Ok-Life-Accident-and-Health-or-Sickness-Producer Exam Dumps - Insurance Licensing Life, Accident, and Health Questions and Answers

Under Title 36 O.S. § 1435.13, the Oklahoma Insurance Commissioner may take disciplinary action against a licensee for causes such as fraud, providing false information on a license application, or failing to comply with state laws, including tax obligations. However, a misdemeanor conviction does not automatically warrant license action unless it involves a crime of moral turpitude (e.g., fraud, theft) or is directly related to insurance activities.

Option A: Incorrect (is a cause). Admitting to fraud is grounds for license suspension or revocation.

Option B: Incorrect (is a cause). Providing misleading or untrue information on a license application is a violation.

Option C: Correct (is the exception). A misdemeanor conviction alone, without specific relevance to insurance or moral turpitude, is not typically grounds for license action.

Option D: Incorrect (is a cause). Failing to pay state taxes can lead to disciplinary action as a violation of state law.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers licensing disciplinary actions.

Medical expense plans often include exclusions for high-risk activities or situations not typically covered under standard health insurance. A common exclusion is injuries or losses resulting fromair travel in a private plane, as this is considered a hazardous activity. Other options, like auto accidents or recreational sports, are generally covered unless specifically excluded, and home repairs are not standard exclusions.

Option A: Correct. Air travel in a private plane is a common exclusion due to its high-risk nature.

Option B: Incorrect. Auto accident injuries are typically covered, often coordinated with auto insurance.

Option C: Incorrect. Recreational sports injuries are usually covered unless the policy specifies otherwise.

Option D: Incorrect. Injuries from home repairs are not commonly excluded in medical expense plans.

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

Ordinary life insurance, often synonymous with whole life insurance, is a type of permanent life insurance that provides coverage for the insured’s entire life, as long as premiums are paid. It typically includes a level premium, a guaranteed death benefit, and a cash value component that grows over time. It is designed to offer permanent protection with some flexibility, such as the ability to borrow against the cash value or adjust premiums in certain policies (e.g., universal life).

Option A: Incorrect. This describes term life insurance, which provides temporary protection during income-earning years. Ordinary life insurance is permanent, and cash values are not specifically “payable” during non-earning periods but can be accessed.

Option B: Incorrect. Ordinary life is not an endowment policy (which matures at a specific age) or tied directly to income levels. It is a whole life policy with level premiums.

Option C: Correct. Ordinary life insurance provides permanent protection and some flexibility (e.g., cash value loans, dividend options in participating policies) with premiums that are generally lower than other permanent products like limited-pay whole life.

Option D: Incorrect. Ordinary life is not temporary; it provides lifelong coverage. While it accumulates cash value, the protection is permanent, not limited to the policyowner’s life expectancy.

This question is part of the Prometric content outline under “Life Products,” focusing on the characteristics of ordinary (whole) life insurance.

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.

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.

Oklahoma law (Title 36 O.S. § 6060.9), aligned with the federal Newborns’ and Mothers’ Health Protection Act (NMHPA), requires health benefit plans providing maternity coverage to offer postpartum home care for mothers and newborns if childbirth occurs at home and the mother is discharged within48 hoursfor a vaginal delivery (or 96 hours for a cesarean section).

Option A: Incorrect. 24 hours is too short for required postpartum home care.

Option B: Correct. Postpartum home care is required if discharged within 48 hours for vaginal delivery.

Option C: Incorrect. 72 hours is not the standard timeframe.

Option D: Incorrect. 96 hours applies to cesarean deliveries, not vaginal.

For individuals aged 65 or older who are still working and covered by an employer’s group health plan, Medicare’s role depends on the employer’s size. For employers with fewer than 20 employees (as in this case with 18 employees), Medicare is typically theprimary payer, and the group health plan is secondary. However, if the individual is actively working and enrolled in the group plan, the group plan is primary, and Medicare acts as thesecondary payer, covering claims not fully paid by the group plan, as per Medicare Secondary Payer (MSP) rules.

Option A: Incorrect. The group health plan is primary for active employees, not Medicare.

Option B: Correct. Medicare acts as the secondary insurer, paying claims not fully covered by the group plan.

Option C: Incorrect. Medicare does cover claims as a secondary payer, not denying them to prevent overinsurance.

Option D: Incorrect. Medicare does not require cancellation of group insurance; individuals can maintain both.

This question aligns with the Prometric content outline under “Medicare,” which covers Medicare’s coordination with group health plans.

The elimination period in an individual disability insurance policy is the waiting period between the onset of a disability and the time when benefit payments begin. It is essentially a deductible in time, during which the insured must be disabled before receiving benefits. This period can range from 30 days to several months, depending on the policy, and is designed to reduce premiums by excluding short-term disabilities.

Option A: Incorrect. The length of time benefits are paid is determined by the benefit period, not the elimination period.

Option B: Correct. The elimination period is the amount of time the insured must wait after becoming disabled before benefits are paid.

Option C: Incorrect. The point when benefits are exhausted is related to the benefit period or policy limits, not the elimination period.

Option D: Incorrect. The elimination period does not apply after the policy is discontinued; it applies at the start of a disability claim.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which includes knowledge of disability insurance provisions.

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.

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.