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Accident and Health — Information & Free Practice

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Accident and Health

Provider
Pearson VUE
Format
Written examination with general knowledge and Colorado specific portions
Exam questions
50 scored plus 5 pretest general knowledge; 30 scored plus 6 pretest Colorado specific
Time limit
2 hours
Exam fee
$41 per exam session; up to two examinations per session
Examination outline
  • General knowledge — I. TYPES OF POLICIES (16 scored questions)
    • A. Disability income
    • A. Disability income > 1. Individual disability income policy
    • A. Disability income > 2. Business overhead expense policy
    • A. Disability income > 3. Business disability buyout policy
    • A. Disability income > 4. Group disability income policy
    • A. Disability income > 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance > 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance > 2. Major medical policies
    • C. Medical expense insurance > 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance > 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance > 5. Point of Service (POS) plans
    • C. Medical expense insurance > 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance > 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance > 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance > 1. Differences between individual and group contracts
    • E. Group insurance > 2. General characteristics
    • E. Group insurance > 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) > 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) > 2. Levels of care
    • G. Other policies
    • G. Other policies > 1. Dental
    • G. Other policies > 2. Vision
    • G. Other policies > 3. Cancer
    • G. Other policies > 4. Critical illness or specified disease
    • G. Other policies > 5. Worksite (employer-sponsored)
    • G. Other policies > 6. Hospital indemnity
    • G. Other policies > 7. Short-term medical
    • G. Other policies > 8. Accident
  • General knowledge — II. POLICY PROVISIONS, CLAUSES, AND RIDERS (15 scored questions)
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions > 1. Entire contract
    • A. Mandatory and optional provisions > 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions > 3. Grace period
    • A. Mandatory and optional provisions > 4. Reinstatement
    • A. Mandatory and optional provisions > 5. Notice of claim
    • A. Mandatory and optional provisions > 6. Claim forms
    • A. Mandatory and optional provisions > 7. Proof of loss
    • A. Mandatory and optional provisions > 8. Time of payment of claims
    • A. Mandatory and optional provisions > 9. Payment of claims
    • A. Mandatory and optional provisions > 10. Physical examination and autopsy
    • A. Mandatory and optional provisions > 11. Legal actions
    • A. Mandatory and optional provisions > 12. Change of beneficiary
    • A. Mandatory and optional provisions > 13. Misstatement of age or gender
    • A. Mandatory and optional provisions > 14. Change of occupation
    • A. Mandatory and optional provisions > 15. Illegal occupation
    • A. Mandatory and optional provisions > 16. Relation of earning to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses > 1. Insuring clause
    • B. Other provisions and clauses > 2. Free look
    • B. Other provisions and clauses > 3. Consideration clause
    • B. Other provisions and clauses > 4. Probationary period
    • B. Other provisions and clauses > 5. Elimination period
    • B. Other provisions and clauses > 6. Waiver of premium
    • B. Other provisions and clauses > 7. Exclusions and limitations
    • B. Other provisions and clauses > 8. Preexisting conditions
    • B. Other provisions and clauses > 9. Coinsurance
    • B. Other provisions and clauses > 10. Deductibles
    • B. Other provisions and clauses > 11. Eligible expenses
    • B. Other provisions and clauses > 12. Copayments
    • B. Other provisions and clauses > 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses > 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses > 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders > 1. Impairment/exclusions
    • C. Riders > 2. Guaranteed insurability
    • C. Riders > 3. Future increase option
    • D. Rights of renewability
    • D. Rights of renewability > 1. Noncancelable
    • D. Rights of renewability > 2. Cancelable
    • D. Rights of renewability > 3. Guaranteed renewable
  • General knowledge — III. SOCIAL INSURANCE (6 scored questions)
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • General knowledge — IV. OTHER INSURANCE CONCEPTS (5 scored questions)
