Illionis accident and health insurance

Penalties for illegally, withholding, or misappropriating fiduciary funds

-$150 or less has a penalty of a class a misdemeanor -$150 or less repeatedly is a class for felony -$150 or more is a class three felony

The bill on my wife and health insurance guarantee association liability is to the amount of the policy limits or regardless of the number of insurance policies as follows

-$300,000 in life insurance benefits -$100,000 in cash surrender and withdraw values -$250,000 in present cash value of annuity benefits -$300,000 and health insurance benefits -$5 million in benefits irrespective of the number of contracts with respect to the contract owner or plan sponsor

Producers license requirements, pre-studying requirements

-20 hours per line of authority, example life, accent and health, property, casualty, or personal lines. With a minimum of 7 1/2 hours of classroom instruction. -12 1/2 hours for motor vehicle insurance with minimum of 5 hours of classroom instruction

Business entity license

-A business entity is a corporation, association, partnership, LLC, LLP, or other legal entity -Acting as an insurance producer, the entity must obtain an insurance producer license -One license producer must be designated as a pottery, responsible for insurance compliance with the insurance laws and rules of Illinois

Group health insurance, discontinuation replacement requirements, extension of coverage benefits, if injured is totally disabled on the date of policy discontinuation

-HMO or hospital medical expense plans • Earlier of the end of the 12 months, the date, the maximum benefit is reached, or the end of total disability -Hospital, medical or surgical expense is only planned • the earlier end of the 90 days, the date maximum benefit is reach, or the end of total disability

House care maintenance plan HMO's are domestic companies when they are organized under

-Illinois law or -The law of another state and 30% or more more of the enroll is our resident of Illinois

The Director may issue a temporary producers license for up to 90 days provided to the appointee going through the following

-It's going through the agent licensing process -Is enrolled in pre-licensing classes -Has paid applicable fees

Illinois life and health insurance guarantee association. The association maximum liability for anyone's life as follows.

-Life insurance death benefits $300,000 -Life insurance net, cash, surrender, and withdraw value $100,000 -Present value of annuity benefits, $200,000 -Health insurance benefits $300,000 -any benefit introspective of the number of contracts respect to the contract owner or sponsored plan $5 million

Penalty for selling, unapproved, Medicare supplement policies as a class, three felony along with a maximum fine of

$10,000

Up to $ ___ fine for violating a written order issued by the director

$20,000

Bi annual licenses fee

$215 resident $380 non resident

Finds per offense of Medicare supplement law

$500 - $5,000

Pre-license study requirements

-20 hours per line of authority -minimum of 7 1/2 hours minimum for hours in classroom

Nonresident license

-The Director may issue an insurance producers license to qualified non-resident producers -The person must be currently licensed and good standing in his rehearse state of residence -The person must submit the proper application and application fees -The state award insurance to the producers licensed to Illinois producers on the same basis, a.k.a. reciprocal agreement

Bond required for producers, acting as brokers

-The greater of $2500 or 5% of premium broker in the previous year

Civil penalties for insurance license violations

-maximum of $10,000 for each cause -maximum of $100,000 for all causes

All producers are engaged in the sale of annuities must complete

A one time four hour credit, and annuity coures

Small employer, healthcare plans

A small employer is a firm, corporation or association, with employers, at least, but no more than 50 employees -Pre-existing conditions may not exceed 12 months after the enrollment date

Policy summary

A written statement, which may not be combined with a bonus guide that describes the basic and policy

Accelerated benefits eligibility

An insured must have either a terminal illness or result in death within 24 months, or has a condition that requires continuous skilled nursing care in an eligible institution until death

Fiduciary

When a producer receives premium in the process of selling insurance, these funds are considered to be held in fiduciary or trust capacity

Unfair trade practices, defamation

it is illegal to make any statement, written or oral that is falsely malicious critical of the financial condition of an insurance company, or a producer representing that company -violators of the section are subject to find between $200-$10,000

Temporary non-producer license

-The Director of insurance me issue, a temporary non-producer license for up to 180 days without requiring an examination, if necessary for the service scene of insurance business in the following cases -death or disability of a licensed producer -Active military service of a licensed producer

Examine records for ensures by the director of insurance for INSURERS

-The Director, my exam on the records of any domestic insurance company to determine the insurer financial condition in compliance with insurance laws and regulations -Domestic insurance must be examined at least once every five years -violators may request hearing within 10 days of receiving an examination report -The Director must issue a written order within 90 days of the hearing -Maximum penalty for violation order is $2000

