Ok-Life-Accident-and-Health-or-Sickness-Producer Questions and Answers

Arideris an endorsement or amendment to an insurance policy that modifies its clauses, provisions, or coverage. Riders can add, remove, or alter benefits, such as adding coverage for a specific condition or family members in life or health insurance policies. The term is standard in Oklahoma insurance law and practice.

Option A: Incorrect. An attachment is not a specific insurance term for policy modifications.

Option B: Incorrect. A supplement may refer to additional coverage but is not the standard term for policy endorsements.

Option C: Correct. A rider is an endorsement that modifies policy provisions.

Option D: Incorrect. “Add-on” is not a formal insurance term for policy modifications.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers policy endorsements.

Apreexisting conditionis defined in health insurance as a medical condition for which advice, diagnosis, care, or treatment was recommended or received within a specified period (commonly 6 months) before the effective date of coverage. In Oklahoma, group health insurance policies often include provisions limiting or excluding coverage for preexisting conditions for a certain period, as regulated by federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA).

Option A: Incorrect. An elimination period is the waiting period before benefits begin, typically in disability or long-term care policies, not related to preexisting conditions.

Option B: Incorrect. An affiliation period is a waiting period for late enrollees in HMOs under HIPAA, not tied to medical conditions.

Option C: Incorrect. A diagnosed condition is not a standard insurance term; it does not specifically denote the timeframe of prior treatment like a preexisting condition.

Option D: Correct. A preexisting condition matches the definition provided, as per Oklahoma and federal regulations.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance exclusions and limitations.

Medicare Part A covers skilled nursing facility (SNF) care for up to100 daysper benefit period, provided the patient meets eligibility criteria (e.g., a prior 3-day hospital stay and need for skilled care). Beyond 100 days, no benefits are provided, as outlined in CMS guidelines and Oklahoma’s Medicare supplement regulations (Title 36 O.S. § 6217).

Option A: Incorrect. 30 days is too short; coverage extends to 100 days.

Option B: Incorrect. 60 days is within the coverage period but not the limit.

Option C: Correct. No benefits are provided beyond 100 days in an SNF.

Option D: Incorrect. 180 days exceeds Medicare’s SNF coverage limit.

Anendowment policyis a life insurance product that pays the face amount to the insured if they are alive at the end of a specified period (maturity) or to the beneficiary if the insured dies before maturity. It combines life insurance with a savings component, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Universal life is flexible permanent insurance, not tied to a specific maturity payout.

Option B: Incorrect. Modified life has lower initial premiums, not a maturity payout feature.

Option C: Correct. An endowment policy pays the face amount at maturity if the insured is alive.

Option D: Incorrect. A juvenile trust is not a life insurance policy type; it’s a financial arrangement.

Afield underwriter, typically an insurance producer, gathers initial information from applicants to assess their insurability and ensure the application is accurate and complete. A main task is ensuring the accuracy and completeness of an individual’s medical information, as this is critical for the insurer’s underwriting decision. Field underwriters do not approve policies or edit reports to guarantee approval; they facilitate the process by providing reliable data.

Option A: Incorrect. Editing reports to ensure approval is unethical and not a field underwriter’s role.

Option B: Incorrect. Approving policies is the role of the insurer’s underwriting department, not the field underwriter.

Option C: Correct. Ensuring accuracy and completeness of medical information is a key task of a field underwriter.

Option D: Incorrect. Obtaining an MIB report is typically done by the insurer, not the field underwriter.

This question aligns with the Prometric content outline under “Underwriting,” which covers the role of field underwriters.

Suitabilityin long-term care (LTC) insurance involves assessing an individual’s financial situation, health needs, and goals to determine the appropriate coverage, ensuring the policy meets their needs without being unaffordable or excessive. Oklahoma regulations (O.A.C. 365:10-5-40) emphasize suitability to protect consumers from inappropriate LTC products.

Option A: Incorrect. Coinsurance is a cost-sharing mechanism, not about determining coverage.

Option B: Correct. Suitability ensures the LTC policy is appropriate for the individual’s needs.

