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Wisconsin Accident and Health or Sickness: General and State — Information & Free Practice

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Wisconsin Accident and Health or Sickness: General and State

Provider
PSI
Format
Closed-book computer examination
Exam questions
100 scored questions; additional unscored experimental questions may be administered
Time limit
2 hours
Passing score
70% correct
Exam fee
$75
Examination outline
  • 1.0 Insurance Regulation (35%)
    • 1.1 Licensing
    • 1.1 Licensing / Purpose (ch. 628 )
    • 1.1 Licensing / Persons required to be licensed
    • 1.1 Licensing / License Requirements
    • 1.1 Licensing / (2), s. Ins 6.59, s. Ins 6.59(4)(a),
    • 1.1 Licensing / Record keeping, maintenance, and duration
    • 1.1 Licensing / Renewal
    • 1.1 Licensing / Continuing education requirements
    • 1.1 Licensing / Reinstatement
    • 1.1 Licensing / Assumed name
    • 1.1 Licensing / Change of address or telephone number
    • 1.1 Licensing / Reporting of actions
    • 1.1 Licensing / Disciplinary actions
    • 1.1 Licensing / License termination, suspension, or revocation
    • 1.1 Licensing / Monetary forfeiture (fines)
    • 1.2 State Regulation
    • 1.2 State Regulation / Commissioner's general duties and powers
    • 1.2 State Regulation / Duties
    • 1.2 State Regulation / Hearings
    • 1.2 State Regulation / Penalties
    • 1.2 State Regulation / Wisconsin Insurance Security Fund
    • 1.2 State Regulation / Company regulation
    • 1.2 State Regulation / Solvency
    • 1.2 State Regulation / Responsibilities of the insurer
    • 1.2 State Regulation / Rates
    • 1.2 State Regulation / Use of Policy forms
    • 1.2 State Regulation / Readability
    • 1.2 State Regulation / Producer appointments/terminations
    • 1.2 State Regulation / Unfair claims, methods, and practices
    • 1.2 State Regulation / Notice of right to file complaint
    • 1.2 State Regulation / Producer regulation
    • 1.2 State Regulation / Fiduciary and trust account responsibilities
    • 1.2 State Regulation / Place of business/records maintenance
    • 1.2 State Regulation / Compensation of agents
    • 1.2 State Regulation / Controlled business
    • 1.2 State Regulation / Shared commissions
    • 1.2 State Regulation / Proper exchange of business
    • 1.2 State Regulation / Marketing practices
    • 1.2 State Regulation / Misrepresentation
    • 1.2 State Regulation / False advertising
    • 1.2 State Regulation / Rebating
    • 1.2 State Regulation / Unfair discrimination
    • 1.2 State Regulation / Boycott, coercion, or intimidation
    • 1.2 State Regulation / Illegal inducement
    • 1.2 State Regulation / Examination of records
    • 1.2 State Regulation / General statutes, rules, and regulations affecting insurance contracts
    • 1.2 State Regulation / Definitions
    • 1.2 State Regulation / Specific knowledge
    • 1.2 State Regulation / Misrepresentation/Warranties
    • 1.2 State Regulation / Knowledge and acts of the agent
    • 1.2 State Regulation / Certificates of Insurance
    • 1.2 State Regulation / Regulation of specific clauses in insurance contracts
    • 1.2 State Regulation / Cancellation
    • 1.2 State Regulation / Renewal/Nonrenewal
    • 1.2 State Regulation / Notice of proof of loss
    • 1.2 State Regulation / Payment of claims
    • 1.2 State Regulation / Privacy of Consumer Information
    • 1.3 Federal Regulation
    • 1.3 Federal Regulation / Fair Credit Reporting Act (15 USC 1681–1681d)
    • 1.3 Federal Regulation / Fraud and false statements (18 USC 1033, 1034)
    • 1.3 Federal Regulation / HIPAA
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Policy provisions
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Right to return a policy
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Right of insurer to contest
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Preexisting conditions
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Application responsibilities
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Grace period
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Disclosure requirements
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Continuation privileges
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Independent review
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Grievance
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Coverages
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Nurse practitioners
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Optometrists
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Chiropractic benefits
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Handicapped children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Alcohol, drug abuse, mental, and nervous disorders
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Home care
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Skilled nursing facility
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Kidney disease
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Diabetes
