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

Thegrace periodin life and health insurance policies, as mandated by Oklahoma law (Title 36 O.S. § 4005 for life, § 4405 for health), is a period (typically 31 days) after a premium due date during which the policy remains in force, protecting the policyowner from an unintentional lapse. If the insured dies during the grace period, the death benefit is payable, minus any overdue premiums.

Option A: Incorrect. The period after premium payment but before policy issuance is the underwriting or application phase, not the grace period.

Option B: Incorrect. This is similar to Option A and does not describe the grace period.

Option C: Incorrect. The time between death and benefit payment is the claim processing period, not the grace period.

Option D: Correct. The grace period protects against unintentional policy lapse due to late premium payment.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers grace period provisions.

Medical expense plans often include exclusions for high-risk activities or situations not typically covered under standard health insurance. A common exclusion is injuries or losses resulting fromair travel in a private plane, as this is considered a hazardous activity. Other options, like auto accidents or recreational sports, are generally covered unless specifically excluded, and home repairs are not standard exclusions.

Option A: Correct. Air travel in a private plane is a common exclusion due to its high-risk nature.

Option B: Incorrect. Auto accident injuries are typically covered, often coordinated with auto insurance.

Option C: Incorrect. Recreational sports injuries are usually covered unless the policy specifies otherwise.

Option D: Incorrect. Injuries from home repairs are not commonly excluded in medical expense plans.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance exclusions.

Afield underwriter, typically an insurance producer, gathers initial information from applicants to assess their insurability and ensure the application is accurate and complete. A main task is ensuring the accuracy and completeness of an individual’s medical information, as this is critical for the insurer’s underwriting decision. Field underwriters do not approve policies or edit reports to guarantee approval; they facilitate the process by providing reliable data.

Option A: Incorrect. Editing reports to ensure approval is unethical and not a field underwriter’s role.

Option B: Incorrect. Approving policies is the role of the insurer’s underwriting department, not the field underwriter.

Option C: Correct. Ensuring accuracy and completeness of medical information is a key task of a field underwriter.

Option D: Incorrect. Obtaining an MIB report is typically done by the insurer, not the field underwriter.

This question aligns with the Prometric content outline under “Underwriting,” which covers the role of field underwriters.

Under Oklahoma’s Insurance Code (Title 36 O.S. § 1435.13), transacting insurance without a valid license, such as after revocation, is afelonypunishable by a fine of up to $5,000, imprisonment for up to 7 years, or both, depending on the severity and intent. This reflects the serious nature of unlicensed insurance activity.

Option A: Incorrect. The fine limit is $5,000 for a felony, not $10,000.

Option B: Correct. The violation is a felony with a fine up to $5,000.

Option C: Incorrect. The violation is a felony, not a misdemeanor, with higher penalties.

Option D: Incorrect. Imprisonment is up to 7 years, not 10 years.

Anannuityis a financial product purchased from an insurer that provides a stream of income, typically for retirement, in exchange for a lump sum or periodic payments. The primary purpose is to guarantee income, often for the annuitant’s lifetime or a specified period, as outlined in Oklahoma’s regulations for life insurance products (Title 36 O.S. § 4002).

Option A: Correct. An annuity provides guaranteed income, either fixed or variable, based on the contract terms.

Option B: Incorrect. A whole life policy is a type of life insurance, not an annuity.

Option C: Incorrect. Disability insurance covers income loss due to disability, not guaranteed income.

Option D: Incorrect. A universal life policy is a flexible life insurance product, not an annuity.

This question falls under the Prometric content outline section on “Life Products,” which covers annuities and their features.

In Oklahoma, the minimum age for a person of competent legal capacity to contract for life and health insurance is18, as this is the age of majority under Oklahoma law (Title 15 O.S. § 13). Individuals under 18 may be insured (e.g., as dependents or under juvenile policies), but they cannot enter into insurance contracts themselves unless emancipated.

Option A: Incorrect. Age 15 is below the age of majority.

