D9. Washington Disability Law Practice Exam

  1. An insured who pays his health insurance premium quarterly is required to have a grace period of ____ days.



    • A) 31
    • The grace period on an A&H policy is tied to mode of payment. If the premium is paid weekly, the grace period is 7 days, monthly is 10 days, and any other way (including group policies) is 31 days. After the grace period is over, the coverage will lapse.
  2. All of the following are true regarding LTC policies sold in the state of Washington EXCEPT:



    • B) LTC policies may condition coverage on the insured's eligibility for Medicare
    • LTC policies may not condition coverage on the insured's eligibility for Medicare or prior hospitalization.
  3. All of the following are true regarding coverage provided by health care service contractors and HMOs EXCEPT:



    • A) Employers with under 50 employees must offer at least one HMO to their employees
    • Each employer with more than 50 employees must inform their employees that they have the option to enroll in an HMO instead of a health insurance plan. The employer must then actually provide the option if at least 25 employees agree to participate in the HMO.
  4. Agent responsibilities when selling an LTC policy in the state of Washington include all of the following EXCEPT:



    • D) The disclosure form can be designed by the insurer and include whatever information the insurer thinks would be needed
    • All insurers must use the same disclosure form so that purchasers will find it easy to compare competing contracts. This form must follow the format prescribed by Washington insurance code as well as the sample of the form provided by the Commissioner.
  5. Which of the following is false regarding inflation protection on an LTC policy sold in the state of Washington?



    • D) Inflation protection must only be offered if the applicant is under age 50
    • Inflation protection must be included in all LTC contracts, no matter the age of the insured, at a rate of 5%, unless the applicant rejects it in writing.
  6. Blue Cross and Blue Shield are considered to be which of the following?



    • A) Health care service contractors
    • Blue Cross and Blue Shield are considered to be health care service contractors (HCSC).
  7. If a long-term care policy provides coverage for home health care, it must provide benefits of at least ____% of the annual nursing home benefits provided by the policy.



    • A) 50
    • If a long-term care policy provides coverage for home health care, it must provide benefits of at least 50% of the annual nursing home benefits provided by the policy.
  8. Of the following, which one is not considered an unfair or deceptive act?



    • A) Requiring proof of loss be filed
    • Misrepresenting policy pertinent facts or insurance contract provisions, failing to acknowledge and act promptly on claims communications, and failing to state which section of the policy the payment or denial of a claim is based upon are considered unfair or deceptive acts. Requiring proof of loss, such as a hospital bill, be filed is not prohibited since insurers must have evidence that a claim occurred.
  9. All of the following are true regarding payment of claims EXCEPT:



    • D) Legal Actions provision is for five (5) years
    • Legal Actions provision states that the insured cannot sue the insurer until after 60 days from filing proof of loss, nor for more than three (3) years after written proof of loss was required to be filed.
  10. Which of the following is true regarding an employer's duty to offer HMO coverage?



    • D) The duty applies to all state government, or political subdivision, and public and private employers having more than 50 employees in Washington and offering its employees a health benefits plan.
    • The duty to offer HMO coverage applies to all state government, or political subdivision, and public and private employers having more than 50 employees in Washington and offering its employees a health benefits plan.
  11. Under the ____________ provision, insurers must pay individual health insurance claims immediately or no later than 30 days after receipt of Proof of Loss.



    • B) Time Payment of Claims
    • Time Payment of Claims is the provision which states that insurers must pay individual health insurance claims immediately or no later than 30 days after receipt of Proof of Loss. Payment of Claims states that the claim will be paid to the insured, and that death benefits will be paid to the beneficiary, or if there is no beneficiary to the insured’s estate. Notice of Claim states that the insured has 20 days from the date of loss to inform the insurer of the loss (claim). Time Limit on Certain Defenses states that accident and health (disability) policies are incontestable after two years, except for fraud and material misstatements or omissions. All of these are mandatory provisions designed to protect the insured.
  12. In order for a Producer to sell long-term care insurance, they must complete a one-time ____ hour LTC training course and ____ hours of specific LTC continuing education every 24 months.



    • C) 8; 4
    • Prior to soliciting, selling, or negotiating long-term care insurance coverage, all LTC producers must complete 8 hours of LTC training. There is also a specific continuing education (CE) requirement for LTC producers: 4 hours of ongoing LTC training every 24 months.
  13. All of the following are mandatory provisions on individual health insurance policies EXCEPT:



    • B) Change of Occupation
    • Mandatory provisions for individual disability policies issued in Washington include: Entire Contract clause, Change of Beneficiary clause, Time Limit on Certain Defenses, Misstatement of Age or Gender, Grace Period, Reinstatement, Notice of Claim, Claims Forms, Proof of Loss, Physical Exam and Autopsy, Time Payment of Claims, Payment of Claims, and Legal Action. These provisions are designed to protect the insured. Change of Occupation clause is an optional provision, not mandatory. Optional provisions are allowed, but not required by law, and are designed to protect the insurance companies.
  14. Which of the following is false regarding the Health Care False Claim Act?



