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*****The following Basic (Core) benefits must be provided by all Medicare supplement policies or certificates issued in Texas:

-Part A Medicare eligible expenses for hospitalization for days 61-90 per benefit period for the amount not covered by Medicare -Part A Medicare eligible expenses incurred for hospitalization for each Medicare lifetime inpatient reserve day used for the amount not covered by Medicare -100% of the Medicare Part A eligible expenses for hospitalization for 365 additional days after the lifetime reserve days have been exhausted -The reasonable cost of the first 3 pints of blood under Medicare Parts A and B Coinsurance amounts of Medicare eligible expenses under Part B after the deductible is met

The Department will issue a license to a corporation or partnership if the following has been determined:

-organized under the laws of a state and authorized under the corporation or partnership to act as an agent -At least one officer or one active partner and all persons transacting insurance are individually licensed by the department separate from the entity -has the ability to pay any amount up to $25,000 it is legally obligated to pay to a customer and was caused by a negligent act, error, or omission -intends to be actively engaged in the solicitation or writing of insurance for the general public and is actively engaged in the business of insurance -Each business location acting under the authority of a license is registered separately with the Department -An officer, director, member, manager, partner, or other controlling person of the corporation or partnership has not had a license suspended or revoked, been the subject of a disciplinary action by a regulator of any state, or committed an act for which a license may be denied

The following acts and practices are prohibited when marketing Medicare supplement insurance:

-twisting -high pressure sales tactics -cold lead advertising

Under Nonforfeiture Law, a cash surrender payment may be deferred up to:

6 months

Evidence of Coverage

A certificate or agreement issued to an enrollee that states the coverage in which the enrollee is entitled. *cannot be issued in TX unless it has been filed for review and received approval of the Commissioner of Insurance

Preexisting Condition

A condition for which medical advice was given or treatment was recommended by, or received from, a physician within six months before the effective date of coverage.

Deductibles

A deductible is the specific dollar amount for the cost of basic, limited, or single health care service paid by the enrollee, in addition to any premiums paid.

Qualified Long-term Care Insurance Contract

A long-term care insurance contract with benefits that are not taxable.

Capitation

A method used by an HMO to compensate a physician or provider for providing a defined set of health care services and is based on a predetermined payment per enrollee and not the quantity of services actually provided.

Level Premium Long-term Care Policy

A non-cancellable long-term care policy.

Small Group Health Insurance

A small employer is a person who employed an average of 2-50 employees on business days during the preceding calendar year, and who employs at least two employees on the first day of the plan year.

Certificate of Authority

Allows insurer to engage int eh business of insurance must state: -specific kinds of insurance authorized -When issued

The Essential Health benefits package must provide at least the following:

Ambulatory patient services Maternity and newborn care Emergency services Hospitalization Laboratory services Preventive, wellness, and chronic disease management Mental and behavioral health services and substance use disorder Prescription drugs Pediatric services, including dental and vision care Rehabilitative and habilitative services and devices

Long-term Care Insurance

An insurance policy that provides coverage for not less than 12 consecutive months for each covered person on an expense-incurred, indemnity, prepaid, per diem or other basis for one or more necessary or medically necessary services of the following types, administered in a setting other than an acute care unit of a hospital: diagnostic, preventive, therapeutic, curing, treating, mitigating, rehabilitative, maintenance, or personal care.

Existing Insurer

An insurer of the policy or contract that will be changed or affected by a replacement.

Replacing Insurer

An insurer that issues or proposes to issue a new policy or contract that replaces an existing policy or contract.

A licensed life insurance agent in Texas can share commissions with which of the following?

Another licensed life insurance agent in Texas who assisted with the sale

Marketing Standards

Any Medicare supplement advertising must be submitted to the Department for approval at least 60 days before it may be used.

