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Producer - Accident and Health or Sickness — Information & Free Practice

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Producer - Accident and Health or Sickness

Provider
Pearson Professional Assessments
Format
Computer-based written examination at an authorized test center
Exam questions
General knowledge: 50 scored plus 5 pretest questions; Massachusetts specific: 30 scored plus 5 pretest questions
Passing score
70 on the equated scaled-score scale
Exam fee
$37
Examination outline
  • General Knowledge — I. Types of Policies
    • A. Disability income
    • A.1. Individual disability income policy
    • A.2. Business overhead expense policy
    • A.3. Business disability buyout policy
    • A.4. Group disability income policy
    • A.5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C.1. Basic hospital, medical, and surgical policies
    • C.2. Major medical policies
    • C.3. Health Maintenance Organizations (HMOs)
    • C.4. Preferred Provider Organizations (PPOs)
    • C.5. Point of Service (POS) plans
    • C.6. Flexible Spending Accounts (FSAs)
    • C.7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C.8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E.1. Differences between individual and group contracts
    • E.2. General characteristics
    • E.3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F.1. Eligibility
    • F.2. Levels of care
    • G. Other policies
    • G.1. Dental
    • G.2. Vision
    • G.3. Cancer
    • G.4. Critical illness or specified disease
    • G.5. Worksite (employer-sponsored)
    • G.6. Hospital indemnity
    • G.7. Short-term medical
    • G.8. Accident
  • General Knowledge — II. Policy Provisions, Clauses, and Riders
    • A. Mandatory and optional provisions
    • A.1. Entire contract
    • A.2. Time limit on certain defenses (incontestable)
    • A.3. Grace period
    • A.4. Reinstatement
    • A.5. Notice of claim
    • A.6. Claim forms
    • A.7. Proof of loss
    • A.8. Time of payment of claims
    • A.9. Payment of claims
    • A.10. Physical examination and autopsy
    • A.11. Legal actions
    • A.12. Change of beneficiary
    • A.13. Misstatement of age or gender
    • A.14. Change of occupation
    • A.15. Illegal occupation
    • A.16. Relation of earnings to insurance
    • B. Other provisions and clauses
    • B.1. Insuring clause
    • B.2. Free look
    • B.3. Consideration clause
    • B.4. Probationary period
    • B.5. Elimination period
    • B.6. Waiver of premium
    • B.7. Exclusions and limitations
    • B.8. Preexisting conditions
    • B.9. Coinsurance
    • B.10. Deductibles
    • B.11. Eligible expenses
    • B.12. Copayments
    • B.13. Pre-authorizations and prior approval requirements
    • B.14. Usual, reasonable, and customary (URC) charges
    • B.15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C.1. Impairment/exclusions
    • C.2. Guaranteed insurability
    • C.3. Future increase option
    • D. Rights of renewability
    • D.1. Noncancelable
    • D.2. Cancelable
    • D.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
    • K. Subrogation
  • 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.1. Elements of a contract
    • H.2. Insurable interest
    • H.3. Warranties and representations
    • H.4. Unique aspects of the insurance contract
    • H.4.a. Conditional
    • H.4.b. Unilateral
    • H.4.c. Adhesion
    • H.4.d. Aleatory
  • Massachusetts Specific — I. Massachusetts Laws and Rules Pertinent to All Lines of Insurance
    • A. Licensing
    • A.1. Process
    • A.2. Types of licenses
    • A.2.a. Producers
    • A.2.b. Business entity producers
    • A.2.c. Nonresident producers
    • A.2.d. Temporary
    • A.2.e. Advisers
    • A.2.f. Reinsurance intermediaries
    • A.2.g. Exemptions
    • A.3. Maintenance and duration
    • A.3.a. Reinstatement and renewal
    • A.3.b. Address change
    • A.3.c. Reporting of actions
    • A.3.d. Assumed names
    • A.3.e. Continuing education requirements, exemptions and penalties
    • A.4. Disciplinary actions
    • A.4.a. Cease and desist order
    • A.4.b. Hearings
    • A.4.c. Probation, suspension, revocation, refusal to issue or renew
    • A.4.d. Penalties and fines
    • B. State Regulation
    • B.1. Commissioner’s general duties and powers
    • B.2. Company regulation
    • B.2.a. Certificate of authority
    • B.2.b. Solvency
    • B.2.c. Rates
    • B.2.d. Policy forms
    • B.2.e. Examination of books and records
    • B.2.f. Producer appointments
    • B.2.g. Termination of producer appointment
    • B.3. Producer regulation
    • B.3.a. Impersonation
    • B.3.b. Larceny
    • B.3.c. Unlicensed persons compensation
    • B.3.d. Commissions
    • B.3.e. Records Retention
    • B.3.f. Insurance transactions
    • B.4. Unfair or deceptive practices
    • B.4.a. Misrepresentation
    • B.4.b. False advertising
    • B.4.c. Defamation of insurer
    • B.4.d. Boycott, coercion, intimidation
    • B.4.e. False financial statements
    • B.4.f. Failure to maintain a complaint record
    • B.4.g. Unfair discrimination
    • B.4.h. Unfair claims settlement practices
    • B.4.i. Rebating
    • B.5. Insurance fraud regulation
    • B.6. Insurance Information and Privacy Protection
    • B.7. Types of Insurers
    • B.7.a. Foreign, Alien, Domestic
    • B.7.b. Authorized and unauthorized insurers
    • B.7.c. Stock and mutual insurers
  • Massachusetts Specific — II. Massachusetts Laws and Regulations Pertinent to Accident, Health or Sickness Insurance Only
    • A. Life and Health Insurance Guaranty Association Law
    • B. Producer responsibilities in individual accident, health or sickness insurance
    • B.1. Advertising
    • B.1.a. Sales presentations
    • B.1.b. Outline of coverage
    • B.1.c. Disclosure of information about individuals
    • C. Individual underwriting by the insurer
    • C.1. Medical examinations and lab tests (including HIV consent)
    • C.2. Genetic information
    • D. Replacement of Accident, Health, or Sickness Insurance
    • D.1. Massachusetts replacement requirements
    • D.2. Massachusetts individual mandate for minimum creditable coverage requires individual to have health insurance even if the person has accident/sickness
    • E. Required Policy Provisions
    • E.1. Entire contract; changes
    • E.2. Time limit on certain defenses
    • E.3. Grace period
    • E.4. Reinstatement
    • E.5. Claim procedures
    • E.6. Physical examinations and autopsy
    • E.7. Legal actions
    • E.8. Change of beneficiary
    • E.9. Right to examine (free look)
    • F. Optional Policy Provisions
    • F.1. Change of occupation
    • F.2. Misstatement of age
    • F.3. Other insurance in this insurer
    • F.4. Expense-incurred basis
    • F.5. Other benefits
    • F.6. Unpaid premium
    • F.7. Conformity with state statutes
    • F.8. Illegal occupation
    • G. Health Insurance Provisions
    • G.1. Massachusetts eligibility requirements (Open enrollment)
    • G.1.a. Dependent child age limit
    • G.1.b. Disabled adult children
    • G.1.c. Newborn child coverage
    • G.1.d. Coverage of adopted children
    • G.2. Affordable Care Act (ACA) and Massachusetts Health Connector
    • G.2.a. Guaranteed issue
    • G.2.b. Guaranteed renewability
    • G.2.c. Preventive care
    • G.2.d. Emergency services
    • G.2.e. Health status (no discrimination)
    • G.2.f. EHB coverage
    • G.3. Massachusetts Mental Health Parity
    • G.4. Employer group health insurance
    • G.4.a. Nondiscrimination
    • G.4.b. Eligibility for coverage
    • G.4.c. Employee eligibility
    • G.4.d. Coordination of benefits provision (COB)
    • G.4.e. Continuation of coverage under COBRA and Massachusetts specific rules
    • G.5. Small employer and individual medical plans
    • G.5.a. Definition of small employer
    • G.5.b. Availability and eligibility rating rules
    • G.5.c. Restrictions relating to premiums
    • G.5.d. Small group continuation
    • G.5.e. Renewability
    • H. Medicare supplement policies
    • H.1. Open enrollment
    • H.2. Standardized Medicare supplement plans
    • H.2.a. Core benefits, Supplement 1
    • H.3. Massachusetts regulations and required provisions — Advertising
    • H.4. Standards for marketing
    • H.5. Permitted compensation
    • H.6. Appropriateness of recommended purchase and excessive insurance
    • H.7. Required disclosure provisions
    • H.8. Reporting of multiple policies
    • H.9. Buyer's guide
    • H.10. Right to return
    • H.11. Replacement
    • H.12. Benefit standards
    • H.13. Pre-existing conditions
    • H.14. Renewability
    • H.15. Outline of coverage
    • I. MassHealth
    • I.1. Eligibility
    • I.2. Benefits
    • J. Long-Term Care (LTC) Insurance
    • J.1. Home health care
    • J.2. Exclusions
    • J.3. Massachusetts regulations and required provisions
    • J.3.a. Standards for marketing
    • J.3.b. Suitability of recommended purchase
    • J.3.c. Your Options for Financing Long-Term Care
    • J.3.d. Outline of coverage
    • J.3.e. Non-forfeiture benefit offer
    • J.3.f. Required disclosure provisions
    • J.3.g. Right to return
    • J.3.h. Policy illustration
    • J.3.i. Inflation adjustment benefit
    • J.3.j. MassHealth exemption
    • J.3.k. Benefit triggers
    • J.3.l. Unintentional lapse
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