Option C: Incorrect. Contestability relates to the insurer’s ability to contest claims, not coverage selection.

Option D: Incorrect. Accountability is not a term for determining coverage appropriateness.

TheHealth Insurance Portability and Accountability Act (HIPAA)includes provisions from the Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996, which mandates that group health plans cannot restrict hospital stays for childbirth to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section. This federal law applies to group health insurance plans in Oklahoma and ensures minimum coverage for maternity care.

Option A: Incorrect. COBRA allows continuation of group health coverage after certain events but does not mandate maternity stay durations.

Option B: Incorrect. Medicaid is a state-federal program for low-income individuals, not a law mandating hospital stays for childbirth.

Option C: Correct. HIPAA, via the NMHPA, guarantees the 48-hour hospital stay for regular deliveries.

Option D: Incorrect. ERISA governs employee benefit plans but does not specifically address maternity hospital stays.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers federal and state laws affecting health insurance.

Accidental death insurance(or accidental death and dismemberment, AD&D) covers death resulting from accidental bodily injury, independent of illness or intentional acts.Drowningis an example of an accidental cause of death typically covered under such policies. Exclusions often include death from illness, infections, or self-inflicted injuries, as outlined in standard policy provisions.

Option A: Incorrect. Terminal illness is a natural cause, not covered by accidental death insurance.

Option B: Correct. Drowning is an accidental cause of death, covered by AD&D policies.

Option C: Incorrect. Infections are typically excluded as they are not accidental injuries.

Option D: Incorrect. Self-inflicted wounds are intentional and excluded from coverage.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers accidental death coverage.

Medicare Advantage (Part C)plans are private health plans approved by Medicare, includingPPOs,HMOs, andPFFSplans, which provide an alternative to Original Medicare.Social Security Disability Income (SSDI)is a federal program providing income support for disabled individuals, not a Medicare Advantage plan.

Option A: Incorrect. PPO plans are a type of Medicare Advantage plan.

Option B: Incorrect. HMO plans are a type of Medicare Advantage plan.

Option C: Incorrect. PFFS plans are a type of Medicare Advantage plan.

Option D: Correct. SSDI is not a Medicare Advantage plan; it is a disability income program.

This question aligns with the Prometric content outline under “Medicare,” which covers Medicare Advantage plans.

A10-year level term life insurance policyhas a fixed premium and a fixed face amount (death benefit) for the entire 10-year term. The premium and death benefit remain constant, and there is no cash value or dividend accumulation, as term life is not a participating policy.

Option A: Incorrect. Conversion to whole life is an optional rider, not automatic at the end of the term.

Option B: Incorrect. In a level term policy, the premium does not increase during the term; it remains constant.

Option C: Incorrect. Term life policies do not pay dividends or accumulate cash value, so the face amount does not increase.

Option D: Correct. Both the premium and the $100,000 face amount remain constant for the 10-year term.

This question falls under the Prometric content outline section on “Life Products,” which covers term life insurance characteristics.

Theguaranteed insurability riderallows the insured to purchase additional life insurance at specified dates or life events (e.g., marriage, childbirth) without proving insurability, ensuring coverage despite health changes. This is a standard rider in Oklahoma (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. Guaranteed renewability applies to policy renewals, not additional coverage.

Option B: Correct. The guaranteed insurability rider allows additional insurance without underwriting.

Option C: Incorrect. A cost of living rider adjusts benefits for inflation, not additional coverage.

Option D: Incorrect. A disability income rider provides income replacement, not additional insurance.

Precertification(or preauthorization) is a process where the insurer reviews and approves certain medical treatments or procedures before they are provided, ensuring they are medically necessary and covered.Concurrent reviewoccurs during the treatment, monitoring ongoing care (e.g., hospital stays) to ensure continued necessity. The primary difference is timing: precertification happens before treatment, while concurrent review happens during treatment.

Option A: Incorrect. Both precertification and concurrent review are cost containment measures, so this is not unique to precertification.

Option B: Incorrect. Both processes involve review by the insurance company.

Option C: Incorrect. Neither typically requires patient consent beyond agreeing to the policy terms.

