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

When a corporation buys disability income insurance on a key employee, the corporation is both policyowner and beneficiary. Premiums are not deductible because the business is the direct beneficiary. However, benefits received by the business are tax-free when the insured employee becomes disabled.

Exact Extract (Virginia Disability Income Study Guide): “Key person disability insurance—premiums are not deductible to the business, but benefits received are tax-free to the business.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Business Uses of Disability Insurance

For an insurance policy to be legally binding, four essential elements must exist: (1) offer and acceptance, (2) consideration, (3) competent parties, and (4) legal purpose. Consideration refers to the exchange of value: the applicant’s premium and representations in the application, and the insurer’s promise to pay benefits. Exact extract: “Consideration is the value each party gives to the other: the insured provides premiums and truthful statements, while the insurer provides the promise of benefits.” Without consideration, a contract cannot be enforced.

Virginia Code § 38.2-1809 mandates that licensees maintain specific records for regulatory oversight and consumer protection. Option A (accounting records of premium payments) is required to track funds received and remitted, ensuring financial accountability (e.g., premiums collected for a $1,000 policy). Option B (files of insurance applications on current policies) must be kept as part of the contract and for audit purposes, per § 38.2-1810. Option C (policy renewal notices) is required to document communication with policyholders about ongoing coverage, ensuring transparency. Option D (premium quotations of unissued policies) is not mandated; while agents may provide quotes (e.g., $500 annually for a term policy), these are preliminary offers, not binding until a policy is issued, and Virginia law doesn’t require retaining them unless they result in a transaction. The study guide likely details recordkeeping in a compliance chapter, contrasting required records (A, B, C) with optional ones like quotes (D), using examples—e.g., keeping a paid policy’s file but not a rejected quote—making D the item not required. This reflects Virginia’s focus on executed contracts over prospective ones.

The entire contract provision in an individual health insurance policy states that the agent has no authority to change the policy or waive any of its provisions. This provision ensures that the terms of the policy are fixed and cannot be altered or waived by the agent without proper authorization from the insurer.

An insurer that operates in the United States but is headquartered outside of the U.S. is referred to as an "alien insurer." These insurers are typically subject to the same regulations as domestic insurers operating within the U.S. but are considered "alien" because they are based in a foreign country. A "foreign insurer," by contrast, is one that is incorporated in a different state but operates within the same country. Captive insurers are typically created by a single company to insure its own risks, and a reciprocal insurance exchange involves a group of individuals or companies insuring each other.

If an individual’s occupation is considered illegal, it may result in a denial of a disability income claim. Insurance companies generally do not cover risks associated with illegal activities or occupations, as these are deemed outside the scope of insurable risks. Such an occupation could lead to the insurer refusing to pay claims related to disabilities arising from that illegal activity.

The concept of agency authority is foundational in Virginia insurance law, derived from general agency principles and reflected in Title 38.2, Chapter 18. Express authority is explicitly granted in the agency agreement (e.g., soliciting and binding coverage), per Virginia Code § 38.2-1800 et seq. Implied authority, however, is not written but assumed to be necessary for carrying out express duties—such as scheduling client meetings or collecting initial premiums—unless restricted by the insurer. “Mandated authority” (option B) is not a recognized term in Virginia insurance regulations or study materials. Option C (express authority) is incorrect because it’s explicitly stated, not unwritten. Option D (nonexistent) denies the presence of authority, which contradicts the question’s premise. The Virginia Life, Annuities, and Health Insurance study guide likely highlights implied authority as a key concept for agents’ day-to-day operations, making A the correct answer.

Virginia’s Unfair Claims Settlement Practices Act prohibits insurers or agents from misrepresenting facts or policy provisions relating to coverage. Doing so after a loss is classified as an unfair claims settlement practice.

Exact Extract (Virginia Unfair Claims Settlement Law): “Misrepresenting pertinent facts or policy provisions relating to coverages at issue is an unfair claim settlement practice.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-510 (Unfair claim settlement practices)

In insurance contract law, per Virginia Code § 38.2-102, a contract requires consideration—something of value exchanged to make it legally binding. Option C (consideration) fits this definition: the insured’s premium payment and the insurer’s promise of coverage form the mutual value. Option A (grant) implies a unilateral transfer, not a contract element. Option B (codicil) is a will amendment, irrelevant to insurance contracts. Option D (covenant) is a promise within a contract, not the value exchanged. The study guide likely explains consideration as a foundational principle, using examples like a $500 premium for a $100,000 policy, distinguishing it from other legal terms. Virginia follows common law requiring consideration for enforceability, making C the precise answer.

Agents are fiduciaries, meaning they must handle clients’ premiums with the highest standard of care. Misuse or misappropriation of funds constitutes a violation of fiduciary duty.

Exact Extract (Virginia Agent Regulations): “Insurance producers act in a fiduciary capacity regarding premiums received from insureds and must promptly remit them to insurers.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1834 (Fiduciary responsibility of agents)

Single premium whole life insurance is funded with one lump-sum premium that immediately creates both cash value and nonforfeiture value. Because the entire premium is paid upfront, a significant portion is allocated to the policy reserve, making options A, B, and C correct.

Whole life insurance has fixed premiums by definition. Once the single premium is paid, no additional premiums are required, regardless of inflation or economic conditions. Therefore, option D is incorrect and is the correct “EXCEPT” answer.

Virginia exam materials emphasize that whole life policies provide guaranteed premiums, guaranteed death benefits, and guaranteed cash value growth, which distinguishes them from flexible or adjustable policies.

A contingent beneficiary is the person designated to receive life insurance proceeds only if the primary beneficiary is unable to do so, usually because the primary beneficiary has died before the insured. This designation ensures that benefits are still directed to another party without passing through the estate.

Exact Extract (Virginia Life & Annuities Study Guide): “Contingent beneficiary—person designated to receive policy proceeds if the primary beneficiary dies before the insured.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 5.2 Beneficiaries

— Virginia Consumer’s Guide to Life Insurance, Beneficiary Designation Section

Virginia Code § 38.2-3407 et seq. covers health services, where ambulatory care centers (e.g., outpatient clinics) specialize in same-day procedures like outpatient surgical procedures (option C—e.g., cataract surgery). Option A (physical therapy) may occur there but isn’t the primary use; therapy clinics differ. Option B (wellness centers) focuses on prevention, not procedures. Option D (overnight accommodations) contradicts “ambulatory,” meaning walk-in/walk-out care. The study guide likely defines this in a health facilities section, with examples like knee arthroscopy, making C the most frequent use.

In insurance terminology, per Virginia Code § 38.2-100 et seq., a hazard (option A) is a condition increasing the likelihood or severity of a loss from a covered peril (e.g., smoking increases fire risk). Option B (peril) is the cause of loss (e.g., fire, theft). Option C (exposure) is the extent of potential loss, not the condition itself. Option D (risk) is the broader uncertainty of loss, encompassing hazards and perils. The study guide likely differentiates these with examples—e.g., icy roads (hazard) causing a crash (peril)—highlighting hazard’s role in amplifying loss probability, making A the exact match.

