合格させるCalifornia Department of Insurance CA-Life-Accident-and-Health試験には保証が付きます。更新されたのは157問があります
最新のCA-Life-Accident-and-Health合格保証付き試験問題集の認定サンプル問題
質問 # 45
A health insurance issuer offering coverage in the individual market must provide premium rebates if its medical loss ratio (MLR) is less than what percentage?
- A. 85%
- B. 75%
- C. 70%
- D. 80%
正解：D
解説：
Medical Loss Ratio (MLR): The MLR is a measure of the percentage of premium revenues that an insurance company spends on clinical services and quality improvement.
Requirement for Individual Market: Health insurance issuers in the individual market must have an MLR of at least 80%. This means at least 80% of premiums must be spent on healthcare claims and quality improvement.
Premium Rebates: If an insurer fails to meet the 80% MLR, they must provide rebates to policyholders.
References: California Insurance Code Section 10112.25 and the Affordable Care Act regulations require insurers to meet specific MLR standards and issue rebates if these standardsare not met.
質問 # 46
In order to be qualified to sell long-term care insurance in the State of California, agents must comply with all of the following EXCEPT
- A. for licenses issued after Jan 1,1992, eight hours of training in each of the first, four 12-month periods beginning from the date of the original license issuance and thereafter eight hours of training prior to each license renewal.
- B. non-resident licensees must complete an approved California long-term care education requirement.
- C. eight hours each year prior to each renewal for licenses issued prior to January 1,1992.
- D. all licensees are required to pass a long-term care knowledge exam every 10 years.
正解：D
解説：
To sell long-term care insurance in California, agents must comply with specific education and training requirements. This includes completing eight hours of training prior to each license renewal for licenses issued prior to January 1, 1992, and eight hours of training in each of the first four 12-month periods from the date of original license issuance for licenses issued after January 1, 1992. Non-resident licensees must also complete California-approved long-term care education requirements. However, there is no requirement for all licensees to pass a long-term care knowledge exam every 10 years, making option A incorrect according to the regulations set forth by the California Department of Insurance.
質問 # 47
All of the following are optional group medical coverages EXCEPT
- A. dental.
- B. prescription drug.
- C. maternity.
- D. vision.
正解：C
解説：
In group medical coverages, optional coverages are those that can be added to the basic health plan at the employer's or employee's discretion. Dental, prescription drug, and vision coverages are typically considered optional benefits that can be selected in addition to the basic health plan. Maternity coverage, however, is often included as a mandatory benefit in group health insurance policies due to regulations and requirements for comprehensive coverage, particularly under the Affordable Care Act (ACA).References: California Department of Insurance guidelines on group health insurance benefits and ACA requirements.
質問 # 48
The term for an insurer which has met the conditions required to transact business in the State of California is
- A. authorized.
- B. eligible.
- C. admitted.
- D. entitled.
正解：C
解説：
An insurer that has met all the regulatory requirements and has been approved to transact business in California is termed "admitted." This status means the insurer is authorized and licensed by the California Department of Insurance to offer its products within the state.
質問 # 49
Who submits Medicare Part A claims?
- A. Pharmacies
- B. Hospitals
- C. Patients
- D. Physicians
正解：B
解説：
* Definition: Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, and
* some home health care.
* Claims Submission: Hospitals and other institutional providers submit claims for Medicare Part A services rendered to beneficiaries.
* Process: When a Medicare beneficiary receives inpatient care, the hospital submits the claim to Medicare for reimbursement.
* Patients' Role: Patients typically do not submit Medicare claims themselves; they may receive an Explanation of Benefits (EOB) outlining what services were billed and paid.
* Regulations: The Centers for Medicare & Medicaid Services (CMS) regulate the claims submission process, ensuring hospitals comply with Medicare requirements.
References:
* Centers for Medicare & Medicaid Services (CMS) guidelines on Medicare claims submission.
* California Department of Insurance guidelines on Medicare.
質問 # 50
A Hospital Confinement Indemnity insurance policy pays
- A. an indemnity to the insured for all expenses incurred when the insured is confined in a hospital.
- B. the amount of the actual hospital expenses.
- C. the daily benefit dollar amount stated in the policy for each day the insured is confined ina hospital.
- D. 100% of the covered medical expenses less the deductible and coinsurance percentage.
正解：C
解説：
A Hospital Confinement Indemnity insurance policy provides a specific daily benefit amount for each day the insured is confined in a hospital, as stated in the policy. This benefit is predetermined and paid directly to the insured, regardless of the actual hospital expenses incurred. It helps cover out-of-pocket costs and other expenses that may arise during a hospital stay, giving the insured more flexibility in managing their finances during a period of confinement.
質問 # 51
When is the automatic loan provision activated?
- A. On the premium due date.
OB. At the end of the grace period. - B. At the end of the incontestability period.
- C. At the end of the free-look period.
正解：C
解説：
The automatic loan provision is a feature in some life insurance policies that automatically takes a loan against the policy's cash value to pay any overdue premium at the end of the grace period. This prevents the policy from lapsing due to non-payment of premiums. The loan amount is subject to interest and will be deducted from the death benefit if not repaid.
