Missouri Laws & Rules
Which of the following statements described what an Accident and Health policyowner may NOT do?
Adjust the premium payments
In health insurance policies, a waiver of premium provision keeps the coverage in force without premium payments.
After an insured has become totally disabled as defined in the policy
A qualified profit-sharing plan is designed to
Allow employees to participate in the profits of the company
Which of the following would a Medicare Supplement policy cover?
Allowable amounts under Medicare Part B
All of the following statements regarding group health insurance is true, EXCEPT
An individual policy is given to each member
Chemical dependency coverage is required in which type of policy?
Comprehensive major medical
What is considered a valid reason for small businesses to insure the lies of its major shareholders?
Fund a buy-sell agreement
What type of insurance offers permanent life coverage with premiums that are payable for life?
Whole Life
Health insurance policies in Missouri are REQUIRED to contain coverage for human leukocyte antigen testing for bone marrow transplant
With each issued health policy
Health insurance plans that cover physical therapy visits may NOT impose a copay that
Are greater than the copay or coinsurance for primary care office visits
In Missouri, which of the following is considered an Unfair Trade Practice?
Coercion
Life insurance and annuity replacement can be BEST described as
Exchanging an existing policy for a new policy
Long Term Care policies will usually pay for eligible benefits using which of the following methods?
Expense incurred
What benefit does the Payor clause on a Juvenile Life policy provide?
Premiums are waived if payor becomes disabled
What type of rider would be added to an Accident and Health policy if the policyowner wants to ensure the policy will continue if he/she ever becomes totally disabled?
Waiver of Premium rider
The type of annuity that can be purchased with one monetary deposit is called
Immediate annuity
What is the MINIMUM benefit period that must be offered by a Long-Term Care policy issued in Missouri?
12 months
A licensee must complete ____ hours of continuing education every 2 years
16 hours
After a life insurance policy has been in force for a MAXIMUM of ______ years, it becomes incontestable
2 years
What type of renewability guarantees premium rates and renewability?
Noncancellable
What must a producer sign when an existing life insurance policy is being reissued with a reduction in cash value?
Notice Regarding Replacement
S filled a written Proof of Insurance for a Disability income claim on September 1. The insurance company did not respond to the claim. S can take legal action against the insurer beginning
November 1 (60 days after)
What does Guaranteed Insurability rider provide a Disability Income policyowner?
The ability to periodically increase the amount of coverage without evidence of insurability
For the treatment of PKU, a health plan MUST cover formula and low protein modified food products for
Covered children less than 6 years of age
Which of the following types of individual policies does NOT require a policy summary be given?
Credit Life
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?
File written proof of loss
The Missouri Insurance Director attains office in which of the following ways?
Gubernatorial appointment
In Missouri, a health insurance policy that is not exempt from state-mandated benefits must cover childhood immunizations and shall not charge any deductible or copayments. The EXCEPTION to this would be
HMO's that exclude coverage to subscribers who obtain services by a non-participating provider
How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy?
If the primary beneficiary dies before the insured
According to the Time Payment of Claims Provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
Monthly
A credit life insurance policy covers the life of the
Debtor
The conversion provision in a group health insurance policy is
Mandated by state requirements
A producer must report any personal felony charges within ___ days of pre-trial hearing.
30 days
Prior to a universal life insurance policy being terminated, written notice must be given to the policyowner at least
30 days of termination date
According to the Mandatory Uniform Policy Provisions, what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid?
31 days
The grace period for group life policy is _____ days
31 days
T and S are named co-primary beneficiaries on a $500,000 Accidental Death and Dismemberment policy insuring their father. Their mother was named contingent beneficiary. Five years later, S dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother receive?
$0 because T is still alive and the sole primary beneficiary
Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim?
$2,100 ($10,000 x 20% coinsurance + $100 deductible = $2,100)
In Missouri, an A&H policy that is paid on a monthly basis requires a grace period of at LEAST
10 days
Which of these is considered an unfair trade practice?
A producer stating that a policy's dividends are guaranteed
Which of these is considered an unfair trade practice?
