Ch7 Laws and Rules

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An agent must report to the Commissioner of Insurance any administrative action or criminal charges taken against the agent within __ days of the conviction date.

10

An agent that has been or is engaged in conduct that violates the Insurance Information and Privacy Protection Act shall be issued and served a statement of charges and notice of hearing by the Commissioner of Insurance. The date of such hearing shall be AT LEAST how many days after service of charges?

10

The policyholder has how many days to return an Accident/Health Insurance Policy and receive a full refund on premiums?

10

AT LEAST how many days before the effective date of a rate increase must an insurer provide written notice to individual accident and health policyowners?

30

According to the Information and Privacy Protection Act, when access to recorded personal information is requested following an adverse underwriting decision, the insurer must make the information available within how many business days?

30

If after satisfactory proof of loss, an insurer fails or refuses to pay death proceeds, the insurer must pay interest on the proceeds after how many days?

30

Under a Group Health Insurance Policy, continuation shall be available only to an employee who has been insured immediately prior to the date of termination for a period of AT LEAST

30 days

Every insurance agent/broker MUST maintain all records, books, and documents for insurance transactions for a period of not less than

5 years

Eligible employees must be added to group health coverage NO LATER than how many days after their first day of employment?

90

An agent who sells an individual life insurance policy in North Carolina MUST deliver to the policyowner

A Policy Summary and Buyer's Guide

What do Dread Disease policies cover?

A specific disease or illness

Before a Health Policy is issued or delivered, the form, classification or risks, and premium rates MUST be filed with the

Commissioner of Insurance

Insurance agents MUST obtain a license from North Carolina's

Commissioner of Insurance

According to the Affordable Care Act (ACA), which of the following coverages is NOT required?

Coverage for cosmetic surgery

A vacancy that occurs during the North Carolina Commissioner of Insurance's term of office MUST be filled by the

Governor

Which of the following requires that an applicant for an individual Health Policy be notified of an investigation into his personal character, general reputation, and mode of living?

Insurance Information and Privacy Protection Act

Which of the following BEST describes Credit Life insurance?

Insurance issued on a debtor to cover outstanding balances on installment loans

When an existing life insurance policy is being reissued with a reduction in cash value, the agent must sign the

Notice Regarding Replacement of Life Insurance or Annuity

One of the stated purposes of the Life and Health Insurance Guaranty Association is to

One of the stated purposes of the Life and Health Insurance Guaranty Association is to

Which of the following terms is defined as any transaction in which new life insurance or a new annuity is to be purchased and existing life insurance or annuity is to be terminated or discontinued?

Replacement

A written agreement to provide a Life Insurance Policy holder immediate cash in exchange for the sale and transfer of a Life Insurance Policy is a

Viatical Settlement

According to the Affordable Care Act (ACA), a dependent child's eligibility status is determined by:

age

The following acts are examples of unfair methods of competition and deceptive practices in the business of insurance EXCEPT the use of

comparisons showing that a policy has higher benefits

Circulation of any oral or written statement or any pamphlet, circular, article, or literature that is false or maliciously critical of or derogatory to the financial condition of an insurer is known as

defamation

Insurers organized under the laws of North Carolina are called

domestic companies

An example of an unfair claims practice would be

failing to effectuate prompt, fair, and equitable settlements of a claim

When L applies for a Health Insurance Policy, L unintentionally fails to list a previous visit to a cardiologist. If the insurance company contests the policy, it MUST do so within 2 years

from the date of issue

The Life and Health Insurance Guaranty Association is

funded by admitted insurance companies through assessments

An insurance broker in North Carolina is a representative of the

insured

Inducing or attempting to induce any insured person through misrepresentation to lapse, forfeit, or surrender insurance is

twisting

Under the North Carolina insurance code, an insurance company must pay death benefits for suicide if the policy has been in force for a MINIMUM of

two years

To be licensed as an accident and health insurance agent in North Carolina, the applicant MUST

have successfully completed at least 20 hours of instruction approved by the Commissioner of Insurance

Continuation of coverage of a group Hospital, Surgical, and Major Medical Policy MUST include

hospital expenses

An insurance company MUST clearly specify questions designed to obtain information solely for marketing research

in any insurance transaction

The Insurance Information and Privacy Protection Act is designed to limit or direct the information collection activities of all of the following EXCEPT

insurance regulators

An agent who signs a blank contract application or policy of insurance

is guilty of a misdemeanor

Companies in North Carolina may transact solicitations for insurance ONLY through

licensed agents

The funds used by the Life and Health Insurance Guaranty Association to carry out its purpose are obtained from the

member companies

Every Group Health Policy providing benefits for chemical dependency treatments must include, for the life of the contract, a

minimum benefit of $16,000

If a company accepts a renewal premium payment that would extend coverage beyond the policy's MAXIMUM age limit, the company

must continue the coverage to the end of the period of time for which the premium was accepted

The amount received for a life insurance policy in a viatical settlement is

Less than the death benefit

The fund that assures policyholders payment of death benefits on Life Policies, if the company is insolvent at the time of the claim, is called the

Life and Health Insurance Guaranty Association

The rules and regulations of the Life and Health Insurance Guaranty Association in North Carolina apply to

Life and Health Policies issued by companies authorized in North Carolina

Under the Affordable Care Act (ACA), health coverage is provided for dependents up to the age of:

26

North Carolina requires that an insurance agent must complete __ hours of continuing education on the subject of law and ethics every two years.

3

Approved premium rates for group health insurance shall be guaranteed by the insurer for an initial period of not LESS than how many months?

12

A person is required to be AT LEAST how old before he or she is licensed as an agent in North Carolina?

18

A temporary license may be issued for a MAXIMUM period of how many days?

180

An insured MUST submit a proof of loss on a health insurance claim within how many days after the date of loss?

180

K works for XYZ Clothing Store from September through December each year. K works 45 hours a week for this period of time. The employer's Group Policy would consider K

not eligible for the insurance because as a seasonal employee K does not meet the definition of "employee" under North Carolina law

If an insurer has been notified by the Commissioner of Insurance that an individual Health Policy form does not comply with the state's laws, the insurer may

not issue the form in connection with any new application

No insurer shall refuse to insure an individual because of

race

All of the following actions are considered rebating EXCEPT

sharing commissions with other licensed and appointed agents

If the Commissioner of insurance finds that a licensed person has used fraudulent, coercive, or dishonest practices or has proved to be incompetent, untrustworthy, or financially irresponsible, the law allows the Commissioner to

suspend, revoke, or refuse to renew the agent's license

Essential Benefits without annual and lifetime limits are required on any health policy purchased:

through the Federal Marketplace


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