X-Cel, Accident and Health Insurance, Chapter 11 - Laws and Rules Pertinent to Insurance
A consultant obtains their income from which source
Clients
Beginning January 1, 2014, The restricted Annual Limit for plans under the Affordable Care act will be
No Limit
According to 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
Which of the following is considered to be a prohibited business practice
Failing to submit premiums to an insurer
After conducting a hearing, the Commissioner is empowered to issue a cease and desist order. A Violation of such an order is punishable by a monetary fine not to exceed
$50,000
To be classified as a small employer in Connecticut, an employer must employ how many employees?
1 to 50
A producer must secure an appointment with an insurer
Before soliciting applications for that insurer
A Producer that makes an agreement that unreasonably restrains the business of insurance may have violated regulations against:
Boycott, coercion, and intimidation
Prepaid dental plans differ from most other types of Dental plans in what way?
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
How can a group Dental Insurer discourage adverse selection
Limit the Duration of coverage
Why does Connecticut Require Insurers to maintain a minimum level of Assets
To demonstrate Insurer Solvency
A Prepaid Dental plan has an agreement in place with a network of dentists which
accepts an established amount as payment for the full dental services rendered
Making a statement that is false of maliciously critical of the financial condition of an insurer is known as
defamation
In Connecticut, Human Immunodeficiency virus (HIV) consent form
must disclose who will be receiving a copy of the test results
In Connecticut, a temporary license may be issued for a period not to exceed
180 days
An Administrative Action taken against a producer MUST be reported to the Commissioner within ___ days after the final disposition.
30 days
A(n) ________ insurer operates in the United States but is headquartered outside the United States
Alien
A temporary license may be issued to which of the following?
Employee of a disabled producer
When an insurer markets its medicare supplement products in Connecticut, which method is acceptable?
Replacing an existing policy with one that has greater benefits
In the process of obtaining Insurance, a statement made by the applicant that becomes part of the contract is considered to be a
Representation
An insurer may NOT refuse the renewal of a small employer health insurance plan because of
overuse of medical services
Licensed Producers in Connecticut are authorized to
solicit, receive, and forward applications to the insurer
All of these are common limiting factors with Dental Insurance EXCEPT
Limit placed on number of teeth that may be treated annually (limits on cosmetic related procedures, number of x-rays per year, and the number of annual teeth cleanings are all common factors)
Misrepresentation on the application is
Material
A Group Health Plan covers employees in Connecticut, Massachusetts, and Rhode Island. The State Regulatory Jurisdiction established for this plan does NOT affect which plan aspect?
COBRA continuation of coverage
False Advertising of an Insurance Policy is considered
Misrepresentation
Health Providers are compensated by a Preferred Provider Organization (PPO) for normal dental procedures by what means?
Decreased Fee Schedules
An example of an Unfair Claims Settlement practice is
Failing to promptly investigate and settle legitimate claims
Which of the following is NOT classified as an "employee" under a group employer insurance plan?
Independent Contractors
Which of the following causes of disability is NOT covered under Connecticut workers compensation laws?
Intentional, self-inflicted injuries that occur at the worksite
All of the following are covered under most Dental plans except
Mouth Cancer. (Tooth extraction, cleaning, and X-rays are covered).
Why were Exchanges implemented by the ACA (Affordable Care Act)?
To create a one stop market for standardized health insurance plans
When an individual buys insurance under a threat made by a producer, a violation has occurred under the
Unfair Trace Practice Act (for boycott, coercion, and intimidation_)
Mentally or Physically Handicapped dependent Children MUST be covered under an individual health insurance policy
Until they become self-supporting
How many days of notice does the Affordable Care Act require insurers to give before rescinding coverage?
30 days
An Insured has been ordered by the Court to provide a child's health insurance. Upon this order, the insurer must allow the enrollment of this child
At any time
A Group health certificate for coverage issued in Connecticut MUST contain a(n)
Summary of policy features and benefits
Which of the following is NOT a valid cause for termination of an employee's group health coverage?
The Coinsurance limit has been exceeded (Master policy termination, employment termination, and no monetary contributions made by employee are all valid reasons).
To secure Authority for soliciting insurance products in the state of Connecticut, an insurance company must secure a Certificate of Authority from
The Connecticut Insurance Commissioner
Who is responsible for reporting to the Commissioner any name or address change of the licensee?
