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[General] Latest PA-Life-Accident-and-Health Test Dumps, PA-Life-Accident-and-Health Relia

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【General】 Latest PA-Life-Accident-and-Health Test Dumps, PA-Life-Accident-and-Health Relia

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Insurance Licensing Pennsylvania Life, Accident and Health Exam Sample Questions (Q103-Q108):NEW QUESTION # 103
Who is usually eligible to enroll in a group health plan?
  • A. Part-time employees.
  • B. Seasonal Employees.
  • C. Full-time employees.
  • D. All employees.
Answer: C
Explanation:
Under Pennsylvania group health insurance guidelines,full-time employeesare usually eligible to enroll in a group health plan. Group health insurance is designed to provide coverage to a defined class of employees who meet specific employment criteria established by the employer and insurer. Pennsylvania insurance study materials emphasize that eligibility requirements must be applied consistently to avoid unfair discrimination.
Full-time employment status is commonly used because it represents a stable and ongoing employment relationship, which helps insurers manage risk and administrative costs. While some employers may choose to offer coverage to part-time or seasonal employees, this is not the standard requirement under group health insurance rules.
Option A and B are incorrect because part-time and seasonal employees are not automatically eligible unless the employer voluntarily extends coverage. Option D is incorrect because not all employees qualify under standard eligibility guidelines.
Therefore, the correct and verified answer isfull-time employees.

NEW QUESTION # 104
Backdating on a life insurance policy is the practice of
  • A. reinstating a lapsed policy.
  • B. accepting the premium after the expiration of the grace period.
  • C. making the policy effective on an earlier date than the present.
  • D. excluding medical coverage for preexisting medical conditions.
Answer: C
Explanation:
Backdating in a Pennsylvania life insurance policy refers to the practice of assigning an effective date earlier than the actual application or issue date of the policy. This is permitted under Pennsylvania insurance regulations primarily to allow the insured to qualify for a lower premium based on a younger insurance age.
Insurers typically allow backdating up to six months, provided the policyowner pays the required back premiums from the backdated effective date to the current date.
Backdating does not reinstate a lapsed policy, accept late premiums beyond the grace period, or exclude coverage for preexisting conditions. Those activities are governed by separate provisions such as reinstatement clauses, grace period rules, and preexisting condition limitations found mainly in health insurance policies. Pennsylvania life insurance study materials emphasize that backdating is strictly regulated and must be requested by the applicant, not imposed by the insurer. Its sole purpose is age-based premium adjustment, making option A the correct answer.

NEW QUESTION # 105
The primary income earner of the family earns $100,000 annually and has 20 years until retirement Using the Human Life Value Approach, how much coverage is recommended?
  • A. $2,200,000
  • B. $1,100,000
  • C. $2,000,000
  • D. $1,000,000
Answer: C
Explanation:
TheHuman Life Value (HLV) Approachis a method used in Pennsylvania Life Insurance planning to estimate the amount of life insurance coverage needed based on the insured'sfuture earning capacity. Under this approach, the recommended coverage is calculated by multiplying the individual's annual income by the number of working years remaining until retirement.
In this scenario, the primary income earner earns $100,000 annually and has 20 years remaining until retirement. Using the Human Life Value formula:
$100,000 × 20 =$2,000,000
Pennsylvania-approved insurance study materials emphasize that this method does not account for inflation, expenses, or investment returns unless specifically adjusted. It provides a straightforward estimate of income replacement needed for dependents.
The other answer choices do not reflect the correct calculation based on the given information.
Therefore,$2,000,000is the correct and verified answer according to Pennsylvania Life, Accident, and Health Insurance documentation.

NEW QUESTION # 106
An insured has a stop-loss limit of $10,000, a deductible of $500, and an 80%'20% coinsurance. The insured incurs $50,000 of covered losses in an accident. How much I will the insured have to pay?
  • A. $10,000
  • B. $10,400
  • C. $10,600
  • D. $500
Answer: A
Explanation:
In this scenario, the insured has a deductible of $500, 80/20 coinsurance, and a stop-loss limit of $10,000.
Under Pennsylvania accident and health insurance principles, the stop-loss limit caps the insured's total out-of- pocket expenses, including the deductible and coinsurance payments.
The insured incurs $50,000 in covered losses. First, the insured pays the $500 deductible, leaving $49,500.
With an 80/20 coinsurance arrangement, the insured would normally pay 20% of $49,500, which equals
$9,900. Combined with the deductible, the total out-of-pocket cost would be $10,400.
However, the stop-loss limit restricts the insured's total responsibility to $10,000. Once the insured reaches this limit, the insurer pays 100% of remaining covered expenses. Since $10,400 exceeds the stop-loss limit, the insured only pays $10,000. This protection is a critical consumer safeguard emphasized in Pennsylvania insurance education materials. Therefore, option C is correct.

NEW QUESTION # 107
Managed care is typically provided under all of the following EXCEPT a
  • A. major medical indemnity plan.
  • B. preferred provider network health plan.
  • C. point-of-service (POS) plan.
  • D. health maintenance organization (HMO) plan.
Answer: A
Explanation:
Under Pennsylvania Accident and Health Insurance principles,managed careis a system designed to control costs and coordinate healthcare services through provider networks, referrals, and utilization management.
Managed care is typically associated withHealth Maintenance Organizations (HMOs),Preferred Provider Organizations (PPOs), andPoint-of-Service (POS) plans. These plans require insureds to use network providers or face reduced benefits, and they emphasize preventive care and cost containment.
Amajor medical indemnity plan, however, is not considered a managed care plan. Indemnity plans allow insureds to choose any healthcare provider without network restrictions and reimburse expenses based on covered charges, usually without requiring referrals or primary care coordination. Pennsylvania insurance study materials clearly distinguish indemnity plans from managed care models.
Because major medical indemnity plans lack provider networks and cost management controls, they fall outside the managed care classification. Therefore,major medical indemnity planis the correct and verified answer according to Pennsylvania Life, Accident, and Health Insurance documentation.

NEW QUESTION # 108
......
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