Virginia-Life-Annuities-and-Health-Insurance Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Questions and Answers

Keogh plans, established under the Internal Revenue Code, are retirement plans for self-employed individuals and small businesses, also known as HR 10 plans (option B) after the 1962 legislation (H.R. 10) creating them. They allow tax-deferred contributions, similar to qualified plans. Option A (Section 457 plans) applies to government and nonprofit employees, not self-employed individuals. Option C (403(b) plans) is for nonprofit employees (e.g., teachers), distinct from Keogh’s self-employed focus. Option D (Section 2503(c) trusts) relates to gifting for minors, not retirement. The study guide likely contrasts Keogh (HR 10) with other plans in a retirement section, noting its tax benefits and eligibility, confirming B as the correct synonym.

A joint life insurance policy insures two lives under one policy and pays the death benefit at the first insured’s death. After payment, the policy terminates.

This type of policy is commonly used to cover joint financial obligations such as business partnerships or mortgages.

Option B describes survivorship (second-to-die) life insurance, not joint life. Insurable interest is required at policy issue, not at death. Therefore, option A is correct.

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.

Virginia Code § 38.2-3500 et seq. allows health insurance policies to include riders—supplemental agreements modifying coverage or terms (e.g., adding dental benefits or exclusions). Option D (rider) is the standard term. Option A (limit clause) isn’t a distinct attachment; limits are within the policy. Option B (attachment) is vague and not insurance-specific. Option C (insuring clause) is the core promise of coverage, not an alteration. The study guide likely defines riders with examples—e.g., a maternity rider increasing premiums—distinguishing them from policy staples, confirming D as the answer.

This scenario has two defining features: (1) the annuity was funded with a single lump sum ($100,000) and no further purchase payments are allowed, and (2) benefit payments begin in the future (17 years). That combination is the textbook definition of a single premium deferred annuity (SPDA). Virginia’s consumer materials explain that a single premium annuity may be immediate or deferred, and that a single premium deferred annuity begins payments at a future date and can provide larger payments than an immediate annuity purchased for the same amount because the premium earns interest during the deferred period.

General annuity definitions similarly describe an SPDA as an annuity established with one lump-sum payment that grows during the accumulation phase until annuitization, when payments begin. The “lawsuit settlement” detail is consistent with common annuity uses; Virginia’s exam outline lists annuities as a tool for lump-sum settlements. The other options don’t match: an IRA is a tax-qualified retirement arrangement, not implied here, and “individual life annuity” describes a payout form, not the premium structure and deferral features emphasized in the question.

Virginia Code § 38.2-4306 mandates that Health Maintenance Organizations (HMOs) provide comprehensive health services, including emergency care, as a core benefit. Emergency services must be available 24 hours a day, 7 days a week (option D) to ensure immediate access to life-saving treatment, aligning with federal and state standards (e.g., ACA requirements under 42 CFR § 422.113). This reflects the HMO’s obligation to cover urgent needs—e.g., a heart attack at 2 a.m.—via in-network facilities or out-of-network reimbursement if necessary. Option A (16 hours, 6 days) and Option B (16 hours, 7 days) fall short of the continuous access requirement, limiting coverage unreasonably. Option C (24 hours, 6 days) excludes one day, contradicting the nonstop mandate. The study guide likely emphasizes this 24/7 rule in an HMO benefits section, with examples like ER visits covered anytime, making D the correct standard. This ensures HMOs meet Virginia’s consumer protection goals under § 38.2-4300 et seq., distinguishing them from less comprehensive plans.

A certificate of insurance in a group health plan is evidence of the employee's insurance coverage. It provides a summary of the coverage, terms, and benefits the employee is entitled to under the group policy. It is not a contract between the employee and the insurer or between the employer and the insurer. The employer typically holds the master policy, while the certificate is issued to each employee covered under the plan.

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.

An unfair claims settlement practice occurs when insurers do not properly or promptly investigate and settle legitimate claims. This is a key element of unfair practices, as insurers are required by law to act in good faith when handling claims. Failing to promptly investigate or settle legitimate claims is considered unethical and unfair, as it delays rightful compensation and causes unnecessary hardship for policyholders.

The other options may describe improper actions, but failing to promptly investigate and settle claims is more directly tied to unfair practices under the insurance regulations.

Detailed Answer in Step-by-Step Solution:

If an IRA owner dies before distributions, the surviving spouse beneficiary can roll the IRA into their own IRA (B), treating it as their own and delaying distributions until their required beginning date.

Option A (forfeited) is false; assets pass to the beneficiary. Options C and D apply to non-spouse beneficiaries under older rules, not spousal rollovers.

The Virginia study guide, per IRS rules, allows a surviving spouse to roll an inherited IRA into their own, avoiding immediate taxation or forced distributions. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Retirement Plans."

Detailed Answer in Step-by-Step Solution:

Life insurance policies must include a misstatement of age clause (B), grace period clause (C), and incontestability clause (D) as standard provisions under state law.

The waiver of premium clause (A) is optional, typically a rider, not a required provision.

The Virginia study guide lists mandatory life insurance provisions (e.g., grace period, incontestability, misstatement of age) but notes that waiver of premium is an optional benefit, not required. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

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.

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.

