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Health

Provider
PSI Services LLC
Format
Computer examination at a testing center or remotely
Exam questions
88 scored items; the candidate bulletin permits an additional 5–19 unscored experimental questions
Time limit
3.5 hours
Passing score
70% correct
Examination outline
  • I.0 Types of Policies (14 Items)
    • 1.1 Disability Income
    • 1.1 Disability Income / Individual disability income policy
    • 1.1 Disability Income / Business overhead expense policy
    • 1.1 Disability Income / Business disability buyout policy
    • 1.1 Disability Income / Group disability income policy
    • 1.1 Disability Income / Key employee/partner policies
    • 1.2 Accidental Death and Dismemberment
    • 1.3 Medical Expense Insurance
    • 1.3 Medical Expense Insurance / Basic hospital, medical, and surgical policies
    • 1.3 Medical Expense Insurance / Major medical policies
    • 1.3 Medical Expense Insurance / Comprehensive major medical policies
    • 1.3 Medical Expense Insurance / Health Maintenance Organizations (HMOs)
    • 1.3 Medical Expense Insurance / Preferred Provider Organizations (PPOs)
    • 1.3 Medical Expense Insurance / Service organizations (Blue Plans)
    • 1.3 Medical Expense Insurance / Point of Service(POS) plans
    • 1.3 Medical Expense Insurance / Medical Savings Accounts (MSAs)
    • 1.3 Medical Expense Insurance / Flexible Spending Accounts (FSAs)
    • 1.3 Medical Expense Insurance / Health Reimbursement Accounts (HRAs)
    • 1.3 Medical Expense Insurance / High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • 1.3 Medical Expense Insurance / Consumer Driven Health Plans (CDHPs)
    • 1.4 Medicare Supplement Policies
    • 1.5 Group Insurance
    • 1.5 Group Insurance / Group conversion
    • 1.5 Group Insurance / Differences between individual and group contracts
    • 1.5 Group Insurance / General concepts
    • 1.5 Group Insurance / COBRA
    • 1.5 Group Insurance / HIPAA
    • 1.6 Long Term Care
    • 1.6 Long Term Care / Individual LTC contracts
    • 1.6 Long Term Care / Group/voluntary LTC contracts
    • 1.6 Long Term Care / Service days vs. calendar days
    • 1.7 Cancer (for specified diseases) Plans
    • 1.8 Critical Illness Plans
    • 1.9 Worksite (employer-sponsored) Plans
  • 2.0 Policy Provisions, Clauses, and Riders (20 Items)
    • 2.1 Mandatory Provisions
    • 2.1 Mandatory Provisions / Entire contract
    • 2.1 Mandatory Provisions / Time limit on certain defenses (incontestable)
    • 2.1 Mandatory Provisions / Grace period
    • 2.1 Mandatory Provisions / Reinstatement
    • 2.1 Mandatory Provisions / Notice of claim
    • 2.1 Mandatory Provisions / Claim forms
    • 2.1 Mandatory Provisions / Proof of loss
    • 2.1 Mandatory Provisions / Time of payment of claims
    • 2.1 Mandatory Provisions / Payment of claims
    • 2.1 Mandatory Provisions / Physical examination and autopsy
    • 2.1 Mandatory Provisions / Legal actions
    • 2.1 Mandatory Provisions / Change of beneficiary
    • 2.2 Optional Provisions
    • 2.2 Optional Provisions / Change of occupation
    • 2.2 Optional Provisions / Misstatement of age
    • 2.2 Optional Provisions / Illegal occupation
    • 2.3 Other Provisions and Clauses
    • 2.3 Other Provisions and Clauses / Insuring clause
    • 2.3 Other Provisions and Clauses / Free look (10-day, 20-day, etc.)
