A.D. Banker & Company: Life and Health California (Life, Accident and Health Agent) Comprehensive Practice Exam,100% CORRECT

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A.D. Banker & Company: Life and Health California (Life, Accident and Health Agent) Comprehensive Practice Exam Salary continuation plan - CORRECT ANSWERAn agreement by an employer to continue a... key employee's salary upon retirement, death or disability as long as the employee continues employment during the term. Flexible Life Insurance - CORRECT ANSWERUniversal and Variable Universal Life policies offer the policy-owner more decisions in terms of premiums, investment objectives and other policy benefits. These policies have the potential to provide greater cash accumulation than whole life policies. Variable Life Insurance - CORRECT ANSWERA policy that uses a separate account for the cash value accumulation. The separate account includes subaccounts which are similar in nature to mutual funds, and a securities and life insurance license are required to sell this policy. The policyowner takes on the investment risk of the policy. The policy's overall death benefit can increase or decrease Permanent whole life insurance - CORRECT ANSWERA life insurance policy that remains in force to age 100 or beyond. The premium is always higher than that on a term policy at issuance when the amount of coverage and underwriting factors are equal. This policy provides for living benefits for the policyowner or insured by way of its cash values. It also has many options available to the policyowner. Cash value - CORRECT ANSWERMoney accumulated in a permanent whole life policy that is considered a living benefit which the policyowner may borrow against or receive if the policy is surrendered before the insured dies. Face amount (or limit of liability) - CORRECT ANSWERThe death benefit amount payable or coverage provided on a life insurance policy. This is also referred to as the limit of liability. endow (mature) - CORRECT ANSWERthe date on which the contract ends, and the policy value is paid to the owner. rider - CORRECT ANSWERAn added benefit attached to the policy that supplements existing coverage. may result in a small increase in premium Option A: Will recieve a larger cash value accumulation Option B: Will receive a larger death benefit - CORRECT ANSWERUniversal life death benefit option A vs B Interest, because any amount paid in excess of the premium is subject to taxation - CORRECT ANSWERTaxation applies to any ________ on the cash value paid out as a withdrawal of a Universal Life policy. Variable; this annuity is a security; therefore, in order to offer and sell it, the producer needs a securities registration/license. - CORRECT ANSWERA producer needs a securities registration/license in order to sell which of the following annuities? 36 months - CORRECT ANSWERMost companies are required to extend benefits for up to _____ months when the individual is allowed less than that amount of coverage under COBRA. Into the Insured's estate, by default - CORRECT ANSWERIf no beneficiary is living at the time of the insured's death, the benefit will automatically be paid __________. The producer's name and address - CORRECT ANSWERWhat information must appear on the policy summary provided to a life insurance client? flat benefit (all employees receive the same insurance amounts), percentage of income (employees receive 100%, 150%, or 200% of their annual base wage, subject to imputed income), and position in the company - CORRECT ANSWERWhat are the most common methods of determining group insurance benefits? lower - CORRECT ANSWERInterest earned on premiums paid to an insurer helps to ________ the premiums charged. If the policy owner does sell, surrender, or withdraw funds from the policy, the difference between what is received and what had been paid in (cost basis or premiums) is taxed as ordinary income. - CORRECT ANSWERWhat is the Cost Recovery Rule The Spendthrift Clause denies the beneficiary the right to assign his/her interest in the policy proceeds. The purpose is to prevent creditors of the insured and/or the beneficiary from claiming any benefits payable to the beneficiary before they are actually received. This clause does not protect the beneficiary if the benefits are payable in a lump sum, only when the proceeds are held by the insurance company under a settlement option. - CORRECT ANSWERSpendthrift Clause no premium was paid at time of application and the policy is now being delivered. this verifies the insured has remained in the same health status continuously since the