Option B: Incorrect. Age 16 is below the age of majority.

Option C: Correct. Age 18 is the minimum age for contracting insurance in Oklahoma.

Option D: Incorrect. Age 21 is not required; 18 is sufficient.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which covers eligibility to contract insurance.

Alife annuity(or straight life annuity) pays periodic payments to the annuitant until their death, at which point all payments cease, with no further benefits to beneficiaries. This contrasts with other annuity types, such as refund or joint-life annuities, which may continue payments or provide refunds.

Option A: Incorrect. “Terminal annuity” is not a standard insurance term.

Option B: Incorrect. “Finite annuity” is not a recognized annuity type.

Option C: Incorrect. A refund annuity provides a refund or continued payments to a beneficiary if the annuitant dies early.

Option D: Correct. A life annuity ceases payments upon the annuitant’s death.

This question falls under the Prometric content outline section on “Life Products,” which covers annuities and their features.

In group medical insurance, themaster policyis the single contract issued to the employer or group sponsor (e.g., a trust or association) that outlines the terms, conditions, and coverage for the entire group. Individual employees receivecertificates of insurance, which summarize their coverage under the master policy but are not the contract itself.

Option A: Correct. The master policy is the contract issued to the employer for group medical insurance.

Option B: Incorrect. “Employer policy” is not a standard insurance term.

Option C: Incorrect. A certificate policy refers to the document given to individuals, not the group contract.

Option D: Incorrect. “Conglomerate policy” is not a recognized term in insurance.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers group health insurance structures.

Major medical insuranceis designed to cover significant healthcare expenses, particularly those related to hospitalization, surgeries, and other high-cost medical services. It focuses on providing comprehensive coverage for catastrophic or major medical events, as opposed to routine or preventive care, which may be covered to a lesser extent or through separate plans.

Option A: Incorrect. Preventive care is often included but is not the primary focus of major medical insurance.

Option B: Incorrect. Using in-network facilities reduces costs but is a feature of managed care plans, not the core focus of major medical insurance.

Option C: Correct. The focus of major medical insurance is covering hospitalization and other major expenses.

Option D: Incorrect. Providing care to the needy is associated with programs like Medicaid, not private major medical insurance.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers the characteristics of major medical insurance.

Key person insuranceis a life or disability insurance policy purchased by a business to protect against financial loss due to the death or disability of a critical employee or officer (e.g., a CEO or top salesperson). The business is the policyowner and beneficiary, receiving the death benefit or disability payments to offset lost earnings or replacement costs.

Option A: Incorrect. Business continuation life typically refers to buy-sell agreements, not key person coverage.

Option B: Incorrect. Business overhead insurance covers ongoing business expenses during an owner’s disability, not key employees.

Option C: Correct. Key person insurance indemnifies a firm for losses due to a key employee’s death or disability.

Option D: Incorrect. Employee welfare plans focus on employee benefits, not indemnifying the firm for losses.

This question aligns with the Prometric content outline under “Life Products,” which covers business insurance products.

Permanent life insurance (e.g., whole life, universal life) and term life insurance differ fundamentally in their structure and benefits. Permanent life insurance provides coverage for the insured’s entire life (as long as premiums are paid) and often includes a savings component that accumulates cash value. Term life insurance provides coverage for a specific period (e.g., 10, 20, or 30 years) and does not build cash value.

Option A: Incorrect. Term life insurance can cover the insured for various periods (e.g., 5, 10, 20 years), not strictly 1 year, depending on the policy term selected.

Option B: Incorrect. Term life is generally more economical for short-term needs due to lower premiums, but over a long life span, permanent life may be more cost-effective due to its lifelong coverage and cash value growth.

Option C: Correct. Permanent life insurance may develop cash value, which can be borrowed against or withdrawn, while term life does not have this feature.

Option D: Incorrect. Permanent life insurance does not automatically provide coverage for 5 years without premium payments. Policies may lapse without payment unless nonforfeiture options (e.g., extended term or reduced paid-up insurance) are exercised.

