Virginia-Life-Annuities-and-Health-Insurance Questions and Answers

The "Usual, Customary, and Reasonable" (UCR) charges method is used to address geographical variation in medical costs. Under this method, the insurer will pay the amount based on what is considered usual and customary for a particular region or area. This ensures that payments reflect regional variations in healthcare pricing, making it more adaptable to different areas. Fee schedules apply fixed amounts for services, experience rating relates to group insurance, and capitation involves paying a set fee per person for services rendered.

Single premium whole life insurance is funded with one lump-sum premium that immediately creates both cash value and nonforfeiture value. Because the entire premium is paid upfront, a significant portion is allocated to the policy reserve, making options A, B, and C correct.

Whole life insurance has fixed premiums by definition. Once the single premium is paid, no additional premiums are required, regardless of inflation or economic conditions. Therefore, option D is incorrect and is the correct “EXCEPT” answer.

Virginia exam materials emphasize that whole life policies provide guaranteed premiums, guaranteed death benefits, and guaranteed cash value growth, which distinguishes them from flexible or adjustable policies.

Detailed Answer in Step-by-Step Solution:

False advertising includes exaggerating dividends (A), misrepresenting benefits (B), or claiming a policy is a stock (C), all deceptive practices.

Comparing benefits with a competitor (D) is permissible if accurate and not misleading, thus not inherently false advertising.

The Virginia study guide, per state law, prohibits deceptive advertising but allows factual comparisons with competitors, provided they are truthful. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Unfair Trade Practices."

Universal life insurance provides flexible premiums, adjustable death benefits, and transparent monthly deductions for mortality and expenses. Death benefits paid to beneficiaries are generally income-tax free, making option C incorrect.

Mortality charges and expense charges are deducted monthly from the cash value, and policy loans reduce the cash value, which can affect interest credited. These features align with Virginia exam standards.

Because death benefits are not taxed as ordinary income, option C is the correct EXCEPT answer.

The misstatement of age provision is a required standard provision. If age was misstated, the insurer adjusts the death benefit to the amount the paid premium would have purchased at the correct age, rather than canceling the policy.

Exact Extract (Virginia Policy Provisions): “In case of misstatement of age, the amount payable shall be adjusted to what the premium would have purchased at the correct age.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3108 (Misstatement of age provision in life insurance)

A joint and survivor annuity is designed to provide income for two people, typically spouses, and payments continue until both annuitants have died. This feature makes it especially suitable for retirement planning when ongoing income is needed for a surviving spouse.

When the first annuitant dies, payments continue to the survivor, often at the same or a reduced level depending on the contract terms. Only after the second annuitant’s death do payments cease. Therefore, option A is correct.

Options B, C, and D incorrectly describe other annuity structures. Beneficiaries are generally relevant only if a refund or period-certain option applies. Joint and survivor annuities are a core topic in Virginia annuity education because of their longevity risk protection.

Twisting occurs when an agent uses misleading or incomplete comparisons to persuade a policyowner to lapse, surrender, or replace an existing insurance policy with a new one. This practice is unethical and prohibited because it may result in the consumer losing valuable benefits such as cash values, favorable policy provisions, or lower premiums. Rebating involves offering something of value not stated in the policy. Coercion involves force or threats. Defamation concerns false statements damaging another’s reputation. Since the agent is encouraging replacement through misleading comparisons, the act is twisting.

Term life insurance provides coverage for a specified period of time and is designed to offer pure death benefit protection without a savings or investment component. One of its defining characteristics is that it does not accumulate cash value. Term policies offer temporary protection and may have level or decreasing face amounts, depending on the policy design. They are also known for having a low initial cost compared to permanent life insurance, making them attractive for short-term needs such as income replacement or debt coverage. Because term life insurance does not build cash value, there is no opportunity for increasing cash values over time. Therefore, increasing cash values is not a characteristic of term life insurance and is the correct exception.

Whole life contracts guarantee cash values, nonforfeiture options, loan values, and settlement values. Dividends are not guaranteed because they depend on company performance.

Exact Extract (Virginia Life Insurance Study Guide): “Whole life policies provide guaranteed cash values, policy loans, and settlement options. Dividends, if declared, are not guaranteed.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Policy Provisions and Guarantees

The "benefit period" in a long-term care insurance policy refers to the length of time over which the insurer will pay benefits for covered services. This period can vary depending on the terms of the policy, and it typically starts when the policyholder begins receiving care and continues for a specified duration or until the benefit limit is exhausted. The other options, such as the hospitalization period or recovery period, do not relate to the time claims are paid under long-term care policies.

Detailed Answer in Step-by-Step Solution:

A trustee-to-trustee transfer (A) avoids the 20% mandatory tax withholding required when funds are distributed to the participant and rolled over within 60 days.

Options B (lost funds) and C (time) are incidental, not primary benefits. Option D (penalty tax) is irrelevant; rollovers aren’t penalized if timely.

The Virginia study guide, per IRS rules, notes that direct trustee-to-trustee transfers bypass withholding, preserving the full amount for reinvestment. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Retirement Plans."

When underwriting group health, insurers consider the group’s stability, demographics, and industry risk. Persistency (how long the employer has had coverage) is important for business retention but is not directly a health risk factor.

Exact Extract (Virginia Group Insurance Study Guide): “Underwriting group health considers stability, composition, and industry. Persistency of a contract relates to retention, not health risk.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Group Underwriting Factors

Rebating is an unfair trade practice where an agent offers a portion of their commission or any other inducement to encourage the insured to purchase a policy. This is considered illegal because it could mislead the buyer into making a purchase based on incentives rather than the suitability of the policy for their needs.

Insurers may set limits on the amount of benefits an insured can collect from two disability policies with the same insurer. This is done to prevent malingering and false claims, ensuring that the insured does not receive more than their actual income loss or disability benefits. Insurance companies may also impose coordination of benefits provisions, but they would not typically refuse claims for cancer, heart disease, or similar conditions unless specifically excluded in the policy.

The agent’s report on an individual health insurance application typically includes details such as the agent’s relationship to the applicant, the applicant’s financial status, and the applicant’s general character. However, the applicant’s signature is not part of the agent’s report; it is part of the application itself. The signature is required from the applicant as a formal agreement to the terms of the policy and to verify the accuracy of the provided information.

Before an applicant is tested for HIV, they must sign a consent form that acknowledges their understanding of the test and the potential implications of the results. This is required by law to ensure that the test is done voluntarily and that the applicant is aware of their rights. The other options, such as paying for the test or providing evidence of insurability, are not required before HIV testing.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for qualified long-term care insurance are treated as a business expense and are tax-deductible for the employer (B), provided the plan meets IRS requirements.

These premiums are not included in the employee’s gross income (A), as they are tax-exempt benefits under IRC Section 106.

Employees cannot deduct these premiums (C) since they are employer-paid.

Reimbursement (D) does not apply.

