LLQP Accident & Sickness · Component 2.1 · 30% of the exam
An extended health care plan's co-insurance provision means the plan:
- Pays a stated percentage of eligible expenses, with the balance borne by the member
- BRequires the member to be insured under a second plan before benefits are payable
- CPays only after every other plan covering the member has paid its full share of the expense
- DPays the full cost of eligible expenses once the annual deductible has been met
Correct answer: A) Pays a stated percentage of eligible expenses, with the balance borne by the member
Co-insurance is the share split between plan and member, which combines with the deductible and the maximum to determine what the member actually pays.
Why the other options are wrong
- BNo plan requires a second plan as a condition of paying.
- CPaying after other plans describes coordination of benefits.
- DFull payment after the deductible would mean there is no co-insurance at all.
Exam tip
Deductible first, then co-insurance, then the maximum.
Common mistake
Confusing co-insurance with coordination of benefits.
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.