Coverage for newborns must begin:

At birth

The Texas Department of Insurance requires all licensees to:

Be honest, trustworthy, and reliable

All of the following are required to be included in a life insurance illustration, except:

Company specific mortality tables

The following words and terms must be included in all Medicare Select policies, certificates, and plans of operation and must be defined as described in Texas Statutes:

Complaint Emergency care Grievance Medicare Select issuer Medicare Select policy or Medicare Select Certificate Network provider Non-network provider Service area

Replacement regulations do not apply to transactions involving:

Credit life insurance Group life insurance or annuities Life insurance or annuities used to fund prepaid funeral contracts Contractual changes or conversion Life insurance being replaced by the same insurer A policy used to fund a qualified retirement plan, employee benefit plan, or deferred compensation plan New life insurance coverage being paid entirely by the insured's employer Existing nonconvertible and nonrenewable term life insurance scheduled to expire in 5 years or less

Payment of Death Benefits

Death benefits for a person who dies before the end of the 31-day conversion period are payable as a claim under the group policy, regardless of whether the deceased had applied for an individual policy.

All Medicare supplement policies must offer coverage for all of the following, except:

Disability income

Under the ACA, a catastrophic plan may be purchased by any of the following, except an individual:

Enrolled in Medicaid

If an insurer requires an individual to be tested for the AIDS virus, all of the following are required, if applicable, except:

Gather statistical information that identifies the applicant to share with other insurers

Immunizations

HMOs are not permitted to charge a deductible or copayment for immunizations provided to children from birth until a child's sixth birthday

Basic Health Care Services

Health care services that the Commissioner determines a person might reasonably need to be maintained in good health.

Replacement

If a Medicare supplement policy replaces another Medicare supplement policy, the replacing insurer must waive any times periods applicable to pre-existing condition waiting periods, elimination periods, and probationary periods to the extent time has expired under the original policy.

Minimum Standards for Long-term Care Policy Renewability

In Texas,a long-term care policy issued in this state must be, at a minimum, guaranteed renewable.

Statements of the Insured

In the absence of fraud, life insurance policies must consider a statement made by an insured a representation and not a warranty.

With respect to advertising requirements, all of the following are allowable unless the insurer:

Includes the terms investment, savings plan, or profit sharing

Enrollee

Individual enrolled in a health care plan and includes dependents.

The ACA requires employers to provide a notice to new employees at the time of hire of the following:

Inform employees of the existence of the marketplace, including services provided and how to contact for assistance Notify employees of potential eligibility for a premium tax credit through the marketplace if the employer health plan does not offer minimum essential coverage and does not cover at least 60% of costs Inform employees that a qualified health plan is purchased through the marketplace, the employee may lose any employer contribution to health benefits plan offered by the employer

Assignment

Life insurance policies are permitted to contain a provision that allows the transfer or assignment of up to 100% ownership (rights) of the policy, benefits or proceeds. However, policies cannot allow for the assignment of guaranteed returns and dividends to a third party for the purpose of establishing an investment for the policyholder.

Legal Action

Life insurance policies must include a provision that allows legal action to be brought against the insurer within at least 2 years after the cause of the action.

Payment of Claims

Life insurance policies must settle a claim within 2 months after the insurer receives proof of death and proof of the claimant's right to the policy's proceeds.

Which of the following is not a duty of the Commissioner?

Make state insurance laws *The Commissioner must enforce state insurance laws, not establish them.

Cancellation

No Medicare supplement policy or certificate may be canceled or nonrenewed based solely on the health status of the insured

Long-Term Care Nonforfeiture Provision

No insurer may offer a long-term care policy in this state unless the insurer offers the option to purchase a policy that contains a nonforfeiture provision.

An enrollee may have coverage cancelled or nonrenewed by an HMO for which of the following?

Nonpayment of premium

To terminate an agent's appointment, the insurer must:

Notify the Texas Department of Insurance of the termination of appointment *does not cancel or terminate the license

When taking an application for a Medicare supplement policy, an agent must provide the applicant with a(n):

Outline of Coverage

Long-term Care Partnership Insurance Policy

Policy provides access to Medicaid under special eligibility rules should additional LTC coverage be needed beyond what the policy provides.

Which of the following is not included in a Summary of Benefits and Coverage?

