Insurance Licensing Ok-Life-Accident-and-Health-or-Sickness-Producer Dumps

TheStandard Nonforfeiture Law, codified in Oklahoma at Title 36 O.S. § 4029, requires life insurance policies with cash value to provide nonforfeiture benefits if the policyowner stops paying premiums. These benefits ensure the policyowner can access the accumulated cash value through options like a cash surrender value, extended term insurance, or reduced paid-up insurance, preventing total loss of the policy’s value.

Option A: Correct. If the policyowner stops paying premiums, the cash value must be made available per the nonforfeiture law.

Option B: Incorrect. Contractual changes are governed by policy provisions, not nonforfeiture laws.

Option C: Incorrect. Disability may trigger a waiver of premium rider, but it does not directly relate to nonforfeiture benefits.

Option D: Incorrect. Bankruptcy does not trigger nonforfeiture benefits; it may involve creditor claims but is unrelated to premium cessation.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which includes nonforfeiture provisions.

Permanent life insurance (e.g., whole life, universal life) and term life insurance differ fundamentally in their structure and benefits. Permanent life insurance provides coverage for the insured’s entire life (as long as premiums are paid) and often includes a savings component that accumulates cash value. Term life insurance provides coverage for a specific period (e.g., 10, 20, or 30 years) and does not build cash value.

Option A: Incorrect. Term life insurance can cover the insured for various periods (e.g., 5, 10, 20 years), not strictly 1 year, depending on the policy term selected.

Option B: Incorrect. Term life is generally more economical for short-term needs due to lower premiums, but over a long life span, permanent life may be more cost-effective due to its lifelong coverage and cash value growth.

Option C: Correct. Permanent life insurance may develop cash value, which can be borrowed against or withdrawn, while term life does not have this feature.

Option D: Incorrect. Permanent life insurance does not automatically provide coverage for 5 years without premium payments. Policies may lapse without payment unless nonforfeiture options (e.g., extended term or reduced paid-up insurance) are exercised.

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

Amodified whole life policyfeatures premiums that arelower than typical whole life premiums during the initial years(e.g., first 3–5 years) to make the policy more affordable early on, thenhigher thereafterto compensate for the initial discount while maintaining lifelong coverage. This is a variation of whole life insurance, as defined in Oklahoma’s regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Premiums do not decrease in the last few years; they increase after the initial period.

Option B: Incorrect. Premiums are not higher in the last few years compared to typical whole life; they adjust after the initial period.

Option C: Correct. Premiums are lower initially and higher thereafter.

Option D: Incorrect. Premiums are not higher initially and lower later; the opposite is true.

Thefree-look provision, required in Oklahoma for life and health insurance policies (Title 36 O.S. § 4007 for life, § 4405 for health), allows the policyowner to return the policy within a specified period (typically 10 days for life, 30 days for Medigap) from receipt for afull refundof premiums paid, no questions asked. This protects consumers by allowing time to review the policy.

Option A: Incorrect. The insurer cannot rescind during the free-look period; that right applies to contestability.

Option B: Incorrect. The refund is full, not partial, during the free-look period.

Option C: Correct. The policyowner can return the policy for a full refund within the specified period.

Option D: Incorrect. The insurer cannot unilaterally alter the policy during the free-look period.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers free-look provisions.

Afixed annuityprovides guaranteed, stable payments to the annuitant, but a key disadvantage is that the fixed payments may losepurchasing powerover time due to inflation, reducing their real value. This is a concern for long-term annuitants, as noted in Oklahoma’s annuity regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Variable securities apply to variable annuities, not fixed annuities.

Option B: Incorrect. Fixed annuities guarantee a specific benefit amount.

Option C: Correct. Inflation can decrease the purchasing power of fixed payments.

Option D: Incorrect. Payment duration depends on the annuity type (e.g., life annuity), not a 2-year limit.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1435.13), transacting insurance without a valid license, such as after revocation, is afelonypunishable by a fine of up to $5,000, imprisonment for up to 7 years, or both, depending on the severity and intent. This reflects the serious nature of unlicensed insurance activity.

Option A: Incorrect. The fine limit is $5,000 for a felony, not $10,000.

Option B: Correct. The violation is a felony with a fine up to $5,000.

Option C: Incorrect. The violation is a felony, not a misdemeanor, with higher penalties.

Option D: Incorrect. Imprisonment is up to 7 years, not 10 years.

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.

