LIFE, ACCIDENT AND HEALTH PRODUCER INDIANA
LIFE, ACCIDENT AND HEALTH PRODUCERINDIANA EXAMINATION CONTENT OUTLINE*160 QUESTIONS TOTAL**TIME LIMIT 2 hours 40 minutesREVISED 7/10/2015I.INSURANCE BASICS(21 QUESTIONS TOTAL)A. The Very Basics1. What is insurance2. Understanding Risk3. The Law of Large Numbers4. Types of insurance companies Lloyd’s of London Stock companies Mutual companies Fraternals5. Reinsurance(3 QUESTIONS)B. Contract Law(12 QUESTIONS)1. What is a contract2. The five essential parts of a contract Offer Acceptance Consideration Legal capacity Legal purpose3. Insurance Specifics Who makes the offer Who accepts the offer What is each party’s consideration4. Defining truth Warranties Representations Misrepresentations Concealment Material to the risk Consequences of material misrepresentation on the application5. Insurable Interest6. Consent7. When does coverage start If no Interim Insuring Agreement is used If an Interim Insuring Agreement is usedo Conditional Receiptso Collecting the initial premium*Additional non-scored trial questions may be added to exam**Extra time will be allotted to examinations with additional non-scored trial questions
o Explaining the Conditional Receipt8. Policy delivery Agent’s responsibilities Statement of Continued Good Health9. Unique characteristics of insurance contracts Conditional Valued, Reimbursement & Service contracts Unilateral Adhesion Aleatory10. Other contact terms Waiver Fraud11. Insurance law & the Agent/Producer The Agent/Producer The Agency Agreement/ Contract The Agent’s extending the insurance company’s liability Agent’s knowledge Agent vs. Broker12. Powers of Agency Expressed authority Implied authority Apparent authorityC. Underwriting Basics(6 QUESTIONS)1. What is underwriting2. Why is underwriting necessary3. Relationship between risk and premiums charged4. Sources of insurability information Applicationo Making changes on the applicationo Consequence of an incomplete application (blanks)o Required signatures on the application Agent/Producer’s reports Medical information & medical exams The Medical Information Bureau (MIB) and disclosures Attending Physician’s reports Credit reportso Fair Credit Reporting Act & mandatory disclosures Inspection reports5. Selection & Classification Factors Age Gender (sex) Tobacco usage Occupation Avocation, etc.
6. AIDS, HIV & Underwriting7. Classification of Risks & Effects on premiums charged Preferred Standard Substandard Declined8. Gross Premium factors Risk (Mortality and Morbidity) Interest Expense9. Net Premium10. Premium Modes Effect on PremiumsII.TYPES OF LIFE INSURANCE POLICIES(16 QUESTIONS TOTAL)A. Term Life Insurance1. Level Term2. Decreasing Term3. Increasing Term4. Renewable Term5. Convertible Term6. Level Premium Term7. Maturity8. Taxation(2-3 QUESTIONS)B. Whole Life Insurance1. Permanent Protection2. Cash value Guaranteed growth of Cash Value Taxation Policy loans and interest charged3. Level premium payments4. Methods of Premium Payment Single Premium Limited-Pay Continuous Premium/Straight Life5. Maturity6. Taxation(3-4 QUESTIONS)C. Adjustable Life Insurance(0-1 QUESTION)1. Factors that can be adjusted Amount of death protection Amount of premium Type of plan (Term versus Whole Life)