A producer who tells a client that dividends are guaranteed
Which of the following Dividend options results in taxable income to thee policyowner?
Accumulate at Interest
Which of the following statements BEST describes what the Legal Actions provisions of an Accident and Health policy requires?
An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed
When a policyower cash surrenders a Universal Life insurance policy in its early years, this may be considered a red flag for an
Anti-Money Laundering violation
When an insurance application is taken by a producer, which of these statements is true?
Any changes made on the application require the applicant's initials
An applicant for a nonresident producer license MUST
Be a producer in a good standing in their home state
To be eligible for a group health policy, a group MUST comply with which of the following?
Be formed for a purpose other than obtaining insurance
Medicaid was designed to assist individuals who are
Below specific income limit
S would like to use dividends from her life insurance policy to purchase paid-up additions. All of these would be factors that determine how much coverage can be purchased EXCEPT
Beneficiary's age
The guarantee of insurability option provides a long-term care policyowner the ability to
Buy additional coverage at a later date
An example of life insurance policy replacement would be?
Cash surrender an existing whole life policy and purchasing a new whole life policy
When an unfair trade practice has been discovered, the Director may issue a
Cease and desist order
K has a life insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. Under the Common Disaster clause, if K and her husband are both killed in an automobile accident, where would the death proceeds be directed?
Daughter
Non-occupational disability coverage is designed for
Employees who suffer non-work related disabilities are covered by Workers' Compensation
The Director of insurance is authorized to
Enforce state laws relating to insurance
With Accidental Death and Dismemberment policies, what is the purpose of the Grace Period?
Gives the policyowner additional time to pay overdue premiums
Which of the following provisions specifies how long a policyowner's health coverage will remain in effect if the policyowner does not pay the premium when it is due?
Grace period
T, age 70, withdraws cash from a profit-sharing plan and purchases a Straight Life Annuity. What will this transaction provide?
Income that cannot be outlived by the owner
What is the purpose of a Policy Summary?
It highlights the critical parts of the policy issued
The Coordination of Benefits provision
Prevents an insured covered by two health plans from making a profit on a covered loss
A primary beneficiary has died before the insure in a life insurance policy. A contingent beneficiary is also named in the policy. Which of the following will occur when the insured dies?
Proceeds will go to the contingent beneficiary
A(n) ______ sells, solicit, or negotiates insurance on behalf of insurance companies for compensation
Producer
P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period?
Sign an enrollment card
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?
Submit the claim in any form
K is an agent who takes an application for individual life insurance and accepts a check from the client. He submits the application and check to the insurance company, however the check was never signed by the applicant. If the application is approved, when will coverage be effective?
The date the agent delivered the policy, collected the initial premium, and obtained a good health statement from the insured
Which of these statements regarding health coverage for physically handicapped dependents is FALSE?
The dependent must have been over 10 years of age when the handicap was incurred
Under Missouri law, when one group health plan's contract replaces an existing group health plan with similar benefits
The succeeding carrier shall give credit for the satisfaction of any deductibles or waiting periods satisfied or partially satisfied under the prior carrier's plan
The grace period for group life policies is ____ days
31 days
What is the MAXIMUM fixed interest rate for life insurance policy loans?
8%
Which of these require an offer, acceptance, and consideration?
Contract
A policyowner is allowed to pay premiums more than once a year under which provision?
Mode of Premium
A potential client, age 40, would like to purchase a Whole Life policy that will accumulate cash value at a faster rate in the early years of the policy. Which of these statements made by the producer would be correct?
20-pay life accumulates cash value faster than Straight Life
An insurer may exclude pre-existing condition coverage on a Medicare Supplement policy for up to
6 months
The MAXIMUM time period that pre-existing conditions can be excluded in long-term care policies is
6 months
The waiting period for a pre-existing condition under a Medicare Supplement policy may NOT go beyond
6 months
A nondisabled individual is first eligible for a Medicare Supplement policy at age
65
Which of the following annuities pays benefits based on units rather than specific dollar amounts?
