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PA life-n-health ins
| Question | Answer |
|---|---|
| How does the state of Pennsylvania define a business entity? | A person which is not an individual |
| Which of the following activities would require her to be licensed as an insurance producer? If she is person who solicits insurance contracts If she is a person who advises her employer on insurance issues If she is a person engaged in the business | If she is person who solicits insurance contracts |
| Who is eligible for a nonresident insurance producer license in the state of Pennsylvania? | A licensed person who lives in another state or territory that has a reciprocal agreement with Pennsylvania |
| What is the maximum amount of time that a temporary insurance producer license is valid without requiring the licensee to pass the licensing examination? | 180 days |
| Who is eligible to be issued a temporary insurance producer license? The surviving spouse of a licensed insurance producer A designee of a licensed insurance producer entering United States armed forces An employee of an agency on the death of the ag | all of them |
| Charles was issued a temporary insurance producer license. The temporary license allows him to: | service existing contracts |
| Except for a prdcr whose auth is limited primarily to the production of ins bus with limited underwriting auth, or a mngr operating under a mngmnt contract or exclusive general agency agreement, a person engaging in exclsv ins agent activities w/o a licen | 3rd degree misdemeanor |
| What is the maximum fine for a person engaging in exclusive insurance agent activities without a license? | $1000 |
| What is the duration for an insurance producer license? | 2 years |
| If a producer allows their insurance license to lapse, how much time do they have to be reinstated? | 1 year |
| How much time does an insurance licensee have to report to the Director any administrative action taken against them | 30 days |
| How much time does an insurance licensee have to report to the Director any criminal charges brought against them | 30 days |
| If James Gordon wants to start conducting his business as Flash Gordon, when does he have to notify the Commissioner | prior to using the name |
| How much time does an insurance licensee have to notify the Insurance Department of a change in address | 30 days |
| During each licensing period, a licensee must complete _______ of approved continuing education | 24 hours |
| Robert completed more than the required hours of continuing education last year. How many of his excess continuing education hours can be carried forward to the next licensing period | 24 hours |
| Continuing education hours are not required of licensees who were licensed prior to what date | 1 jan 1971 |
| How much time does the Insurance Department have to hold a hearing after notifying a licensee of a possible violation | 10 days |
| If the Commissioner determines that a licensee has committed a violation what is the minimum action that may be taken | issue a cease and desist order |
| What is the maximum civil penalty to a licensee for committing fraud | $5000 for each violation |
| What is the maximum amount of fines in a six month period for willful unfair competition violations | $50,000 |
| What is the maximum amount of fines in a six month period for unknowingly violating insurance rules | $10,000 |
| If a licensee fails to pay an insurance fine within 30 days, how much additional time is given before further fines are levied | 7 days |
| How does the Commissioner of Insurance obtain their job | Appointed by the Governor with the consent of the Pennsylvania Senate |
| What is the term of office for the Commissioner of Insurance | 4 years |
| Which of the following is NOT a responsibility of the Commissioner of Insurance: Regulating insurer solvency Issuing insurance producer licenses Issuing cease and desist orders Prosecuting criminal violations of insurance laws | Prosecuting criminal violations of insurance laws |
| what is the required relationship between an insurance companys liabilities and its funds? | The insurance company must have liabilities equal to no more than 100% of its funds. |
| A stock insurer must maintain at least how much capital for its Life and Annuity lines of insurance | 1 million |
| A mutual insurer must maintain at least how much policyholder surplus for its Life and Annuity lines of insurance | 1 million |
| In Pennsylvania, accident and health insurance lines must maintain at least how much capital | Accident and health insurance lines must maintain $100,000 of capital and $50,000 of surplus |
| Who must approve the manual containing the rates set by an insurer | commissioner of insurance |
| After an insurer sets their rates and submits their manuals, how much time must pass before the rates can be used | 30 days |
| A business entity can apply to the Commissioner for a license as a rating organization. An insurance rating organization is licensed for how many years | 3 years |
| The Commissioner must perform an examination of each rating organization at least once in: | 5 years |
| willful violation by an insurance rating organization of its principles is subject to a maximum fine of: | $500 |
