Virginia Insurance Updated Virginia-Life-Annuities-and-Health-Insurance Exam Questions and Answers by cezar

Detailed Answer in Step-by-Step Solution:

Trade association groups (A) are eligible for group medical benefits because members share a common industry or profession, not just insurance purposes (B).

Membership isn’t limited to large employers (C), and employer contributions (D) depend on the plan, not waived by default.

The Virginia study guide notes that trade associations qualify for group coverage due to a common industry tie among members, distinguishing them from groups formed solely for insurance. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance Eligibility."

Virginia Code § 38.2-5208 allows LTC policy cancellation by the insurer for nonpayment of premium (option A) after a 31-day grace period and notice, a standard contract right. Option B (Medicaid eligibility) isn’t a cancellation cause; it may coordinate benefits, not terminate coverage. Option C (insurer insolvency) affects payment ability, not lawful cancellation grounds. Option D (nuisance claims) isn’t a legal basis; claims frequency doesn’t void coverage unless fraudulent (Virginia Code § 38.2-309). The study guide likely lists nonpayment as the primary insurer-initiated cancellation reason, with examples like missed payments triggering notice, making A the lawful cause.

Detailed Answer in Step-by-Step Solution:

PPOs incentivize use of in-network providers (e.g., specified hospitals) by offering higher coinsurance percentages (D), meaning the insurer pays a larger share of costs (e.g., 80% vs. 60% out-of-network).

Option A (announcements) is not a direct incentive.

Option B (diagnostic coverage) applies broadly, not specifically to in-network use.

Option C (extending hospital days) is not a typical PPO feature.

The Virginia study guide notes that PPOs encourage in-network use through financial incentives like higher coinsurance or lower out-of-pocket costs, distinguishing them from HMOs. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Managed Care Plans."

Detailed Answer in Step-by-Step Solution:

Disability income policies exclude benefits for intentional self-inflicted injuries (B) to prevent abuse or fraud.

Permanent injuries (A), sporting accidents (C), and falls (D) are typically covered unless specifically excluded by the policy.

The Virginia study guide states that disability income insurance excludes self-inflicted injuries as a standard provision to ensure coverage applies to unforeseen events. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."