PA Laws & Rules
In a long-term care policy, the right-to-examine period is
30 Days
A licensed producer must report any administrative action taken against the licensee in another jurisdiction or by another agency department in Pennsylvania within how many days of the final disposition?
30 days
In accident and health plans, premiums paid less frequent than monthly require a minimum grace period of at least
31 days
In Pennsylvania, accident and health plans are required to provide mammograms for women starting at age
40
As of January 1, 2014, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of ___ of the premiums paid by the employer.
50%
In Pennsylvania, a specified disease accident and health plan must provide a minimum benefit in the amount of
$5,000
If a Medicare Supplement policy replaces another that had been in effect for at least 6 months, the replacing policy may impose which of the following time exclusions for pre-existing conditions?
0 months
Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within
10 days
The free look period provided in a life insurance policy is usually
10 days
A Pennsylvania temporary producer may be issued for a period not to exceed
180 days
According to Pennsylvania law, postnatal care must be delivered within how many days of discharge?
2 days
A life insurance policy becomes incontestable after it has been in force for
2 years
In Pennsylvania, the definition of total disability changes from one's "own occupation" to "any occupation" by reason of one's education, training, and experience after what period of time?
24 months
Producers must complete a total of ____ Continuing Education credits for each two-year licensing period.
243
An accelerated death benefit in Pennsylvania must be at least what percentage of the total death benefit?
25%
In Pennsylvania, the Time Limit on Certain Defenses provision provides that no misstatements (EXCEPT fraud) made by the applicant on a health insurance application can be used to void the policy or deny coverage after the explanation of
3 Years
Within how many days must a producer report to the Commissioner any charges made against him/her?
30
Under Pennsylvania statute, first year commision for long-term care insurance may not be greater than
50% of the first year premium
No Long-Term Care policy may exclude pre-existing conditions for a period of more than
6 months
In Pennsylvania, an employee must request spousal coverage under a group sponsored accident and health plan within ____ days of marriage.
60
If a health insurance claim is not promptly paid, legal action may be taken against the insurer after
60 days from the date of loss is furnished
In Pennsylvania, HIPAA laws require that an individual's prior creditable coverage may reduce the maximum pre-existing condition exclusion period that a new group health plan can apply. This rule is applicable as long as there has been no gap in creditable coverage for a period greater than
63 days
In Pennsylvania, what's the requirement for a minor to receive proceeds from a death benefit?
A guardian must be appointed
A producer's license CANNOT be revoked without
A hearing given to the producer
A temporary license may be issued without state examination to all of the following EXCEPT
A prospective producer who is currently enrolled in a pre-licensing insurance class
Charging a client less premium than what is stated in their insurance policy is called
A rebate
For Pennsylvania Insurance Code violations, the Commissioner may assess a(n)
Administrative penalty
Group dental plans will frequently place a limit on annual benefits in order to minimize
Adverse selection
All of these are considered a form of advertising EXCEPT
An insurer's A.M. Best rating
A licensee may only sell, solicit, and negotiate insurance contracts on behalf of the
Appointing insurer
What is the difference between a long-term care partnership plan and a non-partnership plan?
Asset protection
In order to solicit insurance in Pennsylvania, all of the following is required EXCEPT
Be at least 21 years of age
According to Pennsylvania law, which of the following is NOT considered to be personally identifiable financial information?
Blind trust at that does not include names and addressees
What are the levels of coverage as defined by the Affordable Care Act?
Bronze, SIlver, Gold, and Premium
In Pennsylvania, who is responsible for continuing education (CE) course content approval?
Commisioner
In Pennsylvania, which of the following is NOT something a licensee must do to renew their insurance license?
Confirm previous exam scores
Which of the following does restorative dental treatment cover?
Crowns
Which prohibited act involves a producer spending a client's insurance premiums for his/her own personal use?
Embezzlement
When soliciting insurance, a producer CANNOT
Emphasize Guaranty Association benefits
Violations of US Code Title 18 section 1033, may result in
Fine and/or imprisonment
When collecting insurance premiums from a client, a producer MUST
Forward premiums to the insurer on a timely basis
For licensing purposes, if an applicant has a home or office location in the state of Pennsylvania, this would be consistent with which of the following?
Home State
Sharing 50% of a producer's commission with the insured is an example of
Illegal Inducement
When a producer offers something of value in return for the purchase of an insurance policy, which prohibited sales practice has been committed?
Inducement
A long-term care plan must provide which of the following options for coverage in the state of Pennsylvania?
Inflation protection rider
A resident producer license requires each of the following EXCEPT
Insurer appointment
Commissions may be shared by
Licensed and appointed Producers
In Pennsylvania, completion of continuing education is required upon license renewal for which of the following
Licensed individuals qualified in major lines of insurance
Viatical settlement brokers are permitted to do all of the following EXCEPT
Make the first transaction up to 30 days before approved for a license
A producer who sells insurance in Pennsylvania but resides in another state is called a(n)
Non-resident producer
The document that describes policy features, benefits, exclusions and riders in a long-term care policy is known as the
Outline of coverage
In most dental plans, a deductible typically is NOT applied to
Preventative and diagnostic services
What is required before an insurance producer can act as a representative of an insurer?
Producer needs to be appointed by that insurer
The branch of dentistry which deals with the replacement of missing parts is called
Prosthodontics
What is the purpose of the Pennsylvania Lie and Health Insurance Guaranty Association?
Provide policyowner protection if an insurer becomes insolvent
Any of the following may be unfair claim practice EXCEPT
Refusing to pay persons bringing false or fraudulent claims
According to the Affordable care act, what metal tier is required to have an actuarial value of 70% with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features
Silver Plan
In Pennsylvania, no legal action may be taken against an insurer for failure to honor a valid claim after the expiration of how many years from the time proof of loss is furnished?
Three Years
When an insurance company consistently fails to provide reasonable explanations for the denial of a claim, this is called a(n)
Unfair claim settlement
Life insurance may make an immediate benefit payment before the insured dies in which transaction?
Viatical settlement
Agreements made by terminally ill persons to sell their life insurance policies at a discount in order to pay medical expenses are called
Viatical settlements
Pennsylvania law requires that an insurer must notify the Commissioner of a producer appointment termination
Within 30 days of termination
Holding premium funds for timely submission to the insurer is an example of
acting in a fiduciary capacity
The commissioner has the right and duty to
audit insurer financial reports and conduct market studies
A licensee can have his/her license denied or revoked by the commissioner if
the license has committed insurance-related fraud or dishonesty
A transaction in which a new life insurance policy is purchased and an existing life insurance policy is surrendered is called
Replacement
All statements in an insurance application, in the absence of fraud, are considered
Representations
Which of the following is the Pennsylvania Insurance Department NOT responsible for?
Shareholders
In Pennsylvania, an insurer may backdate policy issue not more than how many months from the date of a life insurance application?
Six months
A life insurance producer licensed in the Commonwealth of Pennsylvania is authorized to
Solicit, receive and forward applications to the insurer
A life insurance illustration showing future premiums paid out of nonguaranteed values must disclose that
The policyowner may need to resume premium payments depending on actual results