OpenExamsFREE PRACTICE — ANY EXAM

Accident & Health or Sickness Producer — Information & Free Practice

US-CT · Examination information

166 free questions · Answer explanations · No signup required

Start free practice →

Accident & Health or Sickness Producer

Provider
Pearson VUE
Format
One-part multiple-choice examination scored as a whole
Time limit
2 hours
Passing score
70%
Exam fee
$65
Examination outline
  • I. TYPES OF POLICIES 16
    • A. Disability income
    • A. Disability income / 1. Individual disability income policy
    • A. Disability income / 2. Business overhead expense policy
    • A. Disability income / 3. Business disability buyout policy
    • A. Disability income / 4. Group disability income policy
    • A. Disability income / 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance / 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance / 2. Major medical policies
    • C. Medical expense insurance / 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance / 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance / 5. Point of Service (POS) plans
    • C. Medical expense insurance / 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance / 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance / 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance / 1. Differences between individual and group contracts
    • E. Group insurance / 2. General characteristics
    • E. Group insurance / 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) / 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) / 2. Levels of care
    • G. Other policies
    • G. Other policies / 1. Dental
    • G. Other policies / 2. Vision
    • G. Other policies / 3. Cancer
    • G. Other policies / 4. Critical illness or specified disease
    • G. Other policies / 5. Worksite (employer-sponsored)
    • G. Other policies / 6. Hospital indemnity
    • G. Other policies / 7. Short-term medical
    • G. Other policies / 8. Accident
  • II. POLICY PROVISIONS, CLAUSES, AND RIDERS 15
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions / 1. Entire contract
    • A. Mandatory and optional provisions / 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions / 3. Grace period
    • A. Mandatory and optional provisions / 4. Reinstatement
    • A. Mandatory and optional provisions / 5. Notice of claim
    • A. Mandatory and optional provisions / 6. Claim forms
    • A. Mandatory and optional provisions / 7. Proof of loss
    • A. Mandatory and optional provisions / 8. Time of payment of claims
    • A. Mandatory and optional provisions / 9. Payment of claims
    • A. Mandatory and optional provisions / 10. Physical examination and autopsy
    • A. Mandatory and optional provisions / 11. Legal actions
    • A. Mandatory and optional provisions / 12. Change of beneficiary
    • A. Mandatory and optional provisions / 13. Misstatement of age or gender
    • A. Mandatory and optional provisions / 14. Change of occupation
    • A. Mandatory and optional provisions / 15. Illegal occupation
    • A. Mandatory and optional provisions / 16. Relation of earnings to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses / 1. Insuring clause
    • B. Other provisions and clauses / 2. Free look
    • B. Other provisions and clauses / 3. Consideration clause
    • B. Other provisions and clauses / 4. Probationary period
    • B. Other provisions and clauses / 5. Elimination period
    • B. Other provisions and clauses / 6. Waiver of premium
    • B. Other provisions and clauses / 7. Exclusions and limitations
    • B. Other provisions and clauses / 8. Preexisting conditions
    • B. Other provisions and clauses / 9. Coinsurance
    • B. Other provisions and clauses / 10. Deductibles
    • B. Other provisions and clauses / 11. Eligible expenses
    • B. Other provisions and clauses / 12. Copayments
    • B. Other provisions and clauses / 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses / 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses / 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders / 1. Impairment/exclusions
    • C. Riders / 2. Guaranteed insurability
    • C. Riders / 3. Future increase option
    • D. Rights of renewability
    • D. Rights of renewability / 1. Noncancelable
    • D. Rights of renewability / 2. Cancelable
