Arizona Laws and Rules Pertinent to Insurance chapter 18
How many hours of initial long-term care training must a producer complete before soliciting long-term care products?
8
The free look period provided in life insurance policy is usually____days.
10
Starting in 2016, businesses with up to ___ employees will be defined by the ACA as a "small business".
100
If an insured legally adopts a baby within ____ month(s) of birth, the maternity coverage for the child's birth is covered.
12
The maximum prison sentence given under federal law for unfair and deceptive insurance practices is
15 years
an Arizona resident producer must be at least____ years of age.
18
Participants of a small group medical plan MUST be given advance notice of at least days prior to the plan's discontinuation.
180
in mass, a temporary license may be issued for a period to not exceed______ days
180
A life insurance policy can usually be contested by the insurer only during the first __years of the contract.
2
After a life insurance policy sold in Arizona has been in force for___ years(s), it becomes incontestable
2
After an annuity has been in force for____year(s), it becomes incontestable.
2
Any administrative action taken against a producer MUST be reported to the Director within ___ days after the final disposition
30
How many days notice does the Affordable Care Act require insurers to give before rescinding coverage?
30
a licensee whose name or address change must notify the director within____days.
30
a life insurance policy that is paid annually must contain a grace period of at least____days.
30
Every producer licensed in Arizona must notify the Director within how many days of any change of residential, business, or e-mail address?
30 days
Newborn children are automatically covered under an existing family medical plan at the moment of birth for a period of at least____days.
31
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
Arizona allows a maximum of how many attempts in a 12-month period, before having to wait one year before attempting the exam again?
4 attempts
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%
What is the actuarial value of a gold-level health plan?
80
According to the Telemarketing Sales Rule, what is the earliest time of the day that telemarketing calls may be received?
8:00 AM
Telemarketing calls may ONLY be received between the hours of
8:00 AM and 9:00 PM
What is the actuarial value of a platinum-level health plan?
90
The Telemarketing Sales Rule states that telemarketing calls may be received. is the LATEST time of day that
9:00 PM
Which of the following individuals is eligible to receive a temporary producer license?
A designated employee who is replacing a deceased producer
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
An individual is seeking coverage for nursing home (custodial) care that does NOT require any previous period of hospitalization. Which program offers these specifications?
AHCCCS (Arizona Health Care Cost Containment System)
which of the following actions would be considered a felony in the State of Arizona?
Attempting to defraud an insurer
Who manages the premiums collected from a group's members for a reciprocal insurer?
Attorney in fact
An intermediary who makes an agreement that unreasonably restrains the business of insurance may have violated regulations against
Boycott, coercion and intimidation
According to the Affordable Care Act, new Health Insurance Marketplaces are established by the
CCIIO (Center for Consumer Information and Insurance Oversight)
Which of these is NOT considered a federal punishment for unfair and deceptive insurance practices?
Community service
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
Health Providers are compensated by a Preferred Provider Organization (PPO) for normal dental procedures by what means?
Decreased fee schedules
Which statement best defines what a Policy Title means on an insurance policy?
Every policy must have a title on the face and on the back of the policy, briefly describing the policy
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
John has a criminal record in which he was convicted of a felony that involved dishonesty. Under Federal law, how would John be able to engage in insurance transactions?
Given written consent by the state insurance regulatory agency
Most Medicare Supplement information used by an insurer must be approved by the State. Which of the following types of information does NOT require State approval?
Government publications
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
Under which circumstance may an insurer discontinue a small employer group medical plan?
Insurer discontinues offering the plan to all employers
Which of the following causes of disability is NOT covered under Arizona worker compensation laws?
Intentional, self-inflicted injuries that occur at the worksite
Jerry has an indemnity plan which covers dental expenses. Typically, these type of plans
Jerry has an indemnity plan which covers dental expenses. Typically, these type of plans
All of these are common limiting factors with dental insurance EXCEPT for
Limit placed on number of teeth that may be treated annually
How can a group dental insurer discourage adverse selection?
Limit the duration of coverage
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 or premiums
Which of the following may be considered an act of misrepresentation?
Misleading or failing to adequately disclose the title and true nature of a policy offered to a client
False advertising of an insurance policy is considered
Misrepresentation
a producer's failure to provide title and true nature of a policy upon solicitation is an example of
Misrepresentation
Which of these actions is considered to be an Unfair Claims Settlement Practice?
Misrepresenting pertinent policy provisions relating to coverage after a loss
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
How would preventative care be encouraged in a dental plan?
No deductible on routine examinations
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(n)____ producer who lives in another state and transacts insurance in Arizona.
Nonresident
Which of these is NOT an Unfair Claims Settlement Practice?
Offering to settle a claim by arbitration
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 signing of the application
When must a producer provide disclosure about information practices to an applicant?
