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Wisconsin Accident and Health Insurance
Exam 3 With 100% Correct Answers.
What is the consequence for an intermediary's failure to pay his/her biennial license fee? Intermediary is incarcerated by the Insurance Commissioner. Intermediary's license is suspended for 180 days. Intermediary's license is revoked. Intermediary's commission rate is reduced. - CORRECT ANSWERS--Intermediary's license is revoked. Which of these situations would NOT potentially involve a prison sentence under Federal law? Selling insurance with a nonresident license. Misappropriating insurance premiums. Embezzlement of an insurer's funds. Sending threatening letters to an insurer. - CORRECT ANSWERS--Selling insurance with a nonresident license. How long can pre-existing conditions be excluded in long-term care policies? 6 months. 12 months. 18 months. 24 months. - CORRECT ANSWERS--6 months. What is the proper procedure for an intermediary to change his/her mailing address? Notify the Governor's office in writing within 15 days. Notify the Commissioner's office in writing within 30 days. Notify the appointing insurer in writing within 15 days. Notify the Commissioner's office via telephone within 30 days. - CORRECT ANSWERS--Notify the Commissioner's office in writing within 30 days. Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means? Usual and customary fee schedules. Increased fee schedules. Decreased fee schedules. Indemnity fee schedules. - CORRECT ANSWERS--Decreased fee schedules. According to the Affordable Care Act, new Health Insurance Marketplaces are established by the ICIICO. CCIIOO.
CCOII.
CCIIO. - CORRECT ANSWERS--CCIIO.
Which of the following is REQUIRED coverage for all newly-issued group disability (accident & health) policies? Alcohol treatment. Wage loss due to unemployment. Long-term disability. Vision care. - CORRECT ANSWERS--Alcohol treatment. Which term refers to insurance written on the interests of the licensee, the licensee's employer, or the licensee's immediate family? Controlled business. Surplus lines. Fraternal organization. Reinsurance. - CORRECT ANSWERS--Controlled business. What is considered interstate travel under the Federal Fraud and False Statements Act? Canada. Jamaica. Mexico. Puerto Rico. - CORRECT ANSWERS--Puerto Rico. Under what circumstances must an intermediary provide his or her business records to the Commissioner? Upon request of an insured. Upon request of the Commissioner. Under no circumstances due to privacy consideration. By authorization from the National Association of Insurance Commissioners (NAIC).
- CORRECT ANSWERS--Upon request of the Commissioner. For group health plans covering employees in more than one state, the state regulatory jurisdiction established for the plan may affect any of the following aspects EXCEPT Minimum enrollment percentages. Eligibility qualifications. Required contract provisions. COBRA continuation of coverage. - CORRECT ANSWERS--COBRA continuation of coverage. If an intermediary chooses to conduct business under an assumed name, when must notification be given to the Commissioner?
Advertisement. Testimony. Promissory warranty. Guaranty. - CORRECT ANSWERS--Testimony. An intermediary who makes an agreement that unreasonably restrains the business of insurance may have violated regulations against Boycott, coercion and intimidation. Defamation. False advertising. Unfair discrimination. - CORRECT ANSWERS--Boycott, coercion and intimidation. Renewal of small employer health insurance plans may be denied for all of the following reasons EXCEPT Nonpayment of premiums. Having less than the required number of participants. Overuse of physician and hospital services. Misrepresentation of the application. - CORRECT ANSWERS--Overuse of physician and hospital services. John has a criminal record in which he was convicted of a felony that involved dishonesty. Under Federal law, how would John be able to engage in insurance transactions? Completing a court-ordered prison sentence. Completing a court-ordered probation period. Paying a fine of up to $50,000. Given written consent by the state insurance regulatory agency. - CORRECT ANSWERS--Given written consent by the state insurance regulatory agency. Which statement is true regarding Wisconsin's continuing education requirements for licensed intermediaries? There are no continuing education requirements in Wisconsin. An intermediary must complete one accredited college course each year. An intermediary must meet specified course requirements within a two-year period. An intermediary who has a four-year degree in insurance is exempt from continuing education requirements. - CORRECT ANSWERS--An intermediary must meet specified course requirements within a two-year period. EXCEPT for fraud, the time after issuance of a policy during which an insurance company may contest a health insurance claim due to the statements on an application is 10 days. 90 days. 2 years.