This question aligns with the Prometric content outline under “Life Products,” which covers the characteristics of term and permanent life insurance.

TheOklahoma Life and Health Insurance Guaranty Association, established under Title 36 O.S. § 2025 et seq., protects policyowners of admitted insurers in Oklahoma if the insurer becomesfinancially insolvent. The association provides coverage up to statutory limits (e.g., $300,000 for life insurance death benefits, $100,000 for cash value) to ensure policyholders receive benefits despite the insurer’s insolvency.

Option A: Incorrect. A merger with a foreign insurer does not trigger Guaranty Association protection unless it leads to insolvency.

Option B: Correct. The Guaranty Association protects policyowners when an admitted insurer becomes financially insolvent.

Option C: Incorrect. Failure to meet capital surplus requirements may lead to regulatory action but does not directly trigger Guaranty Association coverage.

Option D: Incorrect. Depleting loss reserves is a financial issue but not the specific condition for Guaranty Association intervention, which requires insolvency.

This question falls under the Prometric content outline section on “State Insurance Statutes, Rules, and Regulations,” which includes knowledge of the Guaranty Association.

Thecommon disaster provisionin a life insurance policy addresses situations where the insured and primary beneficiary die in the same accident. It typically includes a survivorship clause, presuming thebeneficiary outlived the insuredfor a specified period (e.g., 14–30 days) unless proven otherwise. This ensures the death benefit passes to the beneficiary’s estate or contingent beneficiaries, as outlined in Oklahoma’s life insurance provisions (Title 36 O.S. § 4001 et seq.).

Option A: Incorrect. The provision does not assume the insured outlived the beneficiary.

Option B: Correct. The insurer proceeds as if the beneficiary outlived the insured.

Option C: Incorrect. Simultaneous death is addressed differently under the Uniform Simultaneous Death Act, not the common disaster provision.

Option D: Incorrect. The provision does not treat the beneficiary as unnamed.

Asurvivorship life policy(second-to-die insurance) covers two or more individuals (typically spouses) and pays the death benefitupon the death of the last surviving insured. It is often used for estate planning, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002). This contrasts with a joint life policy, which pays on the first death.

Option A: Incorrect. Payout is not tied to a fixed age but to the last insured’s death.

Option B: Incorrect. Divorce does not trigger a payout; it may affect ownership or beneficiaries.

Option C: Incorrect. Payout occurs on the last insured’s death, not the first.

Option D: Correct. The policy pays upon the death of the last surviving insured.

In Oklahoma’s Insurance Code (Title 36 O.S. § 105), aforeign insureris defined as an insurance company formed under the laws of another U.S. state or territory. This distinguishes it from adomestic insurer(formed in Oklahoma) and analien insurer(formed in a foreign country).

Option A: Incorrect. An insurer formed in Oklahoma is a domestic insurer.

Option B: Incorrect. An insurer from a foreign country is an alien insurer.

Option C: Correct. A foreign insurer is formed under the laws of another U.S. state or government.

Option D: Incorrect. Geographic proximity is irrelevant; the definition is based on legal formation.

This question aligns with the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers insurer classifications.

Theunpaid premium Uniform Optional Provisionin health insurance policies, as recognized in Oklahoma (Title 36 O.S. § 4405), allows the insurer to deduct any unpaid premiums from a claim payment if a claim becomes payable while premiums are overdue. This ensures the policy remains in force and the claim is paid, net of the owed premium.

Option A: Incorrect. The claim is not denied; the premium is deducted from the payment.

Option B: Incorrect. The policy is not cancelled; the unpaid premium is addressed via the claim.

Option C: Correct. The unpaid premium is deducted from the claim payment.

Option D: Incorrect. The claim is not delayed; the premium is settled with the claim payment.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance policy provisions.

The clerical error provision in group health insurance policies is designed to protect employees from losing coverage due to administrative mistakes made by the employer or insurer. According to Oklahoma insurance regulations and standard group health insurance practices, if a clerical error results in an employee not being enrolled, the provision allows the error to be corrected by retroactively enrolling the employee, provided any past due premiums are paid. This ensures the employee is insured as if the error had not occurred, covering any claims that would have been eligible during the period of the error.

