Missouri Laws and Rules for Health Insurance
The Missouri Insurance Director attains office in which of the following ways?
The director is an executive position appointed by the governor. Known as gubernatorial appointment
In Missouri, an A&H policy that is paid on a monthly basis requires a grace period of at LEAST
10 days
If an insurer receives a cash payment in excess of ___, it must report this act as stated by the USA Patriot Act
10,000
What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?
12 consecutive months
Once the insurance company receives a notice of claim, they have ___ days to send the claim form.
15, an insurance company will send forms for filing proof of loss to a claimant within after company receives notice
A licensee must complete ___ hours of continuing education every two years
16
After a life insurance policy has been in force for a MAXIMUM of ___ year(s), becomes incontestable
2
To be classified as a small employer, an employer must employ
2-50 employees
When an employee is terminated, how long does this employee have to convert group life coverage to an individual policy?
31 days
An insurer may exclude pre-existing conditions coverage on a Medicare Supplement policy for up to
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
A life policy loan in Missouri cannot charge a fixed rate of interest higher than
8%
What is the MAXIMUM fixed interest rate for life insurance policy loans?
8%
When is a Group Health policy required to provide coverage for a newborn child?
At the moment of birth
An insurer may not transact insurance UNLESS authorized by the
Director of Insurance. He/She issues the certificate of authority necessary for an insurer to transact in Missouri
An example of unfair discrimination would be
When an insurer charges a higher rate for insurance based on an insured's race, religion, or national origin
Which of these individuals may NOT be compensated from an insurance company?
a licensed producer not appointed by the company
Jay's application for a producer's license has been denied. He may request a hearing within ___ days after receipt of the denial
a maximum of 30 days
Which of the following is considered to be misrepresentation?
a producer guaranteeing a policy's dividends
Which of these is considered an unfair trade practice?
a producer stating that a policy's dividends are guaranteed
Anything that mentions subscribers in question is known to be
a question based on HMO's
Which of the following unfair trade practices involves a producer who makes malicious statements about another person's financial condition?
defamation
Which unfair trade practice involves making false statements about the financial condition of another insurance company?
defamation
A ___ ___ is the signed document that startst the free-look period.
delivery receipt
How often must an insurance producer's license in Missouri be renewed?
every 2 years
An example of an unfair claims practice would be
failing to effectuate prompt, fair, and equitable settlements of a claim.
The Missouri Life and Health Insurance Guaranty Association is
funded by insurance companies through assessments
Coverage for human leukocyte antigen testing for bone marrow transplantation is REQUIRED to be provided in all
group comprehensive health policies
In Missouri, a Long Term Care policy must be renewable in which of the following ways?
guaranteed renewable
The conversion provision in a group health insurance policy
is mandated by state requirements
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
Convincing a prospective insured to buy an insurance policy based on exaggerations is called
misrepresentation
___ can be defined as "making an unfair comparison of two insurance policies"
misrepresentation
Which of the following is a requirement to attain an Missouri resident producer license?
must be at least 18 years or older
Whose interest is being protected by the enactment of "The Replacement of Life Insurance and Annuities" regulation?
policyowner
A(n) ___ is an individual who is appointed by an insurance company to transact insurance
producer
Which of the following is NOT a reason for the Director to revoke a producer's license?
producer is insolvent
___ is the act of offering an applicant something of value as an inducement to purchase an insurance policy.
rebating
A producer has influenced an 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(n):
replacement
Which situation does not require a producer to provide a suitability statement to the annuity company?
when a producer discusses annuities in general with a client, but no specific recommendation is made.
A hearing must be held before a producer's license can be suspended or revoke. Prior to this hearing, the Director is required to give
written notice to the producer
Prior to a producer's license being revoke, a hearing must be held. Prior to this hearing, the Director of Insurance is REQUIRES to give
written notice to the producer
For the treatment of PKU, a health plan MUST cover formula and low protein modified food products for
a child covered under the policy who is less than 6 years of age
ABC Insurance Company would like to issue a small employer group policy in this state. Before doing so, it is REQUIRED to
be authorized to write accident and health insurance in this state.
Each life insurance applicant in Missouri is expected to be provided with a(n)
buyer's guide and policy summary
A(n) ___ of authority permits an insurance company to transact business in Missouri
certificate
Health coverage for the administration of general anesthesia and hospital charges for dental care MUST be provided to a(n)
child under the age of 5
What does the Missouri Life and Health Insurance Guaranty Association provide?
claim payment of admitted, insolvent insurance companies
One definition of replacement is "the act of replacing an existing insurance policy with another". Replacement is
closely regulated and requires full disclosure by both the producer and the replacing insurance company.