    • D. Rights of renewability / 3. Guaranteed renewable
  • III. SOCIAL INSURANCE 6
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • IV. OTHER INSURANCE CONCEPTS 5
    • A. Total, partial, recurrent, and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • K. Subrogation
  • V. FIELD UNDERWRITING PROCEDURES 8
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law / 1. Elements of a contract
    • H. Contract law / 2. Insurable interest
    • H. Contract law / 3. Warranties and representations
    • H. Contract law / 4. Unique aspects of the insurance contract
    • H. Contract law / 4. Unique aspects of the insurance contract / a. Conditional
    • H. Contract law / 4. Unique aspects of the insurance contract / b. Unilateral
    • H. Contract law / 4. Unique aspects of the insurance contract / c. Adhesion
    • H. Contract law / 4. Unique aspects of the insurance contract / d. Aleatory
  • I. CT STATUTES, RULES, AND REGULATIONS COMMON TO LIFE, ACCIDENT AND HEALTH, PROPERTY, AND CASUALTY INSURANCE 18
    • A. Responsibilities of the Insurance Commissioner
    • A. Responsibilities of the Insurance Commissioner / 1. General duties and powers
    • A. Responsibilities of the Insurance Commissioner / 2. Examination of records
    • A. Responsibilities of the Insurance Commissioner / 3. Hearings/notice of hearings
    • A. Responsibilities of the Insurance Commissioner / 4. Penalties and fines
    • A. Responsibilities of the Insurance Commissioner / 5. Cease and desist orders
    • B. Definitions
    • B. Definitions / 1. Insurance transaction
    • B. Definitions / 2. Insurer
    • B. Definitions / 3. Reinsurance
    • B. Definitions / 4. Domestic, foreign, and alien companies
    • B. Definitions / 5. Fraternal benefit society
    • B. Definitions / 6. Authorized and unauthorized companies / admitted and nonadmitted companies
    • B. Definitions / 7. Stock and mutual companies, and reciprocals
    • B. Definitions / 8. Certificate of authority
    • C. Licensing
    • C. Licensing / 1. Purpose
    • C. Licensing / 2. Licensing Requirements
    • C. Licensing / 2. Licensing Requirements / a. Producer
    • C. Licensing / 2. Licensing Requirements / b. Agent
    • C. Licensing / 2. Licensing Requirements / c. Broker
    • C. Licensing / 2. Licensing Requirements / d. Resident/Nonresident
    • C. Licensing / 2. Licensing Requirements / e. Temporary license
    • C. Licensing / 3. Agent appointment/termination of contract
    • C. Licensing / 4. Obtaining a license
    • C. Licensing / 4. Obtaining a license / a. Qualifications
    • C. Licensing / 4. Obtaining a license / b. Licenses fees and application
    • C. Licensing / 4. Obtaining a license / c. Written examinations
    • C. Licensing / 4. Obtaining a license / d. Exemptions/exceptions
    • C. Licensing / 4. Obtaining a license / e. License denial
    • C. Licensing / 5. Maintaining a license
    • C. Licensing / 5. Maintaining a license / a. Continuing education
    • C. Licensing / 5. Maintaining a license / b. Change of address/name change
    • C. Licensing / 5. Maintaining a license / c. Fees/renewal
    • C. Licensing / 5. Maintaining a license / d. License expiration
    • C. Licensing / 5. Maintaining a license / e. Suspension or revocation of licenses
    • D. Agent responsibilities
    • D. Agent responsibilities / 1. Fiduciary capacity
    • D. Agent responsibilities / 1. Fiduciary capacity / a. Premium accountability
    • D. Agent responsibilities / 2. Disclosure
    • D. Agent responsibilities / 3. Commissions and compensation/ charges for extra services
    • E. Filing and approval of policy forms
    • F. Connecticut Insurance Guaranty Association Act
    • F. Connecticut Insurance Guaranty Association Act / 1. Brokered Transactions Guaranty Fund
    • G. Marketing practices
    • G. Marketing practices / 1. Responsibilities of the insurer
    • G. Marketing practices / 2. Unfair claims practices
    • G. Marketing practices / 3. Unfair trade practices
    • G. Marketing practices / 3. Unfair trade practices / a. Rebating
    • G. Marketing practices / 3. Unfair trade practices / b. Misrepresentation
    • G. Marketing practices / 3. Unfair trade practices / c. False advertising
    • G. Marketing practices / 3. Unfair trade practices / d. Defamation