| In order for an ins comp to sell any policy covering life, health, accident, personal liability, fire, marine, title, and casualty ins, the forms must be submitted and approved by the Commissnr. How long does it take for the Commissioner to approve a form | 30 days |
| $1000 | |
| It is considered an unfair claims practice to fail to respond to an insured within how many days of receiving a claim | 10 working days |
| Barring extenuating circumstances, what is the maximum time an insurer has to complete an investigation of a claim | 30 days |
| In the event a claim is denied, how much time does an insurer have to explain the grounds for a claim denial | 15 working days |
| An insurance producer cannot mix client funds with his own funds because of his | fiduciary responsibility |
| how often can The Commissioner examine an insurer's books and records | how often he wants |
| How often is the Commissioner required to examine an insurer's books and records | once every 5 years |
| Who of the following can receive a commission for selling a policy: -Someone whose license is suspended, but was not suspended at the time of the sale -Someone whose license has been revoked -Someone who has not been licensed | Someone whose license is suspended, but was not suspended at the time of the sale |
| Which of the following is an expressly prohibited act by insurance producers: -Failure to pay child support -Receive excessive traffic citations -Fail to notify the department of a change in address within 15 days -All of the above | failure to pay child support |
| all of the following could affect the status of lic EXCEPT -Obtain a license through msrprsnttn or cheat on a lic exam -Misapprop funds receive and/or accept business sold by an unlic prsn -Unintentionally misrepresenting the terms of ins contracts | Unintentionally misrepresenting the terms of insurance contracts |
| When a producer is appointed by an insurer, an appointment fee must be paid in the amount of | $12.50 |
| A producer has ________ to inform the Pennsylvania Insurance Department of their being appointed as a producer. | 30 days |
| How much time does an insurer have to inform the Pennsylvania Insurance Department of a producer's termination | 30 days |
| Within how many days of informing the Pennsylvania Insurance Department of a producer's termination does the insurer have to inform the producer | 15 days |
| If a producer promises compensation as incentive to purchase a policy, or misrepresents any insurance policy as being shares of stock, they have committed: | rebating |
| What is the penalty for a producer convicted of rebating? | 3rd degree misdemeanor |
| If a producer makes a statement saying that a health discount plan (HMO) is a form of insurance he has committed: | misrepresentation |
| If a producer relates only the benefits of a policy and does not include a description of conditions or limitations the producer is guilty of: | misrepresentation |
| Maria's agent encouraged her to allow her current policy to lapse and buy a new policy from him. He did this without regard to the possible disadvantages of such an action. The producer is guilty of - | twisting |
| If a producer attempts to settle a claim for an amount less than a reasonable amount by using fraudulent printed advertising material, the producer has committed | false advertising |
| Spreading rumors about the financial condition of another company is called | defamation |
| JB's agent made a hint that if JB purchased a policy from him, the agent would pull some strings to get JB accepted for membership in the best golf club in town. Making such an offer is considered | coercion |
| Threatening to hurt someone's business if they dont buy a policy would be considered | intimidation |
| Refusing to do business with a company to try to drive them out of business is considered | boycott |
| Insurance companies are allowed to discriminate when | same principles are applied equally |
| Which of the following is prohibited by the laws of Pa? -Refusing to insure based on religion -Refusing to insure because another company has refused to insure -Refusing to insure because the applicant is physically impaired -All of the above | all of the above |
| Giving an applicant stock in the insurance company if they buy a policy is considered | illegal inducement |
| Producers cannot promise stocks, bonds, or property as an inducement to purchase insurance. Violation of this provision is a | 3rd degree misdemeanor |
| An insurer is prohibited from sharing nonpublic financial information on an insured, unless the insured was provided with the opportunity to opt out, and did not opt out. How often must an insurer send a privacy notice to a client | every year |
| In Pennsylvania, who is responsible for assessing the scope of insurance fraud problems | Insurance Fraud Prevention Authority |
| How is the Insurance Fraud Prevention Trust Fund funded | civil and criminal fees on fraud convictions |
| When does evidence of insurance fraud gathered in an investigation become pubic knowledge | When the Section of Insurance Fraud deems it appropriate |
| Which of the following actions is not considered fraud? -Presenting documents with false information -Making misleading statements concerning claims -Unknowingly benefiting from the fraudulent act of another | Unknowingly benefiting from the fraudulent act of another |