time of application. If the applicant is not in good health, the policy should be returned to the insurer for further underwriting. - CORRECT ANSWERThe producer must also obtain a Statement of Good Health from the applicant/insured at the time of policy delivery if: constructively or legally delivered by the insurer. It is still the producer's responsibility to obtain delivery signatures and explain policy benefits to the policyowner/insured. - CORRECT ANSWEROnce the insurer mails the policy to the producer, it is considered: Long term care coverage - CORRECT ANSWERThis provides coverage for necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital. 60 days - CORRECT ANSWERUnder the Legal Actions Mandatory Uniform Provision, an insured must wait at least _____ days after providing proof of loss before he or she can take legal action against the insurer. Medical Information Burau (MIB) - CORRECT ANSWERCollects adverse medical information about an applicant's health that is known to insurers to which the applicant has previously applied for coverage. 65 years of age - CORRECT ANSWERMedicare Part A enrollment is mandatory for all citizens and legal residents at age: 4 years - CORRECT ANSWERUnder the California Insurance Code, a restricted license requires the agent to comply with all laws, and complete all CE requirements and license renewals on time for up to ________? policy is in force during the grace period, the insurer pays the death benefit, minus any premiums or loans due. - CORRECT ANSWERIf an insured dies during the policy's grace period, the insurer will essential health benefits. - CORRECT ANSWERThe Patient Protection and Affordable Care Act prohibited insurers offering group or individual health insurance coverage from imposing lifetime or annual limits on the dollar value of the mandatory _____________? Stop-Loss - CORRECT ANSWEROnce the out-of-pocket limit has been reached, the provision kicks in and the policy will cover 100% of covered losses for the balance of the year. Hospital Insurance, mainly providing in-patient coverage. - CORRECT ANSWERPart A of Medicare provides: Part B of Medicare is Medical Insurance, under which outpatient services are covered. (Physicians, Surgeons, and Outpatient) - CORRECT ANSWERPart B of Medicare provides: Temporary Disability - CORRECT ANSWERAn insured's ability to work is impaired, but a full recovery is expected. Temporary Disability - CORRECT ANSWERoccurs when the insured suffers a disability and is expected to recover fully. this disability may be total or partial, depending on the person's ability to work or not a partial disability - CORRECT ANSWERWhen a person cannot perform 1 or more of the essential duties of his/her occupation, but is not totally disabled, this disability benefit may provide up to 50% of the total disability benefit for a limited period of time, such as 90-180 days. Own Occupation - Some policies require the insured's inability to perform the main duties of his/her own occupation Any Occupation (strict) - CORRECT ANSWERTotal disability Provides benefits for loss of income after the insured returns to work following a total disability. Benefits are based on the reduction of earnings as a result of the disability. - CORRECT ANSWERResidual Disability 70% of the total amount an individual will spend for essential health benefits during a year. - CORRECT ANSWERThe Essential Health Benefits: The Silver Plan provides coverage for? An employer may deduct 100% of the total group life premium it pays as a business expense, but the value of premiums for any employee's coverage in excess of $50,000 must be 'imputed' to the employee and income tax paid on that amount. - CORRECT ANSWERThe exception to the rule concerning the non-deductibility of life insurance premiums is: 1% - CORRECT ANSWERIf a person does not enroll in Medicare Part D when first eligible after age 65 and goes more than 63 days before enrolling, a cumulative penalty of _____% for each month the beneficiary has no 'creditable coverage' for prescription medications will be charged upon subsequent enrollment. Residual Disability - CORRECT ANSWERprovides benefits for loss of income after the insured returns to work usually following a disability. Total disability - CORRECT ANSWERResidual Disability Income pays funds to the insured, to make up for what the insured would have earned after returning to work, and while recovering from ___________. unearned premiums until coverage has been provided, and the insurer has 'earned' the right to retain the premium. - CORRECT ANSWERPremiums paid in advance are considered? State insurance