Anendowment policyis a life insurance product that pays the face amount to the insured if they are alive at the end of a specified period (maturity) or to the beneficiary if the insured dies before maturity. It combines life insurance with a savings component, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Universal life is flexible permanent insurance, not tied to a specific maturity payout.

Option B: Incorrect. Modified life has lower initial premiums, not a maturity payout feature.

Option C: Correct. An endowment policy pays the face amount at maturity if the insured is alive.

Option D: Incorrect. A juvenile trust is not a life insurance policy type; it’s a financial arrangement.

Twistingis the unethical practice of using misrepresentation or incomplete information to persuade an insured to terminate an existing policy and purchase a new one, often to the insured’s detriment. It is prohibited under Oklahoma’s Unfair Trade Practices Act (Title 36 O.S. § 1204). This differs fromchurning(replacing policies for commission without benefit to the insured) orrebating(offering inducements to purchase).

Option A: Correct. Twisting involves misrepresentation to induce policy replacement.

Option B: Incorrect. Subrogation is the insurer’s right to recover payments from a third party.

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

Option D: Incorrect. Churning involves excessive policy replacements for commissions, not necessarily misrepresentation.

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

Ahospital indemnity policypays a fixed daily, weekly, or monthly benefit directly to the insured for hospitalization, regardless of other insurance coverage or actual expenses incurred. This is a supplemental policy common in Oklahoma (Title 36 O.S. § 4405).

Option A: Incorrect. “Limited-amount per diem” is not a standard insurance term.

Option B: Incorrect. Blanket policies cover groups for specific risks, not individual hospitalization benefits.

Option C: Incorrect. Medigap covers Medicare gaps, not fixed hospitalization payments.

Option D: Correct. Hospital indemnity policies pay a fixed amount per day for hospitalization.

Awhole life insurance policyprovidespermanent coveragefor the insured’s entire life, as long as premiums are paid, along with a guaranteed death benefit and cash value accumulation. This is a key advantage over term life, which is temporary. Whole life premiums are typically higher than term life, and underwriting guidelines or premium flexibility depend on the insurer, not the product itself.

Option A: Incorrect. Underwriting guidelines vary by insurer, not by policy type.

Option B: Incorrect. Whole life has higher initial premiums compared to term life.

Option C: Incorrect. Whole life typically has fixed premiums, unlike universal life, which offers variable premiums.

Option D: Correct. Permanent coverage is a primary advantage of whole life insurance.

This question falls under the Prometric content outline section on “Life Products,” which covers the benefits of whole life insurance.

Oklahoma regulations (O.A.C. 365:10-3-16) provide afree-look periodfor life insurance or annuity replacement policies, allowing the policyowner to return the policy for afull refund of premiumwithin20 daysfrom receipt. This extended period for replacements (compared to 10 days for non-replacement policies) ensures consumers can review the new policy and compare it to the replaced one.

Option A: Incorrect. 3 days is too short for the free-look period.

Option B: Incorrect. 7 days is not the required timeframe.

Option C: Incorrect. 14 days is shorter than the replacement free-look period.

Option D: Correct. The free-look period for replacement policies is 20 days.

An individual insurance application typically requires signatures from theapplicant(the person applying for the policy), theinsured(if different from the applicant, e.g., a parent applying for a child), and theproducer(to certify the information provided). Theinsurerdoes not sign the application, as their acceptance is indicated by issuing the policy, per Oklahoma’s insurance application processes (Title 36 O.S. § 1435.2).

Option A: Incorrect. The applicant’s signature is required to confirm the application details.

Option B: Incorrect. The insured’s signature is required if they are not the applicant.

Option C: Incorrect. The producer’s signature is required to verify the application process.

Option D: Correct. The insurer’s signature is not required on the application.

This question falls under the Prometric content outline section on “Underwriting,” which covers application requirements.

Ajoint life policy(first-to-die) covers both spouses under a single contract and pays the death benefit upon thefirst spouse’s death, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002). This is often used for financial protection needs like mortgages.

Option A: Incorrect. “Dual capacity” is not a standard life insurance term.

Option B: Incorrect. Family term covers dependents but is not specific to first-to-die spousal coverage.

Option C: Incorrect. Whole life is a permanent policy type, not inherently joint.

Option D: Correct. A joint life policy pays on the first spouse’s death.