    • 2.3 Other Provisions and Clauses / Consideration clause
    • 2.3 Other Provisions and Clauses / Probationary period
    • 2.3 Other Provisions and Clauses / Elimination period
    • 2.3 Other Provisions and Clauses / Waiver of premium
    • 2.3 Other Provisions and Clauses / Exclusions
    • 2.3 Other Provisions and Clauses / Preexisting conditions
    • 2.3 Other Provisions and Clauses / Recurrent disability
    • 2.3 Other Provisions and Clauses / Coinsurance
    • 2.3 Other Provisions and Clauses / Deductibles
    • 2.3 Other Provisions and Clauses / Eligible expenses
    • 2.3 Other Provisions and Clauses / Copayments
    • 2.3 Other Provisions and Clauses / Pre-authorizations and prior approval requirements
    • 2.3 Other Provisions and Clauses / Usual, reasonable, and customary (URC) changes
    • 2.3 Other Provisions and Clauses / Lifetime, annual or per cause maximum benefit limits
    • 2.4 Riders
    • 2.4 Riders / Impairment rider
    • 2.4 Riders / Guaranteed insurability rider
    • 2.4 Riders / Multiple indemnity rider (double, triple)
    • 2.5 Rights of Renewability
    • 2.5 Rights of Renewability / Noncancelable
    • 2.5 Rights of Renewability / Cancelable
    • 2.5 Rights of Renewability / Guaranteed renewable
    • 2.5 Rights of Renewability / Conditionally renewable
    • 2.5 Rights of Renewability / Optionally renewable
    • 2.5 Rights of Renewability / Period of time for renewal
  • 3.0 Social Insurance (3 Items)
    • 3.1 Medicare
    • 3.1 Medicare / Primary, secondary payor
    • 3.1 Medicare / Medicare Parts A,B,C,D
    • 3.2 Medicaid
    • 3.3 Social Security Benefits
  • 4.0 Other Insurance Concepts (4 Items)
    • 4.1 Total, Partial, and Residual Disability
    • 4.2 Owner’s Rights
    • 4.3 Dependent Children Benefits
    • 4.4 Primary and Contingent Beneficiaries
    • 4.5 Modes of Premium Payments (annual, semiannual, etc.)
    • 4.6 Nonduplication and Coordination of Benefits (e.g., primary vs. excess)
    • 4.7 Occupational vs. Nonoccupational
    • 4.8 Tax Treatment of Premiums and Proceeds of Insurance Contracts (e.g., disability income and medical expenses, etc.)
    • 4.9 Managed Care
    • 4.10 Workers Compensation
    • 4.11 Subrogation
  • 5.0 Field Underwriting Procedures (9 Items)
    • 5.1 Completing application and obtaining necessary signatures
    • 5.2 Explaining sources of insurability information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • 5.3 Initial premium payment and receipt and consequences of the receipt (e.g. medical examination, etc.)
    • 5.4 Submitting application (and initial premium if collected) to company for underwriting
    • 5.5 Assuring delivery of policy and related documents to client
    • 5.6 Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • 5.7 Replacement
    • 5.8 Contract law
    • 5.8 Contract law / Requirements of forming a contract
    • 5.8 Contract law / Insurable interest
    • 5.8 Contract law / Warranties and representations
    • 5.8 Contract law / Unique aspects of the health contract
    • 5.8 Contract law / Unique aspects of the health contract / Conditional
    • 5.8 Contract law / Unique aspects of the health contract / Unilateral
    • 5.8 Contract law / Unique aspects of the health contract / Adhesion
  • 6.0 New Jersey Laws, Rules, and Regulations Common to Life, Accident and Health, Property, and Casualty Insurance (25 Items)
    • 6.1 State Regulatory Jurisdiction (4 Items)
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / State Laws
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Court Action
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Court Action / Interpretations
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Court Action / Effect on Law and Policy Forms
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Related Federal Laws and court Cases
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Related Federal Laws and court Cases / Paul v. Virginia
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Related Federal Laws and court Cases / US v. South-Eastern Underwriters Assoc.
