PA Life, Accident, Health Insurance Exam

Fraud

Misrepresentation of material fact, made knowingly with intent to be deceptive?

Property/Casualty: Time of loss or claim occurs

Life Insurance: Only at time of application when policy is purchased

Insurable Interest must exist when for property/casualty and life insurance?

The group must not have formed for the purpose of purchasing life insurance

In order for a group to be eligible for group life insurance what must the group not have done?

5 years

How long must one be covered to convert a whole life policy?

Loss

The reduction in value of an asset which is measured before and after

Domestic

State in which insurer is/was formed and is headquartered

Foreign

Insurer writes business in states other than its home state

Alien

Insurer outside of the United States

Mutual

Insurer whose participation/dividends owned by policyowners

Stock

Insurer who is non-participating and no dividends are owned by stockholders

Admitted

Insurer where company has certificate of authority and approved to transact insurance in state

Non-Admitted

Insurer where company has no certificate and is not approved to transact

30 days

Probationary period cannot exceed how many days?

10 days

What is the time given for a free look for health insurance?

30 days

What is the time given for a free look for long term care or medicare?

3 years in PA

What is the time limit on certain defenses for health policies?

24 hours

How many hours of education are required to obtain a license?

18 years old

How old do you have to be to obtain a license?

Underwriting

What is the process of evaluating risk to determine if it is acceptable based on established guidelines?

Group as a whole

When underwriting for group plans does the underwriter look at the group as a whole or at the individuals?

Unilateral

One sided contract where only one party is legally bound to perform under the contract

Aleatory

Feature of insurance contracts in that there is an element of chance for both parties and that the dollar given by the policy holder (premiums) and the insurer (benefits) may not be equal

Concealment

The intentional failure to disclose facts

Waiver

Intentionally or voluntarily giving up your known right

Express Authority

Authority in writing

Implied Authority

Authority not in writing

Apparent Authority

Authority in actions/statements

10 days

What is the time frame where an insurer must acknowledge claim and provide a form?

15 days

When must an insurer respond to a commissioner inquiry?

30 days

When insurer must provide an explanation if claims are not completed in how many days?

15 days

First party claims must be settled in within how many days?

Insurance

Transfer of risk

Risk

Uncertainty

Pure risk

Type of risk with only possibility of loss

Speculative risk

Type of risk with possibility of loss or gain

Reinsurance

Transfer of risk from one insurer to another, company accepts the risk

Ceding insurer

Reducing risk onto the reinsurer

The inability to perform 2 activities of daily living

What defines the eligibility for long term care?

100 percent

In proprietors or partnerships what percent can someone who is self-employed deduct when showing a net profit?

100 percent

What percentage is the principal sum?

50 percent

What percentage is the capital sum?

Employer discontinues plan, policy lapses, employee quits or is laid off, divorce, or a child reaches age 26

What events terminate group health coverage?

COBRA

Requires employers within 20 or more employees to allow former employees and their dependents to continue coverage by employer plan at their own cost

Cash Payment

Life Income

Interest Only

Fixed Period

Fixed Amount

What are the 5 types of settlement options for paying death benefits? (CLIFF)

Accidental Death

Guaranteed Insurability

Cost of Living

Return of Premium

Accelerated Living Benefit

Long Term Care Rider

What are the 6 riders that affect death benefits? (AGCRAL)

Fixed Period

Fixed Amount

Multiple

Single

Pure Life

Guaranteed Minimum

What are 6 annuity payment options? (FFMSPG)

Permanent

What type of life insurance is also known as "whole life" and is in place until age 100?

Term

What type of life insurance is temporary, only offers death benefit, and has no cash value?

Participating

What type of life insurance has a distribution of dividends to its policyowners? (75 percent)

Non-participating

What type of life insurance has no distribution of dividends? (100 percent)

Fixed

What type of life insurance offers a guaranteed minimum or set benefits?

Variable

What type of life insurance has no guarantee of performance and has a separate account?

10 days

What is the free look period for life insurance?

45 days

What is the free look internally for life replacement?

20 days

What is the free look externally for life replacement?

30 days

What is the grace period for life insurance?

Fee for service

Medical plan where fee is paid in return for service provided

Prepaid

Medical plan where individuals pay health maintenance organizations specified amount and HMO agrees to provide needed care

Continuous Premium Whole Life

What type of whole life insurance has the same premiums for the life of the policy and pays the cash value if premiums are stopped?

