XCEL REVIEW LAWS AND RULES
An accident and health Major Medical plan would provide coverage for -injury sustained in an undeclared war -intentional self-inflicted injury -cosmetic surgery -accidental overdose of a prescription drug
accidental overdose of a prescription drug
Health insurance advertisements that mention statistical information are required by Pennsylvania law to
accurately convey all pertinent facts
Holding premium funds for timely submission to the insurer is an example of
acting in a fiduciary capacity
For Pennsylvania Insurance Code violations, the Commissioner may assess a(n)
administrative penalty
Group dental plans will frequently place a limit on annual benefits in order to minimize
adverse selection
If the Insurance Department determines that the issuance of a temporary producer license serves in the publics beat interest, the license may be issued to
an executer of a deceased producers estate
Which of these may NOT be used in a health insurance advertisement -celebrity endorsement -a statement that highlights coverage amounts -a paid testimonial -an insurance company's trademark instead of the company's actual name
an insurance company's trademark instead of the company's actual name
Which of the following is included in the entire contract according to the entire contract provision? -investigative report -occupational rating -clauses -application
application
A licensee may only sell, solicit, and negotiate insurance contracts on behalf of the
appointing insurer
Why is the difference between a Long-Term Partnership Plan and a Non-Partnership Plan?
asset protection
The Commissioner has the right and duty to
audit insurer financial reports and conduct market studies
An insured dies from what appears to be accidental causes. When confirming the cause of death, which of these actions by the insurer takes precedence? -autopsy -eyewitness account -police report -physician notes
autopsy
With a scheduled dental policy, how are covered expenses paid
benefits are limited to a specific maximum dollar amount per procedure
Coverage for newborns under an accident and health plan MUST include coverage for
birth abnormalities
According to Pennsylvania law, which of the following is NOT considered to be personally identifiable financial information -information obtained from an insurance application -consumer report information -account balance information -blind trust data that does not include names and addresses
blind trust data that does not include names and addresses
An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called
coinsurance
In Pennsylvania, which of the following is NOT something a licensee must do ti renew their insurance license? -confirm previous exam scores -submit proper paperwork -complete required continuing education -pay the proper fees
confirm previous exam scores
Proceeds of a viatical settlement. contract could be subject to the claims of
creditors
Which of the following does restorative dental treatment cover?
crowns
A Medicare Supplement policys outline of coverage MUST include a(n)
description of policy benefits
When soliciting insurance a producer CANNOT -illustrate dividends -emphasize Guaranty Association benefits -execute a conditional receipt upon receipt of premium deposit -disclose insurer ratings
emphasize Guaranty Association benefits
Which of the following constitutes grounds for suspending a Pennsylvania producers license? -summary action conviction -felony conviction -failure to comply with underwriting guidelines -failure to maintain insurance records for at least 10 years
felony conviction
Violations of US Code Title 18 Section 1033, may result in
fine and/or imprisonment
When collecting insurance premiums from a client, a producer MUST
forward premiums to the insurer on a timely basis
For licensing purposes, if an applicant has a home or office location in the state of Pennsylvania, this would be consistent with which of the following? -territory -delivery state -home state -non-resident requirement
home state
When an applicant for a producers license has a principal place of residence or business location in Pennsylvania l, for licensing purposes the State of Pennsylvania is know as the
home state
The Pennsylvania Department of Insurance may take each of the following actions EXCEPT -issue cease and desist order -impose fines -revoke license -incarceration
incarnation
Who issues Medicare Supplement policies?
insurance companies
In Pennsylvania, health insurance advertisements are required to contain the
insurance company's name
The identity of the ____ must be made clear in every health insurance advertisement
insurer
Violating Pennsylvania insurance law may result in which of the following Insurance Department actions? -loss of producer premium fund account -insurer appointments terminated -issuance of a cease and desist order after a hearing -minimum 3 month prison sentence
issuance of a cease and desist order after a hearing
Commissions may be shared by
licensed and appointed Producers
In Pennsylvania, completion of continuing education is required upon license renewal for which of the following? -attorney at law -full time active duty military -licensed individuals qualified in major lines of insurance -non resident producers
licensed individuals qualified in major lines if insurance
In Pennsylvania, HIPAA laws require that an individuals 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
63 days
As classified by the Affordable Care Act (ACA), a Silver Plan offers
70% actuarial level of coverage provided
Proof of loss on a health insurance claim must be submitted to an insurer within ____ days after the insureds date of loss
90 days
Health insurance policies that provide maternity benefits must provide for a minimum of ____ hours of impatient care following a C-section delivery
96 hours
Under the Affordable Care Act, how would a grandfathered health plan lose its grandfathered status?
The insurer significantly raises co-insurance charges, deductibles, or co-payment charges
In Pennsylvania, no legal action may be taken against an insurer for failure to honor a valid claim after the expiration of how many years from the time proof of loss is furnished?
