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California Health Insurance — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Accident and Health or Sickness Agent

The individual or organizational license authorizes sickness, bodily injury, accidental death and disability-income coverage. Resident status and entity type distinguish applicant routes, not the license line.

Licensing authority: California Department of Insurance · Application information

Proof of qualifications by ordered examination after a licensing hearing
Accident and Health or Sickness Agent License Examination
Discretion
The examination order and time are set by the Commissioner, in lieu of other action or in addition to action other than revocation; failure terminates the applicable license.
Trigger
After a hearing establishes grounds for denial, suspension or revocation, the Commissioner may order the applicant or licensee to take and pass the qualifying examination for the license held or sought.
Reactivation after all appointments or endorsements terminate
No examination is required for this applicant pathway.
Activation
File a new appointment or qualifying endorsement; inactive status confers no authority to transact insurance. No new qualifying examination is prescribed by section 1704(b).
Existing License
The permanent license is inactive rather than canceled and has not expired.

Official no-examination sources

Effective from 2026-09-22.

LLC reactivation after financial security inactivation
No examination is required for this applicant pathway.
Effective Restoration
Continuous insurance coverage restores the license retroactively; coverage beginning later restores it from that coverage effective date.
Time Limit
Within 30 days after inactivation, demonstrate required financial security and submit fees, penalties and required licensing documents, including appointments, bonds or endorsements where required.

Official no-examination sources

Effective from 2026-09-22.

Relicensing during the statutory military service protection period
No examination is required for this applicant pathway.
Application
During that period, file the application and fee for the license type previously held without examination or penalty.
Military Service
The licensed natural person entered United States military service and was in service when renewal was due. The existing license remains in force during service and through the protected post-service period specified in section 1722, at least six months after release.

Official no-examination sources

Effective from 2026-09-22.

Organizational issuance — nonresident
No examination is required for this applicant pathway.
Activation
An insurer appointment must be filed before the entity transacts, solicits or negotiates insurance.
Applicant
A nonresident organization.
Endorsees
Name the natural persons who will exercise the license powers. Each must already hold an active corresponding California individual Accident and Health or Sickness license; unlicensed natural persons separately apply for their own licenses. A nonresident organization must name at least one person from outside California; other endorsees may be California residents.
Llc Security
An LLC must demonstrate the financial security in section 1647.5 and file annual confirmation.
Name And Application
Reserve or obtain approval of the business name and file the business-entity application, filing fee and endorsee fees.

Official no-examination sources

Effective from 2026-09-22.

Nonresident initial issuance outside the statutory reciprocal exemption
Accident and Health or Sickness Agent License Examination
Applicant
An individual maintains resident licensure elsewhere for life or disability insurance and applies as a nonresident under sections 1638 and 1639(c).
Application
File the nonresident application and fee and requested documents; active transactions require an insurer appointment or business-entity endorsement.
Background Consent
Applicants convicted of dishonesty or breach-of-trust felonies or a violation of 18 U.S.C. 1033 must obtain the Commissioner’s written consent before engaging in California insurance business.
Exam Score Age
The qualifying examination must have been passed within the 12 months preceding issuance (section 1676(a)); taking it before application still involves this examination.
Examination
The applicant is outside section 1638.5 reciprocity. The same qualifying examination as a resident is involved; under section 1679(a), the Commissioner may accept a qualifying reciprocal certificate in lieu of the examination, which remains an applicant-specific discretionary exception.
Fingerprints
Fingerprints are required unless the applicant qualifies for CDI’s resident-state fingerprint exemption.
Nonresident issuance by reciprocal resident licensure
No examination is required for this applicant pathway.
Applicant
An individual maintains resident licensure elsewhere for life or disability insurance and applies as a nonresident under sections 1638 and 1639(c).
Application
File the nonresident application and fee and requested documents; active transactions require an insurer appointment or business-entity endorsement.
Background Consent
Applicants convicted of dishonesty or breach-of-trust felonies or a violation of 18 U.S.C. 1033 must obtain the Commissioner’s written consent before engaging in California insurance business.
Fingerprints
Fingerprints are required unless the applicant qualifies for CDI’s resident-state fingerprint exemption.
Reciprocity
Hold a current resident producer license in good standing in a jurisdiction granting equivalent reciprocity to California residents, submit the resident application or completed NAIC Uniform Nonresident Application, and pay the fee. Under section 1679(b), the California examination provision does not apply to this reciprocal route.

Official no-examination sources

Effective from 2026-09-22.

Nonresident renewal
No examination is required for this applicant pathway.
Applicant
A nonresident holding an existing California license and maintaining qualifying resident authority; submit any required education certification.
Filing
Submit the renewal application and fee. An expired license can be late-renewed until the same month and day in the next year under section 1718(c); pay the 50-percent penalty and file new appointments or endorsements when required.
Product Training
Selling long-term care or 24-hour care requires additional statutory product training. The 24-hour care course includes an approved proctored examination under section 1749.33(d); no particular current examination is identified, and the course requirement remains a condition.

Official no-examination sources

Effective from 2026-09-22.

Nonresident simultaneous application for both license types outside reciprocity
Life, Accident & Health or Sickness (practice unavailable)
Applicant
An individual maintains resident licensure elsewhere for life or disability insurance and applies as a nonresident under sections 1638 and 1639(c).
Application
File the nonresident application and fee and requested documents; active transactions require an insurer appointment or business-entity endorsement.
Application Choice
The nonreciprocal applicant requests both life and accident and health or sickness licenses simultaneously; section 1676(b) prescribes one examination covering both types.
Background Consent
Applicants convicted of dishonesty or breach-of-trust felonies or a violation of 18 U.S.C. 1033 must obtain the Commissioner’s written consent before engaging in California insurance business.
Discretion
Section 1679(a) permits acceptance of the qualifying reciprocal certificate instead of requiring the applicant to sit the examination.
Exam Score Age
The qualifying examination must have been passed within the 12 months preceding issuance (section 1676(a)); taking it before application still involves this examination.
Fingerprints
Fingerprints are required unless the applicant qualifies for CDI’s resident-state fingerprint exemption.
Continuation after a qualifying change of organization
No examination is required for this applicant pathway.
Change
A qualifying natural person remains named, there is no substantial change in ownership and no change in control. File the prescribed application and fees within 30 days; section 1711 separately covers the continuing partnership conditions.
Individual Licensure
The natural person must remain eligible and licensed; this route does not replace the person’s separately required individual licensure.

Official no-examination sources

Effective from 2026-09-22.

Organizational renewal
No examination is required for this applicant pathway.
Applicant
An existing organization maintaining qualified individual endorsees; an LLC must maintain and confirm section 1647.5 security.
Filing
Submit the renewal application and fee. An expired license can be late-renewed until the same month and day in the next year under section 1718(c); pay the 50-percent penalty and file new appointments or endorsements when required.
Product Training
Selling long-term care or 24-hour care requires additional statutory product training. The 24-hour care course includes an approved proctored examination under section 1749.33(d); no particular current examination is identified, and the course requirement remains a condition.

Official no-examination sources

Effective from 2026-09-22.

