Louisiana Laws and Rules Flashcards

Questions and Answers

The branch of dentistry which deals with the replacement of missing parts is called?

Prosthodontics

The Fair Credit Reporting Act protects consumers with guidelines regarding what?

credit reporting and distribution

Within how many days must a producer submit a change in address?

What happens if the insurer discovers that the insured's age was accidentally misstated on an application for an individual life insurance policy?

Benefits will be calculated according to how much coverage the premium paid would have purchased for the correct age. Signup and view all the answers

Proof of loss on a health insurance claim must be submitted to an insurer within _____ days after the insured's date of loss.

90 Signup and view all the answers

How long is the free-look period for a life insurance policy sold in Louisiana?

10 days Signup and view all the answers

Which of the following permits an insurance company to transact business in Louisiana?

Certificate of authority Signup and view all the answers

When the Commissioner of Insurance requests a producer's business records, they must be produced?

Upon request Signup and view all the answers

A licensed producer MUST be __________ by an insurer to be eligible for soliciting insurance contracts.

appointed Signup and view all the answers

To be classified as a small employer in Louisiana, an employer must employ?

1-50 employees Signup and view all the answers

Must a Louisiana insurance producer be age 21 to obtain a license?

False Signup and view all the answers

After an annuity has been in force for _____ year(s), it becomes incontestable.

2 Signup and view all the answers

All of the following actions are considered rebating EXCEPT?

Sharing commissions with other producers Signup and view all the answers

How often must the Commissioner examine each domestic insurance company?

Every 5 years Signup and view all the answers

Sharon the producer intentionally submitted a false statement in support of a claim. This is considered a form of?

fraud Signup and view all the answers

An existing life insurance policy is being replaced by a new one. A notice of replacement must be provided by the ________ to be signed by the applicant.

producer Signup and view all the answers

Maria the producer would like to advertise an annuity product on a highway billboard. Which of the following must be included in the advertisement?

Her name Signup and view all the answers

Charles is a producer who is licensed in Louisiana but resides in Mississippi. Charles is considered to be a(n)?

nonresident producer Signup and view all the answers

A life insurance applicant in Louisiana may backdate the application for up to ______ month(s).

6 Signup and view all the answers

A Medicare Supplement policy's outline of coverage MUST include a(n)?

Description of policy benefits Signup and view all the answers

An insurer has _____ days to file a notice of appointment to the Commissioner.

15 Signup and view all the answers

In order for a business entity to be licensed as a producer, a licensed producer must be designated as responsible for compliance with __________.

state insurance laws Signup and view all the answers

How often must an insurance producer's license in Louisiana be renewed?

Every two years Signup and view all the answers

After a disability policy has been in force for ____ year(s), it is considered incontestable.

3 Signup and view all the answers

An individual who has a contract with an insurance company to represent it is called a(n)?

Producer Signup and view all the answers

A nonresident producer from a state outside of Louisiana may become licensed in Louisiana IF a(n)?

reciprocal arrangement exists with the state of domicile Signup and view all the answers

What are the levels of coverage as defined by the Affordable Care Act?

Bronze, Silver, Gold, and Platinum Signup and view all the answers

Under the Louisiana Health Plan, comprehensive health benefits are provided to?

medically uninsurable residents Signup and view all the answers

A producer must notify the Commissioner within _____ days of a felony conviction.

30 Signup and view all the answers

Which of the following is NOT information found in a life insurance buyer's guide?

False Signup and view all the answers

A company that is authorized by the Commissioner to transact insurance business in Louisiana is called a(n)?

authorized insurer Signup and view all the answers

Which license is REQUIRED in order to solicit Long Term Care insurance in the State of Louisiana?

Health Insurance Producer License Signup and view all the answers

A domestic insurance company in Louisiana MUST?

be organized under Louisiana insurance laws Signup and view all the answers

Which of these is NOT considered a form of life insurance advertisement?

False Signup and view all the answers

Jim recently sold his life insurance policy under a viatical settlement contract. The proceeds of this contract could be subject to the claims of?

creditors Signup and view all the answers

A pre-existing condition is a condition for which medical advice or treatment was recommended by or received from a provider of health care service within _____ months preceding a healthy policy's effective date.

Six Signup and view all the answers

In Louisiana, a small employer may not consist of more than how many eligible employees?