Premiums *The Summary of Benefits and Coverage includes the plan's benefits and services, cost-sharing provision, and coverage exceptions, exclusions, and limitations. It does not include the premium.

If a proposed insured is required to take an HIV-related test to detect the AIDS virus as part of the application process, the insurer must:

Provide written notice to the proposed insured or parent/legal guardian of proposed insured Obtain written authorization/consent of the proposed insured or parent/legal guardian on the Notice and Consent for HIV-Related Testing form

Health Maintenance Organization

Provides a health care plan to enrollees on a prepaid basis.

An agent's appointment:

Remains in force until terminated or withdrawn

A small employer health insurer may not offer coverage to an eligible employee unless the employee has:

Satisfied the applicable waiting period

Give, sell, or purchase (or offer to give, sell, or purchase):

Stocks, bonds, or securities of an insurer Dividends or profits from the stocks, bonds, or securities of an insurer Anything of value not stated in the policy

Consumer Complaints

The Department must notify each party to an active complaint of its status at least quarterly until disposition, unless the notice would compromise an undercover investigation.

High-pressure Sales Tactics

The employment of any marketing method that induces or recommends the purchase of insurance coverage through the use of force, fear, threats, or undue pressure

All of the following regarding Evidence of Coverage are correct, except:

The evidence of coverage must be delivered in writing -The evidence of coverage may be delivered in writing or electronically.

Guaranteed renewability describes a policy in which:

The policyholder has the right to continue the policy when making timely premium payments The insurer does not have any unilateral right to change any provision or rider while the insurance is in force The insurer cannot non-renew the policy; however, it may revise rates if doing so for every policyholder within a class

Twisting

The practice of knowingly making a misleading representation or incomplete or fraudulent comparison of any policies or insurers to induce any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, convert, or borrow against a policy or to take out a policy with another insurer

Cold lead Advertising

The use of any marketing method that fails to disclose in an obvious manner that its purpose is to solicit insurance and that contact will be made by an insurance company or agent (other regulatory definitions of "cold lead advertising" also exist)

Copayments

a charge, in addition to an enrollee's premium, to supplement payment for health care services

agent

a person authorized and licensed to transact insurance on behalf of an insurer. including: selling, soliciting, and negotiating insurance or annuity contracts and collecting such premiums.

fraudulent act examples:

accepting premiums for coverage that will knowingly not be provided, submitting a false claim or altered bill to an insurance company, or filing false statements with the intent to deceive.

supplemental illustration

an illustration, furnished in addition to a basic illustration, that depicts only a scale of non-guaranteed elements

Affordable Care Act

consists of a combination of measures to control healthcare costs and to expand health insurance coverage in the United States through public and private insurance.

Bronze plans

cover 60% of the benefit costs

Silver plans

cover 70% of the benefit costs

Gold plans

cover 80% of the benefit costs

Platinum plans

cover 90% of the benefit costs

Insurance Fraud Unit

created to enforce laws pertaining to fraudulent insurance acts.

Termination of Employment

entitled to coverage under individual policy. Must be applied for within 31 days after termination

Outline of Coverage

for individual or LTC insurance policy must be delivered a time of initial solicitation before an app or enrollment form

Subsidies

helps legal residents pay their insurance premiums or cost sharing obligations (co-insurance or co-payments) under a plan, but ONLY if they purchase a plan through the marketplace.

Incontestability

his provision must explain that all statements made by the subscriber on the enrollment application will be considered representations and not warranties

Extensions and Exemptions

if requested by an agent on a timely basis, the department may extend the time for an agent to comply with or exempt the agent for some or all of the continuing education requirements for a licensing period if the agent is unable to comply due to illness, medical disability, or another extenuating circumstance.

Enrollment

initial enrollment period for subscribers and dependents must be at least 31 days, with a 31-day open enrollment period provided at least annually (every 12 months). A late enrollee may be excluded from coverage until the next open enrollment period.

A life insurance illustration must include:

insurer's name, authorized representative of insurer or agent, proposed insured's name, age and gender, underwriting or rating classification used as the basis for the illustration, policy's generic name, company product name and policy form number, and the initial death benefit.

