State Laws
Fiduciary
Producers in Missouri are held responsible in a __________ capacity for any money collected from an insured.
Offering any discount of premium, sharing commissions with an applicant, or allowing a credit not specified in the policy is considered rebating.
Rebating is described in which of the following statements?
The insurer must acknowledge a grievance, in writing, within 30 days
Which of the following is NOT one of the requirements of health insurance grievance procedures in this state?
A LTC policy based on health status can be field issued by a licensed producer
Which of the following is NOT true about the Long-Term Care policy?
It must be delivered within 15 days after the individual's coverage has been approved
Which of the following is NOT true of an LTC outline of coverage?
An association or association group
Which of the following is considered a group and eligible for group coverage in Missouri?
Defamation
Which of the following is defined as an unfair trade practice and could be considered fraudulent?
The home state is not obligated to insure nonresident producers licensed in Missouri
Which of the following is not true about a nonresident producer?
The terminated employee must request continuation within 21 days after the date of coverage would terminate
Which of the following is not true about continuation of group health coverage?
The producer may use a professional designation to assure the applicant that the producer is specially trained to sell the policy
Which of the following is not true about personal insurance transactions?
Contingent benefit
Which of the following is provided by the insurer if the insured declines the nonforfeiture benefi
Notice of intent to initiate administrative action must be served personally or by certified mail
Which of the following is true about the Missouri insurance cease and desist order?
The policyowner must be given an annual financial report that includes a notice that he/she may request a current illustration of benefits
Which of the following regulations apply to individual universal life policies?
Insurers must obtain rejections of inflation protection in writing
Which of the following statements BEST describes Missouri law about the offer of inflation protection benefits with respect to LTC insurance?
b. Ads for Medicare supplement coverage must first be approved by the Director
Which of the following statements BEST describes an insurer's use of advertisements for a Medicare supplement policy?
Resident producer licenses are issued for 2 years
Which of the following statements about producer licenses is TRUE?
A health policy must continue coverage for a dependent child after the child attains any limiting age if the child is incapable of self-sustaining employment due to physical/mental handicap and continues to be a dependent on the enrollee
Which of the following statements is correct?
Preexisting conditions or diseases are not covered
Which of the following statements is true regarding the LTC disclosure provisions?
To regulate the activities of insurers and producers
Which of the following statements pertains to the purpose of replacement regulations in Missouri?
Mental health
Which of the required health provisions provides coverage for outpatient treatment to the same extent as any other illness and inpatient hospitalization treatment for up to 90 days per benefit period?
Life insurance on the life of a debtor in connection with a credit transaction
Which statement best defines Credit Life Insurance?
Nursing home care
A long-term care policy is designed to cover what type of care?
Yes, if he informs the plan administrator within 60 days after the divorce is final
A married couple are insured by the wife's employer's group health insurance policy. When they become divorced, will the husband still be covered?
Defamation
A producer is guilty of ___________ when he makes a derogatory statement about a competing insurer's financial statement.
Applicant's financial goals and needs
A producer may not recommend a Variable Life policy unless the recommendation suits which of the following?
30
A producer must notify the Director of Insurance of any change of residence address within ______ days.
Being charged with a felony
A producer's license may be revoked or suspended for all of these reasons, except:
Knowledge of misappropriation of money
A producer's license will not be revoked for which of the following?
2 - 50
A small employer consists of how many eligible employees?
Within 30 days
When must a producer notify the Director of any change in legal address?
A sole proprietor
Which group does not qualify for a group health policy?
Coverage must be provided for up to 26 office visits per policy period; co-pay cannot exceed 50%
Which is TRUE of chiropractic coverage under Missouri law?
The plan issued to the custodial parent
Which of the following health plans is considered the primary plan to pay a claim if more than one form of health insurance is in place to cover a loss?
The primary plan
Which of the following health plans must be the first to pay a claim if more than one form of health insurance is in place to cover a loss?
Being assessed a civil penalty up to $5,000 per violation
Which of the following is NOT a penalty for refusing to testify in a Department hearing?
Investment options
Which of the following is NOT a required disclosure provision in a LTC policy?
The terminated employee has a spouse who was covered under the original group policy
A converted policy is not required under each of the following circumstances, except:
All forms used to process a grievance
A copy of the insurer's grievance procedures must be filed with the Director, including which of the following?
Funeral benefit up to $1,000 if there is no designated beneficiary
A group life policy must not include which of the following provisions?
Preexisting conditions
A health policy is not obligated to cover which of the following?
Foreign language processing disorder
A communicative disorder not covered under a health policy is which of the following?
Testimonials must be facts
All of the following advertising standards exist in Missouri, except:
Testing for lead poisoning
All of the following coverages must be offered by health insurers in Missouri, except:
An individual who fails to appear for an exam as scheduled
All of the following persons would be exempt from taking the Missouri licensing exam, EXCEPT:
Medical doctor
An administrator of a utilization review program must be which of the following?
Agent who assumes less than 5% of the insurance risk
An insurer can pay commissions to any agent, except which of the following?
Property and casualty producer for the sale of life insurance
An insurer is permitted by law to pay commissions to each of the following, except:
24 hours
An insurer making an adverse determination must notify the provider within what time period of making the decision?
30
An insurer may cancel a policy at any time, but must give the insured at least how many days advance notice before the cancellation becomes effective?
Pay the required $100 licensing fee
Anyone who wants to transact business as an insurance producer must do which of the following?