The primary purpose of credit life insurance is to pay off the outstanding debt of a borrower in the event of their death. This ensures that the borrower’s family or estate is not burdened with the debt after their passing. It does not cover illness, act as a savings vehicle, or directly increase financing ability.

A POS plan blends characteristics of HMOs and PPOs/indemnity plans. Like an HMO, members choose a primary care physician, but they can also go out-of-network and receive partial reimbursement (similar to indemnity coverage). Exact extract: “POS plans combine features of HMOs and indemnity plans, permitting members to seek care within the network or outside the network at higher cost-sharing.” This flexibility allows broader provider choice while controlling costs through the HMO model.

In a deferred annuity, benefit payments to the annuitant typically begin when the contract matures. Maturity occurs at a specified time, such as the annuitant’s retirement age or another defined period. The annuity may then begin making periodic payments to the annuitant or a beneficiary, depending on the terms of the contract.

Virginia Code § 38.2-3505 requires disability income policies to include a misstatement of age provision. If an applicant misstates their age, the insurer adjusts benefits to what the paid premium would have purchased at the correct age, rather than voiding or canceling the policy. Option A reflects this adjustment process. Option B is false; the insurer remains liable, adjusting claims rather than denying them outright. Option C is incorrect; immediate cancellation isn’t standard unless fraud is proven (Virginia Code § 38.2-309), and age misstatements are typically clerical errors, not fraud. Option D is wrong; voiding from inception requires material misrepresentation with intent to deceive, not a simple age error. The study guide likely explains this clause as a fairness mechanism, protecting both parties, making A the correct answer.

Detailed Answer in Step-by-Step Solution:

Group insurance (B) covers individuals based on their affiliation with an organization (e.g., employees of a company), not as individuals.

Contributory insurance (A) refers to group plans where employees pay part of the premium, but it’s not the defining feature.

Health insurance (C) is too broad, and COBRA (D) extends group coverage, not defines it.

The Virginia study guide defines group insurance as coverage tied to membership in an organization, such as an employer or association. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance."

Detailed Answer in Step-by-Step Solution:

If an IRA owner dies before distributions, the surviving spouse beneficiary can roll the IRA into their own IRA (B), treating it as their own and delaying distributions until their required beginning date.

Option A (forfeited) is false; assets pass to the beneficiary. Options C and D apply to non-spouse beneficiaries under older rules, not spousal rollovers.

The Virginia study guide, per IRS rules, allows a surviving spouse to roll an inherited IRA into their own, avoiding immediate taxation or forced distributions. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Retirement Plans."

Once an agent is appointed by an insurer in Virginia, the appointment remains in effect until either the insurer or the Bureau of Insurance terminates it. No quarterly renewal or NAIC approval is required.

Exact Extract (Virginia Producer Licensing Rules): “Appointments remain in effect until terminated by the insurer or the Bureau of Insurance.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1833 (Appointments of agents)

Keogh plans, established under the Internal Revenue Code, are retirement plans for self-employed individuals and small businesses, also known as HR 10 plans (option B) after the 1962 legislation (H.R. 10) creating them. They allow tax-deferred contributions, similar to qualified plans. Option A (Section 457 plans) applies to government and nonprofit employees, not self-employed individuals. Option C (403(b) plans) is for nonprofit employees (e.g., teachers), distinct from Keogh’s self-employed focus. Option D (Section 2503(c) trusts) relates to gifting for minors, not retirement. The study guide likely contrasts Keogh (HR 10) with other plans in a retirement section, noting its tax benefits and eligibility, confirming B as the correct synonym.

Detailed Answer in Step-by-Step Solution:

Term life insurance (B) provides coverage for a specified period (temporary protection) and does not accumulate cash value.

Option A (cash value) applies to permanent life insurance, not term.

Option C (five years or less) is false; term policies can span 10, 20, or 30 years.

Option D (same premium) is incorrect; renewable term policies increase premiums at renewal based on age.

The Virginia study guide describes term life insurance as temporary coverage with no cash value, contrasting it with permanent policies. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance."

The primary purpose of disability income insurance is to replace a portion of the insured’s income when they are unable to work due to illness or injury. It is not designed to cover hospital or physician expenses (those fall under medical insurance). Instead, it ensures that the insured continues to receive income during periods of disability.

Virginia Code § 38.2-1833 defines an “appointment” as a formal authorization by an insurer for a licensed agent to act on its behalf in transacting insurance. An insured (option A) is the policyholder or beneficiary and has no role in representing the insurer. An employee of the insurer (option B) may work internally but isn’t automatically appointed to sell insurance unless they hold an agent’s license and an appointment, which isn’t implied here. A consultant (option C), under Virginia Code § 38.2-1837, advises on insurance but doesn’t transact it unless also licensed and appointed as an agent, making this a less direct fit. Only an agent (option D), licensed under Virginia Code § 38.2-1819 and appointed per § 38.2-1833, is required to hold an appointment to represent an insurer. The study guide emphasizes that appointments link licensed agents to specific insurers, solidifying D as the correct choice.

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.”

The free look period allows a policyowner to review a newly issued life insurance policy and cancel it within a specified number of days after delivery for a full refund of premiums paid. Virginia requires this consumer protection provision to ensure buyers have time to examine policy terms and confirm suitability.

A grace period applies to late premium payments, not policy cancellation. Discovery and probationary periods are not standard life insurance provisions. The free look period strengthens consumer confidence and transparency in the insurance marketplace, making option D correct.

An application for individual health insurance must be in writing and becomes part of the insurance contract. The information provided in the application, along with any attachments, helps form the basis of the policy. If any statements or answers in the application are found to be false or misrepresented, the insurer may have grounds for denying a claim.

When a health insurer requires a physical examination, the insurer typically has the right to choose the examining physician. This is because the insurer is the one paying for the examination as part of the claims or underwriting process, ensuring that the exam is conducted by a professional selected by the insurance company. While the insured may be asked for preferences in some cases, the final decision is generally up to the insurer.

For individuals with end-stage renal disease (ESRD), employer group coverage is primary for the first 30 months of treatment, even if the individual also qualifies for Medicare. After 30 months, Medicare becomes primary. Exact extract: “Employer group health plans are primary for 30 months for ESRD patients; thereafter Medicare assumes primary responsibility.”

The monthly indemnity paid to an employee under employer-paid group disability income insurance is not always tax-free. If the employer pays the premiums, the benefits received by the employee are typically taxed as income, unless the employee pays a portion of the premiums with after-tax dollars. The employer-paid premiums are deductible as a business expense for the employer, but the tax treatment of the indemnity benefits depends on who pays the premiums.

Detailed Answer in Step-by-Step Solution:

In a PPO, using a non-preferred (out-of-network) provider typically results in higher out-of-pocket expenses (A) due to lower reimbursement rates (e.g., 60% vs. 80% in-network) and potential excess charges.

Option B (full cost) may apply to HMOs, not PPOs, which still offer some coverage. Option C (100% reimbursement) is false. Option D (waiting period) is unrelated to provider choice.

