Life and Health California Exam California Health and Life Insurance Regulations 2 — Questions and Answers
Question 1: California Insurance Code Section 10291.5 prohibits life and disability insurers from unfairly discriminating based on which of the following?
- Applicant's occupation
- Applicant's geographic location within California
- Applicant's HIV antibody test results, marital status, or sexual orientation (Correct answer)
- Applicant's tobacco use history
Correct answer: Applicant's HIV antibody test results, marital status, or sexual orientation
California law specifically prohibits discrimination in life and disability insurance underwriting based on HIV status, marital status, or sexual orientation.
Question 2: Under California's 'Independent Medical Review' (IMR) system, a patient may request an IMR when:
- Their claim exceeds $10,000
- Their health plan denies, modifies, or delays care based on medical necessity (Correct answer)
- They disagree with their physician's treatment recommendation
- They want to change their primary care physician
Correct answer: Their health plan denies, modifies, or delays care based on medical necessity
California's IMR process allows patients to have disputed medical necessity decisions reviewed by independent medical experts at no cost, overriding the health plan's decision if found appropriate.
Question 3: Under California's 'timely access to care' standards for HMOs, urgent care appointments must be available within:
- 24 hours
- 48 hours (Correct answer)
- 72 hours
- 7 days
Correct answer: 48 hours
California's timely access regulations require HMOs to provide urgent care appointments within 48 hours of a patient's request.
Question 4: The California Life and Health Insurance Guarantee Association (CLHIGA) protects policyholders of insolvent insurers up to what limit for individual health insurance claims?
- $100,000
- $200,000
- $300,000 (Correct answer)
- $500,000
Correct answer: $300,000
CLHIGA provides protection of up to $300,000 for individual health insurance claims when a member insurer becomes insolvent.
Question 5: Under California law, a 'replacement' transaction in life insurance occurs when a new policy is purchased and within 5 years an existing policy is:
- Renewed at its anniversary date
- Lapsed, surrendered, converted, reduced, or used as collateral for the new policy (Correct answer)
- Subject to a policy loan
- Transferred to a new owner
Correct answer: Lapsed, surrendered, converted, reduced, or used as collateral for the new policy
California defines a replacement as a transaction where a new policy is purchased and within 5 years an existing life policy is lapsed, surrendered, reduced, converted, assigned, or used as collateral.
Question 6: Under California law, an insurance agent who receives a commission for placing insurance that the agent wrote also as the insurer's underwriter is engaged in:
- Twisting
- Churning
- Rebating
- A conflict of interest requiring disclosure (Correct answer)
Correct answer: A conflict of interest requiring disclosure
When an agent acts in a dual capacity—both as the placing agent and underwriter—they must disclose this conflict of interest to the applicant under California insurance law.
Life and Health California Exam California Health and Life Insurance Regulations 2
California Insurance Code Section 10291.5 prohibits life and disability insurers from unfairly discriminating based on which of the following?