質問 # 52
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. defines seniors as someone 55 years of age or older on the date of purchase of the policy.
- C. applies to group policies.
- D. mandates a 30 day free look for all applicants.
正解：A
解説：
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.
質問 # 53
Characteristics of Preferred Provider Organizations (PPOs) include all of the following EXCEPT
- A. primary physicians serve as gatekeepers.
- B. there are incentives to use network providers.
- C. employees can see specialists without referrals.
- D. benefits are paid for care received by non-network physicians.
正解：A
解説：
Preferred Provider Organizations (PPOs) offer flexible and broad access to healthcare providers.
Characteristics of PPOs include incentives for using network providers (B), the ability for employees to see specialists without referrals (C), and coverage for care received from non-network physicians, although at a higher cost (D). Unlike Health Maintenance Organizations (HMOs), PPOs do not require primary care physicians to serve as gatekeepers, making option A incorrect.
質問 # 54
Indexed annuities offer all of the following features EXCEPT
- A. a minimum guarantee of interest rate.
- B. an annually increasing maximum rate of interest.
- C. an opportunity to participate in gains associated with the stock market.
- D. protection during stock market declines.
正解：B
解説：
Indexed Annuities Features:Indexed annuities provide a minimum guarantee of interest rate (A) to protect the principal. They also offer protection during stock market declines (B) by ensuring the value does not drop below a certain level and allow participation in stock market gains (D) through interest crediting linked to a stock market index.
Incorrect Feature:Indexed annuities do not offer an annually increasing maximum rate of interest (C). The maximum rate is often capped and does not increase each year.
Reference:These features are outlined in the annuity product guidelines provided by the California Department of Insurance.
質問 # 55
Why is an injury caused by an accident at an employee's workplace excluded from individual healthinsurance coverage?
- A. It is covered by Social Security benefits.
- B. It is covered by the state Workers' Compensation program.
- C. It is covered by the employer's group health insurance plan.
- D. It is covered by the employer's group disability insurance plan.
正解：B
解説：
Workplace Injuries:Injuries that occur at an employee's workplace are excluded from individual health insurance coverage because they fall under the jurisdiction of the state Workers' Compensation program, which provides benefits for work-related injuries and illnesses.
Exclusions in Individual Policies:Individual health insurance policies specifically exclude coverage for injuries covered by Workers' Compensation (C), ensuring there is no duplication of benefits.
Reference:This exclusion is detailed in the California Department of Insurance regulations regarding health insurance policies.
質問 # 56
Insureds are entitled to recover an amount NOT greater than the amount of their loss under the principle of
- A. indemnity.
- B. adhesion.
- C. warranty.
- D. utmost good faith.
正解：A
解説：
The principle of indemnity in insurance means that insureds are entitled to recover an amount not greater than the amount of their loss. This principle ensures that the insured does not profit from the insurance claim but is restored to the same financial position they were in before the loss occurred. This concept is fundamental to insurance policies to maintain fairness and prevent fraud. The California Department of Insurance emphasizes this principle to ensure proper compensation for losses.
質問 # 57
Which life insurance classification carries the highest premium?
- A. Standard
- B. Preferred
- C. Substandard
- D. Preferred Plus
正解：C
解説：
Substandard life insurance classification carries the highest premium because it represents a higher risk to the insurer. Individuals in this category have health conditions, risky occupations, or lifestyles that make them more likely to file a claim. Preferred Plus, Preferred, and Standard classifications are for individuals with better health and lower risk, thus they have lower premiums.
質問 # 58
Specified disease insurance covers all of the following EXCEPT
- A. incidental costs.
- B. out-of-pocket payments.
- C. costs covered by medical expense insurance.
- D. noncovered medical expenses.
正解：C
解説：
Specified disease insurance is designed to provide coverage for expenses related to specific diseases, such as cancer or heart disease. It typically covers noncovered medical expenses, out-of-pocket payments, and incidental costs that are not reimbursed by regular medical expense insurance. It does not cover costs that are already covered by medical expense insurance, as its purpose is to supplement and provide additional financial support for disease-specific expenses.References: California Department of Insurance guidelines on specified disease insurance policies.
質問 # 59
According to California Insurance Code, which of the following MUST be specified in an insurance contract?
- A. Risks insured against.
- B. Policy exclusions.
- C. Insurer financial rating.
- D. Additional coverages.
正解：A
解説：
The California Insurance Code mandates that certain elements must be specified in an insurance contract, including the risks insured against. This requirement ensures clarity regarding what perils or events are covered by the policy. Other elements that must be specified include the parties involved, the premium amount, and the coverage period, but not necessarily the insurer's financial rating or additional coverages.References: California Insurance Code, Section 381.
質問 # 60
The additional premium charged by an insurer for adding the accidental death benefit to a whole life policy
- A. increases the policy's cash value.
- B. does not affect the policy's cash value.
- C. increases the yearly dividend amount.
- D. decreases the length of time that premiums are payable.
正解：B
解説：
Accidental Death Benefit: This is a rider added to a whole life policy that provides an additional payout if the insured dies as a result of an accident.