The Virginia study guide, aligned with IRS rules, notes that employer-paid premiums for qualified long-term care insurance are deductible as a business expense and excluded from employees’ taxable income. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

For individuals with end-stage renal disease (ESRD), employer group coverage is primary for the first 30 months of treatment, even if the individual also qualifies for Medicare. After 30 months, Medicare becomes primary. Exact extract: “Employer group health plans are primary for 30 months for ESRD patients; thereafter Medicare assumes primary responsibility.”

A SPDA is funded with a single lump sum payment. The payout (distribution) begins at a later date, not immediately, and withdrawals are taxable.

Exact Extract (Virginia Annuities Study Guide): “Single Premium Deferred Annuity—funded with a single lump-sum payment; benefits begin at a future date.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Types of Annuities

Virginia insurance regulations require insurers and agents to protect consumer privacy while also allowing insureds access to their personal information. When an insured submits a written request to review personal information collected by the insurer or agent, the request must be addressed within 45 business days. This timeframe ensures consumers have reasonable access to their records while allowing insurers sufficient time to retrieve and verify the information. The regulation balances consumer rights with administrative practicality. Shorter or longer timeframes are not consistent with Virginia insurance privacy requirements, making 45 business days the correct response.

Adjustable life allows policyholders to adjust face amount, premium, or coverage period. Increases in coverage may require proof of insurability. Exact extract: “Adjustable life permits increases in coverage, subject to evidence of insurability.”

Custodial care is non-medical assistance with daily living activities, requiring no professional medical training. Rehabilitative, therapeutic, and intermediate care require licensed or trained personnel. Exact extract: “Custodial care provides assistance with daily living activities and does not require medical skills.”

Detailed Answer in Step-by-Step Solution:

Disability income policies exclude benefits for intentional self-inflicted injuries (B) to prevent abuse or fraud.

Permanent injuries (A), sporting accidents (C), and falls (D) are typically covered unless specifically excluded by the policy.

The Virginia study guide states that disability income insurance excludes self-inflicted injuries as a standard provision to ensure coverage applies to unforeseen events. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."

Virginia small-group medical insurance disclosure rules require insurers to inform policyholders of renewability provisions, available benefits, and rights related to premium rate increases. However, insurers are not required to disclose their business operating expenses. Exact extract: “At the request of the policyholder, the insurer shall disclose the insurer’s right to increase premium rates, the renewability provisions, and all available benefits.”

Detailed Answer in Step-by-Step Solution:

The grace period in a life insurance policy (typically 30 or 31 days) allows the policy to remain in force even if the premium is unpaid, provided the insured dies during this period.

If death occurs during the grace period, the insurer must pay the full death benefit (face amount), minus any unpaid premium, but only if explicitly stated. In this question, no indebtedness or dividends complicate the scenario, and standard practice assumes full payment unless otherwise specified.

Option B (cash value) applies to surrender, not death claims.

Option C (face amount less premium due) is a possibility in some policies, but absent specific policy language here, the default is full payment.

Option D (nonforfeiture provisions) applies if the policy lapses, not during the grace period.

Thus, the insurer pays the face amount (A).

The Virginia study guide states that the grace period provision protects the policyholder by keeping coverage active for a short period after a missed premium, and upon death during this time, the full face amount is payable unless loans or specific deductions apply. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Standard Policy Provisions - Grace Period."

If an individual’s occupation is considered illegal, it may result in a denial of a disability income claim. Insurance companies generally do not cover risks associated with illegal activities or occupations, as these are deemed outside the scope of insurable risks. Such an occupation could lead to the insurer refusing to pay claims related to disabilities arising from that illegal activity.

Virginia Code § 38.2-3431 et seq., aligned with the ACA, requires small employer health plans (1-50 employees) to offer coverage to all eligible employees who apply, without discrimination based on health status or other factors. “Eligible” typically means full-time employees meeting the employer’s criteria (e.g., 30+ hours/week). Option A reflects this guaranteed issue mandate, ensuring broad access. Option B (12-month waiting period) is false; Virginia and federal law cap waiting periods at 90 days (Virginia Code § 38.2-3445), not 12 months. Option C (evidence of insurability) contradicts guaranteed issue rules for small groups, which prohibit medical underwriting. Option D (under age 65) is incorrect; coverage extends to all eligible employees regardless of age, though Medicare coordination may apply post-65. The study guide likely stresses this inclusivity as a cornerstone of small group market reforms, making A the correct answer.

Common life insurance nonforfeiture options include extended term insurance, reduced paid-up insurance, and cash surrender value. These options allow policyholders to access some of the policy’s value if they decide to stop paying premiums or surrender the policy. A life income annuity is not a nonforfeiture option; rather, it is a type of annuity that provides periodic payments for the annuitant's lifetime.

In Virginia, an insurance agent’s license remains active for 30 calendar days without an appointment. During this period, the agent may not transact insurance business until an appointment is in place.

Appointments link the agent to an insurer and authorize the agent to act on the insurer’s behalf. Virginia regulations require insurers to file appointments promptly, and failure to secure an appointment within the allowed timeframe may result in license inactivity.

This rule ensures regulatory oversight and consumer protection by confirming that agents operate only under authorized insurer relationships.

A juvenile life insurance policy is a life insurance policy that insures the life of a minor (a child). These policies are typically purchased by a parent or guardian, and the intent is to provide coverage for the child at a young age. These policies are not limited to children under five years old, nor are they necessarily available only as decreasing term insurance.

For an insurance policy to be legally binding, four essential elements must exist: (1) offer and acceptance, (2) consideration, (3) competent parties, and (4) legal purpose. Consideration refers to the exchange of value: the applicant’s premium and representations in the application, and the insurer’s promise to pay benefits. Exact extract: “Consideration is the value each party gives to the other: the insured provides premiums and truthful statements, while the insurer provides the promise of benefits.” Without consideration, a contract cannot be enforced.

A five-year annuity certain provides guaranteed payments for a specific period (in this case, five years). If the annuitant dies before the end of the five-year period, the beneficiary will receive the remaining payments for the balance of the five years. This ensures the payment duration regardless of the annuitant’s death.

A simplified employee pension (SEP) plan is a retirement plan that allows employers to make tax-deductible contributions to individual retirement accounts established for employees. Under IRS regulations, employer contributions to a SEP plan are limited to a maximum of 25% of an employee’s compensation, subject to an overall annual dollar limit. SEP plans are popular among small businesses because they are easy to establish and administer and have minimal reporting requirements. Contributions are made solely by the employer, not the employee, and must be allocated using the same percentage of compensation for all eligible employees. The exam tests the maximum allowable percentage of pay, which is 25%.

An insurance agent’s overall authority is typically classified as implied authority. This refers to the powers that are not explicitly stated in the agent's contract but are understood to be part of the agent's role in conducting business. Implied authority includes activities such as explaining policy details to clients and collecting premiums. "Imposed" and "residual" authorities are not common terms in the insurance industry, while "absolute authority" is typically reserved for higher-level management or organizational authority.

