VALID STUDY INSURANCE LICENSING OK-LIFE-ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER QUESTIONS - TEST OK-LIFE-ACCIDENT-AND-HEALTH-OR-SICKNESS-PRODUCER TUTORIALS

Valid Study Insurance Licensing Ok-Life-Accident-and-Health-or-Sickness-Producer Questions - Test Ok-Life-Accident-and-Health-or-Sickness-Producer Tutorials

Valid Study Insurance Licensing Ok-Life-Accident-and-Health-or-Sickness-Producer Questions - Test Ok-Life-Accident-and-Health-or-Sickness-Producer Tutorials

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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Exam Sample Questions (Q31-Q36):

NEW QUESTION # 31
A group major medical policy is written with a $1,000 deductible, 80/20 coinsurance, and an out-of-pocket maximum of $3,000. The insured goes into the hospital for a covered procedure. The total cost of the procedure is $5,000. How much does the insured have to pay towards the $5,000 total?

  • A. $1,800
  • B. $3,000
  • C. $1,000
  • D. $5,000

Answer: B

Explanation:
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.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Accident and Health Insurance).
Oklahoma Insurance Department, Title 36 O.S. § 6060.3 (health insurance policy provisions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.


NEW QUESTION # 32
Generally, all of the following apply to group life insurance EXCEPT

  • A. evidence of insurability is not required.
  • B. the insured pays a higher rate for the group policy.
  • C. individual underwriting is not required.
  • D. it is priced according to the risk factors of the group.

Answer: B

Explanation:
Group life insurance is typically provided through an employer or organization, covering multiple individuals under a single master policy. It does not require individual underwriting or evidence of insurability for most members, and premiums are based on the group's overall risk factors (e.g., age, occupation), as outlined in Oklahoma's Insurance Code (Title 36 O.S. § 4101 et seq.). A key advantage is that group policies generally havelower ratesper individual compared to individual policies due to risk pooling, making the statement that insureds pay a higher rate incorrect.
* Option A: Incorrect (applies). Individual underwriting is not required; the group is assessed as a whole.
* Option B: Incorrect (applies). Evidence of insurability is typically not required for standard group coverage.
* Option C: Incorrect (applies). Pricing is based on the group's risk factors.
* Option D: Correct (does not apply). Group life insurance rates are generally lower, not higher, than individual policies.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Life Insurance Provisions).
Oklahoma Insurance Department, Title 36 O.S. § 4101 et seq. (group life insurance provisions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.


NEW QUESTION # 33
Failure of an insurance producer to complete the continuing education requirements may result in

  • A. revocation of license.
  • B. nonrenewal of license.
  • C. an additional 20 continuing education hours the following year.
  • D. a felony conviction.

Answer: B

Explanation:
Oklahoma requires insurance producers to complete 24 hours of continuing education (CE) every 2 years, including 3 hours of ethics and 2 hours of legislative updates (Title 36 O.S. § 1435.29; O.A.C. 365:25-3-1).
Failure to meet CE requirements results innonrenewal of the license, as the Oklahoma Insurance Department will not renew until CE is completed. Revocation or felony charges apply to more serious violations (e.g., fraud), not CE non-compliance.
* Option A: Incorrect. There is no provision for additional CE hours as a penalty; CE must be completed for renewal.
* Option B: Incorrect. CE failure is not a felony; it's an administrative issue.
* Option C: Correct. Nonrenewal of the license occurs if CE requirements are not met.
* Option D: Incorrect. Revocation is for severe violations, not CE non-compliance.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: State- Specific Knowledge - Licensing Requirements).
Oklahoma Insurance Department, Title 36 O.S. § 1435.29; O.A.C. 365:25-3-1 (continuing education).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.


NEW QUESTION # 34
A license is NOT required when you are

  • A. selling insurance.
  • B. soliciting insurance.
  • C. providing referrals.
  • D. negotiating insurance.

Answer: C

Explanation:
In Oklahoma, an insurance producer license is required for activities defined astransacting insurance, which includes selling, soliciting, or negotiating insurance contracts (Title 36 O.S. § 1435.2).Providing referrals(e.
g., passing along contact information without discussing insurance products) does not constitute transacting insurance and does not require a license, provided no compensation is tied to the sale.
* Option A: Correct. Providing referrals does not require a license if it avoids solicitation or negotiation.
* Option B: Incorrect. Selling insurance requires a producer license.
* Option C: Incorrect. Negotiating insurance requires a producer license.
* Option D: Incorrect. Soliciting insurance requires a producer license.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: State- Specific Knowledge - Licensing Requirements).
Oklahoma Insurance Department, Title 36 O.S. § 1435.2 (definition of transacting insurance).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.


NEW QUESTION # 35
An insured individual who just turned 67 years old is still working and is a member of the group health insurance plan provided by his employer, which has 18 insured employees. In this case, Medicare will MOST likely

  • A. act as a secondary insurer and pay claims not completely covered by the group health insurance.
  • B. require the individual to cancel his group insurance.
  • C. act as the primary insurer and pay claims up to the limit of the policy.
  • D. not cover any claims to protect against overinsurance.

Answer: A

Explanation:
For individuals aged 65 or older who are still working and covered by an employer's group health plan, Medicare's role depends on the employer's size. For employers with fewer than 20 employees (as in this case with 18 employees), Medicare is typically theprimary payer, and the group health plan is secondary.
However, if the individual is actively working and enrolled in the group plan, the group plan is primary, and Medicare acts as thesecondary payer, covering claims not fully paid by the group plan, as per Medicare Secondary Payer (MSP) rules.
* Option A: Incorrect. The group health plan is primary for active employees, not Medicare.
* Option B: Correct. Medicare acts as the secondary insurer, paying claims not fully covered by the group plan.
* Option C: Incorrect. Medicare does cover claims as a secondary payer, not denying them to prevent overinsurance.
* Option D: Incorrect. Medicare does not require cancellation of group insurance; individuals can maintain both.
This question aligns with the Prometric content outline under "Medicare," which covers Medicare's coordination with group health plans.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Medicare).
Oklahoma Insurance Department, Title 36 O.S. § 6217 (Medicare supplement insurance).
Medicare Secondary Payer Rules, 42 CFR § 411.100 et seq.


NEW QUESTION # 36
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