Laws and Rules OHIO Life & Health Insurance XCEL

Pierre is covered by his employer's group major medical plan. His employer pays for 75% of the premium and he pays for 25%. How much would a $10,000 benefit be taxable as income under this plan?

$0

defamation

publishing information that is false and maliciously critical to an insurer and intended to cause injury

What are the 3 types of hazards?

Physical, Moral, Morale

True or false. Loans obtained by a policyowner against the cash value of a life insurance policy is NOT treated as taxable income.

True

An agent has committed insurance crime that violates US Code 1033 (interstate commerce). Who would be responsible for the prosecution of this crime?

United States Attorney General

What are group disability benefits considered tax-free to the insured?

When the recipient pays the premiums

Coverage for newborns under accident and health plan MUST include coverage for:

birth abnormalities

Donald is the primary insured of a life insurance policy and adds a children's term rider. What is the advantage of adding this rider?

can be converted to permanent coverage without evidence of insurability

An order issued by the superintendent that prohibits a specific practice listed in the order is called a(n)

cease and desist order

level premium, decreasing death benefit

decreasing term

An example of a tax-qualified retirement plan would be:

defined contribution plan

Advertising regulations exist in order to:

demonstrate full and truthful disclosures to the public

One of the most important considerations in replacing health insurance would be the:

exclusions on a new policy

In Ohio, a long-term policy must be ___________ renewable

guaranteed

The deeds and actions of a producer indicate _______ authority

apparent

A licensed agent must be ___ by an insurer to be eligible for soliciting insurance contracts.

appointed

The Do Not Call Registry offers exemptions for calls placed from all of the following EXCEPT

insurance sales calls

Which signature is not required on an individual insurance application?

insurer

A non-admitted insurer

is not afforded protection by the guaranty fund

The standard grace period for a life insurance policy sold in Ohio is ____ month(s).

1 month

Lorenzo is self employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year?

100% of his health insurance costs can be deducted from his gross income

An agent's license has been suspended for non-renewal. The agent may apply for reinstatement within ___ months of the license renewal date

12 months

An employer with under 20 employees must allow a terminated employee to continue accident and health coverage for a MINIMUM of ___ months

12 months

How many days is a temporary agent's license valid?

180 days

Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss.

20 days

What is another term for cash value?

nonforfeiture value

An insurer may refuse to renew an employer's small group health plan due to:

nonpayment of premium

A clause that allows an insurer the right to terminate coverage on any anniversary date is called a(n)

optionally renewability clause

An employer may qualify for health care tax credits through SHOP Marketplace if that employer has fewer than ____ employees

25 employees, full-time, make an average of $50,000/year or less

Open enrollment for Medicare Supplement coverage starts:

3 months before your 65th birthday

A life insurance policy must be in effect for ___ years before the policyowner may use the nonforfeiture provision.

3 years

According to the Affordable Care Act, any plan in existence prior to what date is considered a grandfathered plan?

March 23, 2010

What is the tax liability for employer contributions in Health Savings Accounts (HSA's)?

No tax payment needed

What is a corridor in relation to a Universal Life insurance policy?

The gap between total death benefit and the policy's cash value

A foreign insurance company doing business in Ohio is:

a company domiciled under the laws of another state

How does life insurance create an immediate estate?

after first premium is paid, the face amount may be available to the beneficiary

An agent is legally permitted to share his/her commissions with:

another licensed agent

A guaranteed issue insurance policy has no:

medical underwriting

An unauthorized insurer may place insurance business in Ohio through a(n):

surplus lines agent

Kristi purchases an annuity that will pay her husband an income for 15 years. If he dies, this income will become payable to their children for the remainder of the period. Kristi has what kind of annuity?

temporary annuity certain

An advertisement for an insurance product may contain:

the insurer's name

According to the Affordable Care Act, the maximum amount an individual can contribute to a Flexible Spending Account is:

$2,500

Mary's Medicare Supplement policy had been in effect for 12 months. She recently replaced policy with a new one that provides better coverage. The replacing policy may only impose a ___ month time exclusion for pre-existing conditions.

0 months

A life insurance policyowner is allowed ___ days upon policy delivery to return policy for full premium refund?

10 days

If health insurance benefits are not paid in a timely basis, the benefits paid shall bear simple interest from a date ___ month(s) after satisfactory proof of loss was received by the insurer.

2 months

Every admitted insurance company in Ohio MUST have their financial affairs examined by the superintendent at LEAST

3 years

In Ohio, legal action may be taken up to _____ years against an insurer for failure to pay health insurance claims after proof of loss was submitted.