Medicare provides home health care benefits for individuals who are homebound and need skilled nursing or therapy services. Custodial care, hospice care, and long-term nursing home stays are covered under different provisions.

Exact Extract (Virginia Medicare Study Guide): “Home health care—Medicare pays for part-time or intermittent skilled care for patients confined to the home.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Medicare Part A and B Benefits

Detailed Answer in Step-by-Step Solution:

Designating a beneficiary "by class" means identifying a group (e.g., "my children") rather than naming specific individuals (C).

Option A (business life insurance) is unrelated to class designation.

Option B (no primary beneficiary) is incorrect; a class can still be primary.

Option D (unrelated beneficiaries) is not a requirement of class designation.

The Virginia study guide notes that a class designation identifies beneficiaries by a category (e.g., "spouse" or "heirs") rather than specific names, offering flexibility. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Beneficiary Designations."

Detailed Answer in Step-by-Step Solution:

Rebating (B) is the illegal practice of offering a portion of an agent’s commission or other financial incentives to induce a sale, prohibited in most states, including Virginia, to ensure fair competition.

Twisting (A) involves misrepresenting policies to replace existing coverage. Replacement (C) is switching policies, not necessarily with a rebate. Retention (D) is not a recognized term here.

The Virginia study guide defines rebating as an unfair trade practice under Virginia insurance law, aimed at preventing agents from undercutting prices with commission kickbacks. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Unfair Trade Practices."

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.”

Adjustable life insurance is specifically designed to provide flexibility in both face amount and premium structure, allowing policyowners to adapt coverage as financial needs and objectives change. This flexibility may include adjustments to death benefit levels and premium payments within policy limits.

Term life and modified premium whole life lack this degree of adaptability. Current assumption whole life allows interest rate sensitivity but does not permit the same broad adjustments to coverage structure.

Virginia licensing materials identify adjustable life as a hybrid policy combining features of term and whole life insurance, making option B the correct answer.

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."

Group credit life insurance does not insure the life of an individual for personal benefit. Instead, it insures a debtor’s obligation, with the creditor as beneficiary. The purpose is to pay off a loan balance if the borrower dies, not to provide income protection to survivors.

Employer group plans and association group plans insure individuals within a defined group, and equity indexed universal life insures a specific individual with cash value linked to an equity index. Therefore, those options do insure individual lives.

Virginia licensing materials clearly distinguish credit life insurance as debt protection rather than personal life insurance, making option C the correct answer.

Detailed Answer in Step-by-Step Solution:

In Virginia, unintentional violations by an agent can result in fines, with a maximum aggregate penalty of $10,000 (C) for similar violations, as set by state insurance regulations.

Options A, B, and D deviate from this standard cap for unintentional acts.

The Virginia study guide, aligned with Virginia Code, specifies a $10,000 maximum aggregate penalty for unintentional violations, with higher penalties possible for willful acts. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Penalties and Enforcement."

Agents act as representatives of insurers to solicit, receive, and forward applications. They cannot approve claims or unilaterally reinstate or replace contracts. Exact extract: “An agent is authorized to solicit, receive, and forward applications to the insurer but has no power to approve claims or reinstate policies.”

A twenty-payment whole life insurance policy is a limited-pay whole life policy that requires premiums to be paid for only 20 years. If the insured survives the 20-year payment period, the policy becomes fully paid-up and remains in force for the insured’s lifetime without any further premium payments. If the insured dies before the 20-year payment period ends, premium payments stop at death, and the death benefit is paid to the beneficiary. Therefore, premium payments cease at the earlier of the insured’s death or the end of the 20-year payment period. The policy does not require premium payments until maturity or until cash value exceeds premiums. The correct definition focuses on the limited premium payment structure of the policy.

The primary purpose of disability income insurance is to replace a portion of the insured’s income when they are unable to work due to illness or injury. It is not designed to cover hospital or physician expenses (those fall under medical insurance). Instead, it ensures that the insured continues to receive income during periods of disability.

The grace period provision allows a policyholder a specified time (usually 31 days) after the due date to pay overdue premiums while coverage continues. If the insured dies during this period, the premium due is deducted from the policy proceeds.

Exact Extract (Virginia Policy Provisions Requirement): “Life insurance policies shall provide a grace period of not less than 31 days for the payment of premiums, during which the policy shall continue in force.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3107 (Grace period in life insurance policies)

Universal life (Virginia Code § 38.2-3113.1) features: Option A is true; a mortality charge funds the death benefit, deducted monthly from cash value. Option B is true; expense charges are disclosed (e.g., admin fees). Option D is true; loans reduce the cash value earning interest. Option C is false; death benefits are generally tax-free under IRC § 101(a)(1), not ordinary income, unless an exception (e.g., transfer for value) applies, which isn’t standard. The study guide likely contrasts universal life mechanics—e.g., $50 monthly mortality charge—with tax-free benefits, making C the exception.

In a non-qualified deferred annuity, the owner’s cost basis is the total amount of premiums paid into the contract. This figure is used to determine the taxable and non-taxable portions of withdrawals and annuity payments.

Earnings in the annuity grow tax-deferred, and when distributions occur, amounts exceeding the cost basis are taxable as ordinary income. Opportunity cost and cash values are unrelated to tax basis calculations.

