Insurance Licensing Virginia-Life-Annuities-and-Health-Insurance - Virginia Life, Annuities, and Health Insurance Examination Series 11-01

Most medical expense policies exclude elective cosmetic procedures unless medically necessary. Exact extract: “Policies may exclude benefits for cosmetic surgery unless required to correct accidental injury or congenital defect.”

Virginia adopts the Accident and Sickness advertising standards that define “advertisement” broadly (print, online, audiovisual, etc.), but specifically carve out employer announcements about available group coverage. Exact extract: “Advertisement means any printed, published, audio/visual, or descriptive literature used to solicit the public… including material on an insurer’s website.” “The term does not include general announcements by an employer to its employees that a plan of coverage is available.”

Indemnity dental insurance plans generally cover treatments directly related to dental health, such as fillings, root canal treatments, extractions, and certain preventive treatments like fluoride treatments for children under 16. However, dietary counseling and instructions are typically not covered under indemnity dental plans as they fall outside the scope of dental treatment.

The recurrent disability provision allows a relapse of the same disability within a specified time (usually 6 months) to be treated as a continuation of the prior disability, avoiding a new elimination period. Exact extract: “Recurrent disability is one which results from the same cause as a prior disability and occurs within a stated period; it is considered a continuation of the prior claim.”

When funds are transferred directly (a direct rollover) from one IRA to another, no taxes are withheld. This is because the transfer is not considered a taxable event as long as the funds are moved directly between the institutions and not distributed to the individual. Taxes would only be owed when the funds are eventually withdrawn, depending on the type of IRA and the individual’s tax situation.

Detailed Answer in Step-by-Step Solution:

The entire contract clause includes the policy and the attached application (B), ensuring all terms and representations are part of the agreement.

The premium receipt (A) is temporary, the waiver rider (C) is optional, and the declaration page (D) is part of the policy, not separate.

The Virginia study guide states that the entire contract provision encompasses the policy and attached application, defining the full legal agreement. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

Detailed Answer in Step-by-Step Solution:

For unintentional violations in Virginia, the maximum penalty is $1,000 per occurrence, with an aggregate cap of $10,000 (C), per state insurance regulations.

Options A, B, and D deviate from this standard penalty structure.

The Virginia study guide, per Virginia Code, sets unintentional violation penalties at up to $1,000 per act, with a $10,000 total cap, escalating for willful violations. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Penalties and Enforcement."

Detailed Answer in Step-by-Step Solution:

The grace period in a life insurance policy (typically 30 or 31 days) allows the policy to remain in force even if the premium is unpaid, provided the insured dies during this period.

If death occurs during the grace period, the insurer must pay the full death benefit (face amount), minus any unpaid premium, but only if explicitly stated. In this question, no indebtedness or dividends complicate the scenario, and standard practice assumes full payment unless otherwise specified.

Option B (cash value) applies to surrender, not death claims.

Option C (face amount less premium due) is a possibility in some policies, but absent specific policy language here, the default is full payment.

Option D (nonforfeiture provisions) applies if the policy lapses, not during the grace period.

Thus, the insurer pays the face amount (A).

The Virginia study guide states that the grace period provision protects the policyholder by keeping coverage active for a short period after a missed premium, and upon death during this time, the full face amount is payable unless loans or specific deductions apply. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Standard Policy Provisions - Grace Period."

Disability buy-sell insurance funds a business partner’s buyout if one becomes disabled, per Virginia Code § 38.2-3100 et seq. Option C is true; proceeds are typically tax-free under IRC § 104(a)(3) as insurance benefits, not income, if premiums aren’t deducted. Option A is false; the policyowner (e.g., a partner or business) is often the beneficiary to fund the buyout. Option B is false; benefits go to the business or partner, not the disabled individual, who may receive separate disability income coverage. Option D is false; premiums aren’t tax-deductible (IRC § 265), preserving tax-free proceeds. The study guide likely explains this with scenarios—e.g., $500,000 paid tax-free to buy out a disabled partner—highlighting tax treatment, making C the true statement.

In Virginia law and standard insurance terminology, the period during which a new employee must wait before becoming eligible for group health insurance is called a probationary period.

The Code of Virginia defines a “waiting period” as the length of time that must pass before an individual becomes eligible for coverage under a group plan. By law, this waiting period cannot exceed 90 days.

Virginia regulations further distinguish between two types of waiting times:

The eligibility waiting period imposed by an employer before coverage begins (commonly referred to in industry study materials as the probationary period).

A policy’s internal waiting period during which no benefits are provided after coverage becomes effective.

Additionally, Virginia’s insurance replacement regulations explicitly reference “probationary periods” when describing limitations or exclusions related to preexisting conditions. This confirms that the industry-standard term used in exam and licensing study guides for this eligibility wait is probationary period.

References (Virginia official documents and study materials):

Code of Virginia § 38.2-3431 (Definitions — “Waiting period”)

Code of Virginia § 38.2-3452 (Limitation — 90-day maximum waiting period for group health plans)

14VAC5-141-20 (Definitions — distinguishes employer eligibility waiting period from policy waiting period)

14VAC5-200-110 (Replacement notice — references to “probationary periods”)