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NEW QUESTION # 129
In Virginia, a group health certificate of insurance must contain:
Answer: D
Explanation:
Virginia law requires insurers to provide each group member with a certificate that summarizes the group policy's benefits and features, including coverage, exclusions, and how to file claims.
Exact Extract (Virginia Group Health Law): "Each individual insured under a group health policy shall be provided with a certificate summarizing the essential features of the insurance coverage." Reference (Virginia Documents / Study Guide):
- Code of Virginia §38.2-3521.2 (Certificates of coverage under group health policies)
NEW QUESTION # 130
A typical disability income insurance policy EXCLUDES benefits for which one of the following causes of loss?
Answer: B
Explanation:
Detailed Answer in Step-by-Step Solution:
* Disability income policies exclude benefits for intentional self-inflicted injuries (B) to prevent abuse or fraud.
* Permanent injuries (A), sporting accidents (C), and falls (D) are typically covered unless specifically excluded by the policy.
The Virginia study guide states that disability income insurance excludes self-inflicted injuries as a standard provision to ensure coverage applies to unforeseen events. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."
NEW QUESTION # 131
A person with dishonest tendencies may pose a:
Answer: B
Explanation:
Moral hazard refers to the increased chance of loss due to the insured's dishonesty or fraudulent intent. Examples include exaggerating claims or intentionally causing loss.
Exact Extract (Virginia Insurance Fundamentals Study Guide): "Moral hazard-hazard arising from dishonesty or lack of integrity of the insured, such as filing fraudulent claims." Reference (Virginia Documents / Study Guide):
- Virginia General Insurance Concepts Outline, Risk and Hazards
NEW QUESTION # 132
Preferred provider organizations (PPOs) encourage patients to use specified hospitals by:
Answer: B
Explanation:
Preferred Provider Organizations (PPOs) encourage patients to use specified hospitals by offering greater coinsurance percentages for services received from network providers. If patients use out-of-network providers, they typically have to pay a higher share of the costs. PPOs work by incentivizing patients to choose providers within the network by offering lower out-of-pocket costs.
NEW QUESTION # 133
Which concept states that the insured is entitled to the coverage under a policy that a sensible and prudent buyer would expect it to provide?
Answer: B
Explanation:
The concept of "reasonable expectations" states that the insured is entitled to the coverage under a policy that a sensible and prudent buyer would expect it to provide. This means that the insurer must honor the expectations of the insured based on the policy's terms, even if the wording is unclear or ambiguous, as long as those expectations are reasonable.
NEW QUESTION # 134
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