Which of the following BEST describes a waiver of premium clause in a typical disability policy?
Correct Answer: A
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. : Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge - Accident and Health Insurance). Oklahoma Insurance Department, Title 36 O.S. § 4405 (health insurance provisions). Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.
Any person entitled to reimbursement for expenses of health care services and procedures under an Accident and Health Insurance Policy issued by an insurer is
Correct Answer: B
Aninsuredis the person covered by an accident and health insurance policy and entitled to reimbursement for covered health care expenses, as defined in Oklahoma's Insurance Code (Title 36 O.S. § 4401). The insured (or their assignee, e.g., a provider) receives benefits for services like medical treatments or hospital stays. * Option A: Incorrect. An insurer is the company issuing the policy, not receiving reimbursement. * Option B: Correct. The insured is entitled to reimbursement for covered health care expenses. * Option C: Incorrect. A practitioner provides services, not receives policy reimbursements. * Option D: Incorrect. A PPO is a network of providers, not an individual entitled to benefits. : Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge - Accident and Health Insurance). Oklahoma Insurance Department, Title 36 O.S. § 4401 (health insurance definitions). Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.
What is the main reason a Medicare supplement policy is purchased?
Correct Answer: D
AMedicare supplement policy(Medigap) is designed to cover out-of-pocket costs not paid by Original Medicare (Parts A and B), such as deductibles, coinsurance, and copayments. The primary reason for purchasing Medigap is tofill the gapsin Medicare coverage, as outlined in Oklahoma's regulations (Title 36 O. S. § 6217) and federal guidelines (CMS, Medicare & You Handbook). Dental services, long-term care, and prescription drugs are not typically covered by Medigap; these require separate plans (e.g., Medicare Part D for drugs). * Option A: Incorrect. Dental services are not covered by Medigap; they require separate dental insurance. * Option B: Incorrect. Long-term care is not covered by Medigap; it requires LTC insurance. * Option C: Incorrect. Prescription drugs are covered by Medicare Part D, not Medigap. * Option D: Correct. Medigap fills gaps in Medicare Parts A and B coverage. : Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge - Medicare). Oklahoma Insurance Department, Title 36 O.S. § 6217 (Medicare supplement insurance). CMS, Medicare & You Handbook (Medigap benefits).
Oklahoma resident Joe served in the military the past 4 years. When he returned and tried to reinstate his individual health insurance policy, he was denied coverage. His producer stated that because he was covered under a government plan he would be required to be re-underwritten as a new applicant subject to more restrictive coverage and increased premiums. Which of the following is TRUE?
Correct Answer: C
Under the federalUniformed Services Employment and Reemployment Rights Act (USERRA)(38 U.S.C. § 4317) and Oklahoma's insurance regulations (Title 36 O.S. § 4405), military members whose individual health insurance lapsed due to active duty and coverage under a government-sponsored plan (e.g., TRICARE) are entitled toreinstatementof their prior policy without re-underwriting or new pre-existing condition exclusions, provided they apply within a specified period (typically 120 days) after leaving service. Joe cannot be denied reinstatement due to his military service coverage. * Option A: Incorrect. Joe is not subject to re-underwriting for reinstatement post-military service. * Option B: Incorrect. Joe does not need to be free of pre-existing conditions for reinstatement. * Option C: Correct. Joe cannot be denied reinstatement of his lapsed policy due to government plan coverage. * Option D: Incorrect. Federal government denial is irrelevant; USERRA protects reinstatement rights. : Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: State- Specific Knowledge - Oklahoma Insurance Statutes). Oklahoma Insurance Department, Title 36 O.S. § 4405 (health insurance provisions). USERRA, 38 U.S.C. § 4317 (health plan reinstatement for military service).
If a primary beneficiary dies, life insurance benefits are then paid to
Correct Answer: C
In a life insurance policy, theprimary beneficiaryis the first in line to receive the death benefit. If the primary beneficiary predeceases the insured, the benefits are paid to thecontingent (or secondary) beneficiaries, as specified in the policy. If no contingent beneficiaries are named, the benefits typically go to the insured's estate, but "contingent beneficiaries" is the correct choice here (Title 36 O.S. § 4001 et seq.). * Option A: Incorrect. Benefits are not paid to "no one"; they go to contingent beneficiaries or the estate. * Option B: Incorrect. "Tertiary beneficiaries" is not a standard term in life insurance. * Option C: Correct. Contingent beneficiaries receive benefits if the primary beneficiary dies. * Option D: Incorrect. "Sub-primary beneficiaries" is not a recognized term. : Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: General Knowledge - Life Insurance Provisions). Oklahoma Insurance Department, Title 36 O.S. § 4001 et seq. (beneficiary designations). Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.
