Chapter Exam - Laws and Rules (Health + Accident)
who issues Medicare Supplement policies?
a) insurance companies
a producer must have _____ hours(s) of ethics per continuing education reporting period.
d) 3
t is a producer, and when hired, is reminded that he has a responsibility to handle client's funds in an honest and ethical manner. this responsibility is referred as
a) fiduciary responsibility
in arkansas, inflation protection must be offered to applicants for a(n)
a) long-term care policy
which requirement must be met by a group that seeks group health coverage for its members?
a) must have been formed for a purpose other than obtaining insurance
an example of rebating would be
a) returning a portion of a premium as inducement to purchase insurance
which of the following is not considered rebating? a) sharing commission with a producer licensed in the same line of business b) returning premium to a client as an inducement for purchasing a policy c) giving something of value to an insured in exchange for their business d) offering special dividends
a) sharing commission with a producer licensed in the same line of business
why would the commissioner examine the records of an insurance company?
a) to determine the solvency of the company
the contestable period for a health insurance policy remains in effect for a MAXIMUM period of:
a) two years
if a person is convicted of a crime stemming from a hearing, a fine up to $____ per violation may be imposed.
b) $1,000
chemical dependency treatment under a group health policy MUST include (over the life of the contract) a minimum of
b) $12,000
in arkansas, monthly-premium health insurance policies must provide a grace period of at least
b) 10 days
what is the MINIMUM benefit period that must be offered by a long-term care policy?
b) 12 months
a producer must notify the commissioner within _____ days of an address change.
b) 30
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?
b) 30 days
when a health policy requires payment of an additional premium to provide coverage for a newborn, how many days after the birth is the first payment due?
b) 30 days
medicare supplement insurance is a guaranteed issue if the policy effective date is within ____ months of the insured's medicare part b starting date.
b) 6
if a health insurance claim is not promptly paid, legal action may be taken against the insurer after:
b) 60 days from the date proof of loss is furnished
a proof of loss is required to be submitted to the insurer within ____ days after the date of loss.
b) 90
which of the following is considered to be misrepresentation? a) replacing an existing policy with a new one b) a producer guaranteeing a policy's dividends c) sharing commissions with other licensed producers d) representing a foreign insurer
b) a producer guaranteeing a policy's dividends
what does a medicare supplement policy cover?
b) allowable amounts under medicare part b
an example of false advertising would be
b) an insurer exaggerating its dividends in a magazine advertisement
an insurer may pay commissions directly to any person for services as a producer provided the producer is licensed and _____.
b) appointed
all insurers must be members of what organization, as a condition of their authority to transact insurance in arkansas
b) arkansas life and disability insurance guaranty association
when is a Group Health policy required to provide coverage for a newborn child?
b) at the moment of birth
what are the levels of coverage as defined by the affordable care act?
b) bronze, silver, gold, and platinum
one definition of replacement is "the act of replacing an existing insurance policy with another". replacement is
b) closely regulated and requires full disclosure
to protect information systems, producers, brokers, and insurance companies must implement and maintain a(n):
b) cybersecurity policy
making a statement that is false or maliciously critical of the financial condition of an insurer is known as:
b) defamation
an example of an unfair claims practice would be
b) failing to effectuate prompt, fair, and equitable settlement of a claim
which of the following constitutes grounds for suspending an arkansas producer's license?
b) felony conviction
a hearing must be held before a producer's license can be suspended or revoked. prior to the hearing, the commissioner of insurance is required to
b) give written notice to the producer
a foreign insurance company doing business in arkansas
b) is a company that was formed under thr laws of another state
a medicare supplement policy can be cancelled by the insurer for
b) nonpayment
p's individual health policy is now in the grace period. p's coverage will remain in force if
b) p pays the premium
in arkansas, anyone who lies under oath during a hearing is guilty of
b) perjury
an insurance producer agrees to pay the first monthly premium for an insurance applicant. this is called a(n):
b) rebate
before holding a hearing regarding a producer's unfair or deceptive practice, the commissioner of Insurance MUST give how many days notice? a) 10 b) 20 c) 30 d) 40
a) 10
a policy that provides coverage for a dependant child of an employee or other member of the covered group MUST provide coverage up to a limiting age of
a) 26 years old
a sickness may have a probationary period of up to ____ in arkansas.
a) 30 days
How long can an insurer exclude coverage for preexisting condition on a Medicare Supplement Policy? a) 6 months b) 12 months c) 18 months d) 24 months
a) 6 months
how long can an insurer excluse coverage for a preexisting condition on a medicare supplement policy?
a) 6 months
the MAXIMUM time period that pre-existing conditions can be excluded in long-term care policies is
a) 6 months
which of the following is not covered under long-term care insurance in arkansas? a) alcohol and drug addiction b) organic brain disease c) alzheimer's disease d) AIDS
a) alcohol and drug addiction
if an agent has a combined agent/broker license, and recommends a particular insurer to a customer in which he/she is not appointed, in what capacity is the agent acting?
a) as a broker
according to arkansas law, when must a producer deliver the outline of coverage to a medicare supplement applicant?
a) at the time of application.
failing to promptly provide a reasonable explanation for the denial of a claim is considered to be a(n)
a) fiduciary act
michael the insurance producer acts in a fiduciary capacity when conducting business with all of these principals EXCEPT a) insurance companies b) the commissioner c) insureds d) applicants for insurance
b) the commissioner
which circumstance REQUIRES the pre-existing condition clause in a long-term care policy be waived?