The Oklahoma Life, Accident, and Health or Sickness Producer Study Guide specifies that under the clerical error provision, "an employee who was eligible for coverage but was not enrolled due to an administrative error can be retroactively enrolled upon correction of the error, with coverage effective from the original eligibility date, provided all required premiums are paid." This aligns with option C, which states the employee will be allowed to submit an enrollment form and all past due premiums, and will be retroactively insured.

Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs) are two common types of managed care plans in health insurance. According to standard insurance study materials for the Oklahoma Life, Accident, and Health or Sickness Producer exam, a key distinction between PPOs and HMOs lies in the flexibility of provider choice. PPOs allow members to choose from a broader network of doctors and medical service providers, both in-network and out-of-network, without requiring a referral from a primary care physician. HMOs, in contrast, typically restrict members to in-network providers and require a designated primary care physician to coordinate care.

Option A: Incorrect. PPO plans often provide coverage for out-of-state medical services, especially within their network or through out-of-network benefits, though at potentially higher costs. This is not a defining characteristic compared to HMOs.

Option B: Correct. PPOs are known for offering more choices of doctors and medical service providers, as they do not mandate a primary care physician or referrals for specialists, unlike HMOs.

Option C: Incorrect. HMOs require members to designate a primary care physician, while PPOs do not.

Option D: Incorrect. While PPOs offer flexibility, the ability to see a physician on a walk-in basis is not a standard feature distinguishing them from HMOs, as both may vary in appointment requirements.

This aligns with the Prometric exam content outline under “Health Providers and Products,” which emphasizes understanding differences between health insurance plans like HMOs and PPOs.

Per IRS Publication 502,Long-Term Care (LTC) insurance premiumsare considered qualified medical expenses and may be tax deductible if the taxpayer’s total medical expenses exceed 10% of their adjusted gross income (AGI), subject to age-based limits on the deductible amount. Premiums for disability income insurance (group or personal) and accidental death and dismemberment (AD&D) insurance are not deductible as medical expenses, as they do not directly relate to medical care.

Option A: Correct. LTC insurance premiums are deductible as medical expenses, subject to limits.

Option B: Incorrect. Group disability insurance premiums are not deductible as medical expenses.

Option C: Incorrect. Personal disability income insurance premiums are not deductible.

Option D: Incorrect. AD&D insurance premiums are not deductible as medical expenses.

Ajoint life policy(also called a first-to-die policy) covers two or more individuals (e.g., spouses) and pays the death benefit upon the death of the first insured. This contrasts with asurvivorship life policy(second-to-die), which pays after both insureds die. Joint life policies are used for purposes like mortgage protection or family income needs (Title 36 O.S. § 4002).

Option A: Correct. A joint life policy pays benefits at the first spouse’s death.

Option B: Incorrect. A variable life policy is a permanent policy with investment options, not tied to joint coverage.

Option C: Incorrect. A universal life policy is flexible permanent insurance, not specifically joint.

Option D: Incorrect. A survivorship life policy pays after both spouses die.

According to IRS guidelines (Publication 525), disability benefits from a group policy paid for by the employer are consideredtaxable incometo the employee because the premiums were not included in the employee’s taxable income. If the employee paid the premiums with after-tax dollars, the benefits would be tax-free.

Option A: Incorrect. Benefits are taxable if the employer paid the premiums.

Option B: Incorrect. Disability benefits are not deductible from gross income.

Option C: Correct. The benefits are taxable income.

Option D: Incorrect. Benefits are subject to income tax, not just Social Security or FUTA taxes.

When applying for a life or health insurance policy in Oklahoma, the insurer’s underwriting process typically involves reviewing the applicant’smedical historyto assess risk, as permitted under Title 36 O.S. § 1204. This may include questions about personal and family health, but not all family illnesses need to be reported unless specifically requested. Physical examinations are not always required, and undiagnosed conditions are not expected to be recorded; the applicant must disclose known conditions truthfully.

