Laws and rules pertinent t insurance

non-admitted insurer

- An insurance company that has been denied or not yet applied for a Certificate of Authority and may not sell insurance in this state. - Also called an unauthorized insurance company - A non-admitted insurer is not afforded protection by the guaranty fund - An unauthorized insurer can place business in Ohio through surplus lines agents

inducement

- No life insurance company or agent shall pay or offer special favor to a customer as an inducement to purchase insurance. This would be considered a rebate of premium payable and is an illegal inducement in the State of Ohio.

Ohio Continuation rules

- Under Ohio continuation rules, an employer with fewer than 20 employees must allow terminated employees to continue accident and health coverage for at least 12 months - A group health insurance policy must be continued for an employee or member at least 6 months after the insurance has been cancelled for any reason other than nonpayment.

buyer's guide

- a buyer's guide provides basic information about an insured policy - this document explains how a buyer should go about choosing the amount and type of insurance to buy and how a buyer can save money by comparing the cost of similar policies - the insurer must provide a buyer's guide along with a policy summary to any possible client before accepting the applicant's initial premium or upon the clients request.

21. Ohio Insurance superintendent is appointed to office and has all of the following powers and duties

- authority to conduct hearings - responsibilities to adopt reasonable rules and regulations - jurisdiction over complaints against anyone engaged in the insurance business in Ohio

17. quiz - a licensee is suspended for non-renewal, the licensee may apply for reinstatement with

12 month period following the date when the license should have been renewed

7. quiz - under Ohio continuation rules, an employer with fewer than 20 employees must allow terminated employees to continue accident and health coverage for at least

12 months

an employer may qualify for health care tax credits through SHOP marketplace if that employer has fewer than

25 employees

16. quiz - a licensee who is required to take continuing education must include how many hours of ethics coursework

3 hours

15. quiz - In Ohio, legal action can be taken against an insurer for failure to pay Health insurance claims for a period not to exceed

3 years

how long must a life insurance policy e in effect before the policyowner may use the nonforteiture provision

3 years

superintendent is required to examine domestic insurers every

3 years

18. quiz - after the date of marriage an insurer is required to provide what minimum period of time for an employee to add a new spouse to a small group health plan.

30 days

5. quiz - felony convictions must be reported to the superintendent within

30 days

12. quiz - as of January 1, 2014 an employer with up to 25 full time equivalent (FTE) with an average annual wage of less than $50,000 may be eligible for a tax credit of

50% of the premium paid by the employer

2. quiz - how long can an insurer exclude coverage for a pre-existing condition on a Medicare SUPPLEMENT Policy

6 months

22. quiz - an insured must submit a prof of loss on a health insurance claim within how many days after the date of loss

90 days

continuing education

Agents must complete 24 hours of continuing education per line of authority every 2 years (by the last day of the licensee's birth month) in order to renew their licenses 3 of these hours must cover agent ethics. Cheating or falsifying CE continuing education completion in any way is a violation of insurance laws and is grounds for refusal to renew a license. An agent may surrender his or her license at any time this will cause all appointment with insurer to be void.

guaranteed issue

All applications for long-term care insurance policies except those that are guaranteed issue shall contain clear and unambiguous questions designed to determine the health condition of the applicant.

Cancellation of an appointment

All appointments held by an agent become void when the agent's license is: - surrendered, - revoked, - suspended, - canceled, or - inactivated by request. Otherwise, the insurer is responsible for an agent's termination of appointment to the superintendent.

Nonresident agents

An agent who holds a resident license in a different state may apply for a nonresident license in Ohio, as long as both states have a reciprocal agreement to apply, nonresidents must: -submit an application form, -proof of resident license in good standing, and -fees.

inflation protection

Inflation protection must be included in all long-term policies delivered in Ohio UNLESS the policyholder rejects the coverage in writing.

license renewal

Licenses are renewable biennially (every two years) with a $25 fee, renewal application, and proof of completing continuing education (CE) on or before the last day of the agent's birth month. A lapsed license may be reinstated within 12 months of the renewal date - late license renewal may be applied for as late as the last day of the second month following the license renewal date

claims

No legal action can be initiated within 60 days after proof of loss has been submitted to the insurance company. In addition no legal action can be initiated after 3 years from the initial time written proof of loss has been provided.

