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

Long-Term Care (LTC) policies cover services for individuals who need assistance withActivities of Daily Living (ADLs), which are basic self-care tasks. Oklahoma regulations (O.A.C. 365:10-5-44) and federal standards define ADLs as including dressing, eating, toileting, bathing, transferring, and continence.Talkingis not considered an ADL, as it is not a fundamental self-care activity.

Option A: Incorrect. Dressing is an ADL.

Option B: Correct. Talking is not an ADL.

Option C: Incorrect. Eating is an ADL.

Option D: Incorrect. Toileting is an ADL.

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.

Health Maintenance Organizations (HMOs) focus on preventive and essential medical care within a network.Adult routine eye examinationsare often excluded from HMO coverage, as they are considered non-essential or covered under separate vision plans. Other services like emergency care, physical exams, and surgeries are typically covered, as per Oklahoma’s managed care regulations (Title 36 O.S. § 652 et seq.).

Option A: Incorrect. Out-of-area emergency services are generally covered by HMOs.

Option B: Correct. Adult routine eye examinations are often excluded or require separate coverage.

Option C: Incorrect. Physical examinations are typically covered as preventive care.

Option D: Incorrect. In-patient surgeries are covered as essential medical services.

Precertification(or preauthorization) is a process where the insurer reviews and approves certain medical treatments or procedures before they are provided, ensuring they are medically necessary and covered.Concurrent reviewoccurs during the treatment, monitoring ongoing care (e.g., hospital stays) to ensure continued necessity. The primary difference is timing: precertification happens before treatment, while concurrent review happens during treatment.

Option A: Incorrect. Both precertification and concurrent review are cost containment measures, so this is not unique to precertification.

Option B: Incorrect. Both processes involve review by the insurance company.

Option C: Incorrect. Neither typically requires patient consent beyond agreeing to the policy terms.

Option D: Correct. Precertification occurs before treatment, distinguishing it from concurrent review.

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

Anendowment policyis a life insurance product that pays the face amount to the insured if they are alive at the end of a specified period (maturity) or to the beneficiary if the insured dies before maturity. It combines life insurance with a savings component, as defined in Oklahoma’s life insurance regulations (Title 36 O.S. § 4002).

Option A: Incorrect. Universal life is flexible permanent insurance, not tied to a specific maturity payout.

Option B: Incorrect. Modified life has lower initial premiums, not a maturity payout feature.

Option C: Correct. An endowment policy pays the face amount at maturity if the insured is alive.

Option D: Incorrect. A juvenile trust is not a life insurance policy type; it’s a financial arrangement.

A10-year level term life insurance policyhas a fixed premium and a fixed face amount (death benefit) for the entire 10-year term. The premium and death benefit remain constant, and there is no cash value or dividend accumulation, as term life is not a participating policy.

Option A: Incorrect. Conversion to whole life is an optional rider, not automatic at the end of the term.

Option B: Incorrect. In a level term policy, the premium does not increase during the term; it remains constant.

Option C: Incorrect. Term life policies do not pay dividends or accumulate cash value, so the face amount does not increase.

Option D: Correct. Both the premium and the $100,000 face amount remain constant for the 10-year term.

This question falls under the Prometric content outline section on “Life Products,” which covers term life insurance characteristics.

Asupplemental attending physician’s statement (APS)is requested by the insurer during underwriting when additional medical information is needed to assess the applicant’s risk, particularly if it could affect the underwriting decision. Oklahoma regulations (Title 36 O.S. § 1204) and HIPAA require the applicant’s consent for obtaining medical records, ensuring privacy and transparency.

Option A: Incorrect. An APS is not routine; it’s requested based on specific needs.

Option B: Incorrect. The applicant’s consent is required for medical information requests.

Option C: Incorrect. Applicants typically do not request an APS; insurers do.

Option D: Correct. An APS is appropriate when requested by the insurer with the applicant’s consent for underwriting purposes.

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.