Wisconsin Accident and Health Insurance Exam 3
Any intentional criminal violation of Wisconsin insurance law may result in an individual receiving a fine of up to $3,000. $4,000. $5,000. $6,000.
$5,000.
How long is the free-look period for individual health insurance policies in Wisconsin? 7 days. 10 days. 14 days. 20 days.
10 days.
Starting in 2016, businesses with up to ___ employees will be defined by the ACA as a "small business". 40 60 80 100
100
Long-term care policies issued in Wisconsin must provide benefits for at least 6 months. 12 months. 18 months. 24 months.
12 months.
A licensee whose name or address changes must notify the Commissioner within 15 days by written notice. 15 days by phone notice. 30 days by written notice. 30 day by phone notice.
30 days by written notice.
Individual Medicare Supplement policies must allow an insured a MINIMUM of how many days after policy delivery to return the policy and receive a refund of premium? 10. 30. 60. 90.
30.
An insurer may EXCLUDE preexisting conditions on a Medicare Supplement policy for up to ___ months after policy issue. 3 4 5 6
6
Disability (accident & health) policies MUST cover lead poisoning screenings for children under ___ years of age. 5 6 7 8
6
How long can pre-existing conditions be excluded in long-term care policies? 6 months. 12 months. 18 months. 24 months.
6 months.
What is the actuarial value of a bronze level health plan? 60 70 80 90
60
How long must all health plans provide coverage for newborn children? 7 days 15 days 30 days 60 days
60 days
Which individual would be the best candidate for a temporary insurance license? Prospective intermediary who is waiting to take the state licensing examination. An individual who would like to sell insurance to family and friends for 6 months. A personal representative of a deceased or physically ill intermediary. A full-time college student soliciting insurance over the phone.
A personal representative of a deceased or physically ill intermediary.
Wisconsin requires advertisements for accident and health insurance policies covering ONLY a specified illness to prominently display. The premium guarantee. A statement that the policy is limited. A schedule of payments. The policy exclusions.
A statement that the policy is limited.
According to the Affordable Care Act, new Health Insurance Marketplaces are established by the ICIICO. CCIIOO. CCOII. CCIIO.
CCIIO.
A handicapped child is covered under an individual disability (accident & health) policy. If continuation of coverage is needed beyond the policy's age limit, which of the following is required? Child must be enrolled full-time in an accredited university. Child must be dependent on the primary insured and is incapable of self-sustaining employment. Child must produce evidence of insurability. Child must be employed part-time.
Child must be dependent on the primary insured and is incapable of self-sustaining employment.
Which of these is NOT considered a Federal punishment for unfair and deceptive insurance practices? Prison sentence. Revocation of license. Monetary fine. Community service.
Community service.
When the Commissioner examines an intermediary's insurance records, the purpose will primarily be to determine: The intermediary's sales volume. The number of insurers represented. Compliance with state insurance laws and regulations. Solvency of the intermediary's personal accounts.
Compliance with state insurance laws and regulations.
Which event must a producer report to the Commissioner? Conducting business under an assumed name. Earning new insurance designations. Sharing commissions with another licensed intermediary. Involvement in an automobile accident.
Conducting business under an assumed name.
Which of these is typically regarded as a major treatment in an indemnity dental plan? Fluoride treatment. X-rays. Restorative fillings. Dentures.
Dentures.
Which of these is NOT considered a preventative service in a dental plan? Fluoride treatment. Oral examination. Teeth cleaning. Fillings.
Fillings.
Which type of Medicare Supplement information can be used without prior State approval? Insurance company brochures. Radio announcements approved by the insurer. Television advertisements approved by the insurer. Government publications.
Government publications.
All of these are common limiting factors with dental insurance EXCEPT for Limit placed on number of teeth that may be treated annually. Limit on cosmetic-related procedures. Limit on number of X-rays per year. Limit on number of annual teeth cleanings.
Limit placed on number of teeth that may be treated annually.
Misrepresentation on the application is Intentional. Concealed. Material. Twisting.