J is a producer who recently told a claimant that his rights might be impaired if he does not complete a release form within a specified time. What could the producer be found guilty of?
coercion
Any state-regulated health insurance plan issued in Missouri MUST
cover childhood immunization services
An example of an unfair claims settlement practice is
denying or turning down an insured's claim without providing the basis of denial under the policy
What is the purpose of the Missouri Life and Health Insurance Guaranty Association?
ensures that claims filed against insolvent insurance companies will be paid
Life insurance and annuity replacement can be BEST described as
exchanging an existing policy for a new policy
An example of rebating would be
offering a client something of value not stated in the contract in exchange for their business.
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
Within ___ days after policy delivery, a Medicare Supplement policy can be returned for a 100% premium refund.
MAX of 30 days
Who is responsible for administering insurance laws?
The Director
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
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 copayment. The EXCEPTION to this would be
an HMO that excludes coverage for services rendered by non-participating providers
An example of false advertising would be
an insurer exaggerating its dividends in a magazine advertisement
In Missouri, all health policies must address diabetes coverage in which way?
apple the same deductible and copays to covered diabetic supplies as other medical conditions
A health insurance policy application may ONLY be altered with the written consent of the
applicant
An example of rebating would be
returning a portion of a premium as inducement to purchase insurance
A producer must notify the Director within ___ days of a felony conviction.
30
A producer must report any personal felony charges within ___ days of a pre-trail hearing.
30
The required free-look period in a Medicare Supplement policy is ___ days
30
When an insured receives chiropractic service, the co-payment may NOT exceed ___ of the total cost of providing the service.
50% of the total cost of providing the service
The MAXIMUM time period that pre-existing conditions can be excluded in long-term care policies is
6 months
All of these statements concerning a licensee's responsibility for premiums received are true EXCEPT
The licensee must hold them in a separate account before transmitting them to the insurance company.
Which entity issues Medicare Supplement insurance?
insurance companies
Who may assign benefits from a group life insurance policy?
insured also known as the person who is covered by group life insurance
A license may be denied, suspended, or revoked if the licensee
is found guilty of misrepresentation or fraud in obtaining the license
A person covered by a group major medical policy leaves the group and converts the coverage to an individual policy. Which of the following statements is INCORRECT about the new policy?
it pays the same benefits as the group policy
Which licensee faces possible license revocation by the Director of Insurance?
licensee who commingles monies belonging to policyholders with personal funds
Which of the following is NOT a situation that involves life insurance policy replacement?
maintaining an existing policy and applying for a new one. Replacement is involved in depleting cash value in an existing policy and applying for new one, taking a reduced paid up option for a policy and applying for a new one, and terminating an existing policy and applying for one with better coverage
Defamation occurs when a producer makes a false statement intended to
malign another insurer
Health insurance coverage of autism spectrum disorder treatments may be limited in which way?
medically necessary treatment in accordance with a treatment plan
A producer is circulating incorrect information about the benefits of a policy. This producer may be found guilty of
misrepresentation
A Medicare Supplement policy can be cancelled by the insurer for
nonpayment
P is a producer who is licensed in Missouri but a resident of Nebraska. P is a(n) ___ producer
nonresident
T the producer is replacing a client's existing insurance policy with a new one. Prior to policy delivery, which form must the client be provided with?
notice regarding replacement
During the course of a Medicare Supplement sale, T the producer determines there is an existing policy being replaced. Which of these actions is this producer NOT required to perform?
notify the Director of the replacement
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
At the time of application, major medical health plans (including HMOs) are REQUIRED to
offer coverage for prosthetic devices
An individual who has a contract with an insurance company to represent it is called a(n)
producer
The ___ must provide an insured with proper disclosure concerning the replacement of an existing policy.
producer
a(n) _________ sells, solicits, or negotiates insurance on behalf of insurance companies for compensation.
producer
Who signs a "Notice Regarding Restatement" form when an application is taken for a new life insurance policy that replaces an existing one?
producer and applicant
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
When making a recommendation to a consumer to purchase an annuity, the producer must make reasonable efforts to obtain suitability information. Suitability information includes
the client's age, annual income, and financial experience.
Life insurance replacement regulation protects the interests of
the policyowner
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 Director of Insurance is authorized
to enforce state laws relating to insurance
T the producer is selling a life insurance contract to a client. T is engaging in
transacting insurance
ABC Insurance Company failed to accept a valid Proof of Loss statement. This is considered to be a(n)
unfair claims practice