    • 6.1 State Regulatory Jurisdiction (4 Items) / Legislation / Related Federal Laws and court Cases / McCarran-Ferguson Act/Public Law 15
    • 6.1 State Regulatory Jurisdiction (4 Items) / Commissioner/Dept. of Banking and Insurance
    • 6.1 State Regulatory Jurisdiction (4 Items) / Commissioner/Dept. of Banking and Insurance / Broad Powers of Commissioner
    • 6.1 State Regulatory Jurisdiction (4 Items) / Commissioner/Dept. of Banking and Insurance / Notice and Hearing
    • 6.1 State Regulatory Jurisdiction (4 Items) / Commissioner/Dept. of Banking and Insurance / Penalties
    • 6.2 Definitions (4 Items)
    • 6.2 Definitions (4 Items) / Insurance-related conduct
    • 6.2 Definitions (4 Items) / Domestic, foreign, and alien companies
    • 6.2 Definitions (4 Items) / Stock and mutual
    • 6.2 Definitions (4 Items) / Reinsurance
    • 6.2 Definitions (4 Items) / Certificate of authority
    • 6.2 Definitions (4 Items) / A producer acting as:
    • 6.2 Definitions (4 Items) / A producer acting as: / Insurance Agent
    • 6.2 Definitions (4 Items) / A producer acting as: / Insurance Broker
    • 6.2 Definitions (4 Items) / A producer acting as: / Insurance Consultant
    • 6.2 Definitions (4 Items) / “Sell, Solicit, and Negotiate”
    • 6.3 Licensing (8 Items)
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Producer
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Business entity
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Nonresident
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Nonresident / Producer
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Nonresident / Business Entity
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Prelicensing requirements
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Surplus lines
    • 6.3 Licensing (8 Items) / Types of licenses/authorities/requirements / Temporary work authority
    • 6.3 Licensing (8 Items) / Contractual relationships
    • 6.3 Licensing (8 Items) / Contractual relationships / Company/producer
    • 6.3 Licensing (8 Items) / Contractual relationships / Producer substituting for or taking over the business of a disabled/deceased producer
    • 6.3 Licensing (8 Items) / Maintenance and duration of license
    • 6.3 Licensing (8 Items) / Maintenance and duration of license / Renewal
    • 6.3 Licensing (8 Items) / Maintenance and duration of license / Certification of license status
    • 6.3 Licensing (8 Items) / License refusal/termination
    • 6.3 Licensing (8 Items) / License refusal/termination / Denial
    • 6.3 Licensing (8 Items) / License refusal/termination / Cancellation/reinstatement
    • 6.3 Licensing (8 Items) / License refusal/termination / Revocation/suspension
    • 6.4 Trade Practices (6 Items)
    • 6.4 Trade Practices (6 Items) / Prohibited practices
    • 6.4 Trade Practices (6 Items) / Licensee responsibilities (Reporting information to the Department of Banking and Insurance)
    • 6.4 Trade Practices (6 Items) / Licensee responsibilities (Reporting information to the Department of Banking and Insurance) / Business names (including fictitious)
    • 6.4 Trade Practices (6 Items) / Licensee responsibilities (Reporting information to the Department of Banking and Insurance) / Branch offices
    • 6.4 Trade Practices (6 Items) / Licensee responsibilities (Reporting information to the Department of Banking and Insurance) / Change of address
    • 6.4 Trade Practices (6 Items) / Licensee responsibilities (Reporting information to the Department of Banking and Insurance) / Standards of conduct
    • 6.5 Guaranty Associations (1 item)
    • 6.6 Ethics
    • 6.6 Fraud (2 items)
    • 6.7 Information Privacy
  • 7.0 New Jersey Laws, Rules, and Regulations Pertinent to Accident and Health Insurance Only (13 Items)
    • 7.1 Marketing Methods and Practices
    • 7.1 Marketing Methods and Practices / Solicitation
    • 7.1 Marketing Methods and Practices / Advertising
    • 7.1 Marketing Methods and Practices / Discrimination based on genetic characteristics
    • 7.2 Policy Clauses and Provisions
    • 7.2 Policy Clauses and Provisions / Minimum standards, claims notices, and standard provisions
    • 7.2 Policy Clauses and Provisions / New Jersey Mandated Benefits
    • 7.2 Policy Clauses and Provisions / Coordination of benefits
    • 7.2 Policy Clauses and Provisions / Prompt payment of claims
    • 7.3 Medicare supplement plans
    • 7.4 Temporary disability law
    • 7.5 Health Insurance Reform Markets
    • 7.5 Health Insurance Reform Markets / Individual
    • 7.5 Health Insurance Reform Markets / Small employer
    • 7.6 The Health Care Claims Authorization Processing and Payment Act
    • 7.7 Group Health Coverage
Examination sources

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