LAH- MN regulations- health Flashcards
free look period for life insurance ?
replacement policies?
10 days
30 days
Commissioner of commerce duties:
elected by governor
can assist with making rules and regulations
examine records (must every 5 years)
CANT make laws, only enforce them
commissioner orders:
- fine amount?
- restore deficiency
- cease and desist= 10,000$ fine for each day
notice and hearings from insurer or agent from the commissioner
- amount of days to notice and appeal?
30 days to appeal at hearing
30 days for commissioner to hold hearing
Forms and rates must be approved by commissioner before use or how many days have gone by without hearing from commish’s.?
60 days elapsed without hearing anything
Reciprocal insurer
- UNincorporated group
- insure EACH OTHER and share losses with each other
- attorney in fact manages it
- no life insurance
mutual insurer
owned by policyholders can participate in dividends - refund of premium = NOT taxed board of directors = management legal reserves (non assessable)
stock insurers
general public and don’t have to be policy owners
-(subscribers)= shareholders/owners
board of directors
non participating policies (policyholders don’t get dividends)
- stockholders do
fraternal insurers
lodge system
solely for the benefit of its members
member get certificates
subrogation
legal right of insurance company to sue a third party who caused the loss to the insured
LTC study requirements
8 study hours
4 ours of continuing education every 2 years
annuity training
one time 4 hour course
continuing education
24 credit hours per 2 years
3 hours in ethics
license expiration
Last day of birth month every 2 years (3 years for first one)
temporary license
180 days
surviving spouse
employee of the business entity
disgnee of a producer who is going into armed forces
change of address days to notify?
10 days
commissioner must notify agent of nonrenewable in writing as to why
- the agent has ___ days to respond?
- hearing must be held in ___ days after response from agent?
30 days
30 days
revoked license for how long?
minimum 2 years and 20,000$ performance bond (filed with commissioner)
amount fine per violation to a producer?
10,000$
appointment of insured to the insurer rules?
must be appointed by insurer
or
permission to transact business on behalf of insurer AND obtains appointment within 15 days of first application
insurer rules to appoint an agent?
file notice of appointment within 15 days of contract or first application of insured
commissioner wil verify appointment in how many days if eligible?
if ineligible?
30 days
5 days
termination of appointment:
1- if insurer terminates agent appointment, how many days to commissioner?
2- notice to agent from insurer?
3- agent file appeal of termination with commissioner days?
30 days
15 days
30 days
penalty to insurer for not filing appointment is?
___ $ per offense (per sale of unappointed agent)
____$ max amount
days to pay fine to commissioner after notice?
25$ per
300$ total
10 days
agent administrative action must be notified to commissioner within___ days?
30 days
criminal PROSECUTION of agent must notify commish within ___days?
30 days
agent criminal CONVICTION/plea notify commish with ___ days?
10 days
reinstating a lapsed license must be done within how many months???
12 months (1 year)
rebating
- legal amount?
- fine amount for penalty?
offering or giving something in exchange for a sale
- anything over 25$ is considered rebating
- 60 to 200$ per violation
twisting
replacing one policy for another policy without benefit to insured
advertising material includes:
printer and published material audio descriptive literature radio or television billboard circulars or leaflets form letters prepared sales talks/presentations
number of years loan records must be kept?
6 years
policies must be delivered with how many days to insured?
30 working days
financial and complaint records of agents must be held for how many years?
6 years
agent must request refund from insurer within how many days after receiving cancellation notification from insured?
how many days must refund be issued in once received by agent from insurer?
- 10 days
- 5 days
company complaint records must be kept on file for how many years?
4 years
policy forms, applications and advertisement and claim records:
must be kept on file for how many years?
3 years
flesch scale is what?
readability of insurance policies
after policy termination, all unearned premium must be returned within how many days after insurer receives request?
30 days
oral binders must be followed up in writing within how many days?
5 days
must have written or verbal communication(followed up in writing) of the agents?
name
company they represent
that they are in the business of selling insurance
sources other than the application that underwriters use with permission from potential insured?
driving records
medical records
credit reports from consumer reporting agency
fair credit reporting act says:
must notify consumer in BOTH verbal and writing when credit report is being done (and provide a copy if the consumer wants it)
adverse credit information stays on report for how many years?