Option A: Incorrect. Reporting all family illnesses is not mandatory unless relevant to underwriting questions.

Option B: Incorrect. A physical exam is not always required; it depends on the insurer’s underwriting guidelines.

Option C: Incorrect. Undiagnosed conditions cannot be recorded; only known conditions are reported.

Option D: Correct. The insured’s medical history may be reviewed and reported during underwriting.

In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO’s cost-containment model.

Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.

Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.

Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.

Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.

This question falls under the Prometric content outline section on “Health Providers and Products,” which covers HMO structures and strategies.

A collateral assignment is a provision in a life insurance policy that allows the policyowner to temporarily transfer certain ownership rights (e.g., the right to the death benefit or cash value) to a creditor as security for a loan. The assignee (creditor) has a claim to the policy proceeds up to the loan amount, but the policyowner retains other rights and regains full ownership once the loan is repaid.

Option A: Incorrect. Reinstatement allows a lapsed policy to be restored under certain conditions, not related to securing a loan.

Option B: Incorrect. The entire contract provision defines the policy and application as the complete agreement, not related to loans.

Option C: Correct. Collateral assignment temporarily assigns policy rights to secure a loan, as per standard life insurance provisions.

Option D: Incorrect. An automatic premium loan uses the policy’s cash value to pay overdue premiums, not to secure an external loan.

This question is part of the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers ownership and assignment provisions.

Theownership provisionin a life insurance policy specifies that the policyowner (who may or may not be the insured) holds all rights and privileges during the insured’s lifetime, including changing beneficiaries, borrowing against cash value, or surrendering the policy. This is standard in Oklahoma’s Insurance Code (Title 36 O.S. § 4001 et seq.). Beneficiaries have no rights until the insured’s death, and the insured’s family has no automatic rights unless designated as owners.

Option A: Incorrect. The insured has no ownership rights unless they are also the policyowner.

Option B: Correct. The policyowner holds all rights and privileges.

Option C: Incorrect. The insured’s family has no inherent rights unless they are the policyowner.

Option D: Incorrect. Beneficiaries have rights only after the insured’s death.

In insurance, a contract is effective when there is mutual consideration, offer, acceptance, and a meeting of the minds. For a health insurance contract, this occurs when the insured pays the initial premium (consideration from the insured) and the insurer issues the policy as applied for (acceptance by the insurer), as outlined in Oklahoma’s Insurance Code (Title 36 O.S. § 4401). The policy becomes binding at this point, assuming all other conditions (e.g., underwriting approval) are met.

Option A: Incorrect. Providing services occurs during claims, not when the contract is effective.

Option B: Incorrect. Paying the premium alone is not sufficient without policy issuance.

Option C: Correct. The contract is effective when the premium is paid and the policy is issued as applied for.

Option D: Incorrect. Signing by both parties is not typically required; issuance and premium payment suffice.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers contract formation in health insurance.

The elimination period in an individual disability insurance policy is the waiting period between the onset of a disability and the time when benefit payments begin. It is essentially a deductible in time, during which the insured must be disabled before receiving benefits. This period can range from 30 days to several months, depending on the policy, and is designed to reduce premiums by excluding short-term disabilities.

Option A: Incorrect. The length of time benefits are paid is determined by the benefit period, not the elimination period.

Option B: Correct. The elimination period is the amount of time the insured must wait after becoming disabled before benefits are paid.

Option C: Incorrect. The point when benefits are exhausted is related to the benefit period or policy limits, not the elimination period.

Option D: Incorrect. The elimination period does not apply after the policy is discontinued; it applies at the start of a disability claim.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which includes knowledge of disability insurance provisions.

In aterm life insurance policy, premiums are typicallylevelduring the policy term (e.g., 10, 20 years), meaning they remain constant. At renewal, premiums may increase based on the insured’s attained age, but during the initial term, they are fixed, as outlined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Convertible refers to a policy’s ability to convert to permanent insurance, not premium structure.