Guarantee association

-The purpose of Illinois life and health insurance guarantee association is to provide the payment of covered claims of insolvent insures -ensures and producers may not use the existence of the association for the purpose of sign forms of insurance coverage by the association

Resident insurance

-The venting exam consist of two parts, general knowledge and state specific knowledge -Both parts must be passed within 90 days of each other -Licenses are issued for two year. Period. -license must contain the licenses name, address, licensed number, and national producer number, date of issue, line of authority and expiration date of license

An insurer is not required to present an application with a copy of the notice to applicant regarding replacement of accident and health insurance before issuing

-accident only policies Where is required: -major medical insurance -surgical expense policies -basic hospital policies

Accident and health advertising

-advertising includes print, publishing and auto visual materials, descriptive, literature, radio and television, scripts, billboards, illustrations, for wonders, sales, and presentations. -penalties for advertising violates range from $200 to a maximum penalty of $10,000

Suspension or revocation of license

-applicant or licensee must receive a written notice of reasons to non-renew, suspend, or rev vocal license -Hearing may be requested within 30 days of the notice that must be held within 20 to 30 days of mailing the notice of the hearing -civil penalties for up to $10,000 per or $100,000 for all causes may be levied -A person is in eligible to apply for any license since for three years following revocation, suspension or denial

Producers license requirement, an applicant for a producers license must

-be 18 years old -be sufficiently rehabilitated in cases of any previous committed acts that are grounds for denial, suspension or revocation of license, other than being convicted of a felony -complete licensing course of study for lines of authority for which the person has applied -Pay required fee -Past licensing examinations for lines of authority which the individual has applied

Licensed exemptions and officer, Director, or employee of an insurer or an insurance producer is exempt if

-commissions are not received on policy sold in Illinois -activities are executive, administrative, managerial, or clerical and indirectly, relate to insurance sales -Activities are related to underwriting, lost control, inspection, adjusting, investigation, or settling claims -Supervisor activities do not include selling, soliciting, or negotiating insurance

Grievance procedures for HMO's

-determination of grievance must be made within 60 days of the date of receipt -Records must be retained for at least three years

Replacements, a replacement is a transaction in which life insurance or an annuity is to be purchased, and as a part of the transaction, existing life insurance needs to be

-elapsed, surrendered, forfeited, or otherwise terminated -Converted to reduced paid up insurance or extended term insurance -Amanda to reduce benefits or term coverage -reissued with a reduction and cash value -used in a financed purchase

continuing education units (CEUs)

-every resident producer must complete 24 credit hours of CE every two years -At least 3 credit hours must be consistent of approved as its course delivered in a classroom -Records of courses must be kept for 3 years

Limited health service organizations LHSO

-evidence of coverage • and Rollies must receive evidence of coverage within 30 days from the effective date of coverage or when the LHS receive notification of enrollment -Complaint resolution • And LHSO must respond to a complaint within 21 days after receiving a notice from the department of insurance

Unfair claims practices penalties

-failure to obey a cease-and-desist order by the Director may result in the following -Reflection of a company certificate of authority for six months -A civil penalty up to $250,000 -A combination of both

Cease-and-desist orders are for violation of insurance statues

-hearings are held 20 to 30 days from the date of hearing notice -Penalties -$100 per day as each violation continues -$5000 maximum fine -revoke or suspension of certificate of authority or license

Controlled business is insurance procured, or through a person upon

-his own life, person, property, or risk, or those of his spouse or -The life, person, property, or risk of his employer, or own business

Unfair claim settlement practices

-knowingly, miss, representing irrelevant facts, or policy provision, to claimants or insured -Failing to acknowledge communications regarding claims -failing to implement procedures for the prompt investigation and settlement of claims -Refusal to pay claim so that conducting a reasonable investigation -Feeling to offer more denied coverage with a reasonable amount of time after completing a claims investigation -Not attempting a good faith to bring about prompt, fair, and equitable settlements of claims submitted in which liability has become reasonably clear -insured to institute suits to recover amounts due under their policies by offering substantially less the amount ultimately recovered in suits brought to them -Attempting to settle claims for amount the insured was reasonably led to believe they were entitled to -Claim payments without indicating the coverage under which each payment is being made -Denying or offering compromise settlement without a prompt explanation for such actions -unreasonable delay, claims investigation or payment by requiring both formal proof of loss and subsequent verification that duplicate information -To settle claims promptly where liability has become recently clear under proportion of insurance coverage in order to influence settlement under other portions of insurance policy -to promptly provide a explanation for the basis of denial of a claim

Viatical Settlement

-licensing: a license is required and is renewable annually by submitting $1500 fee to the director -Reports: annual reports must be filed by March 1 -Training initial for our course with waste four hours over a 24 month Period. -penalties $50,000 per violation of cease and desist order

