DE Accident and Health Producer — Information & Free Practice

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DE Accident and Health Producer

Provider: Pearson VUE
Format: Computer-delivered examination with general knowledge and state statutes and regulations portions
Exam questions: 92 scored questions: 50 general knowledge and 42 state-specific; handbook lists 10 general and 13 state pretest questions, while the general outline lists 5 general pretest questions
Time limit: 1 hour 15 minutes general knowledge; 1 hour state statutes and regulations
Passing score: Scaled score on a 0–100 scale; the handbook states that the required passing score is printed on the score report
Exam fee: $90 per examination

Examination outline

General knowledge: I. TYPES OF POLICIES
- 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
General knowledge: II. POLICY PROVISIONS, CLAUSES, AND RIDERS
- 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
General knowledge: III. SOCIAL INSURANCE
- A. Medicare (Parts A, B, C, D)
- B. Medicaid
- C. Social Security benefits
General knowledge: IV. OTHER INSURANCE CONCEPTS
- 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
- J. Workers Compensation / 1. Impact on health insurance benefits
- K. Subrogation
- L. Cost containment
General knowledge: V. FIELD UNDERWRITING PROCEDURES
- 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
State specific: I. DELAWARE STATUTES, REGULATIONS, AND BULLETINS PERTINENT TO LIFE, ACCIDENT AND HEALTH, PROPERTY AND CASUALTY INSURANCE
- A. LICENSE REGULATIONS
- A. LICENSE REGULATIONS / 1. Persons required to be licensed and responsibilities
- A. LICENSE REGULATIONS / 1. Persons required to be licensed and responsibilities / a. Producer/Agent
- A. LICENSE REGULATIONS / 1. Persons required to be licensed and responsibilities / b. Producer/Consultant
- A. LICENSE REGULATIONS / 2. License requirements
- A. LICENSE REGULATIONS / 2. License requirements / a. Fees and application
- A. LICENSE REGULATIONS / 2. License requirements / b. Prerequisites
- A. LICENSE REGULATIONS / 2. License requirements / c. Written examinations and exemptions
- A. LICENSE REGULATIONS / 2. License requirements / d. Exemptions from licensing
- A. LICENSE REGULATIONS / 2. License requirements / e. Insurer’s appointment
- A. LICENSE REGULATIONS / 3. Authority
- A. LICENSE REGULATIONS / 3. Authority / a. Definitions
- A. LICENSE REGULATIONS / 3. Authority / b. License requirements
- A. LICENSE REGULATIONS / 3. Authority / c. Lines of authority
- A. LICENSE REGULATIONS / 3. Authority / d. Termination of appointment
- A. LICENSE REGULATIONS / 4. Notice of address change
- A. LICENSE REGULATIONS / 5. Continuing education
- B. Marketing Practices
- B. Marketing Practices / 1. Duties of licensed personnel
- B. Marketing Practices / 2. Record keeping
- B. Marketing Practices / 3. Compensation of licensees
- B. Marketing Practices / 4. Termination, suspension, fines
- C. Insurance Commissioner
- C. Insurance Commissioner / 1. Election and term
- C. Insurance Commissioner / 2. General powers and duties
- C. Insurance Commissioner / 3. Examination of insurers and producers
- C. Insurance Commissioner / 4. Hearings
- C. Insurance Commissioner / 5. Cease and desist orders and penalties
- C. Insurance Commissioner / 6. General penalties
State specific: II. DELAWARE STATUTES, RULES, REGULATIONS, AND BULLETINS COMMON TO BOTH LIFE AND HEALTH INSURANCE
- A. Credit Life and Health
- B. Life and Health Guaranty Association Act
State specific: III. DELAWARE STATUTES, RULES, REGULATIONS, AND BULLETINS PERTINENT TO HEALTH INSURANCE ONLY
- A. Individual Health insurance required provisions
- B. Individual Health insurance optional provisions
- C. Individual accident and health minimum standards
- D. Group and blanket health insurance
- D. Group and blanket health insurance / 1. Definitions
- D. Group and blanket health insurance / 2. Required provisions
- D. Group and blanket health insurance / 3. Small employer health insurance
- D. Group and blanket health insurance / 4. Medicare Secondary Payor
- E. Long Term Care
- F. Medicare Supplement
- G. AIDS related testing
State specific: IV. INSURANCE ETHICS
- A. Definitions
- A. Definitions / 1. Market Conduct
- A. Definitions / 2. Authority
- A. Definitions / 2. Authority / a. Express
- A. Definitions / 2. Authority / b. Implied
- A. Definitions / 2. Authority / c. Apparent
- A. Definitions / 3. Agency versus individual licensee
- A. Definitions / 4. Suitability
- A. Definitions / 5. Ethical behavior and good moral standards
- B. Market Conduct examination
- C. Binding coverage
- D. Disclosure letters and forms
- E. Errors and Omissions insurance
- F. Unfair practices
- F. Unfair practices / 1. Twisting
- F. Unfair practices / 2. Churning
- F. Unfair practices / 3. Commingling
- F. Unfair practices / 4. Misrepresentation
- F. Unfair practices / 5. Defamation
- F. Unfair practices / 6. Coercion and intimidation
- F. Unfair practices / 7. Unfair discrimination
- F. Unfair practices / 8. Rebating
- F. Unfair practices / 9. Unfair claims settlement practices
- F. Unfair practices / 10. Coercion of debtors
- F. Unfair practices / 11. Publicized Founded Complaints
- G. Insurance fraud and Fraud Prevention Bureau
- H. Advertisement procedures
- I. Privacy
- J. Conflict of issues and producer’s responsibilities

Examination sources

Delaware Insurance Content Outlines
cover, Content outlines effective date
Delaware Insurance Candidate Handbook
page 12, Content Outlines
Delaware Insurance Content Outlines
S3, Accident & Health general knowledge title
Delaware Insurance Content Outlines
S3, Accident & Health general knowledge question count
Delaware Insurance Content Outlines
S4, Accident & Health state specific question count
Delaware Insurance Candidate Handbook
page 10, Score Reporting, both portions
Delaware Insurance Candidate Handbook
page 10, Score Explanation
Delaware Insurance Candidate Handbook
page 12, Exam Content, scored and pretest questions
Delaware Insurance Candidate Handbook
page 9, Exam Procedures, computer delivery
Delaware Insurance Candidate Handbook
page 14, Available Examinations, InsDE_Health02

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