laws require a 30- or 31-day Conversion Period in group insurance policies. - CORRECT ANSWERPayment of the first premium and an application must be submitted to an insurer for individual coverage within how many days to convert group coverage to an individual policy not requiring proof of insurability? Dividends are never guaranteed. - CORRECT ANSWERIn a policy summary what is never guaranteed? Increasing Term; the rider is Return of Premium - CORRECT ANSWERThis rider uses _____________ insurance to provide coverage equal to the amount of premiums paid. If the insured dies within the term, the beneficiary would receive the face amount of the policy plus the benefit of the rider equaling the total amount of premiums paid. decreases - CORRECT ANSWERThe death benefit ___________, but premiums remain level for the policy term. Often such policies are sold as mortgage protection with the amount of insurance decreasing as the balance of the mortgage decreases. Increasing term - CORRECT ANSWERcan be issued as a rider on a policy to provide cost of living or return of premium benefits. defines who is covered, by whom, and for what amount of coverage. It states the insurer's obligation to address the risk, premature death. - CORRECT ANSWERThe Insuring Clause in a life insurance policy: only the earned premium may be deducted from the death benefit, then the death benefit must be paid to the benficiary - CORRECT ANSWERwhat occurs to the beneficiary if a death occurs during the grace period? A Noncontributory - CORRECT ANSWERGroup Life Plan; one in which the participant does not pay premiums State law requires that 100% of eligible employees are covered. - CORRECT ANSWERWith a Noncontributory Group Life Plan, what percentage of eligible employees must participate? Private hospital rooms - CORRECT ANSWERHMOs may NOT provide this supplemental benefits A trial application - CORRECT ANSWERIf no initial premium is paid, the application is considered: COBRA Federal law - CORRECT ANSWERmandates that employers with 20 or more employees provide coverage: Termination of employment provides only 18 months of continuation. Qualifying events for dependents only (not employees) permit continuation up to 36 months. The insured will be permitted to resume coverage and premiums without any waiting periods - CORRECT ANSWERWhen an insured is discharged from the military, what happens to health insurance coverage that was in place prior to being called up for active military service? When the policyowner elects to convert the annuity into an income benefit payment - CORRECT ANSWERWhen does the annuitization period begin? Risk - CORRECT ANSWERWhich term is defined as the probability of loss? serious and immediate danger. - CORRECT ANSWERperil def. Free Insurance, Offering free insurance is a violation that may result in suspension or revocation of a license. - CORRECT ANSWEROffering any kind of insurance as an inducement to the purchase of property or services without a separate fee charged to the insured for the insurance is a violation and is considered: Rehabilitation - CORRECT ANSWERSam is totally disabled and receiving benefits while attending an insurer-approved vocational training program. What provision guarantees the continuation of benefits while Sam participates in the training program and remains totally disabled? total disability benefits will be continued as long as the insured is actively participating in the training program and remains totally disabled. - CORRECT ANSWERUnder the Rehabilitation Provision The insured is restored to the same financial condition as prior to the loss, with no intent of loss or gain - CORRECT ANSWERwhat best describes a Contract of Indemnity under insurance? The HMO has a contract with medical providers within the service area and subscribers must seek treatment from a contracted provider. Coverage will not be provided outside the service area, except in cases of an emergency, unless prior authorization is obtained. - CORRECT ANSWERregarded as a managed health care system providing a comprehensive array of medical services on a prepaid basis: PPOs subscribers may see any licensed physician or health care professional, and use any hospital or ancillary facility, in or out of the local network - CORRECT ANSWER__________ are an arrangement under which a selected group of independent hospitals and medical practitioners become preferred providers in a geographic area at a discounted fee-for-service negotiated in advance Gatekeeper - CORRECT ANSWERIn a HMO, a Primary Care Physician (PCP) also known as a _____________. the conditions under which the