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New Mexico Accident and Health or Sickness Insurance — Information & Free Practice

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New Mexico Accident and Health or Sickness Insurance

Provider
PSI Services LLC
Format
Computer examination at a test center or by online proctor
Exam questions
100 scored items plus 5–10 unscored experimental questions
Time limit
2 hours
Passing score
70% correct
Examination outline
  • Insurance Regulation (10%)
    • Licensing
    • Licensing — Process (59A-11-2, 3, 59A-12-12; Reg 13.4.2.8, .9)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11) — Insurance Producers (59A-12-2)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11) — Brokers (59A-12-3)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11) — Consultants (59A-11A-1-8)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11) — Nonresident (59A-12-25) (59A-11-24)
    • Licensing — Types of Licensees (Reg 13.4.2.7, .11) — Temporary (59A-11-4; 59A-12-19; Reg 13.4.2.12)
    • Licensing — Maintenance and Duration
    • Licensing — Maintenance and Duration — Expiration and Renewal (59A-11-10, 11)
    • Licensing — Maintenance and Duration — Address Change (59A-12-17) (59A-11-24)
    • Licensing — Maintenance and Duration — Continuing Education (59A-12-26; Reg 13.4.7.9, .12)
    • Licensing — Disciplinary Actions
    • Licensing — Disciplinary Actions — Suspension, Revocation, or Refusal to Renew (59A-11-8, 10, 14–16, 18)
    • Licensing — Disciplinary Actions — Cease and Desist Orders (59A-16-27)
    • Licensing — Disciplinary Actions — Penalties and Fines (59A-1-18, 59A-11- 17, 21)
    • State Regulation
    • State Regulation — Superintendent's General Duties and Powers (59A-2-8-10)
    • State Regulation — Company Regulation
    • State Regulation — Company Regulation — Certificate of Authority (59A-5-10)
    • State Regulation — Company Regulation — Unfair Claims Settlement Practices (59A-16-20)
    • State Regulation — Company Regulation — Complaint Record (59A-16-22)
    • State Regulation — Company Regulation — Appointment of Insurance Producer (59A- 11-12; Reg 13.4.2.17)
    • State Regulation — Company Regulation — Termination of Insurance Producer Appointment (59A-11-13; Reg 13.4.2.29)
    • State Regulation — Insurance Producer Regulation
    • State Regulation — Insurance Producer Regulation — Shared Commissions (59A-12-24)
    • State Regulation — Insurance Producer Regulation — Fiduciary Duties (59A-12-22)
    • State Regulation — Insurance Producer Regulation — Prohibited Premiums or Charges (59A-16- 24)
    • State Regulation — Unfair Insurance Trade Practices
    • State Regulation — Unfair Insurance Trade Practices — Misrepresentation (59A-16-4, 23)
    • State Regulation — Unfair Insurance Trade Practices — False Advertising (59A-16-4, 5)
    • State Regulation — Unfair Insurance Trade Practices — Twisting (59A-16-6)
    • State Regulation — Unfair Insurance Trade Practices — Defamation (59A-16-10)
    • State Regulation — Unfair Insurance Trade Practices — Unfair Discrimination (59A-16, 13, 17(D))
    • State Regulation — Unfair Insurance Trade Practices — Rebating (59A-16-16–18)
    • State Regulation — Unfair Insurance Trade Practices — Boycott, Coercion, or Intimidation (59A- 16-19)
    • State Regulation — Examination of Books and Records (59A-4-3, 4)
    • State Regulation — Insurance Fraud Act (59A-16C-1-16)
    • State Regulation — Consumer Information Privacy (59A-2-9.3; Reg 13.1.3.1-.28)
  • Federal Laws and Regulations (3%)
    • Fair Credit Reporting Act - Purpose
    • Privacy [Gramm Leach Bliley]
    • Prohibited Persons in Insurance (18 United States Code (USC) Sections 1033 and 1034) waiver
    • Affordable Care Act (ACA)
    • National Do Not Call List
    • CAN-SPAM Act
  • General Insurance Concepts (10%)
    • Risk
    • Risk — Methods of Handling Risk (Avoidance, Retention, Sharing, Reduction, Transfer)
    • Risk — Elements of Insurable Risks
    • Risk — Definitions (Risk, Hazard, Peril, Loss)
    • Elements of a Contract
    • Elements of a Contract — Consideration
    • Elements of a Contract — Competent Parties
    • Elements of a Contract — Legal Purpose
    • Elements of a Contract — Offer
    • Elements of a Contract — Acceptance
    • Authority and Powers of Producers
    • Authority and Powers of Producers — Express
    • Authority and Powers of Producers — Implied
    • Authority and Powers of Producers — Apparent
    • Authority and Powers of Producers — The Law of Agency
    • Legal Interpretations Affecting Contracts
    • Legal Interpretations Affecting Contracts — Reasonable Expectations
    • Legal Interpretations Affecting Contracts — Indemnity
    • Legal Interpretations Affecting Contracts — Good Faith
    • Legal Interpretations Affecting Contracts — Fraud
    • Legal Interpretations Affecting Contracts — Warranties, Representations, Misrepresentations, and Concealment
