Test 4
Long-Term Care policies issued in Iowa MUST be
Guaranteed
According to the Time Payment of Claims provision, how soon must an insurer pay for a covered medical expense after proof of loss has been submitted?
Immediately
What is one of the roles of the Commissioner?
Enforce state insurance laws
A producer does not have the authority to change a policy or waive any of its provisions. The health provision that best describes this statement is called the
Entire Contract
In a life insurance contract, the policy, application, and riders or endorsements are considered to be the
Entire Contract
Which of the following policy provisions prohibits an insurance company from incorporating external documents into an insurance policy
Entire Contract
The act of an insurance company publishing misleading information about its policy's provisions is called
False advertising
The Insurance company that Jack represents has been placed into rehabilitation, but Jack continues to tell his clients the company is "financially strong" and he uses an outdated financial rating to back up his claim. What unfair trade practice has Jack committed?
False financial statements
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
Which of the following is a requirement to be eligible for a group life policy in Iowa?
Group must be formed for a purpose other than obtaining insurance
T applied for a Disability Income policy and has a history of back injuries. The insurer issued the policy with a statement that excludes coverage for back injuries. This statement is called a(n)
Impairment rider
XYZ Corp was issued a group health policy for its employees. Under this plan a
Policy must be issued to XYZ, and a certificate must be issued to each employee
What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?
Premiums may increase at time of renewal
A(n) _______ sells, solicits, or negotiates insurance on behalf of insurance companies for compensation
Producer
Which Accident and Health policy provision addresses preexisting conditions?
Time limit on certain defenses
Group Life policies in Iowa are required to contain a conversion privilege that allows for conversation
To an individual policy for a stated period of time
Why would the commissioner examine the records of an insurance company?
To determine the solvency of the company
Under the Affordable Care Act (ACA), health coverage is provided for dependents up to the age of
26
A producer must notify the Insurance Division within ____ days of a felony conviction
30
How many days must the insured wait to take legal action against a health insurer after submitting written proof if the insurer refuses to pay?
60
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
Which of the following BEST describes how pre-admission certification is used?
Used to prevent nonessential medical costs
An example of false advertising would be
An insurer exaggerating its dividends in a magazine advertisement
According the the affordable care act (ACA), which of the following coverages is NOT required?
Coverage for cosmetic surgery
Iowa's 10-day free-look period for life insurance policies begins at the
Date of delivery
During an insurance transaction, who does the producer represent?
Insurer
P is self-employed and owns an Individual Disability Income policy. He becomes totally disabled on June 1 and receives $2,000 a month for the next 10 months. How much of this income is subject to federal income tax?
0
After purchasing an individual health insurance contract, policyowners have ____ days from the date receiving the policy to return it for a full refund for any reason.
10
Which situation does NOT require a producer to provide a suitability statement to the annuit company?
When a producer discusses annuities in general with a client, but no specific recommendation is made
An example of life insurance policy replacement would be?
cash surrender an existing whole life policy and purchasing a new whole life policy
Health insurance benefits NOT covered due to an act of war are:
excluded by the insurer in the contract provisions
Under an individual Health Insurance policy, the Time Limit of certain defenses provision states that nonfraudulent misstatements first become incontestable two years
from the date that the policy was issued
Information obtained from a phone conversation to the proposed insured can be found in which of these reports?
inspection report
Who issues Medicare Supplement policies
insurance companies
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best desribes this policy is called
noncancellable
The Notice of Claims provision requires a policyowner to:
notify an insurer of a claim within a specified time
An example of unfair discrimination would be
offering different terms of coverage for different policyowners having the same risk classification
An example of rebating would be
returning a portion of a premium as inducement to purchase insurance
An example of an unfair claims settlement practice is
turning down a claim without providing the basis of denial
Before holding a hearing regarding an agent's unfair or deceptive practice, the Insurance Commissioner MUST give how many days notice?
10
A group life insurance policy insured may assign up to ____ of the insured's coverage.
100%
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 plan?
31 days
The Commissioner of Insurance is the chief officer of the Iowa Insurance Division and is appointed by the Governor for a __ year term.
4
The Commissioner of Insurance is the chief officer of the Iowa Insurance Division and is appointed by the Governor for a ____ year term
4
The waiting period for a pre-existing condition under a Medicare Supplement policy may NOT go beyond
6 Months
Inflation protection is not required in a partnership long-term care policy if the individual is at least how old at issue
76
What is Iowa's definition of Life insurance replacement?
A transaction in which a new policy is bought and an old policy is terminated
Which of these is NOT a required group life policy provision?
Accidental Death and Dismemberment
When is a Group Health policy required to provide coverage for a newborn child?
At the moment of birth
P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?
Claim will be denied
A Disability Income policyowner recently submitted a claim for chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of the application. How will the insurer handle this claim?
Claim will be paid and coverage will remain in force
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 this producer be found guilty of?
Coercion
Which of these is a requirement for obtaining a resident insurance producer license in this state?
Complete a prelicensing examination
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 customers signature then send the application off to the insurance company
T the producer is trying to dissuade a policyowner from replacing an existing insurance policy. This action taken by T is called
Conservation
An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?
Consideration clause
Which of the following unfair trade practices involves a producer who makes malicious statements about another person's financial condition?
Defamation
An agent takes an individual Disability Income application, collects the appropriate premium, and issues the prospective insured a conditional receipt. The next step the insurance company will take is to
Determine if the applicant is an acceptable risk by completing standard underwriting procedures
An insurance company that conducts business in Iowa and was incorporated in Iowa is called a(n) ______ insurer.
Domestic
Which is the sate's high-risk pool coverage for residents who cannot obtain coverage through the traditional insurance market?
Iowa comprehensive Health Insurance Association
Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a disability income policy?
Issue the policy with an altered Time of Payment of Claims provison
Which type of plan normally includes hospice benefits?
Managed care plans
Which of the following are Not managed care organizations
Medical Information Bureau
Periodic health claim payments MUST be made at least
Monthly
A Medicare Supplement policy can be cancelled by the insurer for
Nonpayment
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
What must be signed by both the producer and applicant when existing life insurance policy is being reissued with a reduction in cash value
Notice Regarding Replacement
If a Medicare Supplement policy involves replacement, it must be verified on a question located
On the application
The insured and insurance company will share the cost of covered losses under which health policy feature?
Payment of Claims provision
Which of these is considered a mandatory provision?
Payment of claims
What must the policyowner provide to the insurer for validation that a loss has occurred?
Proof of loss
Which of these individuals would require continuing education?
Resident Producer
In order to terminate a producer's appointment, the insurer MUST
Send notice of the termination to the commisioner
Which mode of payment is NOT used by health insurance policies?
Single premium
Which of the following statements about the classification of applicants is INCORRECT?
Substandard applicants are never declined by underwriters
Obtaining information from the applicant to determine whether an insurance or annuity product is appropriate is called
Suitability
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
T files a claim on his Accident and Health policy after being treated for an illness. The insurance company believes that T misrepresented his actual health on the initial insurance application and is, therefore, disputing the claim's validity. The provision that limits the time period during which the company may dispute a claim's validity is called
Time limit on certain defenses
If an individual is covered under an Accidental Death Policy and dies, an autopsy can be performed in all these situations, EXCEPT:
When the state prohibits this by law