2. Advantages and DisadvantagesD. Variable Whole Life Insurance(0-1 QUESTION)1. A securities version of Whole Life insurance2. The Separate Investment Account (as opposed to the General Account)3. Additional licensing is required to sell securities products National Association of Securities Dealers (NASD)E. Universal Life Insurance(3-4 QUESTIONS)1. Permanent Protection2. Policy design and structure3. Annual management fees4. Death benefit options5. Flexible premium options6. Cash accumulation options Cash value growth on an interest sensitive basis Tax deferred growth Partial surrenders Tax consequences of partial surrenders Policy loans7. Waiver of Premium vs. Waiver of Cost of Insurance8. TaxationF. Variable Universal Life Insurance(0-1 QUESTION)1. A securities version of Universal Life insurance2. Special securities licensing requirements (NASD)G. Interest Sensitive Whole Life Insurance(0-1 QUESTION)H. Equity Indexed Life Insurance(1 QUESTION)I. Joint Life Insurance1. Number of Insureds2. First to dieJ. Survivorship Life Insurance1. Number of Insureds2. Last to dieK. Family (Protection) Policy1. Policy structure2. Who are the insureds3. Newborns and adopted children4. Premium factors(0-1 QUESTION)L. Other Life Insurance Policy Types1. Modified Life2. Graded Premium Whole Life3. Re-Entry Term4. Juvenile Life(0-1 QUESTION)(0-1 QUESTION)(0-1 QUESTION)
5. Credit LifeM. Modified Endowment Contracts (MEC)1. IRS Definition/ Seven-Pay test2. Taxation3. 10% Penalty for early withdrawal4. Age 59 ½ RuleIII.ANNUITY CONTRACTS(1 QUESTION)(7 QUESTIONS TOTAL)A. Concept of an AnnuityB. The Accumulation (pay-in) Period vs. the Annuity (pay-out/liquidation) PeriodC. The Pay-In Period1. Who controls policy2. Premium payment options3. Cash value grows tax deferred4. Penalty for contract surrender prior to age 59 ½ Exceptions5. May be surrender charges for early withdrawals6. Tax consequences of policy surrender7. Consequences of policyowner death during the pay-in period TaxationD. The Pay-Out Period1. Age 59 ½ Rule2. Choices Take the Money Annuity Certain Life Annuity3. Annuity Certain Fixed Period Fixed Amount4. Life Annuity Who controls policy Policyowner becomes the Annuitant Annuitant(s) will receive a life income Annuitant can name a beneficiary should there be any installment payments madeafter the death of the Annuitant. Exclusion Ratio Pay out choices include:o Straight Life (or Life Only) Annuityo Life Annuity with Period Certaino Refund Life Annuityo Joint and Survivor Life Annuity
E. Types of Annuities1. Fixed Dollar (Conventional) Annuity-General Account2. Variable Annuity-Separate Account-NASD license required3. Equity Indexed AnnuityF. Other Annuity Terms1. Immediate vs. Deferred Annuity2. Single Premium vs. Level Premium vs. Flexible Premium payment plansIV.LIFE INSURANCE POLICY PROVISIONS(8 QUESTIONS TOTAL)A. Required Provisions(5-6 QUESTIONS)1. Entire Contract/ Changes Clause2. Insuring Clause3. Premium Payment Clause4. Incontestable Clause5. Misstatement of Age and Sex Clause6. Grace Period Clause7. Reinstatement Clause8. Ownership Clause9. Assignment Clause10. Loan Values and Automatic Premium Loan (APL) Provision11. Time Limit on Lawsuits12. Methods of Settlement13. The Practice of Back-Dating14. Application of State Law15. Free Look ProvisionB. Discretionary Provisions (Exclusions)(0-1 QUESTION)1. Suicide Clause2. Hazardous Occupation (or Hobby/Avocation) ClauseC. Beneficiary Designations(2 QUESTIONS)1. Policyowner can name and change beneficiary designations2. Primary and Contingent beneficiaries3. Revocable and Irrevocable designations4. The Estate as beneficiary5. A Trust as beneficiary6. Minors (children) as beneficiaries7. Uniform Simultaneous Death Act Common Disaster Provision8. Naming Beneficiaries Per capita Per stirpes9. Spendthrift Clause
V.LIFE INSURANCE POLICY OPTIONS(7 QUESTIONS TOTAL)A. Dividend Options1. What are Policy Dividends2. Taxation3. Options: Cash Reduction of Premium Accumulate at Interest Paid-Up Additions One Year Term Paid-Up Life(1-2 QUESTIONS)B. Nonforfeiture Options1. Purpose2. Options: Cash Reduced Paid-Up insurance Extended Term insurance3. Reinstatement(2 QUESTIONS)C. Settlement Options(1-2 QUESTIONS)1. Maturity2. Options: Cash Interest Fixed Period (Annuity Certain) Fixed Amount (Annuity Certain) Life Income (Life Annuity)o Straight Life (or Life Only) Annuityo Life Annuity with Period Certaino Refund Life Annuityo Joint and Survivor Life AnnuityD. Living Benefit Options1. Accelerated Death Benefits2. Viatical Settlements(1-2 QUESTIONS)
