Virginia Laws And Rules Flashcards
General powers and duties of commissioner
He is appointed a 4year term by the state corporation commission, administers all laws pertaining to insurance.
Examination of records
Commissioner must conduct a financial examination to every insurance company licensed In VA every 5 years. All examination fees and expenses are the responsibility of the company being examined
Licensing requirements for Agents
An agent is a person required to be licensed pursuant to the laws of their state to sell, solicit, or negotiate insurance. Licenses for agents are issued for 2 years.
An insurance broker is a representative of the insured, and an insurance agent is a representative of the insurance company
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No residents acting in different states must meet these requirements..
Currently licensed and is in good standing in their home state, has submitted proper request for licensure and has paid fees prescribed by commissioner, submitted to the commissioner the application for licensure, the states reciprocate.
Insurance consultant
Is licensed solely to advise insureds about their policies for s free compensation. Both consultant and client must sign an agreement prepared for outlining the nature of activity to be preformed and fees to be paid.. consultants license must be renewed annually, submit application by June 1st
Temporary license is valid for 180 days
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Change of address
Must notify bureau of insurance within 30days of any changes to address
An agent whose license is denied or revoked must wait 5years before reapplying
The commissioner may not suspend, revoke, or deny a license app due to filing bankruptcy or receiving a misdemeanor
Rebating
Any inducement offered to the insured in the sale of insurance products that is not specified I. The policy
Twisting
Unfair trade practice of replacing an insurance policy from one insurer to another based on misrepresentation
Certificate of authority
Acknowledges that the requirements of the insurance laws have been met and authorizes the company to transact insurance.
Fiduciary responsibilities
Your in charge of funds given to you by a client sense you are an agent
Insurance transaction records
All the paper trail of all transactions between brokers, insureds and agents for all money going between them and the company. Company must keep records for 3 years
Commissions and compensations
A company can only pay a licensed agent for selling insurance, no other person
You can share commission as long as all agents involved are licensed in the same line of insurance for whatever was written
All fees must be stated in the premiums…
Must notify client of all fees
Eligible groups for purchasing group insurance
Employee groups, debtor, labor union, association, credit unions, multiple employer welfare arrangements
Insurance information and privacy protection act
Requires that an applicant for an individual insurance policy be notified of an investigation into his personal character, general reputation, and mode of living
Under the insurance information and privacy protection act…
Insurers must give customers a privacy protection notice at the time of application
Also an insurance company must clearly specify questions designed to obtain information solely for marketing research In Any insurance transaction
When access to recorded personal info is requested, the insurer must make the info available within 30 business days
Any reported violations of this act require the commissioner of insurance to issue and serve a statement of charges an notice of hearing. The date of hearing shall be at least 10 days after service of charges
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The purpose of the guaranty fund is to ensure that claims filed against insolvent insurance companies will be paid
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Replacement
Is strictly regulated and requires full disclosure by both the agent and the replacing insurance company
Duties of the replacing agent
Present to the applicant a notice regarding replacement that is signed by both the applicant and the agent, a copy must be left with the applicant
Also leave the applicant with the original copy
Submit to the replacing insurance company a copy of the replacement notice with the application
Associations, A policy issued to an association for the benifit of its members shall
Have a minimum of 100 persons, have been in existence for 5 years… to be eligible for group life policy, group must be formed for a purpose other than obtaining insurance
Conversion, conversion period of 31 days
There are no restrictions regarding the assignment of coverage under a group life insurance policy, in group life insurance policies, assignment of benefits is not permitted to the insureds employer
A health disability policy is incontestable after it has been in force for a period of 2 years.
Grace period, no less than 7dyas for weekly premium policies, 10 days for monthly policies, and 31 days for all others.
Reinstatement, waiting period of 10 days before claiming sickness and being coveredZ
Notice of claim, written notice of claim must be giver within 20days after a covered loss starts
Individual health insurance..
Recommended or received 12 months prior to effective date of enrollment
Group health insurance, 6 months prior to effective date of enrollment
And 18 months on late enrolled
When replacing an individual health policy in VA, the required replacement notice to the applicant must include notice that pre-existing conditions may not be covered
An individuals waiting period is reduced when they have credible coverage, creditable coverage is previous coverage under another group or individual health plan when there has not been a break in coverage of 63 days.. this period begins when the individuals previous coverage is ended.
Defined groups. A
A group plan may be issued to any labor union with at least 25 members.
An association may be the policy holder of a group policy that covers its members. Providing this has a minimum of 100 members. Organized in good faith for purposes other than obtaining insurance, been in existence for at least 5 years
When replacing, must be signed by the client and the agent
Right to examine (free look)
Free look period of 10 days upon policy delivery. If they decided not to keep it, then a full refund will happen within 10 days
Rate adjustments, they must adjust the rates every 6 months after second year
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Newborn child coverage
All health plans that provide coverage to family members of the insured must provide coverage for the insureds newborn child from the moment of birth and for a period of 31 days
Definition of small employee, 2-50 employees
HIPAA provides certain benefits to those who terminate employment and wish to continue individual coverage in lieu of coverage with a new employer or during a period of unemployment
Agents under Virginia long term care insurance partnership must undergo ongoing training every 24 months
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Hmo
Public or private organization that provides or makes available health services that are restricted to a specific service area on a prepaid basis