Virginia exam standards emphasize understanding cost basis to correctly apply annuity taxation rules, making option B correct.

Individual health policies must include a free look period of at least 10 days, giving policyholders the right to return the policy for a full refund if dissatisfied.

Exact Extract (Virginia Insurance Regulations): “Every individual health insurance policy shall include a free-look provision of not less than 10 days.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3514 (Standard Policy Provisions – Free Look)

Outstanding policy loans reduce the policy’s death benefit and cash value by the unpaid balance plus accrued interest. Exact extract: “Any outstanding loan amount at the insured’s death shall be deducted from the death benefit.” Policies remain in force as long as cash value is sufficient to cover charges.

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.

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)

If a health insurance policy provision conflicts with the statutes of Virginia, the provision must be amended to conform to the minimum statutory requirements. This ensures that the policy complies with state law and that the insured receives the protection mandated by Virginia's insurance regulations. Provisions that do not meet these requirements are typically adjusted to align with legal standards.

Medicare supplement policies in Virginia are guaranteed renewable. This means the insurer cannot cancel coverage as long as premiums are paid on time, regardless of the insured’s health status or claim history. Exact extract: “Every Medicare supplement policy shall be guaranteed renewable and may not be terminated except for nonpayment of premium or material misrepresentation.” This provides strong consumer protection for seniors relying on supplemental coverage.

A variable life insurance policy is considered a securities product because its cash value is invested in separate accounts that fluctuate based on market performance. Policyowners assume investment risk, and cash values are not guaranteed beyond any stated minimum death benefit. Because of this market exposure, variable life insurance is regulated under both insurance and securities laws. Agents selling variable life policies must hold appropriate insurance licenses and securities registrations. The other policy types listed are traditional insurance products and do not involve direct investment in securities. Variable life is the only option that combines life insurance protection with securities-based investment components.

Medicare Part A Hospital Insurance is available regardless of age to individuals who have received Social Security disability benefits for at least 24 months. This is a key provision that allows individuals who are disabled and have been receiving Social Security Disability Insurance (SSDI) for two years to qualify for Medicare Part A.

Disability buy-sell insurance funds a business partner’s buyout if one becomes disabled, per Virginia Code § 38.2-3100 et seq. Option C is true; proceeds are typically tax-free under IRC § 104(a)(3) as insurance benefits, not income, if premiums aren’t deducted. Option A is false; the policyowner (e.g., a partner or business) is often the beneficiary to fund the buyout. Option B is false; benefits go to the business or partner, not the disabled individual, who may receive separate disability income coverage. Option D is false; premiums aren’t tax-deductible (IRC § 265), preserving tax-free proceeds. The study guide likely explains this with scenarios—e.g., $500,000 paid tax-free to buy out a disabled partner—highlighting tax treatment, making C the true statement.

In an AD&D (Accidental Death and Dismemberment) policy with a revocable beneficiary designation, the policyowner has the right to change the beneficiary. A revocable beneficiary designation means that the policyowner can change the beneficiary at any time without the beneficiary's consent. This is in contrast to an irrevocable beneficiary designation, where the beneficiary's consent would be required to make a change.

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."

Only distributions from qualified employer-sponsored retirement plans (like 401(k)s or pensions) are eligible for rollover into an IRA. Personal savings, lottery winnings, or insurance death benefits do not qualify. Exact extract: “Eligible rollover distributions from qualified plans may be directly transferred or rolled over into an IRA within 60 days to preserve tax-deferred status.” This ensures retirement funds remain tax-deferred until later withdrawal.

Detailed Answer in Step-by-Step Solution:

The Virginia Bureau of Insurance has authority to request and review an agent’s business records (C) to ensure compliance with state laws, without requiring a court order (A) or NAIC approval (B).

Option D (no access) is false; regulatory oversight overrides privacy in this context.

The Virginia study guide confirms that the Bureau of Insurance can demand records as part of its regulatory powers under Virginia insurance law, ensuring market conduct compliance. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Regulation."

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

When a health insurer requires a physical examination, the insurer typically has the right to choose the examining physician. This is because the insurer is the one paying for the examination as part of the claims or underwriting process, ensuring that the exam is conducted by a professional selected by the insurance company. While the insured may be asked for preferences in some cases, the final decision is generally up to the insurer.

In individual health insurance underwriting, factors such as age, sex, and occupation can influence the decision to offer coverage, the premium rates, and any exclusions or limitations. However, religion is not a factor that can be considered, as it is prohibited by law to discriminate based on religious beliefs in the underwriting process. The inclusion of religion as a factor would be considered discriminatory.

Virginia requires licensees to report felony convictions within 30 days. Exact extract: “A licensed agent shall report to the Commission any felony conviction within 30 calendar days.”

The Virginia Life, Accident and Sickness Insurance Guaranty Association exists to protect policyholders, insureds, and beneficiaries when a licensed insurer becomes insolvent. Insolvency occurs when an insurer is unable to meet its financial obligations. In such cases, the guaranty association may provide coverage benefits up to statutory limits to ensure consumers do not lose all protection. The association does not protect against normal business events such as mergers, demutualization, or the sale of company assets. Its sole purpose is to provide a safety net in the event of insurer failure. This protection helps maintain public confidence in the insurance system.