VI.LIFE INSURANCE POLICY RIDERS(4 QUESTIONS TOTAL)A. Multiple Indemnity/Accidental Death riderB. Guaranteed Insurability riderC. Cost of Living riderD. Waiver of Premium riderE. Payor Benefit riderF. Accelerated Death Benefit riderG. Automatic Premium Loan riderVII.BUSINESS USES OF LIFE INSURANCE(1 QUESTION TOTAL)A. Key Employee Life policiesB. Buy and Sell AgreementsC. Split Dollar plansVIII. QUALIFIED RETIREMENT PLANS(3 QUESTIONS TOTAL)A. Qualified versus Nonqualified plansB. Characteristics of qualified plansC. Tax treatment of qualified plans and age limitations (59 ½ & 70 ½ )D. Penalty for premature withdrawals1. ExceptionsE. Defined Contribution plans versus Defined Benefit plansF. Common types of Qualified Retirement plans1. 401 K plans2. 403 B Tax Sheltered Annuities (TSAs) for 501 C corporations3. Individual Retirement Accounts (IRAs)4. Roth IRAs5. Keogh (HR-10) plans6. Simplified Employee Pension (SEPs) plansG. Plan Roll-Overs
IX.X.GROUP LIFE INSURANCE(3 QUESTIONS TOTAL)A.B.Group Insurance ConceptsEligible Groups1. Single Employers2. Labor Unions3. Associations4. Credit Unions5. Creditors (Credit Life Insurance)6. Multiple Employer Trusts (METs)7. Multiple Employer Welfare Arrangements (MEWAs)C.The Group Contract1. Master Contract2. Individual Certificates of InsuranceD.Group Underwriting1. Experience rating vs. Community rating2.Reduced Adverse Selection3.Group Risk Selection4.Purpose of the Group5.Eligible Members6.No discrimination7.Contributory vs. Non-Contributory8.TurnoverE.Reduced Administrative CostsF.Life Conversion PrivilegesGOVERNMENT INSURANCE - SOCIAL SECURITY (1 QUESTION TOTAL)A.Social Security Retire Income Benefit1. Who is Eligible for income benefits2. Currently Insured vs. Fully Insured status3. Benefits based on Primary Insurance Amount (PIA)4. Blackout Period
XI.HEALTH INSURANCE BASICS(13 QUESTIONS TOTAL)A. Definitions of Key Terms(6-8 QUESTIONS)1. Insuring Clause2. Consideration Clause3. Free Look Provision4. Probationary (Waiting) Periods5. Elimination Periods6. Definition of Perils Accident Sickness Activities of Daily Living (ADLs)7. Deductibles Dollar Deductibles Time Deductibles (Elimination Periods)8. Policy Renewal Provisions Noncancellable Guaranteed Renewable Conditionally Renewable Optionally Renewable Cancellable Term (Period of Time)9. Preexisting Conditions10. Coinsurance11. Adverse Selection12. Included/Excluded Benefits Individual Medical Expense policies Group Major MedicalB. Common Health Insurance Riders1. Impairment Rider2. Guaranteed Insurability Rider3. Multiple Indemnity Rider (AD&D)(0-1 QUESTIONS)
C. Major Health Insurance Providers(3-4 QUESTIONS)1. Stock and Mutual insurance companies2. Blue Cross and Blue Shield companies3. Health Maintenance Organizations (HMOs)4. Preferred Provider Organizations (PPOs)5. Multiple Employer Trusts (METs)6. Multiple Employer Welfare Associations (MEWAs)XII.D. Tax Treatment of Health Benefits(1-2 QUESTIONS)E. Occupational vs. Nonoccupational Coverages(0-1 QUESTION)DISABILITY INCOME INSURANCE(4 QUESTIONS TOTAL)A. Characteristics of Disability Income Policies1. Who is the insured2. How are benefits paid3. How long are benefits paid4. To whom are benefits paid5. Triggers for benefit payments6. Elimination Periods7. Taxation of Disability Income benefitsB. UnderwritingC. Benefit LimitsD. Definitions of Total Disability1. Own Occupation2. Any Occupation3. Presumptive Total DisabilityE. Definitions of “Partial” Disability1. Partial Disability Benefits2. Residual Disability BenefitsF. Other Disability Income Provisions1. Recurrent Disability2. Waiver of PremiumG. Business Applications of Disability Income Policies1. Business Overhead Expense policies2. Key Employee Disability Income Policies3. Disability Buy-Sell (Business Disability Buyout) policies4. Group Disability Income policies
