PA Laws & Rules

In a long-term care policy, the right-to-examine period is

30 Days

A licensed producer must report any administrative action taken against the licensee in another jurisdiction or by another agency department in Pennsylvania within how many days of the final disposition?

30 days

In accident and health plans, premiums paid less frequent than monthly require a minimum grace period of at least

31 days

In Pennsylvania, accident and health plans are required to provide mammograms for women starting at age

40

As of January 1, 2014, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of ___ of the premiums paid by the employer.

50%

In Pennsylvania, a specified disease accident and health plan must provide a minimum benefit in the amount of

$5,000

If a Medicare Supplement policy replaces another that had been in effect for at least 6 months, the replacing policy may impose which of the following time exclusions for pre-existing conditions?

0 months

Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within

10 days

The free look period provided in a life insurance policy is usually

10 days

A Pennsylvania temporary producer may be issued for a period not to exceed

180 days

According to Pennsylvania law, postnatal care must be delivered within how many days of discharge?

2 days

A life insurance policy becomes incontestable after it has been in force for

2 years

In Pennsylvania, the definition of total disability changes from one's "own occupation" to "any occupation" by reason of one's education, training, and experience after what period of time?

24 months

Producers must complete a total of ____ Continuing Education credits for each two-year licensing period.

243

An accelerated death benefit in Pennsylvania must be at least what percentage of the total death benefit?

25%

In Pennsylvania, the Time Limit on Certain Defenses provision provides that no misstatements (EXCEPT fraud) made by the applicant on a health insurance application can be used to void the policy or deny coverage after the explanation of

3 Years

Within how many days must a producer report to the Commissioner any charges made against him/her?

30

Under Pennsylvania statute, first year commision for long-term care insurance may not be greater than

50% of the first year premium

No Long-Term Care policy may exclude pre-existing conditions for a period of more than

6 months

In Pennsylvania, an employee must request spousal coverage under a group sponsored accident and health plan within ____ days of marriage.

60

If a health insurance claim is not promptly paid, legal action may be taken against the insurer after

60 days from the date of loss is furnished

In Pennsylvania, HIPAA laws require that an individual's prior creditable coverage may reduce the maximum pre-existing condition exclusion period that a new group health plan can apply. This rule is applicable as long as there has been no gap in creditable coverage for a period greater than

63 days

In Pennsylvania, what's the requirement for a minor to receive proceeds from a death benefit?

A guardian must be appointed

A producer's license CANNOT be revoked without

A hearing given to the producer

A temporary license may be issued without state examination to all of the following EXCEPT

A prospective producer who is currently enrolled in a pre-licensing insurance class

Charging a client less premium than what is stated in their insurance policy is called

A rebate

For Pennsylvania Insurance Code violations, the Commissioner may assess a(n)

Administrative penalty

Group dental plans will frequently place a limit on annual benefits in order to minimize

Adverse selection

All of these are considered a form of advertising EXCEPT

An insurer's A.M. Best rating

A licensee may only sell, solicit, and negotiate insurance contracts on behalf of the

Appointing insurer

What is the difference between a long-term care partnership plan and a non-partnership plan?

Asset protection

In order to solicit insurance in Pennsylvania, all of the following is required EXCEPT

Be at least 21 years of age

According to Pennsylvania law, which of the following is NOT considered to be personally identifiable financial information?

Blind trust at that does not include names and addressees

What are the levels of coverage as defined by the Affordable Care Act?

Bronze, SIlver, Gold, and Premium

In Pennsylvania, who is responsible for continuing education (CE) course content approval?

Commisioner

In Pennsylvania, which of the following is NOT something a licensee must do to renew their insurance license?

Confirm previous exam scores

Which of the following does restorative dental treatment cover?

Crowns

Which prohibited act involves a producer spending a client's insurance premiums for his/her own personal use?

Embezzlement

When soliciting insurance, a producer CANNOT

Emphasize Guaranty Association benefits

Violations of US Code Title 18 section 1033, may result in

Fine and/or imprisonment

When collecting insurance premiums from a client, a producer MUST

Forward premiums to the insurer on a timely basis

For licensing purposes, if an applicant has a home or office location in the state of Pennsylvania, this would be consistent with which of the following?

Home State

Sharing 50% of a producer's commission with the insured is an example of

Illegal Inducement

When a producer offers something of value in return for the purchase of an insurance policy, which prohibited sales practice has been committed?

Inducement

A long-term care plan must provide which of the following options for coverage in the state of Pennsylvania?

Inflation protection rider

A resident producer license requires each of the following EXCEPT

Insurer appointment

Commissions may be shared by

Licensed and appointed Producers

In Pennsylvania, completion of continuing education is required upon license renewal for which of the following

Licensed individuals qualified in major lines of insurance

Viatical settlement brokers are permitted to do all of the following EXCEPT

Make the first transaction up to 30 days before approved for a license

A producer who sells insurance in Pennsylvania but resides in another state is called a(n)

Non-resident producer

The document that describes policy features, benefits, exclusions and riders in a long-term care policy is known as the

Outline of coverage

In most dental plans, a deductible typically is NOT applied to

Preventative and diagnostic services

What is required before an insurance producer can act as a representative of an insurer?

Producer needs to be appointed by that insurer

The branch of dentistry which deals with the replacement of missing parts is called

Prosthodontics

What is the purpose of the Pennsylvania Lie and Health Insurance Guaranty Association?

Provide policyowner protection if an insurer becomes insolvent

Any of the following may be unfair claim practice EXCEPT

Refusing to pay persons bringing false or fraudulent claims

According to the Affordable care act, what metal tier is required to have an actuarial value of 70% with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features

Silver Plan

In Pennsylvania, no legal action may be taken against an insurer for failure to honor a valid claim after the expiration of how many years from the time proof of loss is furnished?

Three Years

When an insurance company consistently fails to provide reasonable explanations for the denial of a claim, this is called a(n)

Unfair claim settlement

Life insurance may make an immediate benefit payment before the insured dies in which transaction?

Viatical settlement

Agreements made by terminally ill persons to sell their life insurance policies at a discount in order to pay medical expenses are called

Viatical settlements

Pennsylvania law requires that an insurer must notify the Commissioner of a producer appointment termination

Within 30 days of termination

Holding premium funds for timely submission to the insurer is an example of

acting in a fiduciary capacity

The commissioner has the right and duty to

audit insurer financial reports and conduct market studies

A licensee can have his/her license denied or revoked by the commissioner if

the license has committed insurance-related fraud or dishonesty

A transaction in which a new life insurance policy is purchased and an existing life insurance policy is surrendered is called

Replacement

All statements in an insurance application, in the absence of fraud, are considered

Representations

Which of the following is the Pennsylvania Insurance Department NOT responsible for?

Shareholders

In Pennsylvania, an insurer may backdate policy issue not more than how many months from the date of a life insurance application?

Six months

A life insurance producer licensed in the Commonwealth of Pennsylvania is authorized to

Solicit, receive and forward applications to the insurer

A life insurance illustration showing future premiums paid out of nonguaranteed values must disclose that

The policyowner may need to resume premium payments depending on actual results