Material.
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. Market essential coverage. Medical rebate. Minimum issue reform.
Medical loss ratio.
If an intermediary misleads or fails to adequately disclose the title and true nature of a policy offered to a potential insured, it may be considered Defamation. Unfair discrimination. Misrepresentation. Rebating.
Misrepresentation.
All of the following are covered under most dental plans EXCEPT for X-rays. Tooth extraction. Cleanings. Mouth cancer.
Mouth cancer.
Beginning January 1, 2014, the restricted annual limit for plans under the Affordable Care Act will be $500,000. $1,000,000. $1,500,000. No Limit.
No Limit.
Most prepaid dental plans cover Mouth cancer. Oral examinations. Cosmetic dentistry. Work related injuries.
Oral examinations.
Under Federal Law, which of the following actions may result in a producer becoming imprisoned? Producer writing controlled business. Producer embezzling funds from an insurer. Producer selling insurance with a nonresident license. Producer replacing an existing insurance policy with a new one.
Producer embezzling funds from an insurer.
The dental specialty which deals with the replacement of missing teeth is called Periodontics. Otology. Pediatrics. Prosthodontics.
Prosthodontics.
What is considered interstate travel under the Federal Fraud and False Statements Act? Canada. Jamaica. Mexico. Puerto Rico.
Puerto Rico.
Splitting the commission with the buyer on a sale of insurance is known as Twisting. Binding. Soliciting. Rebating.
Rebating.
An individual may become licensed as a nonresident intermediary without passing a written examination by Reciprocal arrangement with the state of domicile. Forfeiting the individual's resident license. Filing for a waiver. Filing for a waiver.
Reciprocal arrangement with the state of domicile.
Security laws passed by Congress are enforced by which Federal agency? Securities Enforcement Agency (SEA). Department of Homeland Security. Security and Exchange Commission. National Association of Insurance Commissioners (NAIC).
Security and Exchange Commission.
Long-term care insurance policies may exclude coverage for all of the following EXCEPT War and acts of war. Alcohol and drug dependency. Self-inflicted injury. Senile dementia.
Senile dementia.
Claims settlement practices of insurers are regulated by: The Internal Revenue Service. The National Association of Insurance Commissioners. Claims adjusters. State insurance departments.
State insurance departments.
Under the Fair Credit Reporting Act, which statement is true? The consumer who was investigated must be advised that credit, insurance, or employment was denied because of an unfavorable report. Disclosure of the name of the reporting agency is prohibited. The consumer must initiate legal action to remove unfavorable information from the report. A reporting agency must furnish an investigative report to any person who request the information.
The consumer who was investigated must be advised that credit, insurance, or employment was denied because of an unfavorable report.
Under Medicare Supplement insurance, what form provides information about services, benefits, copayments, deductibles, exclusions, premiums, and the insurer? The outline of coverage. The notice of benefit change. The supplemental disclosure form. The notice of replacement.
The outline of coverage.
Why were Exchanges implemented by the Affordable Care Act (ACA)? To create a one-stop market for standardized health insurance plans. Provide an additional stream of income for the Federal government. To enforce every U.S citizen to purchase health insurance. Assist in the conversion of individual policies to government mandated plans.
To create a one-stop market for standardized health insurance plans.
How long does an intermediary's license remain in effect? 3 years. 5 years. Depends on sales volume. Until revoked or suspended by Commissioner.
Until revoked or suspended by Commissioner.
A policyowner's statement that promotes an insurance company and its policy by describing the policy's benefits is called a certification. a testimonial. an advertisement. a promotion.
a testimonial.
The Affordable Care Act (ACA) established "exchanges" in order to assist individuals and small businesses when making their health insurance purchases. enforce every U.S citizen to purchase health insurance. issue fines to those U.S. citizens who do not purchase health insurance. assist in the conversion of individual policies to government mandated plans.
assist individuals and small businesses when making their health insurance purchases.
An example of the unfair restraint of competition would be controlled business. rebating. coercion. defamation.
coercion.