XIII. MEDICAL EXPENSE POLICIES(6 QUESTIONS TOTAL)A. Characteristics of Medical Expense Policies(2 QUESTIONS)1. Pays medical bills (doctors, hospitals, drugs, etc.)2. Insureds3. Deductibles and coinsurance requirements4. Probationary (Waiting) periods5. Taxation6. Concept of “Managed Care”B. Types of Plans(3 QUESTIONS)1. Basic Plans (Hospital, Medical & Surgical)2. Major Medical Policy characteristics Catastrophic Coverages Dollar Deductibles Eligible Expenses-Usual, necessary and customary Coinsurance/cost sharing Per Person Maximum Benefit Limits Common Exclusions Calculate a simple Major Medical ClaimC. Medical Expense1. Assignment of Benefits2. Rights of Conversion3. Rights of Newborn and Adopted Children4. Rights of Dependent ChildrenXIV. SENIOR CITIZEN POLICIES(1 QUESTION)(5 QUESTIONS TOTAL)A. Long Term Care (LTCs) Policies1. Purpose2. Types of Benefits paid3. Standard Provisions4. Minimum Benefit Period5. Levels of Care Skilled Nursing Care Intermediate Care Custodial or Residential Care Home Health Care Adult Day Care Respite Care6. LTC Disclosure and Performance Standards Preexisting Condition Limits 30-Day Free Look Provision Outline of Coverages Policy Summary(2-3 QUESTIONS)
B. Medicare Supplement Policies (MSPs)1. Purpose2. Eligibility3. Standard Provisions4. Required Forms of Renewability5. Nonduplication of Coverages6. Probationary Period limits7. Benefit Limits8. Twelve Standardized Plans A-L9. MSP Disclosure and Performance Standards(2-3 QUESTIONS)C. LTC and MSP Marketing Requirements(0-1 QUESTION)1. Suitability2. Nonduplication of Coverage3. Policy Summaries, Outlines of Coverage & Buyers Guides4. Notices Regarding Policy Replacements5. Permitted Compensation ArrangementsXV.ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) POLICIESA. Conditions For Payment Of The Death Claim (Principal Sum)B. Accidental Dismemberment (Capital Sum)XVI. LIMITED HEALTH POLICIESA. Hospital Indemnity policiesB. Prescription Drug policiesC. Dread Disease policiesD. Dental Expense policiesE. Vision Care policies(1 QUESTION TOTAL)(1 Q)
XVII. UNIFORM INDIVIDUAL HEALTH POLICY PROVISIONS(8 Q TOTAL)A. The Required Provisions1. Entire Contract/Changes2. Time Limit on Certain Defenses or Incontestable3. Grace Period4. Reinstatement5. Notice of Claim6. Claim Forms7. Proof of Loss8. Time of Payment of Claims9. Payment of Claims10. Physical Examination and Autopsy11. Legal Action12. Change of Beneficiary13. Relation of Earning to Insurance: Average EarningsB. The Optional Policy Provisions1. Change of Occupation2. Misstatement of Age3. Illegal Occupation4. Other Insurance in this Insurer5. Insurance with Other Insurers: Expense Incurred Basis6. Insurance with Other Insurers: Other Benefits7. Unpaid Premium8. Cancellation9. Conformity with State Statures10. Intoxicants and NarcoticsXVIII. GROUP HEALTH(6 QUESTIONS TOTAL)A. Key Concepts1. Medical exam requirements2. Occupational Losses3. Maternity Benefit requirements4. Rights of Dependent Children5. Preexisting Conditions limitations6. Changing insurance companies - no loss/ no gain7. Coordination of Benefits clause Primary vs. Secondary coverages Simple Claim ProblemB. Portability Issues1. COBRA2. HIPAA
XIX. GOVERNMENT SOCIAL SECURITY HEALTH CARE (3 Q TOTAL)A. Medicare Title 181. Eligibility2. Four Coverage Parts Automatic Part A Hospital Optional Part B Medical Optional Part C Medicare Choice Optional Part D Drug Benefit Premium requirementsB. Medicaid Title 191. Eligibility2. Benefits3. Funding4. AdministrationC. Social Security Disability Income benefits (SSDI)1. Definition of Total Disability2. Triggers3. Duration of benefits4. Benefits based on your PIA
