Insurance Regulations

An insurer is soliciting an individual disability insurance policy to a 67-year-old applicant. Which of the following statements must be printed on the first page of the outline of coverage for that policy?

"This is not a Medicare supplement policy." Any health or disability policy that solicits or provides coverage to state residents eligible for Medicare must notify the applicants or policyholders that the policy is NOT a medicare supplement policy. The notice must be printed on or attached to the first page of the outline of coverage or another disclosure form.

CAN-SPAM legislation requires that any commercial e-mail must contain an opt-out mechanism. How many days does a commercial e-mailer have to cease their distribution?

10 business days. All opt-out requests must be honored within 10 business days.

A consumer receives spam email from an insurance company. He requests to be removed from the company's list. Within what period of time must the insurer comply with the request?

10 days. According to CAN-SPAM, the law mandates that a consumer's request to opt out of an e-mailing list must be honored within 10 business days.

Once a producer's appointment is filed, within how many days will the Commissioner verify the appointment (for eligible producers)

30 days - If the producer is eligible, the Commissioner will verify the appointment by electronic message within 30 days of receiving the notice from the insurer. However, if the producer is deemed ineligible, the Commissioner will notify the insurer within 10 days,

If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that the insurer be notified of the child's birth and pay any required fee within how many days after the child is born for coverage to conintue?

60 days. Washington Insurance Law specifies the insurer be notified within 60 days of the birth of a newborn.

In insurance, an offer is usually made when

An applicant submits an application to the insurer. In insurance, the offer is usually made by the applicant in the form of the application. Acceptance takes place when an insurer's underwriter approves the application and issues a policy.

Individual disability insurance policies cannot be delivered or issued for delivery in this state unless

An outline of coverage is furnished to the applicant.

The document that indicates that an insurer has been approved and is authorized to transact insurance in a particular state is known as

Certificate of Authority. When the Commissioner of a particular state has determined that an insurer has met all of the requirements for transaction insurance in that state, a certificate of Authority shall be issued to that insurer.

Which of the following is a specific dollar amount or a percentage of the cost of care that must be paid by an HMO member?

Copayment. A copayment is a specific dollar amount or a percentage of the cost of care that must be paid by the member. For example, the member may be required to pay $5 or $10 for each office visist. Copayments in the aggregate may not exceed 200% of the annual premium.

The provision is a health insurance policy that ensures that the insurer cannot refer to any document that is not contained in the contract is the

Entire contract clause.

Once a producer has met the requirements to sell long-term care insurance, how often must the producer complete the 4 hours of ongoing training courses?

Every 24 months. Every agent who sells, solicits or negotiates long-term care insurance in Washington must be licensed as an insurance producer of life disability and complete a one-time training course and then ongoing training every 24 months.

In regards to the coverage of maternity services, health carriers must allow decisions regarding the length of inpatient stay be determined by

Health carriers that cover maternity services must allow the attending provider, in consultation with the mother, to make decisions regarding the length of inpatient stay. Decisions regarding the length of inpatient stay should not be made through contracts between providers, hospitals, and insurers.

A producer is selling a client a Variable Life Insurance Policy and as an inducement shows the client a protection based upon shares or dividends paid on a similar policy. This is

Misrepresentation. This is a misrepresentation and a violation of insurance regulations defined by the Insurance Code.

Mandatory provisions required by Washington State Law for health insurance policies

Physical examination and autopsy, misstatement of age, and legal actions are all mandatory provisions required by Washington State Law.

Within how many days from a pretrail hearing must insurance producers report to the Commissioner any criminal prosecutions brought against them?

Producers must report any criminal prosecutions brought against them to the commissioner within no more than 30 days.

Issuers of disability insurance policies that provide hospital or medical expense coverage on an expense-incurred or indemnity basis to persons eligible for Medicare must do which of the following?

Provide to all applicants the pamphlet "Guide to Health Insurance for People with Medicare"

All of the following are considered prohibited practices for producers and insurers issuing Medicare supplement policies EXCEPT

Receiving commisions. Commissions for the sale of Medicare supplement insurance policies are allowed, as long as they are at an identical percentage of the premium paid for each year the policy remains in force.

The Commissioner of Insurance does not have the authority to

Set rates. The commissioner has the authority and the duty to review and approve or ddisapprove any policy forms or rates. The Commissioner, however, does not set rates; those are established by law.

When an agent is soliciting a policy through an insurer, who's responsibility is it to determine that the insurer is authorized to transact business in this state?

The agent's. Any solicitor agent, agent, or broker who solicits, negotiates, or procures an application for insurance in this state must make a good faither effort to determine whether the entity that is issuing the coverage is authorized to transact insurance in this state.

In regards to the coverage of maternity services, health carriers must allow decisions regarding the length of inpatient stay be determined by

The mother and the attending provider. Health carriers that cover maternity services must allow the attending provider, in consultation with the mother, to make decisions regarding the length of inpatient stay. Decisions regarding the length of inpatient stay should not be made through contracts between providers, hospitals and insurers.