Oklahoma insurance regulations mandate that health insurance policies providing child immunization coverage must not impose certain restrictions that could limit access to these benefits. Specifically, the Oklahoma Insurance Code, Title 36 O.S. § 6060.3, states that "benefits for immunizations required under child immunization coverage shall not be subject to prior authorization requirements." This ensures that children can receive necessary immunizations without delays caused by insurer approval processes.

The Oklahoma Life, Accident, and Health or Sickness Producer Study Guide further clarifies, "Child immunization benefits must be provided without prior authorization to promote timely access to preventive care. However, benefits may still follow a recommended immunization schedule or be subject to other policy terms like deductibles, unless otherwise specified." Options A, B, and D are not explicitly prohibited under the law, making option C the correct answer.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1250.4), upon receiving notice of a claim, an insurer must furnish the claimant with forms for filing proof of loss within15 days. This ensures timely processing of claims and compliance with fair claims settlement practices.

Option A: Incorrect. 10 days is not the required timeframe.

Option B: Correct. Insurers must provide forms within 15 days.

Option C: Incorrect. 20 days exceeds the statutory requirement.

Option D: Incorrect. 30 days is too long under Oklahoma law.

Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) at a lower premium cost than whole life insurance, making it ideal for individuals needing maximum death benefit protection but unable to afford the higher premiums of permanent insurance. Unlike whole life, term life does not accumulate cash value or allow policy loans.

Option A: Incorrect. Borrowing against policy values requires cash value, available in whole life, not term life.

Option B: Incorrect. Cash value accumulation is a feature of whole life, not term life.

Option C: Correct. Term life is appropriate for maximum protection at a lower cost when permanent insurance premiums are unaffordable.

Option D: Incorrect. Term life is not permanent insurance; whole life provides permanent coverage.

This question falls under the Prometric content outline section on “Life Products,” which covers the suitability of term versus whole life insurance.

An insurance agent, acting as afield underwriter, is responsible forcompleting applications accuratelyandcollecting initial premiums, ensuring the information provided is truthful and complete for the insurer’s underwriting process, as per Oklahoma’s regulations (Title 36 O.S. § 1435.2). Setting premiums, accepting/declining applications, and issuing policies are duties of the insurer’s underwriting department, not the agent.

Option A: Incorrect. Setting premiums is the insurer’s responsibility, not the agent’s.

Option B: Correct. Agents complete applications and collect initial premiums as part of field underwriting.

Option C: Incorrect. Declining or accepting applications is done by the insurer’s underwriters.

Option D: Incorrect. Issuing policies is the insurer’s role, not the agent’s.

Medicare supplemental insurance(Medigap) covers gaps in Original Medicare (Parts A and B), such as deductibles, coinsurance, and certain costs not covered by Medicare. A core benefit, included in most Medigap plans (e.g., Plans A–N), is coverage for thefirst 3 pints of bloodeach year, which Medicare Part A does not cover. Other options like at-home recovery or prescription drugs are not core benefits, and preventive care is covered by Medicare, not Medigap.

Option A: Correct. The first 3 pints of blood is a core Medigap benefit.

Option B: Incorrect. At-home recovery is not a standard core benefit in most Medigap plans.

Option C: Incorrect. Prescription drug coverage is not a core Medigap benefit; it’s covered by Medicare Part D.

Option D: Incorrect. Preventive care is covered by Medicare Part B, not a core Medigap benefit.

This question falls under the Prometric content outline section on “Medicare,” which covers Medigap benefits.

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.

Anaccelerated death benefit (ADB)provision allows an insured to receive a portion of the life insurance death benefit before death under specific conditions, such as aterminal illness. Theterminal illness settlement benefitis a form of ADB, providing funds for medical or personal needs, as regulated in Oklahoma (Title 36 O.S. § 4051).

Option A: Incorrect. A home care benefit relates to long-term care, not ADB.

Option B: Incorrect. A nonforfeiture extended term benefit is a policy lapse option, not an ADB.

Option C: Correct. A terminal illness settlement benefit is a type of accelerated death benefit.

Option D: Incorrect. A cost of living benefit adjusts benefits for inflation, not an ADB.

According to IRS guidelines (Publication 525), disability benefits from a group policy paid for by the employer are consideredtaxable incometo the employee because the premiums were not included in the employee’s taxable income. If the employee paid the premiums with after-tax dollars, the benefits would be tax-free.

Option A: Incorrect. Benefits are taxable if the employer paid the premiums.

Option B: Incorrect. Disability benefits are not deductible from gross income.

Option C: Correct. The benefits are taxable income.

Option D: Incorrect. Benefits are subject to income tax, not just Social Security or FUTA taxes.