Virginia exam materials describe standard STD plan design as wage-replacement for a short duration with a weekly cap; integration with Social Security and multi-year benefit periods are characteristics of long-term disability (LTD), not STD. Exact extract (Study Guide): “Short-Term Disability (STD) pays weekly benefits, typically 50%–60% of earnings, subject to a weekly maximum, for a short duration (commonly up to 13–26 weeks).” “Coordination with Social Security benefits is generally a feature of LTD, not STD.”

Detailed Answer in Step-by-Step Solution:

Endodontic services involve treatment of the tooth’s interior (pulp and roots), with root canals (C) being a primary example.

Crowns (A) and fillings (D) are restorative, not endodontic. Dentures (B) are prosthetic, unrelated to endodontics.

The Virginia study guide classifies root canals as an endodontic procedure, distinct from restorative or prosthetic dental services, per standard dental insurance definitions. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Dental Insurance."

Detailed Answer in Step-by-Step Solution:

Group health underwriting considers average age (A), claims history (B), and occupation type (D) to assess risk, but marital status (C) is typically irrelevant for group policies, unlike individual underwriting.

The Virginia study guide notes that group underwriting focuses on collective risk factors like age, claims experience, and occupation, not personal details like marital status. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance Underwriting."

Group medical benefits may be offered through trade associations where members share a common professional or occupational interest. Associations must exist for purposes other than solely obtaining insurance. Therefore, the correct feature is that members are usually in the same industry.

Exact Extract (Virginia Group Health Insurance Study Guide): “Trade association groups—members are engaged in the same type of business or industry and may be eligible for group medical coverage if the association is not formed solely for insurance purposes.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Group Insurance Eligibility

Medical expense insurance typically excludes coverage for injuries or sickness resulting from military duty. This exclusion is common across most health insurance policies and aligns with the understanding that military personnel are covered under separate government programs (e.g., Veterans Affairs or military health insurance). The other options, such as terminal diseases, dread diseases, or tropical diseases, are not universally excluded, though they may have specific policy restrictions or coverage limits.

A Virginia agent license remains valid until revoked, suspended, or terminated. Appointments with insurers are separate, but the agent holds only one license. Exact extract: “Licenses are perpetual, subject to biennial renewal requirements and compliance; termination occurs only through suspension, revocation, or voluntary surrender.”

A preferred risk classification is typically available for life insurance applicants who have a better-than-average life expectancy. These individuals are generally in excellent health, have no significant medical issues, and engage in behaviors that reduce health risks, such as non-smoking. Applicants in this category are eligible for lower premiums because they are considered lower risk.

Virginia permits exclusion for losses caused by intoxication or non-prescribed drugs but prohibits arbitrary exclusions like failure to get checkups or automobile accidents. Exact extract: “Policies may exclude losses resulting from the insured’s intoxication or use of narcotics unless prescribed by a physician.”

A Simplified Employee Pension (SEP) plan allows employers to make contributions directly into IRAs owned by employees. The employer determines contributions, and employees are immediately vested.

HR-10 plans are Keogh plans for self-employed individuals. 403(b) plans are salary reduction plans for certain nonprofit and public employees. SIMPLE plans allow both employer and employee contributions but are structured differently. Virginia retirement plan exam content clearly identifies SEP plans as employer-funded IRAs, making option C correct.

Virginia Code § 38.2-623 mandates insurers to implement information security programs to safeguard nonpublic personal information, aligning with the NAIC’s Model Regulation for Privacy. These programs must ensure confidentiality (option B), protect against threats or hazards (option C), and prevent unauthorized access (option D)—all core objectives to secure data against breaches or misuse. Option A (ensure policyholder access without substantial inconvenience) is not a requirement of the security program; while Virginia Code § 38.2-610 allows policyholders to request their information, this is a separate consumer right, not a security program goal. The study guide likely details these mandates in a privacy section, emphasizing protection over access facilitation, as security focuses on safeguarding, not convenience. For example, encryption (B, D) and risk assessments (C) are standard, but streamlining access (A) could even conflict with security if overly permissive, making A the exception.

When replacing individual health insurance, the agent must ensure that the benefits of the new policy are at least comparable to those of the existing policy. The goal is to make sure that the insured's coverage remains consistent or better under the new plan, and that they do not face any gaps in coverage. The other options, such as commissions or grace periods, are secondary considerations, but the primary concern is maintaining similar or improved benefits.

The investment gain in a tax-sheltered annuity (TSA), which is also known as a 403(b) plan, is not included in the participant's gross income until it is withdrawn. This allows the participant to defer taxes on the investment growth until retirement, when distributions are taken. The other statements about TSAs are accurate: they are funded through voluntary salary reductions, and the annuitant can have an individual account or contract.

Under qualified retirement plan rules covered in Virginia licensing materials, an employer’s contribution to a profit-sharing plan is limited to a maximum of 25% of total eligible employee payroll. This limit ensures favorable tax treatment while preventing excessive employer contributions that could otherwise be used to shelter income improperly.

Profit-sharing plans are flexible in that the employer is not required to contribute every year, and the amount can vary depending on business performance. However, when contributions are made, they must remain within the statutory maximum. The other percentages listed exceed the allowable limit and therefore are incorrect. Virginia exam standards consistently emphasize the 25% payroll cap as a key characteristic of profit-sharing plans.