The Virginia study guide explains that PPOs offer flexibility to use out-of-network providers, but at a higher cost to the insured due to reduced coinsurance or additional charges. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Managed Care Plans."

Cancellation, per Virginia Code § 38.2-3106 (life) and § 38.2-3508 (health), is the voluntary termination of a policy by the insured or insurer. Options A, B, and C aren’t standard terms for this action in Virginia insurance law. The study guide defines cancellation as a deliberate act, distinct from lapse (nonpayment) or nonrenewal, making D the correct term.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for group health plans like major medical (B), dental (C), and HMOs (D) result in tax-free benefits under IRC Section 106.

Disability income (A) benefits are taxable if the employer pays the premium, per IRS rules, unlike medical benefits.

The Virginia study guide, aligned with IRS regulations, notes that employer-funded disability income benefits are taxable to the recipient, while medical, dental, and HMO benefits remain tax-free. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

Virginia requires that the Medicare Supplement Buyer’s Guide be delivered at the time of application. This ensures applicants have all necessary information before purchase decisions.

Exact Extract (Virginia Medicare Supplement Regulations): “An outline of coverage and buyer’s guide shall be provided to all applicants at the time of application.”

References (Virginia Documents / Study Guide):

— Virginia Administrative Code 14VAC5-170-150 (Disclosure requirements for Medicare Supplement policies)

Virginia Code § 38.2-5207.1 and 14VAC5-200-75 regulate replacement of long-term care (LTC) insurance, requiring a replacement notice when an applicant with existing coverage applies for a new policy that may replace it. This signed notice, provided to the applicant and retained by the insurer, ensures transparency about potential duplication or lapse of the original policy, protecting consumers from unintended coverage gaps or costs. Option C (replacement notice) fits this requirement. Option A (cancellation notice) relates to terminating a policy, not applying for a new one. Option B (substitution notice) isn’t a standard term; “replacement” is the legal phrase. Option D (duplication notice) might imply overlap but lacks regulatory specificity. The study guide likely includes a sample replacement form, stressing its role in LTC sales compliance, confirming C as the correct choice.

Under most health insurance policies, the insured is required to provide written proof of loss within 30 days of the occurrence of the loss. This allows the insurer to promptly evaluate the claim and ensure that it is processed without unnecessary delays. Some policies may allow extensions under special circumstances, but the general rule is that proof of loss must be provided within 30 days.

Group credit life insurance is typically structured as decreasing term insurance. This means the death benefit decreases over time, generally in line with the outstanding balance of a loan or debt that the insurance is intended to cover. It is commonly used for loans, such as mortgages, where the liability decreases as the debt is paid down.

Detailed Answer in Step-by-Step Solution:

Rebating (B) is the illegal practice of offering a portion of an agent’s commission or other financial incentives to induce a sale, prohibited in most states, including Virginia, to ensure fair competition.

Twisting (A) involves misrepresenting policies to replace existing coverage. Replacement (C) is switching policies, not necessarily with a rebate. Retention (D) is not a recognized term here.

The Virginia study guide defines rebating as an unfair trade practice under Virginia insurance law, aimed at preventing agents from undercutting prices with commission kickbacks. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Unfair Trade Practices."

Virginia Code § 38.2-3502 mandates a “free look” period (typically 10 days) for individual health insurance, allowing the insured to review the policy and cancel it with a full premium refund (option D) if returned within that time. Option A (try without paying) is false; premiums are paid upfront, refundable only upon cancellation. Option B (compare policies) is a practical use but not the legal purpose; the provision ensures cancellation rights, not comparison. Option C (change coverage) isn’t allowed; modifications require underwriting, not free-look terms. The study guide likely details this consumer protection with examples—e.g., returning a policy on day 9 for a refund—making D the precise right.

The accelerated death benefit rider allows the policyholder to access a portion of the death benefit while they are still alive, typically due to a terminal illness or other qualifying event. Since the insurer pays part of the death benefit early, it reduces the remaining amount that will be paid to the beneficiary upon the policyholder’s death.

An automatic premium loan provision is typically found in whole life insurance policies. This provision allows the insurer to automatically pay the premium from the cash value of the policy if the policyholder fails to pay the premium on time. This is a feature unique to permanent life insurance, like whole life, where the policy builds cash value over time. Credit insurance, decreasing term, and level term policies generally do not include such provisions because they are term-based policies and do not accumulate cash value.

A juvenile life insurance policy is a life insurance policy that insures the life of a minor (a child). These policies are typically purchased by a parent or guardian, and the intent is to provide coverage for the child at a young age. These policies are not limited to children under five years old, nor are they necessarily available only as decreasing term insurance.

Virginia Code § 38.2-3501 governs health insurance applications, requiring accuracy and applicant consent. Changes or corrections by an agent (e.g., fixing a misspelled name) must be initialed by the applicant (option B) to verify agreement, as the application becomes part of the contract (Virginia Code § 38.2-3503). Option A (agent) initialing alone risks unauthorized alterations. Option C (physician) is irrelevant; medical input isn’t standard for application edits. Option D (underwriter) assesses, not corrects, applications post-submission. The study guide likely stresses this consumer protection rule, with examples—e.g., an agent correcting a birthdate, initialed by the applicant—ensuring transparency, making B the correct party.

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”)

The notice of claim provision states that notice may be given to the insurer or its authorized agent. Legally, providing notice to an authorized agent constitutes notice to the insurer itself.

Exact Extract (Virginia Uniform Policy Provisions): “Notice of claim may be given to the insurer or to any authorized agent of the insurer.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3514 (Uniform accident and sickness provisions – Notice of claim)

A nonoccupational disability income policy covers accidents and sicknesses occurring off the job. Disabilities caused while performing work-related duties are excluded, since they are covered by workers’ compensation instead.

Exact Extract (Virginia Disability Insurance Study Guide): “Nonoccupational policies exclude coverage for work-related disabilities, which are handled under workers’ compensation.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Disability Income Insurance Exclusions

Twisting involves misrepresenting or making incomplete comparisons to induce a policyholder to replace an existing policy with one from another insurer, often to the client’s detriment.

Exact Extract (Virginia Unfair Trade Practices Law): “Twisting—making incomplete or misleading comparisons of policies to induce replacement.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-503 (Twisting prohibited)

If a health insurance policy provision conflicts with the statutes of Virginia, the provision must be amended to conform to the minimum statutory requirements. This ensures that the policy complies with state law and that the insured receives the protection mandated by Virginia's insurance regulations. Provisions that do not meet these requirements are typically adjusted to align with legal standards.

Ordinary whole life pays the face amount at maturity (traditionally age 100 or 120) if the insured is still alive, or upon earlier death. Term policies have no maturity value.

Exact Extract (Virginia Life Insurance Study Guide): “Ordinary whole life—pays the face amount at death or at policy maturity if the insured survives to that date.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Whole Life Characteristics

Virginia Code § 38.2-3508 defines a cancelable health policy as one either party—the insured or insurer—can terminate before its term ends, with notice (e.g., 30 days). Option C reflects this mutual right. Option A (insurer only) and option B (insured only) are too restrictive; cancelable policies aren’t unilateral. Option D (arbitration committee) isn’t a standard mechanism; cancellation follows policy terms, not third-party rulings. The study guide likely contrasts cancelable with non-cancelable policies, using examples like an insurer canceling for nonpayment or an insured canceling due to better rates, making C the correct scope.

