Virginia-Life-Annuities-and-Health-Insurance Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Questions and Answers

Detailed Answer in Step-by-Step Solution:

The accumulation period (D) is the phase in a deferred annuity where premiums are paid to build value before payouts begin.

The liquidation period (A) is not a standard term here; it might imply payout but isn’t correct.

The annuity period (B) is when payments are received, not paid.

Period certain (C) refers to a payout option, not premium payment phase.

The Virginia study guide defines the accumulation period as the time during which premium payments are made into a deferred annuity, accumulating value until the payout phase. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Annuities."

Detailed Answer in Step-by-Step Solution:

The coordination of benefits (COB) provision prevents overinsurance (B) by ensuring that total payments from multiple group plans don’t exceed 100% of covered expenses, avoiding duplication.

It doesn’t affect dependent coverage (A), probationary periods (C), or waiting periods (D), which are unrelated to claim payments.

The Virginia study guide describes COB as a mechanism to coordinate payments among multiple insurers, reducing overinsurance and ensuring fair claim distribution. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Health Insurance Provisions."

Virginia Code § 38.2-3209 allows a guaranteed insurability rider, enabling the policyowner to buy additional coverage at specified intervals (e.g., every 3 years or life events like marriage) without proving insurability. Option D matches this definition. Option A is unrelated; non-medical underwriting isn’t implied. Option B contradicts the rider’s purpose, which waives insurability proof. Option C is false; premium adjustments aren’t part of this rider. The study guide describes this rider as a planning tool for future needs, confirming D.

Virginia Code § 38.2-4303 defines the HMO model, where the primary care physician (PCP, option A) acts as the gatekeeper, delivering preventive (e.g., vaccines) and routine care (e.g., checkups), and coordinating referrals. Option B (medical director) oversees HMO operations, not direct care. Option C (routine care physician) isn’t a standard term; the PCP fills this role. Option D (provider association) might imply a network, but care comes from the individual PCP, not a collective. The study guide likely explains the PCP’s central role with examples—e.g., a member seeing their PCP for a flu shot—highlighting HMO cost-control via this structure, making A the correct provider.

Detailed Answer in Step-by-Step Solution:

The Virginia Bureau of Insurance has authority to request and review an agent’s business records (C) to ensure compliance with state laws, without requiring a court order (A) or NAIC approval (B).

Option D (no access) is false; regulatory oversight overrides privacy in this context.

The Virginia study guide confirms that the Bureau of Insurance can demand records as part of its regulatory powers under Virginia insurance law, ensuring market conduct compliance. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Regulation."

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.

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.

Detailed Answer in Step-by-Step Solution:

Term life insurance’s primary advantage is its lower initial premium (D) compared to whole life for the same death benefit, due to its temporary nature and lack of cash value.

Option A (same cost) is false; term is cheaper. Option B (cost-effective long-term) is incorrect; premiums rise with renewals. Option C (permanent) applies to whole life, not term.

The Virginia study guide highlights that term life insurance offers affordable initial premiums for temporary coverage, making it attractive for short-term needs compared to whole life. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance."

Virginia Code § 38.2-5200 defines Activities of Daily Living (ADLs) in long-term care (LTC) insurance as basic self-care tasks triggering benefits if the insured can’t perform them (typically 2 of 6). Option D lists common ADLs: dressing, eating, bathing, and mobility (often with toileting and transferring), aligning with federal and Virginia standards (e.g., HIPAA). Option A (age, sex, income, occupation) is underwriting data, not ADLs. Option B (health providers) is unrelated to functional ability. Option C (family members) might confuse beneficiaries, not ADLs. The study guide likely lists ADLs with examples—e.g., needing help bathing due to arthritis—emphasizing their role in LTC eligibility, making D the precise answer.

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.

Detailed Answer in Step-by-Step Solution:

Disability income insurance covers loss of income from accidental injuries (D), provided they aren’t excluded.

Self-inflicted injuries (A), military service injuries (B), and war-related disabilities (C) are standard exclusions in most policies.

The Virginia study guide specifies that disability income insurance pays for accidental or illness-related income loss, excluding self-inflicted, military, or war-related causes. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."

Virginia Code § 38.2-4306 mandates HMO benefits, focusing on comprehensive care. Option A (wellness programs) is common, promoting prevention (e.g., smoking cessation). Option C (24-hour emergency care) is required, ensuring access via PCP coordination or direct ER services. Option D (outpatient services) is standard, covering clinic visits. Option B (discounts on local health spa memberships) isn’t a typical HMO feature; while some plans offer wellness incentives, spa discounts are ancillary, not a core benefit under Virginia law or NAIC HMO models. The study guide likely lists HMO staples (A, C, D) with examples—e.g., annual checkups (D)—contrasting them with optional perks like B, making it the exception.

