XCEL Chapter 11 - Laws and Rules

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According to the Affordable Care Act, what is the maximum amount an individual can contribute to a Flexible Savings Account?

$2,500

A producer that willfully violates any provision of Pennsylvania Insurance law may be imposed to a maximum penalty set by the Commissioner at

$5,000 per violation

If a Medicare Supplement policy replaces another that had been in effect for at least 6 months, the replacing policy may impose which of the following time exclusions for pre-existing conditions?

0 months

If a health policy is reinstated after it had lapsed for nonpayment, there is a waiting period of _______ days before a claim covering sickness will be covered.

10

The free look period in Pennsylvania for individual health insurance policies is _____ days.

10

Every Pennsylvania insurer, upon receiving notification of a claim, must acknowledge receipt of the notice within

10 days

What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?

12 months

Written notice of a health insurance claim should be given to the insurer within ______ days after the occurrence of any loss covered by the policy.

20

Producers must complete a total of ____________ of Continuing Education credits for each two-year licensing period.

24

An employer may qualify for health care tax credits through SHOP Marketplace if that employer has fewer than how many employees?

25

Pennsylvania requires that a licensee complete ______ hours of continuing education on the subject of ethics every reporting period.

3

In Pennsylvania, the Time Limit on Certain Defenses provision provides that no misstatements (EXCEPT fraud) made by the applicant on a health insurance application can be used to void the policy or deny coverage after the expiration of

3 years

In a Long-Term Care policy, the right-to-examine period is

30 days

In accident and health plans, premiums paid less frequent than monthly require a minimum grace period of at least

31 days

In Pennsylvania, accident and health plans are required to provide mammograms for women starting at age

40

As of January 1, 2014, an employer with up to 25 full time equivalent (FTE's) with average annual wages of less than $50,000 may be eligible for a tax credit of _____ of the premiums paid by the employer.

50%

Under Pennsylvania statute, first year of commission for long-term care insurance may not be greater than

50% of the first year premium

The Medicare Supplement open enrollment period is the

6 month period that begins with the month in which enrollment in Part B Medicare occurred, typically at age 65.

No Long-Term Care policy may exclude pre-existing conditions for a period of more than

6 months

If a health insurance claim is not promptly paid, legal action may be taken against the insurer after

60 days from the date proof of loss is furnished

In Pennsylvania, HIPAA laws require that an individual's prior creditable coverage may reduce the maximum pre-existing condition exclusion period that a new group health plan can apply. This rule is applicable as long as there has been no gap in creditable coverage for a period greater than

63 days

An example of rebating would be

A producer who share commissions with a client

A temporary license may be issued without state examination to all of the following EXCEPT

A prospective producer who is currently enrolled in a pre-licensing insurance class

Which of the following is included in the entire contract according to the entire contract provision?

Application

What is the difference between a Long-Term Care Partnership Plan and a Non-Partnership Plan?

Asset protection

When is a Group Accident and Health policy required to provide coverage for a newborn child?

At the moment of birth

With a scheduled dental policy, how are covered expenses paid?

Benefits are limited to a specific maximum dollar amount per procedure

According to Pennsylvania law, which of the following is NOT considered to be personally identifiable financial information?

Blind trust data that does not include names and addresses

How are health plans classified according to the Affordable Care Act?

Bronze, Silver, Gold, Platinum

What are the levels of coverage as defined by the Affordable Care Act?

Bronze, Silver, Gold, and Platinum

Which of the following is required for an insurer to conduct business in this state?

Certificate of Authority

In Pennsylvania, who is responsible for Continuing Education (CE) course content approval?

Commissioner

In Pennsylvania, which of the following is NOT something a licensee must do to renew their insurance license?

Confirm previous exam scores

Which of the following does restorative dental treatment cover?

Crowns

A form of medical health insurance covering the treatment and care of gum disease is called

Dental expense insurance

All of the following may be an unfair claims practice EXCEPT

Denying an insured's fraudulent claim.

Which prohibited act involves a producer spending a client's insurance premiums of his/her own personal use?

Embezzlement

Acme Corporation recently purchased a group health plan for its employees. Who would receive a certificate of coverage?

Employees

A common exclusion or limitation on a dental policy is

Endodontics

Which of the following is required to maintain a producer's license in Pennsylvania?

Field underwriter, who solicits insurance and earns a commission

Violations of US Code Title 18 section 1033, may result in

Fine and/or imprisonment

In Pennsylvania, a Long-Term Care policy must be _________ renewable.

Guaranteed

Which of following provisions protects a Pennsylvania policyowner from an innocent mistake made on the application over 2 years ago?

Incontestability provision

When a producer offers something of value in return for the purchase of an insurance policy, which prohibited sales practice has been committed?

Inducement

An insurer is REQUIRED to offer which of the following to each long-term care applicant at the time of purchase?

Inflation Protection

A Long-Term Care plan must provide which of the following options for coverage in the state of Pennsylvania?

Inflation protection rider

Who issues Medicare Supplement policies?

