General knowledge · Section IX · Life, Accident and Health only
Field underwriting procedures
What the agent does in the field when selling health insurance: completing the application, explaining sources of insurability and HIPAA privacy, collecting the first premium and giving a receipt, submitting the application, delivering the policy, explaining it, and replacement.
Questions on the exam
- Life, Accident and Health: 8 questions
- Life Agent: Not on this exam
Life, Accident and Health exam
What the official outline lists
- Completing the application
- Explaining sources of insurability and HIPAA privacy information
- Initial premium payment and receipt
- Submitting application to company for underwriting
- Policy delivery
- Explaining policy, provisions, riders, exclusions, ratings
- Replacement
- Contract law
Practice questions
Choose your answer, then open “Show the answer” to see why each option is right or wrong and the exact source text.
1. What must be true before an insured may be bound by a statement made in the application for an individual accident and health insurance policy?
- A copy of the application is attached to or endorsed on the policy
- The insured has paid the first premium in full
- The agent has delivered a separate summary of the answers
- The application has been filed with the department
Show the answer
Correct answer: A. A copy of the application is attached to or endorsed on the policy
According to TIC §1201.273, an insured may not be bound by a statement made in the application unless a copy of the application is attached to or endorsed on the policy as a part of the policy when issued.
Why the other options are wrong
- B. TIC §1201.273 conditions binding the insured on attaching or endorsing a copy of the application, not on premium payment.
- C. TIC §1201.273 requires a copy of the application itself to be part of the policy, not a separate summary from the agent.
- D. TIC §1201.273 requires the application copy to be attached to or endorsed on the policy; it does not mention filing with a department.
An insured may not be bound by a statement made in an application for an individual accident and health insurance policy unless a copy of the application is attached to or endorsed on the policy as a part of the policy when issued.
2. An insurer issues an individual accident and health policy that is a single premium nonrenewable policy. A new agent asks whether the policy must include the returnable-policy notice described in Texas Insurance Code §1201.058. What is the correct answer?
- No, because §1201.058 does not apply to a single premium nonrenewable policy
- Yes, because the notice is required in every individual accident and health policy
- Yes, but only if the policy is delivered by mail
- No, because the notice is required only in group policies
Show the answer
Correct answer: A. No, because §1201.058 does not apply to a single premium nonrenewable policy
According to TIC §1201.058(d), the section does not apply to a single premium nonrenewable policy, so the notice requirement does not reach it.
Why the other options are wrong
- B. Subsection (d) creates an exception for single premium nonrenewable policies.
- C. The exception does not depend on the delivery method; the section does not apply to this type of policy.
- D. Section 1201.058(a) concerns individual policies; the exception is for single premium nonrenewable policies, not a group-only rule.
This section does not apply to a single premium nonrenewable policy.
3. Under 28 TAC §3.3309(c), an agent selling a Medicare supplement policy must list other health insurance policies or coverages sold to the applicant that are no longer in force if they were sold within what period?
- The past five years
- The past six months
- The past twelve months
- The past ten years
Show the answer
Correct answer: A. The past five years
According to 28 TAC §3.3309(c), agents shall list any other health insurance policies or coverages sold to the applicant that are still in force, and any sold to the applicant in the past five years that are no longer in force.
Why the other options are wrong
- B. The rule reaches back five years for coverages no longer in force, not six months.
- C. The rule reaches back five years for coverages no longer in force, not twelve months.
- D. The rule's look-back is five years, not ten.
Agents shall list the following: (1) any other health insurance policies or coverages sold to the applicant which are still in force; and (2) any other health insurance policies or coverages sold to the applicant in the past five years which are no longer in force.
4. For purposes of TIC §1103.053, how is a "relative" of the insured defined?
- An individual related to the insured within the third degree by consanguinity or affinity
- An individual related to the insured within the first degree by consanguinity only
- An individual related to the insured within the second degree by affinity only
- An individual related to the insured within the fourth degree by consanguinity or affinity
Show the answer
Correct answer: A. An individual related to the insured within the third degree by consanguinity or affinity
According to TIC §1103.053(d), "relative" means an individual who is related to the insured within the third degree by consanguinity or affinity as determined under Chapter 573, Government Code.
Why the other options are wrong
- B. TIC §1103.053(d) reaches the third degree and includes affinity, not only the first degree by consanguinity.
- C. TIC §1103.053(d) reaches the third degree by consanguinity or affinity, not only the second degree by affinity.
- D. TIC §1103.053(d) stops at the third degree, not the fourth.
(d) In this section, "relative" means an individual who is related to the insured within the third degree by consanguinity or affinity as determined under Chapter 573, Government Code.
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Key flashcards
Front and back, as in the app.
- Individual A&H policy: when may the insured be bound by a statement in the application?
- Only if a copy of the application is attached to or endorsed on the policy when issued (TIC §1201.273). (Texas Insurance Code §1201.273, “Binding statements”)
Terms on this topic
- Renewable — Renovable
- Application — Solicitud
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