CO Life & Health State Laws
If a producer is the subject of criminal prosecution in any jurisdiction, the producer must report to the Commissioner after the initial pretrial hearing date within what time period? 60 days 30 days 10 days 12 months
30 days
An employee, dependent, or member that is eligible for group conversion must apply and pay the premium for the converted policy within how many days, after the termination of coverage?
31 days An employee, dependent, or member covered for at least 3 months under group policy coverage is terminated is entitled to a converted policy, without evidence of insurability, effective the day after group coverage terminates. They must apply and pay the premium for the converted policy within 31 days after the termination of coverage.
What is true regarding interest on life insurance proceeds?
An insurer must pay interest on death benefits from the date of the insured's death through the 30th day following the date the insurer receives the claim, unless the beneficiary elects not to receive the proceeds in a lump sum (The interest is paid through the 30th day following the date the insurer receives the claim, unless the beneficiary elects not to receive the proceeds in a lump sum, not if the beneficiary elects to not receive the interest payment. The interest rate is specified by law.)
Each applicant for an insurance license must provide evidence to the Commissioner of completion of the following: At least 24 hours of an approved course including 3 hours of ethics At least 50 hours of an approved course and an additional 3 hours of ethics At least 50 hours of an approved course including 3 hours of ethics At least 24 hours of an approved course and an additional 3 hours of ethics
At least 50 hours of an approved course including 3 hours of ethics
Each of the following are requirements for licensure, except:
Being at least 21 years of age
The Commissioner may revoke, suspend, or refuse to renew a license for each of the following, except: A) Cheating on an insurance exam B) Being charged with a felony C) The agent is untrustworthy or incompetent D) Failing to pay court-ordered child support
Being charged with a felony (The Commissioner may refuse, suspend, revoke, or non-renew a license if the agent demonstrates a lack of trustworthiness or competence, if they cheat on an insurance examination, or if they fail to pay court-ordered child support. However, being charged with a felony is not enough for the Commissioner to take action against the license; it is only if the agent is convicted of a felony that the Commissioner may act against the license.)
The Commissioner will issue what to all insurance companies that have complied with Colorado laws and authorizing it to do business?
Certificate of Authority (Every insurer must first be approved by the Commissioner who will issue a Certificate of Authority stating that the requirements of the laws of Colorado have been complied with and authorizing it to do business.)
A license can be suspended or revoked by the Colorado Insurance Commissioner under what conditions?
Completed the license application with incorrect, misleading, incomplete, or materially untrue information (After conducting a hearing, the Commissioner may revoke, suspend, or refuse to renew a license if they discover a reason that would have prevented its issuance, or if the licensee has violated any provision under state law, or has failed to pay state income tax or child support.)
Obtaining an insurance license for the sole purpose of writing insurance on the life or property of one's employer constitutes what?
Controlled business (Controlled business is procuring insurance on the life of the producer's self, spouse, or employer, and is punishable by license nonrenewal. Controlled business is procuring insurance on the life of the producer's self, spouse, or employer, and is punishable by license nonrenewal.)
The Commissioner can impose a penalty for all of the following, except a person who has: Failed to pass the licensing examination Engaged in an unfair trade practice Not surrendered his/her license Surrendered his/her license
Failed to pass the licensing examination
What is correct regarding maternity coverage?
Group health policies must cover normal pregnancy on the same basis as any other condition (Pregnancy coverage cannot be denied for unmarried women, and coverage must be provided for at least 48 hours inpatient care following a vaginal delivery and at least 96 hours following a caesarean delivery.)
If the Commissioner suspects that a license holder has violated state law, the Commissioner may revoke, suspend, or refuse to issue or renew such person's license by:
Holding a hearing
Penalties
If, after a hearing, the Commissioner finds the person charged has engaged in an unfair method of competition, deceptive act or practice, or has violated any other rules or laws, the Commissioner will: Provide the findings in writing and issue a Cease and Desist Order Impose a civil fine up to $3,000 per unintentional violation and up to a maximum of $30,000 for all unintentional violations. Fines for knowing violations are $30,000 per violation and have a maximum of $750,000. Suspend or revoke a license, if the licensee knew or should have known a violation was being committed Order payment of a claim not paid because of the violation, unless a civil action concerning the claim is pending Any order issued as a final action by the Commissioner may be appealed and subject to judicial review by the Court of Appeals. Violating a Cease and Desist Order is punishable by a fine of up to $500 per violation of an individual or up to $10,000 per violation of an insurer and/or license suspension or revocation.
