Ok-Life-Accident-and-Health-or-Sickness-Producer Oklahoma Life, Accident, and Health or Sickness Producer Exam Questions and Answers

Twistingis the unethical practice of using misrepresentation or incomplete information to persuade an insured to replace an existing policy with a new one, often to their detriment. It is prohibited under Oklahoma’s Unfair Trade Practices Act (Title 36 O.S. § 1204) to protect consumers from deceptive sales practices.

Option A: Incorrect. Rebating involves offering a portion of the premium or other inducements to purchase insurance.

Option B: Correct. Twisting involves misrepresenting benefits to induce policy replacement.

Option C: Incorrect. Defamation is making false statements harming someone’s reputation, not policy replacement.

Option D: Incorrect. Forfeiting is not a term related to policy replacement practices.

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

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.

Aparticipating whole life insurance policyissued by a mutual insurer allows policyholders to receive areturn of divisible surplusin the form of dividends, which reflect the insurer’s excess profits. This is a feature of mutual insurers, as defined in Oklahoma’s regulations (Title 36 O.S. § 4002). Limited pay, continuous premium, and straight whole life policies do not inherently include dividends.

Option A: Incorrect. Limited pay whole life has a shorter premium payment period, not necessarily dividends.

Option B: Correct. A participating whole life policy provides dividends from surplus.

Option C: Incorrect. Continuous premium whole life refers to lifelong premium payments, not dividends.

Option D: Incorrect. Straight whole life is a general term, not specific to dividends.

Long-Term Care (LTC) insuranceis designed to cover services for individuals with chronic diseases or disabilities who need assistance with activities of daily living (ADLs) or have cognitive impairments. It often includes coverage for nursing home care, home-based care, assisted living, and respite care, as regulated in Oklahoma under Title 36 O.S. § 4426.1.

Option A: Incorrect. Medicare provides limited coverage for skilled nursing or home health care but not comprehensive LTC services.

Option B: Incorrect. Medicaid covers LTC for low-income individuals but is a government program, not a private insurance policy.

Option C: Correct. LTC insurance covers nursing home, home-based, and respite care for chronic conditions.

Option D: Incorrect. Group health insurance covers medical expenses but typically does not include LTC services.

This question falls under the Prometric content outline section on “Long-Term Care (LTC) Policies,” which covers LTC coverage and services.

Ajoint life policy(also called a first-to-die policy) covers two or more individuals (e.g., spouses) and pays the death benefit upon the death of the first insured. This contrasts with asurvivorship life policy(second-to-die), which pays after both insureds die. Joint life policies are used for purposes like mortgage protection or family income needs (Title 36 O.S. § 4002).

Option A: Correct. A joint life policy pays benefits at the first spouse’s death.

Option B: Incorrect. A variable life policy is a permanent policy with investment options, not tied to joint coverage.

Option C: Incorrect. A universal life policy is flexible permanent insurance, not specifically joint.

Option D: Incorrect. A survivorship life policy pays after both spouses die.

Major medical insuranceis designed to cover significant healthcare expenses, particularly those related to hospitalization, surgeries, and other high-cost medical services. It focuses on providing comprehensive coverage for catastrophic or major medical events, as opposed to routine or preventive care, which may be covered to a lesser extent or through separate plans.

Option A: Incorrect. Preventive care is often included but is not the primary focus of major medical insurance.

Option B: Incorrect. Using in-network facilities reduces costs but is a feature of managed care plans, not the core focus of major medical insurance.

Option C: Correct. The focus of major medical insurance is covering hospitalization and other major expenses.

Option D: Incorrect. Providing care to the needy is associated with programs like Medicaid, not private major medical insurance.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers the characteristics of major medical insurance.

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.

In Oklahoma’s Insurance Code (Title 36 O.S. § 105), aforeign insureris defined as an insurance company formed under the laws of another U.S. state or territory. This distinguishes it from adomestic insurer(formed in Oklahoma) and analien insurer(formed in a foreign country).

