Pass the Insurance Licensing Life - Accident - and Health Ok-Life-Accident-and-Health-or-Sickness-Producer Questions and answers with CertsForce

Anextension of benefitsprovision in health insurance allows a policyholder to continue receiving benefits for a covered condition (e.g., disability or hospitalization) after the policy terminates, typically if the condition began while the policy was in force. This is a standard provision in group and individual health insurance policies in Oklahoma, ensuring continuity of care for specific circumstances.

Option A: Incorrect. A qualifying event relates to COBRA or other continuation coverage triggers, not post-termination benefits.

Option B: Incorrect. Duration of coverage refers to the policy term, not benefits after termination.

Option C: Correct. Extension of benefits allows benefits to continue after policy termination.

Option D: Incorrect. A notification statement is unrelated to benefit continuation.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance benefit provisions.

Backdatinga life insurance policy involves setting the policy’s effective date earlier than the current date, often to secure a lower premium based on the insured’s younger age at the earlier date. This requires the policyowner to pay premiums for the backdated period, as permitted under Oklahoma insurance practices (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. Reinstating a lapsed policy involves restoring coverage after a lapse, not changing the effective date.

Option B: Incorrect. Excluding preexisting conditions applies to health insurance, not backdating life insurance.

Option C: Incorrect. Accepting late premiums relates to the grace period, not backdating.

Option D: Correct. Backdating makes the policy effective on an earlier date.

Replacing an older health insurance policy involves terminating an existing policy and purchasing a new one, which can have disadvantages such as proving insurability (new underwriting), a new contestability period (typically 2 years for misstatements), and potential exclusions for preexisting conditions under the new policy, as regulated in Oklahoma (O.A.C. 365:10-3-16). However, if the old policy no longer meets the policyowner’s needs, replacing it is an advantage, not a disadvantage.

Option A: Incorrect (is a disadvantage). Proving insurability may result in higher premiums or denial.

Option B: Incorrect (is a disadvantage). A new contestability period restarts the insurer’s ability to contest claims.

Option C: Incorrect (is a disadvantage). Preexisting conditions may face new exclusions or waiting periods.

Option D: Correct (is not a disadvantage). Replacing a policy that doesn’t meet needs is a benefit of replacement.

This question aligns with the Prometric content outline under “Considerations in Replacing Insurance,” which covers the implications of policy replacement.

In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO’s cost-containment model.

Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.

Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.

Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.

Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers HMO structures and strategies.

In a group medical plan with an80% coinsurance provisionand no deductible, the insurer pays 80% of covered medical expenses, and the insured pays the remaining 20%. For Laura’s $1,000 medical bill, the insurer covers 80% ($1,000 × 0.80 = $800), and Laura pays 20% ($1,000 × 0.20 = $200). This calculation aligns with standard health insurance cost-sharing provisions in Oklahoma (Title 36 O.S. § 6060.3).

Option A: Incorrect. Laura must pay her coinsurance share, not $0.

Option B: Correct. Laura pays $200 (20% of $1,000).

Option C: Incorrect. $800 is the insurer’s share, not Laura’s.

Option D: Incorrect. Laura does not pay the full $1,000; she pays only her coinsurance portion.

Twistingis the unethical practice of using misrepresentation or incomplete information to persuade an insured to replace an existing policy with a new one, often to their detriment. It is prohibited under Oklahoma’s Unfair Trade Practices Act (Title 36 O.S. § 1204) to protect consumers from deceptive sales practices.

Option A: Incorrect. Rebating involves offering a portion of the premium or other inducements to purchase insurance.

Option B: Correct. Twisting involves misrepresenting benefits to induce policy replacement.

Option C: Incorrect. Defamation is making false statements harming someone’s reputation, not policy replacement.

Option D: Incorrect. Forfeiting is not a term related to policy replacement practices.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers unfair trade practices.

Underwriters use various sources to assess an applicant’s risk, including the application, Medical Information Bureau (MIB) reports, consumer reports, medical questionnaires, attending physician statements (APS), and physical examinations, as permitted under Oklahoma’s underwriting practices (Title 36 O.S. § 1204). However,genetic testingis generally restricted or prohibited for life and health insurance underwriting due to federal and state laws, such as the Genetic Information Nondiscrimination Act (GINA) of 2008, which limits the use of genetic information in health insurance decisions.

Option A: Incorrect. Medical questionnaires are a standard underwriting tool.

Option B: Incorrect. Attending physician statements provide medical history and are commonly used.

Option C: Incorrect. Physical examinations are often required for underwriting.

Option D: Correct. Genetic testing is typically not allowed for underwriting due to legal restrictions.

Rebatingis the practice of offering or returning part of a commission, premium, or anything of value to an insured as an inducement to purchase an insurance policy. It is prohibited in Oklahoma under the Unfair Trade Practices Act (Title 36 O.S. § 1204) to ensure fair competition and prevent undue influence.

Option A: Incorrect. Coercion involves forcing someone to buy insurance, not offering inducements.

Option B: Incorrect. Defamation is making false statements harming reputation, not related to inducements.

Option C: Correct. Rebating involves giving value to induce a policy purchase.

Option D: Incorrect. Controlled business refers to writing insurance primarily for oneself or close associates, not inducements.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers unfair trade practices.

TheOklahoma Life and Health Insurance Guaranty Association, established under Title 36 O.S. § 2025 et seq., protects policyowners of admitted insurers in Oklahoma if the insurer becomesfinancially insolvent. The association provides coverage up to statutory limits (e.g., $300,000 for life insurance death benefits, $100,000 for cash value) to ensure policyholders receive benefits despite the insurer’s insolvency.

Option A: Incorrect. A merger with a foreign insurer does not trigger Guaranty Association protection unless it leads to insolvency.

Option B: Correct. The Guaranty Association protects policyowners when an admitted insurer becomes financially insolvent.

Option C: Incorrect. Failure to meet capital surplus requirements may lead to regulatory action but does not directly trigger Guaranty Association coverage.

Option D: Incorrect. Depleting loss reserves is a financial issue but not the specific condition for Guaranty Association intervention, which requires insolvency.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which includes knowledge of the Guaranty Association.

TheOklahoma Insurance Commissioner, an elected official under Title 36 O.S. § 301, has powers including conducting hearings, adopting rules and regulations, and overseeing complaints against insurance entities. However,enacting legislationis a function of the Oklahoma Legislature, not the Commissioner, who can only propose or influence legislation.

Option A: Incorrect (is a duty). The Commissioner can conduct hearings on insurance matters.

Option B: Correct (is not a duty). Enacting legislation is a legislative function, not the Commissioner’s role.

Option C: Incorrect (is a duty). The Commissioner adopts rules and regulations.

Option D: Incorrect (is a duty). The Commissioner has jurisdiction over insurance-related complaints.