| What is the maximum civil penalty for the first fraud violation? | $5000 |
| Tony was the victim of identity theft and subsequently put a fraud alert on his credit file. When may consumer credit reports with fraud alerts be used for insurance applications? | only if the consumer gives consent |
| What is the maximum federal criminal penalty for fraud by an individual engaged in the business of insurance? | 50k and 10 years in prison |
| basic tenet of life ins is called insurable interest. Which is not allowed in Pennsylvania? -person insuring their own life -Businesses insuring their employees -Individuals insuring a child for which they are responsible -None of the above | none of the above |
| In order to sell viatical settlements in Pennsylvania, a person needs a viatical license. Which of the following is not required to obtain a viatical license? | Being a licensed accident/health producer |
| viatical sttlmnt provider must provide the viator with all of the following disclosures EXCEPT - -Some viatical sttlmnt proceeds may be taxable -Viatical proceeds may be subject to the claims of creditors -Funds will be sent within 30 days | Funds will be sent within 30 days |
| Gregs life insurance policy defaulted because he failed to pay the premiums. How much time does he have for reinstatement of his policy after a default? | 3 years |
| How much time does a viatical settlement provider have to give written notice to an insurance company of an agreement with a viator | 20 days |
| A person that on behalf of a viator, offers to negotiate viatical settlements is a | Viatical settlement broker |
| To be considered terminally ill, a person has an illness which is expected to result in death in - | 24 months or less |
| Which of the following is considered a fraudulent viatical settlement act? -Concealing the financial condition of a licensee -Preparing false material information -Engaging in the business of viatical settlements without a license -All of the above | all of the above |
| What is the maximum fine for unfair discrimination between individuals of the same class? | $500 |
| In addition to being licensed in Pennsylvania, life insurance companies that want to offer variable contracts must also - | Gain the satisfaction of the Commissioner |
| Who of the following cannot be offered a variable life insurance contract in Pennsylvania? | someone convicted of a felony |
| A licensed insurer seeking to offer a variable life insurance policy must | Write a statement specifying the standards of suitability |
| How many days prior to publication must advertisements used in the soliciting and sales of insurance be submitted for review? | 30 days |
| How often must an insurer file a Certificate of Compliance stating that their advertisements comply with insurance laws? | every year |
| What is the purpose of the Pennsylvania Life & Health Guaranty Association? | To protect policyholders of policies issued by an insolvent insurance company |
| Who are the members of the Pennsylvania Life and Health Guaranty Association? | All the life and health insurance companies licensed to do business in Pennsylvania |
| Which is not among the max amounts of protection offered by the PA Life and Hlth Guaranty Ass. in the event a member becomes insolvent? Cslty Ins Claims:up to $300k Life Ins Death Bnft:up to $300k Life ins Cash Surrender: $100k Health Ins Claims:$300k | Casualty Insurance Claims: up to $300,000 |
| At what time must a life insurance agent provide a purchaser with a disclosure stating the significant elements of the policy? | when the application is signed |
| Which of the following is true about life ins illustrations? -producer may alter an illstrtn provided by an insurer -llstrtns must be part of any policy issued -llstrtns must be labeled: life ins llstrtn Illustrations must include the premium price | Illustrations must be labeled: life insurance illustration |
| How much time does a buyer have to return a new annuity policy from the same insurer? | 45 days |
| Which is NOT a prohibited provision in life ins policies? -for forfeiture of the policy for failure to repay any loan on the policy -limiting the time within which any legal action may be commenced to less than 3 year after the cause of action. -for | A provision limiting the time within which any legal action may be commenced to less than 3 year after the cause of action. |
| When must the life insurance surrender comparison index disclosure be given to an applicant | when the policy is delivered |
| Replacement regulations apply to life insurance policies whose face amount is at least - | $5000 |
| Who must give signed statements when a life insurance policy is a replacement? | The producer and the insured |
| Replacement rules do not apply to which of the following types of life insurance? -Term life insurance with a different insurer -Whole life insurance with a different insurer -Group life insurance -all of the above | Group life insurance |
| What is the maximum deductible for a specified (dread) disease health insurance policy? | $250 |
| What is the minimum aggregate benefit limit for a specified (dread) disease health insurance policy? | $5000 |
| The minimum benefit period for a specified (dread) disease health insurance policy covering hospital room and board, treatment, x-rays, private services from a registered nurse, and ambulance services is - | 2 years |
