Practice Free Virginia-Life-Annuities-and-Health-Insurance Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Exam Questions Answers With Explanation

A variable life insurance policy is considered a securities product because its cash value is invested in separate accounts that fluctuate based on market performance. Policyowners assume investment risk, and cash values are not guaranteed beyond any stated minimum death benefit. Because of this market exposure, variable life insurance is regulated under both insurance and securities laws. Agents selling variable life policies must hold appropriate insurance licenses and securities registrations. The other policy types listed are traditional insurance products and do not involve direct investment in securities. Variable life is the only option that combines life insurance protection with securities-based investment components.

ADLs (Activities of Daily Living) in long-term care insurance typically include dressing, eating, bathing, transferring (moving from one place to another), and toileting. These are fundamental tasks that individuals need to perform every day to live independently. If a person is unable to perform a certain number of ADLs, they may qualify for benefits under a long-term care insurance policy.

The Bureau of Insurance has the authority to examine a licensee's books and records to determine if unfair trade practices have been violated. This regulatory body ensures compliance with state insurance laws and regulations, and it has the power to investigate potential violations within the industry. The National Association of Insurance Commissioners (NAIC) provides model laws but does not have regulatory power over individual insurers.

Virginia Code § 38.2-3330 mandates a conversion privilege in group term life policies, allowing insureds to convert to an individual policy without evidence of insurability within 31 days after losing group eligibility (e.g., employment termination). Option C matches this precisely. Option A is false; conversion is a legal requirement. Option B is incorrect; conversion applies post-eligibility, not during active membership while still insurable. Option D (five years) is arbitrary and unsupported by law. The study guide likely details this 31-day window with examples—e.g., an employee converting to whole life after layoffs—emphasizing its protective role, making C the correct timing.

The accidental death benefit is typically provided as an optional policy rider. This rider offers additional coverage, paying an extra benefit if the insured dies due to an accident. It is not an exclusion, annuity, or nonforfeiture option. The rider adds extra protection for accidents but is not part of the base policy unless specifically added.

Detailed Answer in Step-by-Step Solution:

A foreign insurer (A) is an insurance company operating in a state other than its state of domicile (where it is incorporated).

A domestic insurer (B) operates in its home state. An alien insurer (C) is domiciled outside the U.S. A captive insurer (D) insures its parent company, not based on location.

The Virginia study guide defines a foreign insurer as one licensed to do business in Virginia but incorporated in another state, per insurance regulatory terminology. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Types."

Medicare Part B covers physician services, outpatient hospital treatment, preventive services, and certain medical supplies. Inpatient hospital services fall under Part A.

Exact Extract (Virginia Medicare Study Guide): “Part B—covers outpatient hospital services, physician services, and preventive care. Part A covers inpatient hospitalization.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Medicare Part A and B Benefits

This scenario has two defining features: (1) the annuity was funded with a single lump sum ($100,000) and no further purchase payments are allowed, and (2) benefit payments begin in the future (17 years). That combination is the textbook definition of a single premium deferred annuity (SPDA). Virginia’s consumer materials explain that a single premium annuity may be immediate or deferred, and that a single premium deferred annuity begins payments at a future date and can provide larger payments than an immediate annuity purchased for the same amount because the premium earns interest during the deferred period.

General annuity definitions similarly describe an SPDA as an annuity established with one lump-sum payment that grows during the accumulation phase until annuitization, when payments begin. The “lawsuit settlement” detail is consistent with common annuity uses; Virginia’s exam outline lists annuities as a tool for lump-sum settlements. The other options don’t match: an IRA is a tax-qualified retirement arrangement, not implied here, and “individual life annuity” describes a payout form, not the premium structure and deferral features emphasized in the question.

Detailed Answer in Step-by-Step Solution:

When age is misstated, the insurer adjusts the death benefit based on the premium paid versus what should have been paid.

Premium paid: $15 per $1,000 (understated age). Correct premium: $18 per $1,000 (actual age).

Ratio: $15/$18 = 5/6 of the intended coverage. Thus, the benefit is 15/18 of the face amount (A).

Option B (95%) is arbitrary. Option C (full amount) ignores the misstatement. Option D (nothing) applies only in fraud cases beyond the incontestability period, not specified here.

