Georgia Life and Health Insurance Cross Reference Study Guide

Transcription

1 Georgia Life and Health Insurance Cross Reference Study Guide This cross reference provides you with the exam outline for your state insurance exam and a reference code where the specific topics can be located in the Kaplan study material. The reference code numbers in the right hand column refer to the unit number and the applicable topic, subtopic, and sub-subtopics within that unit.

2 GEORGIA EXAM CONTENT OUTLINES Effective June 10, 2013 GEORGIA LIFE, ACCIDENT AND SICKNESS AGENT CONTENT OUTLINE 80 scoreable questions plus 20 pretest questions; 120 minute time limit; 70% passing score I. LIFE: TYPES OF POLICIES... 6 A. Traditional whole life products 1. Ordinary (straight) life Limited-pay and single-premium life , Adjustable life B. Interest-sensitive life products 1. Universal life Variable whole life Variable universal life Interest-sensitive whole life C. Term life 1. Level, decreasing, and increasing term , , Special features a. Renewable b. Convertible D. Annuities 1. Single, level, and flexible premium , , Immediate and deferred Fixed and variable 12.7, Equity index E. Combination plans and variations 1. Joint life Survivorship life II. LIFE: POLICY RIDERS, PROVISIONS, OPTIONS, AND EXCLUSIONS.15 A. Policy riders 1. Waiver of premium and waiver of premium with disability income , Guaranteed insurability Payor benefit Accidental death and/or accidental death and dismemberment Term riders Other insureds (e.g., spouse, children, nonfamily) Cost of living B. Policy provisions and options 1. Entire contract Insuring clause Free look Consideration Owner s rights Beneficiary designations a. Primary and contingent b. Revocable and irrevocable c. Changes d. Common disaster e. Minor beneficiaries Premium payment a. Modes 4.6.3, b. Grace period c. Automatic premium loan d. Level or flexible 4.6.3, Reinstatement Policy loans, withdrawals, partial surrenders 9.3.9, Nonforfeiture options

3 11. Dividends and dividend options 11.5, Incontestability Assignments Suicide Misstatement of age and gender Settlement options 11.3 C. Policy exclusions III. LIFE: COMPLETING THE APPLICATION, UNDERWRITING, AND DELIVERING THE POLICY... 8 A. Completing the application 1. Required signatures Changes in the application Consequences of incomplete applications Warranties and representations Collecting the initial premium and issuing the receipt 7.2, Replacement Disclosures at point of sale (i.e., HIPAA, HIV consent) , B. Underwriting 1. Insurable interest Medical information and consumer reports , , Fair Credit Reporting Act Risk classification 4.5 C. Delivering the policy 1. When coverage begins Explaining the policy and its provisions, riders, exclusions, and ratings to the client D. Do Not Call List IV. LIFE: TAXES, RETIREMENT, AND OTHER INSURANCE CONCEPTS 6 A. Third-party ownership 5.3 B. Group life insurance 1. Conversion privilege Contributory vs. noncontributory C. Retirement plans 1. Tax-qualified plans Nonqualified plans 15.2 D. Business insurance E. Social Security benefits and taxes , F. Tax treatment of insurance premiums, proceeds, dividends 1. Individual life Group life Modified endowment contracts (MECs) G. Accelerated death benefits living benefits H. Endowments V. ACCIDENT & SICKENESS: TYPES OF POLICIES A. Disability income 1. Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee/partner policies B. Accidental death and dismemberment C. Medical expense insurance 1. Basic hospital, medical, and surgical policies 20.3, , Major medical policies Comprehensive major medical policies Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Service organizations (Blue Plans) Point of service (POS) plans Medical savings accounts (MSAs) Flexible spending accounts (FSAs) Health reimbursement accounts (HRAs) High deductible health plans (HDHPs) and related health savings accounts (HSAs) ,