Option A: Incorrect. An insurer formed in Oklahoma is a domestic insurer.

Option B: Incorrect. An insurer from a foreign country is an alien insurer.

Option C: Correct. A foreign insurer is formed under the laws of another U.S. state or government.

Option D: Incorrect. Geographic proximity is irrelevant; the definition is based on legal formation.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers insurer classifications.

Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) are two common types of managed care plans in health insurance. According to standard insurance study materials for the Oklahoma Life, Accident, and Health or Sickness Producer exam, a key distinction between PPOs and HMOs lies in the flexibility of provider choice. PPOs allow members to choose from a broader network of doctors and medical service providers, both in-network and out-of-network, without requiring a referral from a primary care physician. HMOs, in contrast, typically restrict members to in-network providers and require a designated primary care physician to coordinate care.

Option A: Incorrect. PPO plans often provide coverage for out-of-state medical services, especially within their network or through out-of-network benefits, though at potentially higher costs. This is not a defining characteristic compared to HMOs.

Option B: Correct. PPOs are known for offering more choices of doctors and medical service providers, as they do not mandate a primary care physician or referrals for specialists, unlike HMOs.

Option C: Incorrect. HMOs require members to designate a primary care physician, while PPOs do not.

Option D: Incorrect. While PPOs offer flexibility, the ability to see a physician on a walk-in basis is not a standard feature distinguishing them from HMOs, as both may vary in appointment requirements.

This aligns with the Prometric exam content outline under “Health Providers and Products,” which emphasizes understanding differences between health insurance plans like HMOs and PPOs.

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.

The Oklahoma Unfair Claims Settlement Practices Act, under Title 36 O.S. § 1250.5, defines practices that constitute unfair or deceptive acts in the settlement of insurance claims. Knowingly misrepresenting pertinent facts or policy provisions related to coverage to a claimant is explicitly listed as an unfair practice, as it misleads policyholders and undermines fair claim handling.

Option A: Correct. Misrepresenting facts or policy provisions is an unfair claims settlement practice under Oklahoma law.

Option B: Incorrect. There is no specific 45-day requirement to interview parties in the Act; timelines relate to acknowledging or settling claims.

Option C: Incorrect. Maintaining an audit trail is a best practice but not explicitly an unfair claims settlement practice.

Option D: Incorrect. Incomplete policy notes are not specifically cited as an unfair practice under the Act.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers unfair claims practices.

Oklahoma insurance law requires licensed insurance producers to maintain records of insurance transactions for a minimum of5 years, as specified in Title 36 O.S. § 1435.13. This ensures compliance with regulatory oversight and allows for audits or investigations by the Oklahoma Insurance Department.

Option A: Incorrect. 3 years is insufficient per Oklahoma law.

Option B: Correct. Licensees must keep records for 5 years.

Option C: Incorrect. 7 years exceeds the requirement.

Option D: Incorrect. 10 years is not mandated by Oklahoma insurance regulations.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which includes recordkeeping requirements.

Term life insurance provides coverage for a specific period at a lower premium cost compared to permanent insurance, such as whole life. The primary advantage is its affordability, making it suitable for individuals needing significant coverage with lower initial costs. Unlike whole life, term life does not accumulate cash value, and premiums typically increase upon renewal as the insured ages.

Option A: Incorrect. Premiums for term life do not decrease as the insured ages; they increase at renewal due to higher risk.

Option B: Incorrect. While death benefits in level term policies remain constant during the term, this is not the primary advantage compared to lower costs.

Option C: Correct. Term life has lower initial costs, making it more affordable for the same coverage amount compared to permanent insurance.

Option D: Incorrect. Term life does not offer a cash value, a feature of permanent insurance.

This question aligns with the Prometric content outline under “Life Products,” which covers the characteristics and advantages of term life insurance.

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.

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.

Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) and does not accumulate cash value, unlikepermanent life insurance(e.g., whole life), which provides lifelong coverage with cash value. Term policies may be renewable, but this is not automatic unless specified, and premium payment periods are shorter than permanent policies (Title 36 O.S. § 4002).