Reapplication by a recently licensed California Accident and Health or Sickness agent
No examination is required for this applicant pathway.
Application
File the application and fee and satisfy applicable licensing and background prerequisites.
Previous License
The applicant held an Accident and Health or Sickness agent license during any part of the license year in which the application is filed or the immediately preceding license year. Section 1675(c) exempts this applicant from the examination article.

Official no-examination sources

Effective from 2026-09-22.

Organizational issuance — resident
No examination is required for this applicant pathway.
Activation
An insurer appointment must be filed before the entity transacts, solicits or negotiates insurance.
Applicant
A California resident organization.
Endorsees
Name the natural persons who will exercise the license powers. Each must already hold an active corresponding California individual Accident and Health or Sickness license; unlicensed natural persons separately apply for their own licenses. A nonresident organization must name at least one person from outside California; other endorsees may be California residents.
Llc Security
An LLC must demonstrate the financial security in section 1647.5 and file annual confirmation.
Name And Application
Reserve or obtain approval of the business name and file the business-entity application, filing fee and endorsee fees.

Official no-examination sources

Effective from 2026-09-22.

Resident initial issuance by examination
Accident and Health or Sickness Agent License Examination
Activation
A sponsoring insurer appointment or business-entity endorsement is required before transacting insurance; issuance alone does not authorize active transactions (section 1704).
Applicant
A California resident applying for the Accident and Health or Sickness license, rather than a statutory examination exemption or a simultaneous application for both license types.
Application
File the electronic license application and filing fee, answer all background questions truthfully, provide requested supplementary documents, and satisfy the licensing qualifications in sections 1666, 1668 and 1669.
Education
Complete one approved 12-hour Ethics and California Insurance Code course, including one hour of insurance fraud, before issuance; the former 20-hour product course was repealed effective January 1, 2026. The ethics certificate expires three years after completion (Insurance Code section 1749).
Exam Score Age
The qualifying examination must have been passed within the 12 months preceding issuance (section 1676(a)); taking it before application still involves this examination.
Fingerprints
Unlicensed resident applicants must submit fingerprint impressions. The resident application page says: “you must submit your fingerprints after filing your insurance license application with the Department, or soon after”. The 2026 Ethics FAQ instead says: “you must submit your fingerprints before submitting your license application”. Both implementing directions are preserved for the applicant.
Minimum Age
18 years (CDI Qualifications).
Resident renewal
No examination is required for this applicant pathway.
Applicant
A resident individual with an existing license.
Continuing Education
Complete 24 hours before each two-year renewal, including three hours of ethics containing one hour of fraud, subject to the statutory good-standing 30-year/age-70 exemption for persons first licensed before January 1, 2010.
Filing
Submit the renewal application and fee. An expired license can be late-renewed until the same month and day in the next year under section 1718(c); pay the 50-percent penalty and file new appointments or endorsements when required.
Product Training
Selling long-term care or 24-hour care requires additional statutory product training. The 24-hour care course includes an approved proctored examination under section 1749.33(d); no particular current examination is identified, and the course requirement remains a condition.

Official no-examination sources

Effective from 2026-09-22.

Resident simultaneous issuance of life and accident and health or sickness licenses
Life, Accident & Health or Sickness (practice unavailable)
Activation
A sponsoring insurer appointment or business-entity endorsement is required before transacting insurance; issuance alone does not authorize active transactions (section 1704).
Applicant
The applicant applies for both statutory license types simultaneously and checks both Life and Accident and Health or Sickness on the initial application. This route uses the one real qualifying examination described in section 1676(b), not two compulsory standalone examinations.
Application
File the electronic license application and filing fee, answer all background questions truthfully, provide requested supplementary documents, and satisfy the licensing qualifications in sections 1666, 1668 and 1669.
Education
Complete one approved 12-hour Ethics and California Insurance Code course, including one hour of insurance fraud, before issuance; the former 20-hour product course was repealed effective January 1, 2026. The ethics certificate expires three years after completion (Insurance Code section 1749).
Exam Score Age
The qualifying examination must have been passed within the 12 months preceding issuance (section 1676(a)); taking it before application still involves this examination.
Fingerprints
Unlicensed resident applicants must submit fingerprint impressions. The resident application page says: “you must submit your fingerprints after filing your insurance license application with the Department, or soon after”. The 2026 Ethics FAQ instead says: “you must submit your fingerprints before submitting your license application”. Both implementing directions are preserved for the applicant.
Minimum Age
18 years (CDI Qualifications).
Adding former resident authority after the California resident transfer
No examination is required for this applicant pathway.
Previous Authority
After issuance of the California resident license, the individual adds Accident and Health or Sickness authority previously held in good standing. The application must arrive within 12 months of cancellation of the prior resident license.
Waiver
Section 1675(f)(2) extends the examination waiver to these additional lines.

Official no-examination sources

Effective from 2026-09-22.

Transfer from current nonresident to California resident licensure
No examination is required for this applicant pathway.
Education
Complete the 12-hour Ethics and California Insurance Code course including one hour on fraud.
Resident License
The applicant is currently licensed for the same authority in the current resident jurisdiction; the California application must arrive within 90 days after cancellation of that resident license, and NAIC producer records must show good standing for the requested line.
Statutory Terminology
Section 32(b) expressly assigns the section 1626 license types to the term life agent; the section 1675(f)(1) life-agent waiver therefore includes Accident and Health or Sickness. The inspected short section-32 page contains the substantive statute.

Official no-examination sources

Effective from 2026-09-22.

Certificate of Convenience

The Commissioner may issue this applicant certificate upon satisfactory proof of prerequisites, before issuing the permanent license upon satisfaction of any applicable examination requirement.

Licensing authority: California Department of Insurance

Discretionary applicant certificate before permanent issuance
No examination is required for this applicant pathway.
Adverse Proceeding
A statement of issues automatically suspends the certificate until final decision; final denial of the permanent-license application terminates it.
Eligibility
Provide a satisfactory showing that the prerequisites are met; issuance of the certificate is discretionary. Permanent issuance follows meeting any applicable qualifying examination requirement under a separate permanent-license route.

Official no-examination sources

Effective from 2026-09-22.

Covered California Agency Certification

Certification of an agency that is not a sole proprietor requires an agency application, agency agreement, errors and omissions insurance, and administrative training completed by an authorized agency manager.

Licensing authority: Covered California · Application information

Covered California organizational agency certification
Agency Manager Certification Exam (practice unavailable)
Active Business
Maintain the agency’s and agents’ California health-insurance licensure, carrier appointments, certified personnel and agency account.
Agency
A licensed sole proprietorship, corporation or partnership onboarding with a designated manager; this route represents organizational agencies, while individual sole proprietors have their own agent-certification route.
Documents
Submit the agency application, agency agreement, E&O proof at not less than $1 million per occurrence and aggregate, and STD 204 when seeking CCSB commissions. For non-sole-proprietor agencies, execute the additional Non-Monetary Agency Manager Agreement.
Manager
The designated licensed manager completes Agency Manager Certification, including the 80-percent passing examination and applicable administrative training.

Covered California Certified Insurance Agent

An additional certification for licensed health-insurance agents assisting consumers with Covered California coverage. Agency manager, sole proprietor and downline-agent conditions have distinct routes.