The Virginia study guide states that under the misstatement of age provision, the benefit is adjusted proportionally to the premium paid versus the correct premium, not denied entirely. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

A juvenile life insurance policy is a life insurance policy that insures the life of a minor (a child). These policies are typically purchased by a parent or guardian, and the intent is to provide coverage for the child at a young age. These policies are not limited to children under five years old, nor are they necessarily available only as decreasing term insurance.

The bailout provision (also known as a “market-value adjustment escape clause”) allows the annuity owner to surrender the contract without penalty if the credited interest rate falls below a certain guaranteed minimum. This protects the annuitant from being locked into low rates.

Exact Extract (Virginia Annuities Study Guide): “Bailout provision—permits withdrawal of funds without surrender charges if the credited interest rate drops below a specified level.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Annuity Contract Features

Agents are fiduciaries, meaning they must handle clients’ premiums with the highest standard of care. Misuse or misappropriation of funds constitutes a violation of fiduciary duty.

Exact Extract (Virginia Agent Regulations): “Insurance producers act in a fiduciary capacity regarding premiums received from insureds and must promptly remit them to insurers.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1834 (Fiduciary responsibility of agents)

For an insurance policy to be legally binding, four essential elements must exist: (1) offer and acceptance, (2) consideration, (3) competent parties, and (4) legal purpose. Consideration refers to the exchange of value: the applicant’s premium and representations in the application, and the insurer’s promise to pay benefits. Exact extract: “Consideration is the value each party gives to the other: the insured provides premiums and truthful statements, while the insurer provides the promise of benefits.” Without consideration, a contract cannot be enforced.

A single premium whole life policy requires only one lump-sum payment. That single payment fully funds the policy for the insured’s lifetime. The insurer places the premium into the policy’s cash value account, where it grows to cover the cost of insurance throughout life. Exact extract: “Single premium whole life provides lifetime protection with one lump-sum premium payment at issue.” This design is often used for estate planning or wealth transfer because the insured never has to make another payment, and the cash value builds immediately.

A market value adjusted (MVA) annuity applies an adjustment to the annuity’s value if funds are withdrawn before the end of the guarantee period. Virginia regulations require sales materials to clearly and fairly explain how MVAs work, including the fact that the adjustment may be either positive or negative, depending on interest rate movements.

Misleading illustrations suggesting guaranteed gains or consistently negative adjustments are prohibited. Insurers must ensure consumers understand that interest rate changes affect annuity values and that withdrawals during certain periods may result in either an increase or decrease in value.

Options A and B improperly imply projections or guarantees, which are not allowed. Option C is incorrect because MVAs are not always negative. Therefore, option D is correct.

Medicare eligibility begins at age 65 for most individuals. Earlier eligibility is available only for certain disabilities or end-stage renal disease, but the standard eligibility age is 65.

Exact Extract (Virginia Health Insurance Study Guide): “Medicare is a federal program providing health insurance to individuals age 65 or older and certain disabled individuals under age 65.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Medicare Overview

When an insured is covered under more than one group health plan, the primary plan pays first. The secondary plan pays remaining eligible expenses after the primary plan has paid.

Exact Extract (Virginia Group Health Insurance Study Guide): “The primary plan is responsible for paying benefits first under coordination of benefits. The secondary plan covers remaining eligible expenses.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Coordination of Benefits

Employees under group life plans receive certificates of insurance summarizing coverage, not full policies. Exact extract: “Each employee insured under a group life policy shall be given a certificate of insurance describing coverage.”

Rebating occurs when an agent gives part of their commission, money, or anything of value to induce a customer to purchase insurance. This practice is prohibited under Virginia’s Unfair Trade Practices Act.

Exact Extract (Virginia Unfair Trade Practices Law): “Rebating includes paying, allowing, or giving any rebate of premium, commission, or other valuable consideration as an inducement to the purchase of insurance.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-509 (Rebates and inducements prohibited)

Dental policies exclude treatment that begins before coverage starts, but generally cover preventive, diagnostic, and restorative care. Exact extract: “Dental insurance typically excludes expenses for treatment initiated before the insured’s eligibility date.”

Detailed Answer in Step-by-Step Solution:

Group insurance (B) covers individuals based on their affiliation with an organization (e.g., employees of a company), not as individuals.

Contributory insurance (A) refers to group plans where employees pay part of the premium, but it’s not the defining feature.

Health insurance (C) is too broad, and COBRA (D) extends group coverage, not defines it.

The Virginia study guide defines group insurance as coverage tied to membership in an organization, such as an employer or association. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance."

A 10% penalty tax applies to "premature" distributions of gains from a modified endowment contract (MEC) before the policyholder reaches the age of 59½. This penalty is applied in addition to regular income taxes on the distribution. The MEC rules were established to prevent the use of life insurance policies as tax shelters.

Virginia Code § 38.2-3502 mandates a “free look” period (typically 10 days) for individual health insurance, allowing the insured to review the policy and cancel it with a full premium refund (option D) if returned within that time. Option A (try without paying) is false; premiums are paid upfront, refundable only upon cancellation. Option B (compare policies) is a practical use but not the legal purpose; the provision ensures cancellation rights, not comparison. Option C (change coverage) isn’t allowed; modifications require underwriting, not free-look terms. The study guide likely details this consumer protection with examples—e.g., returning a policy on day 9 for a refund—making D the precise right.

A profit-sharing plan is an employer-sponsored qualified retirement plan in which the employer makes discretionary contributions based on company profits. Under Virginia exam standards and federal retirement plan rules covered in licensing materials, only the employer contributes to a traditional profit-sharing plan. Employees do not make direct salary deferral contributions as they would in a 401(k) plan. This makes option A correct.

The employer is not required to make a contribution every year, nor is the employer required to contribute a fixed amount. Contributions can vary year to year depending on business performance, which makes option D incorrect. Employers are allowed to offer other retirement plans alongside a profit-sharing plan, so option B is incorrect. Participation rules are typically defined by plan eligibility requirements rather than employee opt-out provisions, making option C inaccurate. Profit-sharing plans are attractive to employers because of flexibility in contributions and favorable tax treatment, while employees benefit from employer-funded retirement savings.

A consumer report contains information about an individual’s credit history, financial reputation, and personal characteristics. Virginia insurance exam materials clearly distinguish consumer reports from medical and underwriting reports. Insurers may use consumer reports during underwriting, but only with proper authorization and disclosure under privacy and fair credit reporting standards.

An agent’s report focuses on observations made by the agent during the application process. An attending physician’s report (APR) contains medical information provided by a healthcare provider. An index bureau report (such as MIB) contains coded medical or application activity data shared among insurers, not credit information.

Because credit standing specifically refers to financial responsibility and credit history, the correct answer is a consumer report. Virginia regulations emphasize strict handling, confidentiality, and disclosure requirements when insurers obtain and use consumer reports.

Virginia Code § 38.2-3508 allows conditionally renewable health policies, where renewal isn’t guaranteed and depends on insurer-specified conditions. Option A is true; health status (e.g., new chronic illness) can be a renewal condition, unlike guaranteed renewable policies. Option B is false; premiums can increase based on risk, not guaranteed. Option C is incorrect; geographic moves typically don’t void renewability unless specified, but health status is more common. Option D is wrong; conditions are set at issuance, not altered arbitrarily. The study guide likely contrasts this with guaranteed renewable policies, using examples like non-renewal for worsening health, making A the true statement.

The return of premium benefit refunds a percentage of premiums paid if the policy is canceled or if the insured dies before benefits are used. Exact extract: “A return of premium rider provides a refund of premiums paid, less claims paid, upon cancellation or death of the insured.” This option is often added to long-term care policies to protect policyholder investment.

Detailed Answer in Step-by-Step Solution:

In a deferred annuity, the owner (who purchases the contract) can be the annuitant (who receives payments), the beneficiary (who receives proceeds), or a third party (C).

Option A (group contract) applies to group annuities, not individual ownership.

Option B (non-transferable) is false; ownership can often be assigned.

Option D (rights at payment phase) is incorrect; owners have rights during accumulation.

The Virginia study guide notes that deferred annuity ownership is flexible, allowing the owner to differ from the annuitant or beneficiary, with rights exercisable before payout. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Annuities."

When replacing individual health insurance, the agent must ensure that the benefits of the new policy are at least comparable to those of the existing policy. The goal is to make sure that the insured's coverage remains consistent or better under the new plan, and that they do not face any gaps in coverage. The other options, such as commissions or grace periods, are secondary considerations, but the primary concern is maintaining similar or improved benefits.

The purchaser of a deferred annuity typically intends for the income benefits to begin on a specified date, often years after issuance. The purpose of a deferred annuity is to allow the policyholder to accumulate funds during the deferral period, and then begin receiving periodic payments at a later date, such as retirement. This is in contrast to immediate annuities, which start paying out shortly after the annuity is purchased.