5 years. - CORRECT ANSWERS--2 years. The intermediary licensing process exists to demonstrate to the Commissioner that an applicant meets specific criteria. Which of the following is NOT one of these criteria? Applicant must successfully pass a licensing examination. Applicant must intend to act in good faith. Applicant has no prior bankruptcies. Applicant must be competent and trustworthy. - CORRECT ANSWERS--Applicant has no prior bankruptcies. All of these statements are true regarding a policyowner's ability to return a disability (accident & health) policy EXCEPT The policy delivery date starts the right-to-return period. First page of the policy must contain the Right-to-Return clause. Policyowner has 10 days to return policy for full refund. Policyowner may return the policy for a full refund at anytime. - CORRECT ANSWERS--Policyowner may return the policy for a full refund at anytime. An Outline of Coverage for a Medicare Supplement policy MUST be given to the applicant at which of the following times? The time of application. No later than the first renewal date. On each anniversary date of the policy. Only when the applicant requests it. - CORRECT ANSWERS--The time of application. All of these are considered to be a violation of the Federal Fraud and False Statements Act EXCEPT Overvaluing land. Abstracting funds. False entries on reports. Claims reimbursement. - CORRECT ANSWERS--Claims reimbursement. Under which circumstance is an intermediary eligible to receive a commission on an insurance contract written on the intermediary's own life? Intermediary's license is revoked and is under appeal with the Insurance Commissioner. Intermediary sold insurance for the same insurer the previous year with the premium on his/her own life equal to the total premiums written.
Intermediary attends a meeting where another intermediary sells an insurance policy. Intermediary begins working as an office manager in a stockbroker's office. Intermediary applies for reinstatement of his/her license. Intermediary becomes employed with an HMO. - CORRECT ANSWERS-- Intermediary attends a meeting where another intermediary sells an insurance policy. Any of the following may be an unfair claims practice EXCEPT Refusing to pay claims without a reasonable investigation. Refusing to pay persons bringing false or fraudulent claims. Failing to promptly provide reasonable explanation of any claim denials. Offering low amounts to force insureds to institute litigation. - CORRECT ANSWERS--Refusing to pay persons bringing false or fraudulent claims. The insured's statement that guarantees certain things will be done after the policy has taken effect is called a(n) representation. promissory warranty. affirmative warranty. guarantee. - CORRECT ANSWERS--promissory warranty. According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age? Age 25. Age 26. Age 27. Age 28. - CORRECT ANSWERS--Age 26. An insurance intermediary must maintain customer records for how many years following the completion date of the insurance transaction? two. three. four. five. - CORRECT ANSWERS--three. For policyholders in the same risk classification, it is unlawful to Charge different premiums. Set different policy effective dates. Issue different amounts of coverage. Establish uniform claims payment procedures. - CORRECT ANSWERS--Charge different premiums. Making a statement that is false or maliciously critical of the financial condition of an insurer is known as
defamation. coercion. slander. boycott. - CORRECT ANSWERS--defamation. In regards to technology and the ACA, which of the following statements is correct? States which operate with an Exchange must offer an internet-based portal. States which operate with an Exchange must increase the costs of their plans to accomodate an internetbased portal. States which operate with an Exchange can only offer an internet-based portal in public buildings. States which operate with an Exchange qualify for Federal aid to initiate an internet- based portal. - CORRECT ANSWERS--States which operate with an Exchange must offer an internet-based portal. The Commissioner may suspend an intermediary's license when the intermediary Fails to notify the insurance department of change of premium trust account location. Rebates a portion of the commission to the insured. Shares commissions with similarly licensed intermediaries. Fails to report annual commission earnings to the insurance department. - CORRECT ANSWERS--Rebates a portion of the commission to the insured. Under Wisconsin law, which of the following is NOT required to be licensed? An employee of a collection agency who collects delinquent premiums. A person who solicits insurance on a door-to-door basis. A person who advises another person about insurance needs and coverage and is directly compensated by the insured only. A person who advises another person about insurance needs and coverage and is directly compensated by an insurance company. - CORRECT ANSWERS--An employee of a collection agency who collects delinquent premiums. The forwarding of insurance business from one intermediary to another because the forwarding intermediary cannot place the business with any of the companies with which the intermediary is listed is considered brokering business.
Six. Nine. Twelve. Twenty four. - CORRECT ANSWERS--Six. No existing insurance license will be revoked until The licensee has been afforded a right to a hearing on the charges. At least three violations have occurred. A jury has decided upon such action. A cease and desist order has been issued. - CORRECT ANSWERS--The licensee has been afforded a right to a hearing on the charges. Which of the following statements regarding an examination of an insurer's books and records by the Commissioner is true? An insurer has a right to delay an examination by the Commissioner for a period of not more than 15 days after notification. The insurer must not impede an examination and is required to assist in the examination procedures. Reports related to solicitors are not official records archived from insurance examinations. The Commissioner only has the authority to examine domestic insurers. - CORRECT ANSWERS--The insurer must not impede an examination and is required to assist in the examination procedures. The maximum prison sentence given under federal law for unfair and deceptive insurance practices is 15 years. 10 years. 5 years. 1 year. - CORRECT ANSWERS--15 years. A licensee whose name or address changes must notify the Commissioner within 15 days by written notice. 15 days by phone notice. 30 days by written notice. 30 day by phone notice. - CORRECT ANSWERS--30 days by written notice. Under Wisconsin standards for marketing long-term care coverage, all of these are prohibited sales practices EXCEPT Twisting.