An intermediary who attempts to intimidate is engaging in coercion. twisting. defamation. discrimination.
coercion.
A requirement for becoming an intermediary is to be trustworthy and competent. forthcoming. bonded. insured.
competent.
A(n) ________ order may be issued by the Insurance Commissioner. compliance. incarceration. reciprocal. subrogation.
compliance.
Select the appropriate response Group disability (accident & health) policies must allow an insured continuation privileges for up to ___ months. three. six. twelve. eighteen.
eighteen.
The Insurance Commissioner does NOT have authority to examine the business affairs and financial conditions of foreign insurance companies. multi-line insurance agencies. group policyowners. surplus lines agents.
group policyowners.
When an individual is covered under a small employer's accident and health plan, the pre-existing conditions exclusion period may be partially or wholly satisfied by having creditable coverage with a previous employer. owning an individual dread disease policy. electing a high deductible plan. paying a fee.
having creditable coverage with a previous employer.
In most dental plans, a deductible typically is NOT applied to preventative and diagnostic services. restorative dentistry. orthodontics. tooth extractions.
preventative and diagnostic services.
An example of endodontic treatment is a bridge. crown. filling. root canal.
root canal.
At the time of application, insurers must provide prospects for Medicare supplement policies with a copy of the Medicare rules. the Medicare supplement buyer's guide. the insurer's warranty. the Notice for Renewal.
the Medicare supplement buyer's guide.
A notice of intent to nonrenew a policy by the insurer requires at least how many days written notice before policy expiration 10 days 30 days 45 days 60 days.
60 days.
Misrepresenting pertinent policy provisions relating to coverage after a loss is A concealment in insurance application. An unfair claims settlement practice. An unfair discrimination between individuals. An unfair discrimination between individuals.
An unfair claims settlement practice.
In order to act as an insurance agent, a producer must hold a valid insurance license and Be appointed by an authorized insurance company. Reside in this state. Maintain an office in this state. Obtain a certificate of authority.
Be appointed by an authorized insurance company.
An intermediary must secure an appointment with an insurer Before taking a licensing examination. Within 90 days of receiving a license. Before soliciting insurance applications for that insurer. Within 90 days of soliciting insurance applications for that insurer.
Before soliciting insurance applications for that insurer.
Health insurance that covers special groups of persons is called what type of insurance? Group. Franchise. Limited. Blanket.
Blanket.
An intermediary who makes an agreement that unreasonably restrains the business of insurance may have violated regulations against Boycott, coercion and intimidation. Defamation. False advertising. Unfair discrimination.
Boycott, coercion and intimidation.
Which of the following is considered to be a prosthodontic dental procedure? Filling. Root canal. Bridgework. Teeth cleaning.
Bridgework.
An intermediary's authority to bind an insurer to an insurance contract may be granted in the: Intermediary's appointment with the insurance company. Countersignature authorization agreement. Intermediary's license. Legislative code.
Intermediary's appointment with the insurance company.
What is considered the purpose of the Wisconsin Insurance Security Fund? Protects consumers from insolvent insurers. Pays premiums for insolvent insureds. Provides coverage for uninsured residents. Guarantees policy loans.
Protects consumers from insolvent insurers.
In the process of obtaining insurance, a statement made by an applicant that becomes part of the contract is considered to be a Warranty. Concealment. Representation. Representation.
Representation.
If an intermediary's license is revoked by the Insurance Commissioner, which of the following statements is CORRECT? The intermediary may accompany another licensed insurance agent during the sale of insurance but may not receive compensation. The intermediary may be paid compensation for services performed as an agent during the revocation period. The intermediary may not participate in the sale of insurance during the revocation period The intermediary may use a referral from another intermediary to solicit insurance during the revocation period but cannot take an application.
The intermediary may not participate in the sale of insurance during the revocation period
No existing insurance license will be revoked until The licensee has been afforded a right to a hearing on the charges. At least three violations have occurred. A jury has decided upon such action. A cease and desist order has been issued.
