Chap 8 - Health - Laws & Rules - PART 1

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Starting in 2016, businesses with up to ___ employees will be defined by the ACA as a "small business".

100

A life insurance policy that is paid annually must contain a grace period of at least ___ days.

30

how many days notice does the affordable care act require insurers to give before rescinding coverage?

30

Which of the following actions is considered to be an unfair trade practice?

A producer who sells insurance to an individual by means of threat

What is the best way to define life insurance replacement?

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

Which of the following individuals is eligible to receive a temporary producer license?

An appointed employee who is replacing a deceased producer

Which of these individuals may NOT obtain a temporary producer license?

An employee of a retired licensed producer

Prepaid dental plans differ from most other types of Dental plans in what way?

Closed panel of Dentists can only be used

Under which circumstance may an Insurer discontinue a small employer group medical plan?

Insurer discontinues offering the plan to all employers

According to the Affordable Care Act (ACA), the proportion of premium revenues spent on clinical services & quality improvements is called the

Medical loss ratio

Who is required to notify the Director of a licensee's change of address?

Licensee

All of these are common limiting factors with dental insurance EXCEPT for

Limit placed on how many teeth can be treated annually

According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation?

Making false entries in a company's books

Which of the following actions may result in a producer's license being suspended?

Misappropriation of premiums

Which of these actions is considered to be an Unfair Claims Settlement Practice?

Misrepresentation pertinent policy provisions relating to coverage after a loss

All of the following are covered under most Dental Plans EXCEPT for

Mouth cancer

Which of the following is covered by a basic dental indemnity plan?

Non-surgical periodontal treatment

Most prepaid dental plans cover

Oral examinations

A life insurance producer is required to give a disclosure notice about information practices to an applicant or proposed insured

Prior to or at the time of signing the application

Replacement Regulations exist in order to

Protect policy owners from misrepresentations and loss of benefits

The ACA (affordable Care act) must ensure a sufficient choice of ________ in the marketplace:

Providers

What is considered interstate travel under the federal fraud and false statements act?

Puerto Rico

Which entity is responsible for regulating claims settlement practice of insures?

State insurance departments

Why were Exchanges implemented by the Affordable Care Act (ACA)?

To create a one-stop market for standardized health insurance plans

Charging different premiums for policyholders under the same risk classification

Unfair discrimination

If a producer replaces a client's existing life insurance policy with a new one, which of these actions is advisable?

Wait until the new policy is issued and delivered before surrendering existing policy

A statement MUST be signed by the ______ for any illustrations used in the sale of a life insurance policy.

producer

A prepaid dental plan has an agreement in place with a network of dentists which

accepts an established amount as payment in full for the dental services rendered

A(n) ________ insurer operates in the United States but is headquartered outside the United States

alien

Life Settlement Brokers are NOT allowed to

complete transactions prior to being approved for a license

AN insurer wishing to conduct business in Arizona MUST obtain a

compliance of authority

An annuity contract may be returned for a full refund during the

free look period

When is it acceptable to charge or receive a fee or service charge in addition to the premium in connection with the transaction of insurance?

if the amount of the fee or service charge is reasonably related to the cost of the service

In Arizona, false advertising is an example of

misrepresentation

In Arizona, the Human Immunodeficiency Virus (HIV) consent form

must disclose who will be receiving a copy of the test results

Autopsies may be requested by an accident and health insurer

only if not prohibited by state law

An example of rebating would be

splitting the commission with the buyer on a sale of insurance

The Arizona Life & Disability Insurance Guaranty Fund protects an insured in the event of

the insurer's insolvency

How long must a producer maintain customer records for an insurance transaction?

three years

A life insurance policy can usually be contested by the insurer only during the first ___ years of the contract

two

A life insurance policy may only be contested by the insurer during the first ______ years of the contract.

two

Mentally or physically handicapped dependent children MUST be covered under an individual health insurance policy

until they become self-supportive

Jerry has an indemnity plan which covers dental expenses. Typically, these type of plans

Cover preventative care once every six months.