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.

Detailed Answer in Step-by-Step Solution:

The incontestability provision in LTC policies typically limits the insurer’s ability to contest coverage based on misrepresentations to two years (B) from issuance, unless fraud is proven (which may extend this in some states).

Option A (six months) is too short. Option C (entire duration) applies only to fraud in some cases, not standard misrepresentations. Option D (prohibited) is incorrect due to the contestable period.

The Virginia study guide, aligned with NAIC standards, notes a two-year contestable period for health-related policies like LTC, after which misrepresentations cannot be challenged absent fraud. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Incontestability."

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.

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.”

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.

Eligibility for long-term care benefits is based on inability to perform Activities of Daily Living (ADLs). Functional assessment measures this ability. Exact extract: “Functional assessments measure the insured’s ability to perform ADLs such as bathing, dressing, eating, continence, and transferring.”

Qualified retirement plans are subject to federal participation standards to ensure broad employee access. Generally, employees age 21 or older must be allowed to participate after completing one year of service. One year of service typically means working at least 1,000 hours during a 12-month period. While some plans may impose longer vesting schedules for employer contributions, participation requirements are designed to prevent unreasonable exclusion of employees. The other options exceed the standard participation limit and are not consistent with general qualified plan rules. Therefore, one year of service is the correct minimum requirement.

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.

Detailed Answer in Step-by-Step Solution:

The health insurance application is signed by the applicant (who provides personal info) and the agent (D), who certifies the information’s accuracy and their role in the process.

The spouse (A) or dependents (B) don’t sign unless they’re co-applicants. An inspection representative (C) is not involved in the application process.

The Virginia study guide specifies that the agent signs the application alongside the applicant to verify the submission and their involvement, per standard industry practice. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Application Process."

Detailed Answer in Step-by-Step Solution:

A foreign insurer (A) is an insurance company operating in a state other than its state of domicile (where it is incorporated).

A domestic insurer (B) operates in its home state. An alien insurer (C) is domiciled outside the U.S. A captive insurer (D) insures its parent company, not based on location.

The Virginia study guide defines a foreign insurer as one licensed to do business in Virginia but incorporated in another state, per insurance regulatory terminology. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Types."

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

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."

Virginia law obligates agents to act as fiduciaries with premiums collected and to promptly remit payments to the insurer. Exact extract: “An agent who accepts funds from an applicant shall hold such funds in a fiduciary capacity and shall promptly remit them to the insurer.”

Virginia Code § 38.2-1833 defines an “appointment” as a formal authorization by an insurer for a licensed agent to act on its behalf in transacting insurance. An insured (option A) is the policyholder or beneficiary and has no role in representing the insurer. An employee of the insurer (option B) may work internally but isn’t automatically appointed to sell insurance unless they hold an agent’s license and an appointment, which isn’t implied here. A consultant (option C), under Virginia Code § 38.2-1837, advises on insurance but doesn’t transact it unless also licensed and appointed as an agent, making this a less direct fit. Only an agent (option D), licensed under Virginia Code § 38.2-1819 and appointed per § 38.2-1833, is required to hold an appointment to represent an insurer. The study guide emphasizes that appointments link licensed agents to specific insurers, solidifying D as the correct choice.

An automatic premium loan provision is typically found in whole life insurance policies. This provision allows the insurer to automatically pay the premium from the cash value of the policy if the policyholder fails to pay the premium on time. This is a feature unique to permanent life insurance, like whole life, where the policy builds cash value over time. Credit insurance, decreasing term, and level term policies generally do not include such provisions because they are term-based policies and do not accumulate cash value.

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.

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.

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 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.

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.

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.”

Most medical expense policies exclude elective cosmetic procedures unless medically necessary. Exact extract: “Policies may exclude benefits for cosmetic surgery unless required to correct accidental injury or congenital defect.”

If the initial premium is not paid at the time of application, the life insurance coverage typically begins when the agent delivers the policy to the insured and collects the required premium. This is known as the "delivery and premium collection" method, which ensures that the insurer receives payment before coverage becomes effective.

A decreasing term policy provides a declining death benefit over the policy term, while premiums remain level. These policies are often used for mortgage protection, as the insurance amount reduces in line with the declining loan balance.

Exact Extract (Virginia Life Insurance Study Guide): “Decreasing term insurance—provides a level premium and a decreasing face amount throughout the term of coverage, often used for debt protection.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Term Insurance

Individual disability income insurance policies are designed to provide coverage for both accident-related disabilities and sickness-related disabilities, unless otherwise excluded.

Exact Extract (Virginia Disability Insurance Study Guide): “Disability income insurance provides benefits for loss of income due to both accident and sickness.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Disability Income Insurance

In the context of health insurance, particularly dental coverage, Virginia Code § 38.2-3407.1 et seq. governs mandated benefits, though dental specifics often appear in policy riders or standalone plans. Orthodontics (option A) is the branch of dentistry focused on preventing and correcting irregularities of the teeth and jaws using mechanical devices like braces or aligners, precisely matching the question’s description. Endodontics (option B) deals with the tooth’s interior (e.g., root canals), not mechanical correction of alignment. Periodontics (option C) addresses gum diseases and supporting structures, not tooth positioning. Prosthodontics (option D) involves replacing missing teeth with prosthetics (e.g., dentures), not correcting irregularities mechanically. The study guide likely defines these terms in a health insurance section, emphasizing orthodontics’ role in alignment correction—both preventive (e.g., avoiding bite issues) and corrective—making A the clear answer. Examples like braces for malocclusion reinforce this distinction from other specialties.