Option B: Correct. Premiums are level during the term prior to renewal.

Option C: Incorrect. Variable premiums apply to certain flexible policies like universal life, not term.

Option D: Incorrect. Adjustable premiums are not a standard term for level term policies.

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.

In a whole life insurance policy, thepayment periodrefers to the duration over which premiums are paid (e.g., until age 100, or a limited period like 20 years). A shorter payment period (e.g., 10-pay or 20-pay whole life) requires higher annual premiums because the total cost of the policy is compressed into fewer payments, while a longer payment period (e.g., until age 100) spreads the cost, resulting in lower annual premiums.

Option A: Incorrect. The payment period directly affects the annual premium amount.

Option B: Incorrect. A shorter payment period increases, not decreases, the annual premium.

Option C: Correct. A shorter payment period results in a higher annual premium due to the condensed payment schedule.

Option D: Incorrect. A longer payment period typically lowers the annual premium, not increases it.

This question aligns with the Prometric content outline under “Life Products,” which covers whole life insurance premium structures.

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.

Afixed annuityprovides guaranteed, stable payments to the annuitant, but a key disadvantage is that the fixed payments may losepurchasing powerover time due to inflation, reducing their real value. This is a concern for long-term annuitants, as noted in Oklahoma’s annuity regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Variable securities apply to variable annuities, not fixed annuities.

Option B: Incorrect. Fixed annuities guarantee a specific benefit amount.

Option C: Correct. Inflation can decrease the purchasing power of fixed payments.

Option D: Incorrect. Payment duration depends on the annuity type (e.g., life annuity), not a 2-year limit.

Theautomatic premium loan (APL)provision in a life insurance policy with cash value allows the insurer to automatically borrow from the policy’s cash value to pay overdue premiums if the policyowner fails to pay by the end of the grace period (typically 31 days, per Title 36 O.S. § 4005). This prevents the policy from lapsing, provided sufficient cash value is available.

Option A: Incorrect. The APL provision does not cover loans from other policies.

Option B: Correct. The APL provision authorizes withdrawal to pay premiums due at the end of the grace period.

Option C: Incorrect. The APL provision prevents termination, not facilitates it.

Option D: Incorrect. Interest on policy loans is separate and not covered by the APL provision.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers automatic premium loans.

Under Oklahoma law (Title 36 O.S. § 4107), individuals covered by a group life insurance policy have the right to designate a beneficiary and, upon termination of employment or group membership, the right toconvertthe group coverage to an individual life insurance policy without evidence of insurability, typically within 31 days. This conversion right ensures continued coverage.

Option A: Incorrect. Group life policies typically do not have cash surrender value for individual insureds.

Option B: Incorrect. Converting premiums to a different policy is not a standard right.

Option C: Incorrect. Remaining insured after termination requires COBRA (for health) or conversion, not automatic continuation.

Option D: Correct. The insured has the right to convert to an individual policy upon termination.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers group life insurance rights.

A life insurance policyowner has several rights, including assigning or transferring the policy (e.g., through absolute or collateral assignment), borrowing against the cash value (in policies with cash value), and selecting or changing the beneficiary, as outlined in Oklahoma’s Insurance Code (Title 36 O.S. § 4001 et seq.). However, anabsolute assignmenttransfers all ownership rights to the assignee, and the original policyowner cannot unilaterally revoke it without the assignee’s consent, as it is a complete transfer of ownership.

Option A: Incorrect (is a right). The policyowner can assign or transfer the policy to another party.

Option B: Incorrect (is a right). The policyowner can borrow against the cash value in policies like whole life or universal life.

Option C: Incorrect (is a right). The policyowner can select and change the beneficiary unless restricted (e.g., irrevocable beneficiary).

Option D: Correct (is not a right). An absolute assignment cannot be revoked by the original policyowner without the assignee’s agreement.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers policyowner rights and assignments.

