215B law
A corporation can be considered a "small group employer" if it has at least one and a maximum of how many employees?
50 -"Small Group Employer" means any person, firm, corporation, partnership, or association that is actively engaged in business that has no more than 50 eligible employees.
Which of the following is the closest term to an authorized insurer?
Admitted -
Which of the following dates must be contained in a policy summary?
The date the summary was prepared
Before starting operations as an HMO, the organization must meet which of the following requirements?
a) Obtain a certificate of authority from the Insurance Department b) Obtain a valid Health Care Provider Certificate from the Department of Health and Rehabilitative Services c) Make a deposit of $10,000 to the Rehabilitation Administration Expense Fund ***d) All of the above
An agent delivers a life insurance policy to the proposed insured. The insured makes a decision not to accept the policy. The insured may return the policy for a full refund of premium within how many days?
14 -The free-look provision in Florida allows the insured to return a life policy or annuity after 14 days if dissatisfied for any reason.
A paid-up nonforfeiture benefit will become effective as specified in the policy, unless the person entitled elects another available option within how many days after the due date of the premium in default?
60 -A paid-up nonforfeiture benefit will become effective as specified in the policy, unless the person entitled elects another available option within 60 days after the due date of the premium in default
In order for an insurer to legally transact insurance, it must obtain which of the following?
Certificate of Authority
What term best describes the act of withholding material information that would be crucial to an underwriting decision?
Concealment -Concealment occurs when a person withholds a material fact that is crucial to making a decision. In insurance, this involves withholding information that would be important for making underwriting decisions.
If an employer decides to change its life insurance policy to a similar one with a different insurer, which of the following describes the extent that replacement regulations will be exercised?
Replacement regulations will not apply in this situation. -If a new life insurance policy is provided under a group life insurance policy covering employees or members of an association, replacement regulations do not apply.
At what point must an Outline of Coverage be delivered?
At the time of application or upon delivery of the policy -An Outline of Coverage must be delivered at the time of application or upon delivery of the policy.
Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy?
Basic information about supplementary policies -The outline of coverage must follow the standard format included in the insurance regulations. It must provide information about the insurance company, the policy number, important features of the policy, and explain the right to return the policy for a refund.
What kind of policy issues certificates of insurance to insureds?
Group insurance -Individuals covered by group life insurance do not receive a policy, but receive a certificate of insurance from the master policy.
All of the following would be legal activities for an HMO to engage in EXCEPT
Health insurance solicitation.
All of the following statements describe a MEWA EXCEPT
MEWAs are groups of at least 3 employers. -MEWAs are groups of at least 2 employers who pool their risks to self-insure. MEWAs can be sponsored by an insurance company, an independent administrator, or another group established to provide group benefits for participants.
All of the following would be considered an insurance transaction EXCEPT
Obtaining an insurance license. -An insurance transaction means the carrying on of business in insurance, which could include the solicitation of a policy, advising, negotiation, or inducement related to coverage or claims. Obtaining an insurance license is a prerequisite to transacting insurance.
Pertaining to insurance, what is the definition of a fiduciary responsibility?
Promptly forwarding premiums to the insurance company -Fiduciary refers to a position of trust. When an agent is handling the premiums that belong to an insurance company, they are acting in a fiduciary capacity.
Under a group plan, Certificates of Insurance must include all of the following EXCEPT
The name of the writing agent.
An insurer hires a representative to advertise its company at a local convention. The representative lies about the details of some of the policies, in an attempt to secure more business for the company. Who is responsible for the representative's claims?
The insurer -An insurer is completely responsible for advertisements regarding its company, regardless of who creates, presents, or distributes the material.
Which of the following is true regarding branch agency licensing?
Agent in charge must be licensed. -Each branch location established by an agent, agency, firm, corporation, or association must be in the active full-time charge of a licensed general lines, or life and/or health agent who is appointed to represent one or more insurers.
An agent has been convicted of a crime punishable by a 1-year imprisonment. Within how many days must the agent notify the department of insurance?
30 days -Agents must notify the Department of Insurance in writing 30 days after being found guilty of a felony or a crime punishable by imprisonment of 1 year or more.
Which of the following insurance providers must be nonprofit and sell insurance only to its members?
Fraternal -To be characterized as a fraternal benefit society, the organization must be nonprofit, have a lodge system that includes ritualistic work and maintain a representative form of government with elected officers. Insurance may only be sold to members of the society.
Under what conditions will proof of insurability NOT be required of an employee wanting to enroll in a group insurance plan?
If the employee enrolls within a certain time period -In group insurance, evidence of insurability is usually not required if participant enrolls during the open enrollment period, and participants (insureds) under the plan do not receive a policy, nor do they own or control the policy. Instead, they receive certificates, indicating that they are included in the coverage.
Which of the following would be considered false advertising?
Implying that the agent is the insurer -A person or entity cannot use a name that deceptively suggests it is an insurer. Premiums do not have to be included in sales materials because they will vary depending on the insured's age and health. Most policies have limitations and exclusions, and there is a difference between whole life and term. It is not illegal to note this for applicants.
An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?
The pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off. -When an insured replaces one Medicare supplement policy with another, the pre-existing conditions waiting period does not start over. All types of waiting and elimination periods are carried over, not restarted, since that time was served with the original policy.
In which of the following situations is it legal to limit coverage based on marital status?
It is never legal to limit coverage based on marital status. -Availability of insurance benefits or coverage may not be denied based on sex or marital status. Marital status may be considered for the purpose of defining persons eligible for dependent benefits.
Which of the following is NOT considered a misrepresentation as it pertains to unfair trade practices?
Making comparisons between different policies
Who does the secondary addressee provision protect?
The insured over the age of 64 -The secondary notice/addressee provision protects elderly insured. Coverage for persons age 64 and older that has been in force for at least 1 year cannot lapse for nonpayment of premium after expiration of the grace period without the insurer notifying the policyowner and a specified secondary addressee (if designated in writing by the policyowner) of the impending lapse in coverage.