insurer will not pay out a death claim if the insured dies while the policy is in force. - CORRECT ANSWERThe exclusions provision specifies: security or protection against a loss or other financial burden. - CORRECT ANSWERIndemnity is a means of collecting a loss payment from a liable party. - CORRECT ANSWERSubrogation of risk both occupational and nonoccupational medical expense claims. - CORRECT ANSWEROnly a 24-hour coverage plan is a program designed to cover: that the payment of the first premium and statements in the application are the applicant's consideration, and the insurer's consideration is the promise to pay within the contract terms. - CORRECT ANSWERThe Consideration Clause stipulates: 100% of the policy's death benefits, this will reduce the ultimate death benefit payable to the beneficiary. - CORRECT ANSWERA Long-Term Care Rider provides up to what percentage of the policy's death benefits if the insured qualifies for long-term care benefits based on being chronically ill as defined in the rider? Pretext interviews - CORRECT ANSWERinvolves an attempt to obtain personal, non-public information through deception, leading the person to believe the "interviewer" is someone other than a licensed agent or insurance company representative acting in an authorized capacity. is substantially the same as or better than the minimum requirements of Medicare Part D. - CORRECT ANSWERCreditable coverage is that which: fixed-income investments and money market funds, unless the owner of the policy directs otherwise - CORRECT ANSWERDuring the 30 day cancellation period (Free-Look), the premium for variable annuities may be invested only in: 14 days - CORRECT ANSWERThe notice of the appointment must be filed with the Commissioner upon licensing the applicant or within _______ of the appointment. It decreases - CORRECT ANSWERWhat happens to the overall annual premium cost once a term rider expires? 12 - CORRECT ANSWERA license may be renewed without examination within _____ months of its expiration date by payment of a penalty fee equal to 50% of the 2-year license fee. A Contract of Adhesion. This is a contract between two parties that does not allow for negotiation. Any ambiguity in the contract is construed against the party who drew it up. - CORRECT ANSWERWhat is the term for a contract written by one party on a "take it or leave it" basis? four, such as gold, silver, bronze, and platinum - CORRECT ANSWERAn Essential Health Benefits package is required by the Patient Protection and Affordable Care Act to provide coverage for at least one of _____ levels (Metal Tiers) of coverage offered through all health exchanges. Since the employer pays 2/3 of the monthly premium, then 2/3 of the monthly benefit ($4,000) would be taxable as income to Nathan. - CORRECT ANSWERNathan is insured under a group disability plan which requires that he pay 1/3 of the premium. Nathan is currently drawing a $6,000 monthly benefit from the plan. How much of the $6,000 is subject to income tax? Since Mr. Stanley is injured while committing an illegal act, the Illegal Occupation/Act Provision (an Optional Uniform Provision) provides the insurer's right to deny liability. - CORRECT ANSWERIf Mr. Stanley is injured while attempting to escape from the police after committing a bank robbery, his A & H coverage will probably pay: Waiver of Cost of Insurance - CORRECT ANSWERis a rider that waives the deduction of the monthly cost of insurance and expense charges associated with a Universal Life type policy while the insured is totally disabled, usually after 6 months of continuous disability. Waiver of Cost of Insurance - CORRECT ANSWERWhat is the 'waiver of premium' called on a Universal Life insurance policy? 10, 60%. - CORRECT ANSWERUnder the Patient Protection and Affordable Care Act, a qualified health plan is any plan which provides coverage for the ____ Essential Health Benefitsand provides a minimum actuarial value of ____. Compare plans and buy health insurance in the private market - CORRECT ANSWERIn California, the Individual Exchange and Small Business Health Options Exchange (SHOP) is an independent public entity within the state government and operates under the name of Covered California to allow individuals and small businesses to: 24 hours - CORRECT ANSWERThe Insurance Code requires producers who meet with prospective clients age 65 and older in their homes for the purpose of transacting life insurance, annuities, or disability insurance products to provide a written notice of the first meeting at least how many hours in advance? Independent - CORRECT ANSWERA(n) ___________ agent enters into agreements with more than one insurer. One; The solicitor license must be for the same line or lines of insurance held by the agent or broker who employs them, and a solicitor may be employed by only one agent or broker at any one time. - CORRECT ANSWERAn insurance solicitor can be employed by how many agents or brokers at any one time? Decreasing Term Riders are ideally suited to cover the balance of an outstanding mortgage. - CORRECT ANSWERSean has a home with a mortgage. He needs life insurance to protect his family but also wants to leave them without a mortgage payment if he dies. Ideally which of the following riders should he acquire? a steady stream of income to an individual, typically upon retirement. It protects against outliving one's retirement income by providing an income for life. - CORRECT ANSWERAn annuity is designed to provide Defamation - CORRECT ANSWER____________ is a maliciously critical statement about an insurance company's financial condition. Advise the producer that he/she is entitled to a public hearing - CORRECT ANSWERIf the Insurance Commissioner has reason to believe that a producer has engaged in unfair competition, he/she is required to: a statement of the premium, or a statement of the basis and rates upon which the final premium was determined, the property or life insured, the interest of the insured or property, the risks insured against, and the period during which the insurance is to continue. - CORRECT ANSWERAll insurance contracts must include: Reduce her normal benefits - CORRECT ANSWERAnna has a contract that includes the Non-Emergency Hospital Preauthorization Admissions Provision. For a scheduled hospital stay, she must first get preauthorization through her insurer. If she does not, the insurer may: The individual jumping off a roof was a conscious decision and intentional; breaking his leg would be considered an accident. - CORRECT ANSWERAn individual jumps off a roof and breaks his leg: Producer - CORRECT ANSWERProbing beyond the stated questions contained in the application as part of the field underwriting process is the responsibility of the: 10% - CORRECT ANSWERFailure to enroll in Medicare Part B, when required, may result in a lifetime cumulative premium penalty of ______ for each 12 month period a beneficiary was not enrolled in Part B. Beneficiary - CORRECT ANSWERUnder Medicare Part B an assignment is the transfer of rights from the __________ to Medicare. nonparticipating provider that does NOT accept Medicare's assigned amount for services provided. Nonparticipating providers may charge up to 115% of the Medicare-approved amount. - CORRECT ANSWERNon-Assignment refers to a: allows the insurer to deny liability if the insured is injured while engaged in an illegal occupation or committing an illegal act. - CORRECT ANSWERThe Illegal Occupation/Act Provision (an Optional Uniform Provision) Upon reinstatement, accidents are covered immediately, and sickness after 10 days. This prevents insureds from reinstating a policy when they are already sick. - CORRECT ANSWERKirk has just reinstated an individual A&H policy that had lapsed and wants to know how soon coverage will be in effect for any accident or sickness. You, the agent, would say: 24 hours - CORRECT ANSWERAll licensed producers must complete a minimum of _____ hours of continuing education prior to each license renewal. Tort - CORRECT ANSWERa wrongful act or an infringement of a right (other than under contract) leading to civil legal liability. tortfeasor - CORRECT ANSWERAn individual committing a tort may be referred to as a: Medicare advantage - CORRECT ANSWERThese plans are offered by private insurance companies that contract with Medicare to provide both Part A and Part B benefits and typically prescription drugs. this is a substitute for Original Medicare. A Medicare Supplement Insurance - CORRECT ANSWER(Medigap) policy helps pay some of the health care costs that Original Medicare doesn't cover, like: Copayments. Coinsurance. Deductibles. 15 days; submit written proof of occurrence, character, and extent of loss. - CORRECT ANSWERThe claim form must be received by the insured from the company within ____ days after notice of claim. If forms are not furnished, the insured may ______________. 