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Newborn children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Maternity benefits for dependent children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Adopted children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Grandchildren
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Mammograms
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Lead poisoning screening
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Temporomandibular joint disorders
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Hospital and ambulatory surgery center charges & anesthetics for dental care
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Autism spectrum
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Breast reconstruction
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Immunizations for children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Student on medical leave
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Hearing aids, cochlear implants, and related treatment for infants and children
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Colorectal cancer screening
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Contraceptives and services
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Emergency medical services
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Prescription drugs and devices
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Experimental treatment
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Requirements relating to HIV
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Cancer clinical trials
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / 3.35, s. Ins 3.36, s. Ins 3.37 s. Ins 3.38, s. Ins 3.47, s. Ins 3.54, s. Ins 3.67(2) - (3)
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Prescription Eye Drops
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Oral and Injected Chemotherapy
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Step therapy protocols
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Marketing methods and practices
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Advertising
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Suitability
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Outline of coverage
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Policy replacement
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Interstate insurance product regulation compact
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Long-term care insurance
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Long-term care partnership program
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Agent training requirements
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Requirements for group health policies
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Special provisions
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Disclosure requirements
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Termination/nonrenewal regulation
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Fair marketing standards
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Medicare supplement
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Short-term medical policies
    • 1.4 Wisconsin statutes, rules, and regulations pertinent to disability (A&H) insurance / Interstate insurance product regulation compact
  • 2.0 General Insurance (10%)
    • 2.1 Concepts
    • 2.1 Concepts / Risk management key terms
    • 2.1 Concepts / Risk
    • 2.1 Concepts / Exposure
    • 2.1 Concepts / Hazard
    • 2.1 Concepts / Peril
    • 2.1 Concepts / Loss
    • 2.1 Concepts / Methods of handling risk
    • 2.1 Concepts / Avoidance
    • 2.1 Concepts / Retention
    • 2.1 Concepts / Sharing
    • 2.1 Concepts / Reduction
    • 2.1 Concepts / Transfer
    • 2.1 Concepts / Elements of insurable risks
    • 2.1 Concepts / Adverse selection
    • 2.1 Concepts / Law of large numbers
    • 2.1 Concepts / Reinsurance
    • 2.2 Insurers
    • 2.2 Insurers / Types of insurers
    • 2.2 Insurers / Stock companies
    • 2.2 Insurers / Mutual companies
    • 2.2 Insurers / Fraternal benefit societies
    • 2.2 Insurers / Reciprocals
    • 2.2 Insurers / Lloyd's associations
    • 2.2 Insurers / Risk retention groups
    • 2.2 Insurers / Private versus government insurers
    • 2.2 Insurers / Admitted versus nonadmitted insurers
    • 2.2 Insurers / Domestic, foreign and alien insurers
    • 2.2 Insurers / Financial status (independent rating services)
    • 2.2 Insurers / Marketing (distribution) systems
    • 2.3 Producers and general rules of agency
    • 2.3 Producers and general rules of agency / Insurer as principal
    • 2.3 Producers and general rules of agency / Producer/insurer relationship
    • 2.3 Producers and general rules of agency / Authority and powers of producer
    • 2.3 Producers and general rules of agency / Express
    • 2.3 Producers and general rules of agency / Implied
    • 2.3 Producers and general rules of agency / Apparent
    • 2.3 Producers and general rules of agency / The law of agency
    • 2.3 Producers and general rules of agency / Responsibilities to the applicant/insured
    • 2.4 Contracts