A second surgical opinion provision in health insurance policies typically requires the insured to seek a second opinion before undergoing certain elective surgeries. This provision is meant to ensure that the surgery is medically necessary and that there are no alternative treatments. The cost of the second opinion may or may not be covered depending on the policy, but the key requirement is that a second opinion must be obtained for elective procedures.

The insurance with other insurers provision prevents over-insurance and duplication of benefits by allowing insurers to coordinate coverage. If an insured has multiple policies with different insurers and fails to notify, each insurer will pay only a proportionate share of the claim.

Exact Extract (Virginia Health Policy Provisions): “If the insurer was not notified that the insured has other valid coverage, benefits will be prorated to prevent duplication.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Required Policy Provisions

When an HIV test is requested by a health insurer, the applicant must sign the consent form. This ensures that the insured is aware of the test and agrees to its administration. The insurance agent, physician, or medical laboratory technician are not required to sign the consent, though they may be involved in administering or facilitating the test.

Indemnity dental insurance plans generally cover treatments directly related to dental health, such as fillings, root canal treatments, extractions, and certain preventive treatments like fluoride treatments for children under 16. However, dietary counseling and instructions are typically not covered under indemnity dental plans as they fall outside the scope of dental treatment.

A major medical policy is designed as a comprehensive health policy, covering a wide range of expenses, including hospital, surgical, physician, and prescription costs. It provides broader coverage than limited benefit plans such as dental or vision policies. Workers’ compensation is not considered a general health policy because it specifically covers occupational injuries.

Exact Extract (Virginia Health Insurance Study Guide): “Major medical insurance—provides comprehensive coverage for hospital, physician, surgical, and other medical expenses, subject to deductibles and coinsurance. Distinguished from limited health expense policies (dental, vision).”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Section 2.2 Comprehensive vs. Limited Policies

Virginia requires life insurance policies to include an incontestability provision stating that, after the policy has been in force during the insured’s lifetime for two years from the date of issue, the insurer cannot contest the policy’s validity (with the key exception of nonpayment of premiums). This is exactly what the question describes: a clause that limits the insurer’s ability to challenge the policy after a defined time period, providing stability and protection to policyowners and beneficiaries.

The other clauses serve different purposes. The entire contract clause identifies what documents make up the contract (typically the policy and attached application), but it does not bar contestability after a time period. Guaranteed renewable and noncancelable are health insurance concepts that address renewal rights and premium stability, not the life policy’s contestability window. The incontestability clause is also closely tied to representations/misrepresentations and underwriting: the insurer has a limited time to investigate and rescind for material misstatements, after which the policy becomes “incontestable” under Virginia statute (again, except for premium nonpayment and certain limited exceptions allowed by law).

Detailed Answer in Step-by-Step Solution:

Agents must notify the Virginia Bureau of Insurance (A) of changes like discontinuing an assumed name, as it regulates licensing and business conduct.

The NAIC (B), Chamber (C), and Surety Organization (D) have no direct authority over this requirement.

The Virginia study guide mandates that agents report significant business changes, including assumed name cessation, to the Bureau of Insurance per state law. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Agent Responsibilities."

The incontestability clause in health insurance policies generally provides that after two years from the date of issue, the insurer cannot deny a claim or void coverage due to material misrepresentation in the application, except in cases of fraud. This ensures that policyholders have long-term protection from policy rescission due to innocent mistakes.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for group health plans like major medical (B), dental (C), and HMOs (D) result in tax-free benefits under IRC Section 106.

Disability income (A) benefits are taxable if the employer pays the premium, per IRS rules, unlike medical benefits.

The Virginia study guide, aligned with IRS regulations, notes that employer-funded disability income benefits are taxable to the recipient, while medical, dental, and HMO benefits remain tax-free. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

Health Maintenance Organizations (HMOs) in Virginia, per Virginia Code § 38.2-4306, emphasize preventive care to reduce long-term costs. Preventive services, as defined in the study guide and aligned with ACA standards, include childhood immunizations (option C), such as vaccines for measles or polio, offered at no cost to members. Option A (rehabilitation therapy) is restorative, not preventive, addressing existing conditions. Option B (treatment for alcoholism) is a treatment service, not prevention, though HMOs cover it separately. Option D (home health services) supports recovery or chronic care, not primary prevention. The study guide likely lists immunizations as a core preventive benefit, contrasting them with treatment-oriented services, confirming C as the correct answer.

The notice of claim is the first step in initiating a health insurance claim. The insured must provide this notice to the insurer within the time limit specified in the policy, or as soon thereafter as reasonably possible. This notice typically includes basic information about the claim, and additional documentation, such as medical bills or a physician's diagnosis, may be required later in the process.

In Virginia law and standard insurance terminology, the period during which a new employee must wait before becoming eligible for group health insurance is called a probationary period.

The Code of Virginia defines a “waiting period” as the length of time that must pass before an individual becomes eligible for coverage under a group plan. By law, this waiting period cannot exceed 90 days.

Virginia regulations further distinguish between two types of waiting times:

The eligibility waiting period imposed by an employer before coverage begins (commonly referred to in industry study materials as the probationary period).

A policy’s internal waiting period during which no benefits are provided after coverage becomes effective.

Additionally, Virginia’s insurance replacement regulations explicitly reference “probationary periods” when describing limitations or exclusions related to preexisting conditions. This confirms that the industry-standard term used in exam and licensing study guides for this eligibility wait is probationary period.

References (Virginia official documents and study materials):

Code of Virginia § 38.2-3431 (Definitions — “Waiting period”)

Code of Virginia § 38.2-3452 (Limitation — 90-day maximum waiting period for group health plans)

14VAC5-141-20 (Definitions — distinguishes employer eligibility waiting period from policy waiting period)

14VAC5-200-110 (Replacement notice — references to “probationary periods”)

Detailed Answer in Step-by-Step Solution:

In health insurance, the "entire contract" refers to all the documents that collectively form the legal agreement between the insurer and the policyholder.

This includes the insurance policy itself (the main document outlining coverage), any endorsements (modifications or additions to the policy), and attached papers such as the application (if attached).

The completed application (A) is part of the contract only if attached, but it alone does not constitute the entire contract.

Uniform mandatory policy provisions (C) are specific clauses required by law within the policy, not the whole contract.

Notice of coverage (D) is a notification, not the contract itself.

Therefore, the correct answer is "entire contract."

The concept of the "entire contract" is a standard provision in health and life insurance policies. Per the Virginia insurance study guide, the entire contract clause ensures that all terms and conditions are contained within the policy, endorsements, and attached documents (like the application), protecting both parties by defining the full scope of the agreement. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Policy Provisions and Contracts."