Option A: Incorrect. Term life accumulates no cash value, not a smaller amount.

Option B: Incorrect. Term life has a shorter premium payment period than permanent life.

Option C: Correct. Term life remains in force for a specific period, unlike lifelong permanent coverage.

Option D: Incorrect. Renewal is not automatic; it depends on the policy’s terms.

TheConsolidated Omnibus Budget Reconciliation Act (COBRA), as regulated under federal law (29 U.S.C. § 1161 et seq.), requires employers with20 or more employeesto offer continuation of group health insurance coverage to employees and their dependents after certain qualifying events (e.g., termination of employment). This applies to private-sector employers and is enforced in Oklahoma.

Option A: Correct. COBRA applies to employers with 20 or more employees.

Option B: Incorrect. 30 employees is not the threshold.

Option C: Incorrect. 31 employees is not the specific requirement.

Option D: Incorrect. 50 employees is unrelated to COBRA’s threshold.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers federal laws like COBRA.

Thecommon disaster provisionin a life insurance policy addresses situations where the insured and primary beneficiary die in the same accident. It typically includes a survivorship clause, presuming thebeneficiary outlived the insuredfor a specified period (e.g., 14–30 days) unless proven otherwise. This ensures the death benefit passes to the beneficiary’s estate or contingent beneficiaries, as outlined in Oklahoma’s life insurance provisions (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. The provision does not assume the insured outlived the beneficiary.

Option B: Correct. The insurer proceeds as if the beneficiary outlived the insured.

Option C: Incorrect. Simultaneous death is addressed differently under the Uniform Simultaneous Death Act, not the common disaster provision.

Option D: Incorrect. The provision does not treat the beneficiary as unnamed.

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.

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.

In insurance underwriting, individuals are classified based on their risk profile. Asubstandard riskis an applicant who, due to health issues, hazardous habits (e.g., smoking), or high-risk occupations (e.g., stunt performer), cannot be insured at standard rates. These individuals may be offered coverage at higher premiums or with exclusions, as outlined in standard underwriting practices and Oklahoma’s regulations (Title 36 O.S. § 1204).

Option A: Incorrect. “Rating risk” is not a standard underwriting term.

Option B: Incorrect. A standard risk qualifies for standard rates with average risk.

Option C: Incorrect. A preferred risk qualifies for lower-than-standard rates due to low risk.

Option D: Correct. A substandard risk is not acceptable at standard rates due to higher risk factors.

This question aligns with the Prometric content outline under “Underwriting,” which covers risk classification.

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.

Twistingis the unethical practice of using misrepresentation or incomplete information to persuade an insured to terminate an existing policy and purchase a new one, often to the insured’s detriment. It is prohibited under Oklahoma’s Unfair Trade Practices Act (Title 36 O.S. § 1204). This differs fromchurning(replacing policies for commission without benefit to the insured) orrebating(offering inducements to purchase).

Option A: Correct. Twisting involves misrepresentation to induce policy replacement.

Option B: Incorrect. Subrogation is the insurer’s right to recover payments from a third party.

Option C: Incorrect. Rebating is offering a portion of the premium or other inducements to purchase insurance.

Option D: Incorrect. Churning involves excessive policy replacements for commissions, not necessarily misrepresentation.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers unfair trade practices.

According to IRS guidelines (Publication 525), disability benefits from a group policy paid for by the employer are consideredtaxable incometo the employee because the premiums were not included in the employee’s taxable income. If the employee paid the premiums with after-tax dollars, the benefits would be tax-free.

Option A: Incorrect. Benefits are taxable if the employer paid the premiums.

Option B: Incorrect. Disability benefits are not deductible from gross income.

Option C: Correct. The benefits are taxable income.

Option D: Incorrect. Benefits are subject to income tax, not just Social Security or FUTA taxes.