Licensing authority: Covered California · Application information

Covered California certification — downline
Certified Insurance Agent Certification Exam (practice unavailable)
Agreements
Pay the applicable endorsement fee and sign the corresponding agency or non-monetary agreement and exhibits. Complete voter-registration training and account activation. Agency managers or sole proprietors also provide E&O coverage, payee documents and required administrative training; an organizational agency manager must sign the additional non-monetary agreement when required.
Applicant
An individual joining an agency as a downline agent.
Appointments
Maintain appropriate direct carrier appointments and comply with the Agent Code of Conduct.
Passing
Score at least 80 percent; three attempts are allowed; the examination is open book.
Prior License
Hold an active California Accident and Health or Sickness license in good standing; Covered California verifies that license.
Training
Complete all courses in the corresponding certification curriculum before the online certification examination.
Covered California certification — manager
Agency Manager Certification Exam (practice unavailable)
Agreements
Pay the applicable endorsement fee and sign the corresponding agency or non-monetary agreement and exhibits. Complete voter-registration training and account activation. Agency managers or sole proprietors also provide E&O coverage, payee documents and required administrative training; an organizational agency manager must sign the additional non-monetary agreement when required.
Applicant
The designated agency manager of an organizational agency.
Appointments
Maintain appropriate direct carrier appointments and comply with the Agent Code of Conduct.
Passing
Score at least 80 percent; three attempts are allowed; the examination is open book.
Prior License
Hold an active California Accident and Health or Sickness license in good standing; Covered California verifies that license.
Training
Complete all courses in the corresponding certification curriculum before the online certification examination.
Covered California certification — sole proprietor
Agency Manager Certification Exam (practice unavailable)
Agreements
Pay the applicable endorsement fee and sign the corresponding agency or non-monetary agreement and exhibits. Complete voter-registration training and account activation. Agency managers or sole proprietors also provide E&O coverage, payee documents and required administrative training; an organizational agency manager must sign the additional non-monetary agreement when required.
Applicant
A sole proprietor operating as an agency of one and designated as agency manager.
Appointments
Maintain appropriate direct carrier appointments and comply with the Agent Code of Conduct.
Passing
Score at least 80 percent; three attempts are allowed; the examination is open book.
Prior License
Hold an active California Accident and Health or Sickness license in good standing; Covered California verifies that license.
Training
Complete all courses in the corresponding certification curriculum before the online certification examination.

Estate Certificate of Convenience

An Accident and Health or Sickness producer estate may be administered by an eligible executor, administrator, surviving spouse or heir, or conservator. Section 32 confirms that the statutory references to a life agent include the section 1626 license types.

Licensing authority: California Department of Insurance · Application information

Estate certificate — conservator
No examination is required for this applicant pathway.
Applicant
The conservator of the producer’s estate after a court determination of incompetence.
Application
Submit the certificate-marked application, supplementary estate-certificate application, supporting estate or conservatorship documents and fee. CDI’s general checklist also lists a cancellation letter and death certificate for deceased-licensee cases.
Limits
The certificate conserves the existing business. It expires on the applicable events in section 1693, usually one year after death; a pending individual permanent-license application may extend it until an opportunity to take the qualifying examination. That later permanent license is a separate route.

Official no-examination sources

Effective from 2026-09-22.

Estate certificate — executor
No examination is required for this applicant pathway.
Applicant
The executor or administrator of the deceased health-insurance producer’s estate.
Application
Submit the certificate-marked application, supplementary estate-certificate application, supporting estate or conservatorship documents and fee. CDI’s general checklist also lists a cancellation letter and death certificate for deceased-licensee cases.
Limits
The certificate conserves the existing business. It expires on the applicable events in section 1693, usually one year after death; a pending individual permanent-license application may extend it until an opportunity to take the qualifying examination. That later permanent license is a separate route.

Official no-examination sources

Effective from 2026-09-22.

Estate certificate — heir
No examination is required for this applicant pathway.
Applicant
No executor or administrator has been appointed; the surviving spouse or heir is otherwise entitled to conduct the deceased producer’s business.
Application
Submit the certificate-marked application, supplementary estate-certificate application, supporting estate or conservatorship documents and fee. CDI’s general checklist also lists a cancellation letter and death certificate for deceased-licensee cases.
Limits
The certificate conserves the existing business. It expires on the applicable events in section 1693, usually one year after death; a pending individual permanent-license application may extend it until an opportunity to take the qualifying examination. That later permanent license is a separate route.

Official no-examination sources

Effective from 2026-09-22.

Limited Lines License

A nonresident limited-lines license for someone holding the corresponding resident license type, with authority restricted to less than the full authority of a license type covered by the statute.

Licensing authority: California Department of Insurance

Nonresident restricted health authority under reciprocal resident licensure
No examination is required for this applicant pathway.
Reciprocity
The resident jurisdiction must grant equivalent reciprocal licenses to California residents. Submit the proper application and fee; the restriction follows the resident authority. No other jurisdiction’s examination is a leaf.
Resident Authority
Hold a current resident limited-lines license in good standing whose restriction concerns health or disability coverage and grants less than full Accident and Health or Sickness authority.

Official no-examination sources

Effective from 2026-09-22.

Renewal of existing nonresident limited health authority
No examination is required for this applicant pathway.
Qualification
Continue holding the qualifying restricted resident authority, renew the California limited-lines license and pay the required fee; use the statutory late-renewal period and penalty when applicable.

Official no-examination sources

Effective from 2026-09-22.

Military Service Certificate of Convenience

Authority to conserve the business of a licensed natural person entering United States military service or of an organization meeting statutory conditions.

Licensing authority: California Department of Insurance

Military certificate — nominated natural person
No examination is required for this applicant pathway.
Application
File the certificate-marked individual application and $39 processing fee. The Board page describes the nominated individual as holding a producer license; prior licensure is an applicant condition.
Nomination
Be nominated by the holder of a permanent health-insurance producer license entering military service; provide the signed nomination and enlistment documentation.
Scope
Conserve the existing business; section 1676 prescribes examinations for permanent licenses, not this certificate.
Termination
The certificate ends when the nominating licensee is relicensed and within the statutory post-service period. CDI’s FAQ states six months after discharge; section 1722 defines the underlying protected military-license term.

Official no-examination sources

Effective from 2026-09-22.

Military certificate — licensed organization
No examination is required for this applicant pathway.
Application
Submit the signed nomination, military enlistment information, certificate-marked business-entity application and processing fee.
Organization
The organization already holds a permanent license and its only named natural person is entering United States military service.
Termination
The certificate ends on qualification of a replacement named person or six months after issuance, whichever occurs first.

Official no-examination sources

Effective from 2026-09-22.

Restricted License

A restricted license issued after a hearing in lieu of revoking an existing license or denying an unrestricted-license application; the Commissioner may impose reasonable conditions.

