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California Department of Insurance Certification
CA-Life-Accident-and-Health Exam
CaliforniaDepartmentofInsurance.CA-Life-Accident-and-Health.v2025-02-19.q58 Dumps

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Question 1

A contract of indemnity is one in which

A.one party is restored to the same financial position the party was in before the loss occurred.
B.one party is obligated to assume the legal liability of another party.
C.one party must adhere to the agreements written by the other party.
D.both parties are expected to act in complete honesty.

Correct Answer: A

Specified disease insurance policies provide coverage for particular diseases listed in the policy. The most common type of specified disease insurance is cancer insurance, which offers financial protection and support specifically for cancer diagnosis and treatment-related expenses. This type of policy helps cover costs not typically covered by standard health insurance, such as experimental treatments, travel, and accommodation during treatment.

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Question 2

In health insurance the coinsurance is

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

Correct Answer: D

* 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.

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Question 3

Policies covered under the California Life and Health Insurance Guarantee Association include all of the following EXCEPT

A.disability income.
B.self-funded group life.
C.deferred annuities.
D.individual health.

Correct Answer: B

Policies covered under the California Life and Health Insurance Guarantee Association (CLHIGA) include disability income, individual health, and deferred annuities. Self-funded group life insurance policies are not covered by CLHIGA because these policies are funded by the employer, not an insurance company, and therefore do not fall under the association's protection.

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Question 4

All of the following are optional group medical coverages EXCEPT

A.dental.
B.maternity.
C.prescription drug.
D.vision.

Correct Answer: B

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.

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Question 5

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 free-look period.
C.At the end of the incontestability period.

Correct Answer: B

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.

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