  • Accident and Health Insurance Basics (15%)
    • Field Underwriting
    • Field Underwriting — Application Procedures
    • Field Underwriting — Disclosures and Privacy
    • Underwriting Requirements (Varies by Insurer)
    • Sources of Underwriting
    • Sources of Underwriting — Application
    • Sources of Underwriting — Producer's report
    • Sources of Underwriting — Medical information bureau (MIB)
    • Sources of Underwriting — Inspection report
    • Sources of Underwriting — Medical examination
    • Sources of Underwriting — Attending physician's report
    • Policy Delivery
    • Policy Delivery — Effective Date of Coverage
    • Policy Delivery — Policy Review
    • Policy Delivery — Premium Collection Methods (e.g., Electronic, Physical, EFT, ACH)
    • Policy Delivery — Statement of Good Health
    • Definitions of Perils
    • Definitions of Perils — Accidental Injury
    • Definitions of Perils — Sickness
    • Types of Losses and Benefits
    • Types of Losses and Benefits — Loss of Income from Disability (Short-Term/Long-Term Disability)
    • Types of Losses and Benefits — Medical Expense
    • Types of Losses and Benefits — Long-Term Care Expense
    • Classification of Risks
    • Classification of Risks — Preferred
    • Classification of Risks — Standard
    • Classification of Risks — Substandard
  • Accident and Health Insurance Policy Provisions (12%)
    • Uniform Required Provisions
    • Uniform Required Provisions — Time Limit on Certain Defenses
    • Uniform Required Provisions — Grace Period
    • Uniform Required Provisions — Reinstatement
    • Uniform Required Provisions — Claim Forms
    • Uniform Required Provisions — Proof of Loss
    • Uniform Required Provisions — Time of Payment of Claims
    • Uniform Required Provisions — Physical Examinations and Autopsy
    • Uniform Required Provisions — Legal Actions
    • Uniform Required Provisions — Entire Contract
    • Uniform Required Provisions — Payment of Claims
    • Uniform Required Provisions — Change of Beneficiary
    • Uniform Required Provisions — Notice of Claim
    • Uniform Optional Provisions
    • Uniform Optional Provisions — Change of Occupation
    • Uniform Optional Provisions — Misstatement of Age/Sex
    • Uniform Optional Provisions — Illegal Occupation
    • Uniform Optional Provisions — Intoxicants, Narcotics, or Other Controlled Substances
    • Other General Provisions
    • Other General Provisions — Right to Examine/Free Look
    • Other General Provisions — Insuring Clause
    • Other General Provisions — Consideration Clause
    • Other General Provisions — Coinsurance
    • Other General Provisions — Probationary Period
    • Other General Provisions — Elimination Period
    • Other General Provisions — Exclusions
  • Disability Income and Related Insurance (10%)
    • Benefits Determination for Disability
    • Benefits Determination for Disability — Indemnity
    • Benefits Determination for Disability — Loss of Income
    • Qualifications of Disability
    • Qualifications of Disability — Total (Own Occupation, Any Occupation)
    • Qualifications of Disability — Partial
    • Qualifications of Disability — Permanent
    • Qualifications of Disability — Presumptive
    • Qualifications of Disability — Recurrent
    • Qualifications of Disability — Residual
    • Qualifications of Disability — Inability to Perform Duties
    • Qualifications of Disability — Occupational versus Non-Occupational
    • Individual Disability Income Insurance
    • Individual Disability Income Insurance — Basic Total Disability Plan
    • Individual Disability Income Insurance — Cost of Living Rider
    • Individual Disability Income Insurance — Future Increase Option Rider
    • Individual Disability Income Insurance — Change of Occupation
    • Individual Disability Income Insurance — Refund Provisions
    • Individual Disability Income Insurance — Exclusions
    • Individual Disability Income Insurance — Waiver of Premium
    • Individual Disability Income Insurance — Probationary Period
    • Individual Disability Income Insurance — Elimination Period
    • Individual Disability Income Insurance — Benefit Limits
    • Unique Aspects of Individual Disability Income Underwriting
    • Unique Aspects of Individual Disability Income Underwriting — Occupational Considerations
    • Unique Aspects of Individual Disability Income Underwriting — Benefit Limits
    • Unique Aspects of Individual Disability Income Underwriting — Policy Issuance Alternatives
    • Group Disability Income Insurance
    • Group Disability Income Insurance — Short-Term Disability
    • Group Disability Income Insurance — Long-Term Disability
    • Group Disability Income Insurance — Coordination of Benefits (Workers' Compensation Benefits and Social Insurance)
    • Group Disability Income Insurance — At-work benefits
    • Business Disability Income Insurance