    • 2.4 Contracts / Elements of a legal contract
    • 2.4 Contracts / Offer and acceptance
    • 2.4 Contracts / Consideration
    • 2.4 Contracts / Competent parties
    • 2.4 Contracts / Legal purpose
    • 2.4 Contracts / Distinct characteristics of an insurance contract
    • 2.4 Contracts / Contract of adhesion
    • 2.4 Contracts / Aleatory contract
    • 2.4 Contracts / Personal contract
    • 2.4 Contracts / Unilateral contract
    • 2.4 Contracts / Conditional contract
    • 2.4 Contracts / Legal interpretations affecting contracts
    • 2.4 Contracts / Ambiguities in a contract of adhesion
    • 2.4 Contracts / Reasonable expectations
    • 2.4 Contracts / Indemnity
    • 2.4 Contracts / Utmost good faith
    • 2.4 Contracts / Representations/misrepresentations
    • 2.4 Contracts / Warranties
    • 2.4 Contracts / Concealment
    • 2.4 Contracts / Fraud
    • 2.4 Contracts / Waiver and estoppel
  • 3.0 Accident and Health Insurance Basics (8%)
    • 3.1 Definitions of perils
    • 3.1 Definitions of perils / Accidental injury
    • 3.1 Definitions of perils / Sickness, medical necessity and emergency
    • 3.2 Principal types of losses and benefits
    • 3.2 Principal types of losses and benefits / Loss of income from disability
    • 3.2 Principal types of losses and benefits / Medical expense
    • 3.2 Principal types of losses and benefits / Dental expense
    • 3.2 Principal types of losses and benefits / Long-term care expense
    • 3.3 Classes of health insurance policies
    • 3.3 Classes of health insurance policies / Individual versus group
    • 3.3 Classes of health insurance policies / Private versus government
    • 3.3 Classes of health insurance policies / Self-funded vs fully insured
    • 3.3 Classes of health insurance policies / Limited versus comprehensive
    • 3.3 Classes of health insurance policies / Employer group versus association group
    • 3.4 Limited policies
    • 3.4 Limited policies / Limited coverage and amounts
    • 3.4 Limited policies / Required notice to insured
    • 3.4 Limited policies / Types of limited policies
    • 3.4 Limited policies / Accident-only
    • 3.4 Limited policies / Specified (dread) disease
    • 3.4 Limited policies / Hospital indemnity (income)
    • 3.4 Limited policies / Credit disability
    • 3.4 Limited policies / Blanket insurance (teams, passengers, other)
    • 3.4 Limited policies / Prescription drugs
    • 3.4 Limited policies / Vision care
    • 3.4 Limited policies / Hearing
    • 3.4 Limited policies / Dental
    • 3.5 Common exclusions from coverage
    • 3.6 Licensee responsibilities in individual health insurance
    • 3.6 Licensee responsibilities in individual health insurance / Marketing requirements
    • 3.6 Licensee responsibilities in individual health insurance / Advertising
    • 3.6 Licensee responsibilities in individual health insurance / Wisconsin Insurance Security Fund
    • 3.6 Licensee responsibilities in individual health insurance / Sales presentations
    • 3.6 Licensee responsibilities in individual health insurance / Outline of coverage
    • 3.6 Licensee responsibilities in individual health insurance / Compensation disclosure
    • 3.6 Licensee responsibilities in individual health insurance / Underwriting
    • 3.6 Licensee responsibilities in individual health insurance / Nature and purpose
    • 3.6 Licensee responsibilities in individual health insurance / Employee waiver form
    • 3.6 Licensee responsibilities in individual health insurance / Disclosure of information about individuals
    • 3.6 Licensee responsibilities in individual health insurance / Application procedures
    • 3.6 Licensee responsibilities in individual health insurance / Warranties and Representations
    • 3.6 Licensee responsibilities in individual health insurance / Requirements at delivery of policy
    • 3.6 Licensee responsibilities in individual health insurance / Effective date of coverage
    • 3.6 Licensee responsibilities in individual health insurance / Policy review
    • 3.6 Licensee responsibilities in individual health insurance / Premium collection
    • 3.6 Licensee responsibilities in individual health insurance / Statement of good health
    • 3.6 Licensee responsibilities in individual health insurance / Individual and small employer health insurance application
    • 3.6 Licensee responsibilities in individual health insurance / Common situations for errors/omissions
    • 3.7 Individual underwriting by the insurer
    • 3.7 Individual underwriting by the insurer / Underwriting criteria
    • 3.7 Individual underwriting by the insurer / Sources of underwriting information
    • 3.7 Individual underwriting by the insurer / Application
    • 3.7 Individual underwriting by the insurer / Licensee report
    • 3.7 Individual underwriting by the insurer / Attending physician statement
    • 3.7 Individual underwriting by the insurer / Investigative consumer (inspection) report
    • 3.7 Individual underwriting by the insurer / Medical Information Bureau (MIB)
    • 3.7 Individual underwriting by the insurer / Medical examinations and lab tests (including HIV consent)
    • 3.7 Individual underwriting by the insurer / Unfair discrimination