    • D) Violations of this act are considered Class 1 misdemeanors
    • Violating the Health Care False Claim Act is a Class C felony, which could result in up to a $10,000 fine or five (5) years in prison.
  15. All of the following are mandatory provisions for individual disability policies issued in Washington EXCEPT:



    • B) Change of Occupation clause
    • Mandatory Provisions for individual disability policies issued in Washington include: Entire Contract clause, Change of Beneficiary clause, Time Limit on Certain Defenses, Misstatement of Age or Gender, Grace Period, Reinstatement, Notice of Claim, Claims Forms, Proof of Loss, Physical Exam and Autopsy, Time Payment of Claims, Payment of Claims, and Legal Action. These provisions are designed to protect the insured. Change of Occupation clause is an optional provision, not mandatory. Optional provisions are allowed, but not required by law, and are designed to protect the insurers.
  16. All of the following are false regarding Medicare Supplement policies sold in the state of Washington EXCEPT:



    • B) They must be guaranteed renewable
    • Medicare Supplement policies sold in the state of Washington must be guaranteed renewable, may not cover the same things that Medicare covers, and are not required to fill in all of the gaps in Medicare.
  17. All of the following are true regarding the LTC policy's benefit triggers allowed by law EXCEPT:



    • B) The policy may not condition benefits upon the insured's cognitive impairment
    • Long-term care insurance provides for payment of benefits based upon cognitive impairment or the loss of functional capacity.
  18. AD&D policies must cover death that results from an accident for at least _____.



    • D) 1 year
    • Washington State law requires AD&D policies to cover accidental death for up to one (1) year from the date of an accident.
  19. Both Medicare Supplement and long-term care insurance policies are required to have a ____ -day free look.



    • C) 30
    • Both Medicare Supplement and long-term care insurance policies are required to have a 30-day free look.
  20. When selling a Medicare Supplement policy which of the following is true?



    • D) Agents must make a diligent effort to determine whether an applicant has a Medicare Supplement, and must also make sure the Medicare Supplement is appropriate for the applicant.
    • When selling a Medicare Supplement policy, agents must make a diligent effort to determine whether an applicant has a Medicare Supplement, and must also make sure a Medicare Supplement is appropriate for the applicant.
  21. In order for an agent to sell Long-Term Care policies in the state of Washington, all of the following are true regarding educational responsibilities of the agent EXCEPT:



    • B) Agents are allowed to sell three (3) LTC policies before completing any LTC CE.
    • Prior to soliciting, selling, or negotiating long-term care insurance coverage, all LTC producers must complete 8 hours of LTC training. There’s also a specific continuing education (CE) requirement for LTC producers: four (4) hours of ongoing LTC training every 24 months.
  22. Producers must give applicants for individual health insurance a Shopper's Guide:



    • A) Prior to making their sales presentation
    • Producers must give an applicant for health insurance a Shopper’s Guide prior to making their sales presentation.
  23. Which of the following is false regarding the rules related to nonrenewal and cancellation?



    • C) An insurer may refuse to renew an individual disability policy because of a change in the insured's physical or mental condition or health.
    • An insurer may not refuse to renew an individual disability policy because of a change in the insured's physical or mental condition.
  24. Which of the following is true regarding group disability policies?



    • C) Each individual or family must be given a certificate of coverage summarizing the coverage
    • On group disability policies, the policyowner is the employer, not the employee or their family. Each individual or family does not receive a copy of the policy, but instead must be given a certificate of insurance summarizing the coverage. Group disability policies allow coverage for dependents of employees.
  25. All LTC policies sold in the state of Washington must meet the following minimum standards EXCEPT:



    • D) LTC policies sold in Washington need only cover skilled care
    • LTC policies sold in Washington must cover skilled care as well as intermediate care and custodial care.
  26. All of the following are true regarding coverage for pre-existing conditions on an LTC policy EXCEPT:



    • C) The maximum pre-existing condition clause is six months
    • LTC policies may not limit coverage for pre-existing conditions that the insured was treated for in the 12-month period prior to the effective date of coverage for more than six (6) months after the coverage takes effect.
  27. All of the following are correct regarding LTC policies sold in the state of Washington EXCEPT:



