LLQP Accident & Sickness · Component 2.1 · 30% of the exam
A CI policy's definitions of covered conditions are important because:
- The benefit is paid only if the diagnosis meets the contract's specific definition
- BThey are irrelevant, since any physician's diagnosis of a listed condition triggers the payment
- CThey are identical across insurers, so the only real difference between policies is the price
- DThey change annually as medical practice evolves, so the client must review them each year
Correct answer: A) The benefit is paid only if the diagnosis meets the contract's specific definition
CI claims turn on definitions. Industry benchmark definitions have narrowed the differences, but they remain. Agents must read them.
Why the other options are wrong
- BDefinitions decide claims; a diagnosis in ordinary language may not qualify.
- CDefinitions differ, though industry benchmarks exist.
- DDefinitions are fixed in the contract.
Exam tip
CI pays on the contract's definition, not the doctor's word.
Common mistake
Assuming any 'heart attack' triggers the benefit.
What this tests
CISRO competency component 2.1 — Analyze the available products that meet the client's needs — which is weighted at 30% of the Accident & Sickness module. Written against the published curriculum.
More from component 2
- A group benefits booklet lists AD&D coverage alongside life and LTD. The AD&D benefit pays:
- A hospital indemnity (hospital cash) policy pays:
- Employment Insurance sickness benefits are available to:
- Which government program coordinates with an individual DI policy through a possible offset AND also affects the definition of insurable income?
- A group plan's 'eligibility waiting period' (probationary period) is:
- A CI policy that is 'convertible' allows the insured to:
Practice the whole Accident & Sickness module
Timed sets weighted like the exam, and review of every question you miss. Free to start.