    • 3.7 Individual underwriting by the insurer / Genetic Information and Nondiscrimination Act of 2008 (GINA)
    • 3.7 Individual underwriting by the insurer / Classification of risks
    • 3.7 Individual underwriting by the insurer / Preferred
    • 3.7 Individual underwriting by the insurer / Standard
    • 3.7 Individual underwriting by the insurer / Substandard
    • 3.8 Considerations in replacing accident and health insurance
    • 3.8 Considerations in replacing accident and health insurance / Pre-existing conditions
    • 3.8 Considerations in replacing accident and health insurance / Benefits, limitations and exclusions
    • 3.8 Considerations in replacing accident and health insurance / Underwriting requirements
    • 3.8 Considerations in replacing accident and health insurance / Licensee liability for errors and omissions
    • 3.8 Considerations in replacing accident and health insurance / Required notification
    • 3.9 Other required, uniform and general provisions
    • 3.9 Other required, uniform and general provisions / Incontestability
    • 3.9 Other required, uniform and general provisions / Grace period
    • 3.9 Other required, uniform and general provisions / Reinstatement
    • 3.9 Other required, uniform and general provisions / Claim procedures
    • 3.9 Other required, uniform and general provisions / Claim forms
    • 3.9 Other required, uniform and general provisions / Time of payment of claims
    • 3.9 Other required, uniform and general provisions / Notice of claim
    • 3.9 Other required, uniform and general provisions / Proof of Loss
    • 3.9 Other required, uniform and general provisions / Change of occupation
    • 3.9 Other required, uniform and general provisions / Misstatement of age
    • 3.9 Other required, uniform and general provisions / Coordination of benefits
    • 3.9 Other required, uniform and general provisions / Right to examine (free look)
    • 3.9 Other required, uniform and general provisions / Rights of spouse - continuation
    • 3.9 Other required, uniform and general provisions / Insuring clause
    • 3.9 Other required, uniform and general provisions / Consideration clause
    • 3.9 Other required, uniform and general provisions / Entire contract; changes
    • 3.9 Other required, uniform and general provisions / Physical examinations and autopsy
    • 3.9 Other required, uniform and general provisions / Legal actions
    • 3.9 Other required, uniform and general provisions / Unpaid premium
    • 3.9 Other required, uniform and general provisions / Conformity with state statutes
    • 3.9 Other required, uniform and general provisions / Illegal occupation
    • 3.9 Other required, uniform and general provisions / Coinsurance
    • 3.9 Other required, uniform and general provisions / Probationary period
    • 3.9 Other required, uniform and general provisions / Elimination period
    • 3.9 Other required, uniform and general provisions / Exclusions
    • 3.9 Other required, uniform and general provisions / Renewability clause
    • 3.9 Other required, uniform and general provisions / Noncancelable
    • 3.9 Other required, uniform and general provisions / Guaranteed renewable
    • 3.9 Other required, uniform and general provisions / Conditionally renewable
    • 3.9 Other required, uniform and general provisions / Renewable at option of insurer
    • 3.9 Other required, uniform and general provisions / Nonrenewable (cancelable, term)
  • 4.0 Disability Income and Related Insurance (8%)
    • 4.1 Qualifying for disability benefits
    • 4.1 Qualifying for disability benefits / Inability to perform duties
    • 4.1 Qualifying for disability benefits / Own occupation
    • 4.1 Qualifying for disability benefits / Any occupation
    • 4.1 Qualifying for disability benefits / Recurrent
    • 4.1 Qualifying for disability benefits / Residual
    • 4.1 Qualifying for disability benefits / Loss of income (income replacement contracts)
    • 4.1 Qualifying for disability benefits / Definition of total disability
    • 4.1 Qualifying for disability benefits / Presumptive disability
    • 4.1 Qualifying for disability benefits / Requirement to be under physician care
    • 4.2 Individual disability income insurance
    • 4.2 Individual disability income insurance / Basic total disability plan
    • 4.2 Individual disability income insurance / Income benefits (monthly indemnity)
    • 4.2 Individual disability income insurance / Elimination and benefit periods
    • 4.2 Individual disability income insurance / Waiver of premium feature
    • 4.2 Individual disability income insurance / Probationary period
    • 4.2 Individual disability income insurance / Coordination with social insurance and workers compensation benefits
    • 4.2 Individual disability income insurance / Additional monthly benefit (AMB)
    • 4.2 Individual disability income insurance / Social insurance supplement (SIS)
    • 4.2 Individual disability income insurance / Occupational versus nonoccupational coverage
    • 4.2 Individual disability income insurance / At-work benefits
    • 4.2 Individual disability income insurance / Partial disability benefit
    • 4.2 Individual disability income insurance / Residual disability benefit
    • 4.2 Individual disability income insurance / Other provisions affecting income benefits
    • 4.2 Individual disability income insurance / Cost of living adjustment (COLA) rider
    • 4.2 Individual disability income insurance / Future increase option (FIO) rider
    • 4.2 Individual disability income insurance / Relation of earnings to insurance
    • 4.2 Individual disability income insurance / Other cash benefits
    • 4.2 Individual disability income insurance / Accidental death and dismemberment
    • 4.2 Individual disability income insurance / Rehabilitation benefit
    • 4.2 Individual disability income insurance / Medical reimbursement benefit (nondisabling injury)
    • 4.2 Individual disability income insurance / Refund provisions
    • 4.2 Individual disability income insurance / Return of premium
    • 4.2 Individual disability income insurance / Cash surrender value
    • 4.2 Individual disability income insurance / Exclusions
    • 4.3 Unique aspects of individual disability underwriting
    • 4.3 Unique aspects of individual disability underwriting / Occupational considerations
    • 4.3 Unique aspects of individual disability underwriting / Benefit limits
    • 4.3 Unique aspects of individual disability underwriting / Policy issuance alternatives
    • 4.3 Unique aspects of individual disability underwriting / Rating system for life; Issue the policy rated up; issue policy with exclusion; decline the policy
    • 4.4 Group disability income insurance
    • 4.4 Group disability income insurance / Group versus individual plans
    • 4.4 Group disability income insurance / Short-term disability (STD)
    • 4.4 Group disability income insurance / Long-term disability (LTD)
    • 4.4 Group disability income insurance / Coordinaton of benefits (Workers' compenstion benefits and social insurance)
    • 4.5 Social Security disability
    • 4.5 Social Security disability / Qualification for disability benefits
    • 4.5 Social Security disability / Definition of disability
    • 4.5 Social Security disability / Waiting period
    • 4.5 Social Security disability / Disability income benefits
  • 5.0 Medical Plans (8%)
    • 5.1 Medical plan concepts
    • 5.1 Medical plan concepts / Fee-for-service basis versus prepaid basis
    • 5.1 Medical plan concepts / Specified coverages versus comprehensive care
    • 5.1 Medical plan concepts / Benefit schedule versus usual/reasonable/customary charges
    • 5.1 Medical plan concepts / Any provider versus limited choice of providers
    • 5.1 Medical plan concepts / Insureds versus subscribers/participants
    • 5.1 Medical plan concepts / Dependent coverage
    • 5.1 Medical plan concepts / Provisions and Clauses
    • 5.1 Medical plan concepts / Deductibles
    • 5.1 Medical plan concepts / Stop-Loss Provision in relation to out-of-pocket expenses
    • 5.2 Types of providers and plans
    • 5.2 Types of providers and plans / Major medical insurance (indemnity plans)
    • 5.2 Types of providers and plans / Characteristics
    • 5.2 Types of providers and plans / Common limitations
    • 5.2 Types of providers and plans / Exclusions from coverage
    • 5.2 Types of providers and plans / Provisions affecting cost to insured
    • 5.2 Types of providers and plans / Defined contribution plans
    • 5.2 Types of providers and plans / Health maintenance organizations (HMOs)
    • 5.2 Types of providers and plans / General characteristics
    • 5.2 Types of providers and plans / Preventive care services
    • 5.2 Types of providers and plans / Primary care physician versus referral (specialty) physician
    • 5.2 Types of providers and plans / Emergency care
    • 5.2 Types of providers and plans / Hospital services
    • 5.2 Types of providers and plans / Other basic services
    • 5.2 Types of providers and plans / Preferred provider organizations (PPOs)
    • 5.2 Types of providers and plans / General characteristics
    • 5.2 Types of providers and plans / Limited health plans
    • 5.2 Types of providers and plans / Open panel or closed panel
    • 5.2 Types of providers and plans / Types of parties to the provider contract
    • 5.3 Cost containment in health care delivery
    • 5.3 Cost containment in health care delivery / Cost-saving services
    • 5.3 Cost containment in health care delivery / Managed Care
    • 5.3 Cost containment in health care delivery / Preventive care
    • 5.3 Cost containment in health care delivery / Hospital outpatient benefits
    • 5.3 Cost containment in health care delivery / Alternatives to hospital services
    • 5.3 Cost containment in health care delivery / Maternity stay minimum limits
    • 5.3 Cost containment in health care delivery / Preauthorization
    • 5.3 Cost containment in health care delivery / Gatekeeper
    • 5.3 Cost containment in health care delivery / Utilization management
    • 5.3 Cost containment in health care delivery / Prospective review
    • 5.3 Cost containment in health care delivery / Concurrent review
    • 5.4 State requirements (individual and group)
    • 5.4 State requirements (individual and group) / Eligibility requirements
