Free Delaware Accident & Health practice questions

Answer: A. Delaware law says they shall not be applied to long-term care insurance

Delaware's long-term care chapter applies to policies delivered or issued for delivery in the state on or after January 1, 1990. It leaves other insurance laws in place where they do not conflict with it, but it states one exception outright: laws and regulations designed for Medicare supplement policies shall not be applied to long-term care insurance. They therefore do not apply in full, are not limited to Medicare-eligible buyers, and do not override the long-term care chapter.

Answer: D. Obtain a written referral from the applicant's own physician

Delaware lists three things an insurer must do first: get the applicant's prior written informed consent, reveal how the results may be used and which entities may receive them under the disclosure sections, and provide written information approved by the Department of Health and Social Services, such as an American Red Cross brochure on HIV and AIDS. A referral from the applicant's physician is not among those preconditions. The applicant's physician enters the process later, when an insurer declines coverage and sends results to a physician the applicant designated.

Answer: B. It must fit a group type the Code describes, or qualify under the rule for other groups

Delaware bars delivery of a group health policy in the state unless it conforms to one of the group descriptions in the Insurance Code's group sections, with a separate route for other groups under section 3509. Those descriptions are not limited to employers; they also include debtor, labor union, trustee, association and credit union groups, so the employer-only choice is wrong. Section 3501 sets no membership count and no vote of the insured persons; its test is whether the policy fits a described group.

Answer: B. It cannot apply, since only confinements beginning within 6 months can be excluded

For an individual long-term care policy, Delaware allows a preexisting condition exclusion to reach only a loss or confinement that starts within 6 months after coverage takes effect, unless the Commissioner extends that period for specific age groups in specific policy forms. A confinement beginning at 8 months is outside that window, so a 12-month exclusion period is not allowed. Disclosure on the application does not change the result: whether or not the condition was disclosed, the insurer may withhold coverage for it only until the 6-month waiting period expires. A rider or waiver cannot be used to exclude, limit or reduce coverage for a named preexisting condition beyond that waiting period.

Answer: D. Only the arm injury is covered

After reinstatement, the policy covers loss from accidental injury sustained after the reinstatement date, and loss from sickness only if the sickness begins more than ten days after that date. The March 3 accident happened after the March 1 reinstatement, so the arm injury is covered. The illness began on March 6, within ten days of reinstatement, so it is not covered. The provision has a ten-day rule for sickness and no waiting period for accidents, and it contains no 30-day exclusion for both kinds of loss.

Answer: D. Elected and appointed officials of the county

Delaware's employee group section allows a policy insuring the employees of a public body to include elected or appointed officials within the term employees. The same paragraph lists other permitted extensions, such as retired and former employees and directors of a corporate employer. Independent contractors, residents who use public services and relatives of residents are not on that list, so the policy cannot count them as employees under this rule.

Answer: D. It pays the amounts that the premium paid would buy at the correct age

Delaware's misstatement-of-age clause adjusts the benefit rather than ending the coverage: every amount payable becomes what the premium actually paid would have purchased at the insured's correct age. Voiding the policy and returning premium is not the remedy this clause provides. Paying full benefits and billing the difference reverses the clause, which changes the amount paid, not the premium owed. Denying the claim outright is also inconsistent with the clause, because it calls for a payment at the adjusted level.

Answer: B. The proposed certificate holder under the group policy

The chapter defines applicant in two ways. For an individual Medicare supplement policy, the applicant is the person who seeks to contract for insurance benefits; for a group Medicare supplement policy, the applicant is the proposed certificate holder. The group policyholder holds the master policy but is not the applicant under this definition, and the individual-policy branch does not govern group coverage. The issuer is the entity delivering or issuing the policy, not the one applying for it.

Answer: C. A workers' compensation policy, including one with supplementary expense coverage

Delaware's scope section lists coverages the individual health policy chapter does not apply to or affect, and the first item on that list is a liability or workers' compensation policy, whether or not it includes supplementary expense coverage. The disability income policy, the hospital expense policy and the family expense policy are individual or family health policies. None of them is a liability or workers' compensation policy, and none appears among the exclusions in the scope section, so the chapter applies to each of them.

Answer: C. 110%

In Delaware's optional overinsurance provision, allowable expense is set at 110% of any necessary, reasonable and customary item of expense covered, wholly or partly, as a hospital, surgical, medical or major medical expense under the policy or under other valid coverage. The 80% and 100% figures understate the statutory definition, and 125% overstates it; only 110% matches the text.