7 years
10 years for bankruptcy
gramm leach billey act:
insurance companies must disclose their privacy policies
guaranty association
protects insured from the solvency or bankruptcy of an insurer
- association pays unpaid claims from the company
policyholders rights must be given at?
time of application or with 72 hours (3days) if not taken in person
if mailed, it is considered notified by when?
postmarker, properly addressed, prepaid postage
how many days until refund of free look period after insurer receives cancellation and policy?
10 days
if NO cancellation policy is described in a policy…how long do the insured have to cancel and still get a full refund?
days until refund is issued?
1 year
10 days
amount of credit insurance that can be issued
principal amount PLUS 1 monthly payment
after 63 months, the amount should not exceed what?
unpaid loan amount - interest unearned + 2 monthly payments
group life insurance COBRA (continuation)
- length of coverage?
- time to convert?
premiums payment?
- 18 months(or until other coverage is obtained),
- 60 days to elect conversion coverage
- can’t exceed 102% of plan cost for premiums paid by individual
death of COBRA group life employee during the 60 day sign up/continuation period…what happens?
coverage is in force and death benefit is paid as normal minus the unpaid premiums
conversion of group life
allowed terminated employee and dependents to convert to INDIVIDUAL policy with NO insurability proof, paid by individual
- similar benefits as the group policy
- 30 days
settlement contracts of life insurance
- can’t agree before or within first 4 years of contract
- must not have knowledge of testing results within the 18months prior to policy effective date
change of ownership or beneficiary, insurer must respond within what time length? - life
- 30 calendar days written notice
notice regarding replacement must be issued by when?
- signed by both parties and left with who?
- copy submitted with what to replacing insurer?
at the time of application (taking application)
- signed by both parties and left with INSURED
- signed copy of notice and application must be turned in to insurer
replacing insurer must notify the existing insurer within how many days of receiving replacement notice and application?
written notice within 5 working days
ALL replacement life insurance information must be kept on file for how many years? (notice of replacement, application, existing insurer, agent signings)
6 years
replacement Exemptions are?
credit life
group life or group annuities
within same insurance company
policies still under receipt
coverage of health for physically disabled child must be notified to the insurer by when?
31 days before dependent child reaches policy age limits (every 2 years after that)
newborns and children coverage from when? (includes adoption)
- up to what age?
- covers what?
covered immediately at birth (no notice required)- additional premiums will be charged
- up to age 19, anything initiated before age 19
- medical and dental (orthodontic and surgery for ONLY cleft lip or palet)
health and accident conversion/continuation must be at least what for renewability?
guaranteed renewable
health and accident conversion/continuation must be the same for survivors until when??
surviving spouse becomes covered under new group plan OR coverage would have terminated as normal (without the death of insured)
survivor in H&A has how many days after notification to make premium or fee payments?
- how many days must insurer send written notice of cancellation?
- premiums now paid by survivor should not exceed?
90 days
- 30 days before cancellation
- 102% of plan cost
termination of employee COBRA continuation coverage in H&A
- length of coverage?
- preexisiting conditions, what is primary?
- child birth during continuation period?
- premium amount?
- time to elect coverage?
- 18 months (or new coverage is obtained)
- preexisting conditions MUST still be covered under old plan for 18 months if new plan doesn’t cover them
- child is automatically part of new plan if there is one
- not more than 102%
- 60 days to elect coverage
CONVERSION of H&A from group to individual
- time to make conversion and premium payment?
- insurability?
- coverage amount?
- 30 days to convert after continuation period
- no proof of insurability
- minimum qualified plan benefits
divorced spouse and dependents
- continuation of coverage?
- conversion of coverage how many days to elect?
automatically continuation of coverage, and premiums paid by the dependent to the policyholder (who then pays the insurance company)
- 30 days after continuation coverage to elect and pay premium for conversion coverage to individual coverage
mental health and chemical dependency must be treated as such?
- same as any other patient in the hospital covered under the Affordable Care Act
grace periods length for premium payments in H&A?
- weekly
- monthly
- quarter, semi, or annual
- 7 days
- 10 days
- 31 days
grace periods length for LIFE policies?
31 days (1 month)
reinstatement for H&A?
- length until automatically covered?
- length of past premiums collectable?
- insurability and application?
- waiting (probationary period) length? for what?
- automatically reinstated if not rejected after 45 days
- up to 60 days of past premiums
- can (don’t have to) require proof of insurability and new application
- 10 days for sickness, accident=immediately covered
notice of claim for H&A time length days?
- for disability, continued notice every ?
- 20 days
- every 6 months during disability after original notice