A deliberate lie by an insured to obtain a lower premium constitutesfraud, defined in Oklahoma’s Insurance Code (Title 36 O.S. § 1204) as an intentional misrepresentation of material facts to deceive the insurer. Fraud can lead to policy rescission or legal penalties.

Option A: Incorrect. Omission is failing to disclose information, not actively lying.

Option B: Correct. A deliberate lie to lower premiums is fraud.

Option C: Incorrect. Concealment is withholding material information, not providing false information.

Option D: Incorrect. Aleatory refers to the uncertain nature of insurance contracts, not misrepresentation.

To calculate the insured’s payment:

Deductible: The insured pays the first $1,000 of the $5,000 procedure cost.

Remaining cost: $5,000 - $1,000 = $4,000.

Coinsurance: The policy has 80/20 coinsurance, so the insurer pays 80% ($3,200) and the insured pays 20% ($800) of the $4,000.

Total paid by insured: $1,000 (deductible) + $800 (coinsurance) = $1,800.

Out-of-pocket maximum: The policy’s $3,000 out-of-pocket maximum caps the insured’s total payments. Since $1,800 is less than $3,000, the insured pays $1,800. However, the question asks for the total paid “towards the $5,000,” and the out-of-pocket maximum of $3,000 suggests a cap on total liability for covered expenses. In this context, the correct interpretation is that the insured’s payment is capped at the out-of-pocket maximum if applicable, but standard calculation yields $1,800, and the answer options suggest a possible intent for the maximum.

Upon review, the correct calculation yields $1,800 (Option C), but the out-of-pocket maximum of $3,000 (Option B) may be the intended answer if the question implies the maximum liability. Given the standard insurance calculation,Option C ($1,800)is mathematically correct, butOption B ($3,000)aligns with the out-of-pocket maximum as a potential cap. Since the calculation is clear, we selectC.

Corrected Answer: C

Explanation of Calculation:

Deductible: $1,000.

Coinsurance: 20% of $4,000 = $800.

Total: $1,000 + $800 = $1,800.

The out-of-pocket maximum ($3,000) is not reached, so the insured pays $1,800.

Option A: Incorrect. The insured does not pay the full $5,000 due to insurer contributions.

Option B: Incorrect. The $3,000 out-of-pocket maximum is not reached; the calculated payment is $1,800.

Option C: Correct. The insured pays $1,800 based on the deductible and coinsurance.

Option D: Incorrect. The $1,000 deductible alone does not account for coinsurance.

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

Thewaiver of premium clausein a disability income policy waives the policy’s premiums during a disability claim, ensuring the policy remains in force without the insured having to pay premiums while disabled. This typically begins after the elimination period, as outlined in Oklahoma’s health insurance provisions (Title 36 O.S. § 4405).

Option A: Correct. The waiver of premium pays the policy premium during a disability claim.

Option B: Incorrect. Premiums are waived only during disability, not for the insured’s lifetime.

Option C: Incorrect. Monthly benefits are not reduced to offset waived premiums.

Option D: Incorrect. The waiver begins after the elimination period, not immediately upon a doctor’s statement.

In Oklahoma, the minimum age for a person of competent legal capacity to contract for life and health insurance is18, as this is the age of majority under Oklahoma law (Title 15 O.S. § 13). Individuals under 18 may be insured (e.g., as dependents or under juvenile policies), but they cannot enter into insurance contracts themselves unless emancipated.

Option A: Incorrect. Age 15 is below the age of majority.

Option B: Incorrect. Age 16 is below the age of majority.

Option C: Correct. Age 18 is the minimum age for contracting insurance in Oklahoma.

Option D: Incorrect. Age 21 is not required; 18 is sufficient.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers eligibility to contract insurance.

Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) at a lower premium cost than whole life insurance, making it ideal for individuals needing maximum death benefit protection but unable to afford the higher premiums of permanent insurance. Unlike whole life, term life does not accumulate cash value or allow policy loans.

Option A: Incorrect. Borrowing against policy values requires cash value, available in whole life, not term life.

