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

1. An insured with a major medical policy has a per cause deductible of $100. Over the course of the year, the insured visits the doctor's office three times for injuries. Excluding the premium, what is the MINIMUM amount the insured MUST pay for the year if each visit costs $200?

A) $300
B) $500
C) $200
D) $100

2. Unlike HMO plans, PPO plan members MOST often

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

3. 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 a new enrollment form and will be enrolled as of the date the new form is accepted.
C) The employer will be required to pay the past due premiums.
D) The employee will be allowed to submit an enrollment form and all past due premiums, and will be retroactively insured.

4. In Oklahoma, a foreign insurer is one formed under the laws of

A) Oklahoma.
B) another state or government of the United States.
C) Oklahoma or under the laws of a state geographically bordering Oklahoma.
D) a country other than the United States.

5. A group major medical policy is written with a $1,000 deductible, 80/20 coinsurance, and an out-of-pocket maximum of $3,000. The insured goes into the hospital for a covered procedure. The total cost of the procedure is $5,000. How much does the insured have to pay towards the $5,000 total?

A) $1,000
B) $3,000
C) $1,800
D) $5,000

Solutions: