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MT Health — Information & Free Practice

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MT Health

Provider
Pearson VUE
Format
Computer-based written examination, test-center or OnVUE delivery; general and Montana-specific portions
Exam questions
92 scored questions and 10 pretest questions: 50 + 5 general, 42 + 5 Montana-specific
Time limit
General portion: 75 minutes; Montana-specific portion: 60 minutes
Passing score
Scaled score of 75
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
    • J.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.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
  • Montana-specific — I. Montana Statutes and Rules Common to Life, Disability (A&H) Insurance
    • A. Insurance Commissioner/Department
    • A.1. Broad powers and duties
    • A.2. Examination of records
    • A.3. Cease and desist orders
    • A.4. Penalties
    • B. General Definitions
    • B.1. Domestic, foreign, alien
    • B.2. Insurance transactions
    • B.3. Authorized/unauthorized companies and certificate of authority
    • B.4. Fraternals and their producers
    • C. Licensing Requirements
    • C.1. Definitions
    • C.2. Nonresident/reciprocal producer
    • C.3. Consultant
    • C.4. Administrator
    • C.5. Continuing education
    • C.6. Temporary licenses
    • C.7. Eligibility for license
    • C.8. Suspension, revocation, and termination of licenses
    • C.9. Producer appointment/contract cancellation
    • C.10. Resident producer
    • D. Unfair Trade Practices
    • D.1. False advertising
    • D.2. Rebating
    • D.3. Twisting
    • D.4. Misrepresentation
    • D.5. Defamation
    • D.6. Excess fees/charges
    • D.7. Unfair claims practices
    • E. Licensee Responsibilities
    • E.1. Fiduciary capacity
    • E.2. Commission sharing
    • E.3. Place of business/recordkeeping
    • E.4. Principal producer relationship
    • F. Rate and Form Regulations
    • G. Life and Health Insurance Guaranty Association
    • H. Insurance Information & Privacy Protection Act
    • I. Basic Contract Language
    • J. Insurance Fraud Protection Act
  • Montana-specific — II. Montana Statutes and Rules Pertinent to Disability (A&H) Insurance Only
    • A. Required Coverage and Provisions
    • A.1. Newborn and adopted children
    • A.2. Disabled dependents
    • A.3. Continuation of coverage
    • A.4. Maternity
    • A.5. Home health care
    • A.6. Mental Illness, alcoholism, and drug abuse treatment
    • A.7. Policy provisions
    • A.8. Explanation of charges
    • A.9. Continuity of coverage
    • A.10. Disclosure standards
    • A.11. Elder Abuse Prevention Act
    • B. Medicare Supplements
    • B.1. Policy provisions
    • B.2. Disclosure requirements
    • B.3. Replacement regulations
    • C. Group Disability
    • C.1. Required coverages and provisions
    • C.2. Coordination of benefits (COB)
    • D. Health Maintenance Organizations (HMO)
    • E. Health Service Corporations
    • F. Special Policies
    • F.1. Credit Disability
    • F.2. Blanket Disability
    • G. Preferred Provider Agreements Act
    • H. Freedom of Choice in Selection of Practitioners
    • I. Coverage for Insureds in Special Circumstances
    • I.1. Residents of state institutions
    • I.2. Public assistance recipients
    • J. Long-term Care
    • J.1. Activities of daily living
    • J.2. Nonforfeiture
    • J.3. Pre-existing conditions
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