Under the paid-up life insurance nonforfeiture option, the policy’s cash value is used to purchase a reduced amount of fully paid-up whole life insurance. Because no further premiums are due, the face amount is less than the original policy, making option C correct.

Term insurance is associated with the extended term option, not paid-up insurance. Riders such as accidental death benefits typically terminate at lapse.

Virginia exam materials emphasize reduced paid-up insurance as a permanent solution that preserves lifetime coverage at a lower death benefit.

In insurance contract law, per Virginia Code § 38.2-102, a contract requires consideration—something of value exchanged to make it legally binding. Option C (consideration) fits this definition: the insured’s premium payment and the insurer’s promise of coverage form the mutual value. Option A (grant) implies a unilateral transfer, not a contract element. Option B (codicil) is a will amendment, irrelevant to insurance contracts. Option D (covenant) is a promise within a contract, not the value exchanged. The study guide likely explains consideration as a foundational principle, using examples like a $500 premium for a $100,000 policy, distinguishing it from other legal terms. Virginia follows common law requiring consideration for enforceability, making C the precise answer.

The Medical Information Bureau (MIB) is an organization whose members are insurance companies, primarily life and health insurers. Its purpose is to help insurers detect misrepresentation and fraud during underwriting by sharing coded medical and application history data.

Consumers, agents, and physicians are not members of MIB. However, consumers have rights to access and correct their MIB records under privacy laws.

Virginia exam content emphasizes the role of MIB in underwriting accuracy and risk management while also stressing consumer privacy protections and disclosure requirements.

Consideration in health insurance is the combination of the initial premium payment and the application submitted by the insured. Exact extract: “The consideration clause states that the policy is issued in exchange for the application and payment of the first premium.” This reflects the legal exchange of value between the insured and the insurer.

Detailed Answer in Step-by-Step Solution:

Medicare Part B eligibility generally requires enrollment in or eligibility for Part A (B), which covers hospital insurance and is tied to age (65+) or disability status, not just retirement (A) or insurability (C).

"Fully insured" under Social Security (D) relates to benefits but isn’t a direct Part B requirement.

The Virginia study guide states that Medicare Part B is available to those eligible for Part A, typically U.S. citizens or residents aged 65 or disabled, regardless of other factors. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Eligibility."

Virginia life insurance law follows the principle of rate equity within underwriting classes. Insurers are permitted to classify applicants based on factors such as age, health, lifestyle, and risk characteristics, but once individuals are placed in the same underwriting class with equal life expectancy, they must be charged the same premium rate. This ensures fairness and prevents unfair discrimination.

Age alone is not sufficient because two individuals of the same age may have very different health profiles and mortality risks. Occupation and income may influence underwriting but do not independently mandate identical rates. Virginia regulations emphasize actuarial justification and prohibit unfair discrimination while allowing reasonable risk classification. Therefore, option A correctly reflects the legal standard.

An insurer that operates in the United States but is headquartered outside of the U.S. is referred to as an "alien insurer." These insurers are typically subject to the same regulations as domestic insurers operating within the U.S. but are considered "alien" because they are based in a foreign country. A "foreign insurer," by contrast, is one that is incorporated in a different state but operates within the same country. Captive insurers are typically created by a single company to insure its own risks, and a reciprocal insurance exchange involves a group of individuals or companies insuring each other.

An application for individual health insurance must be in writing and becomes part of the insurance contract. The information provided in the application, along with any attachments, helps form the basis of the policy. If any statements or answers in the application are found to be false or misrepresented, the insurer may have grounds for denying a claim.

Virginia Code § 38.2-4303 defines the HMO model, where the primary care physician (PCP, option A) acts as the gatekeeper, delivering preventive (e.g., vaccines) and routine care (e.g., checkups), and coordinating referrals. Option B (medical director) oversees HMO operations, not direct care. Option C (routine care physician) isn’t a standard term; the PCP fills this role. Option D (provider association) might imply a network, but care comes from the individual PCP, not a collective. The study guide likely explains the PCP’s central role with examples—e.g., a member seeing their PCP for a flu shot—highlighting HMO cost-control via this structure, making A the correct provider.

The concept of "reasonable expectations" states that the insured is entitled to the coverage under a policy that a sensible and prudent buyer would expect it to provide. This means that the insurer must honor the expectations of the insured based on the policy's terms, even if the wording is unclear or ambiguous, as long as those expectations are reasonable.

To qualify for group life insurance, the group must meet certain minimum size requirements, as defined by the insurance provider or state regulations. This ensures that the group is large enough to spread the risk of insuring multiple individuals. Coverage for part-time employees and dependents is not typically mandatory, and new employees do not generally need to provide proof of insurability for group coverage.

Tax-sheltered annuities (TSAs), per IRC § 403(b) and Virginia Code § 38.2-3100 et seq., are retirement plans for nonprofit employees. Option A is true; they’re synonymous with 403(b) plans. Option B is true; contributions often come from voluntary salary reductions, tax-deferred until withdrawal. Option C is true; participants can have individual contracts or accounts. Option D is false; investment gains are tax-deferred, not included in gross income annually, only taxed upon distribution. The study guide highlights TSAs’ tax advantages, making D the incorrect statement.

A joint life annuity pays benefits to two annuitants during their lifetimes, but terminates entirely upon the first death. Exact extract: “Joint life annuities provide income until the death of the first annuitant; no further payments are made thereafter.”

Medicare Part A typically covers skilled nursing facility care, which includes care provided in a facility for patients who require skilled care following a hospitalization. However, Medicare Part A does not cover intermediate or custodial care, which involves assistance with activities of daily living or care provided in a non-skilled nursing facility.

Under required uniform provisions, once an insurer receives notice of claim, it must provide claim forms to the insured within a specified period (usually 15 days). If forms are not provided, the claimant may submit proof of loss in any reasonable written form.

Exact Extract (Virginia Uniform Policy Provisions): “Upon receipt of notice of claim, the insurer shall furnish the claimant forms for filing proof of loss.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3514 (Uniform accident and sickness provisions – Notice and claim forms)

Twisting is an unfair trade practice that involves persuading an insured, to the insured's detriment, to switch policies. This practice usually occurs when an agent convinces the insured to cancel or replace their existing policy with a new one, often through misleading comparisons or false representations. This is illegal because it may harm the policyholder by canceling coverage that would be beneficial to them.

Virginia Code § 38.2-3501 requires individual health insurance policies to incorporate the application as part of the contract, as it contains critical personal data (e.g., name, age, medical history) used to determine insurability (option C). This document—completed by the applicant and agent—details health conditions, lifestyle factors (e.g., smoking), and other risk indicators the underwriter evaluates—e.g., a 30-year-old with asthma noted for rating. Option A (enrollment form) applies to group health plans, not individual policies, where employees join a pre-set plan. Option B (policy schedule) summarizes coverage (e.g., limits, premiums) after issuance, not initial data for underwriting. Option D (agent’s statement) may supplement the application with observations, but it’s not the primary source; the application itself holds the insured’s data. The study guide likely highlights the application’s role in a health insurance section, with examples—e.g., a question about prior hospitalizations triggering a premium adjustment—making C the key document, per Virginia’s legal requirement that it be attached to the policy (§ 38.2-3503) for transparency and enforceability.

Universal life insurance is a type of permanent life insurance that provides flexible premiums, adjustable death benefits, and a cash value component. One distinguishing feature of universal life is that it allows policyowners to access cash value through both policy loans and partial withdrawals. Withdrawals permanently reduce the cash value and may also reduce the death benefit, while policy loans accrue interest and must be repaid to avoid reducing benefits. Whole life insurance generally allows policy loans but not partial withdrawals of cash value. Term life insurance does not accumulate cash value and therefore does not allow loans or withdrawals. While “permanent life” is a broad category, universal life is the specific policy type that permits both loans and withdrawals, making it the correct answer.

Level term life insurance provides a fixed premium for a specified period, even though the risk of death increases as the insured ages. This is possible because premiums are averaged over the term of the policy.

In the early years, the insured pays more than the actual mortality cost, while in later years the cost of insurance exceeds the premium paid. This averaging mechanism allows the premium to remain level throughout the term.

Evidence of insurability is not required annually, the face amount does not necessarily decrease, and no additional lump-sum premium is required. Virginia exam materials consistently emphasize premium averaging as the reason level premiums are possible, making option D correct.

Virginia Code § 38.2-3407 et seq. covers health services, where ambulatory care centers (e.g., outpatient clinics) specialize in same-day procedures like outpatient surgical procedures (option C—e.g., cataract surgery). Option A (physical therapy) may occur there but isn’t the primary use; therapy clinics differ. Option B (wellness centers) focuses on prevention, not procedures. Option D (overnight accommodations) contradicts “ambulatory,” meaning walk-in/walk-out care. The study guide likely defines this in a health facilities section, with examples like knee arthroscopy, making C the most frequent use.

Virginia Code § 38.2-100 et seq. defines insurance terms. A loss (option C) is the actual injury or damage sustained (e.g., a broken leg or burned house), the event insurance covers. Option A (claim) is the request for payment post-loss, not the loss itself. Option B (peril) is the cause (e.g., fire, collision), not the result. Option D (accident) is a type of peril or event, not the damage. The study guide likely clarifies this chain—e.g., a car crash (peril/accident) causes $5,000 damage (loss), prompting a claim—using examples to distinguish loss as the outcome, making C the precise term.

Noncancelable policies guarantee both renewability and level premiums. The insurer cannot raise rates or cancel coverage as long as premiums are paid. Exact extract: “A noncancelable policy may not be canceled nor may premiums be increased by the insurer beyond what is stated in the contract.” This makes noncancelable coverage the most consumer-friendly disability policy type.

The cash value of a permanent life insurance policy may be used as a source of supplemental income for the insured during the policyowner’s lifetime. Cash value accumulates on a tax-deferred basis and may be accessed through policy loans or withdrawals, depending on the type of policy. These funds can be used for retirement income, emergencies, or other financial needs. The death benefit is paid to beneficiaries upon the insured’s death and is not available as income to the insured. A waiver of premium rider simply waives future premium payments in the event of qualifying disability and does not provide income. An automatic premium loan uses cash value to pay premiums and does not provide discretionary income to the insured. Therefore, cash value is the correct benefit that may be used as supplemental income.

Virginia Code § 38.2-3500 et seq. governs major medical plans, which cover catastrophic costs like hospital expenses (option A), physicians’ visits (option C), and surgical expenses (option D). Option B (custodial care)—non-medical assistance with daily living (e.g., bathing)—is typically excluded, as it’s not “medically necessary” under standard definitions (Virginia Code § 38.2-3407.10). The study guide likely lists inclusions (A, C, D) with examples—e.g., $5,000 for surgery—versus exclusions like custodial care, covered by LTC policies instead, making B the usual exception.

Virginia Code § 38.2-1826(C) requires licensees, including insurance agents, to report any felony conviction to the State Corporation Commission’s Bureau of Insurance within 30 calendar days of the final disposition (option C). “Final disposition” means the court’s conclusive ruling—e.g., sentencing after a guilty plea. This rule ensures the Bureau can assess the agent’s fitness to retain their license, protecting the public from untrustworthy practitioners. Option A (10 days) is too short and not specified in Virginia law for this purpose. Option B (20 days) lacks statutory support and falls between standard reporting periods. Option D (60 days) exceeds the mandated timeline, delaying oversight. The study guide likely highlights this 30-day deadline in a licensing compliance section, with examples—e.g., an agent convicted of fraud on June 1 must report by July 1—aligning with Virginia’s adoption of NAIC standards for licensee integrity (Virginia Code § 38.2-1800 et seq.), making C the precise requirement.

Consideration is a required element of a valid contract and refers to the value exchanged between parties. In an insurance contract, the applicant’s consideration is the premium and the statements made in the application, while the insurer’s consideration is the promise to pay benefits as outlined in the policy. Without consideration from both parties, a contract cannot be legally binding. Contribution and subrogation are insurance principles related to claims, not contract formation. Valuation is a general term and not a legal contract requirement. Therefore, consideration correctly describes the mutual exchange of value.

Virginia contract law, reflected in Virginia Code § 38.2-102, requires capacity to form an insurance contract. Option A (intoxicated individuals) lacks capacity if impaired, voiding consent. Option B (mentally ill individuals) may lack comprehension, restricting ability unless adjudicated competent. Option C (minors, typically under 18 per § 38.2-3405) can’t contract without guardian consent, except for necessities. Option D (retired individuals) has no legal restriction; retirement is a status, not a capacity limiter—e.g., a 65-year-old retiree can buy insurance freely. The study guide likely covers capacity in a legal basics section, with examples like a drunk person’s void policy versus a retiree’s valid one, making D the exception.

The fixed-period installment option provides that the death benefit proceeds, together with interest, are paid in equal installments to the beneficiary over a specified number of years. Each installment consists of principal and interest until the proceeds are fully distributed at the end of the fixed period. This ensures a guaranteed stream of income for the chosen period regardless of when the proceeds are exhausted.

Exact Extract (Virginia Life & Annuities Study Guide): “Settlement options include: fixed-period installments—payment of proceeds in equal installments over a specified period of years, consisting of principal and interest.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 5.3 Settlement Options

— Code of Virginia §38.2-3117.2 (Requirement to provide settlement option explanations to beneficiaries)

Virginia Code § 38.2-3508 defines a cancelable health policy as one either party—the insured or insurer—can terminate before its term ends, with notice (e.g., 30 days). Option C reflects this mutual right. Option A (insurer only) and option B (insured only) are too restrictive; cancelable policies aren’t unilateral. Option D (arbitration committee) isn’t a standard mechanism; cancellation follows policy terms, not third-party rulings. The study guide likely contrasts cancelable with non-cancelable policies, using examples like an insurer canceling for nonpayment or an insured canceling due to better rates, making C the correct scope.