Detailed Answer in Step-by-Step Solution:

For unintentional violations in Virginia, the maximum penalty is $1,000 per occurrence, with an aggregate cap of $10,000 (C), per state insurance regulations.

Options A, B, and D deviate from this standard penalty structure.

The Virginia study guide, per Virginia Code, sets unintentional violation penalties at up to $1,000 per act, with a $10,000 total cap, escalating for willful violations. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Penalties and Enforcement."

When an insured is covered under more than one group health plan, the primary plan pays first. The secondary plan pays remaining eligible expenses after the primary plan has paid.

Exact Extract (Virginia Group Health Insurance Study Guide): “The primary plan is responsible for paying benefits first under coordination of benefits. The secondary plan covers remaining eligible expenses.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Coordination of Benefits

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

Detailed Answer in Step-by-Step Solution:

In a deferred annuity, the owner (who purchases the contract) can be the annuitant (who receives payments), the beneficiary (who receives proceeds), or a third party (C).

Option A (group contract) applies to group annuities, not individual ownership.

Option B (non-transferable) is false; ownership can often be assigned.

Option D (rights at payment phase) is incorrect; owners have rights during accumulation.

The Virginia study guide notes that deferred annuity ownership is flexible, allowing the owner to differ from the annuitant or beneficiary, with rights exercisable before payout. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Annuities."

Once an agent is appointed by an insurer in Virginia, the appointment remains in effect until either the insurer or the Bureau of Insurance terminates it. No quarterly renewal or NAIC approval is required.

Exact Extract (Virginia Producer Licensing Rules): “Appointments remain in effect until terminated by the insurer or the Bureau of Insurance.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1833 (Appointments of agents)

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.

The main advantage of tax-qualified retirement plans is that earnings accumulate tax-deferred until distributed to participants. This allows employees’ investments to grow more quickly compared to taxable accounts. Exact extract: “Employees benefit from tax-deferred accumulation of pension and profit-sharing contributions until retirement distribution.” Employers may deduct contributions, but the true long-term tax benefit accrues to employees.

Business overhead expense insurance is designed to cover the fixed business expenses, such as rent, utilities, and employee salaries, if the business owner becomes disabled and cannot work. This insurance ensures that the business can continue to operate in the owner's absence, covering regular business expenses but not providing a direct income replacement to the business owner.

The return of premium benefit refunds a percentage of premiums paid if the policy is canceled or if the insured dies before benefits are used. Exact extract: “A return of premium rider provides a refund of premiums paid, less claims paid, upon cancellation or death of the insured.” This option is often added to long-term care policies to protect policyholder investment.

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.

Detailed Answer in Step-by-Step Solution:

A group health insurance contract is a legal agreement between the employer (policyholder) and the insurance company (C), with employees as covered participants, not direct parties to the contract.

Option A (employer and employees) is the employment relationship, not the insurance contract. Option B (employee and insurer) applies to individual policies. Option D (all three) overcomplicates the contractual relationship.

The Virginia study guide states that group insurance contracts are issued to the employer or group sponsor, who contracts with the insurer, while employees receive certificates of coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance."

Virginia law uses the term viatical settlement contract for an agreement in which compensation (or anything of value) that is less than the expected death benefit is paid in exchange for the policyowner/“viator” transferring ownership or benefits of a life insurance policy. This matches the question’s description: a terminally ill person sells a life policy at a discount to obtain cash—often to cover medical or living expenses—while the purchaser assumes premium payments and receives the death benefit later. Virginia’s administrative definitions also clarify that viatical settlements are distinct from accelerated death benefit riders contained within the life insurance policy itself (those are governed under different rules).

The other answer choices do not fit. “Nonforfeiture” refers to benefits/options available when a policy with cash value lapses, such as cash surrender, reduced paid-up insurance, or extended term—these do not involve selling the policy to a third party. “Living wills” are advance medical directives, not insurance transactions. “Repurchase agreements” are unrelated financial arrangements. Because the described transaction is a sale/transfer of a life policy for less than the expected death benefit, the correct term in Virginia is viatical settlement.

If all named beneficiaries die before the insured, the proceeds of the life insurance policy will typically be paid to the insured's estate. If no beneficiary survives, the estate is the default recipient, and the assets are distributed according to the terms of the will or, if no will exists, according to state law (intestate succession).

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.

An outline of coverage must be given to all applicants at the time of application. This document clearly describes the benefits, services, copayments, deductibles, exclusions, limitations, and premium details so that consumers can make informed choices. Virginia regulations require insurers to deliver this document in a standard format prescribed by the Bureau of Insurance.

Exact Extract (Virginia Medicare Supplement Regulations): “Issuers shall provide an outline of coverage to all applicants at the time the application is presented… It shall include a description of benefits, services, exclusions, copayments, deductibles, and premiums.”