A Variable annuity
The part of a life insurance policy guaranteed to be true is called
A Warranty
An individual covered under a Group Life insurance policy is considered to be
A certificate holder
A foreign insurance company CANNOT conduct business in Missouri without
A certificate of authority
Health coverage for the administration of general anesthesia and hospital charges for dental care MUST be provided to
A child under the age of 5
When is a Group Health policy required to provide coverage for a newborn child?
At the moment of birth
Which of the following correctly explains the actions an agent should take if a customer wants to apply for an insurance policy?
Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company.
The Consideration Omnibus Budget Reconciliation Act (COBRA) gives workers (and their families) whose employment has been terminated the right to
Continue group health benefits
What group term life feature permits an individual to depart from the group and continue to be covered without providing evidence of insurability?
Conversion
A business Disability Buyout plan policy is designed
To pay benefits to the Corporation or other shareholders
Medicare Part A and Part B do NOT pay for
Dental work
An insurer may not transact insurance UNLESS authorized by
Director of Insurance
Which of these is NOT a characteristic of a Health Reimbursement Arrangement (HRA)?
Employee funds the HRA entirely
Which health policy clause stipulates that an insurance company must attach a copay of the application to the policy that it is part of the contract?
Entire Contract
N is a student pilot with a large life insurance policy. Which of these features would limit the insurer's obligation in the event N was killed while flying as a student pilot?
Exclusion
The sections of an insurance contract which limit coverage are called
Exclusions
Which of the following is NOT included in the policy face?
Exclusions
What does a Face Amount Plus Cash Value Policy supposed to pay at the insured's death?
Face amount plus the policy's cash value
This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year
Family maximum deductible
Which of the following actions require a policyowner to provide proof of insurability in an Adjustable Life policy?
Increase face amount
How does an indexed annuity differ from a fixed annuity?
Indexed annuity owners receive credited interest tied to the fluctuations of the linked index
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
Inspection report
A life insurance policy would be considered a wagering contract WITHOUT
Insurable interest
Who may assign benefits from a group life insurance policy?
Insured
T was treated for an aliment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?
Insurer will likely treat as a pre-existing condition which may not be covered for 1 year
The clause identifying which losses resulting from an accident or sickness are insured by the policy is called the
Insuring clause
The clause in an Accident and Health policy which defines the benefit amount the insurer will pay is called the
Insuring clause
Jay's application for a producer's license has been denied. He may request a hearing within ____ days after receipt of the denial.
Irrevocable beneficiary
______ can be defined as "making an unfair comparison of two insurance policies."
Misrepresentation
On January 8, an applicant filled out an application for a life insurance policy but did not include the initial premium. The insurance company approved the application on January 14 and issued the policy January 15. The producer delivered the policy on January 26 and collected the first premium. When did the coverage become effective?
January 26
Which license faces possible license revocation by the Director of Insurance?
Licensee who commingles monies belonging to policyholders with personal funds
Which settlement option pays a stated amount to an annuitant, but no residual value to a beneficiary?
Life Income
Which of these would be considered a Limited-Pay Life policy?
Life Paid-Up at Age 70
Under Missouri law, which of the following provisions is NOT required in a Medicare Supplement policy?
Limitation on pre-existing conditions for up to 12 months
Life insurance that covers an insured's whole life with level premiums paid over a limited time is called
Limited-Pay Life
The Accelerated Death Benefit provision in a life insurance policy is also known as a(n)
Living benefit
Health insurance coverage of autism disorder treatments may be limited in which way?
Medically necessary treatment in accordance with a treatment plan
If a retiree on Medicare required five hospital stays in one year, which policy would provide the best insurance for excess hospital expenses?
Medicare Suppement
Deductibles are used in health policies to lower
Overuse of medical services
In a life insurance policy, which provision states who may select policy options, designate and name a beneficiary, and be the recipient of any financial benefits from the policy?
Owner's rights
Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)?
PPO's are NOT type of managed care systems
What does Medicare Part A and Part B cover?
Part A covers hospitalization, Part B covers doctor's services
Whole life insurance policies are contractually guaranteed to provide each of the following, EXCEPT
Partial withdrawal features beyond a surrender change period
Which of the following is a requirement for obtaining a resident producer license in Missouri?