    • 5.4 State requirements (individual and group) / Newborn child coverage
    • 5.4 State requirements (individual and group) / Dependent child age limit
    • 5.4 State requirements (individual and group) / Court ordered dependency coverage
    • 5.4 State requirements (individual and group) / Eligibility of dependent children not based solely on residency
    • 5.4 State requirements (individual and group) / Policy extension for handicapped children
    • 5.4 State requirements (individual and group) / Adoptions
    • 5.4 State requirements (individual and group) / Federal health care reform required dependent coverage
    • 5.4 State requirements (individual and group) / Grandchildren
    • 5.4 State requirements (individual and group) / Benefit offers
    • 5.4 State requirements (individual and group) / Substance abuse coverage
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Eligibility
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Terms
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Privacy
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Guaranteed issue
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Creditable coverage
    • 5.5 HIPAA (Health Insurance Portability and Accountability Act) requirements / Renewability
    • 5.6 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs)
    • 5.6 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) / Definition
    • 5.6 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) / Eligibility
    • 5.6 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) / Contribution limits
    • 5.6 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs) / Portability
    • 5.7 Federal Health Care Reform (Affordable Care Act)
    • 5.7 Federal Health Care Reform (Affordable Care Act) / Major Provisions
    • 5.7 Federal Health Care Reform (Affordable Care Act) / Market wide reforms
    • 5.7 Federal Health Care Reform (Affordable Care Act) / Guarantee issue
    • 5.7 Federal Health Care Reform (Affordable Care Act) / Essential Health Benefits
    • 5.7 Federal Health Care Reform (Affordable Care Act) / No annual limits for essential benefits
    • 5.7 Federal Health Care Reform (Affordable Care Act) / Coverage for pre-existing conditions
    • 5.7 Federal Health Care Reform (Affordable Care Act) / All plans have certain levels of coverage (platinum, gold, silver, bronze, catastrophic)
    • 5.8 Health Insurance Exchange
    • 5.8 Health Insurance Exchange / Individual exchange
    • 5.8 Health Insurance Exchange / Qualified health plan certification
    • 5.8 Health Insurance Exchange / Premium tax credits which may be taken in advance
    • 5.8 Health Insurance Exchange / Reduced cost sharing if silver plan is purchased
    • 5.8 Health Insurance Exchange / Opportunity to purchase through the federal exchange call center, online or mail
    • 5.8 Health Insurance Exchange / Comparison shopping tools
    • 5.8 Health Insurance Exchange / Single application
  • 6.0 Group Accident and Health Insurance (8%)
    • 6.1 Characteristics of group insurance
    • 6.1 Characteristics of group insurance / Group contract
    • 6.1 Characteristics of group insurance / Certificate of coverage
    • 6.1 Characteristics of group insurance / Experience rating versus community rating
    • 6.1 Characteristics of group insurance / Contributory versus noncontributory
    • 6.2 Types of eligible groups
    • 6.2 Types of eligible groups / Employment-related groups
    • 6.2 Types of eligible groups / Individual employer groups
    • 6.2 Types of eligible groups / Multiple-Employer Trusts (METs) or Welfare Arrangements (MEWAs)
    • 6.2 Types of eligible groups / Associations (alumni, professional, other)
    • 6.2 Types of eligible groups / Customer groups (depositors, creditor-debtor, other)
    • 6.2 Types of eligible groups / Discretionary groups
    • 6.3 Marketing considerations
    • 6.3 Marketing considerations / Advertising
    • 6.3 Marketing considerations / Unfair inducements
    • 6.3 Marketing considerations / Regulatory jurisdiction/place of delivery
    • 6.4 Employer group health insurance
    • 6.4 Employer group health insurance / Insurer underwriting criteria
    • 6.4 Employer group health insurance / Characteristics of group
    • 6.4 Employer group health insurance / Plan design factors
    • 6.4 Employer group health insurance / Persistency factors
    • 6.4 Employer group health insurance / Administrative capability
    • 6.4 Employer group health insurance / Eligibility for insurance
    • 6.4 Employer group health insurance / Annual open enrollment
    • 6.4 Employer group health insurance / Probationary period
    • 6.4 Employer group health insurance / Employee eligibility
    • 6.4 Employer group health insurance / Dependent eligibility
    • 6.4 Employer group health insurance / Coordination of benefits provision
    • 6.4 Employer group health insurance / Change of insurance companies or loss of coverage
    • 6.4 Employer group health insurance / Coinsurance and deductible carryover
    • 6.4 Employer group health insurance / No-loss no-gain
    • 6.4 Employer group health insurance / Events that terminate coverage
