Ch. 20 - Oklahoma Laws & Rules (Part 2)

All of the following are covered under most dental plans EXCEPT for

a. x-rays
b. tooth extraction
c. cleanings
d. mouth cancer

Blank is the authority given to a producer to sell, solicit, or negotiate policies on behalf of the insurer.

a. admission
b. appointment
c. adjustment
d. authorization

Producers must complete a total of           Continuing Education credits for each two-year licensing period.

a. 12
b. 24
c. 36
d. 48

Which of the following Long-term care benefits would NOT encourage home health care?

a. respite care
b. custodial facility care
c. home health care
d. adult day care

Proceeds payable under a life insurance contract to a policyowner in anticipation of death are called

a. expedited benefits
b. anticipated benefits
c. accelerated benefits
d. cost of living benefits

A domestic insurance company in Oklahoma MUST

a. be formed under Oklahoma insurance laws
b. own real estate in Oklahoma
c. write insurance on risks located only in Oklahoma
d. honor the charter of the National Association of Insurance Commissioners (NAIC)

An insurance producer is BEST defined as

a. a person appointed by more than one insurance company to issue policies
b. a person who has a contract with an insurance company to represent it
c. a person who places insurance with nonadmitted companies
d. an employee of an insurance company who has the authority to underwrite insurance

Jerry is a resident producer who has moved to another city in Oklahoma. How long does he have to notify the Insurance Commissioner of the change of address?

a. 10 days
b. 20 days
c. 30 days
d. 60 days

The Fair Credit Reporting Act protects consumers

a. from insolvent insurers
b. by recommending insurers with good AM Best ratings
c. with guidelines regarding credit reporting and distribution
d. by providing consumer credit counseling

A small employer in Oklahoma may NOT consist of more than           eligible employees.

a. 15
b. 25
c. 50
d. 75

The dental specialty which deals with the replacement of missing teeth is called

a. periodontics
b. otology
c. pediatrics 
d. prosthodontics

An example of endodontic treatment is a 

a. bridge
b. crown
c. filling
d. root canal

Which of these situations would NOT potentially involve a prison sentence under Federal law?

a. selling insurance with a nonresident license
b. misappropriating insurance premiums
c. embezzlement of an insurer's funds
d. sending threatening letters to an insurer

According to the Federal Fraud and False Statements Act, which of these is considered to be an intentional violation?

a. writing controlled business
b. making false entries in a company's books
c. transacting insurance outside a licensee's home state
d. sharing commissions with a licensed agent

Who is required to notify the producer in the event of appointment termination?

a. insurer
b. commissioner
c. governor
d. attorney general

A life insurance illustration showing future premiums being paid out of non-guaranteed values must disclose that

a. these policy premiums will vanish
b. the policy guarantees payment of these premiums
c. the policyowner forfeits the option of paying these premiums from other
d. the policyowner may need to resume premium payments depending on actual results

Under Federal Law, which of the following actions may result in a producer becoming imprisoned?

a. producer writing controlled business
b. producer embezzling funds from an insurer
c. producer selling insurance with a nonresident license
d. producer replacing an existing insurance policy with a new one

The Oklahoma Life and Health Insurance Guaranty Association

a. protects insured from insolvent insurers
b. pays premiums for insolvent insureds
c. provides coverage for uninsured residents
d. guarantees policy loans

Health providers are compensated by a preferred provider organization (PPO) for normal dental procedures by what means?

a. usual and customary fee schedules
b. increased fee schedules
c. decreased fee schedules
d. indemnity fee schedules

The maximum prison sentence given under federal law for unfair and deceptive insurance practices is 

a. 15 years
b. 10 years
c. 5 years
d. 1 year

An insurer may pay a commission in which of the following scenarios?

a. to an applicant as an incentive to purchase an insurance policy
b. to an unlicensed person who has sold, solicited, or negotiated a policy of insurance on behalf of the insurer
c. to a licensed producer who is appointed with the insurer
d. to a licensed non-appointed producer who has sold, solicited, or negotiated a policy of insurance on behalf of the insurer

Which of the following is considered to be a prosthodontic dental procedure?

a. filling
b. root canal
c. bridgework
d. teeth cleaning

John has a criminal record in which he was convicted of a felony that involved dishonesty. Under Federal law, how would John be able to engage in insurance transactions?

