Insurance Licensing Ok-Life-Accident-and-Health-or-Sickness-Producer - Oklahoma Life, Accident, and Health or Sickness Producer Exam

Asupplemental attending physician’s statement (APS)is requested by the insurer during underwriting when additional medical information is needed to assess the applicant’s risk, particularly if it could affect the underwriting decision. Oklahoma regulations (Title 36 O.S. § 1204) and HIPAA require the applicant’s consent for obtaining medical records, ensuring privacy and transparency.

Option A: Incorrect. An APS is not routine; it’s requested based on specific needs.

Option B: Incorrect. The applicant’s consent is required for medical information requests.

Option C: Incorrect. Applicants typically do not request an APS; insurers do.

Option D: Correct. An APS is appropriate when requested by the insurer with the applicant’s consent for underwriting purposes.

Thewaiver of premium clausein a disability income policy waives the policy’s premiums during a disability claim, ensuring the policy remains in force without the insured having to pay premiums while disabled. This typically begins after the elimination period, as outlined in Oklahoma’s health insurance provisions (Title 36 O.S. § 4405).

Option A: Correct. The waiver of premium pays the policy premium during a disability claim.

Option B: Incorrect. Premiums are waived only during disability, not for the insured’s lifetime.

Option C: Incorrect. Monthly benefits are not reduced to offset waived premiums.

Option D: Incorrect. The waiver begins after the elimination period, not immediately upon a doctor’s statement.

Theguaranteed insurability riderallows the insured to purchase additional life insurance at specified dates or life events (e.g., marriage, childbirth) without proving insurability, ensuring coverage despite health changes. This is a standard rider in Oklahoma (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. Guaranteed renewability applies to policy renewals, not additional coverage.

Option B: Correct. The guaranteed insurability rider allows additional insurance without underwriting.

Option C: Incorrect. A cost of living rider adjusts benefits for inflation, not additional coverage.

Option D: Incorrect. A disability income rider provides income replacement, not additional insurance.

Asurvivorship life policy(also called second-to-die insurance) covers two or more individuals and pays the death benefit upon the death of the last insured person. It is often used for estate planning, as opposed to ajoint life policy, which pays on the first death (Title 36 O.S. § 4002).

Option A: Incorrect. Universal life is a flexible single-life policy, not a multiple-person policy.

Option B: Correct. A survivorship life policy pays on the last insured’s death.

Option C: Incorrect. A joint life policy pays on the first insured’s death.

Option D: Incorrect. An annuity life policy is not a standard term; annuities are separate products.

Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) and does not accumulate cash value, unlikepermanent life insurance(e.g., whole life), which provides lifelong coverage with cash value. Term policies may be renewable, but this is not automatic unless specified, and premium payment periods are shorter than permanent policies (Title 36 O.S. § 4002).

Option A: Incorrect. Term life accumulates no cash value, not a smaller amount.

Option B: Incorrect. Term life has a shorter premium payment period than permanent life.

Option C: Correct. Term life remains in force for a specific period, unlike lifelong permanent coverage.

Option D: Incorrect. Renewal is not automatic; it depends on the policy’s terms.

Under Oklahoma’s statute of limitations for insurance contracts (Title 12 O.S. § 95), an insured has5 yearsto bring a lawsuit against an insurer for breach of contract, such as dissatisfaction with claim handling, unless the policy specifies a shorter period (minimum 1 year per Title 36 O.S. § 3617).

Option A: Incorrect. 1 year is the minimum allowed by policy terms, not the general statute.

Option B: Incorrect. 3 years applies to some torts, not insurance contracts.

Option C: Correct. The statute of limitations is 5 years for insurance contract disputes.

Option D: Incorrect. 7 years exceeds the standard limitation period.

An insurance agent, acting as afield underwriter, is responsible forcompleting applications accuratelyandcollecting initial premiums, ensuring the information provided is truthful and complete for the insurer’s underwriting process, as per Oklahoma’s regulations (Title 36 O.S. § 1435.2). Setting premiums, accepting/declining applications, and issuing policies are duties of the insurer’s underwriting department, not the agent.

Option A: Incorrect. Setting premiums is the insurer’s responsibility, not the agent’s.

Option B: Correct. Agents complete applications and collect initial premiums as part of field underwriting.

Option C: Incorrect. Declining or accepting applications is done by the insurer’s underwriters.

Option D: Incorrect. Issuing policies is the insurer’s role, not the agent’s.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1435.2),transacting insuranceincludes activities such as soliciting or selling insurance, engaging in preliminary negotiations for insurance contracts, and delivering insurance contracts or collecting premiums.Gathering prospective buyer information(e.g., lead generation) is not considered transacting insurance unless it involves direct solicitation or negotiation.

Option A: Incorrect (is transacting). Selling insurance is a core part of transacting insurance.

Option B: Incorrect (is transacting). Preliminary negotiations are included in transacting insurance.

Option C: Incorrect (is transacting). Delivering insurance contracts is part of transacting insurance.

Option D: Correct (is not transacting). Gathering prospective buyer information alone does not constitute transacting insurance.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers the definition of transacting insurance.

Amodified whole life policyfeatures premiums that arelower than typical whole life premiums during the initial years(e.g., first 3–5 years) to make the policy more affordable early on, thenhigher thereafterto compensate for the initial discount while maintaining lifelong coverage. This is a variation of whole life insurance, as defined in Oklahoma’s regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Premiums do not decrease in the last few years; they increase after the initial period.

Option B: Incorrect. Premiums are not higher in the last few years compared to typical whole life; they adjust after the initial period.

Option C: Correct. Premiums are lower initially and higher thereafter.

Option D: Incorrect. Premiums are not higher initially and lower later; the opposite is true.

Medicare Part A covers skilled nursing facility (SNF) care for up to100 daysper benefit period, provided the patient meets eligibility criteria (e.g., a prior 3-day hospital stay and need for skilled care). Beyond 100 days, no benefits are provided, as outlined in CMS guidelines and Oklahoma’s Medicare supplement regulations (Title 36 O.S. § 6217).

Option A: Incorrect. 30 days is too short; coverage extends to 100 days.

Option B: Incorrect. 60 days is within the coverage period but not the limit.

Option C: Correct. No benefits are provided beyond 100 days in an SNF.

Option D: Incorrect. 180 days exceeds Medicare’s SNF coverage limit.