Colorado Health Only

After a client signs a disclosure statement regarding additional fees charged by a producer, the producer must keep a copy of the statement for at least

3 years from the date of completion of the services

All insurers that terminate employment with a producer are required to notify the Commissioner within how many days following the effective date of the termination?

30 days

An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?

$102

What is the maximum civil penalty per violation if an unauthorized entity violates the Commissioner's cease and desist order?

$25,000

What is the maximum a producer may be fined for violating a cease and desist order?

$500

Insurers must provide health insurance claim forms within how many days?

15

Health insurance policies become incontestable after what time period from the policy issue?

2 years

All of the following are correct about the required provisions of a health insurance policy EXCEPT

A reinstated policy provides immediate coverage for an illness

The premium charged for exercising the Guaranteed Insurability Rider is based upon the insureds

Attained age

Which of the following would NOT be considered an unfair and deceptive practice?

Controlled business

All of the following are true about group disability Income Insurance EXCEPT

Coverage applies both on and off the job

When rating small employer group, small employer carriers may use all of the following factors EXCEPT

Gender

The Commissioner of Insurance is appointed by which authority?

Governor

Which of the following is a producer's fiduciary duty?

Handling premiums

The type of dental plan which is incorporated into a major medical expense plan is a/an

Integrated dental plan

What statement best describes the free look provision?

It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason

Which of the following statements is NOT true concerning Medicaid?

It consists of 3 parts: Part A: hospitalization, Part B: doctor's services, Part C: disability income

Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?

Metal level classification

Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Dons basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?

Pay a special deductible on his major medical policy

Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT

When the amount payable under Social Security is more than the amount payable under the rider

Which of the following statements about occupational vs. nonoccupational coverage is TRUE?

Disability insurance can be written as occupational or nonoccupational

In disability income insurance, the time between the onset of an injury or sickness and when benefits begin is known as the

Elimination period

During a sale of a Medicare Supplement policy, an agent must give out a copy of the Buyer's Guide and an Outline of Coverage. The Outline must state all of the following EXCEPT

How the agent's commission is paid

When would a misrepresentation on an insurance application be considered fraud?

If it is intentional and material

Under Colorado's Unfair Claims Practices regulations, when denying a claim an insurer must do all of the following EXCEPT

Pay a claim that occurs after the grace period has ended

An insurance producer soliciting applications for Long-Term Care insurance policies must deliver the shopper's guide

Prior to the presentation of an application

The Federal Fair Credit Reporting Act

Regulates consumer reports

What type of care is Respite care?

Relief for a major care giver

If a business wants to buy a disability income policy on a key employee, which of the following is considered the beneficiary?

The employer

An employee insured under a group health policy is injured in a car wreck while performing her duties for her employer. This results in a long hospitalization period. Which of the following is true?

The group plan will not pay because the employee was injured at work

An insured purchased a noncancellable health insurance policy 1 year ago. Which of the following circumstances would NOT be a reason for the insurance company to cancel the policy?

The insured is in an accident and incurs a large claim

Which of the following is NOT a feature of a guaranteed renewable provision?

The insurer can increase the policy premium on an individual basis

The regulation of the insurance industry primarily rests with

The state

An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductibles and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer?

$500

What is the maximum dollar amount limit that must be provided under a sickness and accident insurance policy for annual prostate cancer screening for early prostate cancer in men?

$65

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?

$900 (deductible + 20% of the bill after the deductible [20% of $2,000])

The guaranteed issue provision will apply to any health benefit plan that provides coverage to the employees of a small employer if

-Any portion of the premium or benefit is paid by or on behalf of a small employer -An eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of a small employer for any portion of the premium -The plan is marketed to individual employees through an employer or at a place of business

A licensee has met licensing qualifications for Life, Health, Property, and Casualty insurance. How many separate licenses will the Department of Insurance issue?

1

For how many years must a producer keep supporting documentation of his or her continuing education completion?

5 years following license continuation

In accident and health policies issued in this state, an insured must submit proof of loss within how many days?

90 days

Under the uniform required provisions, proof of loss under a health insurance policy normally should be filled within

90 days of a loss

A hospital indemnity policy will pay

A benefit for each day the insured is in a hospital

The insureds health policy only pays for medical costs related to accidents. Which of the following types of policies does the insured have?

Accident - only

The Commissioner may revoke a producer license for all of the following reasons EXCEPT

Acting in a fiduciary capacity

An insured misstated her age on an application for an individual health insurance policy. The insurance company found the mistake after the contestable period had expired. The insurance company will take which of the following actions regarding any claim that has been issued?

Adjust the claim benefit to reflect the insureds true age

Which of the following would NOT be a violation of state insurance regulations?

Agent C uses her license to write only business other than controlled

An insured pays a $100 premium every month for his insurance coverage, yet the insurer promises to pay $10,000 for a covered loss. What characteristic of an insurance contract does this describe?