Detailed Answer in Step-by-Step Solution:

Long-term care insurance (B) is designed to cover custodial care (e.g., help with daily activities like bathing or dressing) when individuals cannot care for themselves, often outside a hospital setting.

Medicare (A) provides limited long-term care coverage (e.g., skilled nursing for a short period), not comprehensive custodial care.

Major medical (C) covers hospital and medical expenses, not long-term custodial care.

Disability income (D) replaces lost income, not care costs.

The Virginia study guide defines long-term care insurance as coverage for extended care needs, such as in nursing homes or at home, when individuals cannot perform activities of daily living, distinguishing it from Medicare or major medical plans. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Health Insurance."

Virginia Code § 38.2-5200 defines ADLs (Activities of Daily Living, option C) as essential tasks—e.g., bathing, dressing, eating—used to determine LTC benefit eligibility (typically inability to perform 2 of 6). Option A (aggregate dollar limits) refers to coverage caps, not ADLs. Option B(aggregate days limitation) might confuse with elimination periods, not ADLs. Option D (approved doctor lists) relates to provider networks, not functional criteria. The study guide likely details ADLs with examples—e.g., needing help with mobility—emphasizing their role in claims, making C the correct term.

Detailed Answer in Step-by-Step Solution:

A group health insurance contract is a legal agreement between the employer (policyholder) and the insurance company (C), with employees as covered participants, not direct parties to the contract.

Option A (employer and employees) is the employment relationship, not the insurance contract. Option B (employee and insurer) applies to individual policies. Option D (all three) overcomplicates the contractual relationship.

The Virginia study guide states that group insurance contracts are issued to the employer or group sponsor, who contracts with the insurer, while employees receive certificates of coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance."

Detailed Answer in Step-by-Step Solution:

Medicare Part B eligibility generally requires enrollment in or eligibility for Part A (B), which covers hospital insurance and is tied to age (65+) or disability status, not just retirement (A) or insurability (C).

"Fully insured" under Social Security (D) relates to benefits but isn’t a direct Part B requirement.

The Virginia study guide states that Medicare Part B is available to those eligible for Part A, typically U.S. citizens or residents aged 65 or disabled, regardless of other factors. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Eligibility."

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."

Detailed Answer in Step-by-Step Solution:

Qualified retirement plans allow investments in stocks (A), allocations to participants (B), and distributions of vested funds (C), but repossessing funds for business use (D) violates IRS rules, as funds are held in trust for employees’ benefit.

The Virginia study guide, per IRS regulations, states that qualified plan assets are protected for participants and cannot be diverted for business purposes, ensuring retirement security. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Retirement Plans."

Detailed Answer in Step-by-Step Solution:

The reinstatement provision in health insurance allows a policy that lapsed due to nonpayment of premiums to be restored (B), typically within a set period (e.g., 3 years), if the insured pays back premiums and meets conditions like proving insurability.

Option A (reinstates amount after loss) relates to property insurance, not health.

Option C (change application statements) is unrelated to reinstatement.

Option D (Bureau approval) is false; reinstatement is handled by the insurer, not a regulatory body.

The Virginia study guide explains that the reinstatement provision protects policyholders by allowing revival of a lapsed health policy upon payment of overdue premiums and, if required, evidence of insurability. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Policy Provisions."

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."

Virginia Code § 38.2-502 defines misrepresentation as an unfair practice, where an agent misstates or omits key policy details (e.g., calling a term policy “permanent”) to mislead the insured. OptionC fits this legal breach. Option A (defamation) involves false reputational harm, not policy sales. Option B (unfair discrimination, § 38.2-211) involves unequal treatment, not misrepresentation. Option D (coercion) implies force, not deception. The study guide likely warns of misrepresentation penalties—e.g., an agent fined for hiding exclusions—making C the applicable violation.

Detailed Answer in Step-by-Step Solution:

A viatical settlement involves a terminally ill policyowner selling their life insurance policy for a lump sum. The policyowner in this transaction is called the viator (C).

The viatical settlement provider (A) is the entity purchasing the policy.

The viatical settlement broker (B) facilitates the transaction.

"Viatee" (D) is not a recognized term in this context.

The Virginia study guide defines the viator as the insured policyowner who sells their policy in a viatical settlement, typically due to a terminal illness. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Viatical Settlements."

Detailed Answer in Step-by-Step Solution:

If a health insurer requires a physical exam (e.g., for underwriting or claims), the insurer pays the cost (D), as it’s their condition for coverage or payment.

