CA Accident and Health Insurance Flashcards
All of the following are covered under the Access for infants and Mothers Program. EXCEPT:
any mother who reside in the state of California whether or not she has applied
What happens under a misstatement of age clause on a disability policy?
all amounts payable under this policy shall be what the premium originally would have purchased and been paid at the correct age.
Which of the following is an INACCURATE statement regarding replacement for long-term care coverage?
Group long-term care policies have the same rules regarding replacement as individual long-term care policies
In which situation is a person or other entity that provides coverage for medical expenses Not subject to the jurisdiction of the insurance department?
When they are subject to the jurisdiction of another agency of this or another state or the federal government
Which is an INACCURATE statement regarding inflation protection for long-term care insurance?
The protection covers a specified percentage of actual or reasonable charges, and includes a maximum specified indemnity amount.
A policy with a life insurance benefit for a disabled employee includes an extension of benefits upon its discontinuance when all of the following are met EXCEPT
during a 30 day period in which to accept the terms of the new policy
Which of the following may be described as an “administrator” of life & health coverage or annuities?
the Insurance Commissioner who has access to the records for examination, audit, and inspection purposes
When does a license become inactive for a broker?
upon the termination of all appoinments, or all endorsements
Which is an ACCURATE statement regarding benefits of Medicare supplement and Medicare select plans?
There is no restriction for benefits after the coverage has been in effect for six months when involving a preexisting condition
All of the following may be eligible to qualify for enrollment in the Healthy Families Program EXCEPT
children who fail to meet citizenship or immigration rules
Who is the California Life and Health & Guarantee Association is regulated by?
The California Insurance Commissioner
All of the following are permitted to have blanket insurance policies with specific restrictions EXCEPT
any union with dues-paying members.
Which is an INACCURATE statement regarding standards to avoid unfair underwriting for applicants at risk for auto immune deficienct, human immunodeficiency virus, or AIDS related conditions?
Insurers are permitted to schedule AIDS and HIV testing without the specific consent of the individual applying for insurance
When shall an individual certificate be deemed to be “individualized” within the meaning of the CIC?
if it contains either the name of the person covered or some other means of identifying to the individual covered that it is his individual certificate
Can any life insurer issue group life insurance with premium rates less than the usual rates for such insurance?
yes, they may do so on any group plan, with or without annuities
Which is considered unnecessary replacement for long-term coverage unless as a means to consolidate policies with one insurer?
Issuing 3 or more policies within a 12 month period
under which situation would an individual enrolled in Medicare Part B be INELIGIBLE for open enrollment?
notice of end stage renal decease from the primary care physician
What do all long-term care insurers, agents and brokers owe to the policyholder or prospective policyholder?
a duty of honesty, good faith, and fair dealing
When is the practice of ‘post claims’ underwriting allowable on disability insurance covering hospital, medical or surgical expenses?
At no time
All of the following are types of licenses EXCEPT
accident and health solicitor
Life and Disability Insurance Analysts must provide an agreement with a statement that includes all of the following EXCEPT
that fees can be received for servicing a policy on which they were the selling agent
Which of the following BEST defines the general concept of the 24-hour care plan?
It integrates workers’ compensation medical care with the care provided by the group health insurance.
When is it allowable for a written application for any disability policy to be altered?
by the insurer, for administrative purposes only, when it is clear that the applicant has not made the insertions
Which is a requirement of an insurer who offers long-term care policies?
Provide the name, address and phone number for the local Health Insurance Counseling and Advocacy Program
What happens under a misstatement of age clause on a disability policy?
All amounts payable under this policy shall be what the premium originally would have purchased and been paid at the correct age.
Which is an INACCURATE statement regarding standards to avoid unfair underwriting for applicants at risk for auto immune deficiency, human immunodeficiency virus, or AIDS related conditions?
Insurers are permitted to schedule AIDS and HIV testing without the specific consent of the individual applying for insurance.
all of the following may be eligible to qualify for enrollment in the Healthy Families Program EXCEPT
Children who fail to meet citizenship or immigration rules.
When shall an individual certificate be deemed to be “individualized” within the meaning of the CIC?
If it contains either the name of the person covered or some other means of identifying to the individual covered that it is his individual certificate
Which is an INACCURATE statement regarding inflation protection for long-term care insurance?
The protection covers a specified percentage of actual or reasonable charges, and includes a maximum specified indemnity amount
Can any life insurer issue group life insurance with premium rates less than the usual rates for such insurance?
Yes, they may do so on any group plan, with or without annuities
Which is considered unnecessary replacement for long-term coverage unless as a means to consolidate policies with one insurer?
issuing 3 or more policies within a 12 month period
Which of the following BEST defines the general concept of the 24-hours care plan?
It integrates worker’s compensation medical care with the care provided by group health insurance
Life and Disability Insurance Analysts must provide an agreement with a statement that includes all of the following EXCEPT
that fees can be received for servicing a policy on which they were the selling agent
Which is an ACCURATE statement regarding benefits of Medicare supplement and Medicare select plans?
There is no restriction for benefits after the coverage has been in effect for six months when involving a preexisting condition
All of the following are requirements for an applicant to be licensed as a life & disability insurance analyst EXCEPT
having been employed by an insurance company
Which of the following may be described as an “administrator” of life and health coverage or annuities
The insurance Commissioner who has access to the records for examination, audit, and inspection purposes
Which of the following may insurers use in their underwriting?
family medical history
Which is NOT a requirement of Medicare Supplement provider?