    • 6.4 Employer group health insurance / Continuation of coverage under COBRA
    • 6.4 Employer group health insurance / Eligibility
    • 6.4 Employer group health insurance / Duration of Coverage
    • 6.4 Employer group health insurance / Premium
    • 6.4 Employer group health insurance / State continuation
    • 6.4 Employer group health insurance / Reinstatement of coverage for military personnel
    • 6.5 Small employer medical plans
    • 6.5 Small employer medical plans / Definition of small employer
    • 6.5 Small employer medical plans / Availability of coverage
    • 6.5 Small employer medical plans / Rating of small employer plans
    • 6.5 Small employer medical plans / Benefit choices
    • 6.5 Small employer medical plans / Defined contribution arrangement market
    • 6.5 Small employer medical plans / Renewability of coverage
    • 6.5 Small employer medical plans / Participation requirements
    • 6.5 Small employer medical plans / Open enrollment
    • 6.6 Regulation of employer group insurance plans
    • 6.6 Regulation of employer group insurance plans / Employee Retirement Income Security Act (ERISA)
    • 6.6 Regulation of employer group insurance plans / Applicability
    • 6.6 Regulation of employer group insurance plans / Fiduciary responsibilities
    • 6.6 Regulation of employer group insurance plans / Reporting and disclosure
    • 6.6 Regulation of employer group insurance plans / Age Discrimination in Employment Act (ADEA)
    • 6.6 Regulation of employer group insurance plans / Applicability to employers and workers
    • 6.6 Regulation of employer group insurance plans / Permitted reductions in insured benefits
    • 6.6 Regulation of employer group insurance plans / Permitted increases in employee contributions
    • 6.6 Regulation of employer group insurance plans / Requirements for medical expense coverage
    • 6.6 Regulation of employer group insurance plans / Civil Rights Act/Pregnancy Discrimination Act
    • 6.6 Regulation of employer group insurance plans / Applicability
    • 6.6 Regulation of employer group insurance plans / Guidelines
    • 6.6 Regulation of employer group insurance plans / Relationship with Medicare
    • 6.6 Regulation of employer group insurance plans / Medicare secondary rules
    • 6.6 Regulation of employer group insurance plans / Medicare carve-outs and supplements
    • 6.6 Regulation of employer group insurance plans / Nondiscrimination rules (highly-compensated)
    • 6.7 Types of funding and administration
    • 6.7 Types of funding and administration / Conventional fully-insured plans
    • 6.7 Types of funding and administration / Fully self-funded (self-administered) plans
    • 6.7 Types of funding and administration / Characteristics
    • 6.7 Types of funding and administration / Conditions suitable for self-funding
    • 6.7 Types of funding and administration / Benefits suitable for self-funding
  • 7.0 Dental Insurance (4%)
    • 7.1 Categories of dental treatment
    • 7.1 Categories of dental treatment / Diagnostic and preventive
    • 7.1 Categories of dental treatment / Restorative
    • 7.1 Categories of dental treatment / Oral surgery
    • 7.1 Categories of dental treatment / Endodontics
    • 7.1 Categories of dental treatment / Periodontics
    • 7.1 Categories of dental treatment / Prosthodontics
    • 7.1 Categories of dental treatment / Orthodontics
    • 7.2 Indemnity plans
    • 7.2 Indemnity plans / Choice of providers
    • 7.2 Indemnity plans / Scheduled versus nonscheduled plans
    • 7.2 Indemnity plans / Benefit categories
    • 7.2 Indemnity plans / Diagnostic/preventive services
    • 7.2 Indemnity plans / Basic services
    • 7.2 Indemnity plans / Major services
    • 7.2 Indemnity plans / Deductibles and coinsurance
    • 7.2 Indemnity plans / Combination plans
    • 7.2 Indemnity plans / Exclusions
    • 7.2 Indemnity plans / Limitations
    • 7.2 Indemnity plans / Predetermination of benefits
    • 7.3 Employer group dental expense
    • 7.3 Employer group dental expense / Integrated deductibles versus stand-alone plans
    • 7.3 Employer group dental expense / Minimizing adverse selection
  • 8.0 Medicare (8%)
    • 8.1 Medicare standard policies
    • 8.1 Medicare standard policies / Nature, financing and administration
    • 8.1 Medicare standard policies / Part A — Hospital Insurance
    • 8.1 Medicare standard policies / Individual eligibility requirements
    • 8.1 Medicare standard policies / Enrollment
    • 8.1 Medicare standard policies / Coverages and cost-sharing amounts
    • 8.1 Medicare standard policies / Part B — Medical Insurance
    • 8.1 Medicare standard policies / Individual eligibility requirements
    • 8.1 Medicare standard policies / Enrollment
    • 8.1 Medicare standard policies / Coverages and cost-sharing amounts
    • 8.1 Medicare standard policies / Exclusions
    • 8.1 Medicare standard policies / Claims terminology and other key terms
    • 8.1 Medicare standard policies / Part C — Medicare Advantage
    • 8.1 Medicare standard policies / Part D — Prescription Drug Insurance
    • 8.2 Medicare supplement
    • 8.2 Medicare supplement / Purpose
    • 8.2 Medicare supplement / Open enrollment
