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| Section | Objectives |
|---|---|
| Accident and Health Insurance | - Health insurance products
|
| Insurance Fundamentals | - Principles of insurance and risk management
|
| State Regulations (New York) | - Ethics and compliance
|
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NEW QUESTION # 27
According to the Affordable Care Act, a child can remain on a parent ' s health benefit plan until the child
Answer: C
Explanation:
The correct answer is reaches age 26 . The Affordable Care Act (ACA) introduced a major change in health insurance dependent coverage rules by requiring most health insurance plans that provide dependent coverage to allow children to stay on their parent's health insurance policy until they reach age 26 . This rule applies to both individual and employer-sponsored health plans .
One important feature of this regulation is that eligibility does not depend on the child's marital status, student status, financial independence, or residence . This means a young adult may still remain covered under the parent's plan even if the child is married, living independently, or no longer attending school. The goal of this provision is to reduce the number of uninsured young adults who may otherwise lose coverage after finishing school or aging out of traditional dependent eligibility requirements.
The other options are incorrect because dependent coverage does not automatically end when the child marries, graduates from college, or turns age 19 . The ACA clearly sets the maximum age for dependent coverage at 26 years old , making Option C the correct answer.
Because the owner's physician, accountant, and insurance consultant are all specifically barred from receiving such referral compensation, the only correct option is D. life settlement broker .
NEW QUESTION # 28
Mortality is based on a large risk pool of
Answer: D
Explanation:
The correct answer is people and time . In insurance, mortality refers to the statistical measurement of death within a defined population. Insurers rely on mortality tables , which are developed using large pools of data that track the probability of death among groups of people over specific periods of time. These tables allow insurance companies to estimate the likelihood that individuals within certain age groups will die within a given year. The concept is based on the law of large numbers , meaning that when a very large group of people is observed over time, patterns of mortality become predictable and can be used to calculate insurance premiums.
Life insurance companies analyze mortality data across large populations and extended time periods to determine appropriate premium rates and to ensure that they maintain sufficient reserves to pay future claims.
By spreading risk across many policyholders, insurers can accurately project expected losses and maintain financial stability.
The other options are incorrect because mortality statistics are not primarily based on income, geographic area alone, or personal characteristics such as hobbies or family history. The essential foundation of mortality calculations is large groups of people observed over time .
NEW QUESTION # 29
Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if
Answer: C
Explanation:
The Affordable Care Act (ACA) requires health plans to maintain a formal internal claims and appeals process and to provide access to external review when appropriate. A key consumer protection under the ACA is that, after a claim is denied (an "adverse benefit determination"), the covered person must be given a reasonable opportunity to appeal. Standard ACA claims-and-appeals rules provide a specific filing window for an internal appeal: the insured generally has up to 180 days from receipt of the denial notice to submit the appeal. If an appeal request is made after that deadline, the insurer (or plan) may treat it as untimely and can refuse to accept it as a valid internal appeal.
The other options do not reflect ACA requirements. ACA appeals are not limited by a minimum dollar amount like $500, and plans cannot impose an appeal fee as a condition of filing. Also, ACA rules do not set a
"three appeals per year" cap; appeal rights are tied to adverse determinations, not an annual quota. Therefore, the insurer may refuse only if the appeal is filed more than 180 days after denial.
NEW QUESTION # 30
Individuals who are eligible for Medicare on the first day of the month in which they turn age 65 are automatically enrolled in
Answer: D
Explanation:
Medicare is a federal health insurance program primarily available to individuals age 65 and older , as well as certain younger individuals with disabilities. Medicare is divided into several parts, each covering different types of healthcare services. Medicare Part A , also known as Hospital Insurance , covers inpatient hospital care, skilled nursing facility care, hospice care, and some limited home health services.
Individuals who qualify for Medicare-especially those already receiving Social Security retirement benefits
-are typically automatically enrolled in Medicare Part A when they reach age 65. Coverage generally begins on the first day of the month in which the individual turns 65 (or the prior month if their birthday falls on the first day of the month). Because most individuals have paid Medicare taxes through payroll contributions during their working years, Part A usually requires no monthly premium .
Medicare Part B (Medical Insurance), which covers physician services, outpatient care, and preventive services, requires a monthly premium and may require active enrollment if the individual is not automatically enrolled. Part C refers to Medicare Advantage plans offered by private insurers, and Part D provides prescription drug coverage. Therefore, the part of Medicare that eligible individuals are automatically enrolled in is Medicare Part A .
NEW QUESTION # 31
The insured, who is 59 years of age decides to replace a long-term care policy they had for five years for a new policy. Which of the following is true of the insurer?
Answer: A
Explanation:
The correct answer is D. The replacement insurer will waive probationary periods pertaining to preexisting conditions satisfied under the original policy. In long-term care insurance replacement rules, an insured should not lose credit for time already served under an existing policy when moving to a new long-term care policy. If the insured has already satisfied a preexisting condition limitation or probationary period under the old policy, the replacing insurer must give credit for that satisfied period instead of starting a new waiting period from the beginning. This protects consumers from being penalized simply because they replaced coverage.
Choice A is incorrect because the original insurer is not required to reimburse unused benefit dollars when a policy is replaced. Choice B is incorrect because the replacement insurer may not simply impose a brand-new probationary or preexisting condition exclusion for periods already satisfied under the old coverage. Choice C is also incorrect because the replacement coverage must recognize prior satisfied waiting periods. Therefore, under long-term care replacement standards, the insurer replacing the policy must waive any probationary periods for preexisting conditions that were already satisfied under the original policy .
NEW QUESTION # 32
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