Coinsurance is a cost-sharing arrangement where, after the deductible is met, the insured pays a percentage of covered expenses and the insurer pays the rest. A common split is 80/20, where the insurer pays 80% and the insured pays 20% until the maximum out-of-pocket limit is reached.

Exact Extract (Virginia Health Insurance Study Guide): “Coinsurance—after the deductible has been satisfied, the insured and insurer share covered expenses in a stated ratio (e.g., 80/20).”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Major Medical Policy Provisions

A joint and survivor annuity is designed to provide income for two individuals, typically for retirement planning. When one annuitant dies, payments continue to the surviving annuitant, either at the same amount or at a reduced percentage, depending on the contract terms selected at issue.

Payments do not cease at the first death, and refund or period-certain options apply only if specifically elected. Virginia annuity education emphasizes joint and survivor annuities as a way to protect surviving spouses from loss of income, making option C correct.

If an individual covered under a disability income policy is injured while engaged in an occupation that is more hazardous than the one stated in the policy, the policy's change of occupation provision typically results in the benefit level being reduced. This provision allows the insurer to adjust the benefits based on the new, more hazardous occupation, reflecting the increased risk.

Detailed Answer in Step-by-Step Solution:

A single premium whole life policy is a type of permanent life insurance where the entire premium for the policy’s lifetime coverage is paid in one lump sum at issuance.

Unlike policies with recurring premiums (e.g., monthly or annual), this single payment funds the policy for the insured’s full life (D).

Options A (one month) and B (one year) apply to term or recurring premium policies.

Option C (to age 65) might relate to limited-pay policies, not single premium ones.

Per the Virginia study guide, a single premium whole life policy requires one payment upfront, providing coverage for the insured’s entire life and building immediate cash value. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance Policies."

Detailed Answer in Step-by-Step Solution:

A continuous premium whole life policy requires premiums for the insured’s lifetime (A), while a limited payment policy has a set payment period (e.g., 20 years).

Settlement options (B), mortality tables (C), and dividends (D) are similar across both types.

The Virginia study guide distinguishes continuous premium whole life (lifelong payments) from limited payment whole life (fixed-term payments), both providing permanent coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Whole Life Insurance."

The accidental death benefit is typically provided as an optional policy rider. This rider offers additional coverage, paying an extra benefit if the insured dies due to an accident. It is not an exclusion, annuity, or nonforfeiture option. The rider adds extra protection for accidents but is not part of the base policy unless specifically added.

Fixed annuities are designed to credit interest at a rate that is no lower than the contract’s guaranteed rate. This guaranteed rate is specified at the time of the contract and ensures that the policyholder will receive at least this minimum interest rate, regardless of market conditions. The fixed annuity’s interest rate can be higher depending on the insurer's performance, but it cannot fall below the guaranteed rate.

The application is the primary underwriting source for personal data and risk assessment. It provides the insured’s age, health, occupation, and lifestyle factors. Exact extract: “The application is a written request to the company for a contract and is the source of the insurer’s underwriting information.”

An independent agent is one who may represent multiple insurance companies, offering a variety of policies from different insurers. This contrasts with exclusive agents who typically represent only one insurer. Independent agents are not tied to a single company and can offer more choices to their clients. The other options are not defining characteristics of independent agents.

A restorative dental procedure refers to treatments that restore the function and integrity of a tooth, typically after damage or decay. A filling is a common restorative procedure, where the dentist repairs a cavity. An extraction removes a tooth, while a root canal treats infection within the tooth, and fitting dentures replaces missing teeth, all of which are not categorized as restorative procedures but are considered reparative or replacement treatments.

An agent's license will not be revoked unless the agent has been afforded the right to a hearing on the charges. This ensures due process and that the agent is given an opportunity to present their case before any disciplinary action is taken. Revoking a license is a serious matter, and the law requires a fair hearing process to protect the agent's rights before taking such steps.

A revocable beneficiary designation allows the policyowner to change beneficiaries at any time without the consent of the existing beneficiary. This right remains solely with the policyowner.

Exact Extract (Virginia Health Insurance Study Guide): “Revocable beneficiaries—policyowner retains the right to change the beneficiary designation at will.”

References (Virginia Documents / Study Guide):

— Virginia Life & Health Insurance Examination Outline, Beneficiary Designations

Virginia insurance law (Title 38.2, Chapter 18) recognizes three types of agent authority: express, implied, and apparent. Express authority (option B) is explicitly granted by the insurer in the agency agreement (e.g., soliciting policies), per Virginia Code § 38.2-1800 et seq. Implied authority (option C) is unwritten power to perform incidental acts necessary for express duties (e.g., collecting premiums). Apparent authority (option A) arises when a third party reasonably believes the agent has authority based on the insurer’s actions (e.g., providing branded materials), binding the insurer legally. Option D (residual authority) is not a recognized term in Virginia insurance or agency law; “residual” might relate to markets or benefits elsewhere, but not agent authority. The study guide likely outlines these three authorities with examples, excluding D as a fabricated or irrelevant concept, making it the exception.

The 10-day free look provision in individual health insurance policies allows the insured to review their policy after purchase. If they are unsatisfied with the policy, they can cancel it within 10 days and receive a full refund of premiums. This provision is distinct from a grace period (which allows for late payment) and does not apply only when no premium has been paid. A surrender charge typically applies to cash-value policies, not health insurance.

With a decreasing term life insurance policy, the premium remains level, but the amount of coverage decreases annually. This type of policy is often used to cover debts that decrease over time, such as a mortgage. Since the coverage amount drops each year, premiums are not reduced — they remain the same throughout the policy term.

Virginia’s Unfair Claims Settlement Practices Act prohibits insurers or agents from misrepresenting facts or policy provisions relating to coverage. Doing so after a loss is classified as an unfair claims settlement practice.

Exact Extract (Virginia Unfair Claims Settlement Law): “Misrepresenting pertinent facts or policy provisions relating to coverages at issue is an unfair claim settlement practice.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-510 (Unfair claim settlement practices)

A conditional receipt is issued when the initial premium is collected with the application. Coverage may become effective upon meeting insurability conditions. Exact extract: “When the first premium is paid, the applicant is given a receipt. This conditional receipt provides coverage based on insurability.”

Virginia Code § 38.2-3100 et seq. governs deferred annuities, where a surrender charge (option A) is a penalty for early withdrawal, starting high (e.g., 7-10%) and declining over a surrender period (e.g., 7-10 years) until it reaches zero. Option B (front-end sales load) is a one-time fee deducted upfront, not diminishing over time. Option C (guaranteed interest rate) is a fixed return (e.g., 2%), stable or adjustable, not disappearing. Option D (expense charge) covers ongoing costs (e.g., mortality and expense fees), typically level, not phased out. The study guide likely illustrates this with a table—e.g., 10% year 1, 9% year 2, 0% year 10—emphasizing surrender charges as a liquidity deterrent, making A the matching feature.