3 years

Greg has recently been terminated from his job that covered him for group life insurance. How many days does he have to convert his coverage to an individual policy?

31 days

In Ohio, semi annual premium health insurance must provide a grace period of at least: 7 days 10 days 20 days 31 days

31 days

As of January 1, 2014, an employer with up to 25 FTE's with average annual wages < $50,000 may be eligible for a tax credit of ___% of the premiums paid by the employer.

50%

Erica is 35 years old and owns an IRA. At what age can she begin to receive distributions without a tax penalty?

59.5 years

An insurer can exclude coverage for a pre-existing condition on Medicare Supplement policy for up to ___ months

6 months

Within how many days must a rollover be completed in order to avoid being taxed as current income?

60 days

Proof of loss on a health insurance must be submitted to an insurer within _____ days after the insured's date of loss

90 days

All of the following are core benefits of Medicare Supplement Plan A EXCEPT:

Deductible payments for the first 60 days of hospitalization under Medicare hospitalization insurance

An insurance company advertises an accident and health insurance product in a local Ohio newspaper and refers to dollar amount benefits. The insurer may also disclosed what in the advertisement?

any applicable benefit reduction

An indemnity plan limitation that will pay the dental bills after a small amount is paid by the insured is called

coinsurance

Field underwriting performed by the producer involves:

completing the application and collecting initial premium

A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called:

conditionally renewable

In Ohio, an agent may have his/her license revoked for

failure to pay state income tax

Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this?

guaranteed insurability rider

Long-term care insurance applications MUST contain plain and unambiguous health questions. The exception to this rule would be application for:

guaranteed issue

A Buyer's Guide MUST

have its content approved by the superintendent

What is a condition or situation that creases or increases a chance of loss called?

hazard

level premium, increasing death benefit

increasing term

An insurer is REQUIRED to offer what to each long-term care applicant at the time of purchase?

inflation protection

An example of endodontic treatment is a: bridge crown filling root canal

root canal

Typically, Long-Term Disability benefits are coordinated with which benefit plan?

social security

Advertisements for accident and health policies that ONLY cover a stated illness MUST display a statement that:

the policy is limited

A whole life insurance policy accumulates cash value that becomes:

the policy value which the insured may borrow against

What type of insurance offers flexible premiums, a flexible death benefit, and the choice of how the cash value will be invested?

variable universal policy

An employee has ___ days after date of marriage to add a new spouse to a small group health plan.

30 days

An insurance company has just received a request for verification from a viatical settlement provider. The insurer is required to respond within ___ calendar days to this request.

30 days

How much does Medicare Part B pay for physician fees?

80%

How are health plans classified according to the Affordable Care Act?

Bronze, Silver, Gold and Platinum

Which of these is considered a major tax advantage of life insurance?

Income tax is not typically owed on proceeds paid directly to a beneficiary

What is an advantage of child's term rider?

It can be converted to permanent coverage without evidence of insurability

All of these are responsibilities of the superintendent EXCEPT: administering oaths subpoena a witness approving policy forms endorsing insurers

endorsing insurers

A professional liability for which producers can be sued for mistakes of putting a policy into effect is called:

errors and omissions

REPLACEMENT can be BEST described as:

exchanging a new policy for one already in force

One of the most important considerations when replacing health insurance would be:

exclusions on a new policy

The XYZ Corporation took out billboard ads in Ohio indicating that it can transact business in Ohio. This insurer is not approved in Ohio. XYZ is guilty of:

false advertising

All Health Benefit Plans issued after January 1, 2014 must provide

preventive health services

What is the elimination period of individual disability policy?

time period disabled person must wait before benefits are paid

The analysis of applicant's personal information and determining whether insurance should be issued or declined is called:

underwriting

A ________ life policy pays a death claim in the amount of the death benefit PLUS the savings element.

universal

A life insurance policy that contains a guaranteed interest rate with the chance to earn a rate that is higher than the guaranteed rate is called:

universal life

A life insurance policy that is subject to contract interest rate is:

universal life

To be eligible for small employer group coverage, an employee must work a MINIMUM of ___ hours in a typical week.

25 hours

A life insurance applicant in Ohio may backdate the application for up to ___ months

3 months

Tim's life insurance policy has just recently lapsed. His policy may be reinstated at any time within ___ year(s).

3 years

The first payment for newborn accident and health coverage is due ___ days after birth

31 days

If an insurer refuses to pay a claim, how many days must the insured wait to take legal action against a health insurer after submitting written proof of loss?