Termination Due to Attaining Limiting Age

must state the coverage will not be terminated due to a child's attainment of a limiting age if the child is incapable of self-sustaining employment due to mental retardation or physical disability, and is chiefly dependent upon the subscriber for support and maintenance.

health insurance exchange

online marketplace created by the ACA to make health insurance more readily available to Americans.

mutual insurer

owned by the company's policyholders, who may also be referred to as members, and issues Participating policies. -board of trustees or directors manage -dividends non-taxable return to profit

stock insurer

owned by the company's stockholders or shareholders and issues Non-participating policies. -directors/officers manage -dividends taxable return to profit

A Life and Health Insurance Counselor is ___________________ from charging a fee for services IN ADDITION TO earning a commission on the products that he or she recommended to a client.

prohibited

The ACA's primary goals are to

provide stronger consumer rights and protections, to make health insurance more affordable, strengthen the Medicaid program, and to make available subsidized, regulated private insurance.

individual mandate

requires all Americans, unless specifically exempt under the ACA, to maintain "minimum essential coverage" for themselves and their dependents or pay a tax penalty, known as the shared responsibility payment.

The evidence of coverage must include

the name, address, and phone number of the HMO. A toll-free number, as defined in insurance code, must appear on the face page of the contract or certificate.

Guaranty Association

was created for the payment of claims or continuation of policy obligations of financially impaired or insolvent insurers. A financially impaired insurer does not have assets at least equal to all its liabilities. An insolvent insurer is unable to pay its obligations on time.

marketplace

where individuals and small businesses seeking insurance can go to compare different options that may be available to them and to enroll in a Qualified Health Plan (QHP) that fits them best

Advertising

-must identify the person or entity responsible for the advertisement. -

General life, accident, and health agents must complete a minimum of ______ continuing education hours per renewal period.

24. *2 of those hours must be ethics

Reinstatement

3 years to reinstate a lapsed policy do to unpaid premiums

if denied for certificate of authority, the applicant has right to request a hearing. he Commissioner must request a hearing date no later than ______ days after the applicant's request for the hearing

30

domestic and licensed insurers must be examined by the Commissioner or appointed examiner no less frequently than once every ___ years

5

An advertisement, other than institutional, may not use:

A trade name Any insurance group designation Name of the insurer's parent company or name of a particular division of the insurer Service mark, slogan, symbol, or other device that, without disclosing the name of the actual insurer, would mislead or deceive a prospective purchaser as to the true identity of the insurer, or its relation with public or private institutions

Replacement

A transaction under which a new policy is purchased, and it is (or should be) known that an existing policy will be: -Lapsed, forfeited, surrendered, or otherwise terminated Converted to reduced paid-up insurance, continued as extended term insurance, or reduced in face value by use of a nonforfeiture option Amended with a reduction in benefits, term of coverage, or reissued with a reduced cash value

License Termination, Revocation, and Suspension

An individual who was denied a license, or whose license was revoked, must wait 5 years before applying for an agent license.

Free Look

If a buyer's guide and the disclosure document are not provided at or before the time of application, a free look period of at least 15 calendar days must be provided during which the applicant may return the contract without penalty. -begins on the date the consumer receives the annuity contract

An insurance agent does NOT owe a fiduciary duty to:

Insurance counselors *An agent owes a fiduciary responsibility to its insurer, insurance applicants, insureds, but not insurance counselors or other agents.

fraudulent insurance act

an act that violates a penal law and is committed while engaging in the insurance business, as part of an insurance transaction, or as a part of an attempt to defraud an insurer.

in-force illustration

an illustration furnished at any time after the policy it depicts has been in force for 1 year or longer

basic illustration

an illustration that shows both guaranteed and non-guaranteed elements

A group life policy may be delivered in this state only if it covers an eligible group. Eligible groups include:

employer groups, labor unions, government entities including dependents, and creditor groups are eligible.