Thegrace periodin life and health insurance policies, as mandated by Oklahoma law (Title 36 O.S. § 4005 for life, § 4405 for health), is a period (typically 31 days) after a premium due date during which the policy remains in force, protecting the policyowner from an unintentional lapse. If the insured dies during the grace period, the death benefit is payable, minus any overdue premiums.

Option A: Incorrect. The period after premium payment but before policy issuance is the underwriting or application phase, not the grace period.

Option B: Incorrect. This is similar to Option A and does not describe the grace period.

Option C: Incorrect. The time between death and benefit payment is the claim processing period, not the grace period.

Option D: Correct. The grace period protects against unintentional policy lapse due to late premium payment.

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

Long-Term Care (LTC) policies cover services for individuals who need assistance withActivities of Daily Living (ADLs), which are basic self-care tasks. Oklahoma regulations (O.A.C. 365:10-5-44) and federal standards define ADLs as including dressing, eating, toileting, bathing, transferring, and continence.Talkingis not considered an ADL, as it is not a fundamental self-care activity.

Option A: Incorrect. Dressing is an ADL.

Option B: Correct. Talking is not an ADL.

Option C: Incorrect. Eating is an ADL.

Option D: Incorrect. Toileting is an ADL.

Precertification(or preauthorization) is a process where the insurer reviews and approves certain medical treatments or procedures before they are provided, ensuring they are medically necessary and covered.Concurrent reviewoccurs during the treatment, monitoring ongoing care (e.g., hospital stays) to ensure continued necessity. The primary difference is timing: precertification happens before treatment, while concurrent review happens during treatment.

Option A: Incorrect. Both precertification and concurrent review are cost containment measures, so this is not unique to precertification.

Option B: Incorrect. Both processes involve review by the insurance company.

Option C: Incorrect. Neither typically requires patient consent beyond agreeing to the policy terms.

Option D: Correct. Precertification occurs before treatment, distinguishing it from concurrent review.

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

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.

Therecurrent periods of disability provisionin a disability income policy allows related or recurring disabilities within a specified timeframe (e.g., 6 months) to be treated as a single disability period. This protects the insured from serving multipleelimination periods(the waiting period before benefits begin), ensuring faster benefit payments for recurrent conditions, as per standard disability policy provisions in Oklahoma (Title 36 O.S. § 4405).

Option A: Incorrect. The provision does not reduce premiums; it affects benefit timing.

Option B: Correct. It protects the insured from multiple elimination periods for recurrent disabilities.

Option C: Incorrect. The provision does not impact insurability; it’s a policy feature.

Option D: Incorrect. It does not reduce the disability period; it simplifies benefit access.

Theautomatic premium loan (APL)provision in a life insurance policy with cash value allows the insurer to automatically borrow from the policy’s cash value to pay overdue premiums if the policyowner fails to pay by the end of the grace period (typically 31 days, per Title 36 O.S. § 4005). This prevents the policy from lapsing, provided sufficient cash value is available.

Option A: Incorrect. The APL provision does not cover loans from other policies.

Option B: Correct. The APL provision authorizes withdrawal to pay premiums due at the end of the grace period.

Option C: Incorrect. The APL provision prevents termination, not facilitates it.

Option D: Incorrect. Interest on policy loans is separate and not covered by the APL provision.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers automatic premium loans.

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.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1435.13), a producer who knowingly and willfully makes a fraudulent statement on an insurance application faces disciplinary actions, includingsuspension,revocation, orcensureof their license, as well as potential fines or criminal penalties.Discriminationis not a disciplinary action; it refers to unfair treatment and is unrelated to fraud penalties.

Option A: Incorrect (is a penalty). Suspension of the license is a possible consequence.

Option B: Incorrect (is a penalty). Revocation of the license is a possible consequence.

Option C: Correct (is not a penalty). Discrimination is not a disciplinary action for fraud.

Option D: Incorrect (is a penalty). Censure is a formal reprimand and a possible consequence.

Afield underwriter, typically an insurance producer, gathers initial information from applicants to assess their insurability and ensure the application is accurate and complete. A main task is ensuring the accuracy and completeness of an individual’s medical information, as this is critical for the insurer’s underwriting decision. Field underwriters do not approve policies or edit reports to guarantee approval; they facilitate the process by providing reliable data.

Option A: Incorrect. Editing reports to ensure approval is unethical and not a field underwriter’s role.