An annuity is primarily designed to provide a stream of income, typically during retirement, and to protect against the risk of outliving one’s assets. One important purpose of an annuity is to liquidate an estate, not create one. Unlike life insurance, which creates an immediate estate by paying a death benefit, annuities are intended to systematically distribute accumulated funds over time. Payments received from annuities are generally taxable to the extent they represent interest earnings, meaning they are not tax-free. Annuities do not typically provide tax-free lump sums or tax-free interest income to beneficiaries. Instead, they focus on income distribution and longevity protection. Therefore, the correct purpose listed is the liquidation of an estate.

This scenario has two defining features: (1) the annuity was funded with a single lump sum ($100,000) and no further purchase payments are allowed, and (2) benefit payments begin in the future (17 years). That combination is the textbook definition of a single premium deferred annuity (SPDA). Virginia’s consumer materials explain that a single premium annuity may be immediate or deferred, and that a single premium deferred annuity begins payments at a future date and can provide larger payments than an immediate annuity purchased for the same amount because the premium earns interest during the deferred period.

General annuity definitions similarly describe an SPDA as an annuity established with one lump-sum payment that grows during the accumulation phase until annuitization, when payments begin. The “lawsuit settlement” detail is consistent with common annuity uses; Virginia’s exam outline lists annuities as a tool for lump-sum settlements. The other options don’t match: an IRA is a tax-qualified retirement arrangement, not implied here, and “individual life annuity” describes a payout form, not the premium structure and deferral features emphasized in the question.

Virginia law requires agents to report any administrative action taken against them in another jurisdiction within 30 calendar days. Exact extract: “A licensee shall report to the Commission any administrative action taken against the licensee in another jurisdiction within 30 days.” This requirement ensures transparency and regulatory oversight.

Medicare Part A Hospital Insurance is available regardless of age to individuals who have received Social Security disability benefits for at least 24 months. This is a key provision that allows individuals who are disabled and have been receiving Social Security Disability Insurance (SSDI) for two years to qualify for Medicare Part A.

Detailed Answer in Step-by-Step Solution:

In Virginia, unintentional violations by an agent can result in fines, with a maximum aggregate penalty of $10,000 (C) for similar violations, as set by state insurance regulations.

Options A, B, and D deviate from this standard cap for unintentional acts.

The Virginia study guide, aligned with Virginia Code, specifies a $10,000 maximum aggregate penalty for unintentional violations, with higher penalties possible for willful acts. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Penalties and Enforcement."

Virginia Code § 38.2-3508 governs cancellation of individual health insurance policies. For the insured to cancel, they must notify the insurer in writing (option A), specifying intent to terminate, typically effective upon receipt or a stated date, per policy terms. This formal notice ensures clarity and protects both parties, aligning with contract law principles. Option B (replace with another policy) is a practical choice but not a legal requirement; cancellation can occur without replacement. Option C (challenge mandatory provisions) is nonsensical; uniform provisions (e.g., grace period, per § 38.2-3503) are standard and unrelated to cancellation. The study guide likely outlines this process in a policyholder rights section, with examples—e.g., a letter stating “Cancel effective 5/1/2025”—emphasizing written notice as the sole requirement, making A the correct action.

A revocable beneficiary designation allows the policyowner to change beneficiaries at any time without the consent of the existing beneficiary. This right remains solely with the policyowner.

Exact Extract (Virginia Health Insurance Study Guide): “Revocable beneficiaries—policyowner retains the right to change the beneficiary designation at will.”

References (Virginia Documents / Study Guide):

— Virginia Life & Health Insurance Examination Outline, Beneficiary Designations

PPO plans allow members to seek care from non-network providers but at reduced benefit levels. This typically results in higher deductibles, coinsurance, and overall out-of-pocket expenses. Members retain freedom of choice, but the plan incentivizes using preferred providers.

Exact Extract (Virginia Health Insurance Study Guide): “Preferred Provider Organizations allow coverage for non-network services, but at a lower reimbursement level, leading to greater out-of-pocket expenses.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, PPO Plan Features

A Simplified Employee Pension (SEP) plan allows employers to make contributions directly into IRAs owned by employees. The employer determines contributions, and employees are immediately vested.

HR-10 plans are Keogh plans for self-employed individuals. 403(b) plans are salary reduction plans for certain nonprofit and public employees. SIMPLE plans allow both employer and employee contributions but are structured differently. Virginia retirement plan exam content clearly identifies SEP plans as employer-funded IRAs, making option C correct.

Detailed Answer in Step-by-Step Solution:

A cost of living (COLA) rider (B) adjusts disability income benefits to account for inflation, maintaining purchasing power.

Inflation guard (A) is more common in property insurance. Price escalation (C) and wage protection (D) are not standard disability riders.

The Virginia study guide describes the COLA rider as an optional feature in disability income policies, increasing benefits based on inflation indices like the CPI. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Insurance Riders."

Virginia Code § 38.2-5208 allows LTC policy cancellation by the insurer for nonpayment of premium (option A) after a 31-day grace period and notice, a standard contract right. Option B (Medicaid eligibility) isn’t a cancellation cause; it may coordinate benefits, not terminate coverage. Option C (insurer insolvency) affects payment ability, not lawful cancellation grounds. Option D (nuisance claims) isn’t a legal basis; claims frequency doesn’t void coverage unless fraudulent (Virginia Code § 38.2-309). The study guide likely lists nonpayment as the primary insurer-initiated cancellation reason, with examples like missed payments triggering notice, making A the lawful cause.

The Limited Payment Whole Life policy provides life insurance protection that extends to age 100, but the policyholder is only required to pay premiums for a shorter period, such as 10, 20, or 30 years, or even until a certain age (e.g., age 65). After that period, the insurance coverage continues, but no further premiums are required, and the insured continues to be covered for the rest of their life. This type of policy is designed to provide the benefit of lifetime coverage while reducing the duration of premium payments.

In contrast, Endowment policies typically provide coverage for a set period and pay out either at the end of that period or upon the death of the insured. Continuous Premium Whole Life requires premiums to be paid continuously, which does not reduce the payment period. Yearly Renewable Term is term insurance, not permanent life insurance, and coverage expires at the end of each term period.

Tax-sheltered annuities (TSAs), per IRC § 403(b) and Virginia Code § 38.2-3100 et seq., are retirement plans for nonprofit employees. Option A is true; they’re synonymous with 403(b) plans. Option B is true; contributions often come from voluntary salary reductions, tax-deferred until withdrawal. Option C is true; participants can have individual contracts or accounts. Option D is false; investment gains are tax-deferred, not included in gross income annually, only taxed upon distribution. The study guide highlights TSAs’ tax advantages, making D the incorrect statement.