The Licensee
The Affordable Care Act established "Exchanges" in order to
assist individuals and small businesses when making their health insurance premiums
Medical costs in birthing centers are lowered by using
certified nurse midwives
Misrepresenting Pertinent Policy Provisions relating to coverage after a loss is
An Unfair claims settlement Practice
A television advertisement features a health insurance product that is endorsed by a specific group. In this advertisement
Any control by the insurer over this group must be disclosed
To receive an Insurance License an applicant must
Apply for the license after passing the appropriate examination
When does a family's health policy's coverage for a newborn child begin?
At the moment of birth
A producer recently replaced an existing Medicare Supplement policy with a new policy. The producer's compensation for the new policy
CANNOT exceed the renewal commission of the original policy
According to the Affordable Care Act, new Health Insurance Marketplaces are established by the
CCIIO (Center for Consumer Information and Insurance Oversight)
In Connecticut, Continuing education courses must be approved by the
Commissioner
In Connecticut, continuing education courses must be approved by the
Commissioner
Which of these is NOT considered a federal punishment for unfair and deceptive insurance practices
Community Service (Prison, monetary fees, and revocation of license are punishments)
When evaluating an insurer's financial status, the Commissioner may consider each of the following EXCEPT
Comparing an insurer's agency agreements to determine maximum-paid commissions
A producer MUST notify the Commissioner for
Conducting business under an assumed name
A(n) ________ is a licensee who charges a fee for contracted insurance advisory services
Consultant
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 (Maximum participation required. Waiting and Probationary Periods, and providing evidence of insurability are used).
Which of the following would be considered a violation of Connecticut Insurance Law?
Failure to reemit premiums in a timely manner
A Consumer who has been recently denied insurance, credit, or employment based on an unfavorable consumer report MUST be advised as such. Which of the following does this statute originate from?
Fair Credit Reporting Act
Which of these is NOT considered a preventative service in a dental plan?
Fillings (A Restorative Service. Oral Examinations, teeth cleaning, and fluoride treatments are preventative services).
A(n) ________ insurer writes business in a state other than the one in which it is domiciled
Foreign
According to the Affordable Care ACT (ACA), coverage may be rescinded
If Intentionally false statements were offered
Under the Pregnancy Discrimination Act of 1978, employers MUST treat pregnancy
In the same manner as any other covered disability
The Commissioner is empowered to perform each of the following acts EXCEPT
Make rules that are consistent with neighboring states
According to the Federal Fraud and False Statements act, which of these is considered to be an intentional violation?
Making False entities in a company's books
Which of these is NOT a standard provision in qualified long-term care policies sold in Connecticut?
Prior Hospitalization
Under Federal Law, which of the following actions may result in a producer becoming imprisoned?
Producer embezzling funds from an insurer
What is considered Interstate Travel under the Federal Fraud and False Statements Act?
Puerto Rico
Which of the following actions may result in a producer's license being suspended by the Commissioner?
Rebating part of a commission to the applicant
Which of the following facilitates nonresident licensing in the state of CT
Reciprocity Agreement
In Connecticut, a producer cannot use his/her license for primarily writing controlled business. In order to conform to this requirement, annual premiums collected on controlled business cannot exceed _______ of total premiums.
10%
How many days notice does the Affordable Care Act (ACA) require insurers to give before rescinding coverage
30 days
Producers Licensed in Connecticut must notify the Insurance Department within ___ days of any change of name or address
30 days
A Producer is holding a meeting with a potential client about replacing an existing group health insurance policy. The topic that should be included in that conversation is
A comparison of benefits between the current and proposed plans
Which of these situations would NOT potentially involve a prison sentence under federal law?
Selling insurance with a nonresident license
Long term care policies sold in Connecticut may NOT EXCLUDE coverage for
Senile Dementia
A Producer's failure to provide title and true nature of a policy upon solicitation is an example of
Solicitation
Which of the following is the BEST candidate for a temporary Insurance License?
The Executor of the estate of a deceased license producer
If one producer provides a referral to another producer which results in the sale of an insurance contract, Who will likely be paid a commission?
The commission will likely be shared between the two producers
All of the following are typically covered under Dental Insurance Except
Treatment which began before the eligibility date. (Fluoride Treatment, teeth cleanings, and x-rays are all covered under Dental Insurance)