XX.STATE OF INDIANAGENERAL INSURANCE REGULATIONS(24 QUESTIONS TOTAL)A. Department of Insurance1. Insurance Commissioner Appointment by Governor Member of NAIC Powers Duties(6 QUESTIONS)2. Admission of Insurance Companies Certificate of Authority Admitted versus Non-Admitted companies Domestic, Foreign & Alien companies3. Examination of Admitted Insurance Companies Frequency of fiscal examinations Waiving examinations of Foreign & Alien companies4. Insurance Guaranty Associations Purpose Policy benefits that are guaranteedB. Licensing Laws1. Types of Insurance Licenses, EligibilityRequirements & Powers and Duties Resident Producer Nonresident Producer Temporary Producer Consultant Limited Lineso Travelo Portable Electronicso Titleo Credito Funeral Directors(11 QUESTIONS)2. Who must be licensed Solicit, negotiate or sell contracts of insurance3. Producer qualifications and the licensing process4. Insurance Company: Producer appointments and termination
5. Duties of a Producer License application process, examination, and fees for obtaining a license Controlled Business Acting as a Consultant Fees and commissions6. Producer’s License Maintenance Producer notification requirements for change of business or residential address License renewal process Continuing Education requirements Sircon license & C/E tracking systemo Producer ResponsibilitiesC. Producer/Company Compliance1. Producer Licensing Law & Violations(6 QUESTIONS)2. Unfair Competition Law & Violations3. Definitions Twisting Rebating Sharing commissions with an unlicensed person Unfair discrimination4. Complaint process Time frame for hearings5. Penalties/Disciplinary Actions Penalty for violating Licensing law Penalty for violating Unfair Competition Law Penalty for violating Cease and Desist Orders Criminal violationsD. Claims1. When must claims be paid2. Unfair Claim Settlement Practices(1 QUESTION)
XXI. LIFE REGULATIONS(8 TOTAL QUESTIONS)A. Policies and Contracts1. Policy Provisions2. Underwriting Restrictions3. Right to Examine (10 Day Free Look)4. Payment of Claims5. Interest on Loans6. Interest on Death Benefits7. AIDS & HIV8. Accelerated Death Benefits9. Viatical Settlements(4 QUESTIONS)B. Marketing Practices1. Advertising(3 QUESTIONS)2. Solicitation Purpose Documentation Buyer’s Guide and Policy Summary Duties of Producers3. Replacement Definition of Replacement Purpose Free Look Duties of Producers Duties of CompaniesC. Group Life1. Eligible Groups2. Conversion Rights to Individual PolicyXXII. HEALTH REGULATIONS(1 QUESTION)(10 TOTAL QUESTIONS)A. Health Insurance Contracts1. Standard Provisions in Medical Expenseand Disability Income Policies Individual Provisions Group Provisions2.Required Coverages Mammogram coverage3.Underwriting Restrictions(3 QUESTIONS)
4.Rights of Dependent Children Newborns and adopted children Limiting age Handicapped children Adopted children5.AdvertisingB. Specialized Coverage(2 QUESTIONS)1. Indiana Comprehensive Health Insurance Association (ICHIA)2. Indiana Small Group Health3. Group Coordination of Benefits4. Children’s Health Insurance Program (CHIP)C. Long Term Care and Medicare Supplement Policies1. Provisions Free Look Length of coverage Pre-existing conditions, etc.2. Standards for Marketing3. Replacement4. Producer’s Duties5. Long Term Care Partnership Program (LTCP)D. Affordable Care Act (ACA)1. Major Provisions/Definitions Individual Mandate Employer Mandate Preexisting Conditions Minimum Essential Coverage (MEC) Essential Health Benefits (EHBs) Qualified Health Plan (QHP)o Eligibilityo Metal Plans/Tiers (Bronze,Silver, Gold, Platinum)o Premium Tax Credito Cost-sharing Reduction Guaranteed Available Guaranteed Renewable Dependent Coverage Life Change Open Enrollment Period Special Enrollment Period Catastrophic Coverage Small vs. Large Employer2. Marketplaces/Exchanges Federal Marketplaces – healthcare.govo Individualo SHOP(3 QUESTIONS)(1-3 QUESTIONS)