The licensee has been afforded a right to a hearing on the charges.
In Wisconsin, an insurer providing small employer group medical plans may discontinue an employer's coverage if The insurer no longer offers the plan to any employer. The employer has poor claims experience. The employer declares bankruptcy. The insurer's service area has too few providers.
The insurer no longer offers the plan to any employer.
An insurance company writing business in a state other than the one in which it is domiciled is called A foreign. A domestic. An Alien. A Illegal.
A foreign.
John has a criminal record in which he was convicted of a felony that involved dishonesty. Under Federal law, how would John be able to engage in insurance transactions? Completing a court-ordered prison sentence. Completing a court-ordered probation period. Paying a fine of up to $50,000. Given written consent by the state insurance regulatory agency.
Given written consent by the state insurance regulatory agency.
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. Accident plan. Individual plan. Group plan.
Grandfathered plan.
The forwarding of insurance business from one intermediary to another because the forwarding intermediary cannot place the business with any of the companies with which the intermediary is listed is considered brokering business. transferring risk. improper business ethics. a proper exchange of business.
a proper exchange of business.
The Commissioner can issue a temporary license as an intermediary for a period of 6 months 12 months 18 months 24 months
12 months
What is the minimum number of employees needed for a small employer medical expense plan in Wisconsin? 1. 2. 3. 4.
2.
Which of these is considered to be an intermediary? A salaried employee involved in handling claims. An accountant giving incidental insurance advice to a client. An airline employee who sells over-the-counter short-term travel insurance. A person who sells insurance on behalf of an insurer.
A person who sells insurance on behalf of an insurer.
All of the following are unfair claims settlement practices EXCEPT Misrepresentation of policy provisions to an insured. An unreasonable delay in the payment of a claim. An attempt to settle a claim by arbitration. Failure to give a reasonable explanation for denying a claim.
An attempt to settle a claim by arbitration.
An intermediary has his license revoked because of a failure to pay the required license fees. How soon after the revocation may he apply for reinstatement? Immediately. Within 6 months. Within 12 months. Never.
Immediately.
What is the consequence for an intermediary's failure to pay his/her biennial license fee? Intermediary is incarcerated by the Insurance Commissioner. Intermediary's license is suspended for 180 days. Intermediary's license is revoked. Intermediary's commission rate is reduced.
Intermediary's license is revoked.
Which of the following statements is CORRECT about an insured's failure to report a claim in a timely manner based on the advice of an intermediary? It is a material misrepresentation It affects the insured's claim settlement It invalidates the claim It does not affect the insurance company's obligations
It does not affect the insurance company's obligations
False advertising of an insurance policy is considered Defamation Misrepresentation Coercion Boycott
Misrepresentation
What is the proper procedure for an intermediary to change his/her mailing address? Notify the Governor's office in writing within 15 days. Notify the Commissioner's office in writing within 30 days. Notify the appointing insurer in writing within 15 days. Notify the Commissioner's office via telephone within 30 days.
Notify the Commissioner's office in writing within 30 days.
Renewal of small employer health insurance plans may be denied for all of the following reasons EXCEPT Nonpayment of premiums. Having less than the required number of participants. Overuse of physician and hospital services. Misrepresentation of the application.
Overuse of physician and hospital services.
A copy of all Medicare Supplement advertisements must be submitted for approval to The Commissioner. The Department of Health. The Centers for Medicare and Medicaid Services. The Social Security Administration.
The Commissioner.
Access to premium tax credits and reduced cost sharing is made available ONLY if the consumer purchases health coverage in The health insurance exchange. an HMO. a PPO. a self-directed health plan.
The health insurance exchange.
Which of the following statements regarding an examination of an insurer's books and records by the Commissioner is true? An insurer has a right to delay an examination by the Commissioner for a period of not more than 15 days after notification. The insurer must not impede an examination and is required to assist in the examination procedures. Reports related to solicitors are not official records archived from insurance examinations. The Commissioner only has the authority to examine domestic insurers.
The insurer must not impede an examination and is required to assist in the examination procedures.