Required provisions for HMO's

-maternity care, including pre-and postnatal care -emergency medical services, 24/7/365 for accidental injury or emergency illness -Rehabilitation services for alcohol or drug abuse for addiction on an impatient basis for 24 days per year or an outpatient basis for 60 visits per year -Preventative healthcare services appropriate to the patient -Blood transfusion services -diagnostics, imaging, pathology, service and radiation therapy

Life insurance illustrations must include the following

-name of insurer -The name and address of the insurance producer -The age and gender of the proposed insured -Rating classification -Initial death benefit Illustrations may not include the following -Representation of a policy other than life insurance -description non-guaranteed element, confusingly or provide any incomplete information to the applicant

Examination records by the Director of insurance for producers

-our Director may examine records of any license, insurance, producer, temporary insurance, producer, limit, lines, producer, or any business, entitled to ensure compliance with insurance laws and regulations -Violators may request a hearing within 14 days of receiving an examination report -A Director must issue a written order within 90 days of the hearing -violation is $20,000

at the time of application, all applications for accident and health insurance except policies issued by direct response insurer must be given

-outline of coverage

Long-term care insurance

-policies are designed to provide coverage for at least 12 consecutive months -Policyholders of the right to return free look the policy within 30 days for a full refund -in covered by the group policy for at least six months prior to plan termination has 31 days to convert into an individual policy without providing proof of insurability

Replace all producers who initiate replacement must

-present an important notice regarding my placement of life insurance to the applicant and have it signed -provided an application with copies of any sales proposals used and -submit an important notice regarding replacement of life, insurance and copies of all sales proposed, signed by the applicant to the replacing ensure

Advertising and sales ad advertising includes all of the following

-printed in published material -Descriptive literature used indirect mail -There was paper and magazines -Radio and television, scripts -Billboards -Prepared sales tax and presentations -Materials use for recruiting, training and educating sales personnel -ensures must maintain an advertising file for four years or until the next examination whichever is longer

The Director can suspend or refuse issue, or renew license to a producer who

-provides incorrect, isolating, and complete or materially untrue information in the license application -Riley, any luck, rule, regulation, subpoena, or order of Director, or another state director -License by fraud or misrepresentation -Cheat on the licensing exam -Failed to pay child support -Failed to pay federal or estate income tax -appropriate Monet or properties received in the course of doing insurance business -Potentially must represent the terms of insurance contractor application for insurance -Was convicted of a felony -Admit to, or was found to have committed any insurance unfair practices -use fraudulent or dishonest practices or demonstrate incompetence, untrustworthiness, or financial irresponsibility in the conduct of business -Had a insurance producers license, denied, suspended or revoked in any other state -For another person name and insurance contract -excepted insurance business from an unlicensed individual

A Medicare supplement

-ready to return free, look provision • the applicant has a right to return a policy within 30 days of delivery, if not satisfied for any reason -coverage pre-existing conditions restrictions any coverage may not be excluded for pre-existing conditions longer than six months from the day of the policy issued

Change of address why he must informed the Director within 30 days of any of the following

-resident address -Business address -Mailing address -Email address

Group health insurance policies must provide extended benefits to insured who are disabled at the time of policy discontinuance until the earliest of any of the following occurrences EXCEPT

-the end of the policy conversion period Not: -the end of 12 months -the end of the total disability period -the date the maximum benefit is reached

Which of the following statements concerning grandfathered individual accident and health insurance policies is CORRECT?

-they may exclude podiatry care, including flat feet, fallen arches, corns, or calluses NOT: -there is must not be territorial limitations -they must include a provision covering pregnancy -they must include a provision covering eyeglasses and hearing aids for adults

Continuing education requirements

-total of 24 credit hours every two year licensing. -includes 3 credit hours required of ethics per licensing.

Maximum penalties

-unfair claims practices $250,000 -Misrepresentation $10,000 -Defamation $10,000 -Unfair, marketing practices per violation $1,000

Reinstatement of license of producer, who allows her I sent two laps may have it reinstated

-within 12 months after the past due date of the renewal fee -without passing a written, examination and pain, a penalty of double unpaid renewal fee

Companies may request hearings within ___ days of receiving an examination report

10 days

Licenses may be reinstated within ____ months after due date of renewal

12 months

Long term care insurance, maximum pre-existing exclusion period

12 months

Long-term care insurance minimum benefit.