Licensing authority: California Department of Insurance

Restricted license issued in lieu of adverse licensing action
Accident and Health or Sickness Agent License Examination
Applicant
A current or former licensee whose violation would justify suspension or revocation after a hearing.
Examination Discretion
The applicable qualifying examination is involved when required for initial permanent licensing or ordered under section 1741; the Commissioner’s decision, existing license and statutory waivers determine whether this applicant must sit it.
Restrictions
The Commissioner may impose reasonable conditions on acquisition and conduct and may suspend or revoke the restricted license with or without cause or hearing.
Restricted license issued in lieu of adverse licensing action
Accident and Health or Sickness Agent License Examination
Applicant
An applicant for an unrestricted license whose application could be denied after a hearing.
Examination Discretion
The applicable qualifying examination is involved when required for initial permanent licensing or ordered under section 1741; the Commissioner’s decision, existing license and statutory waivers determine whether this applicant must sit it.
Restrictions
The Commissioner may impose reasonable conditions on acquisition and conduct and may suspend or revoke the restricted license with or without cause or hearing.
Reactivation of an unexpired inactive restricted license
No examination is required for this applicant pathway.
Activation
Maintain restrictions and restore the appointment or endorsement before expiration under the same statutory license conditions; the Commissioner retains authority over the restricted license.

Official no-examination sources

Effective from 2026-09-22.

Renewal of an existing restricted license
No examination is required for this applicant pathway.
Renewal
Section 1742 requires the restricted license to be renewed in the same manner, at the same time and under the same conditions and fees as an unrestricted license in the same capacity. Maintain the imposed restrictions and applicable continuing education; disciplinary reexamination is a separate ordered-qualification route.

Official no-examination sources

Effective from 2026-09-22.