Option D: Correct. Precertification occurs before treatment, distinguishing it from concurrent review.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance utilization management.

Key person insuranceis a life or disability insurance policy purchased by a business to protect against financial loss due to the death or disability of a critical employee or officer (e.g., a CEO or top salesperson). The business is the policyowner and beneficiary, receiving the death benefit or disability payments to offset lost earnings or replacement costs.

Option A: Incorrect. Business continuation life typically refers to buy-sell agreements, not key person coverage.

Option B: Incorrect. Business overhead insurance covers ongoing business expenses during an owner’s disability, not key employees.

Option C: Correct. Key person insurance indemnifies a firm for losses due to a key employee’s death or disability.

Option D: Incorrect. Employee welfare plans focus on employee benefits, not indemnifying the firm for losses.

This question aligns with the Prometric content outline under “Life Products,” which covers business insurance products.

Theincontestable clause, mandated in Oklahoma (Title 36 O.S. § 4004), states that a life insurance policy cannot be contested by the insurer after it has been in force for2 yearsduring the insured’s lifetime, except for non-payment of premiums. This limits the insurer’s ability to deny claims based on application misstatements after this period.

Option A: Correct. The contestable period is 2 years.

Option B: Incorrect. 3 years exceeds the standard period.

Option C: Incorrect. 4 years is not the required timeframe.

Option D: Incorrect. 5 years is too long for the contestable period.

Under the federalUniformed Services Employment and Reemployment Rights Act (USERRA)(38 U.S.C. § 4317) and Oklahoma’s insurance regulations (Title 36 O.S. § 4405), military members whose individual health insurance lapsed due to active duty and coverage under a government-sponsored plan (e.g., TRICARE) are entitled toreinstatementof their prior policy without re-underwriting or new pre-existing condition exclusions, provided they apply within a specified period (typically 120 days) after leaving service. Joe cannot be denied reinstatement due to his military service coverage.

Option A: Incorrect. Joe is not subject to re-underwriting for reinstatement post-military service.

Option B: Incorrect. Joe does not need to be free of pre-existing conditions for reinstatement.

Option C: Correct. Joe cannot be denied reinstatement of his lapsed policy due to government plan coverage.

Option D: Incorrect. Federal government denial is irrelevant; USERRA protects reinstatement rights.

Oklahoma law (Title 36 O.S. § 6060.9), aligned with the federal Newborns’ and Mothers’ Health Protection Act (NMHPA), requires health benefit plans providing maternity coverage to offer postpartum home care for mothers and newborns if childbirth occurs at home and the mother is discharged within48 hoursfor a vaginal delivery (or 96 hours for a cesarean section).

Option A: Incorrect. 24 hours is too short for required postpartum home care.

Option B: Correct. Postpartum home care is required if discharged within 48 hours for vaginal delivery.

Option C: Incorrect. 72 hours is not the standard timeframe.

Option D: Incorrect. 96 hours applies to cesarean deliveries, not vaginal.

Ordinary life insurance, often synonymous with whole life insurance, is a type of permanent life insurance that provides coverage for the insured’s entire life, as long as premiums are paid. It typically includes a level premium, a guaranteed death benefit, and a cash value component that grows over time. It is designed to offer permanent protection with some flexibility, such as the ability to borrow against the cash value or adjust premiums in certain policies (e.g., universal life).

Option A: Incorrect. This describes term life insurance, which provides temporary protection during income-earning years. Ordinary life insurance is permanent, and cash values are not specifically “payable” during non-earning periods but can be accessed.

Option B: Incorrect. Ordinary life is not an endowment policy (which matures at a specific age) or tied directly to income levels. It is a whole life policy with level premiums.

Option C: Correct. Ordinary life insurance provides permanent protection and some flexibility (e.g., cash value loans, dividend options in participating policies) with premiums that are generally lower than other permanent products like limited-pay whole life.

Option D: Incorrect. Ordinary life is not temporary; it provides lifelong coverage. While it accumulates cash value, the protection is permanent, not limited to the policyowner’s life expectancy.