    • 8.2 Medicare supplement / Standardized Medicare supplement plans
    • 8.2 Medicare supplement / Core benefits
    • 8.2 Medicare supplement / Additional benefits
    • 8.2 Medicare supplement / Regulations and required provisions
    • 8.2 Medicare supplement / Standards for marketing
    • 8.2 Medicare supplement / Advertising
    • 8.2 Medicare supplement / Appropriateness of recommended purchase and excessive insurance
    • 8.2 Medicare supplement / Right to return (free look)
    • 8.2 Medicare supplement / Replacement
    • 8.2 Medicare supplement / Pre-existing conditions
    • 8.2 Medicare supplement / Required disclosure provisions
    • 8.2 Medicare supplement / Outline of coverage
    • 8.2 Medicare supplement / Guide to Health Insurance for People with Medicare
    • 8.2 Medicare supplement / Permitted compensation
    • 8.2 Medicare supplement / New plans effective January 1, 2020
    • 8.3 Other options for individuals with Medicare
    • 8.3 Other options for individuals with Medicare / Employer group health plans
    • 8.3 Other options for individuals with Medicare / Disabled employees
    • 8.3 Other options for individuals with Medicare / Employees with kidney failure (End Stage Renal Disease) (ESRD)
    • 8.3 Other options for individuals with Medicare / Individuals age 65 and older
    • 8.3 Other options for individuals with Medicare / Medicaid
    • 8.3 Other options for individuals with Medicare / Eligibility
    • 8.3 Other options for individuals with Medicare / Benefits
    • 8.4 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
  • 9.0 Long-Term Care Insurance (8%)
    • 9.1 Long-term care (LTC) policies
    • 9.1 Long-term care (LTC) policies / Eligibility for benefits
    • 9.1 Long-term care (LTC) policies / Levels of care
    • 9.1 Long-term care (LTC) policies / Skilled care
    • 9.1 Long-term care (LTC) policies / Intermediate care
    • 9.1 Long-term care (LTC) policies / Custodial care
    • 9.1 Long-term care (LTC) policies / Home health care
    • 9.1 Long-term care (LTC) policies / Adult day care
    • 9.1 Long-term care (LTC) policies / Respite care
    • 9.1 Long-term care (LTC) policies / Benefit periods
    • 9.1 Long-term care (LTC) policies / Benefit amounts
    • 9.1 Long-term care (LTC) policies / Optional benefits
    • 9.1 Long-term care (LTC) policies / Guarantee of insurability
    • 9.1 Long-term care (LTC) policies / Return of premium
    • 9.1 Long-term care (LTC) policies / Tax Qualified LTC plans
    • 9.1 Long-term care (LTC) policies / Exclusions
    • 9.1 Long-term care (LTC) policies / Underwriting considerations
    • 9.1 Long-term care (LTC) policies / Regulations and required provisions
    • 9.1 Long-term care (LTC) policies / Standards for marketing
    • 9.1 Long-term care (LTC) policies / Advertising
    • 9.1 Long-term care (LTC) policies / Shopper's guide
    • 9.1 Long-term care (LTC) policies / Outline of coverage
    • 9.1 Long-term care (LTC) policies / Appropriateness of recommended purchase
    • 9.1 Long-term care (LTC) policies / Right to return (free look)
    • 9.1 Long-term care (LTC) policies / Replacement
    • 9.1 Long-term care (LTC) policies / Renewal provisions
    • 9.1 Long-term care (LTC) policies / Continuation or conversion
    • 9.1 Long-term care (LTC) policies / Required disclosure provisions
    • 9.1 Long-term care (LTC) policies / Inflation protection
    • 9.1 Long-term care (LTC) policies / Pre-existing conditions
    • 9.1 Long-term care (LTC) policies / Protection against unintentional lapse
    • 9.1 Long-term care (LTC) policies / Prohibited provisions
    • 9.1 Long-term care (LTC) policies / Rate disclosure form
  • 10.0 Federal Tax Considerations for Accident and Health Insurance (3%)
    • 10.1 Personally-owned health insurance
    • 10.1 Personally-owned health insurance / Disability income insurance
    • 10.1 Personally-owned health insurance / Medical expense insurance
    • 10.1 Personally-owned health insurance / Long-term care insurance
    • 10.1 Personally-owned health insurance / Flexible Spending Accounts (FSAs)
    • 10.1 Personally-owned health insurance / High Deductible Health Plans (HDHPs)
    • 10.2 Employer group health insurance
    • 10.2 Employer group health insurance / Disability income (STD, LTD)
    • 10.2 Employer group health insurance / Benefits subject to FICA
    • 10.2 Employer group health insurance / Medical and dental expense
    • 10.2 Employer group health insurance / Long-term care insurance
    • 10.2 Employer group health insurance / Accidental death and dismemberment
    • 10.2 Employer group health insurance / Flexible Spending Accounts (FSAs)
    • 10.2 Employer group health insurance / High Deductible Health Plans (HDHPs)
    • 10.3 Medical expense coverage for sole proprietors and partners
    • 10.4 Business disability insurance
    • 10.4 Business disability insurance / Key person disability income
    • 10.4 Business disability insurance / Buy-sell policy
    • 10.4 Business disability insurance / Business overhead expense
    • 10.5 Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs)
Examination sources

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