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 law treats a licensed agent as the agent of the insurer that issued the insurance sold, solicited, or negotiated by that agent in controversies between the insured (or beneficiary) and the insurer. This statutory framework reflects the principle that, when the agent is acting within the scope of authority granted by the insurer (the “agency contract” authority), the insurer is responsible to the consumer for those acts in the transaction. That is why option A is the best answer among the choices presented.

The other options are inconsistent with Virginia’s allocation of responsibility. The insurer is not automatically “exempt” simply because an agent makes a misrepresentation; misrepresentations can create insurer responsibility in disputes with insureds, and the law’s default is that the agent is the insurer’s agent in such controversies. Nor does the insurer “transfer all liability” to the agent—agency status means the insurer can be bound by and accountable for authorized acts. Finally, limiting responsibility to “express authority only” is too narrow: agency authority in practice includes the authority actually granted and recognized in the insurer-agent relationship in the sale/solicitation/negotiation context addressed by Virginia statute. The statute’s consumer-protection focus is to prevent insurers from avoiding responsibility when their agents act on their behalf in insurance transactions.

Detailed Answer in Step-by-Step Solution:

The proof of loss is a formal statement of a claim, and standard health insurance policies require it within 90 days of the loss (C), unless the policy specifies otherwise or state law extends it.

Options A (30 days) and B (60 days) are too short for most policies, while D (120 days) exceeds the typical requirement.

The Virginia study guide aligns with the NAIC model laws, stating that proof of loss must typically be filed within 90 days of the loss, though insurers may accept later submissions if not prejudicial. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Claims Provisions."

The elimination of a hazard is an example of risk avoidance. This involves removing or eliminating the risk entirely by preventing hazardous activities or conditions. This is different from other risk management strategies such as transfer (shifting risk to another party), pooling (combining risks to spread the impact), or retention (accepting the risk).

If an individual covered under a disability income policy is injured while engaged in an occupation that is more hazardous than the one stated in the policy, the policy's change of occupation provision typically results in the benefit level being reduced. This provision allows the insurer to adjust the benefits based on the new, more hazardous occupation, reflecting the increased risk.

Detailed Answer in Step-by-Step Solution:

An absolute assignment transfers all ownership rights (C) of a life insurance policy to a new owner, relinquishing the original owner’s control.

Option A (limited rights) is a partial assignment. Option B (premium payment) is not ownership. Option D (collateral) is a collateral assignment, not absolute.

The Virginia study guide defines absolute assignment as the complete transfer of all policy rights to a new owner, distinct from collateral assignments for loans. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Policy Assignments."

Virginia requires licensees to report felony convictions within 30 days. Exact extract: “A licensed agent shall report to the Commission any felony conviction within 30 calendar days.”

Detailed Answer in Step-by-Step Solution:

Designating a beneficiary "by class" means identifying a group (e.g., "my children") rather than naming specific individuals (C).

Option A (business life insurance) is unrelated to class designation.

Option B (no primary beneficiary) is incorrect; a class can still be primary.

Option D (unrelated beneficiaries) is not a requirement of class designation.

The Virginia study guide notes that a class designation identifies beneficiaries by a category (e.g., "spouse" or "heirs") rather than specific names, offering flexibility. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Beneficiary Designations."

Coinsurance is a cost-sharing arrangement where, after the deductible is met, the insured pays a percentage of covered expenses and the insurer pays the rest. A common split is 80/20, where the insurer pays 80% and the insured pays 20% until the maximum out-of-pocket limit is reached.

Exact Extract (Virginia Health Insurance Study Guide): “Coinsurance—after the deductible has been satisfied, the insured and insurer share covered expenses in a stated ratio (e.g., 80/20).”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Major Medical Policy Provisions

The automatic premium loan provision is an optional feature found in many cash value life insurance policies. Its purpose is to prevent a policy from lapsing when the policyowner fails to pay a premium by the end of the grace period. If the policy has sufficient cash value, the insurer will automatically issue a policy loan in the amount needed to cover the overdue premium. This loan is secured by the policy’s cash value and accrues interest according to the policy’s loan terms. Over time, unpaid loan balances and interest may reduce the policy’s cash value and death benefit. This provision differs from a waiver of premium, which waives premiums due to disability, and from options that purchase additional insurance. The automatic premium loan simply uses the policy’s existing value to keep coverage in force.

A survivorship life insurance policy, also known as second-to-die life insurance, insures two individuals under a single policy. The death benefit is paid only after both insured individuals have died. This type of policy is most commonly issued to spouses but may also insure business partners or other pairs with shared financial interests. Because the insurer does not pay the benefit until the second death occurs, survivorship policies typically have lower premiums than purchasing two separate permanent life insurance policies with the same combined face amount. Survivorship life insurance is primarily used for estate planning purposes, such as providing funds to pay estate taxes, create liquidity for heirs, or fund trusts. It is not designed to replace income upon the first death. The defining feature of survivorship life insurance is that exactly two lives are insured, and the benefit is triggered by the second death.

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.

Penalty-free withdrawals from a traditional IRA before age 59½ are permitted for disability, qualified first-time home purchase (up to $10,000), or certain unreimbursed medical expenses. Bankruptcy is not a qualifying exception.

Exact Extract (Virginia Retirement Study Guide): “Exceptions to early withdrawal penalty include disability, first-time home purchase, qualified education, or medical expenses. Bankruptcy is not included.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Retirement Plans – Taxation Rules

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a surviving spouse may continue health coverage after the death of the covered employee. The surviving spouse can be charged up to 102% of the cost of the coverage, which includes the full premium cost (what the employer was paying plus the employee’s portion), with a 2% administrative fee. This ensures the spouse can continue to receive the same benefits as before the employee’s death.

Detailed Answer in Step-by-Step Solution:

The incontestability provision in LTC policies typically limits the insurer’s ability to contest coverage based on misrepresentations to two years (B) from issuance, unless fraud is proven (which may extend this in some states).

Option A (six months) is too short. Option C (entire duration) applies only to fraud in some cases, not standard misrepresentations. Option D (prohibited) is incorrect due to the contestable period.

The Virginia study guide, aligned with NAIC standards, notes a two-year contestable period for health-related policies like LTC, after which misrepresentations cannot be challenged absent fraud. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Incontestability."

Virginia law obligates agents to act as fiduciaries with premiums collected and to promptly remit payments to the insurer. Exact extract: “An agent who accepts funds from an applicant shall hold such funds in a fiduciary capacity and shall promptly remit them to the insurer.”

Agents act as representatives of insurers to solicit, receive, and forward applications. They cannot approve claims or unilaterally reinstate or replace contracts. Exact extract: “An agent is authorized to solicit, receive, and forward applications to the insurer but has no power to approve claims or reinstate policies.”