5 - CORRECT ANSWERUnder the California Insurance Code, records must be kept by agents for at least _____ years following actual policy delivery, or the date of application if no policy is issued. who will be attending the meeting, and the insurance license numbers of those persons. - CORRECT ANSWERThe California Insurance Code requires all producers who meet with prospective clients age 65 and older in their homes for the purpose of transacting life insurance, annuities, or disability insurance products to first provide a written notice of the first meeting which provides information concerning Time of Payment of Claims (a Mandatory Uniform Provision) stipulates that claims are to be paid immediately upon written proof of loss. - CORRECT ANSWERWhich provision states that the insurance company must pay claims immediately? 6 - CORRECT ANSWERIn a Medicare Supplement replacement sale, if the original policy has been in force for less than ______ months, the replacing insurer shall waive any time periods applicable to preexisting conditions to the extent that they have already been satisfied under the original policy. a Medicare supplement, Medicare Advantage, Medi-Cal coverage, or another health insurance policy or certificate in force. - CORRECT ANSWERAll Medicare Supplement application forms must include questions to determine if at the date of application the applicant currently has: Pre-authorization - CORRECT ANSWERWith a managed health care plan failure to obtain ____________ can result in denial of coverage, or a substantial reduction in the coverage normally provided. 5 - CORRECT ANSWERLong-term care insurers in California must offer the insured the option of purchasing inflation protection that is not less favorable than an annual increase at a rate of not less than ______% of the original daily benefit, either at a fixed or compounding rate. National Association of insurance commissioners (NAIC) - CORRECT ANSWERApplicants must complete and submit a Long-Term Care Personal Worksheet, as developed by the _______, which will be used to determine suitability. Determine the insurer's solvency - CORRECT ANSWERThe Insurance Commissioner may examine the records of an insurer in order to: policies be reasonably priced and widely available - CORRECT ANSWERCalifornia Insurance Code establishes as a goal that: not a risk management technique, but rather a means of collecting a loss payment from a liable party. (Avoiding, transferring, and retaining risk are) - CORRECT ANSWERSubrogation is: Twisting - CORRECT ANSWERIntentionally making any false or materially inaccurate representation or comparison of two or more policies which induces any person to lapse, forfeit, surrender, or not take, a policy of insurance is known as: Premiums - CORRECT ANSWERWhat is earned by a life insurer for each day a life insurance policy is in force? Not directly involved in sales, production, or service - CORRECT ANSWERA key person is typically all of the following, except: a policy requested when the applicant's age, medical history or amount of coverage does not require a medical examination for underwriting. - CORRECT ANSWERA Nonmedical Application is used for: collects any charges or premium from, or who adjusts or settles claims on residents of this state in connection with life, health or annuity insurance coverage and must hold a Certificate of Registration as an administrator issued by the Commissioner. An administrator must have a written agreement with an insurer. A copy of the agreement must be kept for 5 years after the agreement has ended. - CORRECT ANSWERAn administrator is any person who: (3) All children (beyond 14 or 15 days of age) are covered, and the rider may be converted to permanent coverage at a specified age without evidence of insurability - CORRECT ANSWERThe benefit of a Child Rider is twofold: 60 - CORRECT ANSWERThe employee or the beneficiary must notify the employer within ______ days if they elect to continue coverage under COBRA. Moral hazard describes a conscious change in behavior to try to benefit from an event that occurs. Morale hazard describes an unconscious change in a person's behavior when he is insured. - CORRECT ANSWERmoral vs morale hazard 7 days for weekly; 10 days for monthly; and 31 days for all other payment modes (quarterly, semi-annual, and annual). - CORRECT ANSWERThe grace period for an individual health insurance policy being paid on a weekly, monthly and for all other payments (quarter, semi-annual, and annual) basis is: The owner specifies the amount of each periodic payment and the insurer pays that amount until the funds plus interest are depleted - CORRECT ANSWERA policyowner has chosen the Fixed Amount Settlement Option. What best describes this option? the annuity has no residual values at the annuitant's death and nothing goes into the annuitant's estate for valuation. - CORRECT ANSWERIf the annuitant, now deceased, was receiving income from a