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

1. Unlike HMO plans, PPO plan members MOST often

A) have more choices of doctors and medical service providers.
B) can see a physician on a walk-in basis.
C) receive no medical benefits while traveling to other states.
D) must designate a primary care physician.

2. Benefits required under the child immunization coverage shall NOT be subject to

A) a set immunization schedule.
B) an annual maximum number of immunizations.
C) a prior authorization.
D) a deductible.

3. Which of the following is NOT an example of inducement?

A) Giving merchandise to a client with a value of $250.
B) A promise of employment.
C) A gift having a value less than $100.
D) A special favor in the payment of premiums.

4. What is the purpose of the coordination of benefits provision in group health care?

A) To protect a secondary insurer from paying a claim.
B) To determine which parent's plan covers a dependent child.
C) To determine what is paid by the primary and secondary insurers in case of a claim.
D) To ensure that the insured gets all the treatment needed.

5. Both husband and wife have group health insurance through their employers. Each spouse is covered under both policies. Under the coordination of benefits provision, how will the benefits be paid if the wife incurs a
$400 covered loss?

A) Only the wife's insurer will pay expenses toward the loss.
B) Only the primary insurer will pay expenses toward the loss under the limits of the plan.
C) The husband's insurer will pay as much of the claim as the policy permits, then the wife's insurer will pay the remainder.
D) The primary insurer will pay as much of the claim as the policy permits, then the secondary insurer will pay the remainder of the claim as its policy permits.

Solutions: