Selected Ok-Life-Accident-and-Health-or-Sickness-Producer Life, Accident, and Health Questions Answers

To calculate the insured’s payment:

Deductible: The insured pays the first $1,000 of the $5,000 procedure cost.

Remaining cost: $5,000 - $1,000 = $4,000.

Coinsurance: The policy has 80/20 coinsurance, so the insurer pays 80% ($3,200) and the insured pays 20% ($800) of the $4,000.

Total paid by insured: $1,000 (deductible) + $800 (coinsurance) = $1,800.

Out-of-pocket maximum: The policy’s $3,000 out-of-pocket maximum caps the insured’s total payments. Since $1,800 is less than $3,000, the insured pays $1,800. However, the question asks for the total paid “towards the $5,000,” and the out-of-pocket maximum of $3,000 suggests a cap on total liability for covered expenses. In this context, the correct interpretation is that the insured’s payment is capped at the out-of-pocket maximum if applicable, but standard calculation yields $1,800, and the answer options suggest a possible intent for the maximum.

Upon review, the correct calculation yields $1,800 (Option C), but the out-of-pocket maximum of $3,000 (Option B) may be the intended answer if the question implies the maximum liability. Given the standard insurance calculation,Option C ($1,800)is mathematically correct, butOption B ($3,000)aligns with the out-of-pocket maximum as a potential cap. Since the calculation is clear, we selectC.

Corrected Answer: C

Explanation of Calculation:

Deductible: $1,000.

Coinsurance: 20% of $4,000 = $800.

Total: $1,000 + $800 = $1,800.

The out-of-pocket maximum ($3,000) is not reached, so the insured pays $1,800.

Option A: Incorrect. The insured does not pay the full $5,000 due to insurer contributions.

Option B: Incorrect. The $3,000 out-of-pocket maximum is not reached; the calculated payment is $1,800.

Option C: Correct. The insured pays $1,800 based on the deductible and coinsurance.

Option D: Incorrect. The $1,000 deductible alone does not account for coinsurance.

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

Thefree-look provision, required in Oklahoma for life and health insurance policies (Title 36 O.S. § 4007 for life, § 4405 for health), allows the policyowner to return the policy within a specified period (typically 10 days for life, 30 days for Medigap) from receipt for afull refundof premiums paid, no questions asked. This protects consumers by allowing time to review the policy.

Option A: Incorrect. The insurer cannot rescind during the free-look period; that right applies to contestability.

Option B: Incorrect. The refund is full, not partial, during the free-look period.

Option C: Correct. The policyowner can return the policy for a full refund within the specified period.

Option D: Incorrect. The insurer cannot unilaterally alter the policy during the free-look period.

This question aligns with the Prometric content outline under “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers free-look provisions.

When applying for a life or health insurance policy in Oklahoma, the insurer’s underwriting process typically involves reviewing the applicant’smedical historyto assess risk, as permitted under Title 36 O.S. § 1204. This may include questions about personal and family health, but not all family illnesses need to be reported unless specifically requested. Physical examinations are not always required, and undiagnosed conditions are not expected to be recorded; the applicant must disclose known conditions truthfully.

Option A: Incorrect. Reporting all family illnesses is not mandatory unless relevant to underwriting questions.

Option B: Incorrect. A physical exam is not always required; it depends on the insurer’s underwriting guidelines.

Option C: Incorrect. Undiagnosed conditions cannot be recorded; only known conditions are reported.

Option D: Correct. The insured’s medical history may be reviewed and reported during underwriting.

Whole life insurance policies accumulate cash value over time, which policyowners can borrow against. Typically, cash value begins to accrue immediately, but sufficient value for a loan is often available after1 year, depending on the policy’s terms and premium payments. Oklahoma law (Title 36 O.S. § 4029) requires nonforfeiture benefits, including access to cash value, but does not specify a minimum time; insurer practices generally allow loans after 1 year when cash value is meaningful.

Option A: Incorrect. Policyowners can borrow against cash value once it accumulates.

Option B: Correct. Loans are typically available after 1 year, as cash value is sufficient.

Option C: Incorrect. 2 years is not a standard requirement; loans are often available sooner.

Option D: Incorrect. 3 years is excessive; most policies allow loans earlier.

This question falls under the Prometric content outline section on “Provisions, Options, Exclusions, Riders, Clauses, and Rights,” which covers cash value loans.