Free Insurance Licensing Ok-Life-Accident-and-Health-or-Sickness-Producer Practice Exam with Questions & Answers | Set: 4

Suitabilityin long-term care (LTC) insurance involves assessing an individual’s financial situation, health needs, and goals to determine the appropriate coverage, ensuring the policy meets their needs without being unaffordable or excessive. Oklahoma regulations (O.A.C. 365:10-5-40) emphasize suitability to protect consumers from inappropriate LTC products.

Option A: Incorrect. Coinsurance is a cost-sharing mechanism, not about determining coverage.

Option B: Correct. Suitability ensures the LTC policy is appropriate for the individual’s needs.

Option C: Incorrect. Contestability relates to the insurer’s ability to contest claims, not coverage selection.

Option D: Incorrect. Accountability is not a term for determining coverage appropriateness.

When applying for a life or health insurance policy in Oklahoma, the insurer’s underwriting process typically involves reviewing the applicant’smedical historyto assess risk, as permitted under Title 36 O.S. § 1204. This may include questions about personal and family health, but not all family illnesses need to be reported unless specifically requested. Physical examinations are not always required, and undiagnosed conditions are not expected to be recorded; the applicant must disclose known conditions truthfully.

Option A: Incorrect. Reporting all family illnesses is not mandatory unless relevant to underwriting questions.

Option B: Incorrect. A physical exam is not always required; it depends on the insurer’s underwriting guidelines.

Option C: Incorrect. Undiagnosed conditions cannot be recorded; only known conditions are reported.

Option D: Correct. The insured’s medical history may be reviewed and reported during underwriting.

Theunpaid premium Uniform Optional Provisionin health insurance policies, as recognized in Oklahoma (Title 36 O.S. § 4405), allows the insurer to deduct any unpaid premiums from a claim payment if a claim becomes payable while premiums are overdue. This ensures the policy remains in force and the claim is paid, net of the owed premium.

Option A: Incorrect. The claim is not denied; the premium is deducted from the payment.

Option B: Incorrect. The policy is not cancelled; the unpaid premium is addressed via the claim.

Option C: Correct. The unpaid premium is deducted from the claim payment.

Option D: Incorrect. The claim is not delayed; the premium is settled with the claim payment.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance policy provisions.

Term life insurance provides coverage for a specific period at a lower premium cost compared to permanent insurance, such as whole life. The primary advantage is its affordability, making it suitable for individuals needing significant coverage with lower initial costs. Unlike whole life, term life does not accumulate cash value, and premiums typically increase upon renewal as the insured ages.

Option A: Incorrect. Premiums for term life do not decrease as the insured ages; they increase at renewal due to higher risk.

Option B: Incorrect. While death benefits in level term policies remain constant during the term, this is not the primary advantage compared to lower costs.

Option C: Correct. Term life has lower initial costs, making it more affordable for the same coverage amount compared to permanent insurance.

Option D: Incorrect. Term life does not offer a cash value, a feature of permanent insurance.

This question aligns with the Prometric content outline under “Life Products,” which covers the characteristics and advantages of term life insurance.

TheHealth Insurance Portability and Accountability Act (HIPAA)includes provisions from the Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996, which mandates that group health plans cannot restrict hospital stays for childbirth to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section. This federal law applies to group health insurance plans in Oklahoma and ensures minimum coverage for maternity care.

Option A: Incorrect. COBRA allows continuation of group health coverage after certain events but does not mandate maternity stay durations.

Option B: Incorrect. Medicaid is a state-federal program for low-income individuals, not a law mandating hospital stays for childbirth.

Option C: Correct. HIPAA, via the NMHPA, guarantees the 48-hour hospital stay for regular deliveries.

Option D: Incorrect. ERISA governs employee benefit plans but does not specifically address maternity hospital stays.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers federal and state laws affecting health insurance.

In insurance, a contract is effective when there is mutual consideration, offer, acceptance, and a meeting of the minds. For a health insurance contract, this occurs when the insured pays the initial premium (consideration from the insured) and the insurer issues the policy as applied for (acceptance by the insurer), as outlined in Oklahoma’s Insurance Code (Title 36 O.S. § 4401). The policy becomes binding at this point, assuming all other conditions (e.g., underwriting approval) are met.

Option A: Incorrect. Providing services occurs during claims, not when the contract is effective.

Option B: Incorrect. Paying the premium alone is not sufficient without policy issuance.

Option C: Correct. The contract is effective when the premium is paid and the policy is issued as applied for.

Option D: Incorrect. Signing by both parties is not typically required; issuance and premium payment suffice.

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

A collateral assignment is a provision in a life insurance policy that allows the policyowner to temporarily transfer certain ownership rights (e.g., the right to the death benefit or cash value) to a creditor as security for a loan. The assignee (creditor) has a claim to the policy proceeds up to the loan amount, but the policyowner retains other rights and regains full ownership once the loan is repaid.

Option A: Incorrect. Reinstatement allows a lapsed policy to be restored under certain conditions, not related to securing a loan.

Option B: Incorrect. The entire contract provision defines the policy and application as the complete agreement, not related to loans.

Option C: Correct. Collateral assignment temporarily assigns policy rights to secure a loan, as per standard life insurance provisions.

Option D: Incorrect. An automatic premium loan uses the policy’s cash value to pay overdue premiums, not to secure an external loan.

This question is part of the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers ownership and assignment provisions.

Asurvivorship life policy(second-to-die insurance) covers two or more individuals (typically spouses) and pays the death benefitupon the death of the last surviving insured. It is often used for estate planning, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002). This contrasts with a joint life policy, which pays on the first death.

Option A: Incorrect. Payout is not tied to a fixed age but to the last insured’s death.

Option B: Incorrect. Divorce does not trigger a payout; it may affect ownership or beneficiaries.

Option C: Incorrect. Payout occurs on the last insured’s death, not the first.

Option D: Correct. The policy pays upon the death of the last surviving insured.

Anaccelerated death benefit (ADB)provision, regulated in Oklahoma (Title 36 O.S. § 4051), allows an insured with aterminal illness(typically with a life expectancy of 12–24 months) to receive a portion of the life insurance death benefit before death. This provides funds for medical or personal expenses during the insured’s lifetime.

Option A: Incorrect. Disability may trigger other riders (e.g., waiver of premium), not ADB.

Option B: Correct. A terminal illness qualifies for accelerated death benefits.

Option C: Incorrect. Reaching retirement age does not trigger ADB.

Option D: Incorrect. A dependent’s illness is not a qualifying condition for ADB.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers accelerated death benefits.

Aper cause deductiblemeans the insured pays a $100 deductible for each separate medical condition or cause of treatment. The insured visits the doctor three times for injuries, each costing $200. Assuming each visit is for adifferent injury(to calculate the minimum amount, we consider the maximum number of deductibles), the insured pays a $100 deductible per visit (3 visits × $100 = $300). If the policy includes coinsurance (not specified but common in major medical policies), additional costs may apply, but the question asks for theminimum amount, which is the total deductibles for three separate causes.

Calculation:

Visit 1: $100 deductible (first injury).

Visit 2: $100 deductible (second injury).

Visit 3: $100 deductible (third injury).

Total: $100 × 3 = $300.

If all visits were for the same injury, only one $100 deductible would apply, but the question implies separate causes to reach the minimum of $300.

Option A: Incorrect. $100 assumes one deductible for a single cause, not three visits.

Option B: Incorrect. $200 does not account for three separate deductibles.

Option C: Correct. $300 reflects a $100 deductible for each of three separate injuries.

Option D: Incorrect. $500 exceeds the minimum, possibly including coinsurance not specified.