    • G. Marketing practices / 3. Unfair trade practices / e. False financial statements
    • G. Marketing practices / 3. Unfair trade practices / f. Controlled business
    • G. Marketing practices / 3. Unfair trade practices / g. Boycott, coercion, intimidation
    • G. Marketing practices / 3. Unfair trade practices / h. Unfair discrimination
    • G. Marketing practices / 3. Unfair trade practices / i. Coercion of borrower
    • G. Marketing practices / 3. Unfair trade practices / j. Illegal inducement
    • G. Marketing practices / 3. Unfair trade practices / k. Misrepresentation on applications
    • G. Marketing practices / 3. Unfair trade practices / l. Twisting
    • G. Marketing practices / 4. Return of premium
    • H. Connecticut Insurance Information and Privacy Protection Act
  • II. STATE STATUTES, RULES, AND REGULATIONS PERTINENT TO ACCIDENT AND HEALTH INSURANCE ONLY 7
    • A. Policy clauses and Provisions
    • A. Policy clauses and Provisions / 1. Minimum Standards
    • A. Policy clauses and Provisions / 1. Minimum Standards / a. Purpose
    • A. Policy clauses and Provisions / 1. Minimum Standards / b. Definition
    • A. Policy clauses and Provisions / 1. Minimum Standards / c. Prohibited provisions
    • A. Policy clauses and Provisions / 1. Minimum Standards / d. Preexisting conditions
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / a. Newborns
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / b. Handicapped dependents
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / c. Mental Health and Nervous Disorder Coverages
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / d. Substance Abuse Treatment
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / e. Dependent children
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / f. Maternity benefits for dependent children
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / g. Infertility coverage
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / h. Right to return
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / i. Right of insurer to contest
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / j. Grace period
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / k. Coordination of benefits
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / l. Continuation/Conversion in group policies
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / m.Chiropractic
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / n. Adopted and prospective adopted children
    • A. Policy clauses and Provisions / 2. Required and Optional Coverages / o. Mammograms
    • A. Policy clauses and Provisions / 3. Benefit Standards
    • B. Disability
    • B. Disability / 1. Connecticut minimum benefit standards for disability income
    • C. Agent Disclosure
    • D. Carrier Disclosure
    • D. Carrier Disclosure / 1. Outline of Coverage
    • D. Carrier Disclosure / 2. Renewal Agreements/Nonrenewal and Cancellation
    • D. Carrier Disclosure / 3. Advertising
    • D. Carrier Disclosure / 4. Suitability
    • D. Carrier Disclosure / 5. Policy Replacement
    • D. Carrier Disclosure / 6. Evidence of Coverage
    • D. Carrier Disclosure / 7. Group Health
    • D. Carrier Disclosure / 7. Group Health / a. Required Provisions
    • D. Carrier Disclosure / 8. Unfair Practices
    • D. Carrier Disclosure / 8. Unfair Practices / a. Prohibited use of genetic information
    • D. Carrier Disclosure / 8. Unfair Practices / b. Unfair discrimination
    • D. Carrier Disclosure / 9. Application Responsibilities
    • D. Carrier Disclosure / 10. Limited Benefit Disclosure
    • E. Connecticut children's health insurance plan (HUSKY)
    • F. Medicare Supplement Insurance
    • F. Medicare Supplement Insurance / 1. Definitions
    • F. Medicare Supplement Insurance / 2. Minimum Standards
    • F. Medicare Supplement Insurance / 3. Application Responsibilities
    • F. Medicare Supplement Insurance / 4. Outline of Coverage/Disclosure Requirements
    • F. Medicare Supplement Insurance / 5. Buyers Guide
    • F. Medicare Supplement Insurance / 6. Pre-existing Conditions
    • F. Medicare Supplement Insurance / 7. Right to Return
    • F. Medicare Supplement Insurance / 8. Replacement/Replacement Forms
    • F. Medicare Supplement Insurance / 9. Duplication of Benefits