Selling fake insurance policies and misappropriating premiums is a fraudulent act under Oklahoma’s Insurance Code (Title 36 O.S. § 1204, § 1435.13), classified as a felony. TheOklahoma Insurance Department Anti-Fraud Unitinvestigates insurance fraud, theOklahoma State Bureau of Investigationhandles criminal investigations, and theOklahoma Attorney Generalmay prosecute or oversee legal actions. TheSecurities Exchange Commission (SEC)regulates securities markets, not insurance fraud, unless securities are involved (which is not indicated here).

Option A: Incorrect. The Attorney General may be involved in prosecution.

Option B: Incorrect. The State Bureau of Investigation handles criminal fraud cases.

Option C: Incorrect. The Anti-Fraud Unit directly investigates insurance fraud.

Option D: Correct. The SEC is not typically involved in insurance fraud investigations.

Theentire contract provision, mandated in Oklahoma for life and health insurance (Title 36 O.S. § 4001 for life, § 4405 for health), specifies that theentire contractconsists of the policy, any attached endorsements or riders, and a copy of theapplicationif endorsed upon or attached to the policy at issuance. This ensures no external documents can alter the agreement unless included. Clauses and provisions are part of the policy itself, while credit reports are used in underwriting but not part of the contract.

Option A: Incorrect. Clauses are components of the policy, not a separate item added to the entire contract.

Option B: Incorrect. Credit reports are underwriting tools, not part of the contract.

Option C: Incorrect. Provisions are part of the policy, not a distinct addition.

Option D: Correct. The application, when attached, is part of the entire contract.

To calculate the insured’s payment:

Deductible: The insured pays the first $1,000 of the $5,000 procedure cost.

Remaining cost: $5,000 - $1,000 = $4,000.

Coinsurance: The policy has 80/20 coinsurance, so the insurer pays 80% ($3,200) and the insured pays 20% ($800) of the $4,000.

Total paid by insured: $1,000 (deductible) + $800 (coinsurance) = $1,800.

Out-of-pocket maximum: The policy’s $3,000 out-of-pocket maximum caps the insured’s total payments. Since $1,800 is less than $3,000, the insured pays $1,800. However, the question asks for the total paid “towards the $5,000,” and the out-of-pocket maximum of $3,000 suggests a cap on total liability for covered expenses. In this context, the correct interpretation is that the insured’s payment is capped at the out-of-pocket maximum if applicable, but standard calculation yields $1,800, and the answer options suggest a possible intent for the maximum.

Upon review, the correct calculation yields $1,800 (Option C), but the out-of-pocket maximum of $3,000 (Option B) may be the intended answer if the question implies the maximum liability. Given the standard insurance calculation,Option C ($1,800)is mathematically correct, butOption B ($3,000)aligns with the out-of-pocket maximum as a potential cap. Since the calculation is clear, we selectC.

Corrected Answer: C

Explanation of Calculation:

Deductible: $1,000.

Coinsurance: 20% of $4,000 = $800.

Total: $1,000 + $800 = $1,800.

The out-of-pocket maximum ($3,000) is not reached, so the insured pays $1,800.

Option A: Incorrect. The insured does not pay the full $5,000 due to insurer contributions.

Option B: Incorrect. The $3,000 out-of-pocket maximum is not reached; the calculated payment is $1,800.

Option C: Correct. The insured pays $1,800 based on the deductible and coinsurance.

Option D: Incorrect. The $1,000 deductible alone does not account for coinsurance.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers health insurance cost-sharing provisions.

TheHealth Insurance Portability and Accountability Act (HIPAA)includes provisions from the Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996, which mandates that group health plans cannot restrict hospital stays for childbirth to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section. This federal law applies to group health insurance plans in Oklahoma and ensures minimum coverage for maternity care.

Option A: Incorrect. COBRA allows continuation of group health coverage after certain events but does not mandate maternity stay durations.

Option B: Incorrect. Medicaid is a state-federal program for low-income individuals, not a law mandating hospital stays for childbirth.

