LLQP Accident & Sickness · Component 2.1 · 30% of the exam
'Co-insurance' in a group health or dental plan means:
- AThe member pays nothing because the employer covers the full premium for the plan
- The plan pays a percentage of eligible expenses and the member pays the rest
- CCoverage is doubled when the member's spouse also has a group plan of their own
- DTwo insurers share the risk on the plan under a reinsurance agreement between them
Correct answer: B) The plan pays a percentage of eligible expenses and the member pays the rest
Co-insurance shares cost with members to control utilization. Combined with deductibles and maximums it defines the plan's generosity.
Why the other options are wrong
- AThe member pays the uncovered percentage.
- CThat is coordination of benefits, and it never exceeds the expense.
- DThat is reinsurance or pooling, not co-insurance.
Exam tip
Co-insurance = plan's percentage share; deductible = first dollars; maximum = ceiling.
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.