The premium payor (A), insured (B), or patient (C) aren’t responsible for insurer-mandated exams.

The Virginia study guide specifies that insurer-required exams, such as for contesting claims, are at the insurer’s expense, per the physical examination provision. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Policy Provisions."

Virginia Code § 38.2-1826(C) requires licensees, including insurance agents, to report any felony conviction to the State Corporation Commission’s Bureau of Insurance within 30 calendar days of the final disposition (option C). “Final disposition” means the court’s conclusive ruling—e.g., sentencing after a guilty plea. This rule ensures the Bureau can assess the agent’s fitness to retain their license, protecting the public from untrustworthy practitioners. Option A (10 days) is too short and not specified in Virginia law for this purpose. Option B (20 days) lacks statutory support and falls between standard reporting periods. Option D (60 days) exceeds the mandated timeline, delaying oversight. The study guide likely highlights this 30-day deadline in a licensing compliance section, with examples—e.g., an agent convicted of fraud on June 1 must report by July 1—aligning with Virginia’s adoption of NAIC standards for licensee integrity (Virginia Code § 38.2-1800 et seq.), making C the precise requirement.

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.

Virginia Code § 38.2-3117.1 permits life insurance policies to include an accelerated death benefit (ADB) provision, allowing the policyowner to receive a portion of the death benefit early if the insured is diagnosed with a terminal illness (typically less than 12-24 months life expectancy, per policy terms). Option B correctly identifies this benefit, often used for medical expenses or quality-of-life needs. Option A (death benefit) is paid only upon death, not during life, so it’s incorrect here. Option C (reduced paid-up insurance) is a nonforfeiture option converting cash value to a smaller, paid-up policy, unrelated to terminal illness. Option D (extended term insurance) uses cash value to extend term coverage, also not tied to life expectancy triggers. The study guide likely details ADB as a modern feature addressing critical health scenarios, distinguishing it from standard death benefits or nonforfeiture options, confirming B as the accurate choice.

Detailed Answer in Step-by-Step Solution:

Medicare Part D (C) specifically covers prescription drug costs for enrollees.

Medical expenses (A) are under Part B, hospital costs (B) under Part A, and dental (D) is generally not covered by Medicare unless supplemental.

The Virginia study guide states that Medicare Part D, introduced in 2006, provides prescription drug coverage through private plans, distinct from Parts A and B. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare."

Detailed Answer in Step-by-Step Solution:

An alien insurer (B) is headquartered outside the U.S. but licensed to operate within it, distinguishing it from a foreign insurer (A), which is domiciled in another U.S. state.

A captive insurer (C) insures its parent company, and a reciprocal exchange (D) is a mutual insurance structure, neither based on location.

The Virginia study guide defines an alien insurer as one incorporated outside the U.S., operating under state licensing, per standard insurance terminology. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Types."

Adjustable life insurance, per Virginia Code § 38.2-3113.1, blends whole and term features, allowing policyowners to adjust face amount and premiums. Option B is true; simultaneous changes (e.g., increasing face amount and premium) are possible, adapting coverage and cash value. Option A is false; higher premiums typically increase cash value, not decrease it, unless misallocated. Option C is incorrect; increasing face amount doesn’t inherently extend term duration—it adjusts cost or cash value. Option D is false; face amount increases don’t shorten whole life premium periods, which are fixed or flexible based on design. The study guide likely highlights adjustability with examples—e.g., raising $100,000 to $150,000 with a premium hike—making B the true capability.

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 ofinsurability) 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.

Detailed Answer in Step-by-Step Solution:

Reinsurance (C) is a process where one insurer (the ceding company) transfers part or all ofits risk to another insurer (the reinsurer) to reduce exposure.

A reciprocal contract (A) involves mutual insurance exchanges, not risk transfer between insurers.

Coinsurance (B) refers to shared risk between the insurer and policyholder, not between insurers.

A captive contract (D) involves a company insuring itself through a subsidiary, not transferring risk to another insurer.

The Virginia study guide defines reinsurance as a contractual arrangement allowing insurers to mitigate risk by transferring it to another insurer, a common practice in the industry. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Operations."

Detailed Answer in Step-by-Step Solution:

The "time limit on certain defenses" provision (B), often tied to incontestability, limits the insurer’s ability to deny claims based on application errors after a period (e.g., 2 years), unless fraud is proven.

Legal actions (A) governs lawsuits, grace period (C) covers premium delays, and time payment of claims (D) sets claim payment deadlines—none relate to application defenses.