12 months

Producers may request hearings within __ days upon receipt of a report

14 days

Minimum age for licensed producer

18 yrs old

The Director of insurance may issue a temporary non-producer license for a maximum of _____ days to a surviving spouse, business, partner, or employee, if the producer dies becomes too disabled, or is called into active duty military service

180 days

An accident or health insurance policy may not be rescinded, except for fraud after it has been effect for

2 years

Grievance records must be kept for how many years for health maintenance organizations

3 years

Change of address must be reported within...

30 days

Long-term care insurance, right to a free look provision

30 days

Medicare supplement insurance is entitled to a right for a free look period of

30 days

Non-Resident Producer must file change of address within moving to another state

30 days

Producers must report felony convictions to the Director of insurance within ____ days

30 days

When a resident producer, nonresident producer moves to another state the producer must file a change of address, and provide certification from a new state of residence within how many days of changing legal address

30 days. No fee or license application is required.

Health maintenance organization, and HMO is a domestic company when it is organized under the laws of another state and blank percent or more of enroll are Illinois residence

30%

Long-term care insurance rate to recover group contract to an individual contract without proof of insurability

31 days

The director must examine an insurer at least every _____ years

5 years -maximum fine for refusal to submit to an examination = $2,000

Minimum inflation, protection percentage offered by ensures for long-term care insurance is a rate of

5%

Small employer healthcare plans, has at least two, but no more than how many employees

50

A temporary producers license may be issued for a _____ days provided to the applicant is currently rolled in a pre-licensing course

90 days

Applicants must pass both parts of the licensing exam within ___ days

90 days

Buyers guide

A document describing my insurance from a buyers perspective

Unfair, trade practices, boycott

A group that avoid a certain company or producer to steer business to other companies or producers

Medicare supplement outline of coverage

And ensure must give perspective, applicant and outline of coverage at the time of application

Individual Health Insurance

Disclosure requirement -10 day free, look provision -Outline of coverage must be provided at the time of application application Replacement requirements -applicants must be furnished with a notice of application regarding replacement of accident and health insurance -replacement notice are not required with accident only or single premium non-renewable policies

Unfair trade practices penalties

Failure to obey season cyst order by Director will offer a fine of $1000 for each violation

Un fair trade practices coercion

Forcing a person to buy an insurance through a particular company or producer

Life insurance cost index

Hypothetical amount re-representing the final cost of life insurance policies that surrendered before death immaturity

Unfair trade practices, rebating

Illegal inducement -Offering valuable consideration live in which is offered in the contract as an inducement to purchase a policy is illegal -rebating includes kickbacks of commissions, extra ordinary gifts, payment of consulting fees, or offering to pay the insureds premium

Unfair trade practices, unfair, discrimination

It is illegal to unfairly discriminate between individuals of the the same class and equal life, expectancy rates, dividends, benefits, or terms of any life or life annuity contract -Jun for discrimination between neighborhoods with unity and of essential the same hazard, or the use of sexual orientation and under reading process or in determining and true ability

Licensing fees, and bond requirements

Licensing fees are paid over two years -$215 for Illinois residence -$380 for non-residence

Required provisions, right to return free look period

Life policies is not contained attend day right to return or free, look provision

Insurers must provide a 20 day free look period

New policies only get a 10 day, free, walk provision -copies of notifications regarding replacements must be retained for at least three years

Replacing insurance must within three working days

Notify each existing and share, who is being replaced

Required provisions, Grace period

Premium must be paid within 30 days or one month of the due date

Maximum pre-existing conditions exclusion period for long term care insurance.

Six months

The Director of insurance

The Director is appointed by the governor -Duties include the following conduct, investigations and examinations. -Right reasonable rules and regulations not was. -Impose penalties, such as fines, suspensions, and revoke. -Approve insurance, policy forms, rates, and rate increases. -Issue insurance, licensing, and certificates of authority.

Total times of premium from controlled business either one year, after issuance of a license or two years prior to renewal may not exceed

The total amount of premiums on all other insurance business

Unfair trade practices, intimidation

The use of words are actions to make a consumer pay and insurance policy from a producer

All HMO must have a certificate of authority from the department of insurance

True

Medicare supplement penalties

Violation of penalties will result in fines from $500-$5000 for each offense -Selling policy is not approved by the Director is a class three felony if unknowingly fireworks will be fined up to $10,000

Reporting, actions and insurance producer, who is convicted of a felony, must report the conviction to the director

Within 30 days of the judgment

Required provisions settlement

death claims must be settled within two months -interested cruise at 10% annually on Mountain Dew beyond 30 days

cease and desist order from the director of insurance

•maximum fine each day of voilation -$100 •maximum pentaly in total -$5,000