Accident and Health or Sickness Agent License Examination

Provider
California Department of Insurance / PSI Services LLC
Format
Multiple-choice; test center or online remote proctored
Exam questions
75
Passing score
60 percent
Examination outline
  • I. General Insurance (25%)
    • I.A.Basic Insurance Concepts and Principles (7 questions of the 18 General Insurance questions) Be able to: 1.Identify the definition of insurance (California Insurance Code section 22) 2.Recognize the definition of risk 3.Differentiate between a pure risk and a speculative risk 4.Identify the definition of peril 5.Identify the definition of hazard 6.Differentiate between moral, morale, and physical hazards 7.Identify the definition of the law of large numbers 8.Identify the definition or the correct usage of the term loss exposure 9.Identify risk management techniques 10.Identify risk situations that present the possibility of a loss 11.Recognize the requisites of an ideally insurable risk 12.Identify the definition of insurable events (California Insurance Code section 250) 13.Identify and apply the definitions of insurable interest, the principle of indemnity and utmost good faith 14.Identify the steps in the underwriting process 15.Identify the meaning of adverse selection and profitable distribution of exposures
    • I.B. Contract Law (4 questions of the 18 General Insurance questions) 1.Be able to compare contract law and tort law 2.Be able to identify the four basic elements of a contract a.Agreement, offer, and acceptance b.Competent parties c. Legal purpose d.Consideration 3.Be able to identify the meaning and effect of the following special characteristics of an insurance contract a.Contract of adhesion b.Conditional contract c.Aleatory d.Unilateral e.Personal 4.Be able to identify the term “insurance policy” (California Insurance Code section 380) 5.Be able to identify the meaning and effect of each of the following on a contract: a.Concealment (California Insurance Code section 333) i.Be able to identify information that does not need to be communicated in a contract: 1)Known information 2)Information that should be known 3)Information which the other party waives 4)Information that is excluded by a warranty and not material to the risk 5)Information that is excepted from insurance and not material to the risk 6)Information based on personal judgment (California Insurance Code section 339) b.Warranty (California Insurance Code sections 440 through 445, and 447) i.Know that a warranty may be expressed or implied ii.Know that violation of a material warranty allows the other party to rescind the contract c.Representations (California Insurance Code sections 350 through 361) i. Know when a representation can be altered or withdrawn (California Insurance Code section 355) ii.Know that a representation is false when the facts fail to correspond with its assertions or stipulations (California Insurance Code section 358) iii.Know that a representation cannot qualify an express provision in a contract of insurance, but it may qualify an implied warranty (California Insurance Code section 354) d.Misrepresentation (California Insurance Code sections 780 through 784) e.Materiality (California Insurance Code section 334) i.Know that materiality is to be determined not by the event, but solely by the probable and reasonable influence of the facts on the party to whom the communication is due 6.Be able to identify when an insurer has the right of rescission (California Insurance Code sections 331, 338, 359, and 447) a.Know that either intentional or unintentional concealment entitles an injured party to rescission of a contract (California Insurance Code section 331) 7.Be able to identify six required specifications for all insurance policies (California Insurance Code section 381) a.The parties between whom the contract is made b. The property or life insured c.The interest of the insured in property insured, if he is not the absolute owner thereof d.The risks insured against e.The period during which the insurance is to continue f.Either: i.A statement of the premium ii.If the insurance is of a character where the exact premium is only determinable upon the termination of the contract, a statement of the basis and rates upon which the final premium is to be determined and paid g.Know that the financial rating of the insurer is not required to be specified in the insurance policy (California Insurance Code section 381) 8.Given an insurance situation, be able to identify the following terms correctly: a.Application, policy, rider b.Cancellation, lapse, grace period c.Rate, premium, earned and unearned premium
    • I. C.The Insurance Marketplace (7 questions of the 18 General Insurance questions)
    • I.C.1.Distribution Systems 1.Be able to identify different distribution systems that include, but are not limited to, the following: a.Agency b.Direct response
    • I.C.The Insurance Marketplace (7 questions of the 18 General Insurance questions)
    • I.C.2.Producers 1.Be able to understand the general rules of agency as they apply to an agent, broker, and insurance company a.The responsibilities and duties of each b.The effect of the types of authority an agent may exercise (express, implied, and apparent) 2.With regard to the underwriting of applicants and/or insureds, be able to: a.Identify a producer’s responsibilities b.Understand the insurers’ requirements 3.Be able to define the following: a.Accident and Health or Sickness agent (California Insurance Code section 1626(a)(2)) b. Certified insurance agent (California Code of Regulations, Title 10, section 6800) c.Life agent (California Insurance Code section 1626(a)(1)) d.Life and disability insurance analyst (California Insurance Code sections 32.5, and 1831 through 1849) 4.Be able to identify the California Insurance Code definition of transact and why the definition is important (California Insurance Code sections 35, 1631, and 1633). a.Have knowledge of the penalties for transacting without a license (California Insurance Code section 1633) 5.Be able to identify: a.That the California Insurance Code prohibits certain acts by unlicensed persons (California Insurance Code section 1631) b.The penalties for such prohibited acts (California Insurance Code section 1633) 6.Written Consent in Regards to Interstate Commerce (Prohibited Persons in Insurance): a.Be able to identify what conduct is prohibited by United States Code, title 18, section 1033 b.Be able to identify what civil and criminal penalties apply (United States Code, title 18, sections 1033 and 1034) 7.Be able to identify the differences between the terms “agent” and “broker” with respect to their relationship with insurers and with their insureds a.Insurance agent means a person authorized, by and on behalf of an insurer, to transact all classes of insurance other that life, disability, or health insurance (California Insurance Code section 31) b. A life licensee is a person authorized to act as a life agent on behalf of a life insurer or a disability insurer to transact life insurance, accident and health or sickness insurance, or life and accident and health or sickness insurance (California Insurance Code section 32) c.Insurance broker means a person who, for compensation and on behalf of another person, transacts insurance other than life, disability, or health with, but not on behalf of, an insurer (California Insurance Code section 33) 8.Be able to recognize: a.The differences between the authority of an agent and a solicitor; b.That there is no such license as “accident and health or sickness solicitor” (California Insurance Code section 1704(d)) c.That an insurance solicitor is a natural person employed to aid an insurance agent or insurance broker in transacting insurance other than life, disability, or health (California Insurance Code section 1624) 9.For Insurance Agent’s Errors & Omissions insurance, be able to identify: a.The types of coverages available b.The types of losses commonly covered and not covered c.The need for the coverage 10.Be able to identify acts prohibited (unless a surplus line broker) with regard to non-admitted insurers (California Insurance Code section 703) 11.Be able to identify the prohibitions of free insurance (California Insurance Code section 777.1) 12.Be able to identify the California Insurance Code requirements for the following: a.An agency name, use of name (California Insurance Code sections 1724.5 and 1729.5) b.Change of address (California Insurance Code section 1729) c.Filing license renewal application (California Insurance Code section 1720) d.Printing license number on documents (California Insurance Code section 1725.5) 13.Be able to identify the records an insurer and agents must maintain (California Insurance Code sections 10508 through 10508.5) 14.Be able to identify the California Insurance Code specifications regarding producer application investigation, denial of applications, and suspension or revocation of license (California Insurance Code sections 1666, 1668 through 1670, and 1738) 15.Be able to identify the importance and the scope of the California Insurance Code regarding: a.The filing of a notice of appointment to transact accident and health or sickness insurance (California Insurance Code sections 1704 and1705) b.An inactive license (California Insurance Code section 1704(b)) c.Cancellation of a license by the licensee in the licensee's possession or in the employer’s possession (California Insurance Code section 1708) 16.Be able to identify the scope and effect of the California Insurance Code regarding termination of a (producer’s) license, including when producers dissolve a partnership (California Insurance Code sections 1708 through 1712.5) 17.Be able to identify and apply: a.The definition of the term "fiduciary" b.Producer fiduciary duties (California Insurance Code sections 1733 through 1735) 18.Be able to identify the continuing education (CE) requirements for: a.An individual licensed as an accident and health or sickness agent (California Insurance Code sections 1749.3 through 1749.33) i.Accident and health or sickness agents also licensed as a property and casualty may complete 24 hours of continuing education in either license type, three (3) hours of which must be in ethics (California Insurance Code sections 1749.3(b) and 1749.33(b)) ii.An agent writing long-term care insurance (LTC) (California Insurance Code section 10234.93) iii.Agents writing applications for Partnership coverage must also meet additional CE requirements for the California Partnership for Long-Term Care (CPLTC) (California Code of Regulations, Title 22, section 58056) iv.The total hours of continuing education required for the accident and health or sickness agent are not increased by LTC or CPLTC 19.Be able to identify the definition of “administrator” (California Insurance Code section 1759) 20.Concerning a Life and Disability Insurance Analyst license, be able to identify the requirements and prohibitions for charging fees (California Insurance Code section 1848) The following License Examination Objectives are derived from the California Insurance Code and codes of ethics of major industry organizations. This is the basis for accident and health or sickness examination questions. 21.Be able to identify and apply the meaning of the following: a.Place the customer's interest first b.Know your job and continue to increase your level of competence c.Identify the customer’s needs and recommend products and services that meet those needs d.Accurately and truthfully represent products and services e.Use simple language; talk the layman’s language when possible f.Stay in touch with customers and conduct periodic coverage reviews g.Protect your confidential relationship with your client h.Keep informed of and obey all insurance laws and regulations i.Provide exemplary service to your clients j.Avoid unfair or inaccurate remarks about the competition 22.Be able to identify that the California Insurance Code and the California Code of Regulations identify many unethical and/or illegal practices, but they are NOT a complete guide to ethical behavior 23.Be able to identify special ethical concerns that may occur when dealing with Senior Citizens 24.Be able to identify the alterations an agent may make to an applicant's written disability application (California Insurance Code section 10382)
    • I.C. The Insurance Marketplace (7 questions of the 18 General Insurance questions)