Under most health insurance policies, the insured is required to provide written proof of loss within 30 days of the occurrence of the loss. This allows the insurer to promptly evaluate the claim and ensure that it is processed without unnecessary delays. Some policies may allow extensions under special circumstances, but the general rule is that proof of loss must be provided within 30 days.

Virginia Code § 38.2-3209 allows a guaranteed insurability rider, enabling the policyowner to buy additional coverage at specified intervals (e.g., every 3 years or life events like marriage) without proving insurability. Option D matches this definition. Option A is unrelated; non-medical underwriting isn’t implied. Option B contradicts the rider’s purpose, which waives insurability proof. Option C is false; premium adjustments aren’t part of this rider. The study guide describes this rider as a planning tool for future needs, confirming D.

The insuring clause in a health insurance policy is a key provision that outlines the general terms of the coverage provided by the insurer. It typically includes a broad description of what the policy covers and the conditions under which benefits will be paid. It does not contain a list of specific hospitals, nor does it detail how premiums are determined or act as part of the application.

Virginia Code § 38.2-3330 mandates a conversion privilege in group term life policies, allowing insureds to convert to an individual policy without evidence of insurability within 31 days after losing group eligibility (e.g., employment termination). Option C matches this precisely. Option A is false; conversion is a legal requirement. Option B is incorrect; conversion applies post-eligibility, not during active membership while still insurable. Option D (five years) is arbitrary and unsupported by law. The study guide likely details this 31-day window with examples—e.g., an employee converting to whole life after layoffs—emphasizing its protective role, making C the correct timing.

The concept of agency authority is foundational in Virginia insurance law, derived from general agency principles and reflected in Title 38.2, Chapter 18. Express authority is explicitly granted in the agency agreement (e.g., soliciting and binding coverage), per Virginia Code § 38.2-1800 et seq. Implied authority, however, is not written but assumed to be necessary for carrying out express duties—such as scheduling client meetings or collecting initial premiums—unless restricted by the insurer. “Mandated authority” (option B) is not a recognized term in Virginia insurance regulations or study materials. Option C (express authority) is incorrect because it’s explicitly stated, not unwritten. Option D (nonexistent) denies the presence of authority, which contradicts the question’s premise. The Virginia Life, Annuities, and Health Insurance study guide likely highlights implied authority as a key concept for agents’ day-to-day operations, making A the correct answer.

In an HMO, members designate a primary care physician (PCP) who coordinates care and issues referrals to specialists. This gatekeeper function is a hallmark of HMO plans.

Exact Extract (Virginia HMO Study Guide): “HMO members select a primary care physician responsible for providing and coordinating all medical care.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, HMO Characteristics

The monthly indemnity paid to an employee under employer-paid group disability income insurance is not always tax-free. If the employer pays the premiums, the benefits received by the employee are typically taxed as income, unless the employee pays a portion of the premiums with after-tax dollars. The employer-paid premiums are deductible as a business expense for the employer, but the tax treatment of the indemnity benefits depends on who pays the premiums.

In a deferred annuity, benefit payments to the annuitant typically begin when the contract matures. Maturity occurs at a specified time, such as the annuitant’s retirement age or another defined period. The annuity may then begin making periodic payments to the annuitant or a beneficiary, depending on the terms of the contract.

The needs approach calculates the amount of life insurance a client should have by analyzing family financial obligations—such as income replacement, education costs, debts, and funeral expenses. This approach ensures sufficient coverage to meet survivors’ future needs.

Exact Extract (Virginia Life Insurance Study Guide): “The needs approach considers the financial needs of survivors to determine the appropriate amount of life insurance coverage, including income, debt repayment, education funding, and final expenses.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 2.1 Needs approach

Pre-existing conditions are defined as illnesses or conditions for which an insured received medical advice, diagnosis, or treatment prior to the effective date of coverage.

Exact Extract (Virginia Health Insurance Study Guide): “Pre-existing condition—any condition for which diagnosis, medical advice, or treatment was received prior to the policy’s effective date.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Policy Exclusions and Limitations

Detailed Answer in Step-by-Step Solution:

Accidental death and dismemberment (AD&D) insurance (B) provides a lump sum benefit for specific losses, such as loss of sight in both eyes, due to an accident.

Hospital expense (A) covers hospital stays, not lump sums for dismemberment.

Major medical (C) and medical expense (D) cover healthcare costs, not specific injury benefits.

The Virginia study guide describes AD&D as providing lump sum payments for accidental death or specific injuries like loss of sight, distinct from medical expense coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Types."

Detailed Answer in Step-by-Step Solution:

Medicare Part D (C) specifically covers prescription drug costs for enrollees.

Medical expenses (A) are under Part B, hospital costs (B) under Part A, and dental (D) is generally not covered by Medicare unless supplemental.

The Virginia study guide states that Medicare Part D, introduced in 2006, provides prescription drug coverage through private plans, distinct from Parts A and B. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare."

Life insurance proceeds are generally exempt from income tax but may be included in the insured’s gross estate for estate tax purposes if they are payable to the estate or if the insured retained ownership rights. If the proceeds are paid directly to a named beneficiary, they usually bypass probate and are not part of the taxable estate.

Exact Extract (Virginia Life Insurance Study Guide): “Proceeds of life insurance are included in the insured’s gross estate if payable to the estate or if the insured retained incidents of ownership at death.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 6.3 Federal estate tax treatment

Virginia’s long-term care (LTC) rules allow certain exclusions (e.g., war, alcoholism/drug addiction, intentionally self-inflicted injury) but prohibit disease-specific exclusions for conditions like Alzheimer’s or senile dementia. Exact extract: “No long-term care insurance policy or certificate may exclude or limit coverage for Alzheimer’s disease, senile dementia, organic brain disorder, or other demonstrable organic disease.” Permitted exclusions include: “loss resulting from war or act of war,” “alcoholism and drug addiction,” and “intentionally self-inflicted injury.”

Detailed Answer in Step-by-Step Solution:

Reinsurance (C) is a process where one insurer (the ceding company) transfers part or all of its risk to another insurer (the reinsurer) to reduce exposure.

A reciprocal contract (A) involves mutual insurance exchanges, not risk transfer between insurers.

Coinsurance (B) refers to shared risk between the insurer and policyholder, not between insurers.

A captive contract (D) involves a company insuring itself through a subsidiary, not transferring risk to another insurer.

The Virginia study guide defines reinsurance as a contractual arrangement allowing insurers to mitigate risk by transferring it to another insurer, a common practice in the industry. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Operations."

