an individual exceeds their flexible spending account limit?
• Which of the following is NOT a typical exclusion in most disability policies?
• Insurers' appointments of producers last until what occurs?
• In health insurance, what is a premium?
• Who determines the eligibility and contribution limits of a Health Reimbursement Arrangement (HRA)?
• For how long must administrators keep records of all insurance transactions?
• What happens if a non-member physician is utilized under a Point of Service plan?
• In Medicare Part A, how long does the insured need to be hospitalized in order to qualify for coverage in a skilled nursing facility?
• If a policy lapses due to nonpayment of premium, within how many days would it be automatically reinstated once the outstanding premium is paid?
• Under group policies, statements made by insured individuals are considered to be what?
• What is true if a 65-year-old HSA holder uses funds for a non-health expense?
• In Montana, how many activities of daily living must an individual be unable to perform to trigger Long-Term Care (LTC) benefits?
• What is another term used to describe "no deductible" coverage?
• If an insured covered by a partially contributory group disability income plan pays 25% of the premium, how much of a $4,000 monthly benefit will be taxable?
• Which of the following situations is typically excluded from general disability policy coverage?
• If a small company can no longer afford group disability insurance, what happens to its employees' coverage?
• What benefit does a small business owner receive from a disability policy tied to a buy-sell agreement?
• Group disability policies are required to provide well child care coverage until what age?
• What do the restricted network provisions in Medicare Select policies entail?
• A group health plan or insurance must provide benefits for which of the following?
• Most Long-Term Care (LTC) insurance plans are known for which of the following features?
• Which rider would not increase the premium for a policyowner?
• What is the name of the section in a health policy that outlines the causes of eligible loss under which an insured is considered disabled?
• In group health policies, who does a probationary period apply to?
• Which entities can legally bind coverage?
• What is the percentage of covered charges an insured must pay under Medicare Part B after the deductible?
• Which type of long-term care (LTC) is NOT provided in an institutional setting?
• Which term describes the mandatory waiting period before insurance benefits begin?
• What constitutes a competent party in a legal contract in the context of health insurance?
• What is an essential feature of home health care in long-term care policies?
• In the process of replacing an insured's current health insurance policy with a new one, what is a proper action for the agent?
• What is the main objective of underwriting in health insurance?
• The type of dental plan which is incorporated into a major medical expense plan is called?
• What are the two types of flexible spending accounts?
• Which characteristic typically ensures that premiums reflect the risks and coverage provided in an insurance policy?
• If a producer's license is suspended in their home state, what happens to their nonresident license in Montana?
• What is the main purpose of managed care health insurance plans?
• What is the continuing education requirement for producers licensed in life insurance every 2 years?
• To comply with the Insurance Information and Privacy Protection Act, how many days does a producer have to respond to a written request for personal information?
• What information cannot be included in an insurance company’s advertisement?
• What is the primary purpose of coinsurance provisions?
• According to standard requirements, proof of loss under a health insurance policy should typically be filed within how many days?
• What is the role of restricted network provisions in Medicare Select policies?
• What does workers compensation insurance cover regarding work-related sickness or injuries?
• What percentage of benefits does an insured receive when covered by a Medicare Supplement plan for blood after three pints?
• A waiver of premium provision may be included with which type of health insurance policy?
• What type of care is characterized as 'skilled care'?
• Which of the following is typically not covered by an HMO?
• If a small company can no longer offer group disability insurance, can employees convert their coverage to individual policies?
• Group medical and dental benefits are received ________ to ________.
• What is the tax implication for contributions made to a health savings account (HSA)?
• For how long may an insurer contest fraudulent misstatements made in a health insurance application?
• A guaranteed renewable disability insurance policy is renewable under what condition?
• Which of the following is NOT true about short-term disability plans?
• When an insurer issues an individual health insurance policy that is guaranteed renewable, what does the insurer agree to?
• What does the term "deductible" refer to in health insurance?
• What characteristic do short term disability plans have?
• What percentage of individually owned disability income benefits is taxable?