Replacing existing coverage. High pressure tactics. Cold lead advertising. - CORRECT ANSWERS--Replacing existing coverage. How many hours of continuing education is required every two years for license renewal?
- CORRECT ANSWERS--24. How can a group dental insurer discourage adverse selection? Allow pre-existing conditions. Eliminate deductibles and coinsurance. Extend open enrollment period. Limit the duration of coverage. - CORRECT ANSWERS--Limit the duration of coverage. Misrepresenting pertinent policy provisions relating to coverage after a loss is A concealment in insurance application. An unfair claims settlement practice. An unfair discrimination between individuals. An unfair discrimination between individuals. - CORRECT ANSWERS--An unfair claims settlement practice. A small employer group is an employer that employs how many? 2 - 25 employees. 2 - 50 employees. 2 - 75 employees. 2 - 100 employees. - CORRECT ANSWERS-- 2 - 50 employees. In regards to the Affordable Care Act (ACA), which of these is NOT a role of a health insurance exchange? Offer individual, unique formats for consumers to evaluate different health plan options. Certify that a health plan is qualified to be offered on the exchange. Contact the employer if an employee stops coverage under a plan offered in the exchange. Resolve and verify an applicant's inconsistent or incomplete information. - CORRECT ANSWERS--Contact the employer if an employee stops coverage under a plan offered in the exchange.
An accountant who gives incidental insurance advice in the normal course of his or her professional activities. An employee who collects premiums from delinquent policyholders. An individual listed as a salesperson by an insurance company. - CORRECT ANSWERS--An individual listed as a salesperson by an insurance company. A prepaid dental plan has an agreement in place with a network of dentists which Allows the dentists to determine the deductible and coinsurance amounts. Accepts an established amount as payment in full for the dental services rendered. Requires all the dentists to be located within the same state. Must cover 100% of all orthodontic treatments. - CORRECT ANSWERS--Accepts an established amount as payment in full for the dental services rendered. Access to premium tax credits and reduced cost sharing is made available ONLY if the consumer purchases health coverage in The health insurance exchange. an HMO. a PPO. a self-directed health plan. - CORRECT ANSWERS--The health insurance exchange. In order to act as an insurance agent, a producer must hold a valid insurance license and Be appointed by an authorized insurance company. Reside in this state. Maintain an office in this state. Obtain a certificate of authority. - CORRECT ANSWERS--Be appointed by an authorized insurance company. A(n) ________ order may be issued by the Insurance Commissioner. compliance. incarceration. reciprocal. subrogation. - CORRECT ANSWERS--compliance. A person who is not licensed as an intermediary may do all of the following EXCEPT make appointments for an intermediary. receive a referral fee. mail policies to insureds.
receive a commission. - CORRECT ANSWERS--receive a commission. Prepaid dental plans differ from most other types of dental plans in what way? X-rays and teeth cleanings are fully covered. Possible exclusion of pre-existing conditions. Closed panel of dentists can only be used. Deductibles may have to be met. - CORRECT ANSWERS--Closed panel of dentists can only be used. What is the minimum number of employees needed for a small employer medical expense plan in Wisconsin?
- CORRECT ANSWERS--2. An insurance applicant has made a false statement on the application that will affect the insurer's decision on whether or not to issue the policy. This false statement is considered to be a(n) irrelevant representation. immaterial representation. material misrepresentation. consensual representation. - CORRECT ANSWERS--material misrepresentation. According to federal fraud and false statements regulation, what is required for a prohibited person to transact insurance business in this state? Completing twenty-four hours of ethics education. Completing three years of community service. Written consent from the U.S. Attorney General. Written consent from the state insurance regulatory agency. - CORRECT ANSWERS--Written consent from the state insurance regulatory agency. Medicare supplement policies may not include renewal provisions less favorable to the insured than conditionally renewable. nonrenewable. noncancellable. guaranteed renewable. - CORRECT ANSWERS--guaranteed renewable. Claims settlement practices of insurers are regulated by: The Internal Revenue Service. The National Association of Insurance Commissioners. Claims adjusters.