    • I.C.3.Insurers 1.Be able to differentiate between: a.Admitted and non-admitted insurers (California Insurance Code sections 24 through 25) b.Domestic, foreign and alien insurers (California Insurance Code sections 26 through 27) c.Regulation of an admitted insurer and non-admitted insurer, and the potential consequences for consumers (California Insurance Code sections 24, 25, and 1760 through 1780) 2.Be able to identify the penalty for unlawfully acting as an insurer without a certificate of authority (California Insurance Code section 703) 3.Be able to identify the functions of the following major operating divisions of insurers: marketing or sales, underwriting, claims, and actuarial 4.Be able to identify that a primary insurer (e.g., ceding company) is the insurance company who transfers its loss exposure to another insurer in a reinsurance transaction 5.Know that any person, association, organization, partnership, business trust, limited liability company, or corporation capable of making a contract may be an insurer (California Insurance Code sections 19 and 150) 6.Be able to differentiate between mutual, stock, and fraternal insurers a.Earned surplus b.Divisible surplus as policy dividends
    • I.C.The Insurance Marketplace (7 questions of the 18 General Insurance questions)
    • I.C.4.Market Regulation – General 1.Be able to identify: a.The California Insurance Code and how it may be changed b.The California Code of Regulations, Title 10, chapter 5 and how it may be changed c.How the Insurance Commissioner is selected and the responsibilities of the position (California Insurance Code sections 12900 and 12921) 2.Be able to identify that the California Department of Insurance Department) has jurisdiction over entities that provide coverages designed to pay for health care providers' services and expenses unless the health care providers are appropriately licensed or certified by other governmental agencies (California Insurance Code section 740) a.The Department is the primary regulator of issuers of most Preferred Provider Organization (PPO) and Exclusive Provider Organization (EPO) plans and other disability insurance companies b.The California Department of Managed Health Care is the Primary regulator of issuers of all Health Maintenance Organization (HMO) and Point of Service (POS) plans, and some PPO and EPO plans, http://www.dmhc.ca.gov/ 3.Be able to identify the correct application of the Unfair Practices article, including its prohibitions and penalties (California Insurance Code sections 790 through 790.15) a. Know that only the Commissioner may enforce the provisions of the Unfair Practices Act 4.Be able to identify the privacy protection provisions of: a.The Gramm-Leach-Bliley Act (GLBA)/California Financial Information Privacy Act (California Financial Code sections 4050 through 4060) b.Insurance information and Privacy Protection Act regarding practices, prohibitions and penalties (California Insurance Code sections 791 through 791.29) 5.Be able to define an insolvent insurer (California Insurance Code section 985) a.Know the definition of Paid-in Capital (California Insurance Code sections 36 and 985) b.Know that it is a misdemeanor to refuse to deliver any books, records, or assets to the Commissioner once a seizure order has been executed in an insolvency proceeding (California Insurance Code section 1013) 6.Be able to identify the scope and correct application of the conservation proceedings described in California Insurance Code sections 1011, 1013, and 1016 7.Be able to identify the purpose and scope of the California Insurance Code concerning the California Life and Health Insurance Guarantee Association (CLHIGA) (California Insurance Code sections 1067.02(a)(1) and 1067.02(b)(1)) a. Basic coverage and exclusions of CLHIGA (California Insurance Code sections 1067 through 1067.18) 8.Be able to identify the scope and correct application of the False and Fraudulent Claims article of the Code (California Insurance Code sections 1871 and 1871.4) a.Efforts to combat fraud (California Insurance Code sections 1872, 1874.6, 1875.8, 1875.14, 1875.20, and 1877.3(b)(1)) b.That if an insured signs a false claim form, the insured may be guilty of perjury 9.Be able to identify the requirements for discontinuance and replacement of Group Disability Insurance (California Insurance Code sections 10128.1 through 10128.4) 10.Be able to identify discriminatory practices prohibited by the California Insurance Code (California Insurance Code sections 10140 through 10145) 11.Be able to identify the meaning of shall and may (California Insurance Code section 16) 12.Be able to identify the requirements for notice by mail and by electronic transmission (California Insurance Code sections 38 and 38.6)
    • I.C. The Insurance Marketplace (7 questions of the 18 General Insurance questions)
    • I.C.5.Fair Claims Settlement Practices Regulations (California Code of Regulations Title 10, chapter 5, subchapter 7.5, article 1) 1.Be able to identify a definition of the following: a.Claimant (California Insurance Code section 2695.2(c)) b.Notice of legal action (California Code of Regulations Title 10, section 2695.2(o)) c.Proof of claims (California Insurance Code section 2695.2(s)) 2.Be able to identify File and Record Documentation (California Code of Regulations, Title 10, section 2695.3) 3.Be able to identify Duties upon Receipt of Communications (California Insurance Code section 2695.5) 4.Be able to identify Standards for Prompt, Fair and Equitable Settlements (California Code of Regulations, Title 10, sections 2695.7(a), (b), (c), (g), and (h))
  • II. General Concepts of Medical and Disability Insurance (5%)
    • II.A.General Concepts (4 questions of the 4 Health and Disability Insurance questions) 1.Be able to identify and/or apply your understanding of the following: a.Accidental means vs. accidental bodily injury Accident vs. sickness Coinsurance Copayment Deductible Elimination period Extension of benefits Gatekeeper concept Managed care Master policy owner Preexisting conditions Probationary period Stop-loss provision Waiver of premium Waiting period b.Cancellation and renewability features (e.g., cancellable, optionally renewable, conditionally renewable, guaranteed renewable, noncancelable) 2.Be able to identify a definition of the following limited insurance policies: a.Travel accident b.Specified or dread disease and critical illness c.Hospital income and hospital confinement indemnity d.Accident only e.Credit disability 3. Be able to describe limited benefit plans according to: a.Policies that provided benefits for expenses incurred for an accidental injury only b.Policies that pay fixed dollar amounts for specified diseases or other specified impairments c.Policies that provide benefits for specified limited services d.Indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies
  • III. Medical Expense Insurance (60%)
    • III.A. Individual Insurance (14 questions of the 45 Accident and Health or Sickness Insurance questions) 1. Be able to identify the: a.Main types of plans i.Health Maintenance Organizations (HMOs) ii.Preferred Provider Organizations (PPOs) iii.Exclusive Provider Organizations (EPOs) b.Consumer Driven Health Plans (CDHPs) i.Health Reimbursement Arrangements (HRAs) ii.Medical Savings Accounts (MSAs) iii.High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs) iv. Flexible Spending Arrangements (FSAs) c.Optional coverages i.Adult Dental ii.Adult Vision iii.Know that limited pediatric dental and vision benefits are mandatory d.Contract issues and provisions (deductibles, grace period, elimination periods, right to terminate, coordination of benefits, coinsurance, deductible, co-pays, maximum out of pocket expense) e.Common exclusions and limitations
    • III.B.Group Medical Expense Insurance (8 questions of the 45 Accident and Health or Sickness Insurance questions) 1.Know the following characteristics of group medical expense insurance: a.Eligible groups (California Insurance Code sections 10270.5, 10270.505, 10270.55 and 10270.57) i.Small groups (2 through 100 employees) ii. Large groups (101+ employees) iii.Contributory vs. noncontributory participation requirements b.Coverage forms i.Care Plans (HMO, POS, PPO, EPO) ii.Self-funded/self-insured plans 1)Know that self-insured “Association” health plans are prohibited by regulation. iii. Consumer-driven models 1)Flexible Spending Accounts (FSAs) 2)Health Reimbursement Accounts (HRAs) 3)Health Savings Accounts (HSAs) c.Coverage for dependents of insured employees (California Insurance Code section 10270.65) i.Registered domestic partners (California Insurance Code section 10121.7) d.Blanket insurance (California Insurance Code section 10270.2) 2.Large group health insurance underwriting considerations a.Occupational class(es) represented b.Group size and prior claims experience 3.Small group health insurance a.Guaranteed issue b.Businesses with 25 or fewer employees may be eligible for federal premium tax credits i.Must purchase health insurance through the Covered California for Small Business (CCSB) program c.Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) i.Individual Coverage Health Reimbursement Arrangement (ICHRA) 4.Be able to identify the impact of the following legislation on group health insurance a.Employee Retirement Income Security Act (ERISA) b.Consolidated Omnibus Budget Reconciliation Act (COBRA 1985) c.Americans with Disabilities Act (ADA) d.Health Insurance Portability and Accountability Act (HIPAA) e.Family and Medical Leave Act (FMLA) f.Pregnancy Discrimination Act g.Mental Health Parity Act h.Affordability under Patient Protection and Affordable Care Act (PPACA) i.Employer “Shared Responsibility” payments and other penalties i.Cal-COBRA
    • III.C.Patient Protection and Affordable Care Act (PPACA) (Public Law 111 through 148) (8 questions of the 45 Accident and Health or Sickness Insurance questions) 1.Be able to identify the purpose of the Act 2.Overview a.Modified Adjusted Gross Income (MAGI) eligibility for Medi-Cal i.Individuals age 19 through 64 qualify with household income up to 138 percent of the Federal Poverty Level (FPL) ii.Children under age 19 qualify if household income is up to 266 percent FPL b.MAGI eligibility for Cost Sharing Reductions (CSR) i.Consumers qualify for varying CSRs between 138 percent and 250 percent FPL c.Know that health insurance is now guaranteed issue i.Know the definition of Open Enrollment Period ii.Know the requirements for a Special Enrollment Period d.Advance Premium Tax Credits (APTCs) may be available to certain households with income not more than 400 percent FPL i.Calculated by California Health Benefit Exchange (Covered California) and paid by the Exchange to insurers 3.PPACA Definitions a.Qualified Health Plan (QHP) b.Guaranteed issue - all new group and individual health policies c.Advanced Premium Tax Credits d.Essential Health Benefits e.Open Enrollment Period (OEP) f.Special Enrollment Period (SEP) requirements g.Cost Sharing Reductions h.Health plan metal tiers - Bronze, Silver, Gold, Platinum 4.Be able to identify and differentiate between a.QHP – Qualified Health Plan b.Minimum Essential Coverage i.Minimum actuarial value requirement of each “metal tier” of benefits c.Essential Health Benefits 5.California Health Benefit Exchanges (Individual Exchange and Covered California for Small Business (CCSB)) a.Consumers must purchase a QHP through Covered California to obtain Premium Tax Credits i.Know that the CCSB program serves small businesses with up to 50 employees b.Know that agents writing applications for QHPs through Covered California must first complete all Covered California agent agreements and certification requirements 6.Know that coverage for children under a parent’s individual or group policy may extend through 26th birthday or unless the child qualifies as a disabled dependent a.Know that COBRA permits a child who “ages out” of a group health plan to continue coverage under the group plan for up to 36 months 7.Know the definition of Medical Loss Ratio (MLR) a.Individual Plans 80 percent b.Group plans 85 percent c.Know that any insurer that fails the MLR test in a calendar year for all plans in a given market segment (individual or group) must refund excess premiums to consumers enrolled in plans in that market segment