A joint and survivor annuity, as outlined in Virginia Code § 38.2-3100 et seq., is an annuity contract that pays benefits as long as at least one of the named annuitants (typically two, such as spouses) is alive. Option A accurately reflects this, stating benefits continue throughout their lifetimes, ceasing only upon the last survivor’s death. Option B is false because payments aren’t tied to life expectancy but to actual survival, per standard annuity terms in the study guide. Option C is incorrect; an annuity provides income, while whole life insurance offers a death benefit—combining them is a different product (e.g., a universal life policy), not a joint and survivor annuity. Option D is wrong because annuities, unlike life insurance, don’t typically require evidence of insurability, as they’re based on longevity, not mortality risk (Virginia Code § 38.2-3113). The study guide emphasizes the lifetime payment feature as the defining trait, confirming A.

Tax-sheltered annuities (403(b) plans) are funded by employer salary reduction agreements, not personal checks written directly to the insurer. Eligible participants are employees of nonprofit or educational institutions. Exact extract: “Contributions to tax-sheltered annuities are made by salary reduction agreements; employees of public schools and nonprofit organizations are eligible.”

Virginia Code § 38.2-510 regulates unfair claim settlement practices, enforced by the State Corporation Commission’s Bureau of Insurance—a state insurance department (option D). This includes timely claim processing and fair payment, with penalties for violations. Option A (IRS) oversees tax compliance, not insurance claims. Option B (NAIC) develops model laws and guidelines (e.g., Unfair Claims Settlement Practices Act), but lacks enforcement power; states adopt and regulate these standards. Option C (claims adjusters) are practitioners, not regulators. The study guide likely emphasizes Virginia’s Bureau as the authority, citing examples like investigating delayed claims, aligning with state-level oversight under § 38.2-200 et seq., making D the correct regulator.

A decreasing term policy provides a declining death benefit over the policy term, while premiums remain level. These policies are often used for mortgage protection, as the insurance amount reduces in line with the declining loan balance.

Exact Extract (Virginia Life Insurance Study Guide): “Decreasing term insurance—provides a level premium and a decreasing face amount throughout the term of coverage, often used for debt protection.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Term Insurance

A single premium whole life policy requires only one lump-sum payment. That single payment fully funds the policy for the insured’s lifetime. The insurer places the premium into the policy’s cash value account, where it grows to cover the cost of insurance throughout life. Exact extract: “Single premium whole life provides lifetime protection with one lump-sum premium payment at issue.” This design is often used for estate planning or wealth transfer because the insured never has to make another payment, and the cash value builds immediately.

Term life insurance provides coverage for a specified period of time and is designed to offer pure death benefit protection without a savings or investment component. One of its defining characteristics is that it does not accumulate cash value. Term policies offer temporary protection and may have level or decreasing face amounts, depending on the policy design. They are also known for having a low initial cost compared to permanent life insurance, making them attractive for short-term needs such as income replacement or debt coverage. Because term life insurance does not build cash value, there is no opportunity for increasing cash values over time. Therefore, increasing cash values is not a characteristic of term life insurance and is the correct exception.

The incontestability clause in health insurance policies generally provides that after two years from the date of issue, the insurer cannot deny a claim or void coverage due to material misrepresentation in the application, except in cases of fraud. This ensures that policyholders have long-term protection from policy rescission due to innocent mistakes.

Accidental death benefit (ADB) riders pay an additional death benefit if death results from accidental causes. It is not automatically included in every policy and requires an additional premium. Exact extract: “The accidental death benefit rider provides extra coverage in the event of accidental death and is available only by payment of an additional premium.” It does not affect cash values or nonforfeiture options.

Detailed Answer in Step-by-Step Solution:

Disability income policies exclude benefits for intentional self-inflicted injuries (B) to prevent abuse or fraud.

Permanent injuries (A), sporting accidents (C), and falls (D) are typically covered unless specifically excluded by the policy.

The Virginia study guide states that disability income insurance excludes self-inflicted injuries as a standard provision to ensure coverage applies to unforeseen events. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."

The agent’s report on an individual health insurance application typically includes details such as the agent’s relationship to the applicant, the applicant’s financial status, and the applicant’s general character. However, the applicant’s signature is not part of the agent’s report; it is part of the application itself. The signature is required from the applicant as a formal agreement to the terms of the policy and to verify the accuracy of the provided information.

Virginia law clearly states that misrepresentation of a policy is an unlawful act and a violation of the Unfair Trade Practices Act. The violation applies regardless of whether the misrepresentation concerns the agent’s own product or a competitor’s.

Exact Extract (Virginia Unfair Trade Practices Law): “It is an unfair and prohibited practice for any person to make, issue, or circulate any misrepresentation of a policy or contract of insurance.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-502 (Misrepresentation prohibited)

The Virginia Life, Accident and Sickness Insurance Guaranty Association exists to protect policyholders, insureds, and beneficiaries when a licensed insurer becomes insolvent. Insolvency occurs when an insurer is unable to meet its financial obligations. In such cases, the guaranty association may provide coverage benefits up to statutory limits to ensure consumers do not lose all protection. The association does not protect against normal business events such as mergers, demutualization, or the sale of company assets. Its sole purpose is to provide a safety net in the event of insurer failure. This protection helps maintain public confidence in the insurance system.

A restorative dental procedure refers to treatments that restore the function and integrity of a tooth, typically after damage or decay. A filling is a common restorative procedure, where the dentist repairs a cavity. An extraction removes a tooth, while a root canal treats infection within the tooth, and fitting dentures replaces missing teeth, all of which are not categorized as restorative procedures but are considered reparative or replacement treatments.

Life insurance proceeds are generally exempt from income tax but may be included in the insured’s gross estate for estate tax purposes if they are payable to the estate or if the insured retained ownership rights. If the proceeds are paid directly to a named beneficiary, they usually bypass probate and are not part of the taxable estate.

Exact Extract (Virginia Life Insurance Study Guide): “Proceeds of life insurance are included in the insured’s gross estate if payable to the estate or if the insured retained incidents of ownership at death.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 6.3 Federal estate tax treatment

The "Usual, Customary, and Reasonable" (UCR) charges method is used to address geographical variation in medical costs. Under this method, the insurer will pay the amount based on what is considered usual and customary for a particular region or area. This ensures that payments reflect regional variations in healthcare pricing, making it more adaptable to different areas. Fee schedules apply fixed amounts for services, experience rating relates to group insurance, and capitation involves paying a set fee per person for services rendered.

The purchaser of a deferred annuity typically intends for the income benefits to begin on a specified date, often years after issuance. The purpose of a deferred annuity is to allow the policyholder to accumulate funds during the deferral period, and then begin receiving periodic payments at a later date, such as retirement. This is in contrast to immediate annuities, which start paying out shortly after the annuity is purchased.

Whole life contracts guarantee cash values, nonforfeiture options, loan values, and settlement values. Dividends are not guaranteed because they depend on company performance.