Twisting is an unfair trade practice that involves persuading an insured, to the insured's detriment, to switch policies. This practice usually occurs when an agent convinces the insured to cancel or replace their existing policy with a new one, often through misleading comparisons or false representations. This is illegal because it may harm the policyholder by canceling coverage that would be beneficial to them.

A five-year annuity certain provides guaranteed payments for a specific period (in this case, five years). If the annuitant dies before the end of the five-year period, the beneficiary will receive the remaining payments for the balance of the five years. This ensures the payment duration regardless of the annuitant’s death.

Custodial care is non-medical assistance with daily living activities, requiring no professional medical training. Rehabilitative, therapeutic, and intermediate care require licensed or trained personnel. Exact extract: “Custodial care provides assistance with daily living activities and does not require medical skills.”

The notice of claim provision states that notice may be given to the insurer or its authorized agent. Legally, providing notice to an authorized agent constitutes notice to the insurer itself.

Exact Extract (Virginia Uniform Policy Provisions): “Notice of claim may be given to the insurer or to any authorized agent of the insurer.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3514 (Uniform accident and sickness provisions – Notice of claim)

Qualified retirement plan funds are protected for the exclusive benefit of employees. Employers cannot repossess plan assets for their own use. They may invest, allocate contributions, or distribute vested benefits, but not reclaim assets.

Exact Extract (Virginia Retirement Plans Study Guide): “Plan assets must be held in trust for employees and may not revert to the employer except under limited IRS-approved termination procedures.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Retirement Plans – IRS Rules

Independent agents are not employees of any single insurer. They work independently, representing multiple insurance companies and are responsible for their own expenses. They earn compensation based on commissions from sales, and they typically own the renewal business, meaning they retain the commissions from renewing policies.

Penalty-free withdrawals from a traditional IRA before age 59½ are permitted for disability, qualified first-time home purchase (up to $10,000), or certain unreimbursed medical expenses. Bankruptcy is not a qualifying exception.

Exact Extract (Virginia Retirement Study Guide): “Exceptions to early withdrawal penalty include disability, first-time home purchase, qualified education, or medical expenses. Bankruptcy is not included.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Retirement Plans – Taxation Rules

Tax-sheltered annuities (TSAs), per IRC § 403(b) and Virginia Code § 38.2-3100 et seq., are retirement plans for nonprofit employees. Option A is true; they’re synonymous with 403(b) plans. Option B is true; contributions often come from voluntary salary reductions, tax-deferred until withdrawal. Option C is true; participants can have individual contracts or accounts. Option D is false; investment gains are tax-deferred, not included in gross income annually, only taxed upon distribution. The study guide highlights TSAs’ tax advantages, making D the incorrect statement.

Group term insurance can typically be converted to a permanent individual life insurance policy without the need for a medical exam or evidence of insurability. This option is especially valuable when an employee leaves a company or the group plan ends, as it allows them to retain coverage without having to go through underwriting.

Under Virginia group life insurance provisions, when an employer is the policyholder, the term “employee” includes individuals who work for the employer and may also include individual proprietors if they actively work in the business. This allows sole proprietors and working owners to be covered under group insurance arrangements. Credit unions, labor unions, and trade associations are not employees; they are organizational entities that may serve as policyholders under separate types of group insurance contracts. The question specifically asks which option is included within the definition of employee when the employer is the policyholder. An individual proprietor who performs services for the business qualifies, making that option correct.

Detailed Answer in Step-by-Step Solution:

The conversion privilege in term insurance allows conversion to a permanent policy (e.g., whole life) at the insured’s current (attained) age without proving insurability (B), typically before the term expires.

Option A (another term policy) is not standard. Option C (annuity with insurability) is incorrect; conversion is to life insurance. Option D (issue age rates) doesn’t apply; rates adjust to attained age.

The Virginia study guide explains that the conversion privilege ensures continued coverage by allowing term policies to convert to permanent ones without medical exams, based on attained age. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Term Insurance Features."

Detailed Answer in Step-by-Step Solution:

Life insurance policies typically include a two-year suicide clause; if the insured dies by suicide within this period (e.g., six months), the insurer pays only a refund of premiums, not the full death benefit (C).

Options A (accidental injury), B (lung cancer), and D (heart attack) are covered causes, barring misrepresentation or exclusions, within the first two years.

The Virginia study guide notes that the suicide provision limits payment to premiums paid if suicide occurs within two years of issuance, protecting insurers from early intentional loss. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

The agent’s report includes observations on the applicant’s financial status, character, and other relevant factors, but the applicant’s signature belongs on the application form, not the agent’s report.