An insurer operating in the U.S. but headquartered outside the U.S. is a foreign insurer. an alien insurer. unauthorized. authorized.
an alien insurer.
Making a statement that is false or maliciously critical of the financial condition of an insurer is known as defamation. coercion. slander. boycott.
defamation.
An insurance applicant has made a false statement on the application that will affect the insurer's decision on whether or not to issue the policy. This false statement is considered to be a(n) irrelevant representation. immaterial representation. material misrepresentation. consensual representation.
material misrepresentation.
In Wisconsin, a long-term care policy may offer coverage In which benefits are based on an individual's ability to perform the activities of daily living. In which benefits are based on prior hospitalization. That excludes pre-existing conditions indefinitely. Which terminates at age 80.
In which benefits are based on an individual's ability to perform the activities of daily living.
How would preventative care be encouraged in a dental plan? Deductibles. Exclude pre-existing conditions. Closed dentist panels. No deductible on routine examinations.
No deductible on routine examinations.
The maximum prison sentence given under federal law for unfair and deceptive insurance practices is 15 years. 10 years. 5 years. 1 year.
15 years.
The marketing of Medicare Supplements is regulated to prevent all of the following EXCEPT Sale of excessive insurance. Replacement of any existing coverage. Inaccurate policy provisions. Failure to display notice of limitations to buyer.
Replacement of any existing coverage.
The __________ decides on the suitability of a disability (accident & health) policy for an applicant. applicant. NAIC. intermediary. Commissioner.
intermediary.
An intermediary may share a commission with another intermediary if there is an extra fee involved. there is an extra fee involved. the insurance companies involved approve. the other intermediary is licensed in the same line of business.
the other intermediary is licensed in the same line of business.
An insurance intermediary must maintain customer records for how many years following the completion date of the insurance transaction? two. three. four. five.
three.
A small employer group is an employer that employs how many? 2-25 employees. 2-50 employees. 2-75 employees. 2-100 employees.
2-50 employees.
Under Wisconsin law, which of the following is NOT required to be licensed? An employee of a collection agency who collects delinquent premiums. A person who solicits insurance on a door-to-door basis. A person who advises another person about insurance needs and coverage and is directly compensated by the insured only. A person who advises another person about insurance needs and coverage and is directly compensated by an insurance company.
An employee of a collection agency who collects delinquent premiums.
To receive an insurance license an applicant must Apply for the license after passing the appropriate examination. Provide three character references. Execute an affidavit as to the applicant's integrity. Post a $25,000 bond to guarantee faithful performance.
Apply for the license after passing the appropriate examination.
In regards to the Affordable Care Act (ACA), which of these is NOT a role of a health insurance exchange? Offer individual, unique formats for consumers to evaluate different health plan options. Certify that a health plan is qualified to be offered on the exchange. Contact the employer if an employee stops coverage under a plan offered in the exchange. Resolve and verify an applicant's inconsistent or incomplete information.
Contact the employer if an employee stops coverage under a plan offered in the exchange.
According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation? Writing controlled business. Making false entries in a company's book. Transacting insurance outside a licensee's home state. Sharing commissions with a licensed agent.
Making false entries in a company's books
If an intermediary chooses to conduct business under an assumed name, when must notification be given to the Commissioner? No notice is required. No later than 30 days after using the assumed name. Prior to using the assumed name. At the time of license renewal.
Prior to using the assumed name.
Replacement regulations exist in order to Generate revenues for the state. Protect policyowners from misrepresentations and loss of benefits. Ensure that the original intermediary is paid renewal commissions. Ensure that all insurers get equal exposure.
Protect policyowners from misrepresentations and loss of benefits.
In regards to technology and the ACA, which of the following statements is correct? States which operate with an Exchange must offer an internet-based portal. States which operate with an Exchange must increase the costs of their plans to accomodate an internetbased portal. States which operate with an Exchange can only offer an internet-based portal in public buildings. States which operate with an Exchange qualify for Federal aid to initiate an internet-based portal.
