XCEL Chapter 11 - Laws and Rules
According to the Affordable Care Act, what is the maximum amount an individual can contribute to a Flexible Savings Account?
$2,500
A producer that willfully violates any provision of Pennsylvania Insurance law may be imposed to a maximum penalty set by the Commissioner at
$5,000 per violation
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
If a health policy is reinstated after it had lapsed for nonpayment, there is a waiting period of _______ days before a claim covering sickness will be covered.
10
The free look period in Pennsylvania for individual health insurance policies is _____ days.
10
Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within
10 days
What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?
12 months
Written notice of a health insurance claim should be given to the insurer within ______ days after the occurrence of any loss covered by the policy.
20
Producers must complete a total of ____________ of Continuing Education credits for each two-year licensing period.
24
An employer may qualify for health care tax credits through SHOP Marketplace if that employer has fewer than how many employees?
25
Pennsylvania requires that a licensee complete ______ hours of continuing education on the subject of ethics every reporting period.
3
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 expiration of
3 years
In a Long-Term Care policy, the right-to-examine period is
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%
Under Pennsylvania statute, first year of commission for long-term care insurance may not be greater than
50% of the first year premium
The Medicare Supplement open enrollment period is the
6 month period that begins with the month in which enrollment in Part B Medicare occurred, typically at age 65.
No Long-Term Care policy may exclude pre-existing conditions for a period of more than
6 months
If a health insurance claim is not promptly paid, legal action may be taken against the insurer after
60 days from the date proof 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
An example of rebating would be
A producer who share commissions with a client
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
Which of the following is included in the entire contract according to the entire contract provision?
Application
What is the difference between a Long-Term Care Partnership Plan and a Non-Partnership Plan?
Asset protection
When is a Group Accident and Health policy required to provide coverage for a newborn child?
At the moment of birth
With a scheduled dental policy, how are covered expenses paid?
Benefits are limited to a specific maximum dollar amount per procedure
According to Pennsylvania law, which of the following is NOT considered to be personally identifiable financial information?
Blind trust data that does not include names and addresses
How are health plans classified according to the Affordable Care Act?
Bronze, Silver, Gold, Platinum
What are the levels of coverage as defined by the Affordable Care Act?
Bronze, Silver, Gold, and Platinum
Which of the following is required for an insurer to conduct business in this state?
Certificate of Authority
In Pennsylvania, who is responsible for Continuing Education (CE) course content approval?
Commissioner
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
A form of medical health insurance covering the treatment and care of gum disease is called
Dental expense insurance
All of the following may be an unfair claims practice EXCEPT
Denying an insured's fraudulent claim.
Which prohibited act involves a producer spending a client's insurance premiums of his/her own personal use?
Embezzlement
Acme Corporation recently purchased a group health plan for its employees. Who would receive a certificate of coverage?
Employees
A common exclusion or limitation on a dental policy is
Endodontics
Which of the following is required to maintain a producer's license in Pennsylvania?
Field underwriter, who solicits insurance and earns a commission
Violations of US Code Title 18 section 1033, may result in
Fine and/or imprisonment
In Pennsylvania, a Long-Term Care policy must be _________ renewable.
Guaranteed
Which of following provisions protects a Pennsylvania policyowner from an innocent mistake made on the application over 2 years ago?
Incontestability provision
When a producer offers something of value in return for the purchase of an insurance policy, which prohibited sales practice has been committed?
Inducement
An insurer is REQUIRED to offer which of the following to each long-term care applicant at the time of purchase?
Inflation Protection
A Long-Term Care plan must provide which of the following options for coverage in the state of Pennsylvania?
Inflation protection rider
Who issues Medicare Supplement policies?
Insurance companies
Who is required to notify the producer in the event of appointment termination?
Insurer
A resident producer license requires each of the following EXCEPT
Insurer appointment
Violating Pennsylvania insurance law may result in which of the following Insurance Department actions?
Issuance of a cease and desist order after a hearing
In Pennsylvania, completion of continuing education is required upon license renewal for which of the following?
Licensed individuals qualified in major lines of insurance
According to the Affordable Care Act, any plan in existence prior to which date is considered a grandfathered plan?