This question is part of the Prometric content outline under “Life Products,” focusing on the characteristics of ordinary (whole) life insurance.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1435.2),transacting insuranceincludes activities such as soliciting or selling insurance, engaging in preliminary negotiations for insurance contracts, and delivering insurance contracts or collecting premiums.Gathering prospective buyer information(e.g., lead generation) is not considered transacting insurance unless it involves direct solicitation or negotiation.

Option A: Incorrect (is transacting). Selling insurance is a core part of transacting insurance.

Option B: Incorrect (is transacting). Preliminary negotiations are included in transacting insurance.

Option C: Incorrect (is transacting). Delivering insurance contracts is part of transacting insurance.

Option D: Correct (is not transacting). Gathering prospective buyer information alone does not constitute transacting insurance.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers the definition of transacting insurance.

Therecurrent periods of disability provisionin a disability income policy allows related or recurring disabilities within a specified timeframe (e.g., 6 months) to be treated as a single disability period. This protects the insured from serving multipleelimination periods(the waiting period before benefits begin), ensuring faster benefit payments for recurrent conditions, as per standard disability policy provisions in Oklahoma (Title 36 O.S. § 4405).

Option A: Incorrect. The provision does not reduce premiums; it affects benefit timing.

Option B: Correct. It protects the insured from multiple elimination periods for recurrent disabilities.

Option C: Incorrect. The provision does not impact insurability; it’s a policy feature.

Option D: Incorrect. It does not reduce the disability period; it simplifies benefit access.

Backdatinga life insurance policy involves setting the policy’s effective date earlier than the current date, often to secure a lower premium based on the insured’s younger age at the earlier date. This requires the policyowner to pay premiums for the backdated period, as permitted under Oklahoma insurance practices (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. Reinstating a lapsed policy involves restoring coverage after a lapse, not changing the effective date.

Option B: Incorrect. Excluding preexisting conditions applies to health insurance, not backdating life insurance.

Option C: Incorrect. Accepting late premiums relates to the grace period, not backdating.

Option D: Correct. Backdating makes the policy effective on an earlier date.

Replacementrefers to the act of terminating an existing insurance policy and purchasing a new one, often with the same or a different insurer. This is regulated in Oklahoma under O.A.C. 365:10-3-16 to protect consumers from misleading practices, requiring disclosures and suitability assessments.

Option A: Correct. Replacement is the term for exchanging a new policy for an existing one.

Option B: Incorrect. Enhancement is not a standard insurance term for this process.

Option C: Incorrect. Conversion refers to changing a policy type (e.g., term to whole life) without replacing it.

Option D: Incorrect. Renewal extends an existing policy, not exchanges it for a new one.

This question aligns with the Prometric content outline under “Considerations in Replacing Insurance,” which covers replacement regulations.

In life insurance, aninsurable interestexists when the policyowner would suffer a financial loss or hardship from the insured’s death. Oklahoma law (Title 36 O.S. § 3604) requires insurable interest at the time the policy is purchased, typically based on a financial benefit from the insured’s continued life (e.g., spouse, business partner). Distant relationships or business ties alone are insufficient without financial dependency.

Option A: Correct. A financial benefit from the insured’s continued life establishes insurable interest.

Option B: Incorrect. A business relationship alone does not guarantee insurable interest without financial loss.

Option C: Incorrect. Distant family relationships may not qualify unless financial dependency exists.

Option D: Incorrect. Insurable interest must exist at policy purchase, not at the time of death.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers insurable interest.

Under Oklahoma law (Title 36 O.S. § 4105), for group life insurance, the insurer issues amaster policyto the group policyowner (e.g., employer). Each insured individual receives acertificate of insurance, which summarizes the coverage provided under the master policy but is not a separate policy itself.

Option A: Incorrect. An individual policy is not issued; the master policy covers the group.

Option B: Correct. A certificate is issued to each insured person under a group life policy.

Option C: Incorrect. An application is part of the enrollment process, not issued to insureds.

Option D: Incorrect. A rider modifies a policy, not issued to insured individuals.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers group life insurance provisions.