Insurance companies

Who is required to notify the producer in the event of appointment termination?

Insurer

A resident producer license requires each of the following EXCEPT

Insurer appointment

Violating Pennsylvania insurance law may result in which of the following Insurance Department actions?

Issuance of a cease and desist order after a hearing

In Pennsylvania, completion of continuing education is required upon license renewal for which of the following?

Licensed individuals qualified in major lines of insurance

According to the Affordable Care Act, any plan in existence prior to which date is considered a grandfathered plan?

March 23, 2010

A Medicare Supplement policy may be cancelled by an insurer for which of the following reasons?

Material misrepresentation

The document that describes policy features, benefits, exclusions and riders in a Long-Term Care policy is known as the

Outline of Coverage

The _______ is responsible for determining the appropriateness of a Medicare Supplement policy for an applicant.

Producer

Which of the following is a person who negotiates an insurance contract on behalf of an insurer?

Producer

Who can receive an insurance commission?

Producer

What is required before an insurance producer can act as a representative of an insurer?

Producer needs to be appointed by that insurer

In Pennsylvania, an insurance producer license can be denied for failure to pay each of the following EXCEPT?

Property tax

The branch of dentistry which deals with the replacement of missing parts is called

Prosthodontics

What is the purpose of the Pennsylvania Life and Health Insurance Guaranty Association?

Provide policyowner protection if an insurer becomes insolvent

Which of the following is an example of a producer's fiduciary duty?

Recording receipt and remittance of premiums due to the insurance company

Which accident and health policy provision allows the policyowner a stated amount of time to return a newly-delivered policy for a full refund of premiums if not satisfied for any reason?

Right to examine

The Pennsylvania Insurance Department is responsible for each of the following EXCEPT

Shareholders

Which of the following is the Pennsylvania Insurance Department NOT responsible for?

Shareholders

In Pennsylvania, a producer may have license revoked for which of the following acts?

Signing a prospect's name without their knowledge or presence

Under the Affordable Care Act, how would a grandfathered health plan lose its grandfathered status?

The insurer significantly raises co-insurance charges, deductibles, or co-payment charges

When a Medicare Supplement insurance policy is being replaced, who must sign the notice of replacement?

The producer and the applicant

Charging a client less premium than what is stated in their insurance policy is called

a rebate

Health insurance advertisements that mention statistical information are required by Pennsylvania law to

accurately convey all pertinent facts

Holding premium funds for timely submission to the insurer is an example of

acting in a fiduciary capacity

For Pennsylvania Insurance Code violations, the Commissioner may assess a(n)

administrative penalty

Group dental plans will frequently place a limit on annual benefits in order to minimize

adverse selection

An insurer formed according to the legal requirements of another country is considered a(n)

alien insurer

If the Insurance Department determines that the issuance of a temporary producer license serves in the public's best interest, the license may be issued to

an executor of a deceased producer's estate

All of these are considered a form of advertising EXCEPT

an insurer's A.M. Best rating

A licensee may only sell, solicit, and negotiate insurance contracts on behalf of the

appointing insurer

In order to solicit insurance in Pennsylvania, all of the following is required EXCEPT

be at least 21 years of age

A domestic insurance company in Pennsylvania MUST

be formed under Pennsylvania insurance laws

A Medicare Supplement policy's outline of coverage MUST include a(n)

description of policy benefits

When an applicant for a producer's license has a principal place of residence or business location in Pennsylvania, for licensing purposes the State of Pennsylvania is known as the

home state

Sharing 50% of a producer's commission with the insured is an example of

illegal inducement

A non-admitted insurer

is not afforded protection by the guaranty fund

An insurance company may only pay commissions to a(n)

licensed producer appointed by the insurer

The Life and Health Guaranty Association provides funds to carry out its powers and duties by assessing

member insurers

Benefits for a Medicare Supplement policy

must not duplicate Medicare benefits

A producer who sells insurance in Pennsylvania but resides in another state is called a(n)

nonresident producer

A producer's fiduciary duty requires that

premiums are forwarded to the insurer on a timely basis

In most dental plans, a deductible typically is NOT applied to

preventative and diagnostic services

All statements in an insurance application, in the absence of fraud, are considered

representations

In the state of Pennsylvania, a licensed producer

represents the insurer

An example of endodontic treatment is a

root canal

All of the following actions are considered rebating EXCEPT

sharing commissions with other licensed and appointed producers

A(n) _________ company is owned exclusively by shareholders.

stock

Long-term care policies sold in Pennsylvania may exclude coverage related to

substance addictions

A producer does NOT have a fiduciary responsibility to

the Pennsylvania Guaranty Association

Under the Affordable Care Act, a large employer that does NOT provide health insurance and owes an employer mandate penalty MUST pay an annual penalty, which is calculated by multiplying $2,000 by

the number of full time employees minus 30

The act of using misrepresentation to induce an insured person to terminate an existing policy and purchase a new policy is referred to as

twisting

Fair Credit Reporting Act protects consumers

with guidelines regarding credit reporting and distribution


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