Final L&H Section
An individual producer who unintentionally commits a single violation of an insurance law may be fined up to what amount?
$2500
T or F: Coverage for children on family health insurance policies begins when the child is born
True
T or F: Customer service reps, consultants, managing general agents, reinsurance intermediaries in Utah may also be compensated or reimbursed for out of pocket expenses
True
T or F: Employees are allowed to waive coverage from their employer
True
T or F: Every Medicare supplement policy currently available from an insurer must be made available to all qualified applicants regardless of age.
True
T or F: For a producer to receive compensation (commissions), they must be a licensed producer
True
T or F: At least half of a producer's CE hours must be obtained through actual class attendance
True
How long does the Commissioner have to disapprove or discontinue an insurance form?
15 days
Insurers have to file a certificate of appointment for producers within ___ ___ the producer contract is executed
15 days
All licensees must complete ___ hours of approved continuing education for every two-year licensing period
24
All insurers must file with the Commissioner within __ ___ of termination of a producer
30 days
A Medicare supplement policy cannot deny claims due to preexisting conditions for losses occurring more than how long after the effective date of coverage?
6 months
A Medicare supplement policy must offer coverage of Part A Medicare eligible expenses for hospitalization from the ____ through the _____ day
61st-90th
T or F: A nonresident producer can satisfy the Utah CE requirements if they satisfy their home state CE requirements
True
T or F: A public adjuster must be licensed
True
What is an independent adjuster?
An adjuster who is required to be licensed and engages in insurance adjusting as a representative of multiple insurers
T or F: A replacing insurer must send a copy of the replacement notice to the customer's existing insurers within 5 days
True
All insurance companies must obtain a ________ to transact business in Utah.
Certificate of authority
All producers must be ____ by at least one insurer in order to transact insurance business in Utah
Appointed
When must a disclaimer be given to the customer?
Before or at the time of delivery of the policy, contract, or certificate
What are the three types of Business Disability Insurance Plans?
Buy-sell Key person Business overhead expense (BOE)
An individual, corporation, organization, or other legal entity authorized to represent an insurer with respect to a claim is a...
Claim representative
T or F: An insurance examinee does not have the right to contest the report of an examination
False
T or F: Travel insurance agents need to be licensed producers to receive compensation
False
T or F: An HMO is not a limited health plan
True
A public adjuster represents the...
Insured and claimants
What are insurance adjusters responsible for?
Investigation, negotiation, or settlement of a claim under an insurance policy on behalf of an insurer, policyholder, or claimant
Producer's licensing status can be verified through the
National Association of Insurance Commissioners (NAIC)
When must insurers give the customer a Buyer's Guide?
No later than when the policy is delivered
Appointments are continuous until...
Terminated by the insurer or canceled by the Department
Who has the authority to make rules and regulations to help carry out provisions of Utah insurance laws?
The Commissioner
Who pays the fees for an examination by the Department of Insurance?
The company being examined (examinee)
If an applicant does not designate a physician or other health care provider, positive HIV test results will be reported to...
The local health department
T or F: If a Medicare supplement policy replaces one that was in effect for at least six months, the replacing policy cannot impose waiting periods for preexisting conditions, elimination periods, or probationary periods for benefits that are similar to those in the original policy.
True
T or F: If an individual names a spouse as the beneficiary under a life insurance policy, the beneficiary is automatically revoked in the event of a divorce or annulment.
True
T or F: If your employer pays the entire premium for your disability insurance, benefits are subject to taxation.
True
T or F: Individual licensees have to provide their residence address and phone number to the Commissioner
True
T or F: Medicare supplement plans must be guaranteed renewable
True
This organization was established to protect policyholders in the event that a life or health insurer becomes financially unstable and is taken over by the insurance department.
Utah Life and Health Guaranty Association
For noncancellable accident and health insurance policies, policyowners habe the right to continue coverage (as long as they pay the premiums) until...
age 65 or they become eligible for Medicare
I licensees must register the address, email address, and telephone numbers of their ____ ____ ____ with the Commissioner.
principal place of business
Anyone who violates an insurance statute, rule, or order issued by the Commissioner must pay the state _____ ____ _____ of any profit gained by the violation in addition to any other forfeiture or penalty imposed.
twice the amount
A person is a "spokesperson" if they...
