Marketplace Part 3 - Section 4

Under the False and Fraudulent Claims Article, if a person is convicted of insurance fraud, the fine can be up to:

$150,000.

All the following are true concerning conviction of insurance fraud. twice the amount of the fraud if greater 5 years in state prison is the max. $150,000 fine is the max except:

$10,000

Salary continuation plans:

The business can set the plan up with a 3rd party.

Which of the following would not be a method of how much insurance is needed?

agent needs approach. never based on what an agent needs.

Which one is the least practical method of managing risk?

avoidance.

Every insurer must pay the claim within what time period after all the parties are in agreement of the amount of the claim?

30 calendar days. Once all the parties are in agreement the insurer has 30 calendar days to render the claim payment.

All the following are true concerning fraud or are examples of fraud?

50% of all auto claims reported are fraud.

Which of the following statement is true?

Disclosing results of a genetic test in a manner that provides identifying characteristics is submit to a fine.

An insured's consent to receive offers, notices, or disclosures by electronic transmission may be acquired:

Electronically In writing Verbally all of the answers are correct

Concerning fraud the false statement would be:

Every insurer must maintain their own fraud unit to investigate fraudulent claims from other insurers.

Which of the following is incorrect regarding any written notice required to be given or mailed to a person by an insurer relating to any insurance in this state may do so by electronic transmission:

Insurer shall keep a retrievable copy of the confirmation and/or signature while the policy is in force and for up to 3 years after.

Per the Code, the best definitions of "shall" and "may" are:

Mandatory & permissive Shall means "mandatory" (must) and may means "permissive" (can).

All the following are examples of unfair discrimination. religion national origin race. exept:

Sex

Limit of liability in life insurance is what?

death benefit. The face value/amount or death benefit of an individual life insurance policy.

There are 3 provisions that the code protects people with group life and disability:

discontinuance replacement coverage extension of benefits

All the following beneficiaries receive the death benefits exempt from probate: spouse. charity. children. except:

estate

All the following are examples of fair discrimination: smoking. hobbies age except:

religion

All of the following are false regarding mailing requirements on Life Policy information, send to applicant. send to beneficiary. send to insured. Except:

send to owner

Which one bests describes key person insurance?

to protect business in case of death of employee. The purpose of key person insurance is to mitigate the loss to the business due to the death of a key employee.

Any insurer has how many days to accept or deny a claim?

40 calendar days.. Insurers have 40 calendar days to accept or deny a claim.

The primary purpose of key person life insurance is to protect:

A business against the financial loss of an important executive or employee.

The CLHIGA does not provides protection against insolvency for all of the following.

MEWAs Stop loss plans, Self funded plans

All the following are important reasons why people buy life insurance. Which is the most important reason?

because someone needs to keep on living

All the following can be the insured except:

beneficiary

There are 3 provisions that the code protects people with group life and disability which is not one?

Subrogation is not one of the three provisions.

The CLHIGA would cover which of the following?

Life insurance contracts

Every licensee who receives an inquiry from the DOI concerning a claim must furnish a complete written response, including any documentation and claim files requested within:

Within 21 calendar days. The agent has 21 calendar days to get the required information to the DOI concerning a claim.

A life, health, or disability insurer can discriminate based upon:

Age and sex of the proposed insured.

This is an estimate of the financial loss caused by a person's death using the present value of future earnings:

Human life value approach to life insurance. This is an estimate of the financial loss caused by a person's death using the present value of future earnings, and was developed by Solomon Huebner in the 1930s. In calculating the Human Life Value Approach, the following must be considered: probable future earnings, inflation, the number of years to retirement, and the time value of money.

California law requires that the insurer provide falsification information to a person filing a claim by:

Prominently printing the information on the claim form.

Any carrier that provides replacement coverage for hospital, medical or surgical benefits within 60 days of discontinuance of a prior policy must:

Cover all employees and dependents that were validly covered under the previous policy at the time of discontinuance.

Which statement is true concerning definitions for the words "shall and may"? the word shall means permissive the word may means mandatory neither are true

neither are true

Which one of the following is a classification upon which risk and insurability are present?

Location of the home.

All the following are true concerning life and health guarantee association except:

not more than $250,000 in health insurance benefits. $250,000 max paid for a single health policy

The CLHIGA provides protection for insolvency of member life and health insurers for which of the following limits?

$250,000 per one insured life.