States which operate with an Exchange must offer an internet-based portal.
An Outline of Coverage for a Medicare Supplement policy MUST be given to the applicant at which of the following times? The time of application. No later than the first renewal date. On each anniversary date of the policy. Only when the applicant requests it.
The time of application.
According to the Affordable Care Act, coverage may be rescinded if purchased through the employer. if obtained by the individual. if facilitated through the Navigator. if intentionally false statements were offered.
if intentionally false statements were offered.
An intermediary licensed to place insurance with an unauthorized insurer is an intermediary insurance agent. intermediary broker. intermediary surplus lines agent or broker. intermediary corporation or partnership.
intermediary surplus lines agent or broker.
An intermediary's insurance records or pertinent information must be provided, upon request, to the Insurance Commissioner within 30 days of the request. promptly in writing or in any other designated form under no circumstances. upon approval of the Governor.
promptly in writing or in any other designated form
Intermediaries MUST keep policyholder records for at least ___ year(s) after a policy has been terminated. one. two. three. four.
three.
EXCEPT for fraud, the time after issuance of a policy during which an insurance company may contest a health insurance claim due to the statements on an application is 10 days. 90 days. 2 years. 5 years.
2 years.
An intermediary MUST complete ___ credit hours of continuing education for each licensing period. 12. 24. 36. 48.
24.
How many hours of continuing education is required every two years for license renewal? 6. 12. 18. 24.
24.
How many days notice does the Affordable Care Act require insurers to give before rescinding coverage? 10. 20. 25. 30.
30.
How long can an insurer exclude coverage for a preexisting condition on a Medicare Supplement Policy? 6 months. 12 months. 18 months. 24 months.
6 months.
An intermediary cannot sell Long-Term care insurance unless that person has successfully completed an approved education course of 4 hours. 6 hours. 8 hours. 10 hours.
8 hours.
Which of the following individuals is required to be licensed as an intermediary in Wisconsin? An employee of a collection agency who collects delinquent premiums. A teacher who instructs students on insurance contract coverages and deductibles. A person who advises others about insurance needs and coverages and is compensated by an insurance company. An underwriter employed by an insurance company.
A person who advises others about insurance needs and coverages and is compensated by an insurance company.
A prepaid dental plan has an agreement in place with a network of dentists which Allows the dentists to determine the deductible and coinsurance amounts. Accepts an established amount as payment in full for the dental services rendered. Requires all the dentists to be located within the same state. Must cover 100% of all orthodontic treatments.
Accepts an established amount as payment in full for the dental services rendered.
Which of the following is REQUIRED coverage for all newly-issued group disability (accident & health) policies? Alcohol treatment. Wage loss due to unemployment. Long-term disability. Vision care.
Alcohol treatment.
Which of the following persons is required to have an intermediary's license? An insurance company employee who rates and classifies risks. An accountant who gives incidental insurance advice in the normal course of his or her professional activities. An employee who collects premiums from delinquent policyholders. An individual listed as a salesperson by an insurance company.
An individual listed as a salesperson by an insurance company.
For group health plans covering employees in more than one state, the state regulatory jurisdiction established for the plan may affect any of the following aspects EXCEPT Minimum enrollment percentages. Eligibility qualifications. Required contract provisions. COBRA continuation of coverage.
COBRA continuation of coverage.
For policyholders in the same risk classification, it is unlawful to Charge different premiums. Set different policy effective dates. Issue different amounts of coverage. Establish uniform claims payment procedures.
Charge different premiums.
Who reports an intermediary's termination of appointment to the Commissioner? The intermediary. The insurer. The Insurance Department. The State.
The insurer.
If hospital expenses are covered under a disability (accident & health) policy, the policy is REQUIRED to cover short-term disability. LASIK eye surgery. routine dental care. skilled nursing care.
skilled nursing care.
According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age? Age 25. Age 26. Age 27. Age 28.
Age 26.