    • A. Total, partial, recurrent and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • J. Workers Compensation > 1. Impact on health insurance benefits
    • K. Subrogation
    • L. Cost containment
  • General knowledge — V. FIELD UNDERWRITING PROCEDURES (8 scored questions)
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law > 1. Elements of a contract
    • H. Contract law > 2. Insurable interest
    • H. Contract law > 3. Warranties and representations
    • H. Contract law > 4. Unique aspects of the insurance contract
    • H. Contract law > 4. Unique aspects of the insurance contract > a. Conditional
    • H. Contract law > 4. Unique aspects of the insurance contract > b. Unilateral
    • H. Contract law > 4. Unique aspects of the insurance contract > c. Adhesion
    • H. Contract law > 4. Unique aspects of the insurance contract > d. Aleatory
  • Colorado specific — I. COLORADO STATUTES, RULES, AND REGULATIONS COMMON TO LIFE, SICKNESS AND ACCIDENT, PROPERTY (FIRE), AND CASUALTY INSURANCE (19 scored questions)
    • A. Insurance Commissioner
    • A. Insurance Commissioner > 1. Power and duties
    • A. Insurance Commissioner > 2. Hearings and penalties
    • A. Insurance Commissioner > 3. License suspension and revocation
    • A. Insurance Commissioner > 4. Records and requests for information
    • B. Licensing and producers’ legal responsibility
    • B. Licensing and producers’ legal responsibility > 1. Persons required to be licensed
    • B. Licensing and producers’ legal responsibility > 2. Payment and acceptance of commissions/fees
    • B. Licensing and producers’ legal responsibility > 3. Fiduciary/commingling
    • B. Licensing and producers’ legal responsibility > 4. Pre-licensing and continuing education
    • B. Licensing and producers’ legal responsibility > 5. Unauthorized entities
    • C. Unfair competition and deceptive practices
    • C. Unfair competition and deceptive practices > 1. Coercion
    • C. Unfair competition and deceptive practices > 2. Misrepresentation
    • C. Unfair competition and deceptive practices > 3. Unfair discrimination
    • C. Unfair competition and deceptive practices > 4. Controlled business
    • C. Unfair competition and deceptive practices > 5. Defamation
    • C. Unfair competition and deceptive practices > 6. Rebates
    • C. Unfair competition and deceptive practices > 7. Unfair claims practices
    • C. Unfair competition and deceptive practices > 8. Colorado Fraud Statute
  • Colorado specific — II. COLORADO STATUTES, RULES, AND REGULATIONS PERTINENT TO SICKNESS AND ACCIDENT INSURANCE ONLY (11 scored questions)
    • A. Common requirements for Sickness and Accident
    • A. Common requirements for Sickness and Accident > 1. Maternity/newborn coverage
    • A. Common requirements for Sickness and Accident > 2. Complications of pregnancy
    • A. Common requirements for Sickness and Accident > 3. Mammography/prostate screenings
    • A. Common requirements for Sickness and Accident > 4. Diabetes
    • A. Common requirements for Sickness and Accident > 5. Hospice/home health care
    • A. Common requirements for Sickness and Accident > 6. Guaranteed renewability
    • A. Common requirements for Sickness and Accident > 7. Prompt pay
    • A. Common requirements for Sickness and Accident > 8. Utilization review
    • A. Common requirements for Sickness and Accident > 9. Mandated benefits
    • A. Common requirements for Sickness and Accident > 10. Essential Health Benefits
    • B. Individual coverage
    • B. Individual coverage > 1. Required provisions
    • B. Individual coverage > 2. Replacement
    • B. Individual coverage > 3. Grace Period
    • B. Individual coverage > 4. Termination
    • B. Individual coverage > 5. Enrollment periods
    • C. Group coverage
    • C. Group coverage > 1. Continuation
    • C. Group coverage > 2. Maternity
    • C. Group coverage > 3. Mental health
    • C. Group coverage > 4. Leasing companies
    • D. Small group coverage
    • D. Small group coverage > 1. Definitions
    • D. Small group coverage > 1. Definitions > a. small employer
    • D. Small group coverage > 1. Definitions > b. eligible employee
    • D. Small group coverage > 2. Guaranteed issue/open enrollment/ special enrollment
    • D. Small group coverage > 3. Rating factors
    • D. Small group coverage > 4. Participation requirements
    • E. Fair marketing standards
    • F. Specified products
    • F. Specified products > 1. Medicare Supplement
    • F. Specified products > 2. Long Term Care
    • F. Specified products > 3. Benefit plan description
    • G. Commission Disclosure
    • H. Sales and Marketing of Health Insurance
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