    • C) The insured does not have the right to designate another party to receive notice of lapse or termination due to nonpayment of premium.
    • You are looking for the false answer. "The insured does not have the right to designate another party to receive notice of lapse or termination due to nonpayment of premium" is false. On an LTC policy, the insured has the right to designate another party to receive notice of lapse or termination due to nonpayment of premium.
  28. All of the following are prohibited practices by a person selling LTC policies EXCEPT:



    • D) Giving consumers the LTC disclosure form at time of application
    • Giving consumers the LTC disclosure form at time of application is a required practice for producers selling LTC policies.
  29. Should an insured lose disability coverage due to death or divorce of the principal insured, all of the following are true regarding conversion and continuation EXCEPT:



    • B) For conversion, the converted policy may be subject to insurability
    • Coverage must be provided without a physical examination, statement of health, or other proof of insurability.
  30. Which of the following correctly describes the maximum pre-existing condition clause on a Medicare Supplement sold in the state of Washington?



    • A) Pre-existing conditions are those for which medical advice or treatment was given in the previous three (3) months before the effective date of coverage
    • In Washington, a Medicare Supplement can have a maximum probationary period of three (3) months.
  31. All of the following are true regarding Medicare Supplements sold in the state of Washington EXCEPT:



    • D) Medicare Supplement may have a 6-month pre-existing condition clause
    • In Washington, Medicare Supplements may have a pre-existing condition clause of no more than three months.
  32. Insureds who have been found guilty of violating the Health Care False Claims Act may be may be fined up to $10,000 or sentenced to up to ____ years in prison.



    • D) 5
    • Violating the Health Care False Claim Act is a Class C felony, which could result in up to a $10,000 fine or five (5) years in prison.
  33. All of the following may be excluded from coverage on an LTC policy EXCEPT:



    • C) Alzheimer's
    • LTC insurance policies may not exclude coverage for Alzheimer’s disease.
  34. All of the following are optional provisions for an individual disability policy sold in the state of Washington EXCEPT:



    • A) Legal Action
    • Relations of Earnings to Insurance, Illegal Occupation, and Change of Occupation are optional provisions for individual disability policies sold in Washington. Legal Action is a mandatory provision designed to protect the insured.
  35. All of the following are true regarding coverage for newborn children (and adopted children) EXCEPT:



    • A) If an additional premium payment is due for the child, it must be paid within seven (7) days of birth
    • If an additional premium is required to provide coverage for a new child, it must be paid within 60 days of birth to continue coverage beyond that 60-day period.
  36. Which of the following is true about the disclosure requirements for individual disability policies?



    • B) Giving out an outline of coverage is mandatory
    • An applicant for an accident and health (disability) policy must be given an outline of coverage either at the time of application or with the policy.
  37. All of the following are true regarding LTC policies sold in the state of Washington EXCEPT:



    • D) Policies may be canceled due to deterioration of health
    • LTC policies sold in the state of Washington must be guaranteed renewable, have a 30-day free look, or 60-day if solicited through mail. LTC policies may not be canceled or nonrenewed solely on the grounds of the age or the deterioration of the mental or physical health of the insured.
  38. All of the following are prohibited provisions in an LTC contract in the state of Washington EXCEPT:



    • A) Cancellation or nonrenewal of the policy based upon nonpayment of premium
    • LTC policies may not be canceled or nonrenewed solely on the grounds of the age or the deterioration of the mental or physical health of the insured. Nonpayment of premium is a perfectly valid reason for cancellation or nonrenewal of the policy.
  39. The conversion policies offered to an insured who has lost disability coverage due to death or divorce of the principal insured include all of the following EXCEPT:



    • C) HMO
    • A health care service contractor must offer at least three (3) conversion benefit plans that provide at least the minimum coverage required by state law and comply with the following: a major medical plan with a $5,000 deductible and a lifetime benefit maximum of $250,000 per person; a comprehensive medical plan with a $500 deductible and a lifetime benefit maximum of $500,000 per person; or a basic medical plan with a $1,000 deductible and a lifetime maximum of $75,000 per person.
  40. All of the following are true regarding an agent's duty when selling disability policies EXCEPT:



    • A) The agent may obtain a receipt from the insured indicating delivery, but then retain the policy
    • Insurance producers delivering insurance policies to insureds must make an actual physical delivery. It is not acceptable for a producer to merely obtain a receipt indicating a delivery and then to retain the policy, for safekeeping or otherwise, in the producer's possession.
Author
EdiesTeam
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317814
Card Set
D9. Washington Disability Law Practice Exam
Description
Washington Disability Law Practice Exam
Updated