b) the new policy replaces existing coverage with the same insurer
as of January 1, 2014, small group health insurance can be rated on the basis of:
b) tobacco use
an accident & health policy may NOT be contested by the insurance company after the policy has been in force for a minimum of ?
b) two years
when an insurance company consistently fails to provide reasonable explanation for the denial of a claim, this is called a(n):
b) unfair claim settlement
an insurance producer must notify the commissioner of a change in legal name, email, or address:
b) within 30 days of the change
once a policy has been reinstated, the insured MUST wait what amount of time before coverage for sickness is covered?
c) 10 days
a person must be at least ____ years of age to enter into an insurance agreement in the state of arkansas.
c) 18
the MAXIMUM time period that an eligible employee can be excluded from coverage under a group health policy as a late enrollee is:
c) 18 months
a licensed life and health insurance producer must complete ____ hours of continuing education every 2 years.
c) 24
in arkansas, an insurance company must notify the commissioner within ____ days to terminate a producer's appointment.
c) 30
an hmo must notify its subscribers of any change within ____
c) 30 days
any person who knows or suspects than an insurance transaction or life settlement may be fraudulent has a duty to report it to the commissioner within:
c) 30 days
how many days is the free-look period for medicare supplements and long-term care insurance?
c) 30 days
the commissioner must examine the financial affairs of each admitted insurer operating in arkansas at least once every how many years?
c) 5
the waiting period for a pre-existing condition under a medicare supplement policy may NOT go beyond
c) 6 months
in arkansas, 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:
c) 63 days
when does a nondisabled individual first qualify for a medicare supplement policy?
c) age 65
an insurance company formed in a country other than the united states is called a(n) _____ company.
c) alien
which of the following is a requirement to attain a nonresident producer license?
c) be licensed as a producer in the producer's state of domicile
when the insured gives birth, coverage for eligible newly born children consists of coverage for injury or sickness including: a) delivery expenses b) mother's lost wages c) birth abnormalities d) mother's hospitalization
c) birth abnormalities
which of the following statements is NOT true regarding health coverage for a newborn? a) coverage includes congential defects b) coverage does not require a physical exam c) coverage is limited to only congential defects d) coverage begins at moment of birth
c) coverage is limited to only congential defects
fraternal benefit society has each of the following characteristics EXCEPT: a) incorporated b) without capital stock c) exist for profit d) exist for the benefit of its membe
c) exist for profit
which unfair trade practice involves a producer suggesting that an insurance policy is like a share of stock?
c) misrepresentation
an example of rebating would be
c) offering a client something of value not stated in the contract in exchange for their business
The document that describes policy features, benefits, exclusions and riders in a Long-Term Care policy is known as the: a) shopper's guide b) buyer's guide c) outline of coverage d) MIB Report
c) outline of coverage
cost disclosure information is required to appear in bold print on the cover page of each long-term care policy's
c) outline of coverage
what is the purpose of the arkansas life and health insurance guaranty association?
c) protects policyowners against insolvent insurance companies
a producer who shares commissions with a client may be guilty of:
c) rebating
a producer selling medicare supplement policies must provide every applicant with a(n)
c) suitability form
what is a certificate of authority?
c) the license required for an insurer to conduct business in the state
an insurer may pay a commission in which of the following scenarios?
c) to a licensed producer who is appointed with the insurer
a person insured under a health policy is required to give the insurance company a Notice of Claim within how many days after a covered loss?
c) twenty
j is a producer who has induced an insured through misrepresentation to surrender an existing insurance policy. what is j guilty of?
c) twisting
which of the folloing is NOT a reason for a commissioner to deny or refuse a producer license application?
c) unintentionally misrepresented a material fact on the application
a long term care policyholder has ____ days to return the policy after policy deliver and receive a full premium refund.
d) 30
to qualify as a small employer, an employer must employ no more than:
d) 50 eligible employees
an insured may continue coverage under a group plan during their total disability if the premiums are paid for how long?
d) 6 months
written proof os loss must be furnished to the health insurer within how many days after the date of loss?
d) 90 days
exclusions to continued coverage include:
d) all of the above
an insurer is best described as
d) any person, corporation, or society that writes insurance contracts
which of the following permits an insurance company to transact business in arkansas?
d) certificate of Authority
any person who knowingly sells, solicits, or negotiates insurance products with a person or entity that is not licensed in Arkansas is guilty of:
d) class d felony
in arkansas, which of the following is considered an unfair trade practice? a) aleatory b) replacement c) subrogation d) coercion
d) coercion
which license is REQUIRED in order to solicit long term care insurance in the state of arkansas?
d) health insurance producer license
the arkansas insurance department may take each of the following actions EXCEPT: a) issue cease and desist order b) impose fines c) revoke licenses d) incarceration
d) incarceration
under arkanas law, which of the following provisions is NOT required in a medicare supplement policy? a) suitability form b) guaranteed issue c) free-look period of 30 days d) limitation on pre-existing conditions for up to 12 months
d) limitation on pre-existing conditions for up to 12 months
which of the following is NOT an unfair claim settlement practice?
d) needing written documentation of claim details
which is the best way to describe controlled business?
d) policies written on people that a producer has influences over
a person who places insurance on behalf of anyone seeking insurance is required to be licensed as a(n)
d) producer
The branch of dentistry which deals with the replacement of missing parts is called a) endodontics b) periodontics c) orthodontics d) prosthodontics
d) prosthodontics
an example of an unfair claims settlement practice is
d) turning down a claim without providing the basis of denial
