TENNESSEE EXAMINATION CONTENT OUTLINES Effective February 1, 2016

Transcription

1 TENNESSEE EXAMINATION CONTENT OUTLINES Effective February 1, 2016 References are to Tennessee Code Titles 36 (Domestic Relations) and 56 (Insurance) PearsonVue s Life Agent exam consists of a 105-minute exam on a total of 68 scoreable questions plus 14 pretest questions. LIFE-GENERAL KNOWLEDGE CONTENT OUTLINE Product Knowledge, Terms, and Concepts (50 scoreable questions plus 10 pretest questions) I. TYPES OF POLICIES...12 A. Traditional whole life products 1. Ordinary w hole life Limited-pay and single-premium life , B. Interest/market-sensitive/adjustable life products 1. Universal life Variable w hole life Variable universal life Interest-sensitive whole life Indexed life C. Term life 1. Types a. Level b. Decreasing c. Return of premium d. Annually renew able Special features a. Renew able b. Convertible D. Annuities 1. Single and flexible premium , , Immediate and deferred Fixed and variable 12.7, Indexed E. Combination plans and variations 1. Joint life Survivorship life (second to die) II. POLICY RIDERS, PROVISIONS, OPTIONS, AND EXCLUSI ONS...18 A. Policy riders 1. Waiver of premium and w aiver of monthly deduction , Guaranteed insurability Payor benefit Accidental death and/or accidental death and dismemberment Term riders Other insureds Long-term care Return of premium

2 B. Policy provisions and options 1. Entire contract Insuring clause Free look Consideration Ow ner s rights Beneficiary designations a. Primary and contingent b. Revocable and irrevocable c. Common disaster d. Minor beneficiaries Premium payment a. Modes 4.6.3, b. Grace period c. Automatic premium loan d. Level or flexible 4.6.3, Reinstatement Policy loans, w ithdrawals, partial surrenders 9.3.9, Nonforfeiture options Dividends and dividend options (e.g., participating, non-participating) 11.5, Incontestability Assignments Suicide Misstatement of age and gender Settlement options Accelerated death benefits C. Policy exclusions III. COMPLETING THE APPLICATION, UNDERWRITING, AND DELIVERI NG T HE POLICY...12 A. Completing the application 1. Required signatures Changes in the application Consequences of incomplete applications Warranties and representations Collecting the initial premium and issuing the receipt 7.2, Replacement Disclosures at point of sale (i.e., HIPAA, HIV consent) , USA PATRIOT Act/anti-money laundering B. Underwriting 1. Insurable interest Medical information and consumer reports , , , , , Fair Credit Reporting Act Risk classification Stranger/Investor-originated life insurance (STOLI/IOLI) State Law Supplement C. Delivering the policy 1. When coverage begins Explaining the policy and its provisions, riders, exclusions, and ratings to the client D. Contract law 1. Elements of a contract Unique aspects of the insurance contract a. Conditional b. Unilateral c. Adhesion d. Aleatory

3 IV. TAXES, RETIREMENT, AND OTHER INSURANCE CONC EPTS...8 A. Third-party ownership 5.3 B. Viatical Settlements 8.9 C. Life Settlements 8.9 D. Group life insurance 1. Conversion privilege Contributory vs. noncontributory E. Retirement plans 1. Tax-qualified plans Nonqualified plans 15.2 F. Life insurance needs analysis/suitability Personal insurance needs Business insurance needs a. Key person b. Buy sell G. Social Security benefits , F. Tax treatment of insurance premiums, proceeds, dividends 1. Individual life Group life Modified endow ment contracts (MECs) LIFE-TENNESSEE SPECIFIC CONTENT OUTLINE State Laws, Rules, and Regulations (18 scoreable questions plus 4 pretest questions) I. TENNESSEE LAWS, AND DEPARTMENTAL RULES COMMON TO LIFE, ACCIDENT AND HEALTH, PROPERTY AND CASUALTY INSURANC E Ref: through A. Powers of Commissioner Hearings and judicial review State Law Supplement Ref: Investigations State Law Supplement Ref: Regulatory authority State Law Supplement Ref: through Penalties State Law Supplement Ref: (e), B. Definitions Insurance producer State Law Supplement 2. Business entity State Law Supplement 3. Limited lines producer State Law Supplement 4. Unauthorized insurer State Law Supplement Ref: Compensation State Law Supplement Ref: Fiduciary State Law Supplement Ref: Domestic and foreign insurance companies State Law Supplement Ref: C. License requirements Ref: ; ; Insurance producer State Law Supplement Ref: Dept. Rule ; ; ; Agency contracts/termination State Law Supplement 3

