X-Cel, Accident and Health Insurance, Chapter 11 - Laws and Rules Pertinent to Insurance

A consultant obtains their income from which source

Clients

Beginning January 1, 2014, The restricted Annual Limit for plans under the Affordable Care act will be

No Limit

Which of these is NOT a standard provision in qualified long-term care policies sold in Connecticut?

Prior Hospitalization

According to federal fraud and false statements regulation, what is required for a prohibited person to transact insurance business in this state?

Written consent from the state insurance regulatory agency

Which of the following is considered to be a prohibited business practice

Failing to submit premiums to an insurer

After conducting a hearing, the Commissioner is empowered to issue a cease and desist order. A Violation of such an order is punishable by a monetary fine not to exceed

$50,000

To be classified as a small employer in Connecticut, an employer must employ how many employees?

1 to 50

In Connecticut, a producer cannot use his/her license for primarily writing controlled business. In order to conform to this requirement, annual premiums collected on controlled business cannot exceed _______ of total premiums.

10%

A producer must secure an appointment with an insurer

Before soliciting applications for that insurer

A Producer that makes an agreement that unreasonably restrains the business of insurance may have violated regulations against:

Boycott, coercion, and intimidation

A producer recently replaced an existing Medicare Supplement policy with a new policy. The producer's compensation for the new policy

CANNOT exceed the renewal commission of the original policy

According to the Affordable Care Act, new Health Insurance Marketplaces are established by the

CCIIO (Center for Consumer Information and Insurance Oversight)

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

Closed panel of Dentists can only be used

Which term refers to insurance written on the interests of the licensee, the licensee's employer, or the licensee's immediate family?

Controlled Business

All of these are used to prevent adverse selection in a group dental plan EXCEPT

Decreased Employee Participation (Maximum participation required. Waiting and Probationary Periods, and providing evidence of insurability are used).

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

Foreign

How can a group Dental Insurer discourage adverse selection

Limit the Duration of coverage

The Commissioner is empowered to perform each of the following acts EXCEPT

Make rules that are consistent with neighboring states

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

Making False entities in a company's books

Under Federal Law, which of the following actions may result in a producer becoming imprisoned?

Producer embezzling funds from an insurer

What is considered Interstate Travel under the Federal Fraud and False Statements Act?

Puerto Rico

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

Rebating part of a commission to the applicant

Which of the following facilitates nonresident licensing in the state of CT

Reciprocity Agreement

Why does Connecticut Require Insurers to maintain a minimum level of Assets

To demonstrate Insurer Solvency

All of the following are typically covered under Dental Insurance Except

Treatment which began before the eligibility date. (Fluoride Treatment, teeth cleanings, and x-rays are all covered under Dental Insurance)

A Prepaid Dental plan has an agreement in place with a network of dentists which

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

Making a statement that is false of maliciously critical of the financial condition of an insurer is known as

defamation

In Connecticut, Human Immunodeficiency virus (HIV) consent form

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

In Connecticut, a temporary license may be issued for a period not to exceed

180 days

An Administrative Action taken against a producer MUST be reported to the Commissioner within ___ days after the final disposition.

30 days

How many days notice does the Affordable Care Act (ACA) require insurers to give before rescinding coverage

30 days

Producers Licensed in Connecticut must notify the Insurance Department within ___ days of any change of name or address

30 days

A Producer is holding a meeting with a potential client about replacing an existing group health insurance policy. The topic that should be included in that conversation is

A comparison of benefits between the current and proposed plans

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

Alien

Misrepresenting Pertinent Policy Provisions relating to coverage after a loss is

An Unfair claims settlement Practice

A television advertisement features a health insurance product that is endorsed by a specific group. In this advertisement

Any control by the insurer over this group must be disclosed

To receive an Insurance License an applicant must

Apply for the license after passing the appropriate examination

When does a family's health policy's coverage for a newborn child begin?

At the moment of birth

A temporary license may be issued to which of the following?

Employee of a disabled producer

Which of the following would be considered a violation of Connecticut Insurance Law?

Failure to reemit premiums in a timely manner

According to the Affordable Care ACT (ACA), coverage may be rescinded

If Intentionally false statements were offered

When an insurer markets its medicare supplement products in Connecticut, which method is acceptable?

