California Life, Accident, and Health Licensing Questions and Answers Already Passed

California Life, Accident, and Health Licensing Questions and Answers Already Passed Co-insurance The policy provision which requires the insurer and the insured to share in the cost of services rendered Exclusion ratio The formula which is used by the IRS to determine how much is taxable to an annuitant during the pay out period. Occupational policy When a disability income policy provides coverage for injuries which occur on and off the job Most disability income policies are non occupational, meaning They only cover the insured if they become disabled while away from work. Self employed individuals doesn't have workers compensation coverage. They need coverage both on and off the job (occupational). A life agent who offers for sale or sells any financial product on the basis of its treatment under the MediCal Program must provide The Notice Regarding Standards for Medi-Cal Eligibility. Must be signed by applicant. A widow or widower without any children is eligible for social security survivors benefits at age 60 A surviving spouse is eligible for social security survivor's benefits at age 60 An authorized, or admitted carrier (insurer) one which is under compliance with the California Insurance Code (CIC) and can operate legally in California Which type of life insurance utilizes the "level premium concept" Traditional whole life Disability income policy proceeds must be paid out at least monthly What life insurance rider will pay a monthly benefit to the insured when they become disabled The disability income rider. It is a type of health (disability) insurance Dread (Specified) Disease policies, such as cancer insurance, covers Treatment for one specific disease The benefit paid out for a residual disability in a disability income policy is based upon a loss of a minimum of 20% of income Agent may be either Captive (Exclusive) or independent Captive agents agents who agree by contract to represent only one insurer in the sale of insurance Independent agents usually self-employed and often represent several insurance companies Under state law, agents must have at least one appointment in order to keep their license active Agents are prohibited from engaging in any of the following activities 1. using a business name that implies that they are an insurer 2. advertising on behalf of a non-admitted insurer 3. offering free insurance as an inducement to purchase or sale Under a group insurance plan a certificate of insurance is issued to the participants, usually employees. The policy owner, usually employer, gets the master policy Domestic insurer one that domiciled (organized) in this state Foreign insurer one that organized in another state Alien insurer one that organized in another country. All insurers need to obtain a Certificate of Authority from the Commissioner in order to be admitted to transact insurance in this state, except for Surplus Line insurers Indemnity plans allow the insured to select any provider they wish. Traditional indemnity plan the insured generally is supposed to submit their claims directly to an insurer, in reality an "assignment of benefits" form is utilized and the medical care provider submits the claim on the insured's behalf Participants in a managed care indemnity plan select a provider and submits claims to the insurer When an insurer wants to have the applicant complete an HIV test, they must do 1) Have the applicant sign a consent form 2) Find out which doctor they should provide the results to 3) Provide information on where they can receive counseling When an insurer wants to have the applicant complete an HIV test, they do not need to go over a privacy notice 75% of all eligible employees must enroll in a contributory plan. All eligible employees are required to enroll in a non contributory plan Loss exposure a situation which presents the possibility of loss