Xcel ch 19 laws and rules
An insurance producer license is required for which of the following?
A business entity soliciting insurance
An insured dies from what appears to be accidental causes. When confirming the cause of death, which of these actions by the insurer takes precedence?
Autopsy
A producer may give an insurance applicant an article of merchandise having an invoice value of or less.
$5
For individual health insurance, coverage for pre-existing conditions may be excluded for up to months after issuance of the policy
12
XYZ Insurance Company receives satisfactory proof of loss for a claim. If XYZ does NOT pay the claim within 60 days of receipt, the insurer MUST pay simple interest of per annum.
12%
in the state of Michigan, properly filed Health claims that are not timely paid require the insurer to pay simple interest from a date 60 days from satisfactory proof of loss at the rate of
12% per annum
A producer is hired to sell insurance for an insurer. Upon submission of the agency contract application, the producer MUST be appointed by the insurer within days.
15
a producer MUST be appointed by the insurer within how many days from the date the agency contract application is submitted?
15
To be eligible for small employer group coverage, an employee must work a MINIMUM of hours in a typical week.
17.5
To be classified as a small employer in Michigan, an employer must employ
2-50 employees
in Michigan, legal action can be taken against an insurer for failure to pay HEALTH insurance claims for a period not to exceed
3 years
the acceptance of a credit Life Application requires the submission of a Certificate of Insurance to the insured within ___ days
30
A baby is born to a husband and wife covered under a family accident and health insurance policy. If the newborn is covered at birth, the first payment for the additional coverage would become due in days.
31
A life insurance applicant in Michigan may backdate the application for up to month(s).
6
In Michigan, legal action may be taken against an insurer for up to years for failing to pay a life insurance claim after proof of loss was submitted.
6
in Michigan, legal action can be taken against an insurer for failure to pay LIFE insurance claims for a period not to exceed
6 years
A producer has allowed his/her license to lapse by failing to complete the required continuing education credits. The license may be reinstated by completing the requirement within days of the renewal date.
90
a producers license has been suspended due to failure of completing the required continuing education credits. The license may be activated by completing the CE requirement within how many days of the renewal date?
90
Which of the following is considered to be an act of misrepresentation?
Falsifying the terms, benefits, advantages, or conditions of an insurance policy
Paul the producer has provided a false statement in relation to an insurance claim. Which illegal act has been committed?
Fraud
Under which circumstance may a deferred insurance commission be paid to an individual?
Individual was a licensed producer at the time of the sale
An insurer is REQUIRED to offer which of the following to each long-term care applicant at the time of purchase?
Inflation protection
A Medicare Supplement policy issued in the state of Michigan is required to provide each of the following EXCĖPT
It must include outpatient prescription drug coverage
Which of the following is an example of the illegal act of defamation?
Making a statement that is false or maliciously critical of the financial condition of an insurer
Which requirement must be met by associations that seek group health coverage for its members?
Must have been formed for a legitimate purpose other than obtaining insurance
Which of these actions would NOT result in a producer's license revocation?
Not maintaining an adequate level of sales
Which of the following is NOT covered under Workers' Compensation?
Pain and suffering
The branch of dentistry which deals with the replacement of missing parts is called
Prosthodontics
Which of these is the BEST example of misrepresentation?
Providing incorrect, misleading, incomplete, or materially untrue information in a license application
Which of the following is an example of a producer's fiduciary duty?
Recording receipt and remittance of premiums due to the insurance company
Which of these BEST describes the illegal act of twisting?
Replacing an insurance policy from one insurer to another based on misrepresentation
Upon finding a producer guilty of forgery, the Commissioner may tak all of the following actions EXCEPT?
Require the producer to notify his/her clients
Which of the following actions is REQUIRED by a producer who is replacing an existing life insurance policy?
Submit to the replacing insurer a list of the policies to be replaced
A producer's license is required for all of these activities EXCEPT
Underwriting insurance
In the Michigan Insurance Code, Chapter 45, insurance fraud defines financial loss as all of the following EXCEPT
additional premiums
group dental plans will frequently place of limit on annual benefits in order to minimize
adverse selection
A newborn must be covered under an existing health policy
at the moment of birth
Newborn coverage under health insurance policies MUST include coverage for
birth abnormalities
An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called
coinsurance
an Indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called
coinsurance
which of the following does restorative dental treatment cover?
crowns
ABC Insurance Agency is entering each applicant who purchases insurance through their agency into a drawing to win a free trip. This is an unlawful insurance practice known as
illegal inducement
when MUST a newborn child be covered under an existing health insurance policy?
immediately
A foreign insurance company doing business in Michigan
is a company domiciled under the laws of another state
Upon receiving a producer complaint, the Commissioner may immediately
issue a cease and desist order
Producer commissions may NOT be paid to
licensed producers not appointed by an insurer
An insurer would be committing Unfair Discrimination if coverage was denied based upon
marital status
small employer group coverage is NOT required to be renewed in each of the following circumstances EXCEPT
number of claims exceed threshold CORRECT: intentional misrepresentation, non-compliance with minimum participation requirements, small employee insurer no longer offers that type of coverage
under workers compensation, injured employees are covered for all of the following issues EXCEPT
pain and suffering CORRECT: loss of wages, medical expenses, occupational illnesses
which of the following actions MUST be taken by producers
pay premiums due to insurers on a timely basis
A producer's fiduciary duty requires that
premiums are forwarded to the insurer on a timely basis
In most dental plans, a deductible typically is NOT applied to
preventative and diagnostic services
In the state of Michigan, a licensed producer
represents the insurer
An example of endodontic treatment is a
root canal
A life insurance application may be backdated to
save on premiums
A(n) company is owned exclusively by shareholders.
stock
according to the Michigan Insurance code, which of the following MUST a producer do when replacing a life insurance policy?
submit to the replacing insurer a list of all the life insurance policies or annuity contracts proposed to be replaced
According to the Taft-Hartley Act, group insurance premium payments made by an employer MUST be paid to the
trust
The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as
twisting
the unfair trade practice of replacing an insurance policy from one insurer to another based on misrepresentation is called
twisting
A life insurance policy sold in Michigan may be contested by the insurer ONLY during the first year(s) of the contract.
two
The act of insurance does NOT require an individual to hold an insurance producer license.
underwriting
A Universal Life policyowner must receive a notice of cash surrender value at LEAST every
year
Under which circumstance do consumer privacy regulations allow an insured's financial information be released?
An authorized agency makes a written request to the insurer during an insurance fraud investigation
Which of the following is included in the entire contract according to the entire contract provision?
Application
With a scheduled dental policy, how are covered expenses paid?
Benefits are limited to a specific maximum dollar amount per procedure
Which of the following is NOT a valid reason for an insurer to refuse renewal of a small employer group plan?
Claims were higher than expected
In Michigan, a person providing insurance advice to a person or business for a fee is required to hold which license?
Counselor
Nate's dependent son is physically handicapped, but not eligible for Medicare. How long may the son remain on Nate's health coverage after the age of 26?
Coverage remains with written proof of disability and dependency
A form of medical health insurance covering the treatment and care of gum disease is called
Dental expense insurance
A hospital or medical expense policy will typically cover dental treatment expenses under which circumstance?
Dental treatment is needed to repair an injury
A producer's insurance license may ONLY be revoked by the
Department of Insurance and Financial Services (DIFS)
The reserves the right to renew a small employer health plan.
Employer
A common exclusion or limitation on a dental policy is
Endodontics