State MarketplacesAgent/Broker Training/RegistrationRequirementsREVISION HISTORYDateRevisions7/10/2015 Section XI – Total exam questions decreased from 14 to 13; “11.Adverse Selection” was added to subsection B; deleted “CommonExclusions” in subsection B and replaced with “12.Included/Excluded Benefits”; deleted “7. Federal and StateGovernments”, “8. Workers Compensation Plans”, and “9. HealthSavings Accounts (HSAs)”, from subsection C Section XIV – Total exam questions decreased from 6 to 5 Section XX – “Travel”
A. Characteristics of Medical Expense Policies (2 QUESTIONS) 1. Pays medical bills (doctors, hospitals, drugs, etc.) 2. Insureds 3. Deductibles and coinsurance requirements 4. Probationary (Waiting) periods 5. Taxation 6. Concept of “Managed Care” B. Types of Plans (3 QUESTIONS) 1. Basic Plans (Hospital, Medical
This document provides step-by-step instructions for the Producer Online Contracting Application process. TAKE NOTE: There are two options that apply for producer contracting: - Producer (Individual Producer only) - Producer Entity Agency (Individual Producer and Agency) This document has three sections: 1. Producer (Individual Producer Only) 2.
This document provides step-by-step instructions for the Producer Online Contracting Application process. TAKE NOTE: There are two options that apply for producer contracting: - Producer (Individual Producer only) - Producer Entity Agency (Individual Producer and Agency) This document has three sections: 1. Producer (Individual Producer Only) 2.
3 Life and Health Producer Combo General 2015 60 Life and Health Producer Combo State 2016 Property Producer General 2017 60 Property Producer State 2018 Property Casualty Producer Combo General 2019 60 Property Casualty Producer Combo State 2020 Adviser Property Casualty General 2021 60 Adviser Property Casualty State 2022 Retake of the two-part exam
RBC Insurance Accident Claim351.17 RBC Insurance Accident Claim188.37 Pilot Insurance Accident Claim259.95 State Farm Accident Claim182.16 State Farm Insurance Accident Claim178.70 Pafco Accident Claim115.46 Royal & Sunnaliance Accident Claim98.19
Vertical mergers h Examples of a vertical relationship: – producer and retailer – car parts producer and car producer – cement producer and concrete producer – electricity producer and distributor h Vertical mergers have implications which differ from horizo
Producer and Director Producer Name: In the box, type the name of the producer of the programme Producer Contract Type: From the Producer Contract Type drop down list, select the relevant contract type for the producer, identifying if they are a freelancer, or a member of staff (which includes producers on Fixed Term Contracts)
accident reporting and investigation of each accident and incident (near-miss); and periodic review of the program to keep it up to date. The direct cause of an accident usually results from one or more previous unsafe actions or conditions. A good accident investigation program discovers the events leading up to an incident or accident.
In GSM and GPS based accident detection system; GSM cellular technology is used to send the data in case of road accident. The location of the accident spot is identified by the GPS system. In VANET-based accident detection system, in case of an accident, information to the emergency department is sent using the VANET-an ad-hoc network