    • F. Medicare Supplement Insurance / 10.Part A Deductibles and Coinsurance
    • F. Medicare Supplement Insurance / 11.Regulations
    • F. Medicare Supplement Insurance / 12.Medicaid--relationship to Supplements and Long- Term Care
    • F. Medicare Supplement Insurance / 13.Open enrollment
    • F. Medicare Supplement Insurance / 14.Advertising and marketing
    • G. Medicare Advantage
    • H. Long-term Care / Home Health Care Policies
    • H. Long-term Care / Home Health Care Policies / 1. Private Insurance
    • H. Long-term Care / Home Health Care Policies / 1. Private Insurance / a. Regulations
    • H. Long-term Care / Home Health Care Policies / 2. Required Provisions
    • H. Long-term Care / Home Health Care Policies / 2. Required Provisions / a. Mental/emotional disorders
    • H. Long-term Care / Home Health Care Policies / 2. Required Provisions / b. Levels of care
    • H. Long-term Care / Home Health Care Policies / 2. Required Provisions / c. Zero-day hospital
    • H. Long-term Care / Home Health Care Policies / 2. Required Provisions / d. Pre-existing conditions
    • H. Long-term Care / Home Health Care Policies / 3. Other Provisions
    • H. Long-term Care / Home Health Care Policies / 3. Other Provisions / a. Waiver of Premium
    • H. Long-term Care / Home Health Care Policies / 3. Other Provisions / b. Inflation Protection
    • H. Long-term Care / Home Health Care Policies / 3. Other Provisions / c. Spousal discount
    • H. Long-term Care / Home Health Care Policies / 4. Terminology
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / a. Skilled (primary) care
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / b. Home health care vs. home care
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / c. Community care
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / d. Alternate care
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / e. Case management
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / f. Activities of Daily Living (ADL’s) and cognitive impairment
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / g. Medically necessary or appropriate
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / h. Plan of care
    • H. Long-term Care / Home Health Care Policies / 4. Terminology / i. Adult day services
    • H. Long-term Care / Home Health Care Policies / 5. Disclosure
    • H. Long-term Care / Home Health Care Policies / 5. Disclosure / a. Outline of Coverage
    • H. Long-term Care / Home Health Care Policies / 5. Disclosure / b. Shopper’s Guide
    • H. Long-term Care / Home Health Care Policies / 6. Connecticut Partnership for Long Term Care
    • H. Long-term Care / Home Health Care Policies / 6. Connecticut Partnership for Long Term Care / a. Precertification of policies
    • H. Long-term Care / Home Health Care Policies / 6. Connecticut Partnership for Long Term Care / b. Training/Certification of producers
    • H. Long-term Care / Home Health Care Policies / 7. Elimination Period
    • H. Long-term Care / Home Health Care Policies / 8. Right to return policy
    • H. Long-term Care / Home Health Care Policies / 9. Marketing Methods and Practices
    • H. Long-term Care / Home Health Care Policies / 9. Marketing Methods and Practices / a. Solicitation
    • L. Requirements for small employers
    • L. Requirements for small employers / 1. Special Provisions
    • L. Requirements for small employers / 2. Disclosure requirements
    • L. Requirements for small employers / 3. Termination/Nonrenewal
    • L. Requirements for small employers / 4. Fair Marketing Standards
    • M. Requirements relating to HIV/AIDS
    • N. Connecticut Comprehensive Health Care Plan
    • O. Connecticut Comprehensive Health Care Plan
    • P. Affordable Care Act
    • P. Affordable Care Act / 1. Exchanges/Marketplace
    • P. Affordable Care Act / 2. Taxes, penalties, and subsidies
    • P. Affordable Care Act / 3. Essential health benefits
    • P. Affordable Care Act / 3. Essential health benefits / a. Mental health and substance use disorder parity
    • P. Affordable Care Act / 3. Essential health benefits / b. Pediatric services
    • P. Affordable Care Act / 3. Essential health benefits / c. Preventive services
    • P. Affordable Care Act / 4. Employer notification responsibilities
Examination sources