pure life or straight life annuity, how much goes into the annuitant's estate for valuation? the Accidental Death Rider pays a multiple (usually double) of the death benefit of the underlying policy. - CORRECT ANSWERWhich of the following riders is used to increase the death benefit if death is the result of an unintended fatal injury, paying a multiple of the face amount? Policy loans are available from either the general account or the separate account. Typically 75-90% of the cash value can be borrowed against. - CORRECT ANSWERHow much of a cash value policy loan will an insurer normally grant with a variable type policy? Market Value Adjustment - CORRECT ANSWERWhich annuity will be directly impacted by rising and falling interest rates? This is an annuity product that features fixed interest rate guarantees combined with an interest rate adjustment factor that can cause the surrender value to fluctuate in response to market conditions. Upon withdrawal, the MVA will add or deduct an amount from the annuity or the withdrawal amount. - CORRECT ANSWERMarket-Value Adjustment (Adjusted) Annuity does not pay any Medicare reimbursable expenses. - CORRECT ANSWERFavorable tax treatment is given to Long-Term Care contracts that: Covered California - CORRECT ANSWERConsumers in California must purchase a Qualified Health Plan through __________ in order to obtain Premium Tax Credits. cover excessive medical bills that occur above the limit that an insured would be able to manage financially and are offered to those up to age 30, or those individuals who prove they are without affordable coverage options or are experiencing financial hardship. - CORRECT ANSWERMinimum coverage plans are designed to: Cash, premium reduction, accumulate at interest (dividends kept by insurer), paid-up additions (single premium, 1 year term benefit), paid-up option (pays off the policy more quickly) - CORRECT ANSWERDividend Options Available: Explanation of Medical Benefits - CORRECT ANSWERUnder Medicare Part B, a(n) __________ outlines the covered services and approved amounts sent to the beneficiary. Participating - CORRECT ANSWERIn order to receive a policy dividend, the policy owner must own a __________ policy. Concurrent Review Provision: Once an insured is admitted to the hospital, the insurer monitors the insured's hospital stay to make certain that everything is proceeding on schedule - CORRECT ANSWERWhich is a Cost Containment Provision used by insurers to monitor hospital stays? A regular dental checkup - CORRECT ANSWERPart B of Medicare excludes which medical expenses? Agent's Report - CORRECT ANSWERConfidential information shared by the producer to the insurer and does not become part of the policy is the __________. personal statement submitted by the producer to the insurer about information the agent would like to share with the insurer on a confidential basis that they may have learned during the application process while at the applicant's home or place of business. - CORRECT ANSWERAn agent's report is a: listing of policies and plans (A-D, F, G, K-N) for each company that sells Medigap policies in California, which are available for Medicare beneficiaries under age 65. The toll-free telephone number of the company that consumers can use to obtain information from the company. The premium rate methodology for each policy listed. "Premium Rate Methodology" means attained age, issue age, or community rated. - CORRECT ANSWERThe Commissioner's Annual Rate Guide must include: method of premium payment (single, flexible, and periodic), funding (fixed vs. variable), when income benefits are payable (immediate vs. deferred), and the payout option selected (life only vs. annuity certain). - CORRECT ANSWERAnnuity classifications are based on: Date of birth - CORRECT ANSWERIf a policy requires the payment of an additional premium for the continuation of coverage for a newborn, the insurer must be notified within 31 days of the ______. a steady stream of income to an individual, typically upon retirement. They are designed to protect against outliving one's retirement income by providing lifetime income. And they can liquidate an estate over the lifetime of an annuitant - CORRECT ANSWERAnnuities are used primarily to provide: create an estate. - CORRECT ANSWERlife insurance is designed to: In the same leave or part-time status - CORRECT ANSWERAn employer may not discriminate against an employee while on leave under the Family and Medical Leave Act, and must provide the employee with the same benefits normally provided to an employee who is: Formulary - CORRECT ANSWERA listing of