Chapter 20 : California Laws & Ethics Pertinent to Insurance Flashcards
Transaction Records (time period)
5 years
Client, policy and records (Time Period)
2 years
If the agent has not kept the required records, the commissioner may order the agent to establish records within … how many days?
60 days
A company shall be examined once every … years?
5 years
Bank records (time period)
5 years
Life insurance policy replacement (time period)
3 years
LTC Advertisements (Time Period)
3 years
Twisting
Making false written or oral statements made by an agent for the purpose of replacing an existing policy with another, often to the detriment of the insured
Defamation
Any public statement/ad that contains false info about an insurance company
Any person who engages in an unfair method of competition or deceptive act is liable to the state for a fine of up to…
$5000 per violation
$10,000 per act
Claimant
A person who asserts a right of recovery under an insurance policy
Modified Adjusted Gross Income (MAGI)
The figure used to determine eligibility for premium PPACA Tax credits and other marketplace savings
Certified Insurance Agent
An agent certified by the Exchange to transact in the SHOP
Actuarial level for:
Bronze
Silver
Gold
Platinum
Bronze: 60
Silver: 70
Gold: 80
Platinum: 90
Actuarial Value
Percent of total average costs for covered benefits that a plan will cover
All plans must include the following essential health benefits:
- Ambulatory patient services
- Emergency services
3.Hospitalization
- Pregnancy, maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventative
and wellness services and chronic disease management - Pediatric services, including oral and vision care
Granfathered Plan
Purchased before March 23 2010
Special Enrollment Period
In the past 60 days:
1.Got married
2. Child
3. Divorced
4. Died
Changes in residence
Loss in health insurance
Gaining membership in a federally recognized tribe
Becoming a US Citizen
Leaving jail
Starting on ending service s an AmeriCOrps
Advanced Premium Tax Credit (APTC)
A federal tax credit for individuals that lessens the amount they pay for health insurance premiums
Cost Sharing Reduction
A discount that lowers the amount a covered insured must pay for deductibles, copayments and coinsurance
Medical Loss Ratio
Group: 85%
Individual: 80%
Maximum amount an individual can contribute to an FSA:
$2700