• Make a testimonial or endorsement and have a financial interest in the insurer • are compensated • is owned or controlled by the insurer
For self-employers to get a tax deduction on their health insurance, they must
• Show a net profit for the year • Cannot claim the deduction for any month that they were eligible for another health plan
If a nonresident license applicant has a valid license from her home state, the Commissioner may:
• Waive the license requirement • Issue a nonresident producer license
Maternity benefits must have at least a ___ ____ benefit for both mother and newborn after a ceasarean section delivery (C-section)
96-hour
If premiums are paid more often than monthly, the grace period for late life insurance premiums in Utah is...
At least four weeks
Who is the chief officer of the Utah Insurance Department?
Commissioner of Insurance
The illegal act of paying, allowing, giving, or offering to pay, allow or give: • a refund of premium or portion of premium; • a refund of commission or portion of commission; • a refund of all or a portion of a consultant fee; or • providing services or other benefits not specified in an insurance or annuity contract is called...
Rebating
T or F: Company adjusters are not required to be licensed
True
For health benefit plans, a small employer must have had least ___ but not more than ___ eligible employees the preceding calendar year
1, 50
In Utah, a policyholder can return a life insurance policy within ___ _____ after delivery with a refund of all premiums paid
10 days
A producer may not receive compensation from an insurer for controlled business unless during the preceding ____ ____ the premiums of other policies exceeded the premiums from controlled business
12 months
A producer who does not vomplete their CE requirements may have their license suspended or revoked for how many months?
12 months
An insured employee has the right to extend their health coverage under their group policy for ___ ____ if they quit, retire, reduce hours, take a leave of absence, divorce, or become disabled
12 months
The grace period is at least __ ___ for weekly or monthly premium policies and ____ ____ for all other payment timelines (health insurance)
15 days 30 days
For insured persons in the armed forces whose coverage has lapsed due to mobilization must be reinstated if an application is made within ___ ____ of release from active duty
180 days
How many hours of continuing education are required for each two-year licensing period?
24 credit hours
A producer with licensed in health insurance may only sell LTC if they complete a minimum of ______ of training
3 hours
In Utah, a life insurance policy can be reinstated within __ ___ from the date of premium default unless it has been surrendered
3 years
How long does an insurer retain evidence of compliance with the section related to the ULHIG?
3 years or until the conclusion of its next market conduct examination
A licensee must notify the Commissioner within __ days of any change in address, telephone number, and business email address
30
Insurers must file their premium rates (excet worker's compensation) with the Commissioner within ___ days of the effective date
30
For criminal action, a producer must notify the commissioner within...
30 days of initial appearance in court
For administrative actions, a producer must notify the commissioner within...
30 days of the final disposition
The grace period for individual life insurance in Utah allows a premium to be paid late up to __ ___ except for the first premium
31 days
If a person in Utah loses life insurance coverage due to termination of employment or membership, they can be insured without evidence of insurability if they submit an application and pay the first premium within ___ ___ ___________
31 days after termination
If an insurer wants to modify or revise a filed rate, they have to provide supporting documentation within...
45 calendar days of the date the Commisioner requested it
Maternity benefits must have at least a ___ ____ benefit for both mother and newborn after anormal vaginal delivery
48-hour
If a medical policy covers dependent children, how long must coverage continue for a dependent child that is incapable of self-sustaining employment because of a physical impairment?
As long as the insurer receives proof of the child's incapacity when requested
How often must the Commissioner examine all insurers (domestic and foreign)?
At least once every five years
A producer can only become licensed to transact surplus lines insurance if they have been licensed to sell P&C for...
At least three of the four years immediately preceding the application
To be an insurance consultant, a producer must have been licensed and actively transacted insurance...
At least three of the four years immediately preceding the application
Any record either in original form or as recorded by any processes which can accurately and reliably reproduce the original material regarding a claim, investigation, adjustment, or settlement is called a
Claim file
An employer group health benefit plan in which the employer selects the health benefit plan(s) from a single insurer and employees are NOT provided a choice of plans on the Health Insurance Exchange.