Boycott, Coercion, and Intimidation

forceful actions intended to result in the unreasonable restraint of trade, or the establishment of a monopoly, in the business of insurance.

temporary agent license eligibility:

submit application accompanied by: -The appropriate nonrefundable fee -A certificate signed by an agent, insurer, or HMO stating that:The applicant is being considered for appointment by the agent, insurer, or HMO -The agent, insurer, or HMO wants a temporary license to be issued to the applicant -The applicant will complete at least 40 hours of supervised training, with at least 10 of those hours completed in a classroom setting, within 14 days from the application date

Commissioner

the Chief Executive and Administrative Officer of the Texas Department of Insurance (TDI) and is appointed by the governor, with the advice and consent of the senate, for a two-year term.

domicile

the jurisdiction in which an insurer is formed or incorporated, such as a state or country.

Defamation

the publication or circulation of a statement that is false, maliciously critical of, or derogatory to the financial condition of an insurance company if it is intended to injure any individual or organization engaged in the business of insurance.

The following minimum benefit standards apply to Medicare supplement policies being advertised, solicited, or issued for delivery in this state:

-A Medicare supplement policy may not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage due to a preexisting condition -Limitations or exclusions on coverage may not be more restrictive than those of Medicare -A policy cannot contain benefits that duplicate benefits provided by Medicare -A policy may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents -Benefits that are designed to cover cost-sharing amounts under Medicare must automatically change to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts (premiums may be modified to correspond with changes)

Request for Hearing

-A person affected by an order is entitled to request a hearing to contest the order. -no later than 30 days after the date the person receives the order -Be in writing -Be directed to the Commissioner -State the grounds for the request to set aside or modify the order

Continuing Education

-All licensees must complete continuing education requirements before the expiration date of the license AND at least 50% of the hours must be completed in a classroom, or classroom equivalent, setting.

LTC Partnership and Medicare-related Products

-An 8-hour certification course is required before acting as an agent with regard to any of these products -4 hours of certified continuing education, per licensing period, is required if a licensee acts as an agent, or intends to act as an agent, with regard to these products

Life and Health Insurance Counselor

-Charges a fee or other compensation to examine a life, accident, or health policy, annuity or pure endowment contract to provide advice or other information -Publicly uses a title (e.g. insurance adviser, analyst, counselor, or specialist; policyholders' adviser or counselor) that indicates the person is engaged in the business of giving advice or other information to any person having an interest in a life, accident, or health policy, health benefit plan, or annuity or pure endowment contract

Transacting Insurance

-Issuing or proposing to issue, as an insurer, an insurance contract -Taking or receiving of an insurance application -Receiving or collecting any consideration for insurance, including a premium, commission, membership fee, or assessment -Issuing or delivering an insurance contract -Directly or indirectly acting as an insurance producer or otherwise representing an insurer

The Department will collect a nonrefundable fee from each agent or insurer for the following:

-License application fee -Appointment fee for each appointment of the agent by an insurer -Examination fees -License renewal application fees

Minimum standards for individual and group Medicare supplement insurance have been established to:

-Provide for the reasonable standardization of coverage and simplification of terms and benefits -Facilitate public understanding and comparison of such policies -Eliminate policy provisions that may be misleading or confusing with respect to the purchase of coverage or the settlement of claims -Provide for full disclosure in the sale of accident and sickness insurance persons eligible for Medicare

The purpose of replacement regulations is to:

-Regulate the activities of insurers and agents regarding the replacement of existing life insurance and annuities -Establish minimums standards of conduct of replacement transactions to protect the interests of purchasers of life insurance and annuities -Ensure life insurance and annuity purchasers receive information to make decisions in their best interest -Establish penalties for failure to comply with these requirements

The department may not require the passing of a licensing examination if the applicant is:

-Renewing an unexpired license -Renewing a license that expired less than 1 year before the date of the application, as long as the previous license was not denied, revoked, or suspended -Applying for a life-only or life, accident and health license and holds a Chartered Life Underwriter (CLU) professional designation -Applying for a property and casualty license and holds a Chartered Property and Casualty Underwriter (CPCU) professional designation