Which statement is true regarding Wisconsin's continuing education requirements for licensed intermediaries? There are no continuing education requirements in Wisconsin. An intermediary must complete one accredited college course each year. An intermediary must meet specified course requirements within a two-year period. An intermediary who has a four-year degree in insurance is exempt from continuing education requirements.
An intermediary must meet specified course requirements within a two-year period.
Under the Affordable Care Act, all of these are considered one of the 10 essential health benefits EXCEPT Hospitalization Prescription drugs Mental health and substance abuse treatment Annual CAT scans
Annual CAT scans
The intermediary licensing process exists to demonstrate to the Commissioner that an applicant meets specific criteria. Which of the following is NOT one of these criteria? Applicant must successfully pass a licensing examination. Applicant must intend to act in good faith. Applicant has no prior bankruptcies. Applicant must be competent and trustworthy.
Applicant has no prior bankruptcies.
All of these are considered to be a violation of the Federal Fraud and False Statements Act EXCEPT Overvaluing land. Abstracting funds. False entries on reports. Claims reimbursement.
Claims reimbursement.
Prepaid dental plans differ from most other types of dental plans in what way? X-rays and teeth cleanings are fully covered. Possible exclusion of pre-existing conditions. Closed panel of dentists can only be used. Deductibles may have to be met.
Closed panel of dentists can only be used.
Which term refers to insurance written on the interests of the licensee, the licensee's employer, or the licensee's immediate family? Controlled business. Surplus lines. Fraternal organization. Reinsurance.
Controlled business.
All of these are used to prevent adverse selection in a group dental plan EXCEPT Provide evidence of insurability. Probationary periods. Waiting periods. Decreased employee participation.
Decreased employee participation.
Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means? Usual and customary fee schedules. Increased fee schedules. Decreased fee schedules. Indemnity fee schedules.
Decreased fee schedules.
Wisconsin law requires the Human Immunodeficiency Virus (HIV) consent form to State that all positive test results will be reported to the Wisconsin Department of Insurance. Be signed by both the applicant and the first beneficiary. Disclose the types of individuals or organizations that may receive a copy of the test results. Describe the specific types of tests that will be performed.
Disclose the types of individuals or organizations that may receive a copy of the test results.
Which of the following is NOT a valid reason for an insurer to cancel an insurance policy midterm? Breach of policy conditions by the insured. Material misrepresentation. Nonpayment of premium. Insured's change in marital status.
Insured's change in marital status.
Under which circumstance would an insurer be legally protected against? Intermediary and policyowner acted together to defraud the insurer. Intermediary mislead a policyowner with the insurer's knowledge. Intermediary and policyowner are one and the same. Intermediary advertises misleading information provided by the insurer.
Intermediary and policyowner acted together to defraud the insurer.
Which of the following actions is prohibited by an intermediary whose license has been revoked? Intermediary attends a meeting where another intermediary sells an insurance policy. Intermediary begins working as an office manager in a stockbroker's office. Intermediary applies for reinstatement of his/her license. Intermediary becomes employed with an HMO.
Intermediary attends a meeting where another intermediary sells an insurance policy.
Under which circumstance is an intermediary eligible to receive a commission on an insurance contract written on the intermediary's own life? Intermediary's license is revoked and is under appeal with the Insurance Commissioner. Intermediary sold insurance for the same insurer the previous year with the premium on his/her own life equal to the total premiums written. Intermediary is licensed as a life agent in Wisconsin and sold insurance with the same insurer during the previous year with total premiums exceeding the premium on his/her own life. Intermediary is writing business for an exempt insurer.
Intermediary is licensed as a life agent in Wisconsin and sold insurance with the same insurer during the previous year with total premiums exceeding the premium on his/her own life.
How can a group dental insurer discourage adverse selection? Allow pre-existing conditions. Eliminate deductibles and coinsurance. Extend open enrollment period. Limit the duration of coverage.
Limit the duration of coverage.
All of these statements are true regarding a policyowner's ability to return a disability (accident & health) policy EXCEPT The policy delivery date starts the right-to-return period. First page of the policy must contain the Right-to-Return clause. Policyowner has 10 days to return policy for full refund. Policyowner may return the policy for a full refund at anytime.