The Virginia study guide explains that the time limit on certain defenses provision protects insureds by restricting post-issuance claim denials after a contestable period, absent fraud. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Policy Provisions."

Detailed Answer in Step-by-Step Solution:

Whole life insurance offers policy loans (A), lifelong protection (B), and cash value (D), but its initial cost (C) is higher than term insurance for the same death benefit due to the savings component.

Term insurance is cheaper initially, making C the exception.

The Virginia study guide highlights that whole life provides permanent coverage and cash value, but at a higher initial premium than term insurance, which offers temporary, lower-cost protection. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance."

Detailed Answer in Step-by-Step Solution:

The policyowner (A) has the right to designate the beneficiary, as they control the policy’s terms and ownership rights.

The insurer (B) issues the policy, the beneficiary (C) receives proceeds, and the agent (D) facilitates but doesn’t decide.

The Virginia study guide confirms that the policyowner selects the beneficiary, exercising a fundamental ownership right, unless assigned otherwise. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Beneficiary Designations."

Detailed Answer in Step-by-Step Solution:

Life insurance policies typically include a two-year suicide clause; if the insured dies by suicide within this period (e.g., six months), the insurer pays only a refund of premiums, not the full death benefit (C).

Options A (accidental injury), B (lung cancer), and D (heart attack) are covered causes, barring misrepresentation or exclusions, within the first two years.

The Virginia study guide notes that the suicide provision limits payment to premiums paid if suicide occurs within two years of issuance, protecting insurers from early intentional loss. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

Detailed Answer in Step-by-Step Solution:

In a PPO, using a non-PPO provider (out-of-network) leads to higher out-of-pocket expenses (A) due to lower reimbursement rates and potential excess charges.

Option B (full cost) is inaccurate; some coverage applies. Option C (100% reimbursement) is false. Option D (waiting period) is unrelated.

The Virginia study guide reiterates that PPOs cover out-of-network care but at a reduced level, increasing the insured’s costs compared to in-network use. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Managed Care Plans."

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."

Virginia Code § 38.2-5202 allows a guaranteed insurability option in LTC insurance, letting the insured buy additional coverage later (option A) without proving insurability, typically at set intervals or life events (e.g., inflation adjustment). Option B (replace with another insurer) isn’t a policy feature; it’s a market action. Option C (lifetime extension) confuses with benefit periods, not insurability. Option D (fixed premium) relates to non-cancelable policies, not this rider. The study guide likely describes this with examples—e.g., adding $1,000 monthly benefit at age 70—emphasizing future flexibility, making A the correct ability.

Virginia Code § 38.2-3500 et seq. governs major medical plans, which cover catastrophic costs like hospital expenses (option A), physicians’ visits (option C), and surgical expenses (option D). Option B (custodial care)—non-medical assistance with daily living (e.g., bathing)—is typically excluded, as it’s not “medically necessary” under standard definitions (Virginia Code § 38.2-3407.10). The study guide likely lists inclusions (A, C, D) with examples—e.g., $5,000 for surgery—versus exclusions like custodial care, covered by LTC policies instead, making B the usual exception.

Virginia Code § 38.2-3445, aligned with ACA rules, allows group health plans to impose a probationary period (option C)—also called a waiting period—before new employees become eligible for coverage, capped at 90 days. This delay, set by the employer, ensures employment stability before benefits begin. Option A (participation period) isn’t a standard term; it might confuse with minimum participation rules for group plans. Option B (grace period) is the post-due-date window for premium payment (e.g., 31 days), not eligibility. Option D (contributory period) implies employee premium contributions but isn’t a defined phase. The study guide likely explains this as an employer tool, with examples like a 30-day wait, making C the precise term.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for qualified long-term care insurance are treated as a business expense and are tax-deductible for the employer (B), provided the plan meets IRS requirements.

These premiums are not included in the employee’s gross income (A), as they are tax-exempt benefits under IRC Section 106.

Employees cannot deduct these premiums (C) since they are employer-paid.

Reimbursement (D) does not apply.

The Virginia study guide, aligned with IRS rules, notes that employer-paid premiums for qualified long-term care insurance are deductible as a business expense and excluded from employees’ taxable income. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

Detailed Answer in Step-by-Step Solution:

Excess charges in Medicare occur when a provider charges more than the Medicare-approved amount, and the insured (D) is responsible for the difference unless covered by supplemental insurance.

The Social Security Administration (A) and CMS (B) administer Medicare, not pay claims.

Providers (C) may charge excess but don’t absorb it unless they accept assignment.

The Virginia study guide explains that Medicare beneficiaries bear excess charges unless a provider accepts Medicare assignment or a Medigap policy covers them. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Basics."