Defined benefit plan
Employer group health plans individually selected by the employees through the Utah Health Insurance Exchange are called
Defined contribution arrangements
A document that explains the extent that contractual guarantees are not covered or have limited coverage by the ULHIG is called a...
Disclaimer
Is an FSA is funded with employee or employer money?
Employee
T or F: If someone with a LTC policy wants to increase their benefits, the insurer CANNOT establish a new waiting period
False
T or F: In Utah, a life insurance policy may be forfeited for failing to repay a loan even if the debt is less than the loan value
False
T or F: Individuals need IRS authorization to set up an HSA
False
T or F: Selling a new policy that causes an existing one to be surrendered is NOT subject to replacement regulations
False
T or F: The source of statistics used in an advertisement does not need to be identified
False
T or F: Twisting is unethical but not illegal
False It is illegal
A disclaimer must use the text specified in the
Notice of Protection Provided by the ULHIG
When does an insurance license expire?
On the last day of the licensee's birth month following the two-year anniversary of the license issue date
A lapsed license may be reinstated within ___ ___ after the day on which it expired
One year
The period of time following the date of issuance or effective date of the policy before coverage begins for all or certain conditions is called...
Probationary period
All books and records must be available to the Commissioner during all business hours for up to ____ _____ following the calendar year in which they are created.
Three years
T of F: If an employer pays the entire premium for a group life insurance policy, all eligible employees must be insured
True
T or F: A group member's surviving dependents must be offered a conversion policy at the time of the member's death
True
T or F: A health insurance policy or health maintenance organization contract may require authorization for continued treatment of an emergency medical condition after the insured's condition has been stabilized.
True
T or F: A licensed producer must report administrative action by another agency or criminal prosecution to the Commissioner
True
T or F: A securities license (FINRA series 6, 63) is required in Utah to sell a variable contract
True
T or F: All insurance forms must be described, filed with the appropriate fee, and approved by the Commissioner before they can be issued.
True
T or F: An insurer can use marital status to define eligibility for dependent coverage
True
T or F: Every licensee must keep at her principal place of business separate books and records of all insurance transactions
True
T or F: FSA's are funded with employee money through salary reductions
True
T or F: In Utah, a life insurance policy cannot be contested after it has been in force for two years (except for nonpayment of premium)
True
T or F: In Utah, a policy cannot be backdated for more than one year
True
T or F: Insurers and producers may not use the existence of the Association for the purpose of selling or soliciting life and health insurance
True
T or F: Medicare Select policy service areas are approved by the Commissioner
True
T or F: No policy can be delivered in Utah without the appropriate outline of coverage.
True
T or F: Premiums are not tax deductible for buy-sell and key person coverage but they are for BOE
True
T or F: Self-employed persons are allowed to deduct 100% of what they pay for health insurance (including qualified LTC) from their gross income
True
T or F: The Commissioner can inspect the accounts, records, and documents of licensees, insurers, and anyone with executive authority
True
T or F: The Utah Life and Health Guaranty Association continues coverage and pays claims with funds provided by assessments paid by other insurance companies
True
T or F: To transact business in Itah, producers must be appointed by an insurer
True
T or F: When converting a group health insurance policy to an individual policy, the insurer can reduce benefits under the converted policy to prevent overinsurance
True
T or F: You cannot offer benefits not specified in the policy such as premium or commission rebates.
True
T or F: You must spend all the money in your FSA each year or you will lose it
True
Knowingly making any misleading representation or fraudulent comparison of an insurance policy or insurer in order to get someone to lapse, forfeit, surrender, terminate or take out another policy is called
Twisting
The Commission mer may place a licensee on probation for a period of...
Up to 24 months
All funds collected by a producer for an insurer must be held in a...
bank account registered with the FDIC
To sell, solicit, or negotiate insurance as an individual producer you must have
• an appointment from an insurer or a designation from an agency; and • legal liability errors and omissions insurance coverage in an amount not less than $25 $500,000 annual aggregate limit (resident only).