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| Section | Weight | Objectives |
|---|---|---|
| Underwriting, Marketing and Sales Practices | 15% | - Application and Underwriting Procedures
|
| Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Accident and Health Insurance | 35% | - Government Health Programs
|
| Life Insurance Products and Provisions | 30% | - Policy Provisions, Riders and Options
|
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NEW QUESTION # 89
In reference to life insurance in contract law, a person MOST likely will have an insurable interest in insuring a person ' s life if
Answer: A
Explanation:
The correct answer is B. the interest exists at the time of application. In life insurance contract law, the principle of insurable interest requires that the policyowner must have a legitimate financial or emotional interest in the continued life of the insured. This requirement is designed to prevent wagering on human life and to ensure that insurance is purchased for protection rather than speculation. For life insurance policies, the insurable interest must exist at the time the policy is applied for or issued , but it does not need to exist at the time of the insured's death .
Examples of insurable interest include relationships where financial loss would occur if the insured dies, such as spouses, parents and children, business partners, or employers insuring key employees . The other options are incorrect because A states that insurable interest must exist at death, which is not required in life insurance. C is incorrect because a distant family relationship alone may not create a clear financial or legal insurable interest. D is also incorrect because not every business relationship automatically establishes insurable interest; the relationship must involve a genuine potential financial loss. Therefore, the key requirement is that insurable interest must exist when the policy is applied for .
NEW QUESTION # 90
A 65-year-old employee who works for an employer with 24 employees is disabled on the job. The employee has fully recovered and returned to work. Which health coverage is primary?
Answer: C
Explanation:
When an injury or illness is work-related ("on the job") , the primary payer for medical expenses and related benefits is workers' compensation . Workers' compensation laws are designed to provide benefits for occupational injuries and diseases, including payment for necessary medical treatment and, when applicable, lost-time/indemnity benefits. This priority applies regardless of the employee's age and is not determined by the size of the employer's group plan (the "24 employees" detail is often relevant to certain coordination rules such as Medicare secondary payer, but it does not override workers' compensation responsibility for job- related injuries). The fact that the employee has recovered and returned to work does not change which coverage is primary for the injury event-medical bills connected to that occupational injury are still handled first under workers' compensation. Medicaid is needs-based coverage and would not be primary when another legally responsible payer exists. Likewise, an individual plan or the employer's group plan typically coordinates benefits only after workers' compensation for occupational claims.
NEW QUESTION # 91
Which of the following is a common exclusion from coverages found in accident and health policies?
Answer: C
Explanation:
Accident and health (A & H) policies pay benefits only for losses caused by covered injuries or sickness, and they also list specific exclusions -situations for which the insurer will not pay. A very common exclusion across A & H contracts is intentionally self-inflicted injury . The reasoning is that insurance is intended to protect against fortuitous (accidental, unintended) loss, not losses deliberately caused by the insured.
Therefore, injuries resulting from intentional self-harm are typically excluded from coverage, and claims arising from such acts are not payable under standard policy language.
The other options do not represent common exclusions. Emergency room coverage is generally a covered service under major medical plans (though subject to copays, deductibles, medical-necessity rules, and network provisions). Coordination of benefits is not an exclusion-it is a claims provision used when an insured has more than one health plan to determine which plan is primary and how benefits are coordinated.
Chiropractic services may be covered or limited depending on plan design, but they are not universally excluded in the same way as intentional self-inflicted injury.
NEW QUESTION # 92
Insurance agents have duties and responsibilities to the insured and the insurer. Which of the following responsibilities does an agent owe the insured during the policy year?
Answer: A
Explanation:
During the policy year, an agent's continuing responsibilities to the insured are commonly described as policyowner service duties. A key part of that service is assisting the insured with the claims process - helping the insured understand what is covered, how to complete claim forms, what documentation is needed, where and when to submit the claim, and following up when additional information is requested. This ongoing service obligation supports timely claim handling and helps the insured access benefits promised under the contract.
The other options do not represent responsibilities an agent owes the insured. Agents do not report paid claims to the Insurance Department as part of normal duties; claim reporting and market conduct oversight are handled through insurer compliance and regulatory processes. Agents also do not work with rating bureaus to establish insurer ratings-insurer ratings are produced by independent rating organizations and based on financial/claims performance, not agent activity. Finally, an agent is not obligated (and generally should not) pay an insured's premiums; doing so can create improper financial arrangements and is outside normal agent duties. Therefore, helping the insured file and follow up on claims is the correct responsibility.
NEW QUESTION # 93
The policy provision describing the responsibilities of the master policyowner is in
Answer: C
Explanation:
The correct answer is A. group health policies . In a group health insurance plan , the actual contract is issued to the master policyowner , usually an employer, association, or trust. Because that party owns the master contract, the policy contains provisions describing the policyowner's responsibilities, such as premium remittance, eligibility administration, enrollment procedures, and notice requirements. Those duties belong in the group policy itself , not in the individual evidence given to insured members.
A certificate of coverage is provided to each covered employee or member to summarize benefits, exclusions, and rights under the group plan, but it is not the master contract and does not serve as the document that sets out the policyowner's contractual responsibilities. Choices C and D are incorrect because individual health or individual medical policies are issued directly to an individual policyowner, so there is no separate "master policyowner" structure as found in group insurance.
On licensing examinations, whenever the question refers to the master policyowner , it is a strong indicator that the subject is group insurance , making group health policies the correct choice.
NEW QUESTION # 94
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