| Health insurance policies issued in Pennsylvania cannot exclude preexisting conditions in group medical policies for more than - | 6 months |
| Which of the following can be excluded from coverage in health insurance policies? - Intentionally self-inflicted injuries -Elective cosmetic surgery -Injury covered by any Workmen -All of the above | all of the above |
| Which of the following words is NOT specifically forbidden in insurance advertisements in Pennsylvania? Only Just Barely Minimum | barely |
| What is the maximum life insurance death benefit that can be paid for a failed life insurance company? | $300,000 |
| What is the maximum life insurance cash surrender that can be paid for a failed life insurance company? | $100,000 |
| At what time must an outline of coverage be given to a prospective applicant for long term care insurance? | at the time of initial solicitation |
| A producer must give __________________to a buyer who is replacing their life insurance from another company. | Notice Regarding Replacement of Life Insurance |
| Which is not a life ins replacement rule in PA? -The prdcr must sign a sttmnt as to whether they had knowledge of a replacement -Life ins policies cant be replaced by the same company | Life insurance policies cannot be replaced by the same company |
| No misstatements made by the applicant for health insurance may be used to void the policy after: | 3 years |
| What is the grace period for monthly health insurance premiums? | 10 days |
| If the insured defaults on a premium payment, a health insurance policy may be reinstated if | the insured approves |
| After a health or accident loss, how much time does the insured have to file a claim with the insurer? | 20 days |
| Written proof of loss in a health insurance claim must be given to the insurer within - | 90 days |
| After written proof of health loss has been provided, what is the time limit for legal actions on the claim by the insurer? | 60 days |
| Which can be a provision in a health policy -Change of occupations resulting in premium change -Other insurance excess in aggregate indemnity - the excess would be voided and premiums returned -Expense incurred benefit -All of the above | all of the above |
| How much time does a policyholder have to return the first premium for a full refund | 10 days |
| To be considered a total disability, the inability for an insured to perform all their regular occupational duties following an injury must last for how many months? | 24 months |
| Partial disability is defined as an inability to perform how many of the essential duties of a job | one or more |
| How does residual disability differ from partial disability? | Residual disability may involve the inability to perform tasks for the normal time period |
| If Joe has a loss of time benefit of $400 a month on his health insurance policy and he makes currently makes $300 a month, what amount would the insurer be liable to pay? | $300 |
| What is the minimum amount of a loss of time benefit an insurer is obligated to pay, no matter what the insured | 200 a month |
| In Pennsylvania, every policy that provides maternity benefits must provide for a minimum inpatient care time following a normal vaginal delivery of | 48 hours |
| What is the minimum inpatient care time following a Caesarean delivery | 96 hours |
| Which of the following are not mandated health insurance benefits in Pennsylvania? - Pap smears -Gynecological examination -Mammography Coverage -Prostate Examinations | prostate exams |
| All group health insurance policies issued in Pennsylvania must include coverage for alcohol and drug dependency, but may have a life time limit of how many detoxifications? | 4 |
| All group health insurance policies issued in Pennsylvania must include coverage for alcohol and drug dependency, but may have a life time limit of how many detoxifications? | 120 |
| Deductibles for alcohol and drug dependency must be approved by | commissioner of insurance |
| Which of the following is NOT considered a serious mental illness by the state of Pennsylvania? -Bipolar disorder -Anorexia nervosa -Schizophrenia -Antisocial personality disorder | antisocial personality disorder |
| What is the minimum number of annual inpatient care days mandated for serious mental illness treatment | 30 days |
| Health insurance policies issued in Pennsylvania must cover which cancer treatments | Hormone treatment and chemotherapy treatment |
| All health insurance policies must provide coverage for child immunizations up to what percentage of the average wholesale price of the immunizing producer? | %150 |
| Any individual or group health policy issued in Pennsylvania must provide coverage for dependent children up to what age | 19 |
| describe the coverage for adopted children? | All policies which provide hospital and medical coverage must provide the same coverage for an adopted child of the insured as any other covered dependent child |
| Which of the following must be covered for a newborn for all health insurance policies? -Birth abnormalities -Immunizations -Well baby care -All of the above | birth abnormalities |
| How much time does an insured have to inform a health insurance company of a newborn after the date of birth | 31 days |