References (Virginia Documents / Study Guide):

— Virginia Administrative Code 14VAC5-170-150 (Required disclosure provisions – Outline of Coverage)

— Code of Virginia §38.2-3606 (Outline of Coverage requirement)

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.

In Virginia, an insurance agent is treated as the insurer’s agent when selling/soliciting/negotiating insurance, which is why insurers are generally accountable to insureds for authorized acts of their agents in those transactions. However, that does not mean the agent is immune from personal responsibility. When an agent goes beyond the authority granted by the insurer—especially by doing something the agency agreement expressly forbids—the agent is acting outside the scope of the contractually granted authority and may face personal consequences (including civil liability exposure depending on the harm caused and the legal theory asserted). Virginia regulatory guidance also warns that exceeding authority is a violation of Virginia law, underscoring that an agent’s actions are constrained by the authority they’ve been granted. By contrast, “oral but unwritten authority” can still be actual authority if the insurer granted it, and using insurer-provided materials (even if problematic) typically implicates the insurer’s oversight and advertising compliance duties rather than automatically shifting liability to the agent. The “never” option is incorrect because liability can arise when authority is exceeded or prohibited conduct occurs.

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.

Virginia Code § 38.2-3432.1, aligned with the Affordable Care Act (ACA), mandates guaranteed renewability for small employer health plans (1-50 employees in Virginia). Insurers can deny renewal for nonpayment of premiums (option A), insufficient participants (option B, e.g., falling below one eligible employee), or fraud (option D), per Virginia Code § 38.2-3407. However, option C—overuse of services (high claims)—a—is not a permissible reason for denial, as renewability cannot be based on claims experience or health status. The study guide emphasizes this protection under Virginia’s small group market rules, making C the exception.

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."

Detailed Answer in Step-by-Step Solution:

The coordination of benefits (COB) provision prevents overinsurance (B) by ensuring that total payments from multiple group plans don’t exceed 100% of covered expenses, avoiding duplication.

It doesn’t affect dependent coverage (A), probationary periods (C), or waiting periods (D), which are unrelated to claim payments.

The Virginia study guide describes COB as a mechanism to coordinate payments among multiple insurers, reducing overinsurance and ensuring fair claim distribution. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Health Insurance Provisions."

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.

A single premium whole life insurance policy is a form of permanent life insurance in which the policyowner pays the entire premium in one lump sum at policy issuance. In exchange for this single payment, the policy provides lifetime protection and is immediately paid-up, meaning no additional premiums are required. The policy accumulates cash value and provides a guaranteed death benefit for the insured’s entire life. It does not provide coverage for a limited term, nor does it feature a decreasing face amount. While annuities provide income benefits, a single premium whole life policy remains primarily a life insurance contract. Therefore, the defining feature of this policy is that it provides protection for life as a paid-up policy.

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.

Insurance works on the law of large numbers, which states that as the number of exposure units increases, the predictability of losses increases—not that the number of losses decreases. Losses still occur, but they become more statistically predictable.

Exact Extract (Virginia Insurance Fundamentals Study Guide): “Law of large numbers—predictability of loss increases as the number of similar exposure units increases. The number of losses does not decrease.”

References (Virginia Documents / Study Guide):

— Virginia General Insurance Concepts, Risk and Principles of Insurance

Home health care insurance covers long-term physical therapy or nursing services provided at the insured's residence. This type of insurance helps pay for the costs associated with receiving medical care in the home, such as nursing services, physical therapy, or assistance with activities of daily living. Nursing home insurance, on the other hand, covers care provided in a facility, not at home.

Virginia Code § 38.2-3117.1 permits life insurance policies to include an accelerated death benefit (ADB) provision, allowing the policyowner to receive a portion of the death benefit early if the insured is diagnosed with a terminal illness (typically less than 12-24 months life expectancy, per policy terms). Option B correctly identifies this benefit, often used for medical expenses or quality-of-life needs. Option A (death benefit) is paid only upon death, not during life, so it’s incorrect here. Option C (reduced paid-up insurance) is a nonforfeiture option converting cash value to a smaller, paid-up policy, unrelated to terminal illness. Option D (extended term insurance) uses cash value to extend term coverage, also not tied to life expectancy triggers. The study guide likely details ADB as a modern feature addressing critical health scenarios, distinguishing it from standard death benefits or nonforfeiture options, confirming B as the accurate choice.

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)

Virginia Code § 38.2-3100 et seq. defines immediate annuities as contracts starting payments within one year of purchase, typically funded with a lump sum. Option C fits: retirees with savings (e.g., $200,000 from a 401(k)) buy immediate annuities for instant income. Option A (tax deduction) applies to contributions to qualified plans, not immediate annuities, which use after-tax funds unless from a rollover. Option B (tax-sheltered annuity) refers to 403(b) plans, not immediate annuities. Option D (accumulate funds) suits deferred annuities, not immediate ones. The study guide likely contrasts immediate (C) with deferred annuities (D), using examples like a 65-year-old converting a lump sum to monthly payments, making C the typical buyer.

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”)

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

A deferred annuity would be appropriate for an individual, age 50, who wants to help pay for a grandchild's college expenses in fifteen years. With a deferred annuity, the individual can make contributions now, and the annuity will accumulate value over time. The annuity will begin making payments in the future (in this case, fifteen years) to help fund the grandchild’s college expenses. A survivorship annuity, immediate annuity, or pure life annuity would not be suitable for this purpose, as they either begin payments immediately or are focused on providing income for the lifetime of the annuitant.