Replacing an existing policy with one that has greater benefits

In the process of obtaining Insurance, a statement made by the applicant that becomes part of the contract is considered to be a

Representation

An insurer may NOT refuse the renewal of a small employer health insurance plan because of

overuse of medical services

Licensed Producers in Connecticut are authorized to

solicit, receive, and forward applications to the insurer

All of these are common limiting factors with Dental Insurance EXCEPT

Limit placed on number of teeth that may be treated annually (limits on cosmetic related procedures, number of x-rays per year, and the number of annual teeth cleanings are all common factors)

Misrepresentation on the application is

Material

A Group Health Plan covers employees in Connecticut, Massachusetts, and Rhode Island. The State Regulatory Jurisdiction established for this plan does NOT affect which plan aspect?

COBRA continuation of coverage

In Connecticut, Continuing education courses must be approved by the

Commissioner

In Connecticut, continuing education courses must be approved by the

Commissioner

Which of these is NOT considered a federal punishment for unfair and deceptive insurance practices

Community Service (Prison, monetary fees, and revocation of license are punishments)

When evaluating an insurer's financial status, the Commissioner may consider each of the following EXCEPT

Comparing an insurer's agency agreements to determine maximum-paid commissions

A producer MUST notify the Commissioner for

Conducting business under an assumed name

A(n) ________ is a licensee who charges a fee for contracted insurance advisory services

Consultant

In Regards to the Affordable Care Act (ACA), which of these is NOT a role of a health insurance exchange?

Contact the employer if an employee stops coverage under a plan offered in the exchange

False Advertising of an Insurance Policy is considered

Misrepresentation

Health Providers are compensated by a Preferred Provider Organization (PPO) for normal dental procedures by what means?

Decreased Fee Schedules

An example of an Unfair Claims Settlement practice is

Failing to promptly investigate and settle legitimate claims

Which of the following is NOT classified as an "employee" under a group employer insurance plan?

Independent Contractors

Which of the following causes of disability is NOT covered under Connecticut workers compensation laws?

Intentional, self-inflicted injuries that occur at the worksite

All of the following are covered under most Dental plans except

Mouth Cancer. (Tooth extraction, cleaning, and X-rays are covered).

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

To create a one stop market for standardized health insurance plans

When an individual buys insurance under a threat made by a producer, a violation has occurred under the

Unfair Trace Practice Act (for boycott, coercion, and intimidation_)

Mentally or Physically Handicapped dependent Children MUST be covered under an individual health insurance policy

Until they become self-supporting

How many days of notice does the Affordable Care Act require insurers to give before rescinding coverage?

30 days

An Insured has been ordered by the Court to provide a child's health insurance. Upon this order, the insurer must allow the enrollment of this child

At any time

A Consumer who has been recently denied insurance, credit, or employment based on an unfavorable consumer report MUST be advised as such. Which of the following does this statute originate from?

Fair Credit Reporting Act

Which of these is NOT considered a preventative service in a dental plan?

Fillings (A Restorative Service. Oral Examinations, teeth cleaning, and fluoride treatments are preventative services).

Under the Pregnancy Discrimination Act of 1978, employers MUST treat pregnancy

In the same manner as any other covered disability

Which of these situations would NOT potentially involve a prison sentence under federal law?

Selling insurance with a nonresident license

Long term care policies sold in Connecticut may NOT EXCLUDE coverage for

Senile Dementia

A Producer's failure to provide title and true nature of a policy upon solicitation is an example of

Solicitation

A Group health certificate for coverage issued in Connecticut MUST contain a(n)

Summary of policy features and benefits

Which of the following is NOT a valid cause for termination of an employee's group health coverage?

The Coinsurance limit has been exceeded (Master policy termination, employment termination, and no monetary contributions made by employee are all valid reasons).

To secure Authority for soliciting insurance products in the state of Connecticut, an insurance company must secure a Certificate of Authority from

The Connecticut Insurance Commissioner

Which of the following is the BEST candidate for a temporary Insurance License?

The Executor of the estate of a deceased license producer

Who is responsible for reporting to the Commissioner any name or address change of the licensee?

The Licensee

If one producer provides a referral to another producer which results in the sale of an insurance contract, Who will likely be paid a commission?

The commission will likely be shared between the two producers

The Affordable Care Act established "Exchanges" in order to

assist individuals and small businesses when making their health insurance premiums

Medical costs in birthing centers are lowered by using

certified nurse midwives