March 23, 2010
A Medicare Supplement policy may be cancelled by an insurer for which of the following reasons?
Material misrepresentation
The document that describes policy features, benefits, exclusions and riders in a Long-Term Care policy is known as the
Outline of Coverage
The _______ is responsible for determining the appropriateness of a Medicare Supplement policy for an applicant.
Producer
Which of the following is a person who negotiates an insurance contract on behalf of an insurer?
Producer
Who can receive an insurance commission?
Producer
What is required before an insurance producer can act as a representative of an insurer?
Producer needs to be appointed by that insurer
In Pennsylvania, an insurance producer license can be denied for failure to pay each of the following EXCEPT?
Property tax
The branch of dentistry which deals with the replacement of missing parts is called
Prosthodontics
What is the purpose of the Pennsylvania Life and Health Insurance Guaranty Association?
Provide policyowner protection if an insurer becomes insolvent
Which of the following is an example of a producer's fiduciary duty?
Recording receipt and remittance of premiums due to the insurance company
Which accident and health policy provision allows the policyowner a stated amount of time to return a newly-delivered policy for a full refund of premiums if not satisfied for any reason?
Right to examine
The Pennsylvania Insurance Department is responsible for each of the following EXCEPT
Shareholders
Which of the following is the Pennsylvania Insurance Department NOT responsible for?
Shareholders
In Pennsylvania, a producer may have license revoked for which of the following acts?
Signing a prospect's name without their knowledge or presence
Under the Affordable Care Act, how would a grandfathered health plan lose its grandfathered status?
The insurer significantly raises co-insurance charges, deductibles, or co-payment charges
When a Medicare Supplement insurance policy is being replaced, who must sign the notice of replacement?
The producer and the applicant
Charging a client less premium than what is stated in their insurance policy is called
a rebate
Health insurance advertisements that mention statistical information are required by Pennsylvania law to
accurately convey all pertinent facts
Holding premium funds for timely submission to the insurer is an example of
acting in a fiduciary capacity
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
An insurer formed according to the legal requirements of another country is considered a(n)
alien insurer
If the Insurance Department determines that the issuance of a temporary producer license serves in the public's best interest, the license may be issued to
an executor of a deceased producer's estate
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
In order to solicit insurance in Pennsylvania, all of the following is required EXCEPT
be at least 21 years of age
A domestic insurance company in Pennsylvania MUST
be formed under Pennsylvania insurance laws
A Medicare Supplement policy's outline of coverage MUST include a(n)
description of policy benefits
When an applicant for a producer's license has a principal place of residence or business location in Pennsylvania, for licensing purposes the State of Pennsylvania is known as the
home state
Sharing 50% of a producer's commission with the insured is an example of
illegal inducement
A non-admitted insurer
is not afforded protection by the guaranty fund
An insurance company may only pay commissions to a(n)
licensed producer appointed by the insurer
The Life and Health Guaranty Association provides funds to carry out its powers and duties by assessing
member insurers
Benefits for a Medicare Supplement policy
must not duplicate Medicare benefits
A producer who sells insurance in Pennsylvania but resides in another state is called a(n)
nonresident producer
A producer's fiduciary duty requires that
premiums are forwarded to the insurer on a timely basis
In most dental plans, a deductible typically is NOT applied to
preventative and diagnostic services
All statements in an insurance application, in the absence of fraud, are considered
representations
In the state of Pennsylvania, a licensed producer
represents the insurer
An example of endodontic treatment is a
root canal
All of the following actions are considered rebating EXCEPT
sharing commissions with other licensed and appointed producers
A(n) _________ company is owned exclusively by shareholders.
stock
Long-term care policies sold in Pennsylvania may exclude coverage related to
substance addictions
A producer does NOT have a fiduciary responsibility to
the Pennsylvania Guaranty Association
Under the Affordable Care Act, a large employer that does NOT provide health insurance and owes an employer mandate penalty MUST pay an annual penalty, which is calculated by multiplying $2,000 by
the number of full time employees minus 30
The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as
twisting
Fair Credit Reporting Act protects consumers
with guidelines regarding credit reporting and distribution