Medically necessary pharmaceutical prescriptions and durable medical equipment
As part of the insurer's utilization review process, an enrollee (or a provider on behalf of an enrollee) must be allowed to appeal for coverage of what services?
8%
What is the maximum life insurance policy loan interest rate in this state?
Certificate of Authority
Every insurer writing business in Missouri must receive a __________ from the Director.
Medical records
Pay the required $100 licensing fee
Advertisements for an insurer can display any logo
Choose the advertising standard that is not required for health policies in Missouri.
Credit life insurance must remain level as the debt decreases
Choose the incorrect answer from the following regarding credit life insurance.
72
For an expedited review of the insurer's determination of a grievance, within how many hours must the insurance company notify an enrollee?
At least 30 days of outpatient treatments per benefit period
For chemical dependency, which of the following is not covered under a health policy?
50%
Graded death benefits may grade in excess of the first 3 years for ages up to 65 as long as the first-year death benefit is at least ____________.
31 days
Group life insurance contracts must contain a grace period provision of how many days?
$100,000
Health policies in Missouri must offer breast cancer chemotherapy treatment if all requirements are met, and the maximum lifetime benefit can be no less than what amount?
Dental care for children up to age 18
Health policies must provide coverage for all of the following, except:
At least 3 years
How long must a producer keep record of all communications concerning a policy other than a group policy after the policy is no longer in force?
30
How many days does a licensed producer have to notify the Director of a residence or business address change?
90
How many days does a licensed producer who moves to Missouri from another state have to submit an application to become a resident producer?
31
How many days must a health policy cover an adopted child from the date of birth/adoption placement?
Orally within 72 hours
How many hours does an insurer have to notify an enrollee after receiving a request for an expedited review?
16
How many hours of approved continuing education must Missouri insurance producers complete during a license renewal period?
Renewal commissions must be issued for at least 5 years
How must commissions for Medicare supplement policies be paid?
Biennially (once every 2 years)
How often does a producer's license renew?
At least once every 5 years
How often is the financial examination of every licensed insurer in Missouri required to be conducted?
Biennially on the anniversary date of its issuance
If a producer's license continues to be in effect until suspended or revoked, how often is it renewed?
Certificate of Authority
If an insurance license authorizes a producer to transact business in Missouri, what type of license authorizes an insurer?
5
If disciplinary action against a producer resulted in monetary relief of $200 or less, the producer's record will be expunged after ______ years.
24 months
If group life insurance policies have a 31 day grace period, how long is the contestability period?
Within 5 working days
If replacement is involved, how soon must the replacing insurer notify the existing insurer?
30
If the Department of Insurance denies a producer license application, the applicant may request a hearing within how many days of the denial?
30
If the Director issues a summary order due to violations, the producer may request a hearing within how many days of notice of the order?
Up to 90 days per year
If treatment for mental illness disorders is provided by a health policy, how long is treatment for inpatient hospitalization per benefit period?
31
In Missouri, a health policy must cover a newborn child for how many days after birth?
26
In Missouri, chiropractic care must be covered, but the policy may limit the number of treatments to how many per policy period?
1 year of policy issuance
In Missouri, the insurer's liability is limited to a refund of premium if suicide is committed within what period of time?
Sole proprietorship
In Missouri, which entity acting as an insurance producer is NOT required to submit a Registration of Fictitious Name?
Guaranteed renewability
Individual permanent life policies in Missouri are required to include all of the following provisions, EXCEPT:
5 years
Insurers must maintain advertisements in a file for how long after each advertisements' discontinuance of use?
30
Insurers must notify insureds at least how many days in advance of any covered drug being deleted from coverage?
5%
LTC inflation protection must provide annual increases in benefits at no less than ________.
65
LTC premium increases will cease when the insured reaches what age?
16
Licensed life & health producers must complete ______ hours of continuing education every 2 years.
1 year after the policy's issue date
Life insurance policies in Missouri may contain a suicide exclusion for up to:
Misrepresentation
Making a false statement about the benefits or the nature of an insurance policy is what unfair trade practice?
Misrepresentation and False Advertising of Insurance Policies
Making any statement that misrepresents the benefits or true nature of a policy refers to which of the following?
Phases II, III, and IV of any cancer-related clinical trial
Missouri health plans are required to provide coverage for insureds participating in which of the following?
War/Aviation
Of the following potential life insurance policy exclusions, which does Missouri require to be formatted a certain way on the printed policy?
5
The Director may conduct a financial examination of an insurer whenever necessary but no less often than every _____ years.
Administration of general anesthesia and hospital charges for dental care
The Hospital Dental Procedure provision states that if a person is severely disabled or under age 5, a health policy must cover which of the following charges?
30
The free look period is _______ days for a LTC policy.
Yes, if the ex-spouse informs the group within 60 days after the divorce is final
The insured, who is insured under a group health policy, is getting divorced. Will the ex-spouse be able to continue health coverage under the group health policy?
Director's Reserve Valuation Method
The minimum valuation standard for a universal life policy is which of the following?
3 years
The producer must keep a copy of the life insurance replacement form for what period of time?
Protect policyowners in the event an insurer becomes insolvent
The purpose of the Missouri Life and Health Insurance Guaranty Association Act is to guarantee that the life or health insurer will:
2
Under a Utilization Review, within how many working days of making the initial determination must the insurer provide a confirmation to the enrollee and provider?
30
Within how many days must an insurer notify the Director of the appointment of an agent?