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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Exam Sample Questions (Q49-Q54):

NEW QUESTION # 49
Upon surrender of a whole life insurance policy, which has been in force for AT LEAST 3 full years, and within 60 days after the date the premium payment is due and unpaid, the insurer will

A. pay a cash surrender value.
B. extend the grace period.
C. refund premium.
D. reimburse all paid premiums.

Answer: A

Explanation:
Under Oklahoma's Standard Nonforfeiture Law (Title 36 O.S. § 4029), a whole life insurance policy in force for at least 3 years that is surrendered due to non-payment of premiums within 60 days of the due date entitles the policyowner to acash surrender value, provided sufficient cash value has accumulated. This is one of the nonforfeiture options, alongside extended term or reduced paid-up insurance.
* Option A: Correct. The insurer pays a cash surrender value upon surrender.
* Option B: Incorrect. The grace period (typically 31 days) cannot be extended beyond policy terms.
* Option C: Incorrect. Reimbursing all premiums is not a nonforfeiture option.
* Option D: Incorrect. Refunding the premium is not applicable; cash value is paid.
:
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. § 4029 (nonforfeiture law).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 50
A new mother is guaranteed a 48-hour hospital stay after a regular delivery of a child under which federal law and regulations for group health insurance?

A. HIPAA.
B. Medicaid.
C. ERISA.
D. COBRA.

Answer: A

Explanation:
TheHealth Insurance Portability and Accountability Act (HIPAA)includes provisions from the Newborns' and Mothers' Health Protection Act (NMHPA) of 1996, which mandates that group health plans cannot restrict hospital stays for childbirth to less than 48 hours for a vaginal delivery or 96 hours for a cesarean section. This federal law applies to group health insurance plans in Oklahoma and ensures minimum coverage for maternity care.
* Option A: Incorrect. COBRA allows continuation of group health coverage after certain events but does not mandate maternity stay durations.
* Option B: Incorrect. Medicaid is a state-federal program for low-income individuals, not a law mandating hospital stays for childbirth.
* Option C: Correct. HIPAA, via the NMHPA, guarantees the 48-hour hospital stay for regular deliveries.
* Option D: Incorrect. ERISA governs employee benefit plans but does not specifically address maternity hospital stays.
This question is part of the Prometric content outline under "State Insurance Statutes, Rules, and Regulations," which covers federal and state laws affecting health insurance.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: State- Specific Knowledge - Oklahoma Insurance Statutes).
Oklahoma Insurance Department, Title 36 O.S. § 6060.9 (maternity benefits).
HIPAA, Newborns' and Mothers' Health Protection Act, 29 U.S.C. § 1185.

NEW QUESTION # 51
Which of the following describes the gatekeeper strategy used by HMOs?

A. The refusal of coverage for patients with preexisting conditions.
B. The use of supplemental services on an additional cost basis.
C. The emphasis on preventing enrollees from using patient services.
D. The process of obtaining referrals to specialists from primary care physicians.

Answer: D

Explanation:
In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO's cost-containment model.
* Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.
* Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.
* Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.
* Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.
This question falls under the Prometric content outline section on "Health Providers and Products," which covers HMO structures and strategies.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Health Providers and Products).
Oklahoma Insurance Department, Title 36 O.S. § 652 et seq. (managed care regulations).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 52
Both husband and wife have group health insurance through their employers. Each spouse is covered under both policies. Under the coordination of benefits provision, how will the benefits be paid if the wife incurs a
$400 covered loss?

A. The primary insurer will pay as much of the claim as the policy permits, then the secondary insurer will pay the remainder of the claim as its policy permits.
B. The husband's insurer will pay as much of the claim as the policy permits, then the wife's insurer will pay the remainder.
C. Only the primary insurer will pay expenses toward the loss under the limits of the plan.
D. Only the wife's insurer will pay expenses toward the loss.

Answer: A

Explanation:
Thecoordination of benefits (COB)provision, as regulated in Oklahoma (O.A.C. 365:10-5-4), prevents overinsurance when an individual is covered by multiple health plans. For spouses, theprimary insureris typically the wife's employer plan for her claims, as it covers her as an employee. Thesecondary insurer(the husband's plan) pays any remaining covered expenses up to its policy limits, ensuring the total payment does not exceed the loss.
* Option A: Incorrect. Both insurers may pay under COB, not just the wife's insurer.
* Option B: Incorrect. The secondary insurer may also pay if the primary does not cover the full loss.
* Option C: Correct. The primary insurer (wife's plan) pays first, and the secondary insurer (husband's plan) pays the remainder, per COB rules.
* Option D: Incorrect. The husband's insurer is secondary, not primary, for the wife's claim.
This question aligns with the Prometric content outline under "Provisions, Options, Exclusions, Riders, Clauses, and Rights," which covers coordination of benefits.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Accident and Health Insurance).
Oklahoma Insurance Department, O.A.C. 365:10-5-4 (coordination of benefits).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 53
An agent's underwriting duties include which of the following?

A. Declining or accepting an application.
B. Completing all applications and collecting initial premiums.
C. Setting premium amounts.
D. Issuing the policy.

Answer: B

Explanation:
An insurance agent, acting as afield underwriter, is responsible forcompleting applications accuratelyand collecting initial premiums, ensuring the information provided is truthful and complete for the insurer's underwriting process, as per Oklahoma's regulations (Title 36 O.S. § 1435.2). Setting premiums, accepting
/declining applications, and issuing policies are duties of the insurer's underwriting department, not the agent.
* Option A: Incorrect. Setting premiums is the insurer's responsibility, not the agent's.
* Option B: Correct. Agents complete applications and collect initial premiums as part of field underwriting.
* Option C: Incorrect. Declining or accepting applications is done by the insurer's underwriters.
* Option D: Incorrect. Issuing policies is the insurer's role, not the agent's.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Underwriting).
Oklahoma Insurance Department, Title 36 O.S. § 1435.2 (producer responsibilities).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 54
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