60 days

A life policy loan in Ohio cannot charge fixed rate of interest higher than:

8%

What happens to policy proceeds if someone dies with "first to die" joint life insurance?

Policy proceeds will no longer provide insurance protection

An agent's license may only be suspended or revoked if the agent: has been afforded the right to a hearing has engaged in replacement of an existing policy filed for bankruptcy did not meet a sales quota

afforded the right to a hearing

A common exclusion or limitation on dental policy is:

endodontics

Misrepresentation

falsifying terms, benefits, advantages, or conditions of insurance policy

Credit accident and health plans are designed to:

help pay off existing loans during periods of disability

How is the cost of a policy affected when a policyowner pays premiums more frequently? Not affected Increases Decreases Depends on the type of coverage

increases

Who is responsible for assembling the policy forms for insureds?

insurance carriers

An agent's appointment may only be terminated by the:

insurer

Under the Affordable Care Act, a grandfathered health plan can lose its grandfathered status if:

insurer significantly raises co-insurance charges, deductibles or co-payment charges

If an agent is believed to be causing considerable harm, the superintendent may:

issue a cease and desist order against the agent

The authority granted to a licensed producer is provided via the:

law of agency

Which contract element is insurable interest a component of?

legal purpose

A decreasing term policy has decreasing death benefits and ____ premiums.

level

Which of the following annuity payout options makes no additional payments regardless of when annuitant dies:

life only

A limited payment whole life policy provides:

lifetime protection

A life insurance policy that has premiums fully paid up within a stated time period is called:

limited payment insurance

Pete the Agent recently had his license suspended because he was found in violation of a state insurance law. Due to this suspension, Pete:

may be assessed administrative costs sustained by the department

When screening an applicant for HIV, the insurer: may require a blood test for HIV may inquire about applicant's sexual history may inquire about applicant's sexual orientation may ask applicant's relatives confirming sexual orientation

may require blood test for HIV

A minor may receive a life insurance policy's death benefit ONLY if minor is at least 12 years old minor approved by superintendent minor is blood relative minor has appointed guardian

minor has appointed guardian

Knowingly making an untrue or incomplete statement during an insurance transaction is considered an example of:

misrepresentation

A type of insurer that is owned by its policyowners is called

mutual

Long-term care policies or certificates issued in Ohio are required to have:

nonforfeiture value

Inducement is BEST defined as

offer to buy, sell, give or allow the prospective insured employment, stock, or special favors in exchange for insurance transaction

Unmarried children who are incapable of self support and have proof of incapacity are included under their parents' health coverage until:

policy termination

According to the principle of Utmost Good Faith, the insured answers questions to the best of their knowledge and pay the premium, while the insurer will deal fairly with the insured and its:

promises made

The branch of dentistry which deals with replacement of missing parts is called: endodontics periodontics orthodontics prosthodontics

prosthodontics

Kiara filled out a life insurance application and was given a policy illustration that showed future premiums being paid out of nonguaranteed values. The illustration must disclose that:

she may need to resume premium payments depending on actual results

Disability insurance benefits from a group policy for by an employer is considered ___________ income

taxable

What does "level" refer to with Level Term?

the death benefit or face amount, that does NOT change throughout the life of the policy

An agent's renewal date for his/her license is on or before:

the last day of the licensee's birth month

What type of life insurance allows for partial surrender?

universal life

maximum benefits

upper limit of total lifetime benefits that the insurance company will pay

Which policy allows flexibility with investment choices?

variable universal life

What type of policy has flexible premiums, flexible death benefit, and choice of how cash value will be invested?

variable universal policy

When does life insurance policy typically become effective?

when initial premium is collected and policy is issued

What type of insurance ends at age 100, has cash value (savings element), level premiums, and level death benefit?

whole life

Prior to conducting an HIV-related test, the insurer must obtain:

written authorization from the proposed insured

What are two advantages of living benefits?

1) can borrow against cash value when policy is in effect 2) can receive cash value when the policy is surrendered

What are the 3 types of whole life insurance?

1) straight: fixed premium till death, age 100 2) limited pay: limited premiums (e.g. for 20 years) 3) single premium: one time lump sum

Sole proprietors are permitted tax deductions for health costs paid from their earnings in the amount of:

100% of costs

An insurer may deny health insurance claims based on misstatements in application for how long from policy's date of issue?

2 years

Ownership of a life insurance policy may be temporarily transferred with a(n)

collateral assignment