chapter 11 Massachusetts laws and rules

in massachusetts a small employer is comprised of

1-50 employees

how many days notice must a producer be given prior to a scheduled hearing?

21 days

any administrative action taken against a producer must be reported to the superintendent within ____days of the final disposition

30

how many days notice does the affordable care act require insurers to give before rescinding coverage?

30

after the first 3 years of licensure a producer must complete _______ credit hours of continuing education

45

a producer has received the first year commission paid on a medicare supplement policy. renewal commissions must then be provided for at least ______ years after the first year

5

every domestic company must have its financial records examined by the superintendent every ______ years

5

according to the afford new health insurance marketplaces are established by the

CCIIO the center for consumer information and insurance oversight

Insurance crimes which affect interstate commerce are prosecuted by the

US Attorney general

a prepaid dental plan has an agreement in place with a network of dentists which

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

a prepaid dental plan has an agreement in place with a network of dentists which

accepts and established amount as payment in full for dental services rendered

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

closed panel of dentists can only be used

the affordable care Act (ACA) established "exchanges in order to

assist individuals and small business when making their health insurance purchases

at what point must a newborn be covered under and individual or group health policy

at the moment of birth

any agreement that unreasonably restrains the business of insurance is a violation of which unfair trade practice?

boycott, coersion, and intimidation

which of the following is considered to be a prosthodontic dental procedure?

bridgework

a superintendent has reason to believe a producer violated Mass insurance law the superintendent may issue a(n)

cease and desist order

upon receipt of written notice of claim an insurer is required to provide the claimant with

claim forms

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

all of these are used to prevent adverse selection in a group dental plan except

decreased employee participation

health providers are compensated by a preferred provider organization for normal dental procedures by what means?

decreased fee schedules

which of these is typically regarded as a major treatment in an indemnity dental plan?

dentures

beginning January 1, 2014 the restricted annual limit for plans under the affordable care act will be

no limit

in order to renew a producers license continuing education credits must be completed

every three years

the "notice to buyer?" on the first page of each long term care policy delivered in Massachusetts

explains that some long term care costs may not be covered

which of these is not considered a preventative service in a dental plan?

fillings

According to the Affordable Care Act (ACA), insurers can no longer deny health coverage due to pre-existing conditions unless that plan is a(n)

grandfathered plan

under the pregnancy discrimination act of 1978 employers must treat pregnancy

in the same manner as any other covered disability

which of the following is a potential punishment given to a producer found guilty of an unfair method of competition

license suspension or revocation

who is required to notify the superintendent of a license's change of address

licensee

all of these are common limiting factors with dental insurance except for

limit place on the number of teeth that may be treated annually

how can a group dental insurer discourage adverse selection?

limit the duration of coverage

the superintendent is empowered to preform each of the following acts except

make rules that are consistent with those of neighboring states

According to the Affordable Care Act (ACA), the proportion of premium revenues spent on clinical services and quality improvements is called the

medical loss ratio

if the commissioner requests access to a producers business record the producer

must provide access to the records upon request

a(n) ______ producer lives in another state and transacts insurance in Massachusetts

non-resident

which of these is not an unfair claims settlement practice?

offering to settle a claim by arbitration

which of the following is not covered by Massachusetts workers compensation laws?

on the job injury that was both intentional and self inflicted

which of the following is a requirement for an individual to receive an insurance license in Massachusetts

passing the appropriate examination

whose interests are being protected with the existence of replacement rules?

policyowner

the _______ is responsible for determining the appropriates of a medicare supplement policy for an applicant

producer

in order for a handicapped child to continue health insurance coverage beyond the policy's limiting age the insurer may require

proof of incapability

the dental specialty which deals with the replacement of missing teeth is called

prosthodontics

which of the following actions does not need to be taken by a policy-owner to continue a newborns health coverage beyond initial coverage period?

provide evidence of insurability

an example of endodontic treatment is a

root canal therapy

the outline of coverage for a medicare supplement policy provides information about

services, benefits, co payments, deductibles, exclusions, premiums and the insurer

the outline of coverage for a medicare supplement policy provides information about

services, benefits, co-payments, deductibles, exclusions, premiums, and the insurer

in regards to technology and the ACA which of the following statements is correct?

state operate with an exchange must offer an internet based portal

rick provides notice of claim to his health insurer. if he does not receive a claim form within 15 days he may comply with proof of loss provision by

submitting written proof of loss

before a medicare suppliment advertisement is released t the public it must first be approved by the

superintendent

a husband and wife both have group health coverage with there respective employers. how is it determined whose insurance coverage will cover their dependent child

the child's coverage would derive from the parent whose birth month comes first in the calendar year

a producers insurance records must be provided to the superintendent

upon request of the superintendent

a married couple adopts a child that was voluntarily surrendered by birth mother. the married couple is already covered under a group health insurance policy. at what point is the child considered a dependent under this coverage

the date the child is placed in the couples home

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

to create a one-stop market for standardized health insurance plans

what is the primary reason for the superintendents examination of a producers insurance records?

to determine compliance with state insurance laws and regulations

a producer who misrepresented a pertinent policy provision related to a claim committed a(n)

unfair claims settlements practice

according to the 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