Pay a $100 license fee
Which life insurance rider typically appears on a Juvenile life insurance policy?
Payor Benefit rider
Which of the following provisions guarantees that premiums will be waived if a Juvenile Life policyowner becomes disabled?
Payor clause
Insurance policies are considered aleatory contracts because
Performance is conditioned upon a future occurence
When an employee is terminated, which statement about a group term life conversion is true?
Policy proceeds will be paid if the employee dies during the conversion period
Which of these Nonforfeiture Options continue a build-up of cash value?
Reduced Paid-Up
K failed to pay a renewal premium within the time granted by the insurer. K then sends in a payment which the insurer subsequently accepts. Which policy provision specifies that coverage may be restored in this situation?
Reinstatement
With Optionally Renewable Health policies, the insurer may
Review the policy annually and determine whether or not to review it
Which of these is NOT a required group life policy provision?
Right to loan proceeds
Which of these terms accurately defines an underwriter's assessment of information on a life insurance application?
Risk classification
What does a 401(k) plan generally provide its participants?
Salary-deferral contributions
The suicide provision for life policies would apply to
Subsequent increases in benefits
What would the Medical Information Bureau (MIB) identify?
Testing positive for marijuana use from a previous screening
G is involved in an automobile accident as a result of driving while intoxicated and suffers numerous injuries. According to the intoxicants and Narcotics exclusion in G's policy, who is responsible for paying the medical bills?
The insured
Who may assign benefits from a group life insurance policy?
The insured
The amount of coverage on a group credit life policy is limited to
The insured's total loan value
All of these statements concerning a licensee's responsibility for premiums received are true EXCEPT
The licensee must hold them in separate account before transmitting them to the insurance company
All of these statements concerning a licensee's responsibility for premiums received are true EXCEPT
The licensee shall hold them in a fiduciary capacity before transmitting them to the insurance company
All of these statements about Equity Indexed Life Insurance are correct EXCEPT
The premiums can be lowered or raised, based on investment performance
What is the elimination period of an individual disability policy?
Time period a disabled person must wait before benefits are paid
All of these are considered to be a benefit under Social Security, EXCEPT for
Unemployment
Insureds in the same risk classification are being charged different premiums by an insurance company. This insurer is committing the illegal act of
Unfair discrimination
Which of the following types of insurance policies involves an investment account that is separate from the insurer's general account?
Variable Life
Which of the following type of life insurance policies involves an investment account that is separate from the insurer's general account?
Variable life
Disability policies do NOT normally pay for disabilities arising from which of the following?
War
Which of the following may NOT be issued after the Director of Insurance finds an insurance code violation committed by a licensee?
Warrant for arrest
Which statement regarding third-party ownership of a life insurance policy is true?
it is used extensively in estate-planning as well as business circumstances
At the time of application, major medical health plans (including HMOs) are REQUIRED to
Offer coverage for prosthetic devices
Missouri requires that an insurance producer must complete ____ hours of continuing education on the subject of law and ethics every reporting period
3 hours
Continuing Education (CE) providers must report to the Director a licensee's earned credit hours within
30 days of course completion
When an insured receives chiropractic service, the co-payment may NOT exceed _____ of the total cost of providing the service
50%
Why would the Director of insurance examine the records of an insurance company?
To determine the solvency of the company
If the sale of a Medicare Supplement involves replacement, all of these actions must be performed by the producer EXCEPT
Notify the replaced insurance company
M has an insurance policy that also has an outstanding policy loan at the time of M's death. The insurer will deduct the outstanding loan balance from the
Policy proceeds
A health insurance policy application may ONLY be altered with the written consent of the
Applicant
In Missouri, all health policies must address diabetes coverage in which way?
Apply the same deductible and copays to covered diabetic supplies as other medical conditions
Which of the following activities may NOT be granted as credit for continuing education units?
Meeting sales quotas
A producer is circulating incorrect information about the benefits of a policy. This producer may be found guilty of
Misrepresentation
Under which circumstance MUST a health insurer have an expedited grievance review procedure?