Option B: Incorrect. Cash value accumulation is a feature of whole life, not term life.

Option C: Correct. Term life is appropriate for maximum protection at a lower cost when permanent insurance premiums are unaffordable.

Option D: Incorrect. Term life is not permanent insurance; whole life provides permanent coverage.

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

In Oklahoma, aninsurance produceris the term defined by law for an individual or entity licensed to sell, solicit, or negotiate insurance contracts. This is outlined in the Oklahoma Insurance Code, which requires producers to obtain a license to engage in these activities for life, accident, and health or sickness insurance.

Option A: Incorrect. An insurance adjuster investigates and settles claims, not negotiates the sale of insurance.

Option B: Correct. An insurance producer is the licensed individual who negotiates the sale of insurance, as defined by Oklahoma law.

Option C: Incorrect. An insurance appraiser evaluates property damage for claims, not related to selling insurance.

Option D: Incorrect. An insurance underwriter assesses risk and determines policy issuance, not sells insurance.

This question falls under the Prometric content outline section on “Licensing,” which includes knowledge of licensing requirements and definitions.

Afraternal benefit society, as defined in Oklahoma’s Insurance Code (Title 36 O.S. § 2711), is an incorporated organization without capital stock, operating on a lodge system with a representative form of government, and providing insurance benefits solely for its members and their beneficiaries. Unlike commercial insurers, fraternal benefit societies arenot-for-profitentities, making “for profit” an incorrect characteristic.

Option A: Incorrect (is a characteristic). Fraternal benefit societies are incorporated entities.

Option B: Incorrect (is a characteristic). They operate without capital stock, distinguishing them from stock insurers.

Option C: Correct (is not a characteristic). Fraternal benefit societies are not-for-profit, not for-profit organizations.

Option D: Incorrect (is a characteristic). They exist solely for the benefit of their members.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers types of insurers, including fraternal benefit societies.

According to IRS guidelines (Publication 502), premiums paid by an individual for personally owneddisability income insurancearenot tax deductibleas medical expenses or otherwise, unlike certain health insurance premiums. However, benefits received from such policies are generally tax-free if the insured paid the premiums with after-tax dollars.

Option A: Correct. Premiums for personally owned disability insurance are not tax deductible.

Option B: Incorrect. Premiums are not deductible for disability income insurance.

Option C: Incorrect. There is no partial deduction for these premiums.

Option D: Incorrect. Tax deferral applies to certain investment products, not disability premiums.

Per IRS Publication 502,Long-Term Care (LTC) insurance premiumsare considered qualified medical expenses and may be tax deductible if the taxpayer’s total medical expenses exceed 10% of their adjusted gross income (AGI), subject to age-based limits on the deductible amount. Premiums for disability income insurance (group or personal) and accidental death and dismemberment (AD&D) insurance are not deductible as medical expenses, as they do not directly relate to medical care.

Option A: Correct. LTC insurance premiums are deductible as medical expenses, subject to limits.

Option B: Incorrect. Group disability insurance premiums are not deductible as medical expenses.

Option C: Incorrect. Personal disability income insurance premiums are not deductible.

Option D: Incorrect. AD&D insurance premiums are not deductible as medical expenses.

Acancelablehealth insurance policy allows the insurer to cancel the policy at any time during the term with proper notice, typically for reasons like non-payment or fraud, as permitted under Oklahoma’s regulations (Title 36 O.S. § 4405). Other policy types, like optionally renewable (insurer can refuse renewal at term end), conditionally renewable (renewal subject to conditions), or term (fixed duration), do not typically allow mid-term cancellation.

Option A: Incorrect. Optionally renewable policies can be non-renewed at term end, not cancelled mid-term.

Option B: Incorrect. Term policies (life or health) run for a fixed period and are not typically cancelled mid-term.

Option C: Incorrect. Conditionally renewable policies restrict renewal, not mid-term cancellation.

Option D: Correct. A cancelable policy allows mid-term cancellation by the insurer.

