Texas Life and Health 5
Anyone who violates the Insurance Code of Texas may be fined up to
$25,000
In all health care plans under the Affordable Care Act (ACA), how many essential benefit categories are there?
10
How is emergency care covered for a member of an HMO?
A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area
An insured in a group policy has misstated his age on the insurance application. As a result, the insurer will most likely
Adjust the premium.
Which of the following is the closest term to an authorized insurer?
Admitted
All of the following would be considered rebating EXCEPT
An agent misrepresents policy benefits to convince a policyowner to replace policies
The insurers are allowed to disclose the HIV-related test result to all of the following EXCEPT
Another insurer.
An employee quits his job and converts his group policy to an individual policy; the premium for the individual policy will be based on his
Attained age
All of the following information must be disclosed to the viator prior to the execution of a viatal settlement contract EXCEPT
Availability of stranger-originated life insurance (STOLI)
Which of the following describes fixed-period settlement option?
Both the principal and interest will be liquidated over a selected period of time.
Which of the following best describes fixed-period settlement option?
Both the principal and the interest will be liquidated over a selected period of time
Which of the following provisions states the insurer's right to change premium amounts?
Continuation Provision
What is an important feature of a dental expense insurance plan that is NOT typically found in a medical expense insurance plan?
Diagnostic and preventative care
Which of the following terms is used to name the nontaxed return of unused premiums?
Dividend
The Commissioner has full power and authority to do all of the following EXCEPT
Draft insurance laws
How long is a newborn covered without notification to the insurer?
From the moment of birth, and the insurer must be notified within 31 days
Which of the following must be included in all life insurance advertisements?
Identity of the actual insurer
Which of the following best describes the MIB?
It is a nonprofit organization that maintains underwriting information on applicants for life and health insurance.
An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. This blindness improves a month later. To what extent will he receive Presumptive Disability benefits?
No benefits
Where in the policy must the HMO insurer provide information about the HMO's name address, and toll-free number?
On the face page
If a person is compensated for a testimonial in an advertisement, which of the following statements should be included in the advertisement?
Paid endorsement
All of the following are to be included in the application for a certificate of authority to act as an HMO EXCEPT
Records of previous insurers.
Which of the following would be required to obtain a Certificate of Authority?
The HMO
In a case where the primary beneficiary predeceases the insured, in the event of the insured's death benefit proceeds will be paid to
The contingent beneficiary
Who do agents represent?
The insurance company
Under a health insurance policy, benefits other than death benefits, that have not otherwise been assigned, will be paid to
The insured
An insured submitted a notice of claim to the insurer, but never received claims forms. He later submits proof of loss, and explains the nature and extent of loss in a hand written letter to the insurer. Which of the following would be true?
The insured was in compliance with the policy requirements regarding claims.
An individual applies for a life policy. Two years ago he suffered a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. He has also been hospitalized for drug abuse, but does not remember this when applying for insurance. The insurer issues the policy and learns of his history one year later. What will probably happen?
The policy will not be affected
An agent holds an insurance license in the state of Kansas and would like to transact insurance in Texas. The agent became licensed before written examinations were required. Therefore, the agent has not actually passed any kind of examination. Which of the following is true?
The written examination requirement will be waived.
Which of the following is true regarding Medicare supplement policies?
They must be at least guaranteed renewable
Which of the following is true regarding Medicare supplement policies?
They must be at least guaranteed renewable.
Is it illegal for an insurance company to advertise that is it the leader of the financial industry and therefore pays the most claims each year?
Yes, advertisements must not mislead the public in terms of financial standing.
An insurer must acknowledge receipt of a Notice of Claim within how many days?
15
Within how many days must an insured notify the insurer of a child's birth and pay and required fees?
31 days
What percentage of continuing education hours must be in a classroom setting?
50%
Which of the following is a specific dollar amount or a percentage of the cost of care that must be paid by an HMO member?
Copayment
Which of the following is a specific dollar amount or percentage of the cost of care that must be paid by the member?
Copayment