    • III.D.Senior Health Products (15 questions of the 45 Accident and Health or Sickness Insurance questions) 1.Medicare a.Be able to describe Original Medicare and Medicare Advantage b.For Medicare, be able to identify who is eligible for coverage: i.Citizens and legal residents aged 65 or older 1)Must enroll at first eligibility or be subject to late enrollment penalties (10 percent of applicable premium for twice the length of time a beneficiary was not enrolled in Part A, 10% lifetime penalty per each 12-month period not enrolled in Part B) 2)Legal residents must have been in the United States at least five years 3)Monthly Part A premiums required when beneficiary is not “Fully Insured” under Social Security a)30 through 39 credits b)0 through 29 credits ii.Social Security Disability (SSDI) – two years iii.End Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS, known as “Lou Gehrig’s Disease”) c.Medicare Part A (Hospital Insurance), be able to identify: i.Inpatient coverage (does not include physician or surgeon charges) ii.Benefit period (beginning and ending dates) iii.Hospital admission annual deductible iv.Co-payments for hospital days 61 to 90, and the 60 lifetime reserve days 1)When lifetime reserve days are exhausted, there is no out-of-pocket maximum for hospitalizations beyond 90 days v.Home care and hospice may be covered following a hospitalization vi.Mental health inpatient hospitalization lifetime limitations d.Medicare Part B – (Medical Insurance) be able to identify: i.Enrollment in Part B 1)Initial Eligibility Period (seven-month window) 2)Automatic eligibility at age 65 for citizens and legal residents entitled to Part A. 3)Enrollment may be rejected or delayed without penalty while covered by any employer-sponsored health plan 4)Special Enrollment Period (eight-month window) 5)General Enrollment Period (January 1 to March 31) ii.A monthly premium is paid by all beneficiaries. High-income beneficiaries are assessed higher monthly premiums. iii.Annual deductible iv.Coinsurance – Generally 80-20 v.Benefits 1)Medically necessary outpatient health and diagnostic services 2)Physicians and surgeon’s services (in and out of hospital) 3)Home and hospice care not covered under Part A 4)No annual out-of-pocket maximum for Part B claims 5)Payment differences between using approved physicians vs. non-approved physicians e.Medicare Supplement Insurance, be able to identify: i.The federally standardized Medicare Supplement policies and the gaps in Medicare coverage they are designed to fill 1)Basic (or “core”) benefits of Plan A are applicable to all plans 2)The additional benefits included in plans B, C, D, F (including High Deductible and Innovative options), G, K, L, M, and N. ii.California Insurance Code requirements regarding the following: 1) Benefits required in each standardized plan (California Insurance Code section 10192.8) and Medicare Select plans (California Insurance Code section 10192.10) a)Know that insurers offering Medicare Supplement policies must offer Medicare Supplement Plan A and either Plan C or F b)Open enrollment period described in California Insurance Code section 10192.11 and application questions described in California Insurance Code section 10192.18 c)Guaranteed issue periods described in California Insurance Code section 10192.12 d)Permitted commissions (California Insurance Code section 10192.16) e)Inappropriate sales and replacement (California Insurance Code section 10192.20) f)Know that a person cannot receive benefits from more than one Medicare Supplement plan and that applications must include a question to identify persons who already are enrolled in a Medicare Supplement plan g)Know that Medicare Advantage is not a Medicare Supplement plan and does not coordinate with Medicare Supplement plans iii.The Medicare disclosure requirements for: a)Outline of coverage (California Insurance Code section 10192.17(l)(3)(G)) b)Application (California Insurance Code section 10192.18(a)(6)) c)Replacement (California Insurance Code section 10192.18(e)) d)Commissioner’s Annual Rate Guide (California Insurance Code section 10192.20(e)(4)) f.For Medicare Part C (Medicare Advantage), describe the managed care aspects of the coverage provided by health care organizations i.HMO and PPO models ii.Private Fee for Service plans (PFFS) iii.Special Needs Plans (SNP) 1)Medicare – Medi-Cal dual eligible – Dual Special Needs Plans (D-SNP) a)Purpose b)Eligibility - who is eligible, including those with a Share of Cost 2)Persons with ESRD iv.Know that enrollment in a stand-alone PDP automatically terminates enrollment in a Medicare Advantage plan v.Coverage 1)Must cover all benefits provided under Original Medicare but may cover claims to a greater extent than Original Medicare 2)May reduce out-of-pocket costs for senior health care 3)May include additional health care benefits not covered by Original Medicare 4)May include optional and/or “value added” services and benefits g.For Medicare Part D (Prescription Drug Plan) be able to identify: i.Enrollment is optional 1)That failure to maintain “creditable coverage” for prescription drugs after age 65 may result in a lifetime one percent per month premium penalty for each month without such coverage ii.Premiums, deductibles and copayments iii.Be able to identify how Medicare enrollment periods: 1)Initial Enrollment Period (IEP) A.Annual Enrollment Period (AEP) also known as Open Enrollment Period (OEP) B.Special Enrollment Period (SEP) iv.That PDPs may be purchased as stand-alone plans or embedded within Medicare Advantage plans (“MAPD”). v.That a beneficiary may enroll in a PDP if they are enrolled in Part A and/or Part B vi.The coverage periods, deductibles, and co-payments in a PDP vii.The coverage gap and catastrophic coverage, and when each applies to a beneficiary viii.Insurance companies must create and annually file a formulary 1)Be able to explain formulary “tiers” and their importance 2)A formulary must include at least two drugs in each treatment category, but is not required to include all drugs h.Be able to identify how Medicare claims payments are handled under the Original Medicare Fee for Service program: i.Medicare claims are submitted by health care providers and approved medical equipment suppliers to Centers for Medicare and Medicaid Services’ (CMS) ii.“Medicare assignment” vs. non-assignment iii.What information is provided in a “Medicare Summary Notice” (MSN) iv.Common coverage exclusions for Part A and B v.When a beneficiary has the Right of Appeal and how an appeal is processed 2.Health Insurance and Counseling Advocacy Program (HICAP) a.Be able to identify that HICAP is a federally mandated, state and federally funded program that provides free assistance to Medicare beneficiaries and their families concerning Medicare, Medicare Advantage, Medicare Supplement Insurance, Prescription Drug Plans, Medi-Cal, and Long-Term Care Insurance i.The educational services, consumer advocacy, and legal assistance provided ii.The program is administered by the Department of Aging and operated locally by Area Agencies on Aging iii.HICAPs provide assistance by phone or in person, some HICAPs can also provide legal assistance in regard to Medicare and Medi-Cal. 1)Contact information for the local HICAP agencies can be found at: https://www.aging.ca.gov/ProgramsProviders/AAA/AAA_Listing.aspx 3. Centers for Medicare & Medicaid Services (CMS) compliance and regulations that agents and brokers are required to adhere to before assisting consumers with selecting and enrolling in qualified health plans (QHPs) a.Third Party Marketing Organization (TPMO) Disclaimer b.Call Recording c.Permission to Contact d.Scope of Appointment e.Marketing Rules f. Events & Appointments g.Websites h.Secret Shoppers (enforcement of consumer protections)
  • IV. Disability Income Insurance (5%)
    • IV.A.Individual Disability Income Insurance Underwriting, Pricing, Claims (4 questions (5 percent) on the examination) 1.Purpose of underwriting a.Prevention of adverse selection b.Properly classify risks i.Be able to differentiate between preferred, standard, and substandard risk classification ii.Underwriting responses to substandard risks 2.Process of underwriting a.Be able to identify the responsibility of the agent as the field underwriter i.Field underwriting prior to application ii.The agent’s report iii.Know that the insurers must not make unfair distinctions between individuals in underwriting for the risk of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) (California Insurance Code section 799) iv.Know that insurers may not unfairly discriminate on the basis of tests of a person’s genetic characteristics (California Insurance Code Section of 10146) 1)“Genetic characteristics” means any scientifically or medically identifiable gene or chromosome that is known to be a cause of a disease or disorder that is presently not associated with any symptoms of any disease or disorder (California Insurance Code section 10147(b)) b.Completing the application i.The application must be completed accurately and truthfully to the best of the agent’s ability ii.Know that basic underwriting requirements will vary based on the company c.Know that additional information may be required if an application reveals certain health conditions or other risk exposures i.MIB Inc. (formerly “Medical Information Bureau”) report ii.Attending Physician’s Statement (APS) iii.Credit and/or inspection report iv.Department of Motor Vehicle (DMV) report v.Hazardous activity questionnaires (e.g., aviation, scuba diving, auto/boat/motorcycle racing) vi.Additional medical testing (e.g., electrocardiogram (EKG), treadmill examination, physician examination) 3.Underwriting outcomes a.Insurer b.Insured c.Agent 4.Be able to identify the following rate-making components: a.Morbidity b.Insurer expenses c.Investment return d.Benefit duration i.Probationary period ii.Elimination period 5.For disability income insurance, be able to identify: a.The need for the coverage b.Definitions of partial and total disability (including Social Security definition) and eligibility requirements c.The difference between occupational and nonoccupational coverage d.Reasons for insurer limitations on coverage amounts e.Purposes of and needs for long-term disability vs. short-term disability policies i.Reasons why persons might need only one or both coverages 6.Be able to identify the uses of disability income: a.Individual disability income policy b.Business overhead expense policy c.Business disability buyout policy d.Group disability income policy e.Key employee and partner policies 7.Be able to identify how and why each of the following applies to eligibility and/or rating factors to influence rating structures: a.Age b.Gender d.Job classification e.Avocations f.Health (past and present) 8.Be able to identify the income tax liabilities on premiums and benefits for the participants and of sponsors of the following policies: a.Group b.Individual 9.Be able to identify each of the following provisions and/or riders for Disability Insurance: a.Maximum and minimum benefits b.Notice of claim c.Automatic increase provision / future purchase provision d.Own occupation vs. any occupation definitions of disability e.Cost of living rider f.Benefit period g.Social insurance substitute (or supplement) rider h.Benefit integration i.Residual disability j.Recurring disability k.Rehabilitation benefit l.Transplant benefit
  • V. Long-Term Care Insurance (5%)
    • V.A.Long-Term Care (California Insurance Code section 10231) (4 questions (5 percent) on the examination) 1.Regarding long-term care insurance, be able to identify: a.Why this coverage might be needed (i.e. Medicare limitations, Medi-Cal eligibility) b.The standard levels of care i.Skilled nursing ii.Intermediate nursing iii.Custodial or non-skilled nursing iv.Home care v.Community based services c.Places services are generally provided i.Nursing homes ii.Assisted living facilities iii.Residential care facilities for the elderly (RCFE) iv.Home setting, personal care v.Hospice care vi.Respite care vii.Adult day care centers d.The triggers for policy benefits – Activities of Daily Living (ADL), Cognitive Impairment or Alzheimer’s disease e.Marketing standards and responsibilities including Health Insurance Counseling and Advocacy Program (HICAP) (California Insurance Code section 10234.95(c)(3)) f.Available forms of LTC Coverage i.Individual and group policies 1)Tax qualified 2)Non-tax qualified 3)California Partnership for Long-Term Care (California Code of Regulations, Title 10, section 58056) 4)Endorsement/rider to life or annuity policies g.Guaranteed renewability and rates 2. Consumer protection regarding long-term care insurance: a.Know the requirement for producers to complete LTC training prior to selling products (California Insurance Code section 10234.93) b.Be able to identify the provisions about duty of honesty, good faith, and fair dealing (California Insurance Code section 10234.8) c.Be able to identify the provisions about replacement of long-term care insurance unnecessarily (California Insurance Code section 10234.85) d.Be able to identify the disclosure requirements for cold lead advertising (California Insurance Code sections 10234.9(c) and 10234.93(b)(3)) e.Be able to identify the provisions about suitability standards (California Insurance Code section 10234.95) i.Know the requirements to complete a LTC Insurance Personal Worksheet f.Be able to identify the provisions about replacement coverage (California Insurance Code section 10234.97(a) and (b)) i.Know the limitations on producer compensation for replaced policies
Examination sources