50 Signup and view all the answers

A cease and desist order?

forbids a stated practice listed in the order Signup and view all the answers

An example of an Unfair Claims Settlement Practice is?

failing to promptly provide reasonable explanations for the denial of claims Signup and view all the answers

A business entity wishing to act as an insurance producer MUST?

obtain a producer's license Signup and view all the answers

After ____ years from date of issue, a policy can no longer be cancelled by the insurer for misstatements (except for fraud).

3 Signup and view all the answers

Which of these is NOT an Unfair Claims Settlement Practice?

False Signup and view all the answers

Individual health policies sold in Louisiana require dependent children coverage up to age?

26 Signup and view all the answers

How many days is a temporary producer's license valid?

180 Signup and view all the answers

An insurance producer decides to conduct business under an assumed name. The Commissioner MUST be notified of this change?

True Signup and view all the answers

Karen the producer pays for her client's initial premium payment as an incentive for purchase. This act is considered a(n)?

rebate Signup and view all the answers

Before a producer may sell, solicit, or negotiate insurance for an insurer, the producer must have a(n)?

appointment Signup and view all the answers

How long after its effective date will an individual life insurance policy become incontestable?

2 years Signup and view all the answers

Which entity regulates claim settlement practices?

state insurance departments Signup and view all the answers

What is the purpose of the Louisiana Life and Health Insurance Guaranty Association?

Ensures that claims filed against insolvent insurance companies will be paid Signup and view all the answers

All of the following are considered to be fraud EXCEPT?

Collecting an insurance charge that is less than what is required Signup and view all the answers

Which of the following permits an insurance company to transact business in Louisiana?

Certificate of Authority Signup and view all the answers

When a small employer health insurance plan is offered, it must be available?

to all eligible employees who apply Signup and view all the answers

An insurer may exclude preexisting conditions on a Medicare Supplement policy for ______ months.

6 Signup and view all the answers

When a producer is replacing an existing ordinary life insurance policy, the producer must take all of the following actions EXCEPT?

Obtain the beneficiary's signature Signup and view all the answers

All Medicare Supplement policies MUST contain which provision?

False Signup and view all the answers

An alien insurer?

is an insurer operating in the U.S. but headquartered outside the U.S. Signup and view all the answers

An Arkansas resident producer who would like to solicit insurance in Louisiana MUST obtain a nonresident license in Louisiana. Which of these is NOT a requirement for obtaining a nonresident license?

Pass Louisiana's state licensing exam Signup and view all the answers

Advertising regulations exist in order to?

demonstrate full and truthful disclosures to the public Signup and view all the answers

Long-term care policies sold in Louisiana may NOT exclude coverage for?

senile dementia Signup and view all the answers

A life insurance replacement transaction could result in a(n)?

surrender charge Signup and view all the answers

A dependent child may remain on a parent's health insurance plan beyond 26 if the child?

has a mental or physical handicap and remains dependent on the parent Signup and view all the answers

A common exclusion or limitation on a dental policy is?

endodontics Signup and view all the answers

In order for a business entity to be licensed as a producer, _______ is required.

a licensed producer must be designated as responsible for compliance with state insurance laws Signup and view all the answers

A producer license is NOT required when?

False Signup and view all the answers

An eligible employee can be excluded from group health coverage for up to _____ months if he/she is considered a 'late enrollee'.

18 Signup and view all the answers

A producer who sells most of his/her insurance policies to family members is said to be engaging in?

controlled business Signup and view all the answers

What is the MINIMUM benefit period that must be offered by a Long-Term Care policy?

12 months Signup and view all the answers

Under the Affordable Care Act, which of these plans is designed to provide coverage that is actuarially equivalent to 80% of the full actuarial value of the benefits provided under the plan?

Gold Signup and view all the answers

The required grace period for a life insurance policy sold in Louisiana is ____ days.

30 Signup and view all the answers

A policyowner has _____ days after policy delivery to return a major medical policy.

10 Signup and view all the answers

Kiara filled out a life insurance application and was given a policy illustration that showed future premiums being paid out of nonguaranteed values. This illustration MUST disclose that?

she may need to resume premium payments, depending on actual results Signup and view all the answers

An example of unfair discrimination would be?

charging different premiums for policyholders in the same risk classification Signup and view all the answers

Which of the following unfair trade practices involves a producer who makes malicious public statements regarding an insurer's financial condition?

defamation Signup and view all the answers

A viatical settlement broker may NOT?