Concerning license suspension and revocation, the Commissioner can take all of the following actions, except: Notify the producer of any license suspension, revocation, or termination Notify the NAIC of any license suspension, revocation, or termination Notify the Attorney General or District Attorney of criminal violations of the insurance code Impose a civil penalty of $1,500 per violation, up to $10,000 per fine in addition to, or in lieu of, license termination
Impose a civil penalty of $1,500 per violation, up to $10,000 per fine in addition to, or in lieu of, license termination
The Commissioner can refuse, revoke, or non-renew a licensee has committed any of the following, except: Failed to pay child support Cheated on an insurance examination Had a license suspended or revoked in another state Issued insufficient coverage to a customer through apparent authority
Issued insufficient coverage to a customer through apparent authority
What is NOT an unfair claims practice?
Promptly acknowledging communications pertinent to a claim (Promptly acknowledging communications pertinent to a claim is required with respect to claim practices.)
Offering anything such as a rebate, premium discount, credit, service or anything of value that is not specified in the policy is considered?
Rebate (Rebate - Offering any rebate, premium discount, credit, service, advantage, favor, or anything of value that is not specified in the policy.)
What is correct concerning coverage for Hospice Care and Home Health Care?
This coverage must be automatically included (Coverage must be offered to insureds, but is not automatically included.)
All of the following are preventive health care services, except: A) Influenza vaccinations B) Weight loss intervention C) Tobacco cessation intervention D) Cholesterol screening
Weight Loss Intervention (Weight loss intervention is not a preventive health care service.)
The definition of a Colorado producer includes which of the following? A person who solicits or negotiates membership enrollments in a health care plan An employer, association, or trustee administering its own employee benefit program that uses insurance A nonresident licensed to sell or negotiate commercial property and casualty insurance policies in another state An insurer
A person who solicits or negotiates membership enrollments in a health care plan
Insurance Commissioner
The Commissioner is the head of the Division of Insurance and is appointed by the Governor and confirmed by the State Senate. The Commissioner must be well versed in insurance and have no financial interest in any insurance agency or company other than as a policyholder. The Commissioner also can hire employees to help carry out the duties of the office.
Entire contract is defined in what statement?
The individual health insurance policy, including the endorsements and the attached papers, if any (The individual health insurance policy, including the endorsements and attached papers, if any, which constitutes the entire contract of insurance constitutes an entire contract.)
Each of the following is a component of the legal responsibility of maintaining an insurance license, except: A producer must inform the Commissioner of any change in address within 30 days The producer must be given a copy of the termination within 15 days of the Commissioner's notification, but has 30 days to file comments about that termination with the Commissioner A producer must register any assumed name in writing to the Commissioner within 30 days of use An insurer must notify the Commissioner within 30 days of terminating a producer's appointment
A producer must register any assumed name in writing to the Commissioner within 30 days of use
Which of the following statements is true? A) An insurer may describe an enrollment period as "special" even if it usually sells its policies by successive enrollment periods B) The mail-in date for an application must be between 10-40 days after the initial advertisement of an enrollment period C) An advertisement may say that purchasers pay a lower price for a policy sold by direct response because no agent is involved in the sale D) When an enrollment period ends, a new one may begin in 3 month
The mail-in date for an application must be between 10-40 days after the initial advertisement of an enrollment period (The mail-in date may not be less than 10 nor more than 40 days after the initial advertisement.)
Financial Statements
All insurance companies doing business in Colorado must file an annual financial statement with the Commissioner annually by March 1st of each year. This is a detailed statement summarizing the assets and liabilities, amount of business transacted, premiums collected, claims paid, returned premiums, and the amount of reinsurance accepted from admitted and nonadmitted insurers for the previous calendar year. This statement is made under oath and must be provided on what is known as the convention blank form, which is adopted from year to year by the National Association of Insurance Commissioners (NAIC). The Commissioner may require an insurer to file interim financial statements and reports monthly or quarterly as deemed necessary to protect public interest. Authorized insurers are required to file the convention blank form with the NAIC annually along with additional filings as prescribed by the Commissioner.
What is an acceptable participation requirement for small group insurers?
It is acceptable to apply minimum participation requirements to only employee-determined eligible employees (Small employer insurers may apply minimum participation requirements to employee-determined eligible employees. Small group employers cannot increase participation requirements for a small employer after issuing coverage, use case characteristics other than age and geographic area, or family composition in rating.)