Virginia adopts the Accident and Sickness advertising standards that define “advertisement” broadly (print, online, audiovisual, etc.), but specifically carve out employer announcements about available group coverage. Exact extract: “Advertisement means any printed, published, audio/visual, or descriptive literature used to solicit the public… including material on an insurer’s website.” “The term does not include general announcements by an employer to its employees that a plan of coverage is available.”

The misstatement of age provision adjusts benefits to reflect the correct age at which premiums should have been paid. The insurer does not void or cancel the policy; instead, it adjusts the coverage to the amount the paid premium would have purchased at the correct age.

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

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3514 (Uniform individual accident and sickness policy provisions – Misstatement of age)

Under the coordination of benefits provision, when an individual is covered by more than one medical plan, the primary plan (Plan A) pays up to its limit first, and then the secondary plan (Plan B) pays any remaining covered expenses. In this case, since Plan A is primary, it will pay up to its maximum benefit of $4,000. After that, Plan B will pay up to its maximum benefit of $3,000, covering the remaining $2,000 in expenses.

In long-term care (LTC) insurance, the elimination period, per Virginia Code § 38.2-5202, is the waiting period between the onset of a qualifying condition (e.g., confinement due to inability to perform ADLs) and the start of benefit payments. It’s akin to a deductible in days (e.g., 30, 60, or 90 days), during which the insured must cover costs. Option D correctly names this period. Option A (trial period) isn’t a standard LTC term. Option B (exclusion period) might confuse with pre-existing condition exclusions, but it’s not the waiting period for benefits. Option C (qualifying period) could imply eligibility determination, but “elimination period” is the precise industry term. The study guide likely defines this as a cost-sharing feature, with examples illustrating how longer periods reduce premiums, solidifying D as the answer.

Detailed Answer in Step-by-Step Solution:

In a PPO, using a non-PPO provider (out-of-network) leads to higher out-of-pocket expenses (A) due to lower reimbursement rates and potential excess charges.

Option B (full cost) is inaccurate; some coverage applies. Option C (100% reimbursement) is false. Option D (waiting period) is unrelated.

The Virginia study guide reiterates that PPOs cover out-of-network care but at a reduced level, increasing the insured’s costs compared to in-network use. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Managed Care Plans."

Virginia Code § 38.2-3205 governs policy loans in life insurance. When an insured borrows against the policy’s cash value and fails to repay the loan (principal plus interest), the outstanding amount is deducted from the death benefit upon the insured’s death. Option C correctly states this reduction. Option A is false; premiums are fixed unless the policy is adjustable, and loans don’t alter them. Option B is incorrect; dividends depend on insurer performance and policy terms, not loan repayment, though they might be applied to reduce the loan if elected. Option D is wrong; immediate lapse occurs only if the loan exceeds the cash value and premiums aren’t paid, not simply from non-repayment. The study guide likely stresses that the death benefit is the primary adjustment mechanism, ensuring the insurer recovers the loan while honoring the policy, making C the accurate choice.

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.

Insurance contracts are contracts of adhesion, meaning they are drafted by one party—the insurer—and offered to the other party—the insured—on a take-it-or-leave-it basis. Because the insured has little or no ability to negotiate terms, courts apply special rules when interpreting ambiguous language. If a policy provision is unclear, courts generally interpret the ambiguity in favor of the insured, who is considered the weaker party. This approach protects consumers and encourages insurers to draft clear and precise policy language. Courts do not favor the insurer’s intent, technical interpretations, or decisions made by arbitrators when ambiguity exists. The guiding principle is fairness and reasonable expectations of the insured.

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

Detailed Answer in Step-by-Step Solution:

The buyer’s guide for Medicare Supplement insurance must be provided to the consumer at the time of application (B) to ensure they understand the policy’s benefits and limitations before committing.

Option A (replacement only) is incorrect; the guide is required for all sales, though additional notices apply for replacements.

Option C (prior to payment) is too vague and not a specific requirement.

Option D (first-time buyer) is not a condition under Virginia or federal rules.

Per the Virginia study guide, agents must deliver the buyer’s guide at the time of application for Medicare Supplement policies, as mandated by federal and state regulations to promote informed decisions. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Supplement Insurance Regulations."

Agents are fiduciaries, meaning they must handle clients’ premiums with the highest standard of care. Misuse or misappropriation of funds constitutes a violation of fiduciary duty.

Exact Extract (Virginia Agent Regulations): “Insurance producers act in a fiduciary capacity regarding premiums received from insureds and must promptly remit them to insurers.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1834 (Fiduciary responsibility of agents)

In life insurance, the applicant is the person who applies for coverage and is usually the policyowner. The insured is the person whose life is covered, and the beneficiary is the person or entity designated to receive the death benefit. When a person applies for insurance on their own life, they are both the applicant and the insured, and they typically become the policyowner. In this scenario, Kim applies for the policy on Kim’s own life, making Kim the applicant and policyowner. Chris is named only as the beneficiary. None of the other answer choices correctly identify these roles based on the information provided.