Displaying prominently on the first page of the policy disclosure that the policy “will cover all of the medical expenses”
A policy with a life insurance benefit for a disabled employee includes an extension of benefits upon its discontinuance when all of the following are met EXCEPT
during a 30 day period in which to accept the terms of the new policy
When may a licensee surrender for cancellation any license under which they are permitted to act?
at any time
When is the practice of “post claims” underwriting allowable on disability insurance covering hospital, medical or surgical expenses?
at no time
Which of the following is an INACCURATE statement regarding replacement for long-term care coverage?
Group long-term care policies have the same rules regarding replacement as individual long-term care policies
Under which situation would an individual enrolled in Medicare Part B be INELIGIBLE for open enrollment?
notice of end stage renal decease from the primary care physician
When does a disability policy become incontestable as to the statements contained in the application?
after this policy been in force for a period of two years during the lifetime of the insured
Which coverage is a life insurance licensee NOT authorized to produce?
Coverage for major medical expenses
In which situation is a person or other entity that provides coverage for medical expenses NOT subject to the jurisdiction of the insurance department?
When they are subject to the jurisdictions of another agency of this another state or federal government
When is it allowable for a written application for any disability policy to be altered?
by the insurer for administrative purposes only, when it is clear that the applicant has not made the insertions
Are dependents eligible for any premium refunds or dividends paid under any policy of group disability insurance?
Yes, insured employees are generally eligible as well as their dependents
Under which situation would an individual enrolled in Medicare Part B be INELIGIBLE for open enrollment?
Notice of end stage renal decease from the primary care physician
Which is an ACCURATE statement regarding long-term care advertisements and the “cold lead device” disclosure?
The fact that a cold lead device was used must be immediately announced to the customer
Which coverage is a life insurance licensee NOT authorized to produce?
Coverage for major medical expenses
Can any life insurer issue group life insurance with premium rates less than the usual rates for such insurance?
Yes, they may do so on any group plan with or without annuities
All of the following may be eligible to qualify for enrollment in the Healthy Families Program EXCEPT
children who fail to meet citizenship or immigration rules
Which is an INACCURATE statement regarding standards to avoid unfair underwriting for applicants at risk for auto immune deficiency, human immunodeficiency virus, or AIDS related conditions?
Insurers are permitted to schedule AIDS and HIV testing without the specific consent of the individual applying for insurance
Who is the California Life and Health & Guarantee Association is regulated by?
The California Insurance Commisioner
When shall an individual certificate be deemed to be “individualized” within the meaning of the CIC?
if it contains either the name of the person covered or some other means of identifying to the individual covered that it is his individual certificate
Which is considered unnecessary replacement for long-term coverage unless as a means to consolidate policies with one insurer?
Issuing 3 or more policies within a 12 month period
When may a licensee surrender for cancellation any license under which they are permitted to act?
at any time
Which is NOT a requirement of a Medicare Supplement provider?
Displaying prominently on the first page of the policy the disclosure that the policy “will cover all of the medical expenses”
Which of the following is an INACCURATE statement regarding replacement for long-term care coverage?
Group long-term care policies have the same rules regarding replacement as individual long-term care policies
Which of the following BEST defines the general concept of the 24-hour care plan?
it integrates workers’ compensation medical care with the care provided by group health insurance
When does the guaranteed issue period for Medicare Supplement end?
Sixty three days after the dis enrollment of the previous coverage
What do all long-term care insurers, agents and brokers owe to the policyholder or prospective policyholder?
a duty of honesty, good faith, and fair dealing
all of the following are permitted to have blanket insurance policies with specific restrictions EXCEPT
any union with dues paying members
When does a license become inactive for a broker?
upon the termination of all appointments or all endorsements
Which of the following may insurers use in their underwriting
family medical history
What type of licensee can receive a fee from any person or source other than an insurer?
Life and Disability Insurance Analyst
When is the practice of “post claims” underwriting allowable on disability insurance covering hospital, medical or surgical expenses?
at no time
A policy with a life insurance benefit for a disabled employee includes an extension of benefits upon its discontinuance when all of the following are met EXCEPT
during a 30 day period in which to accept the terms of the new policy
All of the following conditions provide a basis for group life insurance coverage EXCEPT
amounts of insurance may be selected as needed per individuals personal need
Which is an INACCURATE statement regarding coverage for domestic partnerships?
A policyholder may not require that a domestic partnership be registered to qualify for coverage
When a replacement policy is being considered, what is required from an insurer?
A list of existing policies, replacement notice signed by the applicant and the agent, and a notice sent to any existing insurers that replacement is possible are all requirements
How long does an employee in a group insurance policy have to exercise the conversion privilege after employment is terminated?
31 days to use the conversion privilege and begin an individual life insurance policy
What happens if an owner requests an immediate investment of monies in a variable annuity policy be returned during the 30 day cancellation period?
The owner shall receive the market value at the time of the cancellation
All of the following are TRUE about the rules regarding the sale of life insurance and annuities to seniors age 65 or older EXCEPT
the agent, broker or insurer is required to show a copy of their insurance license with name, address, and phone number when conducting business in the senior’s home
When is an ACCURATE statement regarding dependent coverage under a group insurance policy?
The coverage must not exceed mote than 100 percent of the coverage for the insured employee
Losses arising from all of the following conditions may be excluded from group life policies EXCEPT
natural disasters