Exact Extract (Virginia Life Insurance Study Guide): “Whole life policies provide guaranteed cash values, policy loans, and settlement options. Dividends, if declared, are not guaranteed.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Policy Provisions and Guarantees

Virginia Code § 38.2-5207 and 14VAC5-200-185 outline marketing standards for long-term care (LTC) insurance to protect consumers. Option A (twisting)—misrepresenting a policy to induce replacement—is prohibited as an unfair practice (Virginia Code § 38.2-502). Option C (high pressure tactics)—aggressive sales forcing quick decisions—violates ethical standards and is banned (14VAC5-200-40). Option B (replacing existing coverage) is incorrect as stated; replacement itself isn’t prohibited but requires disclosure via a replacement notice (14VAC5-200-75), making it regulated, not banned outright—however, the question implies unauthorized or deceptive replacement, which is prohibited. Option D (cold lead advertising)—soliciting via broad, unsolicited leads (e.g., mailers)—is permitted if it complies with disclosure rules and isn’t deceptive (14VAC5-200-50). The study guide likely lists twisting and high pressure as unethical, with examples like misstating benefits, while allowing cold lead ads with proper labeling (e.g., “advertisement”), making D the exception.

Under the conversion option of a group life insurance plan, the insured can convert their coverage to an individual policy without requiring evidence of insurability. This means the individual does not need to prove they are in good health to convert their group coverage to a personal policy. The new policy's premium rate, coverage amount, and duration will vary based on the terms of the conversion option, but no proof of health is required for conversion.

Monthly life annuity benefit payments received from a tax-sheltered annuity (TSA) are taxed as ordinary income in the year received. While contributions to a TSA may be made on a tax-deferred basis, the income received upon distribution is subject to income tax, as it represents earnings on the original tax-deferred contributions.

Virginia law imposes “prompt pay” standards on insurers. If a claim is not paid within the legally required time frame, the insurer must not only pay the claim amount but also interest from the date payment should have been made. This protects policyholders from financial hardship caused by insurer delays. Exact extract: “Any insurer failing to pay claims when due shall be liable for the amount of the claim plus interest at the legal rate of interest from the date payment was due.” This requirement ensures consumer protection by preventing insurers from using delay tactics.

Most medical expense policies contain a war exclusion, denying benefits for losses resulting from war or military action. Auto accidents, sporting accidents, and tropical diseases are generally covered if not otherwise excluded.

Exact Extract (Virginia Health Insurance Study Guide): “Common exclusions include war, military service, self-inflicted injury, and experimental procedures.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Common Exclusions

Policy loan provisions are typically found in whole life and universal life policies, where the policyholder can borrow against the cash value of the policy. A twenty payment life policy is a type of whole life insurance where premiums are paid for 20 years, and it may include loan provisions. However, a five-year life policy is typically a limited-pay policy, and policy loans are generally not available under this type because there is insufficient cash value accumulation in such a short time frame.

A twenty-payment whole life insurance policy is a limited-pay whole life policy that requires premiums to be paid for only 20 years. If the insured survives the 20-year payment period, the policy becomes fully paid-up and remains in force for the insured’s lifetime without any further premium payments. If the insured dies before the 20-year payment period ends, premium payments stop at death, and the death benefit is paid to the beneficiary. Therefore, premium payments cease at the earlier of the insured’s death or the end of the 20-year payment period. The policy does not require premium payments until maturity or until cash value exceeds premiums. The correct definition focuses on the limited premium payment structure of the policy.

Home health care insurance covers long-term physical therapy or nursing services provided at the insured's residence. This type of insurance helps pay for the costs associated with receiving medical care in the home, such as nursing services, physical therapy, or assistance with activities of daily living. Nursing home insurance, on the other hand, covers care provided in a facility, not at home.

Renewable term insurance renews at the insured’s attained age, not the original issue age. Thus, at renewal after five years, the premium is based on age 40 rates.

Exact Extract (Virginia Life Insurance Study Guide): “Renewable term—premiums increase at renewal based on the insured’s attained age.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Term Insurance Features

Virginia Code § 38.2-3432.1, aligned with the Affordable Care Act (ACA), mandates guaranteed renewability for small employer health plans (1-50 employees in Virginia). Insurers can deny renewal for nonpayment of premiums (option A), insufficient participants (option B, e.g., falling below one eligible employee), or fraud (option D), per Virginia Code § 38.2-3407. However, option C—overuse of services (high claims)—a—is not a permissible reason for denial, as renewability cannot be based on claims experience or health status. The study guide emphasizes this protection under Virginia’s small group market rules, making C the exception.

Dental policies exclude treatment that begins before coverage starts, but generally cover preventive, diagnostic, and restorative care. Exact extract: “Dental insurance typically excludes expenses for treatment initiated before the insured’s eligibility date.”

Universal life insurance is a form of permanent life insurance that provides flexibility in both premium payments and death benefit amounts, subject to policy limits and insurer approval. Policyowners may increase or decrease the death benefit, although increases usually require evidence of insurability. Premiums are flexible, allowing the policyowner to vary the timing and amount of payments as long as sufficient cash value exists to cover policy charges. Universal life policies also credit interest to the cash value at a rate that must meet or exceed a stated guaranteed minimum. However, unlike whole life insurance, universal life does not guarantee a minimum cash value for the life of the policy. Cash value growth depends on credited interest and the cost of insurance charges deducted from the policy. If insufficient premiums are paid, the policy can lapse. Therefore, the statement that each policy has a guaranteed cash value for life is incorrect.

Under qualified retirement plan rules covered in Virginia licensing materials, an employer’s contribution to a profit-sharing plan is limited to a maximum of 25% of total eligible employee payroll. This limit ensures favorable tax treatment while preventing excessive employer contributions that could otherwise be used to shelter income improperly.

Profit-sharing plans are flexible in that the employer is not required to contribute every year, and the amount can vary depending on business performance. However, when contributions are made, they must remain within the statutory maximum. The other percentages listed exceed the allowable limit and therefore are incorrect. Virginia exam standards consistently emphasize the 25% payroll cap as a key characteristic of profit-sharing plans.

Universal life insurance provides flexible premiums, adjustable death benefits, and transparent monthly deductions for mortality and expenses. Death benefits paid to beneficiaries are generally income-tax free, making option C incorrect.

Mortality charges and expense charges are deducted monthly from the cash value, and policy loans reduce the cash value, which can affect interest credited. These features align with Virginia exam standards.

Because death benefits are not taxed as ordinary income, option C is the correct EXCEPT answer.

A captive agent represents only one insurance company under a contractual agreement. The agent sells only that insurer’s products and acts as its exclusive representative.

Independent agents represent multiple insurers, brokers represent clients rather than insurers, and “free agent” is not a recognized licensing category. Virginia licensing materials clearly distinguish captive agents from other distribution roles, making option A correct.

Insurance works on the law of large numbers, which states that as the number of exposure units increases, the predictability of losses increases—not that the number of losses decreases. Losses still occur, but they become more statistically predictable.

Exact Extract (Virginia Insurance Fundamentals Study Guide): “Law of large numbers—predictability of loss increases as the number of similar exposure units increases. The number of losses does not decrease.”

References (Virginia Documents / Study Guide):

— Virginia General Insurance Concepts, Risk and Principles of Insurance

Automatic premium loans use policy cash value to keep coverage in force, and interest is charged on the borrowed amount. Exact extract: “The automatic premium loan uses policy values to pay overdue premiums; interest is charged on the loan balance.”