If a holder of insurance license or certificate of authority has violated or failed to comply with the Texas Insurance Code or any rule of the commissioner. The commissioner may:

-Suspend the license for up to 1 year -Issue a cease and desist order from the activity determined to be a violation -Order the licensee to pay an administrative penalty -Direct the licensee to make restitution to each Texas resident or insured in the amount, form, and within the period specified by the Commissioner

The Department may address a reasonable inquiry made to any insurer, agent, or holder of any type of authority to transact business in this state if it pertains to any of the following:

-That person's business condition -Any matter concerning that person's transactions that the Department deems necessary for the public good

Commissioner's powers and duties:

-administering insurance regulations in Texas -Regulating the business of insurance in this state -Executes and enforces, but does not establish, the state's insurance code and other insurance laws -Ensuring fair competition within the insurance industry to foster competition -Protecting and ensuring the fair treatment of consumers and handling insurance-related consumer complaints -Issuing producer licenses and approving, disapproving, or denying applications for a certificate of authority to act as an insurer -Examining the records of an insurer to determine financial condition and solvency *granted by the Department of State Legislature

Group life insurance plans issued to employers to benefit employees must meet the following requirements:

-all employees are eligible under the policy -The policyholder (employer) must pay the premium for the policy wholly from the employer's funds, partly from the employer's funds and partly from the contribution by the employees, or wholly from the employee's funds -The policy must cover at least 2 employees on the date the policy is issued

Small Employer Health Benefit Plans

-an 8-hour certification course is required before a licensee may advertise that he/she is specially trained to serve small employers in the health benefit plan market -5 hours of certified continuing education, per licensing period, is required for a licensee to renew a small employer health benefit plan specialty certification

commissioner qualifications:

-competent and experienced administrator -well informed -qualified in the field of insurance regulation -have at least 5 years experience in the administration of business or government

Examination of Records

-duty of commissioner - primary purpose of an examination is to determine solvency of the insurer. solvency meaning the ability of a company to meet its long term debts and financial obligations

Agent licensing requirements:

-is at least 18 years of age -Has not committed an act for which a license may be denied -Submitted the application, appropriate fees, and any other required information -Passed a licensing exam within the past 12 months

Cease & Desist Orders

-must contain a statement of the charges -must be served by registered or certified mail, return receipt requested, to the affected person's last known address.

temporary agent

-only valid for 90 days -cannot be issued or renewed more than once in any consecutive 6 month period

The agent must submit to the replacing insurer:

A signed statement indicating if replacement is involved A copy of the notice regarding replacement A statement identifying insurer-approved sales materials used Copies of individual sales materials including illustrations relating to a specific policy

An individual may be denied a license by the Department for all of the following reasons, except if the individual has:

Actively engaged in soliciting and writing insurance for the general public *only denied when NOT

Rules Specific to Life Insurance and Annuity Advertising

An advertisement may not include the terms savings, investment, investment plan, profit, profit sharing, interest plan, or other similar terms that imply that the product advertised is something other than life insurance or an annuity.

A licensed agent is required to obtain which of the following before transacting insurance in Texas?

An appointment from an insurer *Licensed agents are not permitted to transact insurance as an agent until they have been appointed by an insurer authorized to transact insurance in this state.

Commission Sharing

An insurer or agent may not pay to another person, or accept from another person, a commission or other valuable consideration unless such person holds a license to act as an agent in the same line of insurance in this state. Insurance counselors cannot charge a fee and get paid commission and temporary licensees cannot get paid commission.

What prohibited trade practice is committed if an agent provides misleading information regarding guaranteed dividends, terms, advantages, or disadvantages of a policy?

Misrepresentation

Pay, give, or allow (or offer to pay, give, or allow) a:

Rebate of policy premiums Special favor or advantage concerning policy dividends or benefits Valuable consideration not stated in the policy

Nonforfeiture provisions must be clearly and conspicuously captioned and at least one of the following nonforfeiture benefit options must be offered:

Reduced paid-up insurance Extended term insurance Shortened benefit period Other offerings approved by the U.S. Secretary of Health and Human Services

Annuity Suitability Agent Training Requirements

must complete a one-time training course approved by the Texas Department of Insurance as provided by an approved continuing education provider. This training must qualify for at least 4 continuing education credits, but may be longer.