Under Oklahoma’s Standard Nonforfeiture Law (Title 36 O.S. § 4029), a whole life insurance policy in force for at least 3 years that is surrendered due to non-payment of premiums within 60 days of the due date entitles the policyowner to acash surrender value, provided sufficient cash value has accumulated. This is one of the nonforfeiture options, alongside extended term or reduced paid-up insurance.

Option A: Correct. The insurer pays a cash surrender value upon surrender.

Option B: Incorrect. The grace period (typically 31 days) cannot be extended beyond policy terms.

Option C: Incorrect. Reimbursing all premiums is not a nonforfeiture option.

Option D: Incorrect. Refunding the premium is not applicable; cash value is paid.

The clerical error provision in group health insurance policies is designed to protect employees from losing coverage due to administrative mistakes made by the employer or insurer. According to Oklahoma insurance regulations and standard group health insurance practices, if a clerical error results in an employee not being enrolled, the provision allows the error to be corrected by retroactively enrolling the employee, provided any past due premiums are paid. This ensures the employee is insured as if the error had not occurred, covering any claims that would have been eligible during the period of the error.

The Oklahoma Life, Accident, and Health or Sickness Producer Study Guide specifies that under the clerical error provision, "an employee who was eligible for coverage but was not enrolled due to an administrative error can be retroactively enrolled upon correction of the error, with coverage effective from the original eligibility date, provided all required premiums are paid." This aligns with option C, which states the employee will be allowed to submit an enrollment form and all past due premiums, and will be retroactively insured.

Rebatingis the practice of offering or returning part of a commission, premium, or anything of value to an insured as an inducement to purchase an insurance policy. It is prohibited in Oklahoma under the Unfair Trade Practices Act (Title 36 O.S. § 1204) to ensure fair competition and prevent undue influence.

Option A: Incorrect. Coercion involves forcing someone to buy insurance, not offering inducements.

Option B: Incorrect. Defamation is making false statements harming reputation, not related to inducements.

Option C: Correct. Rebating involves giving value to induce a policy purchase.

Option D: Incorrect. Controlled business refers to writing insurance primarily for oneself or close associates, not inducements.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers unfair trade practices.

TheFair Credit Reporting Act (FCRA)(15 U.S.C. § 1681) defines aconsumer reportas information communicated by a consumer reporting agency that bears on a consumer’s creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, used to determine eligibility for credit, insurance, or employment. This is relevant in insurance underwriting for consumer reports.

Option A: Incorrect. Information among related entities is not a consumer report.

Option B: Incorrect. Transaction reports between the consumer and the reporter are excluded from the FCRA definition.

Option C: Correct. A consumer report includes information on credit standing and personal characteristics from a reporting agency.

Option D: Incorrect. Credit card authorizations are not consumer reports under FCRA.

Aninsuredis the person covered by an accident and health insurance policy and entitled to reimbursement for covered health care expenses, as defined in Oklahoma’s Insurance Code (Title 36 O.S. § 4401). The insured (or their assignee, e.g., a provider) receives benefits for services like medical treatments or hospital stays.

Option A: Incorrect. An insurer is the company issuing the policy, not receiving reimbursement.

Option B: Correct. The insured is entitled to reimbursement for covered health care expenses.

Option C: Incorrect. A practitioner provides services, not receives policy reimbursements.

Option D: Incorrect. A PPO is a network of providers, not an individual entitled to benefits.

Thecoordination of benefits (COB)provision, regulated in Oklahoma (O.A.C. 365:10-5-4), prevents overinsurance by establishing which group health plan isprimary(pays first) and which issecondary(pays remaining covered expenses) when an insured is covered by multiple plans. This ensures claims are paid efficiently without exceeding the total expense. While COB includes rules for dependent children (e.g., the “birthday rule”), its primary purpose is broader, covering all dual-coverage scenarios.

Option A: Incorrect. COB focuses on payment allocation, not ensuring treatment.

Option B: Correct. COB determines payment responsibilities between primary and secondary insurers.

Option C: Incorrect. Determining dependent coverage is a subset of COB, not its primary purpose.