During the annuitization or distribution phase, the annuitant receives regular income payments—monthly, quarterly, or annually—depending on contract terms. These payments may last for life or a specified period.

Exact Extract (Virginia Annuities Study Guide): “Distribution phase—annuitant receives systematic periodic payments of principal and interest.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Annuity Phases

The Bureau of Insurance has the authority to examine a licensee's books and records to determine if unfair trade practices have been violated. This regulatory body ensures compliance with state insurance laws and regulations, and it has the power to investigate potential violations within the industry. The National Association of Insurance Commissioners (NAIC) provides model laws but does not have regulatory power over individual insurers.

When a Medicare Supplement insurance policy is being replaced, the agent and the applicant must sign the notice of replacement. This is a requirement to ensure that the applicant understands that they are replacing their existing coverage with new insurance. The agent's signature verifies that the applicant was informed of the potential consequences and differences between the old and new policies. This protects both the insurer and the insured by maintaining a clear record of the replacement process.

Medicare Part A is generally available at age 65, but younger individuals may qualify if they have received Social Security disability benefits for at least 24 months.

Exact Extract (Virginia Medicare Study Guide): “Individuals under age 65 become eligible for Medicare Part A after receiving Social Security disability benefits for 24 months.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Medicare Eligibility

Virginia Code § 38.2-3115 governs life insurance settlement options. The interest-only option keeps proceeds with the insurer (option A, true), paying interest periodically to the beneficiary (option C, true, e.g., quarterly), and allows the principal to be withdrawn or redirected later (option D, true, e.g., switching to fixed period). Option B is false; the policyowner can select this option during the policy term, not just the beneficiary post-death—though beneficiaries may elect it if not pre-specified. The study guide likely explains this flexibility with examples—e.g., a $100,000 policy earning 3% interest paid monthly—noting both parties’ roles, making B the exception since it restricts choice to the beneficiary alone.

Virginia Code § 38.2-1826(C) mandates that licensees (agents, brokers, etc.) report administrative actions—such as license revocation or fines by another state or agency—to the Bureau of Insurance within 30 calendar days of the final disposition. “Final disposition” means the conclusion of the action (e.g., final order or settlement). This requirement ensures Virginia regulators can assess the licensee’s fitness to hold a license and protect consumers. Option C (30 days) matches this statutory timeline precisely. Option A (10 days) is too short and not supported by Virginia law. Option B (20 days) lacks a basis in the Code or study materials. Option D (45 days) exceeds the mandated period, risking delayed oversight. The study guide likely emphasizes this 30-day rule as a critical compliance deadline, reinforced by Virginia’s alignment with NAIC standards for licensee reporting, making C the definitive answer.

Moral hazard refers to the increased chance of loss due to the insured’s dishonesty or fraudulent intent. Examples include exaggerating claims or intentionally causing loss.

Exact Extract (Virginia Insurance Fundamentals Study Guide): “Moral hazard—hazard arising from dishonesty or lack of integrity of the insured, such as filing fraudulent claims.”

References (Virginia Documents / Study Guide):

— Virginia General Insurance Concepts Outline, Risk and Hazards

Under the Affordable Care Act (ACA), Essential Health Benefits (EHB) include a variety of categories such as hospitalization, laboratory services, and preventive care services. However, adult dental services are not included as one of the ACA's required essential benefits, though they may be offered as part of a separate plan or rider. This distinction is important as it affects coverage requirements and benefits for different age groups.

An annuity is primarily designed to provide a stream of income, typically during retirement, and to protect against the risk of outliving one’s assets. One important purpose of an annuity is to liquidate an estate, not create one. Unlike life insurance, which creates an immediate estate by paying a death benefit, annuities are intended to systematically distribute accumulated funds over time. Payments received from annuities are generally taxable to the extent they represent interest earnings, meaning they are not tax-free. Annuities do not typically provide tax-free lump sums or tax-free interest income to beneficiaries. Instead, they focus on income distribution and longevity protection. Therefore, the correct purpose listed is the liquidation of an estate.

Accidental death benefit (ADB) riders pay an additional death benefit if death results from accidental causes. It is not automatically included in every policy and requires an additional premium. Exact extract: “The accidental death benefit rider provides extra coverage in the event of accidental death and is available only by payment of an additional premium.” It does not affect cash values or nonforfeiture options.

The "insurance with other insurers" provision, addressed in Virginia Code § 38.2-3514, is a coordination of benefits (COB) mechanism in individual health insurance policies designed to prevent over-insurance and duplicate payments when an insured has multiple policies covering the same loss. This provision allows the insurer to prorate benefits—paying a share based on the total coverage—when certain conditions are met. Option C states that the insurer wasn’t notified prior to the claim of other coverage, which triggers proration. This aligns with standard COB rules: if the insurer isn’t informed of other policies, it may assume primary liability initially but adjust to a pro-rata share upon discovery, ensuring equitable payment across insurers. Option A (within 31 days of renewal) is irrelevant; renewal proximity doesn’t affect benefit coordination. Option B (grace period) relates to premium payment timing, not other insurance, and doesn’t trigger proration. Option D ($2,000 claim threshold) is arbitrary and not a standard condition in Virginia law or study materials for this provision. The study guide likely emphasizes notification as key to COB, as Virginia follows NAIC model regulations requiring disclosure of other coverage (e.g., via application or claim forms). Without prior notice, the insurer applies proration retroactively, making C the correct choice.

A straight life annuity pays income until death, with no further payments to beneficiaries. Exact extract: “Straight life annuities provide income for the life of the annuitant only; payments cease upon death with no refund.” This option offers the maximum periodic income but no residual value.

Medical expense claim forms generally focus on the occurrence, character, and extent of the loss to determine the eligibility and amount of benefits. The employee's annual salary is not typically included on the claim form unless the claim relates to a disability or income replacement policy, but not for medical expense claims.

Uniform policy provisions are mandated by law and cannot be deleted. Underwriting actions include issuing, rejecting, or adding riders. Exact extract: “Insurers may not delete or alter mandatory uniform provisions.”

The doctrine of reasonable expectations holds that insurance contracts will be interpreted as a reasonable person would expect, even if fine print suggests otherwise. Exact extract: “Under the principle of reasonable expectations, coverage is interpreted in line with what a prudent policyholder would believe was provided.” This prevents insurers from denying claims based on obscure or technical language.

Independent agents are not employees of any single insurer. They work independently, representing multiple insurance companies and are responsible for their own expenses. They earn compensation based on commissions from sales, and they typically own the renewal business, meaning they retain the commissions from renewing policies.

Ordinary whole life pays the face amount at maturity (traditionally age 100 or 120) if the insured is still alive, or upon earlier death. Term policies have no maturity value.

Exact Extract (Virginia Life Insurance Study Guide): “Ordinary whole life—pays the face amount at death or at policy maturity if the insured survives to that date.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Whole Life Characteristics