a. completing a court-ordered prison sentence
b. completing a court-ordered probation period
c. paying a fine of up to $50,000
d. given written consent by the state insurance regulatory agency

An alien insurer 

a. must be organized under Oklahoma insurance laws
b. is an insurer operating in the U.S. but headquartered outside the U.S.
c. writes insurance on risks located only outside of Oklahoma
d. is a company that was formed under the laws of another state

Failing to promptly provide a reasonable explanation for the denial of a claim is considered to be a(n)

a. fiduciary act
b. unfair claims settlement practice
c. fraudulent act
d. claim liability

Under the Unfair Claim Settlement Practices, an insurer may recoup overpaid claims within             months after payment was made.

a. 3
b. 6
c. 12
d. 24

Insurance producer Karey offers clients a $250 shopping card if they purchase an insurance product through her. What is this an example of?

a. defamation
b. coercion
c. rebating
d. intimidation

What is considered interstate travel under the Federal Fraud and False Statements Act?

a. Canada
b. Jamaica
c. Mexico
d. Puerto Rico

All of these are used to prevent adverse selection in a group dental plan EXCEPT

a. provide evidence of insurability
b. probationary periods
c. waiting periods
d. decreased employee participation

In most dental plans, a deductible typically is NOT applied to

a. preventative and diagnostic services
b. restorative dentistry
c. orthodontics
d. tooth extractions

A producer's license has been suspended due to non-renewal. The license may be reinstated within the         month period following the date when the license should have been renewed.

a. 3
b. 6
c. 12
d. 18

A deliberate lie by an insured to the insurer to obtain a lower premium is an example of

a. concealment
b. misrepresentation
c. fraud
d. estoppel

Commissions may ONLY be paid to

a. nonresident producers
b. licensed producers not yet appointed
c. licensed and duty appointed producers
d. nonlicensed employees

Upon reaching age          , Medicare supplement coverage is offered on a guaranteed-issue basis during the open enrollment period.

a. 55
b. 62
c. 65
d. 70

Which of the following unfair trade practices involves a producer who makes public malicious statements about an insurer's financial condition?

a. boycotting
b. defamation
c. unfair discrimination
d. misrepresentation

Replacement regulation is designed to protect

a. beneficiaries
b. policyowners from misrepresentations and loss of benefits
c. existing producers
d. insurance companies

A license is NOT required when you are

a. providing referrals
b. selling insurance
c. negotiating insurance
d. soliciting insurance

Joe is a military retiree after having served 20 years of active duty. Upon retiring, he requests reinstatement of his lapsed individual health policy and is denied. Which of the following is correct?

a. reinstatement can be denied only if a government plan finds health issues unrelated to his military service
b. Joe cannot be denied reinstatement to his original individual health plan
c. reinstatement can be denied upon finding negative underwriting results
d. reinstatement applies, but only for lesser coverage and higher cost

Which of these is typically regarded as a major treatment in an indemnity dental plan?

a. fluoride treatment
b. x-rays
c. restorative fillings
d. dentures

How would preventative care be encouraged in a dental plan?

a. deductibles
b. exclude pre-existing conditions
c. closed dentist panels
d. no deductible on routine examinations

All individual and group health insurance policies that provide coverage for a newborn child require that the insurer be notified of a child's birth. Any additional premium due must then be paid within           days of the child's birth.

a. 30
b. 31
c. 45
d. 60

ABC Insurance Agency is entering each applicant who purchases insurance through their agency into a drawing to win a free trip. This is an unlawful practice known as

a. illegal inducement
b. false advertising
c. concealment
d. fraud

A foreign insurance company doing business in Oklahoma

a. is a company domiciled under the laws of another state
b. is not subject to Oklahoma insurance laws
c. is a company that was formed under the laws of another country
d. is only authorized to write business outside the United States

Which of the following statements regarding the Fair Credit Reporting Act is TRUE? 

a. An insurer does NOT need to notify the applicant if an application is denied
b. An insurer does NOT need to discuss any credit history inconsistencies with the applicant
c. An insurer does NOT need to inform the applicant about the scope of an investigation
d. An insurer does NOT need to inform the applicant that an investigation is being conducted

Which of these is NOT considered a preventative service in a dental plan?

a. fluoride treatment
b. oral examination
c. teeth cleaning
d. fillings