4 12. Consumer driven health plans (CDHPs) D. Medicare supplement policies 23.5 E. Group insurance 1. Group conversion Differences between individual and group contracts General concepts COBRA HIPAA F. Long-term care 1. Individual LTC contracts Group/voluntary LTC contracts Service days vs. calendar days G. Cancer (for specified diseases) plans H. Critical illness plans I. Worksite (employer-sponsored) plans 16.8 VI. ACCIDENT AND SICKNESS: POLICY PROVISIONS, CLAUSES, AND RIDERS A. Mandatory provisions 1. Entire contract Time limit on certain defenses (incontestable) Grace period Reinstatement Notice of claim Claim forms Proof of loss Time of payment of claims Payment of claims Physical examination and autopsy Legal actions Change of beneficiary B. Optional provisions 1. Change of occupation Misstatement of age Illegal occupation C. Other provisions and clauses 1. Insuring clause Free look (10-day, 20-day, etc.) Consideration clause Probationary period , Elimination period , Waiver of premium , , Exclusions , 19.6, , 20.6, , Preexisting conditions , , Recurrent disability Coinsurance Deductibles Eligible expenses Copayments , Pre-authorizations and prior approval requirements , Usual, reasonable, and customary (URC) charges Lifetime, annual or per cause maximum benefit limits D. Riders 1. Impairment rider Guaranteed insurability rider Multiple indemnity rider (double, triple) E. Rights of renewability 1. Noncancellable Cancellable Guaranteed renewable Conditionally renewable Optionally renewable Period of time for renewal VII. SOCIAL INSURANCE... 2 A. Medicare 1. Primary, secondary payor Medicare parts A, B, C, D , B. Medicaid

5 C. Social Security benefits VIII. ACCIDENT AND SICKNESS: OTHER INSURANCE CONCEPTS... 3 A. Total, partial, and residual disability , , B. Owner s rights C. Dependent children benefits D. Primary and contingent beneficiaries E. Modes of premium payments (annual, semiannual, etc.) 4.6.3, F. Nonduplication and coordination of benefits (e.g., primary vs. excess) G. Occupational vs. nonoccupational H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.) 25.3, 25.4 I. Managed care 16.5 J. Workers compensation K. Subrogation 20.1 IX. ACCIDENT AND SICKNESS: FIELD UNDERWRITING PROCEDURES... 6 A. Completing application and obtaining necessary signatures 4.4.3, B. Explaining sources of insurability information (e.g., MIB Report, Fair Credit Reporting Act, etc.) , 4.4.2, C. Initial premium payment and receipt and consequences of the receipt (e.g. medical examination, etc.) , , D. Submitting application (and initial premium if collected) to company for underwriting 4.4, E. Assuring delivery of policy to client and related documents 17.4 F. Explaining policy and its provisions, riders, exclusions, and ratings to clients 17.4 G. Replacement 17.6 H. Contract law 1. Requirements of forming a contract Insurable interest Warranties and representations Unique aspects of the health contract a. Conditional b. Unilateral c. Adhesion X. GEORGIA LAWS, RULES, AND REGULATIONS...10 A. Laws, rules, and regulations pertinent to Life and Accident and Sickness Insurance 1. Insurance Department and Commissioner 2. Broad powers and duties ( through 33) 3. Examination of records ( through 13) 4. Investigations/notice of hearing (33-6-6) 5. Penalties (33-6-9) 6. General insurance definitions ( through 30, ) 7. Licensing of agents and counselors ( through 46) 8. Unfair trade practices ( and 5) 9. Reporting and disposition of premiums ( ) 10. Georgia Life and Health Insurance Guarantee Association ( , through 10) B. Laws, rules, and regulations pertinent to Life Insurance only 1. Replacement of life insurance ( ) 2. Life insurance advertisements ( ) 3. Miscellaneous provisions ( and 6.1 C. Laws, rules, and regulations pertinent to Accident & Sickness Insurance only 1. Miscellaneous provisions 2. Medicare supplement advertising ( ) 3. Definition of long-term care ( (5)) 4. Long-term care partnership requirements ( ) 4