Chap 8 - Health - Laws & Rules - PART 1
Starting in 2016, businesses with up to ___ employees will be defined by the ACA as a "small business".
100
A life insurance policy that is paid annually must contain a grace period of at least ___ days.
30
how many days notice does the affordable care act require insurers to give before rescinding coverage?
30
Which of the following actions is considered to be an unfair trade practice?
A producer who sells insurance to an individual by means of threat
What is the best way to define life insurance replacement?
A transaction in which a new life insurance policy is purchased and an existing life insurance policy is surrendered.
Which of the following individuals is eligible to receive a temporary producer license?
An appointed employee who is replacing a deceased producer
Which of these individuals may NOT obtain a temporary producer license?
An employee of a retired licensed producer
Prepaid dental plans differ from most other types of Dental plans in what way?
Closed panel of Dentists can only be used
Under which circumstance may an Insurer discontinue a small employer group medical plan?
Insurer discontinues offering the plan to all employers
According to the Affordable Care Act (ACA), the proportion of premium revenues spent on clinical services & quality improvements is called the
Medical loss ratio
Who is required to notify the Director of a licensee's change of address?
Licensee
All of these are common limiting factors with dental insurance EXCEPT for
Limit placed on how many teeth can be treated annually
According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation?
Making false entries in a company's books
Which of the following actions may result in a producer's license being suspended?
Misappropriation of premiums
Which of these actions is considered to be an Unfair Claims Settlement Practice?
Misrepresentation pertinent policy provisions relating to coverage after a loss
All of the following are covered under most Dental Plans EXCEPT for
Mouth cancer
Which of the following is covered by a basic dental indemnity plan?
Non-surgical periodontal treatment
Most prepaid dental plans cover
Oral examinations
A life insurance producer is required to give a disclosure notice about information practices to an applicant or proposed insured
Prior to or at the time of signing the application
Replacement Regulations exist in order to
Protect policy owners from misrepresentations and loss of benefits
The ACA (affordable Care act) must ensure a sufficient choice of ________ in the marketplace:
Providers
What is considered interstate travel under the federal fraud and false statements act?
Puerto Rico
Which entity is responsible for regulating claims settlement practice of insures?
State insurance departments
Why were Exchanges implemented by the Affordable Care Act (ACA)?
To create a one-stop market for standardized health insurance plans
Charging different premiums for policyholders under the same risk classification
Unfair discrimination
If a producer replaces a client's existing life insurance policy with a new one, which of these actions is advisable?
Wait until the new policy is issued and delivered before surrendering existing policy
A statement MUST be signed by the ______ for any illustrations used in the sale of a life insurance policy.
producer
A prepaid dental plan has an agreement in place with a network of dentists which
accepts an established amount as payment in full for the dental services rendered
A(n) ________ insurer operates in the United States but is headquartered outside the United States
alien
Life Settlement Brokers are NOT allowed to
complete transactions prior to being approved for a license
AN insurer wishing to conduct business in Arizona MUST obtain a
compliance of authority
An annuity contract may be returned for a full refund during the
free look period
When is it acceptable to charge or receive a fee or service charge in addition to the premium in connection with the transaction of insurance?
if the amount of the fee or service charge is reasonably related to the cost of the service
In Arizona, false advertising is an example of
misrepresentation
In Arizona, the Human Immunodeficiency Virus (HIV) consent form
must disclose who will be receiving a copy of the test results
Autopsies may be requested by an accident and health insurer
only if not prohibited by state law
An example of rebating would be
splitting the commission with the buyer on a sale of insurance
The Arizona Life & Disability Insurance Guaranty Fund protects an insured in the event of
the insurer's insolvency
How long must a producer maintain customer records for an insurance transaction?
three years
A life insurance policy can usually be contested by the insurer only during the first ___ years of the contract
two
A life insurance policy may only be contested by the insurer during the first ______ years of the contract.
two
Mentally or physically handicapped dependent children MUST be covered under an individual health insurance policy
until they become self-supportive
Jerry has an indemnity plan which covers dental expenses. Typically, these type of plans
Cover preventative care once every six months.