Grace Period

must contain a grace period provision that allows for a period of at least 1 month from the due date for the payment of each premium, after the first payment, while the policy remains in force.

Incontestable Clause

must include a provision that states an insurer may not contest a claim under a life insurance policy once it has been in force for 2 years from the effective date of coverage.

Duties of the Replacing Agent

must notify the existing insurer of the proposed replacement and mail a copy of the illustration or policy summary for the proposed policy no later than the 5th business day after receipt of the application. The replacing insurer must maintain copies of the notice regarding replacement until the later of 5 years from the date of notification or the date of the next regular examination by the regulatory authority of the insurer's home state. The replacing insurer must notify the policy or contract owner of the right to return the policy within 30 days of delivery to receive a full refund of all premiums.

alien insurer

organized under the laws of a jurisdiction outside the United States, whether it is admitted to do business in this state

foreign insurer

organized under the laws of another U.S. jurisdiction (i.e., another state), whether it is admitted to do business in this state

domestic insurer

organized under the laws of this state, whether it is admitted to do business in this state

before revoking certificate of authority, the Commissioner must:

provide insurer with at least 10 days advance written notice *must state reason for action

Nonforfeiture benefits offered on a life insurance policy include:

reduced paid-up, extended term, and cash surrender

fiduciary responsibility

the highest standard of conduct and care imposed by both ethics and law. A fiduciary: -Owes his loyalty to his principal -Cannot put his or anyone else's personal interests before those of the principal -Cannot profit from the relationship unless the principal permits it

Incontestability

A group life insurance policy must provide that the validity of the policy may not be contested, except for nonpayment of premiums, after the policy has been in force for two years after its date of issue.

The Notice Regarding Application must include:

A list of all policies or contracts being replaced The name of the insurer and named insured The policy or contract number, or application/receipt number A statement as to whether the policy or contract will be replaced

An "agent" is NOT:

A regular salaried employee or officer who: -Devotes substantially all of his/her time to activities other than the solicitation of insurance applications -Does not receive a commission or other compensation directly from the sale of insurance -Does not solicit or accept insurance applications from the public An employer, employee, or trustee engaged in the administration or operation of an employee benefits plan if not directly compensated by the insurer issuing the contracts

Termination of Coverage under Group Policy

If a group life insurance policy is terminated by the policyholder, each insured covered under the policy for at least 5 years is entitled, upon termination of coverage, to convert coverage to an individual policy.

Delay in Payment of Claim

If an insurer delays payment of a claim for a period exceeding the period specified in the law, or if not specified, for a period exceeding 60 days, the insurer must pay damages to the policyholder or beneficiary in addition to the amount of the claim. Damages include interest on the amount of the claim at 18% per year along with reasonable and necessary attorney's fees.

Hearing

The hearing must be held not later than 10 days after the date the Commissioner receives the request for a hearing, unless the parties mutually agree to a later hearing date.

complaint

any written communication expressing a grievance -all insurers must maintain complete record of all complaints received by the insurer during the preceding 3 years or since the last examination by the Department, whichever is shorter.

Insurance under a group life insurance policy may be extended to cover(dependent)

he spouse of an eligible individual insured under the policy A natural or adopted child or grandchild of the insured if the child is younger than age 25 A physically or mentally disabled child/grandchild age 25 or older and under the insured parent/grandparent's supervision.

Accelerated Death Benefits

insured must have a terminal illness, a long-term care illness, or an illness or physical condition that is likely to cause permanent disability or premature death, including but not limited to: Acquired immune deficiency syndrome (AIDS) A malignant tumor A condition that requires an organ transplant Coronary artery disease that results in acute infarction or requires surgery

Credit Life

may be issued as an individual decreasing term life insurance policy issued to a debtor or as a group term life insurance policy issued to a creditor providing insurance on the lives of its creditors.