Option B: Incorrect. Approving policies is the role of the insurer’s underwriting department, not the field underwriter.

Option C: Correct. Ensuring accuracy and completeness of medical information is a key task of a field underwriter.

Option D: Incorrect. Obtaining an MIB report is typically done by the insurer, not the field underwriter.

This question aligns with the Prometric content outline under “Underwriting,” which covers the role of field underwriters.

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.

A life insurance policyowner has several rights, including assigning or transferring the policy (e.g., through absolute or collateral assignment), borrowing against the cash value (in policies with cash value), and selecting or changing the beneficiary, as outlined in Oklahoma’s Insurance Code (Title 36 O.S. § 4001 et seq.). However, anabsolute assignmenttransfers all ownership rights to the assignee, and the original policyowner cannot unilaterally revoke it without the assignee’s consent, as it is a complete transfer of ownership.

Option A: Incorrect (is a right). The policyowner can assign or transfer the policy to another party.

Option B: Incorrect (is a right). The policyowner can borrow against the cash value in policies like whole life or universal life.

Option C: Incorrect (is a right). The policyowner can select and change the beneficiary unless restricted (e.g., irrevocable beneficiary).

Option D: Correct (is not a right). An absolute assignment cannot be revoked by the original policyowner without the assignee’s agreement.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers policyowner rights and assignments.

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.

Apreexisting conditionis defined in health insurance as a medical condition for which advice, diagnosis, care, or treatment was recommended or received within a specified period (commonly 6 months) before the effective date of coverage. In Oklahoma, group health insurance policies often include provisions limiting or excluding coverage for preexisting conditions for a certain period, as regulated by federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA).

Option A: Incorrect. An elimination period is the waiting period before benefits begin, typically in disability or long-term care policies, not related to preexisting conditions.

Option B: Incorrect. An affiliation period is a waiting period for late enrollees in HMOs under HIPAA, not tied to medical conditions.

Option C: Incorrect. A diagnosed condition is not a standard insurance term; it does not specifically denote the timeframe of prior treatment like a preexisting condition.

Option D: Correct. A preexisting condition matches the definition provided, as per Oklahoma and federal regulations.

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

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.

Thecoordination of benefits (COB)provision, as regulated in Oklahoma (O.A.C. 365:10-5-4), prevents overinsurance when an individual is covered by multiple health plans. For spouses, theprimary insureris typically the wife’s employer plan for her claims, as it covers her as an employee. Thesecondary insurer(the husband’s plan) pays any remaining covered expenses up to its policy limits, ensuring the total payment does not exceed the loss.

Option A: Incorrect. Both insurers may pay under COB, not just the wife’s insurer.

Option B: Incorrect. The secondary insurer may also pay if the primary does not cover the full loss.

Option C: Correct. The primary insurer (wife’s plan) pays first, and the secondary insurer (husband’s plan) pays the remainder, per COB rules.

Option D: Incorrect. The husband’s insurer is secondary, not primary, for the wife’s claim.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers coordination of benefits.

Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) and does not accumulate cash value, unlikepermanent life insurance(e.g., whole life), which provides lifelong coverage with cash value. Term policies may be renewable, but this is not automatic unless specified, and premium payment periods are shorter than permanent policies (Title 36 O.S. § 4002).

Option A: Incorrect. Term life accumulates no cash value, not a smaller amount.

Option B: Incorrect. Term life has a shorter premium payment period than permanent life.

Option C: Correct. Term life remains in force for a specific period, unlike lifelong permanent coverage.

Option D: Incorrect. Renewal is not automatic; it depends on the policy’s terms.

Oklahoma insurance law requires licensed insurance producers to maintain records of insurance transactions for a minimum of5 years, as specified in Title 36 O.S. § 1435.13. This ensures compliance with regulatory oversight and allows for audits or investigations by the Oklahoma Insurance Department.

Option A: Incorrect. 3 years is insufficient per Oklahoma law.

Option B: Correct. Licensees must keep records for 5 years.

Option C: Incorrect. 7 years exceeds the requirement.

Option D: Incorrect. 10 years is not mandated by Oklahoma insurance regulations.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which includes recordkeeping requirements.

Life insurance underwriting assesses risk based on factors likeage(affects mortality risk),family history(indicates hereditary conditions), andtobacco use(increases health risks), as outlined in Oklahoma’s underwriting practices (Title 36 O.S. § 1204).Marital statusis not a key factor, as it has minimal impact on mortality risk, though it may be noted for beneficiary or financial planning purposes.