prescription drugs that are covered under Medicare Part D and varies by insurance carrier is called a: Fiduciary - CORRECT ANSWERA person who handles insurer funds in a trust capacity is a(n): the period of time between the onset of a disability, and the time you are eligible for benefits. - CORRECT ANSWERwhat is the elimination period? Appointed - CORRECT ANSWERBefore a licensed agent may transact insurance, the agent must first be _________ by an admitted insurer or a licensed agency which has a marketing agreement with one or more insurers. business cards, price quotations, and printed advertisment - CORRECT ANSWEREvery licensee must include the license number on all of the following: Suitability standards for solicitation and sales - CORRECT ANSWERAll producers who market and sell long-term care policies must be trained in the company's: cancellation or expiration of the license or the filing of a notice of termination by the appointing insurer. - CORRECT ANSWERUnder the California Insurance Code, an agent's appointment remain in effect until a person who compiles and analyzes statistics and uses them to calculate insurance risks and premiums. - CORRECT ANSWERactuary preventive, mental, and home healthcare does not provide LTC (private or custodial nursing care) - CORRECT ANSWERMedicare Part B covers all of the following, except: Assignment of benefits - CORRECT ANSWERReimbursement benefits may be paid directly to the medical providers under which condition? its disclosure or lack of disclosure would change the insurer's decision to issue a policy for the same premium. - CORRECT ANSWERA statement is material if : monthly - CORRECT ANSWERMedicare pays the Medicare Advantage plan provider a ________ capitation fee (roughly equivalent to the combined Part A and Part B premiums) to oversee the health care services of the enrolled participants. Capitation - CORRECT ANSWER_________ is a payment arrangement for health care service providers, it pays a doctors a set amount for each enrolled person Up to 100 days, Only the first 20 days are covered at 100% of the actual cost. - CORRECT ANSWERAn insured is hospitalized for at least 3 days. How long will Medicare pay for confinement in a skilled nursing facility? two - CORRECT ANSWERIf the insured is incapable of performing or requires 'stand-by assistance' with any ______ or more activities of daily living (ADLs), the benefits will be triggered. 60 - CORRECT ANSWERIf an insurer makes a payment for a claim but the insured is dissatisfied with it, the insured must wait _____ days after proof of loss before taking any legal action. $300,000 - CORRECT ANSWERThe maximum amount of life insurance death benefit on any one insured life, regardless of the number of policies, covered by the California Life and Health Guarantee Association is: $1,000,000 - CORRECT ANSWERErrors and Omissions (E&O) policies are typically offered with a minimum limit of liability of how much? Placed on inactive status - CORRECT ANSWERIf renewal fees are paid and continuing education requirements are satisfied, but an agent has no active Notice of Appointment on file with the Commissioner, the license will be: 19 - CORRECT ANSWERUnder the PPACA, insurers are required to cover children under ______ with preexisting conditions and are prevented from dropping policyholders if they get sick. 15 - CORRECT ANSWERUnder California law, a Life Settlement Broker must be a licensed Life-Only agent for more than 1 year or have completed a _____-hour course in life settlements. Total premiums received - CORRECT ANSWERThe medical loss ratio is the ratio of an insurer's claims costs and certain taxes and fees versus its: 15 - CORRECT ANSWERIn California, upon receiving any communication from a claimant, regarding a claim, that reasonably suggests that a response is expected, every licensee shall immediately, but in no event more than _____ calendar days after receipt of the communication, furnish the claimant with a complete response based upon the facts as known. expressing a strong assertion or intention. expressing the future tense. - CORRECT ANSWERShall definition Certificate of Authority - CORRECT ANSWERUnder the California insurance code a person cannot transact any class of insurance business in this state without first being admitted or authorized by securing a _____________________ from the Commissioner. Legal Actions Optional Uniform Provisions: conformity with state statutes, illegal occupation, misstatement of age - CORRECT ANSWERWhich of these is a Mandatory Uniform Provision? [Show More]

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