Policyowner may return the policy for a full refund at anytime.
The Commissioner may suspend an intermediary's license when the intermediary Fails to notify the insurance department of change of premium trust account location. Rebates a portion of the commission to the insured. Shares commissions with similarly licensed intermediaries. Fails to report annual commission earnings to the insurance department.
Rebates a portion of the commission to the insured.
All of the following claims settlement practices could initiate a cease and desist order EXCEPT Misrepresenting insurance policy provisions relating to coverages at issue. Refusing to pay a claim which was NOT reported to the insurer or its agent in the required time. Refusing to pay a claim without conducting a reasonable investigation of all available information where material facts are in dispute. Compelling insureds to implement suits to recover amounts due by offering substantially less than the amounts ultimately recovered in those suits.
Refusing to pay a claim without conducting a reasonable investigation of all available information where material facts are in dispute.
Any of the following may be an unfair claims practice EXCEPT Refusing to pay claims without a reasonable investigation. Refusing to pay persons bringing false or fraudulent claims. Failing to promptly provide reasonable explanation of any claim denials. Offering low amounts to force insureds to institute litigation.
Refusing to pay persons bringing false or fraudulent claims.
Under Wisconsin standards for marketing long-term care coverage, all of these are prohibited sales practices EXCEPT Twisting. Replacing existing coverage. High pressure tactics. Cold lead advertising.
Replacing existing coverage.
Which of these situations would NOT potentially involve a prison sentence under Federal law? Selling insurance with a nonresident license. Misappropriating insurance premiums. Embezzlement of an insurer's funds. Sending threatening letters to an insurer.
Selling insurance with a nonresident license.
Unless specifically excluded in the policy, a Medicare Supplement policy must provide coverage for preexisting conditions after the policy has been in effect for a minimum of how many months? Six. Nine. Twelve. Twenty four.
Six.
An insured's statement of a policy's benefits which is to be used in marketing materials is called a(n) Advertisement. Testimony. Promissory warranty. Guaranty.
Testimony.
All of the following are typically covered under dental insurance EXCEPT Treatment which began before the eligibility date. Flouride treatment. Teeth cleanings. X-rays.
Treatment which began before the eligibility date.
Insurance crimes which affect interstate commerce are prosecuted by the US Attorney General. Governor. FBI. Department of Homeland Security.
US Attorney General.
Under what circumstances must an intermediary provide his or her business records to the Commissioner? Upon request of an insured. Upon request of the Commissioner. Under no circumstances due to privacy consideration. By authorization from the National Association of Insurance Commissioners (NAIC).
Upon request of the Commissioner.
According to federal fraud and false statements regulation, what is required for a prohibited person to transact insurance business in this state? Completing twenty-four hours of ethics education. Completing three years of community service. Written consent from the U.S. Attorney General. Written consent from the state insurance regulatory agency.
Written consent from the state insurance regulatory agency.
Jerry has an indemnity plan which covers dental expenses. Typically, these type of plans has a limited network of dentists to chose from. cover preventative care once every six months. never require a deductible for major services. cover oral surgery as a result from an injury.
cover preventative care once every six months.
Medicare supplement policies may not include renewal provisions less favorable to the insured than conditionally renewable. nonrenewable. noncancellable. guaranteed renewable.
guaranteed renewable.
The insured's statement that guarantees certain things will be done after the policy has taken effect is called a(n) representation. promissory warranty. affirmative warranty. guarantee.
promissory warranty.
A person who is not licensed as an intermediary may do all of the following EXCEPT make appointments for an intermediary. receive a referral fee. mail policies to insureds. receive a commission.
receive a commission.
When testing for the Human Immunodeficiency Virus (HIV), Wisconsin law requires a consent form to be signed by the Commissioner. that is only valid for 10 days. that discloses who may receive a copy of the results. which is provided at the option of the insurer.
that discloses who may receive a copy of the results.
