chapter 11 Massachusetts laws and rules
in massachusetts a small employer is comprised of
1-50 employees
how many days notice must a producer be given prior to a scheduled hearing?
21 days
any administrative action taken against a producer must be reported to the superintendent within ____days of the final disposition
30
how many days notice does the affordable care act require insurers to give before rescinding coverage?
30
after the first 3 years of licensure a producer must complete _______ credit hours of continuing education
45
a producer has received the first year commission paid on a medicare supplement policy. renewal commissions must then be provided for at least ______ years after the first year
5
every domestic company must have its financial records examined by the superintendent every ______ years
5
according to the afford new health insurance marketplaces are established by the
CCIIO the center for consumer information and insurance oversight
Insurance crimes which affect interstate commerce are prosecuted by the
US Attorney general
a prepaid dental plan has an agreement in place with a network of dentists which
accepts an established amount as payment for the dental-services rendered
a prepaid dental plan has an agreement in place with a network of dentists which
accepts and established amount as payment in full for dental services rendered
prepaid dental plans differ from most other types of dental plans in what way?
closed panel of dentists can only be used
the affordable care Act (ACA) established "exchanges in order to
assist individuals and small business when making their health insurance purchases
at what point must a newborn be covered under and individual or group health policy
at the moment of birth
any agreement that unreasonably restrains the business of insurance is a violation of which unfair trade practice?
boycott, coersion, and intimidation
which of the following is considered to be a prosthodontic dental procedure?
bridgework
a superintendent has reason to believe a producer violated Mass insurance law the superintendent may issue a(n)
cease and desist order
upon receipt of written notice of claim an insurer is required to provide the claimant with
claim forms
in regards to the affordable care act ACA which of these is not a role of a health insurance exchange?
contact the employer if an employee stops coverage under a plan offered in the exchange
all of these are used to prevent adverse selection in a group dental plan except
decreased employee participation
health providers are compensated by a preferred provider organization for normal dental procedures by what means?
decreased fee schedules
which of these is typically regarded as a major treatment in an indemnity dental plan?
dentures
beginning January 1, 2014 the restricted annual limit for plans under the affordable care act will be
no limit
in order to renew a producers license continuing education credits must be completed
every three years
the "notice to buyer?" on the first page of each long term care policy delivered in Massachusetts
explains that some long term care costs may not be covered
which of these is not considered a preventative service in a dental plan?
fillings
According to the Affordable Care Act (ACA), insurers can no longer deny health coverage due to pre-existing conditions unless that plan is a(n)
grandfathered plan
under the pregnancy discrimination act of 1978 employers must treat pregnancy
in the same manner as any other covered disability
which of the following is a potential punishment given to a producer found guilty of an unfair method of competition
license suspension or revocation
who is required to notify the superintendent of a license's change of address
licensee
all of these are common limiting factors with dental insurance except for
limit place on the number of teeth that may be treated annually
how can a group dental insurer discourage adverse selection?
limit the duration of coverage
the superintendent is empowered to preform each of the following acts except
make rules that are consistent with those of neighboring states
According to the Affordable Care Act (ACA), the proportion of premium revenues spent on clinical services and quality improvements is called the
medical loss ratio
if the commissioner requests access to a producers business record the producer
must provide access to the records upon request
a(n) ______ producer lives in another state and transacts insurance in Massachusetts
non-resident
which of these is not an unfair claims settlement practice?
offering to settle a claim by arbitration
which of the following is not covered by Massachusetts workers compensation laws?
on the job injury that was both intentional and self inflicted
which of the following is a requirement for an individual to receive an insurance license in Massachusetts
passing the appropriate examination
whose interests are being protected with the existence of replacement rules?
policyowner
the _______ is responsible for determining the appropriates of a medicare supplement policy for an applicant
producer
in order for a handicapped child to continue health insurance coverage beyond the policy's limiting age the insurer may require
proof of incapability
the dental specialty which deals with the replacement of missing teeth is called
prosthodontics
which of the following actions does not need to be taken by a policy-owner to continue a newborns health coverage beyond initial coverage period?
provide evidence of insurability
an example of endodontic treatment is a
root canal therapy
the outline of coverage for a medicare supplement policy provides information about
services, benefits, co payments, deductibles, exclusions, premiums and the insurer
the outline of coverage for a medicare supplement policy provides information about
services, benefits, co-payments, deductibles, exclusions, premiums, and the insurer
in regards to technology and the ACA which of the following statements is correct?
state operate with an exchange must offer an internet based portal
rick provides notice of claim to his health insurer. if he does not receive a claim form within 15 days he may comply with proof of loss provision by
submitting written proof of loss
before a medicare suppliment advertisement is released t the public it must first be approved by the
superintendent
a husband and wife both have group health coverage with there respective employers. how is it determined whose insurance coverage will cover their dependent child
the child's coverage would derive from the parent whose birth month comes first in the calendar year
a producers insurance records must be provided to the superintendent
upon request of the superintendent
a married couple adopts a child that was voluntarily surrendered by birth mother. the married couple is already covered under a group health insurance policy. at what point is the child considered a dependent under this coverage
the date the child is placed in the couples home
Why were Exchanges implemented by the Affordable Care Act (ACA)?
to create a one-stop market for standardized health insurance plans
what is the primary reason for the superintendents examination of a producers insurance records?
to determine compliance with state insurance laws and regulations
a producer who misrepresented a pertinent policy provision related to a claim committed a(n)
unfair claims settlements practice
according to the federal fraud and false statements regulation what is required for a prohibited person to transact insurance business in this state?
written consent from the state insurance regulatory agency