4 Ref: ; Resident/nonresident State Law Supplement Ref: ; Exceptions State Law Supplement Ref: ; ; a. Licenses b. Examination 5. Prelicensing education State Law Supplement Ref: ; Dept. Rule Temporary license State Law Supplement Ref: License renew al State Law Supplement Ref: General requirements State Law Supplement Ref: , Continuing education State Law Supplement Ref: Dept. Rule ; D. License suspension/revocation General provisions State Law Supplement Ref: , , Notice State Law Supplement Ref: E. Unfair practices...4 Ref: , False advertising State Law Supplement 2. Defamation State Law Supplement 3. Boycotting State Law Supplement 4. Unfair discrimination State Law Supplement 5. Rebating State Law Supplement 6. Unfair claims settlement practices State Law Supplement Ref: Other topics State Law Supplement F. Life and Health Guaranty Association Ref: through 220 State Law Supplement II. TENNESSEE LAWS AND DEPARTMENTAL RULES PERTINENT TO LIFE I NSURANC E ONLY...4 A. Required provisions State Law Supplement Ref: B. Definitions State Law Supplement Ref: Dept. Rule , C. Disclosure requirements State Law Supplement Ref: Dept. Rule D. General rules State Law Supplement Ref: Dept. Rule E. Re placement Ref: Dept. Rule Exemptions State Law Supplement Ref: Dept. Rule Duties of producers State Law Supplement Ref: Dept. Rule

5 PearsonVue s Accident and Health Agent exam consists of a 105-minute exam on a total of 68 scoreable questions plus 14 pretest questions. HEALTH-GENERAL KNOWLEDGE CONTENT OUTLINE Product Knowledge, Terms, and Concepts (50 scoreable questions plus 10 pretest questions) I. TYPES OF POLICIES...14 A. Disability income 1. Individual disability income policy Business overhead expense policy Business disability buyout policy Group disability income policy Key employee policies B. Accidental death and dismemberment C. Medical expense insurance 1. Basic hospital, medical, and surgical policies 20.3, , Major medical policies Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Point-of-service (POS) plans Flexible spending accounts (FSAs) High deductible health plans (HDHPs) and related health savings accounts (HSAs) , D. Medicare supplement policies 23.5 E. Group insurance 1. Differences between individual and group contracts General characteristics COBRA F. Individual/Group Long Term Care (LTC) 24.4, G. Other policies 1. Dental Vision Cancer Critical illness or specified disease Worksite (employer-sponsored) Hospital indemnity Short-term medical State Law Supplement 8. Accident II. POLICY PROVISIONS, CLAUSES, AND RIDERS A. Mandatory and optional provisions 1. Entire contract Time limit on certain defenses (incontestable) Grace period Reinstatement Notice of claim Claim forms Proof of loss Time of payment of claims Payment of claims Physical examination and autopsy Legal actions Change of beneficiary Misstatement of age or sex

6 14. Change of occupation Illegal occupation Relation of earnings to insurance B. Other provisions and clauses 1. Insuring clause Free look Consideration clause Probationary period , Elimination period , Waiver of premium , , Exclusions and limitations , 19.6, , 20.6, , Preexisting conditions , , Coinsurance Deductibles Eligible expenses Copayments , Pre-authorizations and prior approval requirements , Usual, reasonable, and customary (URC) charges Lifetime, annual, or per cause maximum benefit limits C. Riders 1. Impairment/exclusions Guaranteed insurability D. Rights of renewability 1. Noncancellable Cancellable Guaranteed renew able III. SOCIAL INSURANCE...3 A. Medicare (Parts A, B, C, D) 23.3, 23.4, 23.6, 23.7 B. Medicaid 23.9 C. Social Security benefits IV. OTHER INSURANCE CONCEPTS...4 A. Total, partial, and residual disability , , B. Ow ner s rights C. Dependent children benefits D. Primary and contingent beneficiaries E. Modes of premium payments 4.6.3, F. Nonduplication and coordination of benefits (e.g., primary vs. excess) G. Occupational vs. nonoccupational H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.) 25.3, 25.4 I. Managed care 16.5 J. Workers compensation K. Subrogation 20.1 V. FIELD UNDERWRITING PROCEDURES...9 A. Completing the application 4.4.3,