Limited Payment Whole Life

What type of whole life insurance allows for a lifetime of premiums to be paid in a shorter period of time? (10 or 20 pay level annual installments)

Single Premium Whole Life

What type of whole life insurance policy has one payment made at the time of purchase and creates immediate cash value?

Modified Premium Whole Life

What type of whole life insurance policy have lower premiums in the first 3-5 years but then increase and become level? (End up being more expensive)

Graded Premium Whole Life

What type of whole life insurance policy has a lower initial premium than modified whole life and increases every 5-10 years as long as the policy remains in force?

Indeterminate Premium Whole Life

What type of whole life insurance policy is similar to a non-participating policy but allows for adjustable premiums

Adjustable Life Insurance

What type of life insurance gives the policyowner the power to adjust the face value and death benefit, premium, and length of coverage without having to change the policy?

Universal Life Insurance

What type of life insurance was designed for flexible premiums and flexible coverage for the life of the policy where death benefits can be altered? Premiums accumulate as interest within this policy's cash value.

Variable Life Insurance

What type of life insurance policy has a separate account instead of a guaranteed cash value with numerous death benefit options?

Hospital/Medical

Disability Income

Dental

Long-Term Care

What are four types of health insurance policies? (HDDL)

Tax deducted

In Health Savings Accounts are contributions not tax deducted or tax deducted?

Tax deferred

Are earnings within Health Savings Accounts not tax-deferred or tax-deferred?

Agreement

Consideration

Competent Parties

Legal Purpose

What are four required elements of legal contracts?

Independent Agent

Agent who sells insurance products of several companies and works for themselves or other agents

Exclusive or Captive Agent

Agent who represents only one company (insurance company) compensated by commission

75 percent

What percent of employees participate in contributory group plans?

100 percent

What percent of employees participate in noncontributory group plans?

10 days

What is the free look period under health insurance?

30 days

What is the free look period for medicare?

60 days

When can no action or law be brought to recover on policy prior to when after filing a written proof of loss?

When the beneficiary is irrevocable

When is the right to change the policyowner not allowed without permission?

31 days

What is the grace period for health insurance policy provisions?

45 days

When is coverage automatically reinstated if not disproved?

Premiums: Not deductible

Benefits: Tax free

In Buy/Sell and Key Person disability insurance premiums are what and benefits are what in reference to taxes?

Premiums: Deductible

Benefits: Tax free

In Business Overhead insurance premiums are what and benefits are what in reference to taxes?

Immediate Annuity

What type of annuity provides an individual with an income within a month or up to 12 months ?

Deferred Annuity

What type of annuity does not provide an immediate income and the owner chooses the amount and frequency of payments with funds able to be withdrawn?

Fixed Annuity

What type of annuity has values guaranteed against loss and never be less than what is paid into the contract?

Variable Annuity

What type of annuity has the potential to keep pace with inflation because they are supported by stocks and bonds and have an investment risk?

Equity Indexed Annuity

What type of annuity is also tax-deferred and its interest is linked to the S&P 500 index?

Waiver of Premium

What type of disability rider waives the premium if the insured is 100 percent disabled with a 6 month waiting period?

Disability Income

What type of disability rider replaces lost income if one cannot work and the premiums are waived?

Payor Benefit Life

What type of disability rider is used for juvenile policies?

Total Disability

Type of disability insurance defined as the inability to perform any duties of own occupation

Partial Disability

Type of disability insurance defined as one can perform some but not all essential duties of their occupation

Presumptive Disability

Type of disability insurance defined as the loss of 2 limbs, total and permanent blindness, total loss of speech, and loss of hearing

Residual Disability

Type of disability insurance defined as one that is paid when insured cannot perform the same duties as before based on income lost

Recurrent Disability

Type of disability insurance defined as one for employees who return to work but become disabled again within 90 days

Social Security Disability

Type of disability insurance defined as requiring 40 quarters completed with a 5 month waiting period, ceases when retirement starts

Home Health Care

Type of long term care that refers to skilled medical and therapy services performed in individuals home by visiting home health aids

Adult Day Care

Type of long term care that provides company, supervision, along with social and recreational support for people whose grown children care for them at home but work during the day

Respite Care

Type of long term care that is similar to hospice care where professionals care for someone who temporarily in order to give a few days rest to family members who provide care