Health Insurance - Chapter 8: Texas Laws and Rules Pertinent to Insurance
the insurance commissioner must give how many days notice prior to holding a hearing regarding an agents unfair or deceptive practice?
30 days
every 12 months after the initial enrollment period, an HMO must hold an open enrollment period of?
31 days
in texas, an individual life insurance policy is REQUIRED to have a grace period of ?
31 days
_____ of continuing education MUST be completed in the classroom or classroom equivalent?
50%
how long can a cash surrender value payment be deferred by the insurance company under the Nonforfeiture Law?
6 months
a temporary agents license issued by the commissioner of insurance is valid for up to ____ days?
90 days
what benefits are required under a group health plan for drug and alcohol treatment?
inpatient treatment, group therapy, outpatient treatment
credit life insurance is?
insurance issued on a debtor to cover outstanding loan balances
what IS included in a life insurance illustration?
insurers name, amount of death benefit, underwriting classification upon which illustration is based
A license may be denied, suspended, or revoked if the licensee
is found guilty of misrepresentation in obtaining the license
a domestic insurance company in Texas is considered a company that?
is incorporated and formed in Texas
who may NOT charge fees for insurance advice?
legal reserve agents
during a sales presentation for a participating life insurance policy, an agent MUST
make a prospect understand that dividends are NOT guaranteed
who MAY charge fees for insurance advice?
managing general agents, life and health insurance counselors, financial planners
what is a valid reason for an enrollee to be cancelled by a health maintenance organization (HMO) plan?
nonpayment of coverage
this isn't true about the Commissioner of Insurance?
the commissioner must be elected in a general election --- false; governor appoints the commission for a 2 year term
true statements about the Commissioner of Insurance?
the commissioner regulates the business of insurance in texas, ensures that texas insurance laws are executed, protects and ensures the fair treatment of consumers
A Medicare supplement policy may be cancelled for which of the following reasons?
the premium has not been paid by the insured
an insurer IS required to provide information on fraudulent claims if requested by?
the texas department of insurance, the attorney general, or the commissioner
why would the insurance commissioner examine the records of an insuance company?
to determine the solvency of the company
what benefit is NOT required under a group health plan for drug and alcohol treatment?
transportation to and from facility
an example of an unfair claims settlement practice is ?
turning down a claim without providing the basis of denial
ABC insurance company is actively engaging in boycott, coercion, and intimidation that results in the unreasonable restraint of trade. ABC is committing a prohibited act under texas insurance laws covering?
unfair methods of competition
how long does an insurance company appointment remain in force?
until terminated
what is required for an agent whose license has been revoked?
wait at least 5 years before applying for a new license
a foreign insurance company conducting insurance business in texas?
was formed under the laws of another state
an employee is covered under a company group life plan with a $50,000 death benefit. what is the MAX amount a spouse may be insured for under this program?
$25,000 group life insurance on an employee spouse may not exceed 1/2 the benefit of the insured
an insured may assign up to ____ of policy ownership under an individual life insurance policy?
100%
what is the MINIMUM benefit period that must be offered by a long term care policy?
12 months
in texas, how long must a policy be in force before an insurance company must pay death benefits for suicide?
2 years
a new agent must complete at LEAST _____ hours of continuing education within 24 months of initial licensure?
24 hours
an example of false advertising would be?
An insurer exaggerating its dividends in a magazine advertisement
an applicant MUST receive an Outline of Coverage when a application is taken for a?
Medicare Supplement policy
Which Unfair Trade Practice involves an agent telling a prospective client that a policy's dividends are guaranteed?
Misrepresentation
what is NOT included in a life insurance illustration?
a company mortality table
An insurance company organized under New York laws and licensed to do business in Texas is considered?
a foreign company -- in texas
what is an organization that solicits insurance only to its members?
a fraternal benefit society
If an insured's age was misstated on a life insurance contract, the misstatement of age provision required that any death benefit payable would be?
an amount that the premiums would have purchased at the current age
in texas, which of these statements regarding the suicide clause is TRUE?
an insurer may not use suicide as a defense against the payment after the second year
With whom may an agent legally share commissions?
another agent with the same line of insurance
a plan through the marketplace may be purchased by?
any legal resident (except those imprisoned)
an insurance agent has a fiduciary responsibility to all of the following?
applicants, insureds, insurers
a certificate of ______ permits an insurance company to transact business in texas?
authority
As a condition for a loan, a bank requires the borrower to purchase credit insurance from a specific company. What is the bank guilty of?
coercion
the phrase "transacting business" includes?
collecting premiums
an Evidence of Coverage form may be issued by a Health Maintenance Organization (HMO) after being approved by the ?
commissioner
true statements about health coverage for newborns?
coverage includes treatment of congenital defects, coverage beings at the moment of birth, coverage continues after the first 31 days upon payment of the first premium
NOT true statements about health coverage for newborns?
coverage is limited to only congenital defects
how often must an insurance agent license normally be renewed?
every 2 years
provision NOT required in a life insurance policy?
extended term
provisions required in a life insurance policy?
free look, grace period, entire contract
required provisions in group life policies?
free look, incontestable, conversion
these are examples of doing insurance business?
receiving an insurance application, collecting insurance premium, delivering an insurance policy
an example of rebating would be?
returning a portion of a premium as inducement to purchase insurance
who is liable when an insured suffers a loss on a policy sold by an agent through an insurer not authorized to conduct business in texas?
the agent and the company