Prior to or at the time of signing the application
If an existing Medicare Supplement policy is being replaced by a new policy, who is required to sign the notice of replacement?
Producer and applicant
Under Federal Law, which of the following actions may result in a producer becoming imprisoned?
Producer embezzling funds from an insurer
the dental specialty which deals with the replacement of missing teeth is called
Prosthodontics
replacement regulations exist in order to
Protect policyowners from misrepresentations and loss of benefits
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
What is a life insurance producer authorized to do?
Solicit, receive and forward applications to the insurer
Which of the following entities does NOT establish regulations for variable insurance Products?
State attorney general
In regards to technology and the ACA, which of the following statements is correct?
States which operate with an Exchange must offer an internet-based portal
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
An insurance company is marketing a health insurance policy in Arizona which contains a provision that is in conflict with Arizona insurance law. What remedy must be taken by the insurer?
The provision must be amended to conform to the minimum statutory requirements
Why were Exchanges implemented by the Affordable Care Act (ACA)?
To create a one-stop market for standardized health insurance plans
All of the following are typically covered under dental insurance EXCEPT
Treatment which began before the eligibility date
Insurance crimes which affect interstate commerce are prosecuted by the
US Attorney General
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
which of the following is an example of defamation
a producer who publicly and erroneously announces that an insurance company is insolvent
A loss of minimum essential coverage usually counts as a qualifying event that triggers what?
a special enrollment period
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
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
According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age?
age 26
A(n)____insurer operates in the U.S but is headquartered outside the U.S.
alien
Which of these individuals may NOT obtain a temporary producer license?
an employee of a retired licensed producer
The Affordable Care Act (ACA) established "exchanges" in order to
assist individuals and small businesses when making their health insurance purchases
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
When does a family accident and health policy's coverage for a newborn child begin?
at the moment of birth
A(n)__insurance business in Arizona. company is licensed by the Department of Insurance to conduct
authorized
The purpose of the 'No-loss No-gain' provision is to avoid duplication of_____and____when an individual is covered under multiple group health insurance plans:
benefit payments and overinsurance
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
The refusal of doing business with an individual or business is called a(n)
boycott
Which of the following is considered to be a prosthodontic dental procedure?
bridgework
A(n)____insurer restricts the exposures it writes to those of its owners
captive
Life settlement brokers are NOT allowed to
complete transactions prior to being approved for a license
A producer MUST notify the Commissioner for
conducting business under an assumed name
If dividend option choices are offered on a whole life insurance policy, the policy MUST
contain a statement that dividends are NOT guaranteed
which of the following does NOT involve a life settlement transaction?
converting term life coverage to whole life insurance
Life settlement proceeds may be subject to the claims of
creditors
All of these are used to prevent adverse selection in a group dental plan EXCEPT
decreased employee particpation
Which of these is typically regarded as a major treatment in an indemnity dental plan?
dentures
If a life insurance applicant is shown future premiums are to be paid out of non- guaranteed values, the illustration used in the sales presentation MUST
disclose that premium payments may need to be resumed depending on actual results
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
the application is part of the annuity contract according to the
entire contract clause
Which of these is NOT considered a preventative service in a dental plan?
fillings
a producer is meeting with a client to determine whether an annuity will be suitable for purchase. Which of the following topics needs to be discussed with the 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 these may encourage adverse selection in an indemnity dental plan?
having multiple or periodic open enrollment periods
a life insurance applicant is tested for the human immunodeficiency virus (HIV). The applicant MUST be informed that the testing
helps determine the insurability of the applicant
According to the Affordable Care Act, coverage may be rescinded
if intentionally false statements were offered
Enrollees in a staff model HMO normally have which of the following pharmacy options available?
in-house pharmacy
The Arizona Life and Disability Insurance Guaranty Fund protects an insured in the event of
insurer's insolvency
Which of the following is NOT information needed to determine the suitability of an annuity recommendation?
level of education
Who is responsible for reporting the licensee's change of name or address to the Superintendent of the Bureau of Insurance?
licensee
Someone who is licensed to negotiate a life settlement contract is called a(n)
life settlement broker
which of the following is an example of defamation?
making a statement that is false or maliciously critical of the financial condition of an insurer
An insurance applicant has made a false statement on the application that will affect the insurer's decision on whether or not to issue the policy. This false statement is considered to be a(n)
material misrepresentation
A producer is purposing that a policyowner replace an existing individual health insurance policy with a new one. under the new contract, a pre-existing conditions exclusion
may reduce the insured's benefits
Under the Affordable Care Act (ACA), what is the proportion of premium revenues spent on clinical services and quality improvements?
medical loss ratio
all of the following are covered under most dental plans EXCEPT for
mouth cancer
in Arizona, the Human Immunodeficiency Virus (HIV) consent form
must disclose who will be receiving a copy of the test results
what must be disclosed when a producer advertises a life insurance policy?