Option C: Correct. HIPAA, via the NMHPA, guarantees the 48-hour hospital stay for regular deliveries.

Option D: Incorrect. ERISA governs employee benefit plans but does not specifically address maternity hospital stays.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers federal and state laws affecting health insurance.

A deliberate lie by an insured to obtain a lower premium constitutesfraud, defined in Oklahoma’s Insurance Code (Title 36 O.S. § 1204) as an intentional misrepresentation of material facts to deceive the insurer. Fraud can lead to policy rescission or legal penalties.

Option A: Incorrect. Omission is failing to disclose information, not actively lying.

Option B: Correct. A deliberate lie to lower premiums is fraud.

Option C: Incorrect. Concealment is withholding material information, not providing false information.

Option D: Incorrect. Aleatory refers to the uncertain nature of insurance contracts, not misrepresentation.

In Oklahoma, an insurance producer license is required for activities defined astransacting insurance, which includes selling, soliciting, or negotiating insurance contracts (Title 36 O.S. § 1435.2).Providing referrals(e.g., passing along contact information without discussing insurance products) does not constitute transacting insurance and does not require a license, provided no compensation is tied to the sale.

Option A: Correct. Providing referrals does not require a license if it avoids solicitation or negotiation.

Option B: Incorrect. Selling insurance requires a producer license.

Option C: Incorrect. Negotiating insurance requires a producer license.

Option D: Incorrect. Soliciting insurance requires a producer license.

In insurance underwriting, individuals are classified based on their risk profile. Asubstandard riskis an applicant who, due to health issues, hazardous habits (e.g., smoking), or high-risk occupations (e.g., stunt performer), cannot be insured at standard rates. These individuals may be offered coverage at higher premiums or with exclusions, as outlined in standard underwriting practices and Oklahoma’s regulations (Title 36 O.S. § 1204).

Option A: Incorrect. “Rating risk” is not a standard underwriting term.

Option B: Incorrect. A standard risk qualifies for standard rates with average risk.

Option C: Incorrect. A preferred risk qualifies for lower-than-standard rates due to low risk.

Option D: Correct. A substandard risk is not acceptable at standard rates due to higher risk factors.

This question aligns with the Prometric content outline under “Underwriting,” which covers risk classification.

According to IRS guidelines (Publication 502), premiums paid by an individual for personally owneddisability income insurancearenot tax deductibleas medical expenses or otherwise, unlike certain health insurance premiums. However, benefits received from such policies are generally tax-free if the insured paid the premiums with after-tax dollars.

Option A: Correct. Premiums for personally owned disability insurance are not tax deductible.

Option B: Incorrect. Premiums are not deductible for disability income insurance.

Option C: Incorrect. There is no partial deduction for these premiums.

Option D: Incorrect. Tax deferral applies to certain investment products, not disability premiums.

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.

Oklahoma regulations (O.A.C. 365:10-3-16) provide afree-look periodfor life insurance or annuity replacement policies, allowing the policyowner to return the policy for afull refund of premiumwithin20 daysfrom receipt. This extended period for replacements (compared to 10 days for non-replacement policies) ensures consumers can review the new policy and compare it to the replaced one.

Option A: Incorrect. 3 days is too short for the free-look period.

Option B: Incorrect. 7 days is not the required timeframe.

Option C: Incorrect. 14 days is shorter than the replacement free-look period.

Option D: Correct. The free-look period for replacement policies is 20 days.

Credit and accident disability insuranceis designed to make loan payments or pay off a loan balance if the insured becomes disabled due to an accident or sickness, ensuring financial obligations are met. This is a specialized product in Oklahoma (Title 36 O.S. § 4101 et seq.).

Option A: Incorrect. Income replacement is the purpose of disability income insurance, not credit disability.

Option B: Correct. The plan helps pay off a loan during disability.

Option C: Incorrect. Paying medical or dental premiums is not the purpose of credit disability insurance.

Option D: Incorrect. Legal actions are unrelated to credit disability plans.