Three years
In Pennsylvania, whats the requirement for a minor to receive proceeds from a death benefit?
a guardian must be appointed
Life insurance may make an immediate benefit payment before the insured dies in which transaction? -viatical settlement -accidental injury -modified endowment contract -absolute assignment
viatical settlement
Agreements made by terminally ill persons to sell their life insurance policies at a discount in order to pay medical expenses are called
viatical settlements
Pennsylvania law requires that an insurer must notify the Commissioner of a producer appointment termination
within 30 days of termination
According to the Affordable Care Act, what is the maximum amount an individual can contribute to a Flexible Savings Account?
$2,500
In Pennsylvania, a Specified disease accident and health plan mist provide a minimum benefit in the amount of
$5,000
If a Medicare Supplement policy replaces another that had been in effect for at least 6 months, the replacing policy may impose which of the following time exclusions for pre-existing conditions -0 months -63 days -6 months -12 months
0 months
An insured may return their accident and health policy within ____ days of policy delivery
10 days
Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within
10 days
If a health policy is reinstated after it had lapsed for nonpayment, there is a waiting period of ____ days before a claim covering sickness will be covered
10 days
The free look period in Pennsylvania for individual health insurance policies is ____ days
10 days
The free look period provided in a life insurance policy is usually
10 days
What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?
12 months
Once the insurance company receives a notice of claim, they have _____ days to send the claim form
15 days
A Pennsylvania temporary producer license may be issued for a period not to exceed
180 days
According to Pennsylvania law, postnatal care must be delivered within how many days of discharge?
2 days
A life insurance policy becomes incontestable after it has been in force for ____
2 years
Written notice of a health insurance claim should be given to the insurer within ___ days after the occurrence of any loss covered by the policy
20 days
Producers must complete a total of ____ Continuing Education credits for each two-year licensing period
24
In Pennsylvania, the definition of total disability changes from ones "own occupation" to "any occupation" by reason of ones education, training, and experience after what period of time?
24 months
An employer may qualify for health care tax credits through SHOP Marketplace if that employer has fewer than how many employees?
25
An Accelerated Death Benefit in Pennsylvania must be at least what percentage of the total death benefit?
25%
Which of the following is NOT an eligible dependent on an Accident and Health policy? -27 year old married child -25 year old married child -19 year old full time student -unmarried disabled child
27 year old married child
In Pennsylvania, the Time Limit on Certain Defenses provision provides that no misstatements (EXCEPT fraud) made by the applicant on a health insurance application can be used to void the policy or deny coverage after the expiration of
3 years
A licensed producer mist 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?
30 days
In a Long-Term Care policy, the right to examine period is
30 days
Within ___ days after policy delivery, both Medicare Supplement and Long-Term Care policies can be returned for a 100% premium refund
30 days
Within how many days must a producer report to the Commissioner any charges made against him/her
30 days
A newborn is required to be covered for ___ days from the moment of birth
31 days
When an insurance company consistently fails to provide reasonable explanation for the denial of a claim, this is called a(n)
unfair claim settlement
Greg has 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 (conversion period)
In Pennsylvania, accident and health plans are required to provide mammograms for women starting at age
40
Under the Pennsylvania statute, first year commission for long-term care insurance may not be greater than
50% of the first year premium
The Medicare Supplement open enrollment period is the
6 month period that begins with the month in which enrollment in Part B Medicare occurred, typically at age 65
No Long-Term Care policy may exclude pre-existing conditions for a period of more than
6 months
In accident and health plans, premiums paid less frequent than monthly require a minimum grace period of at least
31 days
In Pennsylvania an employee must request spousal coverage under a group sponsored accident and health plan within _____ days of marriage
60 days
If a health insurance is not promptly paid, legal action may be taken against the insurer after
60 days from the date proof of loss is furnished
A temporary license may be issued without state examination to all of the following EXCEPT -producers spouse -executor of producers estate -employee of the producer -a prospective producer who is currently enrolled in a pre-licensing insurance class
A prospective producer who is currently enrolled in a pre-licensing insurance class
What are the levels of coverage as defined by the Affordable Care Act?
Bronze, Silver, Gold, Platinum
A form of medical health insurance covering the treatment and care of gum disease is called
Dental expense insurance
A common exclusion or limitation on a dental policy is
Endodontics
Under the ACA, which of these plans is designed to provide coverage that is actuarially equivalent to 80% of the full actuarial value of the benefits provided under the plan?
Gold
What is the required renewability status of all Medicare supplement policies?
Guaranteed renewable
Which of the following provisions protects a Pennsylvania policyowner from an innocent mistake made on the application over 2 years ago?
Incontestability provision
When a producer offers something of value in return for the purchase of an insurance policy, which prohibited sales practice has been committed?