Option D: Incorrect. COB does not protect secondary insurers from paying; it defines their payment role.

Amutual insurance company, as defined in Oklahoma’s Insurance Code (Title 36 O.S. § 105), is owned by its policyholders, not shareholders. Ownership is evidenced byownership of a policy, as policyholders share in the company’s profits through dividends (in participating policies) and have voting rights in the company’s governance.

Option A: Incorrect. Mutual insurers do not issue stock; stock ownership applies to stock insurers.

Option B: Incorrect. Bonds represent debt, not ownership, in any company.

Option C: Correct. Ownership in a mutual insurer is evidenced by holding a policy.

Option D: Incorrect. A certificate of deposit is a banking product, not related to insurer ownership.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers types of insurers and their ownership structures.

Anextension of benefitsprovision in health insurance allows a policyholder to continue receiving benefits for a covered condition (e.g., disability or hospitalization) after the policy terminates, typically if the condition began while the policy was in force. This is a standard provision in group and individual health insurance policies in Oklahoma, ensuring continuity of care for specific circumstances.

Option A: Incorrect. A qualifying event relates to COBRA or other continuation coverage triggers, not post-termination benefits.

Option B: Incorrect. Duration of coverage refers to the policy term, not benefits after termination.

Option C: Correct. Extension of benefits allows benefits to continue after policy termination.

Option D: Incorrect. A notification statement is unrelated to benefit continuation.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance benefit provisions.

TheOklahoma Life and Health Insurance Guaranty Association, established under Title 36 O.S. § 2025 et seq., protects policyowners of admitted insurers in Oklahoma if the insurer becomesfinancially insolvent. The association provides coverage up to statutory limits (e.g., $300,000 for life insurance death benefits, $100,000 for cash value) to ensure policyholders receive benefits despite the insurer’s insolvency.

Option A: Incorrect. A merger with a foreign insurer does not trigger Guaranty Association protection unless it leads to insolvency.

Option B: Correct. The Guaranty Association protects policyowners when an admitted insurer becomes financially insolvent.

Option C: Incorrect. Failure to meet capital surplus requirements may lead to regulatory action but does not directly trigger Guaranty Association coverage.

Option D: Incorrect. Depleting loss reserves is a financial issue but not the specific condition for Guaranty Association intervention, which requires insolvency.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which includes knowledge of the Guaranty Association.

In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO’s cost-containment model.

Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.

Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.

Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.

Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers HMO structures and strategies.

In group medical insurance, themaster policyis the single contract issued to the employer or group sponsor (e.g., a trust or association) that outlines the terms, conditions, and coverage for the entire group. Individual employees receivecertificates of insurance, which summarize their coverage under the master policy but are not the contract itself.

Option A: Correct. The master policy is the contract issued to the employer for group medical insurance.

Option B: Incorrect. “Employer policy” is not a standard insurance term.

Option C: Incorrect. A certificate policy refers to the document given to individuals, not the group contract.

Option D: Incorrect. “Conglomerate policy” is not a recognized term in insurance.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers group health insurance structures.

Oklahoma requires insurance producers and adjusters to complete24 hours of continuing education (CE)every 2 years for license renewal, including 3 hours of ethics and 2 hours of legislative updates, as specified in Title 36 O.S. § 1435.29 and O.A.C. 365:25-3-1.

Option A: Incorrect. 12 hours annually is not the requirement.

Option B: Incorrect. 18 hours every 2 years is insufficient.

Option C: Correct. 24 hours every 2 years is the CE requirement.

Option D: Incorrect. 26 hours every 3 years is not the standard.

Under Oklahoma insurance law and standard group life insurance provisions, a group life policy includes a mandatory grace period of 31 days for the payment of premiums (except the first premium, which must be paid to initiate coverage). During this grace period, the policy remains in force, and the full death benefit is payable if the insured dies, provided the premium is eventually paid or the policy has not lapsed.

Option A: Incorrect. Coverage is not discontinued during the grace period; it continues to protect the insured.