Policy loans are not prohibited in universal life insurance. In fact, one of the key features of universal life insurance is the ability to take loans against the accumulated cash value. The other options are correct: a mortality charge is deducted from the policy’s cash value, the policy specifies how premiums are divided between expenses and savings, and withdrawals may be allowed but can be subject to surrender charges.

In the context of health insurance, particularly dental coverage, Virginia Code § 38.2-3407.1 et seq. governs mandated benefits, though dental specifics often appear in policy riders or standalone plans. Orthodontics (option A) is the branch of dentistry focused on preventing and correcting irregularities of the teeth and jaws using mechanical devices like braces or aligners, precisely matching the question’s description. Endodontics (option B) deals with the tooth’s interior (e.g., root canals), not mechanical correction of alignment. Periodontics (option C) addresses gum diseases and supporting structures, not tooth positioning. Prosthodontics (option D) involves replacing missing teeth with prosthetics (e.g., dentures), not correcting irregularities mechanically. The study guide likely defines these terms in a health insurance section, emphasizing orthodontics’ role in alignment correction—both preventive (e.g., avoiding bite issues) and corrective—making A the clear answer. Examples like braces for malocclusion reinforce this distinction from other specialties.

The bailout provision (also known as a “market-value adjustment escape clause”) allows the annuity owner to surrender the contract without penalty if the credited interest rate falls below a certain guaranteed minimum. This protects the annuitant from being locked into low rates.

Exact Extract (Virginia Annuities Study Guide): “Bailout provision—permits withdrawal of funds without surrender charges if the credited interest rate drops below a specified level.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Annuity Contract Features

The Medical Information Bureau (MIB) is an organization whose members are insurance companies, primarily life and health insurers. Its purpose is to help insurers detect misrepresentation and fraud during underwriting by sharing coded medical and application history data.

Consumers, agents, and physicians are not members of MIB. However, consumers have rights to access and correct their MIB records under privacy laws.

Virginia exam content emphasizes the role of MIB in underwriting accuracy and risk management while also stressing consumer privacy protections and disclosure requirements.

Consideration in health insurance is the combination of the initial premium payment and the application submitted by the insured. Exact extract: “The consideration clause states that the policy is issued in exchange for the application and payment of the first premium.” This reflects the legal exchange of value between the insured and the insurer.

A straight life annuity pays income until death, with no further payments to beneficiaries. Exact extract: “Straight life annuities provide income for the life of the annuitant only; payments cease upon death with no refund.” This option offers the maximum periodic income but no residual value.

Detailed Answer in Step-by-Step Solution:

A single premium whole life policy is a type of permanent life insurance where the entire premium for the policy’s lifetime coverage is paid in one lump sum at issuance.

Unlike policies with recurring premiums (e.g., monthly or annual), this single payment funds the policy for the insured’s full life (D).

Options A (one month) and B (one year) apply to term or recurring premium policies.

Option C (to age 65) might relate to limited-pay policies, not single premium ones.

Per the Virginia study guide, a single premium whole life policy requires one payment upfront, providing coverage for the insured’s entire life and building immediate cash value. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance Policies."

The deductible is the initial portion of covered expenses the insured must pay before the insurer pays benefits. Coinsurance applies only after the deductible has been met. Exact extract: “The deductible is the amount of covered expenses an insured must pay out of pocket before the insurer is obligated to pay under the major medical policy.” This provision ensures cost-sharing and discourages excessive claims.

A simplified employee pension (SEP) plan is a retirement plan that allows employers to make tax-deductible contributions to individual retirement accounts established for employees. Under IRS regulations, employer contributions to a SEP plan are limited to a maximum of 25% of an employee’s compensation, subject to an overall annual dollar limit. SEP plans are popular among small businesses because they are easy to establish and administer and have minimal reporting requirements. Contributions are made solely by the employer, not the employee, and must be allocated using the same percentage of compensation for all eligible employees. The exam tests the maximum allowable percentage of pay, which is 25%.

HMOs emphasize preventive care to control costs and maintain wellness, including immunizations, checkups, and screenings. Exact extract: “Health Maintenance Organizations emphasize preventive health services as a primary means of controlling health costs.”

Virginia Code § 38.2-3431 et seq., aligned with the ACA, requires small employer health plans (1-50 employees) to offer coverage to all eligible employees who apply, without discrimination based on health status or other factors. “Eligible” typically means full-time employees meeting the employer’s criteria (e.g., 30+ hours/week). Option A reflects this guaranteed issue mandate, ensuring broad access. Option B (12-month waiting period) is false; Virginia and federal law cap waiting periods at 90 days (Virginia Code § 38.2-3445), not 12 months. Option C (evidence of insurability) contradicts guaranteed issue rules for small groups, which prohibit medical underwriting. Option D (under age 65) is incorrect; coverage extends to all eligible employees regardless of age, though Medicare coordination may apply post-65. The study guide likely stresses this inclusivity as a cornerstone of small group market reforms, making A the correct answer.

Replacement regulations are intended to safeguard the policyowner, ensuring they are fully informed of disadvantages, such as surrender charges or loss of benefits, before replacing an existing policy.

Exact Extract (Virginia Replacement Rules): “Replacement provisions are designed to protect the policyholder by requiring full disclosure of the implications of replacing an existing policy.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Replacement Regulations (14VAC5-20-10 et seq.)

Medical expense insurance typically excludes coverage for injuries or sickness resulting from military duty. This exclusion is common across most health insurance policies and aligns with the understanding that military personnel are covered under separate government programs (e.g., Veterans Affairs or military health insurance). The other options, such as terminal diseases, dread diseases, or tropical diseases, are not universally excluded, though they may have specific policy restrictions or coverage limits.

In long-term care (LTC) insurance, the elimination period, per Virginia Code § 38.2-5202, is the waiting period between the onset of a qualifying condition (e.g., confinement due to inability to perform ADLs) and the start of benefit payments. It’s akin to a deductible in days (e.g., 30, 60, or 90 days), during which the insured must cover costs. Option D correctly names this period. Option A (trial period) isn’t a standard LTC term. Option B (exclusion period) might confuse with pre-existing condition exclusions, but it’s not the waiting period for benefits. Option C (qualifying period) could imply eligibility determination, but “elimination period” is the precise industry term. The study guide likely defines this as a cost-sharing feature, with examples illustrating how longer periods reduce premiums, solidifying D as the answer.

Detailed Answer in Step-by-Step Solution:

Agents assist underwriting by collecting application data (A), obtaining additional info (C), and reporting material facts (D), but determining the final rate classification (B) is the insurer’s underwriter’s role, not the agent’s.

Rate classification involves risk assessment, which is beyond an agent’s authority.

The Virginia study guide specifies that agents facilitate underwriting by providing accurate information, while the insurer’s underwriters set rates based on that data. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Underwriting Process."

The Bureau of Insurance has the authority to examine a licensee's books and records to determine if unfair trade practices have been violated. This regulatory body ensures compliance with state insurance laws and regulations, and it has the power to investigate potential violations within the industry. The National Association of Insurance Commissioners (NAIC) provides model laws but does not have regulatory power over individual insurers.