Additional Premium: The premium charged for this rider is separate and does not impact the cash value of the whole life policy itself.
Policy's Cash Value: The cash value in a whole life policy grows based on the base policy premiums and interest; it is not affected by the additional premium for the accidental death benefit rider.References:
California Insurance Code Section 10271.5 outlines the treatment of additional benefits and riders in life insurance policies.
質問 # 61
For Social Security purposes, a person with 40 quarters of coverage is considered
- A. fully insured.
- B. currently insured.
- C. conditionally insured.
- D. partially insured.
正解：A
解説：
For Social Security purposes, a person with 40 quarters of coverage is considered "fully insured." This status qualifies them for a range of Social Security benefits, including retirement and disability benefits, as well as survivor benefits for their dependents.
質問 # 62
The initial enrollment period for Medicare Part B ends how many months after the 65th birthday month?
- A. Three months.
- B. One month.
- C. Five months.
- D. Seven months.
正解：D
解説：
The initial enrollment period for Medicare Part B spans seven months. This period starts three months before the month of an individual's 65th birthday, includes the birthday month, and extends three months after the birthday month. Enrolling during this period ensures that beneficiaries avoid late enrollment penalties and have coverage when they first become eligible.
質問 # 63
Under the PPACA, which medical enrollment tier is 80% actuarial value?
- A. gold
- B. silver
- C. bronze
- D. platinum
正解：A
解説：
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).
質問 # 64
The cost of employer-provided group life insurance above $50,000 is
- A. tax deductible by the employee.
- B. taxable to the employer.
- C. tax exempt to the employee.
- D. taxable as income to the employee.
正解：D
解説：
Under the Internal Revenue Code, the cost of employer-provided group life insurance coverage above $50,000 is considered a taxable fringe benefit. This means that the value of the coverage exceeding $50,000 is included in the employee's gross income and is subject to income taxes. This rule ensures that employees are taxed on the additional benefit they receive from their employer.
質問 # 65
Which policy provision protects the insurer against possible adverse selection?
- A. Reinstatement.
- B. Entire contract.
- C. Nonforfeiture.
- D. Suicide clause.
正解：D
解説：
The suicide clause in a life insurance policy protects the insurer against adverse selection by stating that if the insured commits suicide within a specified period (usually two years) after the policy is issued, the insurer will not pay the death benefit but will return the premiums paid. This provision helps prevent individuals from obtaining life insurance with the intention of committing suicide shortly after, thus mitigating the risk for the insurer.
質問 # 66
According to California Insurance Code, an insurance policy must be
- A. approved by the Insurance Commissioner.
- B. economically feasible for the insured.
- C. in writing.
- D. negotiated between the agent and the insured.
正解：C
解説：
According to the California Insurance Code, an insurance policy must be in writing. This requirement ensures that the terms and conditions of the insurance contract are clearly documented and legally enforceable. The written policy provides a tangible record of the agreement between the insurer and the insured, detailing the coverage, exclusions, and obligations of both parties.References: California Insurance Code, Section 381.
質問 # 67
In long-term care policies, which of the following is an activity of daily living?
- A. Driving
- B. Working
- C. Breathing
- D. Bathing
正解：D
解説：
In long-term care (LTC) policies, Activities of Daily Living (ADLs) are basic tasks that are essential for self-care. These typically include bathing, dressing, eating, toileting, transferring (moving from one place to another), and maintaining continence. These ADLs are used to determine the eligibility for benefits under an LTC policy. Bathing is specifically listed as one of these ADLs. Breathing, driving, and working are not considered ADLs in the context of LTC policies.
質問 # 68
If a term life insurance policy is renewable, the renewal provision usually states that
- A. the policy can be renewed at any time, regardless of the insured's age.
- B. evidence of insurability is required at the time renewal is requested.
- C. a higher premium is payable at each renewal.
- D. the policy cash value increases at each renewal.
正解：C
解説：
Renewable term life insurance policies allow the policyholder to renew the policy at the end of each term without providing evidence of insurability. However, the renewal is usually subject to a higher premium, which increases as the insured ages. This increase reflects the higher risk associated with insuring an older individual.References: California Department of Insurance documentation on term life insurance policies and renewal provisions.
質問 # 69
Individual life insurance policies sold to seniors in the State of California must include aprominently placed statement that divulges all of the following information EXCEPT
- A. a charge might apply if declined after the time allowed for surrender.
- B. the policy should be returned to the agent or insurer if not wanted.
- C. the policy can be returned during a free look period for a full refund.
- D. proof of surrender must be notarized at the agent's principal office.
正解：D
解説：
Individual life insurance policies sold to seniors in California must include a prominently placed statement that provides important information about the policy. This includes instructions to return the policy to the agent or insurer if it is not wanted, the possibility of a charge if declined after the allowed surrender period, and the right to return the policy during a free look period for a full refund. However, there is no requirement for proof of surrender to be notarized at the agent's principal office.References: California Department of Insurance regulations on disclosures for life insurance policies sold to seniors.
質問 # 70
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