Life Settlement Proceeds may be subject to the claims of
Creditors
Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means?
Decreased Fee Schedules
A client applies for an individual accident and health policy in Arizona. If the insurer collects personal information from any source other than public records or the applicant, a notice of application practices MUST be given to the applicant no later than the
application date
A trade association group is seeking coverage for group medical benefits. The members of this association
are probably in the same industry
An insured has been court-ordered to provide a child's health insurance. Upon this order, the insurer must allow the enrollment of this child
at any time
Notice of information practices must be given to a policyholder
at least once a year
If a Medicare Supplement policy is cancelled by the insurer, which of these circumstances does NOT require prior approval by the Arizona Department of Insurance?
nonpayment of premium
A health insurance claim may be contested due to statements made on the applications for up to ____ year(s) after issuance of the policy.
2
After a life insurance policy sold in Arizona has been in force for ___ year(s), it becomes incontestable.
2
An insurer markets its products by soliciting customers by mass media advertising and mail WITHOUT using the services of a producer. Which of these marketing systems does the insurer utilize?
Direct response
A producer is meeting with a client to determine whether an annuity would be suitable for purchase. Which of the following topics needs to be discussed with this client?
Financial status of the client
A(n) ________ insurer writes business in a state other than the one in which it is domiciled
Foreign
Which of the following is NOT a valid reason for an insurer to contest a life insurance policy during the policy's first two years of existence?
Misstatement of age
What is a life insurance producer authorized to do?
Solicit, receive, and Forward applications to the insurer
Which of the following is NOT a valid reason for an insurer to refuse renewal of an individual accident and health insurance policy?
The insured is currently in poor health
Greg had recently been terminated from his job that covered him for group life insurance. How long does he have to convert his coverage to an individual policy?
31 days
A policy owner decides to surrender the cash value of a whole life insurance policy. The insurer has up to ___ months to delay this payment
6
A policyowner decides to surrender the cash value of a whole life insurance policy. The insurer has up to ____ month(s) to delay this payment
6
In Arizona, Life insurance policy loans may charge a maximum fixed rate of
8%
According to the Telemarketing Sales Rule, what is the earliest time of the day that telemarketing calls may be received?
8:00 AM
The telemarketing Sales rule states that ______ is the latest time of the day that telemarketing calls may be received.
9:00 PM
The telemarketing sales rule states that ______ is the LATEST time of day that telemarketing calls may be received.
9:00 PM
According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age?
Age 26
The affordable care act established "exchanges" in order to
Assist individuals and small businesses when making their health insurance purchases.
Who manages the premium collected from a group's members for a reciprocal insurer?
Attorney in fact
Long-term care policies sold in Arizona may offer coverage in which
Benefits are based on an individual's ability to perform activities of daily living.
Which of the following actions may result in a producer's license being suspended?
Rebating a portion of the commission to the insured
What is the primary reason for the Director's examination of a producer's insurance records?
To determine compliance with state insurance laws and regulations
Insurance crimes which affect interstate commerce are prosecuted by the
US attorney general
The refusal of doing business with an individual or business is called a(n)
boycott
If dividend option choices are offered on a whole life insurance policy, the policy MUST
contain a statement that dividends are NOT guaranteed
Group life plans sold in ARIZONA typically contain a conversion option. If the insured elects this option, the new policy
does NOT require evidence of insurability
while processing a life insurance claim, the insurer discovers that the insured's age was misstated on the application . under these circumstances, the insurer is entitle to
pay proceeds based on what the premiums would have been if purchased at the insured actual age
In most dental plans a deductible typically is not applied to
preventative and diagnostic services
At what point must a producer give notification to the director about using an assumed name?
prior to using the assumed name
A group Medicare Supplement policy was terminated and not replaced by the insurer. In this situation, the insurer MUST
provide an offer of conversion to individual coverage
Insurance agent Kelly offers insured a $500 shopping card if they purchase an insurance product through her. What is this an example of?
rebating