Who reports an intermediary's termination of appointment to the Commissioner? The intermediary. The insurer. The Insurance Department. The State. - CORRECT ANSWERS--The insurer. All of the following claims settlement practices could initiate a cease and desist order EXCEPT Misrepresenting insurance policy provisions relating to coverages at issue. Refusing to pay a claim which was NOT reported to the insurer or its agent in the required time. Refusing to pay a claim without conducting a reasonable investigation of all available information where material facts are in dispute. Compelling insureds to implement suits to recover amounts due by offering substantially less than the amounts ultimately recovered in those suits. - CORRECT ANSWERS--Refusing to pay a claim without conducting a reasonable investigation of all available information where material facts are in dispute. The Commissioner can issue a temporary license as an intermediary for a period of 6 months 12 months 18 months 24 months - CORRECT ANSWERS--12 months An intermediary's insurance records or pertinent information must be provided, upon request, to the Insurance Commissioner within 30 days of the request. promptly in writing or in any other designated form under no circumstances. upon approval of the Governor. - CORRECT ANSWERS--promptly in writing or in any other designated form According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation? Writing controlled business. Making false entries in a company's book. Transacting insurance outside a licensee's home state. Sharing commissions with a licensed agent. - CORRECT ANSWERS--Making false entries in a company's books
Which of the following statements is CORRECT about an insured's failure to report a claim in a timely manner based on the advice of an intermediary? It is a material misrepresentation It affects the insured's claim settlement It invalidates the claim It does not affect the insurance company's obligations - CORRECT ANSWERS--It does not affect the insurance company's obligations Under the Affordable Care Act, all of these are considered one of the 10 essential health benefits EXCEPT Hospitalization Prescription drugs Mental health and substance abuse treatment Annual CAT scans - CORRECT ANSWERS--Annual CAT scans All of these are used to prevent adverse selection in a group dental plan EXCEPT Provide evidence of insurability. Probationary periods. Waiting periods. Decreased employee participation. - CORRECT ANSWERS--Decreased employee participation. An intermediary has his license revoked because of a failure to pay the required license fees. How soon after the revocation may he apply for reinstatement? Immediately. Within 6 months. Within 12 months. Never. - CORRECT ANSWERS--Immediately. Qualified long-term care policies must include all of the following provisions EXCEPT Nonforfeiture option. Inflation protection. Prior hospitalization. Guaranteed renewability. - CORRECT ANSWERS-- An insurer operating in the U.S. but headquartered outside the U.S. is a foreign insurer. an alien insurer. unauthorized. authorized. - CORRECT ANSWERS--an alien insurer.
Describe the specific types of tests that will be performed. - CORRECT ANSWERS-- Disclose the types of individuals or organizations that may receive a copy of the test results. In Wisconsin, an insurer providing small employer group medical plans may discontinue an employer's coverage if The insurer no longer offers the plan to any employer. The employer has poor claims experience. The employer declares bankruptcy. The insurer's service area has too few providers. - CORRECT ANSWERS--The insurer no longer offers the plan to any employer. An intermediary must secure an appointment with an insurer Before taking a licensing examination. Within 90 days of receiving a license. Before soliciting insurance applications for that insurer. Within 90 days of soliciting insurance applications for that insurer. - CORRECT ANSWERS--Before soliciting insurance applications for that insurer. Which of these is NOT considered a Federal punishment for unfair and deceptive insurance practices? Prison sentence. Revocation of license. Monetary fine. Community service. - CORRECT ANSWERS--Community service. All of the following are covered under most dental plans EXCEPT for X-rays. Tooth extraction. Cleanings. Mouth cancer. - CORRECT ANSWERS--Mouth cancer. An insurer may EXCLUDE preexisting conditions on a Medicare Supplement policy for up to ___ months after policy issue. 3 4 5 6 - CORRECT ANSWERS-- 6 What is the actuarial value of a bronze level health plan? 60 70
90 - CORRECT ANSWERS-- 60
How long must all health plans provide coverage for newborn children? 7 days 15 days 30 days 60 days - CORRECT ANSWERS--60 days An individual may become licensed as a nonresident intermediary without passing a written examination by Reciprocal arrangement with the state of domicile. Forfeiting the individual's resident license. Filing for a waiver. Filing for a waiver. - CORRECT ANSWERS--Reciprocal arrangement with the state of domicile. Disability (accident & health) policies MUST cover lead poisoning screenings for children under ___ years of age. 5 6 7 8 - CORRECT ANSWERS-- 6 Security laws passed by Congress are enforced by which Federal agency? Securities Enforcement Agency (SEA). Department of Homeland Security. Security and Exchange Commission. National Association of Insurance Commissioners (NAIC). - CORRECT ANSWERS-- Security and Exchange Commission. Which individual would be the best candidate for a temporary insurance license? Prospective intermediary who is waiting to take the state licensing examination. An individual who would like to sell insurance to family and friends for 6 months. A personal representative of a deceased or physically ill intermediary. A full-time college student soliciting insurance over the phone. - CORRECT ANSWERS--A personal representative of a deceased or physically ill intermediary. Starting in 2016, businesses with up to ___ employees will be defined by the ACA as a "small business". 40 60 80