| All policies issued after what date are required to cover mentally retarded dependents without regard to age | 1jan1968 |
| A policyholder must show proof of a child's incapacity of self-sustaining employment by reason of physical handicap within how many days of the normal specified dependent termination age? | 31 days |
| Someone is eligible for individual health coverage if they have been insured for how many months prior to their termination | 18 months |
| What reasons can be used to deny individual health insurance enrollment to someone who meets the eligibility requirements | none, no one who is eligible can be denied coverage |
| What is the maximum exclusion period that a group health issuer may impose for a preexisting condition | 12 months |
| What must be issued when someone terminates from a group plan or COBRA | certificate of credible coverage |
| What is grounds for a health insurance provider to discontinue a policy? -The insured failed to pay premiums in accordance with the contract terms -The insured misrepresented a material fact -The insured violated policy rules -All of the above | all of the above |
| What is the maximum time prior to the start of group insurance coverage that a preexisting condition had to have occurred for it to be used for exclusion? | 90 days |
| In which of the following is a preexisting condition exclusion not allowed? -Blanket insurance -Group student accident insurance -Group mortgage disability insurance -All of the above | all of the above |
| How many months must someone be covered by a group health insurance policy to be eligible for conversion to an individual policy | 3 months |
| If an individual under a group health insurance policy becomes eligible for an individual policy, he may do so without evidence of insurability, as long as he pays the first premium within | 31 days |
| A non-forfeiture long-term care insurance policy credit is equal to what percentage of the sum of all premiums paid | %100 |
| An insurer may discriminate in the pricing of a Medicare supplement policy based on | neither health status or claims experience |
| Making a fraudulent comparison or making misleading statements to induce a person to lapse, forfeit, or convert any insurance policy is called | twisting |
| The first year commission for a long-term care insurance policy cannot be greater than what percentage of the first year premium | %50 |
| Marketing methods that fail to acknowledge that the purpose of the marketing is to solicit insurance are known as | cold lead advertising |
| Any Medicare supplement advertisement used in Pennsylvania must be approved by | commissioner of insurance |
| Which is not allowed in PA? -Sell a Medicare supp plcy to someone who already has a Medicare supp plcy -Sell a Medicare supp plcy to someone who is not on Medicare -Sell a Medicare supp plcy to someone who is ineligible for Medicare | Selling a Medicare supplement policy to someone who already has a Medicare supplement policy |
| The rules and regulations pertaining to replacement do not apply to | credit life insurance |
| If the sale involves replacement, an insurer or its agent must furnish the applicant with | notice regarding replacement |
| If a Medicare supplement policy replaces another, for how much time must the first policy have been in effect for there to be no preexisting conditions time period? | 6 months |
| A long-term care insurance producer must give an applicant what | Long-Term Care Insurance Personal Worksheet |
| Medicare supplement policies are required to cover what percentage of Medicare eligible expenses under Part B | %20 |
| What words cannot be used in a Medicare supplement policy | usual and customary |
| How many days is the free return provision in a Medicare supplement policy | 30 days |
| in regards to the replacement of long-term care insurance, replacement contracts must have at least the same benefits as the previous contract. yes or no | no |
| What is the maximum percentage the first year commission for the sale of a Medicare supplement policy can be in comparison to the commission for the succeeding years | 200% |
| Someone cannot be denied coverage if they apply for a Medicare supplement policy within how many days of terminating a previous a Medicare supplement policy | 63 days |
| What is the minimum amount of time allowed for long term care coverage policies | 12 months |
| When must the outline of coverage be given to a prospective client for long term care insurance | at the time of initial solicitation |
| How many days is the free return provision in a long term care insurance policy | 30 days |
| How many daily activities must someone be unable to perform to trigger long-term care benefits | 3 |
| For how much time must an individual have had group long term care insurance to continue coverage with individual long term care insurance without evidence of insurability | 6 months |
| An insurer must give how much notice prior to the lapse of long term care insurance | 30 days |
| Which of the following disclosures must be included in an individual long term care insurance policy? -Renewability -Limitations on preexisting conditions -Definition of reasonable and customary -All of the above | all of the above |
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