name of the actual insurer
Beginning January 1, 2014, The restricted Annual Limit for plans under the Affordable Care act will be
no limit
Autopsies may be requested by an accident and health insurer
only if not prohibited by state law
which of the following is a requirement for an individual to receive an insurance license in Arizona?
passing the appropriate examination
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 entitled to
pay proceeds based on what the premiums would have purchased at the insured's actual age
In most dental plans, a deductible typically is NOT applied to
preventative and diagnostic services
An insurance producer must keep usual and customary records that pertain to transactions under the producer's license, at their
principal place of business
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
The ACA (Affordable Care Act) must ensure a sufficient choice of marketplace:in the
providers
Insurance producer Kelly offers insured a $500 shopping card if they purchase an insurance product through her. What is this an example of?
rebating
a long-term care policyowner is replacing existing coverage with a new policy. Replacement regulations require a(n)_____ notice be signed by the applicant and retained by the replacing insurer.
replacement
An example of endodontic treatment is a
root canal
Security laws passed by Congress are enforced by which Federal agency?
security and exchange commission
Which of these situations would NOT potentially involve a prison sentence under Federal law?
selling insurance with a nonresident license
In order for a health plan to be an "accountable health plan", who has to approve it?
the director
what is the primary reason for the director examination of a producer's insurance records?
to determine compliance with state insurance laws and regulations
Charging different premiums to policyholders in the same risk classification is referred to as
unfair discrimination
Mentally or Physically Handicapped dependent Children MUST be covered under an individual health insurance policy
until they become self-supportive
According to the federal regulations, what is required for a prohibited person to transact insurance business in this state?
written consent from the state insurance regulatory agency
an insured MUST wait ____days to bring legal action against an insurer after written proof of loss has been received by the insurer.
60
In Arizona, at least___employee(s) are needed for a small employer medical expense plan.
2
a health insurance claim may be contested due to statements made on the applications for up to____year(s) after the issuance of the policy.
2
what year was the Mental Health parity and Addiction Equity Act Established?
2008
upon meeting company requirements a lapsed life insurance policy may be reinstated for up to____year(s).
3
An insurer must keep advertising materials and records for at least how many years?
3 years
How long must a producer maintain customer records for an insurance transaction?
3 years
A licensee whose name or address changes must notify the Department of Insurance within ___ days.
30
What is the actuarial value of a bronze-level health plan?
60
What is the actuarial value of a silver-level health plan?
70
The Genetic Information Nondiscrimination Act of 2008 bars all of the following, EXCEPT:
prohibits the use of genetic information in health insurance, unless the applicant signs a waiver
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
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
If replacement was involved int he sale of a life insurance policy, a producer must provide a replacement notice 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 order issued by the Director that prohibits a specific practice listed in order is called a(n)
cease and desist order
an insurer wishing to conduct business in Arizona MUST obtain a
certificate of authority
All of these are considered to be a violation of the Federal Fraud and False Statements Act EXCEPT
claims reimbursement
Prepaid dental plans differ from most other types of dental plans in what way?
closed panel of dentists can only be used
a prospective client was intimidated by a producer to purchase an insurance contract. the producer could be found guilty of
coercion
which of the following is considered to be an example of unfair restraint of competition?
coercion
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
an annuity contract may be returned for a full refund during the
free look period
according to the affordable care act(ACA), insurers can no longer deny health coverage due to pre-exciting conditions unless that plan is a(n)
grandfathered plan
What will Medicare charge if someone doesn't enroll in certain Medicare programs or plans when they're first eligible?
late enrollment penalty
A statement MUST be signed by the___for any illustrations used in the sale of a life insurance policy.
producer
the____is responsible for determining the appropriateness of a Medical Supplement policy for an applicant.
producer
a producer has indicated to a potential client that the proposed life insurance policy is covered by the NH life and health guaranty association. this action taken by the producer is
prohibited by law
a handicapped child is covered under an individual health policy. if continuation of coverage is needed beyond the policy's age limit, which of the following is required?
proof of incapacity and dependency upon reaching the age limit
an example of rebating would be
splitting the commission with the buyer on a sale of insurance
which entity is responsible for regulating claims settlement practices of insurers?
state insurance department
rick provides a notice of claim to his health insurer. if he does not receive a claim form within 15 days, he may comply with the proof of loss provision by
submitting written proof of loss
A group health certificate for coverage issued in Arizona MUST contain a(n)
summary of policy features and benefits
An insured's statement of a policy's benefits which is to be used in marketing materials is called a(n)
testimony
A licensee or applicant who is ordered into active military service may request that the license or application be placed on inactive status by sending the department a:
written statement