False Signup and view all the answers

Terminally ill life insurance policyowners may sell their policy at a discount to a third party. This type of agreement is called a(n)?

viatical settlement Signup and view all the answers

Coverage for newborns under an accident and health plan MUST include coverage for?

birth abnormalities Signup and view all the answers

Study Notes

Louisiana Insurance Laws and Regulations

Prosthodontics: Dentistry branch dealing with replacement of missing parts.
Fair Credit Reporting Act: Protects consumers by regulating credit reporting and distribution practices.
Address Change Notification: Producers must submit address changes within 30 days.
Age Misstatement: If an insured's age is misstated, benefits will reflect the correct age's coverage equivalent.
Proof of Loss Submission: Required within 90 days for health insurance claims after the date of loss.
Free-Look Period: Life insurance policies in Louisiana have a 10-day free-look period.
Certificate of Authority: Necessary for an insurance company to conduct business in Louisiana.
Business Records Compliance: Producers must present their business records upon the Insurance Commissioner's request.
Producer Appointment: A licensed producer must be appointed by an insurer to solicit insurance contracts.
Small Employer Definition: Defined as having 1-50 employees in Louisiana.

Licensing and Compliance

Producer License Requirements: Age 21 is NOT a requirement for obtaining a Louisiana insurance producer license.
Incontestability Period: Annuities become incontestable after 2 years.
Rebating Exceptions: Sharing commissions with other producers is not considered rebating.
Commissioner Examination Frequency: Domestic insurance companies are examined every 5 years.
Fraudulent Claims: Intentionally false statements in claims by a producer are classified as fraud.

Policy Regulations and Practices

Replacement Policies: Producers must provide a notice of replacement for existing life insurance policies.
Annuity Advertisement Disclosure: Producers advertising annuities must include their name in the advertisements.
Nonresident Producers: Producers licensed in other states can operate in Louisiana if there’s a reciprocal licensing agreement.
Application Backdating: Life insurance applicants can backdate applications up to 6 months.
Medicare Supplement Policy: Must include a description of benefits in its outline of coverage.

Duties and Responsibilities

Appointment Notification: Insurers have 15 days to file a notice of appointment to the Commissioner.
Business Entity Licensing: A responsible licensed producer must be designated for compliance with insurance laws.
License Renewal Cycle: An insurance producer's license must be renewed every two years.
Incontestability for Disability Policies: These policies are considered incontestable after 3 years.
Producer Representation: An individual with a contract with an insurance company is termed a 'producer'.

Special Provisions and Consumer Protection

Health Benefits for Uninsurable Residents: The Louisiana Health Plan offers coverage for those deemed medically uninsurable.
Felony Conviction Notification: Producers must notify the Commissioner within 30 days of a felony conviction.
Life Insurance Buyer’s Guide: Must NOT contain legal action instructions against an insurance company.
Authorized Insurer: An insurer permitted by the Commissioner to conduct business in Louisiana.
Long-Term Care Insurance License: A Health Insurance Producer License is mandatory for soliciting Long-Term Care insurance.

Claims and Coverage Details

Grace Period Requirement: Life insurance policies require a 30-day grace period.
Coverage for Dependent Children: Individual health policies must cover dependent children up to age 26.
Temporary Producer's License Duration: Valid for 180 days.
Medicare Supplement Preexisting Conditions: Can be excluded for up to 6 months.
Unfair Claims Settlement Practices: Includes actions like failing to provide timely explanations for claim denials.

Fraud and Misconduct

Definition of Fraud: Includes actions like intentionally false statements but does NOT include charging below required premiums.
Maintaining Confidentiality: Producers who use assumed names are required to notify the Commissioner beforehand.
Control of Business Practice: Producers selling primarily to family members are engaging in controlled business, which could raise ethical concerns.

Additional Regulations

Viatical Settlements: Terminally ill policyowners can sell policies at a discount through viatical settlements, needing a license to engage in such transactions.
Coverage for Newborns: Health plans must cover birth defects or abnormalities for newborns.
Louisiana Life and Health Insurance Guaranty Association: Ensures that claims against insolvent insurance firms will be honored.

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Test your knowledge of Louisiana laws and rules with these flashcards. Each card presents key definitions and concepts that are vital for understanding the legal framework in the state. Perfect for students and professionals alike!