Inducement
An insurer is REQUIRED to offer which of the following to each long-term care applicant at the time of purchase? -lifetime level premiums -conditional renewability -inflation protection -deflation protection
Inflation protection
A Long-Term Care plan must provide which of the following options for coverage in the state of Pennsylvania
Inflation protection rider
Benefits for a Medicare Supplement policy
Must not duplicate Medicare benefits
What is the required action to be taken by a Pennsylvania licensee before operating under an assumed business name
Notify Commissioner
The branch of dentistry which deals with the replacement of missing parts if called
Prosthodontics
What is the purpose of the Pennsylvania Life and Health Insurance Guaranty Association?
Provide policyowner protection if an insurer becomes insolvent
According to the Affordable Care Act, what metal tier is required to have an actuarial value of 70% with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features
Silver Plan
Viatical settlement brokers are permitted to do all of the following EXCEPT -charge a fee for their services -advertise the availability of viatical settlement -introduce viators to settlement providers -make the first transaction up to 30 days before approved for a license
make the first transaction up to 30 days before approved for a license
According to the Affordable Care Act, any plan in existence prior to which date is considered a grandfathered plan? -march 23, 2010 -march 23, 2011 -march 23, 2012 -march 23,2013
march 23, 2010
A Medicare Supplement policy may be cancelled by an insurer for which of the following reasons -higher than expected claims -smoking -material misrepresentation -deterioration of health
material misrepresentation
During the first two years a life insurance policy is in force, the insurer may contest a policy for all of the following reasons EXCEPT -misstatement of age in application -material misrepresentation in the application -fraud in the purchase of the policy -material concealment in the purchase of a policy
misstatement of age in application
Which of the following is a violation of Pennsylvania insurance law? -failure to pay insurer appointment fees -offering insurance contracts through unlicensed entities -charging policy fees - failing to notify the commissioner of any administrative action taken against the licensee within 10 days of the final disposition of the matter
offering insurance contracts through unlicensed entities
Long-term care insurance provides
one or more diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services in a setting other than an acute care unit of a hospital
In most dental plans, a deductible typically is NOT applied to
preventative and diagnostic services
All Health Benefit Plans issued after January 1, 2014 must provide
preventative health services
The ____ is responsible for determining the appropriateness of a Medicare Supplement policy for an applicant -producer -underwriter -applicant -insurer
producer
Which if the following is a person who negotiates an insurance contract on behalf of an insurer? -negotiator -consultant -advisor -producer
producer
Who can receive insurance commission
producer
In Pennsylvania, an insurance producer license can be denied for failure to pay each of the following EXCEPT -state income tax -property tax -child support -license fee
property tax
Charging a client less premium than what is stated in their insurance policy is called
rebate
The Commissioner is responsible for all of the following EXCEPT -issue cease and desist orders -conduct hearings -regulate premium rates -recommending insurers
recommending insurers
A transaction in which a new life insurance policy is purchased and an existing life insurance policy is surrendered is called
replacement
All statements in an insurance application, in the absence of fraud l, are considered
representations
Which accident and health policy provision allows the policy owner a stated amount of time to return a newly delivered policy for a full refund of premiums if not satisfied for any reason?
right to examine
An example of endodontic treatment is a
root canal
The Pennsylvania Insurance Department is responsible for each of the following EXCEPT -insurers -producers -shareholders -approval forms
shareholders
Which of the following is the Pennsylvania Insurance Department NOT responsible for? -regulations -producers -shareholders -reinsurers
shareholders
In Pennsylvania, a producer may have their license revoked for which of the following acts -loss of insurer appointment -failing to renew license on a timely basis -sharing commissions with another licensed producer -signing a prospects name without their knowledge or presence
signing a prospects name without their knowledge or presence
In Pennsylvania, an insurer may backdate policy issue not more than how many months from the date of a life insurance application?
six months
A life insurance producer licensed in the Commonwealth of Pennsylvania is authorized to
solicit, receive, and forward applications to the insurer
Long-Term care policies sold in Pennsylvania may exclude coverage related to:
substance addictions
A licensee can have his/her license denied or revoked by the Commissioner if
the licensee has committed insurance related fraud or dishonesty
Under the Affordable Care Act, a large employer that does NOT provide health insurance and owes an employer mandate penalty MUST pay an annual penalty, which is calculated by multiplying $2,000 by
the number of full time employees minus 30
Which of the following statements about the contestability of a life insurance policy is true? -the policy cannot be contested by the insurer once it is paid for and issued -the policy can bee contested by the insurer only during the first two years of the contract -the policy can never be contested by the insurer -the policy can always be contested by the insurer
the policy can be contested by the insurer only during the first two years of the contract
A life insurance illustration showing future premiums being paid out of nonguaraunteed values must disclose that
the policy owner may need to resume premium payments depending upon actual results
What is required before an insurance producer can act as a representative of an insurer?
the producer needs to be appointed by that insurer