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Free Virginia-Life-Annuities-and-Health-Insurance Exam Braindumps
Virginia Life, Annuities, and Health Insuranceination Series 1101 Questions 216–220 (page: 45)

Updated On: 10-Feb-2026
Page 45 of 89
PDF with 440 Questions

The coinsurance provision of a major medical expense policy requires:

  1. A percentage of expenses in excess of the deductible to be paid by the insured
  2. A proportional sharing of the deductible by the insured and insurer
  3. All expenses in excess of the deductible to be paid by the insurer
  4. The insured to bear expenses between the upper limit of basic coverage and the lower limit of major medical

Answer(s): A

Explanation:

Coinsurance is a cost-sharing arrangement where, after the deductible is met, the insured pays a percentage of covered expenses and the insurer pays the rest. A common split is 80/20, where the insurer pays 80% and the insured pays 20% until the maximum out-of-pocket limit is reached. Exact Extract (Virginia Health Insurance Study Guide): "Coinsurance--after the deductible has been satisfied, the insured and insurer share covered expenses in a stated ratio (e.g., 80/20)."

Reference (Virginia Documents / Study Guide):
-- Virginia Health Insurance Examination Outline, Major Medical Policy Provisions



Field underwriting usually differs from home office underwriting in that the agent:

  1. Requires information on existing coverage
  2. Requires information on the applicant's health
  3. Has personal contact with the applicant
  4. Attempts to reduce moral hazard

Answer(s): C

Explanation:

Field underwriting refers to the duties carried out by the insurance agent during the application process. Unlike home office underwriting, which relies on medical exams and reports, the agent is in personal contact with the applicant and is responsible for gathering correct information. Exact Extract (Virginia Life & Health Insurance Study Guide): "Field underwriting--conducted by the agent, includes personal contact with the applicant, observing general character, and ensuring application completeness."
Reference (Virginia Documents / Study Guide):
-- Virginia Life & Health Insurance Examination Outline, Underwriting Principles



Misrepresenting pertinent policy provisions relating to coverages after a loss is:

  1. A concealment in insurance applications
  2. An unfair claim settlement practice
  3. An unfair discrimination between individuals
  4. A violation of the principle of adhesion

Answer(s): B

Explanation:

Virginia's Unfair Claims Settlement Practices Act prohibits insurers or agents from misrepresenting facts or policy provisions relating to coverage. Doing so after a loss is classified as an unfair claims settlement practice.

Exact Extract (Virginia Unfair Claims Settlement Law): "Misrepresenting pertinent facts or policy provisions relating to coverages at issue is an unfair claim settlement practice." Reference (Virginia Documents / Study Guide):
-- Code of Virginia §38.2-510 (Unfair claim settlement practices)



Medicare Part A Hospital Insurance is normally available regardless of age to any individual who, for at least 24 months, has been a recipient of:

  1. Railroad retirement income benefits
  2. Corporate or self-employment retirement benefits
  3. Workers' compensation benefits
  4. Social Security disability benefits

Answer(s): D

Explanation:

Medicare Part A is generally available at age 65, but younger individuals may qualify if they have received Social Security disability benefits for at least 24 months. Exact Extract (Virginia Medicare Study Guide): "Individuals under age 65 become eligible for Medicare Part A after receiving Social Security disability benefits for 24 months." Reference (Virginia Documents / Study Guide):
-- Virginia Health Insurance Examination Outline, Medicare Eligibility



Insurance company medical expense claim forms typically include questions about all of the following EXCEPT:

  1. The occurrence of the loss
  2. The character of the loss
  3. The extent of the loss
  4. The employee's annual salary

Answer(s): D

Explanation:

Medical expense claim forms are designed to gather information relevant to the medical loss itself-- its occurrence, character, and extent. Employee salary is not part of the standard claim form for medical expense policies.
Exact Extract (Virginia Health Insurance Study Guide): "Claim forms must provide space for details of the occurrence, character, and extent of loss but do not request information unrelated to medical expenses, such as salary."
Reference (Virginia Documents / Study Guide):
-- Virginia Uniform Health Policy Provisions



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