100% Pass California Department of Insurance - CA-Life-Accident-and-Health - Perfect CA Life, Accident and Health or Sickness Examination Latest Dumps Files

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California Department of Insurance CA Life, Accident and Health or Sickness Examination Sample Questions (Q60-Q65):

NEW QUESTION # 60
In health insurance the coinsurance is

A. a payment shared by the insured and provider of covered service minus the deductible.
B. a percentage of the cost for covered expenses paid by more than one insurer.
C. a percentage paid for covered expenses by the insured and insurer after the deductible is satisfied.
D. a portion of the premium paid by the insured and insurer for each covered service.

Answer: C

Explanation:
* Definition: Coinsurance is a cost-sharing mechanism in health insurance policies where the insured and the insurer each pay a specified percentage of the covered medical expenses after the insured has paid the deductible.
* Mechanism: Once the insured meets the deductible, they are responsible for a portion of the remaining costs, typically expressed as a percentage (e.g., 20%), while the insurer pays the rest (e.g., 80%).
* Example: If an insured person has a health policy with an 80/20 coinsurance split and incurs $1,000 in covered medical expenses after meeting their deductible, they would pay $200 (20%), and the insurer would pay $800 (80%).
* Purpose: Coinsurance helps manage healthcare costs by sharing the financial responsibility between the insurer and the insured, encouraging cost-effective use of medical services.
* Regulations: California insurance laws require clear disclosure of coinsurance terms in policy documents to ensure that consumers understand their financial obligations.
References:
* California Department of Insurance guidelines on health insurance cost-sharing.
* Standard health insurance policy provisions.

NEW QUESTION # 61
California long-term care policies may be identified as any of the following EXCEPT

A. Acute Hospital Care only.
B. Home Care only.
C. Comprehensive Long-Term Care.
D. Nursing Facility and Residential Care Facility only.

Answer: A

Explanation:
Long-Term Care Policies:California long-term care policies can include Home Care only (A), Comprehensive Long-Term Care (C), and Nursing Facility and Residential Care Facility only (D).
Exclusion:Acute Hospital Care only (B) is not typically considered a long-term care policy, as it pertains to short-term, acute medical care rather than extended long-term care services.
Reference:This information is supported by the California Department of Insurance guidelines on long-term care insurance.

NEW QUESTION # 62
What happens if an insurer violates the Medical Loss Ratio rule and spends too much money on administrative costs?

A. Insurers that do not meet the Medical Loss Ratio standard will only be required to reduce their spending on administrative costs.
B. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Federal government, n
C. Insurers that do not meet the Medical Loss Ratio standard will be required to provide rebates to their customers and reduce spending on their administrative costs.
D. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Health Benefits Exchange.

Answer: C

Explanation:
The Medical Loss Ratio (MLR) rule requires insurers to spend a minimum percentage of premium dollars on medical care and healthcare quality improvement, rather than on administrative costs and profits. For individual and small group markets, this threshold is 80%, and for large group markets, it is 85%. If insurers fail to meet this requirement, they must provide rebates to their policyholders to ensure compliance. This ensures that a significant portion of premiums is spent on actual medical care.

NEW QUESTION # 63
Which type of insurance policy provides a death benefit that matches the projected outstanding debt on an individual's home?

A. Family protection.
B. Joint life.
C. Mortgage redemption.
D. Level term.

Answer: C

Explanation:
Mortgage redemption insurance is specifically designed to pay off the outstanding balance of a mortgage if the insured dies before the mortgage is fully paid. This type of insurance ensures that the mortgage debt is cleared, thereby protecting the family from losing their home. Unlike other types of life insurance, the death benefit of a mortgage redemption policy decreases over time, matching the decreasing balance of the mortgage. This is different from level term insurance, which provides a constant death benefit throughout the term of the policy.

NEW QUESTION # 64
After the deductible is satisfied, what percentage of a reasonable charge does Medicare Part B pay?

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

Answer: A

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 # 65
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