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.

Under Title 36 O.S. § 1435.13, the Oklahoma Insurance Commissioner may take disciplinary action against a licensee for causes such as fraud, providing false information on a license application, or failing to comply with state laws, including tax obligations. However, a misdemeanor conviction does not automatically warrant license action unless it involves a crime of moral turpitude (e.g., fraud, theft) or is directly related to insurance activities.

Option A: Incorrect (is a cause). Admitting to fraud is grounds for license suspension or revocation.

Option B: Incorrect (is a cause). Providing misleading or untrue information on a license application is a violation.

Option C: Correct (is the exception). A misdemeanor conviction alone, without specific relevance to insurance or moral turpitude, is not typically grounds for license action.

Option D: Incorrect (is a cause). Failing to pay state taxes can lead to disciplinary action as a violation of state law.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers licensing disciplinary actions.

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.

Long-Term Care (LTC) policies cover services for individuals who need assistance withActivities of Daily Living (ADLs), which are basic self-care tasks. Oklahoma regulations (O.A.C. 365:10-5-44) and federal standards define ADLs as including dressing, eating, toileting, bathing, transferring, and continence.Talkingis not considered an ADL, as it is not a fundamental self-care activity.

Option A: Incorrect. Dressing is an ADL.

Option B: Correct. Talking is not an ADL.

Option C: Incorrect. Eating is an ADL.

Option D: Incorrect. Toileting is an ADL.

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.

Alevel term-to-age-65 life insurance policyprovides a fixed death benefit until the insured reaches age 65, as long as premiums are paid. Since Jim purchased a $200,000 policy at age 35 and dies at age 50 (before age 65), the full death benefit of $200,000 is payable, assuming the policy is in force.

Option A: Incorrect. $50,000 is not the policy’s face amount.

Option B: Incorrect. $100,000 is not the policy’s face amount.

Option C: Incorrect. $150,000 is not the policy’s face amount.

Option D: Correct. The $200,000 death benefit is paid, as it is a level term policy.

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

Anaccelerated death benefit (ADB)provision, regulated in Oklahoma (Title 36 O.S. § 4051), allows an insured with aterminal illness(typically with a life expectancy of 12–24 months) to receive a portion of the life insurance death benefit before death. This provides funds for medical or personal expenses during the insured’s lifetime.

Option A: Incorrect. Disability may trigger other riders (e.g., waiver of premium), not ADB.

Option B: Correct. A terminal illness qualifies for accelerated death benefits.

Option C: Incorrect. Reaching retirement age does not trigger ADB.

Option D: Incorrect. A dependent’s illness is not a qualifying condition for ADB.

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

Mortgage redemption or cancellation insuranceis a type ofdecreasing term life insurancedesigned to pay off a mortgage balance if the insured dies. The death benefit decreases over time, matching the declining mortgage balance, while premiums typically remain level, making it cost-effective for this purpose.

Option A: Incorrect. Increasing term insurance has a rising death benefit, unsuitable for mortgage protection.

Option B: Correct. Decreasing term insurance aligns with the declining mortgage balance.

Option C: Incorrect. Whole life provides permanent coverage with cash value, not specific to mortgage payoff.

Option D: Incorrect. Universal life is flexible permanent insurance, not typically used for mortgage redemption.

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

Alife annuity(or straight life annuity) pays periodic payments to the annuitant until their death, at which point all payments cease, with no further benefits to beneficiaries. This contrasts with other annuity types, such as refund or joint-life annuities, which may continue payments or provide refunds.

Option A: Incorrect. “Terminal annuity” is not a standard insurance term.

Option B: Incorrect. “Finite annuity” is not a recognized annuity type.

Option C: Incorrect. A refund annuity provides a refund or continued payments to a beneficiary if the annuitant dies early.

Option D: Correct. A life annuity ceases payments upon the annuitant’s death.

This question falls under the Prometric content outline section on “Life Products,” which covers annuities and their features.