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California Department of Insurance CA Life, Accident and Health or Sickness Examination Sample Questions (Q62-Q67):

NEW QUESTION # 62
What policy is a savings instrument designed to first accumulate funds and then systematically to liquidate the funds?

A. Mortgage insurance.
B. Disability income insurance.
C. Term life.
D. Deferred annuity.

Answer: D

Explanation:
* Definition: A deferred annuity is a type of insurance contract designed as a long-term savings instrument that allows the policyholder to accumulate funds on a tax-deferred basis.
* Accumulation Phase: During the accumulation phase, the policyholder makes contributions to the annuity, which can grow based on the investment options selected (fixed or variable).
* Liquidation Phase: Once the accumulation period ends, the annuity enters the distribution or liquidation phase, where the accumulated funds are systematically paid out to the annuitant, typically as a series of regular payments (e.g., monthly, quarterly).
* Purpose: The primary goal of a deferred annuity is to provide a steady income stream during retirement, ensuring financial stability for the annuitant.
* Regulations: Deferred annuities are regulated under the California Insurance Code and must comply with state-specific rules regarding disclosures, guarantees, and consumer protections.
References:
* California Department of Insurance guidelines on annuities.
* Annuity policy provisions and state regulations.

NEW QUESTION # 63
Characteristics of Preferred Provider Organizations (PPOs) include all of the following EXCEPT

A. employees can see specialists without referrals.
B. there are incentives to use network providers.
C. benefits are paid for care received by non-network physicians.
D. primary physicians serve as gatekeepers.

Answer: D

Explanation:
Preferred Provider Organizations (PPOs) offer flexible and broad access to healthcare providers.
Characteristics of PPOs include incentives for using network providers (B), the ability for employees to see specialists without referrals (C), and coverage for care received from non-network physicians, although at a higher cost (D). Unlike Health Maintenance Organizations (HMOs), PPOs do not require primary care physicians to serve as gatekeepers, making option A incorrect.

NEW QUESTION # 64
According to the Employee Retirement Income Security Act of 1974 (ERISA) fiduciary standards, benefit plans are operated for

A. plan sponsors and employees.
B. plan participants and beneficiaries.
C. plan employees.
D. plan sponsors and beneficiaries.

Answer: B

Explanation:
According to the Employee Retirement Income Security Act of 1974 (ERISA) fiduciary standards, benefit plans must be operated for the exclusive benefit of plan participants and their beneficiaries. Fiduciaries managing the plans are required to act prudently and in the best interest of these participants and beneficiaries, ensuring that the plans are administered properly and that the assets are protected and used solely for providing benefits and defraying reasonable administrative expenses.

NEW QUESTION # 65
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 be required to provide rebates to their customers and reduce spending on their administrative costs.
B. Insurers that do not meet the Medical Loss Ratio standard will only be required to reduce their spending on administrative costs.
C. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Health Benefits Exchange.
D. Insurers that do not meet the Medical Loss Ratio standard will pay a tax penalty to the Federal government, n

Answer: A

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 # 66
The type of health care provider that provides both the health care services and the health care coverage is called:

A. an EPO.
B. a Preferred Provider Organization.
C. a Health Maintenance Organization.
D. a major medical organization.

Answer: C

Explanation:
A Health Maintenance Organization (HMO) is a type of health care provider that offers both health care services and health care coverage. HMOs require members to receive their health care from a network of designated providers and hospitals. These organizations focus on preventative care and typically require members to choose a primary care physician who manages their overall care and provides referrals to specialists if needed. HMOs operate on a pre-paid basis, which often results in lower premiums and out-of-pocket costs for members. This structure aligns both the provision and the coverage of healthcare, making HMOs distinct from other types of health plans such as Preferred Provider Organizations (PPOs), which only provide a network of providers but do not directly deliver health services.

NEW QUESTION # 67
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Valid CA-Life-Accident-and-Health Guide Exam - CA-Life-Accident-and-Health Actual Questions & CA-Life-Accident-and-Health Exam Torrent

California Department of Insurance CA-Life-Accident-and-Health Exam Bible - Latest CA-Life-Accident-and-Health Test Labs

California Department of Insurance CA Life, Accident and Health or Sickness Examination Sample Questions (Q62-Q67):

100% Pass Quiz 2025 CA-Life-Accident-and-Health: CA Life, Accident and Health or Sickness Examination Updated Official Cert Guide

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