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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Sample Questions:

1. Under Medicare Hospital Insurance Part A, there are no medical benefits provided for treatment in a skilled nursing facility beyond

A) 100 days.
B) 180 days.
C) 60 days.
D) 30 days.

2. A newly hired employee gives his enrollment form to his employer, but due to an administrative error, it is never forwarded to the insurance company. The error is detected 3 months later. What will happen if the clerical error provision is in effect?

A) The employee will have to wait until the next open enrollment period to enroll in the plan.
B) The employee will be allowed to submit an enrollment form and all past due premiums, and will be retroactively insured.
C) The employee will be allowed to submit a new enrollment form and will be enrolled as of the date the new form is accepted.
D) The employer will be required to pay the past due premiums.

3. An insured individual who just turned 67 years old is still working and is a member of the group health insurance plan provided by his employer, which has 18 insured employees. In this case, Medicare will MOST likely

A) require the individual to cancel his group insurance.
B) not cover any claims to protect against overinsurance.
C) act as the primary insurer and pay claims up to the limit of the policy.
D) act as a secondary insurer and pay claims not completely covered by the group health insurance.

4. Misrepresenting the advantages and benefits of a new policy to induce replacement of an existing policy is

A) rebating.
B) forfeiting.
C) defamation.
D) twisting.

5. Which of the following describes the gatekeeper strategy used by HMOs?

A) The process of obtaining referrals to specialists from primary care physicians.
B) The refusal of coverage for patients with preexisting conditions.
C) The use of supplemental services on an additional cost basis.
D) The emphasis on preventing enrollees from using patient services.

Solutions: