Chapter 15 - WI State Laws
For small employer coverage, how many employees may a small employer have? A 2-50 B 1-50 C 2-100 D 1-25
A. 2-50
The 1st year commission on a Medicare supplement policy may not exceed ____% of the 2nd year renewal premium. A 125 B 100 C 200 D 150
D. 150
J helped another intermediary violate an insurance statute 5 times. Up to what amount may J be fined? A $5,000 B $2,500 C $1,000 D $500
A. $5,000 The fine for violating a statute or rule or intentionally aiding someone in doing so can be up to $1,000 per violation.
Which of the following is true regarding replacement requirements? A A statement must be signed by both the applicant and the agent as to whether or not replacement is involved B If replacement is involved, an acknowledgement of that fact must be signed only by the applicant C If no replacement is involved, all that is required is the applicant's signature on the application D A statement must be signed by both the applicant and the agent only if replacement is involved
A. A statement must be signed by both the applicant and the agent as to whether or not replacement is involved Both the applicant and the agent must sign a statement with every application indicating whether or not replacement is involved.
What recourse does a party who is aggrieved by a Commissioner's order have? A Request a hearing from the Commissioner within 30 days B File a complaint with the Secretary of State within 30 days C Request a meeting with an administrative judge within 20 days D File a lawsuit in state court within 20 days
A. Request a hearing from the Commissioner within 30 days
Which of the following are true regarding the duties of replacing and existing insurers? A The replacing insurer and existing insurer must retain records relating to replacements for 5 years B The existing insurer must notify the replacing insurer of a policy being replaced within 5 working days C The replacing insurer and existing insurer must retain records relating to replacements for 3 years D Replacement requirements do not apply to the existing insurer
A. The replacing insurer and existing insurer must retain records relating to replacements for 5 years Replacement records must be maintained for 5 years by both replacing and existing insurers. The replacing insurer would be required to notify the existing insurer of a policy being replaced, not the other way around.
Q fails to pay the 6th required monthly premium on an insurance policy with a 1-year term. How many days' notice must the insurer give Q before cancellation can become effective? A 15 B 10 C 7 D 30
B. 10 Early cancellation of a policy requires at least 10 days advance notice to the insured.
Which of the following statements is false with respect to continuing education requirements? A Failing to meet continuing education requirements will result in license revocation B A nonresident licensee is exempt from the requirement for Wisconsin if his/her state of residence grants a similar exemption to Wisconsin residents C Excess credit hours may be carried over to the next period D All required CE credits must be completed before a license can be renewed
C Excess credit hours may be carried over to the next period
Health insurance policies must include a home care benefit that provides for at least how many visits in a 12-month period? A 30 B 20 C 40 D 10
C. 40
For other than Medicare supplement or long-term care insurance policies, the free look period for health insurance policies must be at least how many days? A 30 B 20 C 45 D 10
D. 10
A preexisting conditions exclusion in a group health benefit plan may generally extend no longer than how long? A 3 months B 6 months C 2 months D 12 months
D. 12 months
How many hours of prelicense education must a candidate for a life or accident and health insurance intermediary license complete? A 30 B 40 C 15 D 20
D. 20
For how long must an intermediary retain records of financial transactions and policyholder information? A 4 years B 2 years C 1 year D 3 years
D. 3 years
For up to how many years after revocation may an intermediary be prevented from reapplying for a license? A 15 B 10 C 7 D 5
D. 5
Which of the following is NOT a permissible additional coverage rider that may be attached to a Medicare supplement policy? A Part A deductible rider B Part B deductible rider C 50% Part A deductible rider D 50% Part B deductible rider
D. 50% Part B deductible rider
Which of the following statements correctly describes renewal fee requirements? A Renewal fees are due on the last day of the intermediary's birth month annually B Renewal fees are $70 for resident agents and nonresident agents C Renewal fees are $35 for resident agents and nonresident agents D Renewal fees are due on the last day of the intermediary's birth month every other year
D. Renewal fees are due on the last day of the intermediary's birth month every other year Renewal fees are due on the last day of the intermediary's birth month every other year in the amount of $35 for resident agents, and $70 for nonresident agents.
Which of the following statements is NOT true regarding replacement of long-term care insurance? A Replacing agents must ensure that benefits and coverage are greater than what the existing policy provides B The applicant must be provided with a Notice of Replacement which must be signed by both the applicant and the insurer C Replacing insurers must waive waiting periods for pre-existing conditions to the extent they have been satisfied under the existing policy D Replacing insurers must notify the existing insurer of the pending replacement within 10 days of application or policy delivery, whichever is sooner
D. Replacing insurers must notify the existing insurer of the pending replacement within 10 days of application or policy delivery, whichever is sooner Replacing insurers have 5 days from the earlier of the date of application or the date of policy delivery to notify existing insurers about the pending replacement.
Which of the following is false regarding the Buyer's Guide and Policy Summary requirements? A If the policy contains at least a 10-day Free-Look or Right to Examine, then the Buyer's Guide and Policy Summary are not required B The Policy Summary must disclose the name and address of the insurer and agent C The Policy Summary is a basic illustration for an insurer's policy forms which describes the elements of the policy D A Policy Summary and Buyer's Guide must be provided to a prospective insured upon request
A. If the policy contains at least a 10-day Free-Look or Right to Examine, then the Buyer's Guide and Policy Summary are not required If the policy contains at least a 10-day Free-Look or Right to Examine, then the Buyer's Guide and Policy Summary must be delivered with the policy or prior to delivery.
Q, whose birthday is April 1, completed a nonmedical application for life insurance on June 1. What is the earliest effective date that the policy could have? A June 2 B December 1 C June 1 D September 2
B. December 1 A life insurance policy may not be backdated more than 6 months if it would cause the premium on the policy to be reduced.
All of the following statements are true, except: A Coverage must be provided for hospital or ambulatory surgery center charges and anesthesia provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center and who is a child over the age of 5 B A policy which provides coverage of only certain specified prescription drugs must develop a process through which a physician can obtain an individual patient exception for coverage of a prescription drug not routinely covered by the plan C If a policy provides coverage of any emergency medical services, coverage must include emergency medical services that are needed to evaluate or stabilize an emergency medical condition D Coverage of appropriate and necessary immunizations must be provided from birth to the age of 6 years, for a dependent who is a child of the insured
A Coverage must be provided for hospital or ambulatory surgery center charges and anesthesia provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center and who is a child over the age of 5 The statement is correct if the child is under 5, not over 5
Which of the following statements is false with regard to exchange of business and sharing commissions? A An agent can forward insurance business to another licensed agent, but they are prohibited from splitting commissions B An agent can forward insurance business to another licensed agent if they cannot place the business with any of their listed insurers because of capacity problems or the refusal of the insurer to accept the risk C An agent is presumed to have exceeded the occasional exchange of business if they exchange more than 25 insurance risks per calendar year D An agent is presumed to have exceeded the occasional exchange of business if they place more than 5 insurance risks per calendar year with any single insurer they are not listed as an agent
A. An agent can forward insurance business to another licensed agent, but they are prohibited from splitting commissions
Which of the following statements is NOT correct with respect to required benefits under health insurance policies? A Every policy must provide coverage of inpatient, outpatient and transitional treatment arrangements for the treatment of mental illness, but not substance abuse B Policies that provide coverage for hospital care must provide coverage for at least 30 days for skilled nursing care C Policies must provide cover diagnosis and treatment of a condition by a licensed chiropractor if the policy covers diagnosis and treatment of the condition by a licensed physician or osteopath D Policies must cover a minimum of 40 home care visits in a consecutive 12-month period for each insured
A. Every policy must provide coverage of inpatient, outpatient and transitional treatment arrangements for the treatment of mental illness, but not substance abuse
Which of the following statements is true of LTC insurance coverage? A It must have a free look period of at least 30 days B It must be designed to provide coverage for at least 2 years C It must allow an elimination period of up to 18 months D It must provide a fixed daily benefit of at least $100 a day 0%
A. It must have a free look period of at least 30 days An LTC insurance policy must be designed to provide coverage for at least 12 months, provide a fixed daily benefit of at least $60 a day, and have an elimination period not exceeding 365 days.
What is the latest date on which the policy's incontestable clause could take effect? A 1 year B 2 years C 3 years D 4 years
B. 2 years Life insurance policies must become incontestable no later than 2 years after they have been in force.
The penalty for knowingly obtaining information about someone from an insurer under false pretenses is: A A $5,000 fine, up to 3 months in prison, and liability for up to $5,000 in civil damages B A $25,000 fine, up to 9 months in prison, and liability for up to $25,000 in civil damages C A $10,000 fine, up to 6 months in prison, and liability for up to $10,000 in civil damages D A $20,000 fine, up to 6 months in prison, and liability for up to $20,000 in civil damages
B. A $25,000 fine, up to 9 months in prison, and liability for up to $25,000 in civil damages Persons who knowingly obtain information about a person from an insurer or insurance support organization under false pretenses are liable for a fine of up to $25,000 or up to 9 months in prison, or both. They are also liable for up to $25,000 in actual and exemplary damages plus costs and reasonable attorneys' fees.
With respect to dependent handicapped children, which of the following is incorrect? A Once a handicapped child has been covered for 2 years beyond the limiting age, insurers cannot require proof of incapacity more frequently than annually B A handicapped dependent child may not be covered under a parent's policy beyond the limiting age C The insurer may require the enrollee to provide proof within 31 days before the child attains the limiting age, and once per year thereafter, to continue the child's coverage D A health policy must continue coverage for a dependent child after the child attains any limiting age if the child is incapable of self-sustaining employment due to a physical/mental handicap and continues to be dependent on the insured
B. A handicapped dependent child may not be covered under a parent's policy beyond the limiting age Coverage for handicapped dependent child continues beyond the limiting age as long as such child is incapable of self-sustaining employment due to a physical/mental handicap and continues to be dependent on the insured.
Which of the following policies is subject to the requirement to provide a buyer's guide and policy summary to a prospective purchaser? A A variable life insurance policy B A life insurance policy sold through direct response C A credit life insurance policy D A group life insurance policy
B. A life insurance policy sold through direct response Life insurance policies are generally subject to the solicitation and disclosure requirements whether they are sold through agents or through direct response.
Which of the following persons is a life settlement broker? A An attorney who represents owners of life insurance policies in sales of their policies to third parties B A person paid to negotiate terms of the sales of existing life insurance policies between policyowners and investors C Someone who buys existing life insurance policies from policyowners who no longer need or want their coverage D A CPA who is paid by clients to find buyers for their existing life insurance policies
B. A person paid to negotiate terms of the sales of existing life insurance policies between policyowners and investors This is the definition of a life settlement broker, but attorneys and CPAs are excepted.
Which of the following statements is NOT correct concerning small employer coverage? A A small employer insurer must actively market health benefit plans to small employers B A small employer insurer is not required to actively market health benefit plans to small employers C Compensation to an intermediary for the sale of a health plan cannot be based upon or vary according to small employer's health status, claims experience, industry, occupation or geographic location D A small employer insurer or an intermediary may not, directly or indirectly, discourage or direct a small employer from applying for coverage
B. A small employer insurer is not required to actively market health benefit plans to small employers ***this is misleading because the text told me that they "may actively..." not that they "must"***
Which of the following is an unfair claim practice? A Paying a claim without conducting a reasonable investigation B Compelling an insured to file suit by offering substantially less than what a lawsuit would award C Denying coverage of a claim within 10 days of receipt D Referring to policy provisions and applicable law in explaining a claim denial
B. Compelling an insured to file suit by offering substantially less than what a lawsuit would award It is unfair to offer settlements so low that insureds are compelled to file a suit to obtain a reasonable award.
Employer group health coverage must be renewable at the option of the: A Commissioner B Employer C Certificate holders D Insurer
B. Employer Group health plans must be renewable at the option of the employer or plan sponsor.
Which of the following is an example of what an advertisement cannot do? A Disclose the insurer's name B Imply that dividends are guaranteed C Use any statistics or facts D Describe policy benefits
B. Imply that dividends are guaranteed
With regard to inflation protection for LTC Partnership Policies, which of the following is true? A For people at least 61 but less than 76 years old at the date of policy purchase, the policy must provide compound annual inflation protection with increases at a rate of at least 3% or based on changes in the consumer price index B Inflation protection is not required for individuals who are 76 years of age on the policy purchase date C Inflation protection is not required for individuals who are at least 61 but less than 76 years old on the policy purchase date D For people less than 61 years old at the date of policy purchase, the policy must provide at least 3% annual simple inflation protection
B. Inflation protection is not required for individuals who are 76 years of age on the policy purchase date
Which of the following is NOT a factor for required disclosures to small employer groups? A Insurer's rights concerning rates B Insurer's rights concerning commissions C Insurer's rights concerning increases D Insurer's rights concerning benefit factors
B. Insurer's rights concerning commissions An insurer's rights concerning commissions is not among the factors that are required to be disclosed to small employer groups.
N moved to a new office on September 1. By what date must N notify the Commissioner? A September 15 B October 1 C September 21 D September 10
B. October 1 An intermediary must notify the Commissioner of a change in name or business or residence address within 30 days.
Managing general agents may do which of the following? A Employ an individual who is also employed by their insurer B Pay aggregate claims in one quarter that amount to over 3% of their insurer's latest annual policyholder surplus C Bind their insurer to treaty reinsurance transactions D Put a sub-producer on their insurer's board of directors
B. Pay aggregate claims in one quarter that amount to over 3% of their insurer's latest annual policyholder surplus This is part of the definition of a managing general agent. However, managing general agents are prohibited from paying a single claim amounting to more than 1% of their insurer's latest annual policyholder surplus without its prior approval. The other choices are also prohibited for managing general agents.
Which of the following is NOT an unfair trade practice? A Giving a client an ownership share in a business in return for an insurance purchase B Granting a discount to a client on a policy's first premium C Reducing premiums on mass marketed insurance in accordance with savings in expenses D Splitting the commission on a sale with a client
C Reducing premiums on mass marketed insurance in accordance with savings in expenses Reducing premiums on mass marketed insurance in accordance with savings in expenses is a permissible practice. The others are rebating or illegal inducement.
What are the consequences when the premiums paid for insurance placed on an intermediary's own life exceed those of insurance the intermediary has placed on others' lives? A The intermediary's license may be revoked after a hearing B The intermediary's license is temporarily suspended until premiums paid for insurance placed on others exceeds those on insurance the intermediary has placed on his or her own life C The insurance on the intermediary's life cannot be issued D The intermediary cannot be compensated for the insurance placed on his/her own life
C The insurance on the intermediary's life cannot be issued
Rates on small employer coverage may not be increased more than what ___% due to claims experience? A 25 B 20 C 15 D 10
C. 15 Rates on small employer coverage may not be increased more than 15% due to claims experience.
A health benefit plan must provide mammography coverage for women beginning at what age? A 50 B 40 C 45 D 55
C. 45
Which of the following policies is subject to the requirements for life insurance illustrations? A A $50,000 individual annuity B A $100,000 variable life insurance policy C A $20,000 group life insurance policy D A $25,000 credit life insurance policy
C. A $20,000 group life insurance policy Individual and group life insurance policies with benefits exceeding $10,000 are subject to the requirements. Annuities, credit life, and variable life are exempt.
Which of the following statements is true with respect to privacy of personal medical information? A An individual may not have access to recorded personal medical information B Personal medical information does not include information obtained from a health care provider C A licensee must retain copies of all authorizations to release personal medical information D Personal medical information includes information obtained from public records of a governmental authority maintained by the insurer
C. A licensee must retain copies of all authorizations to release personal medical information Personal medical information does include information obtained from a health care provider, but not from the public records of a governmental authority maintained by the insurer. An individual, or his/her personal representative are entitled to access recorded personal medical information.
Which of the following statements is false? A The commission in the first year cannot exceed 150% of the commission for servicing the policy in the 2nd year B A Medicare supplement policy cannot contain limitations or exclusions on coverage that are more restrictive than those of Medicare C A policyholder may request premiums and benefits be suspended for up to 12 months if he/she will be entitled to Social Security benefits D Applications must include questions to determine whether the Medicare supplement policy being sold will replace existing Medicare supplement coverage
C. A policyholder may request premiums and benefits be suspended for up to 12 months if he/she will be entitled to Social Security benefits
An initial privacy notice is NOT required to be provided to: A An individual when a customer relationship has been established B An individual prior to the disclosure of nonpublic personal financial information about such individual C A prospective customer D Annually to current clients
C. A prospective customer An initial privacy notice must be provided when customer relationship is established and annually to existing customers.
Which of the following statements about advertisements is false? A A testimonial must represent the current opinion of the author B An insurer can imply that its financial condition has been approved by a government agency if that is true C An advertisement may refer to a premium as a "deposit" D An insurer or agent is responsible for statements made in a testimonial
C. An advertisement may refer to a premium as a "deposit" An advertisement must refer to a premium only as a premium. Use of the word "deposit" would be considered misleading.
Which of the following are false regarding the Insurance Security Fund? A It prevents financial loss to policyholders when an insurer becomes insolvent B The Fund is not liable for more than $300,000 in the aggregate for any one life, or $500,000 for property insurance, liability insurance and disability insurance C An insurer has the option of becoming a member of the Fund D Other member insurers are assessed to provide money for the claims of an insolvent insurer
C. An insurer has the option of becoming a member of the Fund Insurers transacting insurance in Wisconsin are required to be members of the Fund.
Policies covering vision care services must provide coverage for vision care services or procedures provided by an optometrist, if the policy provides coverage for these services by: A A PPO B An HMO C Another health care provider D A hospital
C. Another health care provider Policies covering vision care services must provide coverage for vision care services or procedures provided by an optometrist, if the policy provides coverage for these services by another health care provider.
If an intermediary receives compensation from an insurer for insurance on his/her own property, life, or other risk, it is not considered to be controlled business if: A He/she had aggregate premiums of other insurance with the same insurer that are less than the premiums of their risks throughout the last 12 months B He/she had aggregate premiums of other insurance with the same insurer that equal the premiums of their risks throughout the last 12 months C He/she had aggregate premiums of other insurance with the same insurer that exceeded the premiums of their risks throughout the last 12 months D He/she had aggregate premiums of other insurance with the same insurer that exceeded the premiums of their risks throughout the last 24 months
C. He/she had aggregate premiums of other insurance with the same insurer that exceeded the premiums of their risks throughout the last 12 months If an intermediary receives compensation from an insurer for insurance on his/her own property, life, or other risk, it is not considered to be controlled business if he/she had aggregate premiums of other insurance with the same insurer that exceeded the premiums of their risks throughout the last 12 months.
On June 1, XYZ Insurance Company received written notice of a covered loss and the amount of the loss. On what date would the payment for this claim be considered overdue? A August 1 B September 1 C July 1 D July 15
C. July 1 Claim payments are considered overdue if not made within 30 days after an insurer has received written notice of a covered loss and the amount of the loss.
Which of the following is NOT considered to be an advertisement? A Group booklets and summaries of coverage B Envelopes used in connection with sales material C Material used to recruit, train, and educate sales personnel D Material used in the solicitation of renewals and reinstatements
C. Material used to recruit, train, and educate sales personnel
The rights of a beneficiary under a life insurance policy are subordinate to those of an assignee, unless: A The policy is an annuity contract B The policy is a group life policy C The beneficiary designation before the assignment was irrevocable D The policy is a group contract providing annuities as retirement benefits
C. The beneficiary designation before the assignment was irrevocable The rights of a beneficiary under a life insurance policy are subordinate to those of an assignee, unless the beneficiary designation before the assignment was irrevocable.
Which of the following is NOT a purpose of the Interstate Insurance Regulation Compact? A To protect consumers of individual and group annuity, life insurance disability income, and long-term care insurance B To coordinate regulation between the member state insurance departments C To protect consumers of individual and group health insurance D To establish a central clearinghouse to review insurance products and advertisements
C. To protect consumers of individual and group health insurance A purpose of the Interstate Insurance Regulation Compact is to protect consumers of individual and group annuity, life insurance disability income, and long-term care insurance, but health insurance is not included under the Compact.
Which of the following statements is NOT correct concerning replacement of health insurance? A Upon determining that the sale would involve replacement, the agent must furnish the Notice Regarding Replacement to the applicant B Replacement includes any transaction where new health insurance is to be purchased and it is known to the agent or insurer that existing health insurance has been or is to be lapsed C An insurance application must contain a question as to whether the insurance to be issued is to replace any insurance currently in force D It is not considered a replacement if new health insurance is to be purchased and the benefits are significantly reduced under an existing policy
D It is not considered a replacement if new health insurance is to be purchased and the benefits are significantly reduced under an existing policy Replacement includes any transaction where new health insurance is to be purchased and it is known to the agent or insurer that the benefits are significantly reduced under an existing policy or an existing policy is to be lapsed.
Which of the following is true regarding pre-existing conditions in group health insurance policies? A A pre-existing condition that existed 12 months prior to policy effective date may be excluded for up to 6 months B A pre-existing condition that existed 9 months prior to policy effective date may be excluded for up to 12 months C A pre-existing condition that existed 12 months prior to policy effective date may be excluded for up to 24 months D A pre-existing condition that existed 6 months prior to policy effective date may be excluded for up to 12 months
D. A pre-existing condition that existed 6 months prior to policy effective date may be excluded for up to 12 months
Which of the following is part of the legal responsibility of maintaining an insurance license? A An intermediary must inform the Commissioner of any change in address within 60 days B An intermediary must inform the Commissioner of any change in address within 10 days C An intermediary must inform the Commissioner of any change in address within 90 days D An intermediary must inform the Commissioner of any change in address within 30 days
D. An intermediary must inform the Commissioner of any change in address within 30 days
Before selling annuities, an intermediary must complete an approved training course on the subject of: A Consumer protection B Retirement planning C State annuity laws D Annuity suitability
D. Annuity suitability Intermediaries that sell annuities must complete a training course that addresses annuity suitability.
An insurer may be waiving its right to defend against a claim when it: A Furnishes the forms for filing proofs of loss B Investigates a claim C Accepts proofs of loss D Fails to acknowledge receipt of notice or proof of loss
D. Fails to acknowledge receipt of notice or proof of loss If an insurer fails to acknowledge receipt of notice or proof of loss, it may be waiving its right to defend against a claim.
Wisconsin's requirement for approval of most policy forms is referred to as: A File-and-wait B File-upon-request C Use-and-file D File-and-use
D. File-and-use
What kinds of policies would NOT include nonforfeiture provisions? A Group equity indexed life B Group universal life C Group whole life D Group term life
D. Group term life Group life policies, other than term insurance, are required to include nonforfeiture provisions.
Which of the following is subject to the health insurance replacement requirements? A Accident-only coverage B Prescription drug coverage C Group disability income coverage D Individual medical expense coverage
D. Individual medical expense coverage
Which of the following persons is an intermediary? A V advises business owners on how they can lower their insurance costs by implementing safety procedures B Y works in the marketing department of an insurance company C D gives advice about insurance to friends for free D T is paid by clients for obtaining insurance coverage for them
D. T is paid by clients for obtaining insurance coverage for them An intermediary is someone who gets paid for soliciting, negotiating, or placing insurance for insurers or clients or providing insurance advice.
The costs of examinations conducted by the Commissioner are generally paid by: A The Commissioner's office B Policyholders C The state D The examinee
D. The examinee The cost of examinations is paid by the examinee unless the Commissioner finds it would place an undue burden on the examinee.
Which of the following statements correctly describes the readability requirements for insurance policies? A The text must achieve a minimum score of 40 on the Flesch reading ease test for Medicare Supplement policies and a score of 50 for all other policies B The text must achieve a minimum score of 50 on the Flesch reading ease test for all policies C The text must achieve a minimum score of 40 on the Flesch reading ease test for all policies D The text must achieve a minimum score of 50 on the Flesch reading ease test for Medicare Supplement policies and a score of 40 for all other policies
D. The text must achieve a minimum score of 50 on the Flesch reading ease test for Medicare Supplement policies and a score of 40 for all other policies To meet readability requirements, the text must achieve a minimum score of 50 on the Flesch reading ease test for Medicare Supplement policies and a score of 40 for all other policies.
Which of the following is true about applications for a permanent resident agent license? A They may be made online, by mail, or in person at the Insurance Department B They must be made in writing, by mail C They may be made online or by mail D They must be made online
D. They must be made online
