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California Department of Insurance CA Life, Accident and Health or Sickness Examination Sample Questions (Q98-Q103):

NEW QUESTION # 98
What is the definition of premium?

A. Bonus paid by an agent to convince an insured to buy a policy.
B. Amount the insured pays per unit of coverage (e.g., $10 per $1,000 of coverage).
C. Money an insurer pays to an insured to obtain the benefits provided in the policy.
D. Money an insured pays an insurer to obtain benefits provided in the policy.

Answer: D

Explanation:
The premium is the amount of money an insured pays to an insurance company to maintain coverage and receive the benefits outlined in the policy. It is usually paid on a regular basis, such as monthly, quarterly, or annually. This payment ensures that the policy remains in force and that the insurer will pay out claims according to the policy terms.

NEW QUESTION # 99
Under the PPACA, which medical enrollment tier is 80% actuarial value?

A. bronze
B. silver
C. gold
D. platinum

Answer: C

Explanation:
PPACA Tiers: The Patient Protection and Affordable Care Act (PPACA) established different tiers of health insurance plans, categorized by their actuarial value.
Actuarial Value: The actuarial value represents the percentage of total average costs for covered benefits that a plan will cover. The tiers are bronze (60%), silver (70%), gold (80%), and platinum (90%).
Gold Tier: The gold tier, which has an actuarial value of 80%, means that the plan covers approximately 80% of healthcare expenses, with the insured responsible for the remaining 20%.
Regulatory Reference: This information is outlined in the PPACA and further detailed by the Centers for Medicare & Medicaid Services (CMS).

NEW QUESTION # 100
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.

Answer: C

Explanation:
A Preferred Provider Organization (PPO) offers flexibility in choosing healthcare providers and does not require a primary care physician (PCP) to act as a gatekeeper. PPO members can see specialists and any healthcare provider without needing a referral from a PCP (D). Other features include payment on a fee-for-service basis (C) and a choice of practitioners (A).

NEW QUESTION # 101
The California Insurance Code requirements regarding the return of life or annuity contracts issued to seniors

A. gives a senior at least 30 days to return specified life and/or annuity contracts for a full refund.
B. mandates a 30 day free look for all applicants.
C. defines seniors as someone 55 years of age or older on the date of purchase of the policy.
D. applies to group policies.

Answer: A

Explanation:
The California Insurance Code requires that seniors, defined as individuals aged 60 or older, have a minimum of 30 days to return life insurance or annuity contracts for a full refund. This provision ensures that seniors have adequate time to review and reconsider their purchase without financial penalty.

NEW QUESTION # 102
After the deductible is satisfied, what percentage of a reasonable charge does Medicare Part B pay?

A. 40%
B. 100%
C. 80%
D. 20%

Answer: C

Explanation:
Medicare Part B covers outpatient medical services, including doctor visits, preventive services, and medical equipment. After the deductible is satisfied, Medicare Part B typically pays 80% of the reasonable charge for covered services, while the beneficiary is responsible for the remaining 20% coinsurance. This cost-sharing structure helps manage the out-of-pocket expenses for beneficiaries while providing substantial coverage for medical needs. The specifics of these payments are detailed in the Medicare guidelines and the California Department of Insurance documentation.

NEW QUESTION # 103
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BUY NOW TO GET FREE REAL CALIFORNIA DEPARTMENT OF INSURANCE CA-LIFE-ACCIDENT-AND-HEALTH QUESTIONS UPDATES

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