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Accident/Sickness Agent — Information & Free Practice

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Accident/Sickness Agent

Provider
Pearson VUE
Format
Computer-based examination
Exam questions
80 scored questions plus 10 unscored pretest questions
Time limit
2 hours
Passing score
70%
Exam fee
$67
Examination outline
  • I. TYPES OF POLICIES……………………………16
    • A. Disability income
    • 1. Individual disability income policy
    • 2. Business overhead expense policy
    • 3. Business disability buyout policy
    • 4. Group disability income policy
    • 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • 1. Basic hospital, medical, and surgical policies
    • 2. Major medical policies
    • 3. Health Maintenance Organizations (HMOs)
    • 4. Preferred Provider Organizations (PPOs)
    • 5. Point of Service (POS) plans
    • 6. Flexible Spending Accounts (FSAs)
    • 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • 1. Differences between individual and group contracts
    • 2. General characteristics
    • 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • 1. Eligibility
    • 2. Levels of care
    • G. Other policies
    • 1. Dental
    • 2. Vision
    • 3. Cancer
    • 4. Critical illness or specified disease
    • 5. Worksite (employer-sponsored)
    • 6. Hospital indemnity
    • 7. Short-term medical
    • 8. Accident
  • II. POLICY PROVISIONS, CLAUSES, AND RIDERS…….15
    • A. Mandatory and optional provisions
    • 1. Entire contract
    • 2. Time limit on certain defenses (incontestable)
    • 3. Grace period
    • 4. Reinstatement
    • 5. Notice of claim
    • 6. Claim forms
    • 7. Proof of loss
    • 8. Time of payment of claims
    • 9. Payment of claims
    • 10. Physical examination and autopsy
    • 11. Legal actions
    • 12. Change of beneficiary
    • 13. Misstatement of age or gender
    • 14. Change of occupation
    • 15. Illegal occupation
    • 16. Relation of earnings to insurance
    • B. Other provisions and clauses
    • 1. Insuring clause
    • 2. Free look
    • 3. Consideration clause
    • 4. Probationary period
    • 5. Elimination period
    • 6. Waiver of premium
    • 7. Exclusions and limitations
    • 8. Preexisting conditions
    • 9. Coinsurance
    • 10. Deductibles
    • 11. Eligible expenses
    • 12. Copayments
    • 13. Pre-authorizations and prior approval requirements
    • 14. Usual, reasonable, and customary (URC) charges
    • 15. Lifetime, annual or per cause maximum benefit limits
    • D. Riders
    • 1. Impairment/exclusions
    • 2. Guaranteed insurability
    • 3. Future increase option
    • E. Rights of renewability
    • 1. Noncancelable
    • 2. Cancelable
    • 3. Guaranteed renewable
  • III. SOCIAL INSURANCE .................................................... 6
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • IV. OTHER INSURANCE CONCEPTS ................................ 5
    • 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. nonoccupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • K. Subrogation
  • V. FIELD UNDERWRITING PROCEDURES…………… 8
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy (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
    • 1. Elements of a contract
    • 2. Insurable interest
    • 3. Warranties and representations
    • 4. Unique aspects of the insurance contract
    • a. Conditional
    • b. Unilateral
    • c. Adhesion
    • d. Aleatory
  • VI. GEORGIA LAWS, RULES, AND REGULATIONS PERTINENT TO LIFE, ACCIDENT & SICKNESS INSURANCE……………………………………..24
    • A. Insurance Department and Commissioner
    • 1. Broad powers and duties Ref: 33-2-1 through 6; 9 through 32
    • 2. Examination of records Ref: 33-2-10 through 13
    • 3. Investigations/Notice of hearing Ref: 33-6-6
    • 4. Penalties Ref: 33-6-9
    • B. General insurance definitions
    • 1. Domestic, foreign and alien Ref: 33-3-1
    • 2. Stock and mutual Ref: 33-14-2
    • 3. Authorized/unauthorized and certificate of authority Ref: 33-3- 2 through 5; 33-3-13 through 30
    • 4. Insurance transaction / transacting business Ref: 33-1-2
    • C. Licensing of agents & counselors Ref: 33-23-1 through 46; 120-2-3-.09 and .15
    • 1. Agent Responsibility
    • 2. License maintenance
    • 3. License revocation, suspension, denial, or refuse to renew
    • 4. Temporary License
    • 5. Nonresident License
    • 6. Counselor License
    • D. Unfair trade practices Ref: 33-6-4 and 5; 33-6-30 through 35; 33-9-36; 33-23-1; 33-24-7
    • 1. Rebating
    • 2. Defamation
    • 3. Unfair Discrimination
    • 4. Misrepresentation
    • 5. Twisting and Churning
    • 6. Advertising
    • 7. Coercion
    • 8. Controlled business
    • 9. Unfair claims practices
    • 10. Fraud
    • E. Reporting and Disposition of Premiums Ref: 33-23-35
    • 1. Fiduciary Responsibility
    • 2. Commingling
    • F. Georgia Life and Health Insurance Guaranty Association Ref: 33-24-7, 33-38-1 through 10
  • VII. GEORGIA RULES AND CODES PERTINENT TO ACCIDENT & SICKNESS INSURANCE ONLY (6)
    • A. Individual and Group Accident and Sickness Insurance Ref: Reg. 100-2-10 through12; 33-29-1 through 22; 33- 30-1 through 15
    • B. Medicare Supplement Ref: Reg. 120-2-8-.01 through .23; Appendix C; 33-43-1 through 8
    • C. Long Term Care Ref: 33-42-1 through 6; 120-2-16-.01 through .33
    • D. Long Term Care Partnership requirements Ref: Reg. 120-2-16-.34
Examination sources