Hearings
To protect the public, the Commissioner may examine and investigate the business affairs and conduct of every person applying or holding a license to determine whether a person has been or is engaged in the violation of state insurance laws or an unfair or deceptive act, practice, or method of competition. Based on information regarding the possible violation, the Commissioner may issue a statement of charges and hold a hearing. Such person may be required to appear and show cause as to why the Commissioner should not refuse, suspend, revoke, or continue such person's license. The Commissioner can refuse, suspend, revoke, or non-renew the license of an agency or business entity if, after a hearing, it is found the agency or business knew or should have known of its partner's, officer's, or manager's violation of state law and neither reported it nor took corrective action.
Examinations
An examination is a formal or informal financial or market conduct assessment or investigation conducted by the Commissioner to determine compliance with Colorado insurance laws. Market conduct examinations can include routine, targeted, follow-up, multi-state, or desk examinations. Examiners must follow guidelines and procedures set forth in the Colorado insurance examiner's handbook as adopted by the NAIC. An examination or investigation of any person (individual, association, corporation, partnership, or agency) can be conducted at the sole discretion of the Commissioner as frequently as deemed appropriate; however A formal financial examination of every licensed insurer must be conducted not less frequently than once every 5 years An examination is not limited to the financial condition of a company, and also can include all other activities and affairs of the company. Every person from whom information is requested must provide timely, convenient, and free access during reasonable hours at its offices of all books, records, accounts, papers, tapes, computer records, and other documents relating to the property, assets, business, and affairs of the company being examined. The Commissioner and all examiners have the power to issue subpoenas, administer oaths, and examine under oath any person regarding any matter pertinent to the examination. The refusal to submit to examination or comply with any reasonable written request of the examiners is grounds for suspension, revocation, denial, or nonrenewal of any license or authority. Upon the failure or refusal of any person to obey a subpoena, the Commissioner can petition a court of competent jurisdiction for an order, which is enforceable through: Contempt proceedings Compelling the person to appear and testify; or Produce documentary evidence A person who knowingly testifies falsely to any matter related to an investigation, examination, or inquiry is guilty of a misdemeanor and, upon conviction, will be: Punished by a fine up to $5,000 and/or Imprisoned in the county jail up to 3 months The reasonable expenses and charges for the cost of the examination will be paid by the person being examined (examinee) directly to the examiner(s). The cost of financial examinations outside of the state will be paid by the examinee and will include the expenses of the Commissioner and staff.
The requirements for insurance licensing DO NOT include what?
Is at least 21 years of age (An individual applying for a license must be at least 18 years of age, complete the prelicensing course, and pass the state licensing examination.)
Power and Duties
The Commissioner has the power to administer the insurance laws of the state. The Commissioner may establish and amend reasonable rules as necessary to carry out duties. Filing and safeguarding all books and papers required by law Issuing Certificates of Authority to insurance companies that have complied with Colorado's laws: Before receiving a Certificate of Authority, the Commissioner must certify that the insurer is in compliance with Colorado laws and is authorized to transact insurance in this state The Certificate of Authority must be renewed annually as long as the insurer continues to comply with the law Require all authorized insurers to keep books, records, accounts, and vouchers to verify annual statements to determine solvencyInsurance companies doing business in Colorado must file an annual financial statement Any insurer who fails to file required documents or maintain complaint records may be assessed a penalty of up to $500 for the first violation and up to $5,000 for any subsequent violations Issuing, denying, revoking, or suspending licenses or Certificates of Authority as required by Colorado's law Supervise the business of insurance in a manner that is in the best interest of the general public and to protect policyholders Transmitting all fees, surcharges, costs, taxes, penalties, and fines collected by the Division of Insurance to the Department of the Treasury Enforcing state insurance laws; the Commissioner does not make the laws Conducting investigations and hearings to determine if anyone involved in the insurance business has engaged in any unfair method of competition, unfair or deceptive act or trade practice, or has violated the insurance laws in Colorado If violations justify such action, the Commissioner must present the results of investigations and examinations to the district attorney or proper judicial district for possible criminal investigations Establishing effective procedures for examining the activities, operations, financial conditions and affairs of anyone transacting insurance, as determined by the general assembly Examining the financial condition and affairs of authorized insurers whenever it's necessary, but no less than once every 5 years Managing insolvency procedures Ensuring that rates are adequate, as opposed to being excessive, inadequate, or unfairly discriminatory; the Commissioner does not set the rates