Option A: Incorrect. Age is a key underwriting factor.

Option B: Incorrect. Family history is a key underwriting factor.

Option C: Incorrect. Tobacco use is a key underwriting factor.

Option D: Correct. Marital status is not a key underwriting factor.

Thechange of beneficiary provisionallows the policyowner (often the insured) to change the beneficiary at any time unless the beneficiary is designated asirrevocable. An irrevocable beneficiary cannot be changed without their consent, as specified in Oklahoma’s life insurance regulations (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. Insurability of the beneficiary does not affect the right to change them.

Option B: Correct. An irrevocable beneficiary cannot be changed without their consent.

Option C: Incorrect. Power of attorney affects legal authority, not beneficiary changes.

Option D: Incorrect. A deceased beneficiary can be replaced without restriction.

Ajoint life policy(also called a first-to-die policy) covers two or more individuals (e.g., spouses) and pays the death benefit upon the death of the first insured. This contrasts with asurvivorship life policy(second-to-die), which pays after both insureds die. Joint life policies are used for purposes like mortgage protection or family income needs (Title 36 O.S. § 4002).

Option A: Correct. A joint life policy pays benefits at the first spouse’s death.

Option B: Incorrect. A variable life policy is a permanent policy with investment options, not tied to joint coverage.

Option C: Incorrect. A universal life policy is flexible permanent insurance, not specifically joint.

Option D: Incorrect. A survivorship life policy pays after both spouses die.

In Oklahoma’s Insurance Code (Title 36 O.S. § 105), aforeign insureris defined as an insurance company formed under the laws of another U.S. state or territory. This distinguishes it from adomestic insurer(formed in Oklahoma) and analien insurer(formed in a foreign country).

Option A: Incorrect. An insurer formed in Oklahoma is a domestic insurer.

Option B: Incorrect. An insurer from a foreign country is an alien insurer.

Option C: Correct. A foreign insurer is formed under the laws of another U.S. state or government.

Option D: Incorrect. Geographic proximity is irrelevant; the definition is based on legal formation.

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

Long-Term Care (LTC) insuranceis designed to cover services for individuals with chronic diseases or disabilities who need assistance with activities of daily living (ADLs) or have cognitive impairments. It often includes coverage for nursing home care, home-based care, assisted living, and respite care, as regulated in Oklahoma under Title 36 O.S. § 4426.1.

Option A: Incorrect. Medicare provides limited coverage for skilled nursing or home health care but not comprehensive LTC services.

Option B: Incorrect. Medicaid covers LTC for low-income individuals but is a government program, not a private insurance policy.

Option C: Correct. LTC insurance covers nursing home, home-based, and respite care for chronic conditions.

Option D: Incorrect. Group health insurance covers medical expenses but typically does not include LTC services.

This question falls under the Prometric content outline section on “Long-Term Care (LTC) Policies,” which covers LTC coverage and services.

Whole life insurance policies accumulate cash value over time, which policyowners can borrow against. Typically, cash value begins to accrue immediately, but sufficient value for a loan is often available after1 year, depending on the policy’s terms and premium payments. Oklahoma law (Title 36 O.S. § 4029) requires nonforfeiture benefits, including access to cash value, but does not specify a minimum time; insurer practices generally allow loans after 1 year when cash value is meaningful.

Option A: Incorrect. Policyowners can borrow against cash value once it accumulates.

Option B: Correct. Loans are typically available after 1 year, as cash value is sufficient.

Option C: Incorrect. 2 years is not a standard requirement; loans are often available sooner.

Option D: Incorrect. 3 years is excessive; most policies allow loans earlier.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers cash value loans.

In insurance underwriting, individuals are classified based on their risk profile. Asubstandard riskis an applicant who, due to health issues, hazardous habits (e.g., smoking), or high-risk occupations (e.g., stunt performer), cannot be insured at standard rates. These individuals may be offered coverage at higher premiums or with exclusions, as outlined in standard underwriting practices and Oklahoma’s regulations (Title 36 O.S. § 1204).

Option A: Incorrect. “Rating risk” is not a standard underwriting term.

Option B: Incorrect. A standard risk qualifies for standard rates with average risk.

Option C: Incorrect. A preferred risk qualifies for lower-than-standard rates due to low risk.

Option D: Correct. A substandard risk is not acceptable at standard rates due to higher risk factors.

This question aligns with the Prometric content outline under “Underwriting,” which covers risk classification.