outline of coverage

The document that describes: - policy features, - benefits, - exclusions, - and riders

unfair claims practices

The following acts, omissions, or practices are defined as unfair and deceptive claim settlement practices when knowingly committed or performed with such frequency as to indicate a general business practice and are prohibited: - Misrepresenting to insured pertinent facts or policy provisions relating to coverage at issue - Failing to acknowledge and act reasonably promptly upon communications with respect to an insurance claim - Failing to adopt and implement reasonable standards for prompt investigation and processing of insured's claim - Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements are completed and submitted by insureds - Not attempting in good faith to effect prompt, fair, and equitable settlements of claims for which liability has become reasonably clear; refusing or delaying a settlement solely because there is other insurance available to partially or entirely satisfy the claim loss; the claimant who has a right to recover from more than one insurer has the right to choose the coverage from which to recover and the order in which payment is to be made - Compelling insureds to initiate lawsuits to recover amounts due under an insurance policy by offering substantially less than the amount ultimately recovered in those suits.

cease and desist order

The superintendent of insurance may issue a cease-and-desist order to any agent found to have committed an unfair or deceptive act or has broken an insurance law. - The notice will specify the cause, and will provide a date within 15 days of the order, for which the agent must attend a hearing - A cease and desist order issued against an agent prohibits a specific practice listed in the order - The superintendent will consider the agent's statements made during the hearing in order to issue a final order, either confirming or revoking the cease-and-desist order. The final order must be issued within 15 days of the hearing date.

10. a characteristic of a non-admitted insurer

a non-admitted insurer is not afforded protection by the guaranty fund

19. under a long-term care insurance, which of the following must an insurer offer to each policyowner at the time of purchase

an inflation protection feature

3. in Ohio, when an advertisement for accident and health insurance refers to dollar amount benefits, the advertisement must also disclose

any applicable benefit reduction

the superintendent is not responsible for

endorsing insurers

8. quiz - the following act by an insurer, if committed without just cause and performed with such frequency as to indicate standard operation procedures constitutes an unfair claims settlement practice

failing to adopt and implement reasonable standards for the prompt investigation of claims

4. quiz - under SMALL GROUP HEALTH benefit plans a carrier may discontinue coverage or may refuse to renew such a plan if the employer

fails to pay the premium prior to the end of the grace period

6. each application for long-term care insurance shall contain clear and unambiguous questions to determine the health condition of the applicant EXCEPT an application for

guaranteed issue

1. quiz - an insurer must offer a long-term care policy or certificate that

has a nonforfeiture value

14. quiz - when an insurance appointment with an agent is terminated the party that must notify the agent of the termination is the

insurer

9. quiz - when an insurer, agent, broker, solicitor or person , in connection with an insurance transaction offers or promises to buy sell or give or allow the prospective insured employment, stock or special favors

it is called inducement

commissions may be shared by

licensed agent and appointed agent - An appointed agent may pay a lawful referral commission to another licensed agent not appointed with that insurer.

23. quiz - licensed agent who lives in another state and transacts insurance in Ohio is called a nonresident agent

nonresident agent

13. quiz - the document that describes policy features, benefits, exclusions and riders in a long-term care policy is known as the

outline of coverage

all health benefit plans issued after January 1, 2014 must provide

preventive health services

11. quiz - a cease and desist order issued by the superintendent against an agent

prohibits a specific practice listed in the order

this one is meant trick - all of the following may be an unfair claims practice except

refusing to pay a person bringing false or fraudulent claims

20. free-look

the insured has 10 days

when a license is suspended or revoked because the licensee is found to be in violation of a state law

the licensee may be assessed the administrative costs incurred by the department

nonforfeiture value -

those benefits in a life insurance policy that by law, the policy owner does not forfeit even if the policy owner discontinues premium payments: - usually cash value, - loan value, - paid-up insurance value, - and extended term insurance value

what is the purpose of the Ohio life and health insurance guaranty association act

to protect the insured form company insolvency