Life, Accident & Health or Sickness

Provider
California Department of Insurance / PSI Services LLC
Exam questions
150
Passing score
60 percent
Examination outline
  • Subjects pertaining to both life and accident and health or sickness license types
Examination sources

Agency Manager Certification Exam

Provider
Covered California
Format
Online, open book
Passing score
80 percent or better
Examination outline
  • Agency Manager Certification
Examination sources
  • Cc Manager

    Step 2 — only verified curriculum boundary

  • Cc Manager

    Step 2 — online examination, immediate result and 80-percent passing score

  • Agency Onboarding

    Page 3 — open-book examination

  • Cc Manager

    Step 2 — examination access through the named curriculum

  • Cc Manager

    Step 2 — named certification examination and passing score

Certified Insurance Agent Certification Exam

Provider
Covered California
Format
Online, open book
Passing score
80 percent or better
Examination outline
  • Covered California Certified Insurance Agent Certification Training
Examination sources
  • Cc Agent

    Step 2 — only verified curriculum boundary

  • Cc Agent

    Step 2 — online examination, immediate result and 80-percent passing score

  • Downline Onboarding

    Page 4 — open-book examination

  • Cc Agent

    Step 2 — examination access through the named curriculum

  • Cc Agent

    Step 2 — named certification examination and passing score