Option B: Incorrect. The death benefit is not reduced to 50% during the grace period; it remains at 100% of the policy’s face amount.

Option C: Correct. The death benefit coverage continues in force during the 31-day grace period, as mandated by Oklahoma law.

Option D: Incorrect. The death benefit is not reduced to 75%; it remains fully in effect.

This provision is outlined in Oklahoma statutes and aligns with the Prometric exam content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which includes knowledge of grace periods in group life policies.

Selling fake insurance policies and misappropriating premiums is a fraudulent act under Oklahoma’s Insurance Code (Title 36 O.S. § 1204, § 1435.13), classified as a felony. TheOklahoma Insurance Department Anti-Fraud Unitinvestigates insurance fraud, theOklahoma State Bureau of Investigationhandles criminal investigations, and theOklahoma Attorney Generalmay prosecute or oversee legal actions. TheSecurities Exchange Commission (SEC)regulates securities markets, not insurance fraud, unless securities are involved (which is not indicated here).

Option A: Incorrect. The Attorney General may be involved in prosecution.

Option B: Incorrect. The State Bureau of Investigation handles criminal fraud cases.

Option C: Incorrect. The Anti-Fraud Unit directly investigates insurance fraud.

Option D: Correct. The SEC is not typically involved in insurance fraud investigations.

Health Maintenance Organizations (HMOs) focus on preventive and essential medical care within a network.Adult routine eye examinationsare often excluded from HMO coverage, as they are considered non-essential or covered under separate vision plans. Other services like emergency care, physical exams, and surgeries are typically covered, as per Oklahoma’s managed care regulations (Title 36 O.S. § 652 et seq.).

Option A: Incorrect. Out-of-area emergency services are generally covered by HMOs.

Option B: Correct. Adult routine eye examinations are often excluded or require separate coverage.

Option C: Incorrect. Physical examinations are typically covered as preventive care.

Option D: Incorrect. In-patient surgeries are covered as essential medical services.

Aper cause deductiblemeans the insured pays a $100 deductible for each separate medical condition or cause of treatment. The insured visits the doctor three times for injuries, each costing $200. Assuming each visit is for adifferent injury(to calculate the minimum amount, we consider the maximum number of deductibles), the insured pays a $100 deductible per visit (3 visits × $100 = $300). If the policy includes coinsurance (not specified but common in major medical policies), additional costs may apply, but the question asks for theminimum amount, which is the total deductibles for three separate causes.

Calculation:

Visit 1: $100 deductible (first injury).

Visit 2: $100 deductible (second injury).

Visit 3: $100 deductible (third injury).

Total: $100 × 3 = $300.

If all visits were for the same injury, only one $100 deductible would apply, but the question implies separate causes to reach the minimum of $300.

Option A: Incorrect. $100 assumes one deductible for a single cause, not three visits.

Option B: Incorrect. $200 does not account for three separate deductibles.

Option C: Correct. $300 reflects a $100 deductible for each of three separate injuries.

Option D: Incorrect. $500 exceeds the minimum, possibly including coinsurance not specified.

Thecontestable periodfor a life insurance policy in Oklahoma, as mandated by Title 36 O.S. § 4004, is24 months(2 years) from the policy’s issuance. During this period, the insurer can contest the policy’s validity based on material misrepresentations in the application (e.g., health or lifestyle). After 2 years, the policy becomes incontestable except for non-payment of premiums or fraud in some cases.

Option A: Incorrect. 6 months is too short for the contestable period.

Option B: Incorrect. 12 months is insufficient; the standard is 24 months.

Option C: Correct. The contestable period is 24 months.

Option D: Incorrect. 36 months exceeds the standard period.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers the incontestability provision.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1250.4), upon receiving notice of a claim, an insurer must furnish the claimant with forms for filing proof of loss within15 days. This ensures timely processing of claims and compliance with fair claims settlement practices.

Option A: Incorrect. 10 days is not the required timeframe.

Option B: Correct. Insurers must provide forms within 15 days.

Option C: Incorrect. 20 days exceeds the statutory requirement.

Option D: Incorrect. 30 days is too long under Oklahoma law.