Ok-Life-Accident-and-Health-or-Sickness-Producer Exam Dumps - Oklahoma Life, Accident, and Health or Sickness Producer Exam

Ascheduled dental policyprovides coverage based on a predetermined schedule of benefits, which lists specific maximum dollar amounts payable for each dental procedure (e.g., $100 for a filling, $500 for a crown). This contrasts with comprehensive dental plans that may pay a percentage of expenses or cover all costs after a deductible.

Option A: Incorrect. Scheduled dental policies do not pay all expenses after a deductible; they limit payments to scheduled amounts.

Option B: Incorrect. Paying a percentage of expenses is typical of comprehensive dental plans, not scheduled policies.

Option C: Correct. Benefits are limited to a specific maximum dollar amount per procedure, as defined in the schedule.

Option D: Incorrect. Benefits are not paid as a lump sum directly to the insured; they are paid per procedure up to the scheduled limit.

This question aligns with the Prometric content outline under “Health Providers and Products,” which covers dental insurance structures.

Life insurance underwriting assesses risk based on factors likeage(affects mortality risk),family history(indicates hereditary conditions), andtobacco use(increases health risks), as outlined in Oklahoma’s underwriting practices (Title 36 O.S. § 1204).Marital statusis not a key factor, as it has minimal impact on mortality risk, though it may be noted for beneficiary or financial planning purposes.

Option A: Incorrect. Age is a key underwriting factor.

Option B: Incorrect. Family history is a key underwriting factor.

Option C: Incorrect. Tobacco use is a key underwriting factor.

Option D: Correct. Marital status is not a key underwriting factor.

Asurvivorship life policy(also called second-to-die insurance) covers two or more individuals and pays the death benefit upon the death of the last insured person. It is often used for estate planning, as opposed to ajoint life policy, which pays on the first death (Title 36 O.S. § 4002).

Option A: Incorrect. Universal life is a flexible single-life policy, not a multiple-person policy.

Option B: Correct. A survivorship life policy pays on the last insured’s death.

Option C: Incorrect. A joint life policy pays on the first insured’s death.

Option D: Incorrect. An annuity life policy is not a standard term; annuities are separate products.

Long-Term Care (LTC) insuranceis designed to cover services for individuals with chronic diseases or disabilities who need assistance with activities of daily living (ADLs) or have cognitive impairments. It often includes coverage for nursing home care, home-based care, assisted living, and respite care, as regulated in Oklahoma under Title 36 O.S. § 4426.1.

Option A: Incorrect. Medicare provides limited coverage for skilled nursing or home health care but not comprehensive LTC services.

Option B: Incorrect. Medicaid covers LTC for low-income individuals but is a government program, not a private insurance policy.

Option C: Correct. LTC insurance covers nursing home, home-based, and respite care for chronic conditions.

Option D: Incorrect. Group health insurance covers medical expenses but typically does not include LTC services.

This question falls under the Prometric content outline section on “Long-Term Care (LTC) Policies,” which covers LTC coverage and services.

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.

Long-Term Care (LTC) insurance policies cover services for individuals who need assistance with activities of daily living (ADLs) or have severe cognitive impairments. The three primary levels of care in LTC policies areskilled nursing care(intensive medical care by licensed professionals),intermediate care(less intensive medical care with some nursing support), andcustodial care(non-medical assistance with ADLs, such as bathing or dressing). These levels are standard in Oklahoma’s LTC regulations and align with federal guidelines.

Option A: Incorrect. Professional, social, and economic care are not standard LTC levels.

Option B: Incorrect. While home-based and assisted living are settings for LTC, they are not levels of care; medical care is too vague.

Option C: Incorrect. Functional and rehabilitational care are not standard LTC categories; medical care is not specific enough.

Option D: Correct. Skilled nursing, intermediate, and custodial care are the recognized levels of care in LTC policies.

This question falls under the Prometric content outline section on “Long-Term Care (LTC) Policies,” which includes knowledge of LTC services and coverage.

Afalse financial statementin the context of insurance refers to a misrepresentation of an insurer’s financial condition, such as falsely claiming insolvency or bankruptcy, which is prohibited under Oklahoma’s Unfair Trade Practices Act (Title 36 O.S. § 1204). This can mislead consumers and harm the insurer’s reputation. Option B directly involves a false claim about an insurer’s financial status.

Option A: Incorrect. An untrue advertisement about another producer is defamation or misrepresentation, not a financial statement.

Option B: Correct. Posting false information about an insurer’s bankruptcy is a false financial statement, violating Oklahoma law.

Option C: Incorrect. Flyers about a criminal past are defamatory but not related to financial statements.

Option D: Incorrect. Hateful postcards are unprofessional but do not constitute a false financial statement.

This question is part of the Prometric content outline under “State Insurance Statutes, Rules, and Regulations,” which covers unfair trade practices.

In group health insurance, the employer or group sponsor receives themaster policy, while employees covered under the plan are issued acertificate of insurance, which summarizes their coverage but is not the policy itself, as per Oklahoma’s regulations (Title 36 O.S. § 6060.3).

Option A: Incorrect. Employees do not receive individual policies; the employer holds the master policy.

Option B: Incorrect. The contract is the master policy, not issued to employees.

Option C: Incorrect. “Covenant” is not an insurance term.

Option D: Correct. Employees receive a certificate of insurance.