When the enrollee's life or health is jeapordized
When a group accident and health policy is issued to an employer
A policy must be issued to the employer and a certificate must be issued to each employee
A producer has influenced a existing policyowner to convert an existing whole life policy to Reduced Paid-Up insurance. The producer then sells the policyowner a new universal life policy. This transaction is called
A replacement
Credit Life insurance is
Issued in an amount not to exceed the amount of indebtedness
Credit Life Insurance is
Issued in an amount not to exceed the amount of indebtness
Which of the following is NOT allowed in regards to a Medigap (Medicare Supplement) policy?
Issuing an additional Medigap policy to ensure no out-of-pocket exposure for the insured
Michael the insurance producer is acting in fiduciary capacity when conducting business with all of these principals EXCEPT
The Director
A hearing must be held before a producer's license can be suspended or revoked. Prior to this hearing, the Director is required to give
Written notice to the producer
ABC insurance company would like to issue a small group policy in this state. Before doing so, it is REQUIRED to
Be authorized to write accident and health insurance in this state
Which of the following is a standard provision of the conversion privileges in a Group Life policy?
Group Life coverage can be converted to an individual policy at regular rates on an attained-age basis
Coverage for human leukocyte antigen testing for bone marrow transplant is REQUIRED to be provided in all
Group comprehensive health insurance
All of these statements about the Waiver of Premium provision are correct, EXCEPT
Insured must be eligible for Social Security disability for claim to be accepted
Who signs a "Notice Regarding Replacement" form when an application is taken for a new life insurance policy that replaces an existing one?
Producer and Applicant
An individual who has a contract with an insurance company to represent it is called
Producer or Insurance Producer
The Legal Actions provision of an insurance contract is designed to do all of the following EXCEPT
Protect the producer
An insured recently took out a cancer insurance policy. The time limit on certain defenses provision in this policy allows the insurer
To deny the amount of a claim for misstatement on the application occurring prior to the expiration of the first 2 policy years
Which entity issues Medicare Supplement insurance?
Insurance companies
What is being delivered during a policy delivery?
Insurance contract to the proposed insured
An example of rebating would be
Offering a client something of value not stated in the contract in exchange for their business
Agent J takes an application and initial premium from an applicant and sends the application and premium check to the insurance company. The insurance company returns the check back to J because the check is made out to J instead of the insurance company. What action should J take?
Return to the customer, collect a new check made out to the insurance company, and send the new check out to the insurance company
In order to terminate a producer's appointment, the insurer MUST
Send a notice of the termination to the Director
Jasmine Is a salaried employee of an insurance company. Which of the following duties would require her to be licensed as an insurance producer?
Soliciting insurance policies
When making a recommendation to a consumer to purchase an annuity, the producer must make reasonable efforts to obtain
Suitability information
Which of these is a TRUE statement regarding the regulatory authority of the Director?
The Director may establish guidelines for continuing education
Which of these is a TRUE statement regarding how Missouri law recognizes an association eligible for group coverage?
The association must NOT have been organized for the purpose of obtaining insurance
When an insured receives chiropractic service, the copayment may NOT exceed _____ of the total cost of providing the service
50%
A(n) _____ of authority permits an insurance company to transact business in Missouri
Certificate
Which of the following is considered a producer's fiduciary responsibility?
Collect premiums and remit to the insurance company as soon as reasonably possible
Any state-regulated health insurance plan issued in Missouri MUST
Cover childhood immunization services
What is the purpose of the Missouri Life and Health Insurance Guaranty Association?
Ensures that claims filed against insolvent insurance companies will be paid
In a life insurance contract, the policy, application, and riders or endorsements are considered to be the
Entire Contract
P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard the second period of disability as?
A recurrent disability
P is blinded in an industrial accident. Which provision of his life insurance policy will pay a stated benefit amount?
Accidental Death and Dismemberment clause
When making a recommendation to a consumer to purchase an annuity, the producer must make reasonable efforts to obtain suitability information. Suitability information includes
Age, annual income, and financial experience
Which of the following is a requirement to attain a Missouri resident producer license?
Must be 18 years or older