    • Business Disability Income Insurance — Key Employee Disability Income
    • Business Disability Income Insurance — Disability Buy-Sell Policy
    • Business Disability Income Insurance — Business Overhead Expense
    • Social Security Disability Income
    • Social Security Disability Income — Qualification for Disability Benefits
    • Social Security Disability Income — Definition of Disability
    • Social Security Disability Income — Waiting Period
  • Medical Plans (15%)
    • Medical Plan Concepts
    • Medical Plan Concepts — Fee-for-Service
    • Medical Plan Concepts — Prepaid
    • Medical Plan Concepts — Specified disease/Dread disease insurance
    • Medical Plan Concepts — Comprehensive Coverage
    • Medical Plan Concepts — Dependent Coverage
    • Provisions and Clauses
    • Provisions and Clauses — Deductibles
    • Provisions and Clauses — Stop-Loss Provision
    • Provisions and Clauses — Impairment rider
    • Types of Medical Plans
    • Types of Medical Plans — Major Medical Insurance
    • Types of Medical Plans — Health Maintenance Organizations (HMOs)
    • Types of Medical Plans — Preferred Provider Organzations (PPOs)
    • Types of Medical Plans — Point-of-Service (POS) Plans
    • Cost Containment in Health Care Delivery
    • Cost Containment in Health Care Delivery — Managed Care
    • Cost Containment in Health Care Delivery — Preventive Care
    • Cost Containment in Health Care Delivery — Outpatient Benefits
    • Cost Containment in Health Care Delivery — Utilization Management
    • Cost Containment in Health Care Delivery — Preauthorization
    • Cost Containment in Health Care Delivery — Primary Care Physician
    • Limited Health Insurance Policies
    • Limited Health Insurance Policies — Accidental Death and Dismemberment
    • Limited Health Insurance Policies — Hospital indemnity
    • Limited Health Insurance Policies — Critical Illness/Dread Disease
    • Limited Health Insurance Policies — Vision Care
    • Limited Health Insurance Policies — Dental
    • Health Insurance Portability and Accountability Act (HIPAA)
    • Health Insurance Portability and Accountability Act (HIPAA) — Eligibility Requirements
    • Health Insurance Portability and Accountability Act (HIPAA) — Terms
    • Health Insurance Portability and Accountability Act (HIPAA) — Privacy
    • Health Insurance Portability and Accountability Act (HIPAA) — Portability
    • Affordable Care Act (ACA)
    • Affordable Care Act (ACA) — Eligibility
    • Affordable Care Act (ACA) — Dependent coverage
    • Affordable Care Act (ACA) — Essential health benefits
    • Affordable Care Act (ACA) — Levels of Coverage (Metallic Plans)
  • Group Health Insurance (10%)
    • Characteristics of Group Health Insurance
    • Characteristics of Group Health Insurance — Group Contract
    • Characteristics of Group Health Insurance — Certificate of Coverage
    • Characteristics of Group Health Insurance — Eligible Groups
    • Characteristics of Group Health Insurance — Contributory versus Non-Contributory
    • Employer Group Health Insurance
    • Employer Group Health Insurance — Underwriting Criteria
    • Employer Group Health Insurance — Eligibility for Insurance
    • Employer Group Health Insurance — Conversion of Coverage
    • Employer Group Health Insurance — Open Enrollment
    • Employer Group Health Insurance — Probation/Waiting Period
    • Employer Group Health Insurance — Coordination of Benefits
    • COBRA
    • COBRA — Eligibility
    • COBRA — Duration of Coverage
    • COBRA — Premium
  • Specialized Health Insurance for Qualified Individuals (12%)
    • Medicare
    • Medicare — Eligibility
    • Medicare — Part A
    • Medicare — Part B
    • Medicare — Part C
    • Medicare — Part D
    • Medicare Supplement Insurance
    • Medicare Supplement Insurance — Enrollment Periods
    • Medicare Supplement Insurance — Standardized Plan Benefits
    • Medicaid
    • Medicaid — Eligibility
    • Long-Term Care Policies
    • Long-Term Care Policies — Eligibility for Benefits (Activities of Daily Living)
    • Long-Term Care Policies — Benefit/Elimination Periods
    • Long-Term Care Policies — Levels of care (Skilled, Intermediate, Custodial)
  • Federal Tax Considerations for Health Insurance (3%)
    • Health Insurance Premiums and Benefits
    • Health Insurance Premiums and Benefits — Individual
    • Health Insurance Premiums and Benefits — Group
    • Health Insurance Premiums and Benefits — Disability Income (Individual and Group)
    • Health Insurance Premiums and Benefits — Business Disability Insurance
    • Consumer-Driven Health Plans
    • Consumer-Driven Health Plans — Health Savings Accounts (HSAs)
    • Consumer-Driven Health Plans — Health Savings Accounts (HSAs) — High Deductible Health Plans (HDHPs)
    • Consumer-Driven Health Plans — Health Reimbursement Accounts (HRAs)
    • Consumer-Driven Health Plans — Flexible Spending Accounts (FSAs)
Examination sources