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| Section | Weight | Objectives |
|---|---|---|
| Underwriting, Marketing and Sales Practices | 15% | - Application and Underwriting Procedures
|
| Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
| Accident and Health Insurance | 35% | - Government Health Programs
|
| Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
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NEW QUESTION # 54
Which of the following is an example of risk sharing?
Answer: A
Explanation:
Risk sharing is a risk management technique in which a group combines resources so that losses experienced by a few are spread across many. The classic insurance concept behind this is pooling : each participant contributes money to a common fund, and the fund is used to pay covered losses as they occur. Option B describes this directly- pooling money to cover malpractice exposures -because malpractice losses can be unpredictable and potentially severe, and sharing them across a group reduces the financial impact on any one member.
The other options describe different risk management methods. Option A (not purchasing a car) is risk avoidance -eliminating the exposure entirely. Option C (installing sprinklers) is risk reduction/loss control , lowering the frequency or severity of loss. Option D (purchasing an insurance policy) is primarily risk transfer
, shifting the financial consequences of specified losses to an insurer in exchange for a premium. Because only option B reflects spreading losses among a group through pooling, it is the best example of risk sharing .
NEW QUESTION # 55
An annuitant dies during the accumulation period. What happens to the cash value in the annuity?
Answer: D
NEW QUESTION # 56
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: D
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 # 57
An insurer monitors the care an insured is receiving in the hospital to be sure that everything is proceeding according to schedule. This BEST describes
Answer: B
Explanation:
This situation describes concurrent review , a type of utilization management performed while the insured is actively receiving care , such as during an inpatient hospital stay. In concurrent review, the insurer (or its utilization review organization) monitors the ongoing treatment plan to confirm that services remain medically necessary , appropriate in intensity, and consistent with expected treatment timelines (for example, whether continued hospitalization is justified or whether discharge planning is appropriate). This differs from precertification (prior authorization) , which occurs before a service is provided to approve planned hospitalization, procedures, or certain high-cost services. It also differs from claims adjudication , which is the process of evaluating a submitted claim after services are rendered to determine payable benefits under the policy (applying deductibles, coinsurance, exclusions, and coverage limits). "Benefit checking" is not the standard term used for this managed care function. Because the question emphasizes monitoring care "in the hospital" and ensuring it proceeds according to schedule during the stay, the best match is concurrent review .
NEW QUESTION # 58
Predicting an individual ' s future earning potential and determining how much of that amount would be devoted to his dependents incorporates the
Answer: D
Explanation:
The correct answer is human life value approach . In life insurance planning, the human life value approach is used to estimate the economic value of an insured person's future earnings to those who depend on that income. It focuses on the idea that an individual's life has an insurable value based on the amount of income he or she is expected to earn in the future and the portion of that income that would have been used to support dependents. This method is commonly applied when determining how much life insurance is needed to replace the financial contribution of a wage earner.
Under this approach, factors such as current earnings, future earning capacity, years until retirement, inflation, taxes, and personal living expenses are considered. The amount available to dependents is then projected to help establish an appropriate death benefit.
The other options do not fit this definition. The needs approach centers on the survivors' financial needs after death, not strictly on future income value. "Loss exposure" and "salary projection" are not the standard life insurance need-analysis terms tested for this concept. Therefore, the correct answer is human life value approach .
NEW QUESTION # 59
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