Aleatory

In a replacement situation, all of the following must be considered EXCEPT

Assets

How often must the Commissioner examine all insurers to guard against insurance company insolvency?

At least once every 5 years

To be classified as a clean claim, a claim must

Be submitted on the uniform claim form with all fields completed with correct information

A banker is ready to close on a customers loan. The bank is prepared to offer the loan but only if the customer purchases an insurance policy from the bank in the amount of the loan. This is an example of

Coercion

Forcing a client to buy insurance from a particular lender as a condition of granting a loan is defined as

Coercion

If more than one family member covered under the same major medical policy is injured in the same accident, the family only has to pay one deductible. This is due to the

Common accident provision

Which of the following is NOT an exclusion in medical expense insurance policies?

Coverage for dependents

All of the following statements concerning Accidental Death and dismemberment coverage are correct EXCEPT

Death benefits are paid only if death occurs within 24 hours of an accident

What agreement specifies how a business will transfer hands when one of the owners dies or becomes disabled?

Disability Buy-Sell

An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits?

Have accumulated 6 work credits in the past 3 years

An insurer publishes intimidating brochures that portray the insurer's competition as financially and professionally unstable. Which of the following best describes this act?

Illegal under any circumstances

Which of the following riders would NOT increase the premium for a policyowner?

Impairment rider

A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT

Income

Underwriting a group health insurance plan that is paid for by the employer requires all of the following EXCEPT

Individual members of the group may select the level of benefits for their own coverage

The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT

Individual tax deduction for premiums paid

Long-term care policies sold in Colorado must offer which of the following?

Inflation protection

Which of the following best describes the MIB?

It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance.

Under workers compensation, which of the following benefits are NOT included?

Legal benefits

Which of the following best describes the unfair trade practice of defamation?

Making derogatory oral statements about another insurer's financial condition

Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations?

Medicare SELECT

Bethany studies in England for a semester. While she is there, she is involved in a train accident that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of benefits that she receives?

None

Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?

Notice of claim

Before a carrier can offer health benefit plans to small employers what must be filed?

Notice of intent

All of the following are the most common variations in a Long-Term Care policy EXCEPT

Number of family dependents

An insurer pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

Pay the claim

Which of the following provisions is mandatory for health insurance policies?

Physical examination and autopsy

Which of the following must be present in all Medicare supplement plans?

Plan A

A guaranteed renewable health insurance policy allows the

Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class

Insurers must complete claims investigations

Promptly

What is the best way to change an application?

Start over with a fresh application

An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Which of the following allows for that?

Stop-loss limit

Which of the following terms describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?

Stop-loss limit

Which of the following would provide an underwriter with information concerning an applicant's health history?

The Medical Information Bureau

An employee becomes insured under a PPO plan provided by his employer. If the insured decides to go to a physician who is not a PPO provider, which of the following will happen?

The PPO will pay reduced benefits

A health coverage plan will not make a determination that it will deny a request for benefits for a covered individual on grounds that such treatment of covered benefit is not medically necessary, unless such denial is made according to procedure including all of the following EXCEPT

The claim investigator wishes to wait a period of time to see if the procedure remains necessary

Insured Z's health insurance policy year begins in January. His policy contains a carry-over provision. In November, he has a small claim which is less than his deductible. Which of the following is true?

The insured may carry over the amount of this years expenses to next year, which will help satisfy next years deductible

An agent is in the process of replacing the insured's current health insurance policy with a new one. Which of the following would be a proper action?

The old policy should stay in force until the new policy is issued

In terms of parties to a contract, which of the following does NOT describe a competent party?

The person must have at least completed secondary education

Which of the following accurately describes the ability of a licensed Colorado resident producer to become licensed in other states?

The producer can get a nonresident license in all reciprocal states

On a health insurance application, a signature is required from all of the following individuals EXCEPT

The spouse of the policy owner

An insured is upset that her new health insurance policy was delivered to her by certified mail and not through her agent. Which of the following is true?

There is nothing wrong with this form of policy delivery

An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?

Time of payment of claims

What is the purpose of coinsurance provisions?

To help the insurance company to prevent overutilization of the policy

According to the rights of renewability rider for cancellable policies, all of the following are correct about the cancellation of an individual insurance policy EXCEPT

Unearned premiums are retained by the insurance company

A lender is requiring that a borrower purchases an insurance policy through a particular insurer, as a condition to the extension of credit. This is an example of which of the following?

Unfair practice of coercion

Under the Physical Exam and Autopsy provision, how many times can an insurer have the insured examined, at its own expense, while a claim is pending?

Unlimited

Manny has been injured in an accident. Although she is still receiving benefits from her policy, she does not have to pay premiums. Her policy includes

Waiver of Premium rider

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

Within 90 days or as soon as reasonably possible, but not to exceed 1 year