Life Settlement Proceeds may be subject to the claims of

Creditors

Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means?

Decreased Fee Schedules

A client applies for an individual accident and health policy in Arizona. If the insurer collects personal information from any source other than public records or the applicant, a notice of application practices MUST be given to the applicant no later than the

application date

A trade association group is seeking coverage for group medical benefits. The members of this association

are probably in the same industry

An insured has been court-ordered to provide a child's health insurance. Upon this order, the insurer must allow the enrollment of this child

at any time

Notice of information practices must be given to a policyholder

at least once a year

If a Medicare Supplement policy is cancelled by the insurer, which of these circumstances does NOT require prior approval by the Arizona Department of Insurance?

nonpayment of premium

A health insurance claim may be contested due to statements made on the applications for up to ____ year(s) after issuance of the policy.

2

After a life insurance policy sold in Arizona has been in force for ___ year(s), it becomes incontestable.

2

An insurer markets its products by soliciting customers by mass media advertising and mail WITHOUT using the services of a producer. Which of these marketing systems does the insurer utilize?

Direct response

A producer is meeting with a client to determine whether an annuity would be suitable for purchase. Which of the following topics needs to be discussed with this client?

Financial status of the client

A(n) ________ insurer writes business in a state other than the one in which it is domiciled

Foreign

Which of the following is NOT a valid reason for an insurer to contest a life insurance policy during the policy's first two years of existence?

Misstatement of age

What is a life insurance producer authorized to do?

Solicit, receive, and Forward applications to the insurer

Which of the following is NOT a valid reason for an insurer to refuse renewal of an individual accident and health insurance policy?

The insured is currently in poor health

Greg had recently been terminated from his job that covered him for group life insurance. How long does he have to convert his coverage to an individual policy?

31 days

A policy owner decides to surrender the cash value of a whole life insurance policy. The insurer has up to ___ months to delay this payment

6

A policyowner decides to surrender the cash value of a whole life insurance policy. The insurer has up to ____ month(s) to delay this payment

6

In Arizona, Life insurance policy loans may charge a maximum fixed rate of

8%

According to the Telemarketing Sales Rule, what is the earliest time of the day that telemarketing calls may be received?

8:00 AM

The telemarketing Sales rule states that ______ is the latest time of the day that telemarketing calls may be received.

9:00 PM

The telemarketing sales rule states that ______ is the LATEST time of day that telemarketing calls may be received.

9:00 PM

According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age?

Age 26

The affordable care act established "exchanges" in order to

Assist individuals and small businesses when making their health insurance purchases.

Who manages the premium collected from a group's members for a reciprocal insurer?

Attorney in fact

Long-term care policies sold in Arizona may offer coverage in which

Benefits are based on an individual's ability to perform activities of daily living.

Which of the following actions may result in a producer's license being suspended?

Rebating a portion of the commission to the insured

What is the primary reason for the Director's examination of a producer's insurance records?

To determine compliance with state insurance laws and regulations

Insurance crimes which affect interstate commerce are prosecuted by the

US attorney general

The refusal of doing business with an individual or business is called a(n)

boycott

If dividend option choices are offered on a whole life insurance policy, the policy MUST

contain a statement that dividends are NOT guaranteed

Group life plans sold in ARIZONA typically contain a conversion option. If the insured elects this option, the new policy

does NOT require evidence of insurability

while processing a life insurance claim, the insurer discovers that the insured's age was misstated on the application . under these circumstances, the insurer is entitle to

pay proceeds based on what the premiums would have been if purchased at the insured actual age

In most dental plans a deductible typically is not applied to

preventative and diagnostic services

At what point must a producer give notification to the director about using an assumed name?

prior to using the assumed name

A group Medicare Supplement policy was terminated and not replaced by the insurer. In this situation, the insurer MUST

provide an offer of conversion to individual coverage

Insurance agent Kelly offers insured a $500 shopping card if they purchase an insurance product through her. What is this an example of?

rebating


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