7 B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.) , 4.4.2, C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.) , , D. Submitting application (and initial premium if collected) to company for underwriting 4.4, E. Policy delivery 17.4 F. Explaining policy and its provisions, riders, exclusions, and ratings to clients 17.4 G. Replacement 17.6 H. Contract law 1. Elements of a contract Insurable interest Warranties and representations Unique aspects of the health contract a. Conditional b. Unilateral c. Adhesion d. Aleatory ACCIDENT AND HEALTH TENNESSEE SPECIFIC CONTENT OUTLINE State Laws, Rules, and Regulations (18 scoreable questions plus 4 pretest questions) I. TENNESSEE LAWS, AND DEPARTMENTAL RULES COMMON TO LIFE, ACCIDENT AND HEALTH, PROPERTY AND CASUALTY INSURANC E...14 Ref: through A. Pow ers of Commissioner 2 1. Hearings and judicial review State Law Supplement Ref: Investigations State Law Supplement Ref: Regulatory authority State Law Supplement Ref: through Penalties State Law Supplement Ref: (e), B. Definitions 3 1. Insurance producer State Law Supplement 2. Business entity State Law Supplement 3. Limited lines producer State Law Supplement 4. Unauthorized insurer State Law Supplement Ref: Compensation State Law Supplement Ref: Fiduciary Ref: Domestic and foreign insurance companies State Law Supplement Ref: C. License requirements 3-4 7

8 Ref: , , Insurance producer State Law Supplement Ref: Dept. Rule ; ; ; Agency contracts/termination State Law Supplement Ref: ; Resident/nonresident State Law Supplement Ref: ; Exceptions State Law Supplement Ref: ; ; a. Licenses b. Examination 5. Prelicensing education State Law Supplement Ref: ; Dept. Rule Temporary license State Law Supplement Ref: License renew al State Law Supplement Ref: General requirements State Law Supplement Ref: , Continuing education State Law Supplement Ref: Dept. Rule ; D. License suspension/revocation 1 1. General provisions State Law Supplement Ref: , , Notice State Law Supplement Ref: E. Unfair practices 4 Ref: , False advertising State Law Supplement 2. Defamation State Law Supplement 3. Boycotting State Law Supplement 4. Unfair discrimination State Law Supplement 5. Rebating State Law Supplement 6. Unfair claims settlement practices State Law Supplement Ref: Other topics State Law Supplement F. Life and Health Guaranty Association 0-1 Ref: through 220 State Law Supplement II. TENNESSEE LAWS AND DEPARTMENTAL RULES PERTINENT TO ACCIDENT AND HEALTH INSURA NCE ONLY...4 A. Required provisions State Law Supplement Ref: , B. Policy cancellation, renewal State Law Supplement Ref: , 126, C. Group policies State Law Supplement Ref: , 202, , , D. Blanket or franchise school insurance State Law Supplement Ref: , 2324 E. School accident coverage State Law Supplement Ref: , 2325 F. Medicare supplement insurance State Law Supplement Ref: ; Dept. Rule

9 1. Policy terms/definitions State Law Supplement Ref: Dept. Rule , Prohibited policy provisions State Law Supplement Ref: Dept. Rule Minimum standards State Law Supplement Ref: Dept. Rule , Eligibility Ref: ; Dept. Rule G. Long-term care (LTC) State Law Supplement Ref: ; ; Rule H. Mandated coverages State Law Supplement Ref I. External review State Law Supplement Ref: , 116 9