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| Section | Weight | Objectives |
|---|---|---|
| Individual Health Insurance Policy General Provisions | - Uniform required provisions - Optional provisions - Other provisions | |
| Life Insurance Basics | 8% | - Personal uses of life insurance - Factors in premium determination - Licensee responsibilities - Determining amount of personal life insurance - Insurable interest - Differences in life insurance policies - Premiums - Business uses of life insurance - Individual underwriting by the insurer |
| Health Insurance Basics | - Health insurance concepts - Disability income insurance - Medical expense insurance - Social insurance - Policy provisions and riders | |
| General Insurance | 6% | - Agents and general rules of agency - Concepts - Contracts - Insurers |
| Pennsylvania Statutes, Rules and Regulations Common to Life, Accident and Health | 30% | - Licensing requirements - Pennsylvania Insurance Department - Agent conduct and trade practices - Unfair trade practices - Penalties and offenses |
| Specialized Health Insurance for Qualified Individuals | - Medicaid - HIPAA - Medicare - Long-term care insurance | |
| Insurance Regulation | 8% | - Federal regulation - State regulation - Licensing |
| Annuities | - Annuity principles and concepts - Annuity taxation - Annuity products | |
| Life Insurance Policies | 11% | - Flexible premium policies - Group life insurance - Whole life insurance - Term life insurance - Specialized policies |
| Group Health Insurance | - Group health insurance concepts - Group health insurance provisions - Group health insurance plans |
1. Which one of the following types of benefits is often excluded from coverage under an HMO plan?
A) physical examinations
B) emergency services
C) adult routine eye examinations
D) in-patient surgeries
2. All of the following are features of a Preferred Provider Organization (PPO) EXCEPT
A) providers are paid on a fee-for-service basis.
B) employees have a choice of practitioners.
C) dependents do not need referrals to see a specialist.
D) primary care physicians act as gatekeepers.
3. The main purpose of insurance is to
A) retain risk.
B) transfer risk.
C) reduce risk.
D) avoid risk.
4. An insured under a disability income policy is receiving monthly benefit checks after losing both legs in an automobile accident. Although the insured could be assigned desk duties, the condition that automatically qualifies this insured for total disability classification is
A) partial.
B) residual.
C) recurrent.
D) presumptive.
5. An insured submits a $300 claim for medical expenses. The insurer notes that the insured has a past due premium of $100, and as a result, the insurer only pays $200. * Which of the following General Policy Provisions covers this situation?
A) renewability
B) payment actions
C) payment of claims
D) unpaid premium
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: C | Question # 3 Answer: B | Question # 4 Answer: D | Question # 5 Answer: D |
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