Chapter 20 : California Laws & Ethics Pertinent to Insurance

Question 1

Transaction Records (time period)

Answer 1

5 years

Question 2

Client, policy and records (Time Period)

Answer 2

2 years

Question 3

If the agent has not kept the required records, the commissioner may order the agent to establish records within … how many days?

Answer 3

60 days

Question 4

A company shall be examined once every … years?

Answer 4

5 years

Question 5

Bank records (time period)

Answer 5

5 years

Question 6

Life insurance policy replacement (time period)

Answer 6

3 years

Question 7

LTC Advertisements (Time Period)

Answer 7

3 years

Question 8

Twisting

Answer 8

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

Question 9

Defamation

Answer 9

Any public statement/ad that contains false info about an insurance company

Question 10

Any person who engages in an unfair method of competition or deceptive act is liable to the state for a fine of up to…

Answer 10

$5000 per violation
$10,000 per act

Question 11

Claimant

Answer 11

A person who asserts a right of recovery under an insurance policy

Question 12

Modified Adjusted Gross Income (MAGI)

Answer 12

The figure used to determine eligibility for premium PPACA Tax credits and other marketplace savings

Question 13

Certified Insurance Agent

Answer 13

An agent certified by the Exchange to transact in the SHOP

Question 14

Actuarial level for:

Bronze
Silver
Gold
Platinum

Answer 14

Bronze: 60
Silver: 70
Gold: 80
Platinum: 90

Question 15

Actuarial Value

Answer 15

Percent of total average costs for covered benefits that a plan will cover

Question 16

All plans must include the following essential health benefits:

Answer 16

1. Ambulatory patient services
2. Emergency services

3.Hospitalization

4. Pregnancy, maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative services and devices
8. Laboratory services
9. Preventative
   and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Question 17

Granfathered Plan

Answer 17

Purchased before March 23 2010

Question 18

Special Enrollment Period

Answer 18

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

Question 19

Advanced Premium Tax Credit (APTC)

Answer 19

A federal tax credit for individuals that lessens the amount they pay for health insurance premiums

Question 20

Cost Sharing Reduction

Answer 20

A discount that lowers the amount a covered insured must pay for deductibles, copayments and coinsurance

Question 21

Medical Loss Ratio

Answer 21

Group: 85%
Individual: 80%

Question 22

Maximum amount an individual can contribute to an FSA:

Answer 22

$2700