Exact Extract (Virginia Health Insurance Study Guide): “The agent’s report is confidential and includes information on financial condition and character. It does not contain the applicant’s signature.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Field Underwriting

A joint life annuity pays benefits to two annuitants during their lifetimes, but terminates entirely upon the first death. Exact extract: “Joint life annuities provide income until the death of the first annuitant; no further payments are made thereafter.”

Government publications can be used without prior approval from the Commonwealth. These publications, such as materials from the Centers for Medicare & Medicaid Services (CMS), provide authorized and standardized information. On the other hand, insurance company brochures, radio announcements, and television advertisements usually require approval to ensure that they are not misleading or violating advertising regulations related to Medicare Supplement plans.

If the initial premium is not paid at the time of application, the life insurance coverage typically begins when the agent delivers the policy to the insured and collects the required premium. This is known as the "delivery and premium collection" method, which ensures that the insurer receives payment before coverage becomes effective.

PPO plans allow members to seek care from non-network providers but at reduced benefit levels. This typically results in higher deductibles, coinsurance, and overall out-of-pocket expenses. Members retain freedom of choice, but the plan incentivizes using preferred providers.

Exact Extract (Virginia Health Insurance Study Guide): “Preferred Provider Organizations allow coverage for non-network services, but at a lower reimbursement level, leading to greater out-of-pocket expenses.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, PPO Plan Features

To qualify for group life insurance, the group must meet certain minimum size requirements, as defined by the insurance provider or state regulations. This ensures that the group is large enough to spread the risk of insuring multiple individuals. Coverage for part-time employees and dependents is not typically mandatory, and new employees do not generally need to provide proof of insurability for group coverage.

Under qualified retirement plan rules covered in Virginia licensing materials, an employer’s contribution to a profit-sharing plan is limited to a maximum of 25% of total eligible employee payroll. This limit ensures favorable tax treatment while preventing excessive employer contributions that could otherwise be used to shelter income improperly.

Profit-sharing plans are flexible in that the employer is not required to contribute every year, and the amount can vary depending on business performance. However, when contributions are made, they must remain within the statutory maximum. The other percentages listed exceed the allowable limit and therefore are incorrect. Virginia exam standards consistently emphasize the 25% payroll cap as a key characteristic of profit-sharing plans.

In the underwriting process for life insurance, as governed by Virginia Code § 38.2-1800 et seq., the agent’s primary role is to act as a field underwriter, ensuring the application provides accurate and complete information to the insurer (option A). This includes collecting personal data (e.g., age, health history) and verifying its correctness—e.g., asking about smoking habits or past surgeries—to enable the home office underwriter to assess risk properly. Option B (binding coverage immediately) is incorrect; agents typically lack authority to bind life insurance without insurer approval, unlike some property/casualty lines, unless a conditional receipt with premium is issued (Virginia Code § 38.2-3106), which isn’t “immediate” or primary. Option C (issuing the policy) is false; only the insurer’s home office issues policies after underwriting approval, not the agent. Option D (securing MIB information) is an underwriter’s task; agents don’t directly access the Medical Information Bureau—though they may note MIB codes if disclosed, their role is data collection, not retrieval. The study guide likely emphasizes the agent’s frontline duty with examples—e.g., ensuring a 45-year-old applicant discloses diabetes—making A the primary role, aligning with Virginia’s agency framework where agents facilitate, not finalize, underwriting.

Virginia Code § 38.2-4306 mandates HMO benefits, focusing on comprehensive care. Option A (wellness programs) is common, promoting prevention (e.g., smoking cessation). Option C (24-hour emergency care) is required, ensuring access via PCP coordination or direct ER services. Option D (outpatient services) is standard, covering clinic visits. Option B (discounts on local health spa memberships) isn’t a typical HMO feature; while some plans offer wellness incentives, spa discounts are ancillary, not a core benefit under Virginia law or NAIC HMO models. The study guide likely lists HMO staples (A, C, D) with examples—e.g., annual checkups (D)—contrasting them with optional perks like B, making it the exception.

Detailed Answer in Step-by-Step Solution:

A cost of living (COLA) rider (B) adjusts disability income benefits to account for inflation, maintaining purchasing power.

Inflation guard (A) is more common in property insurance. Price escalation (C) and wage protection (D) are not standard disability riders.

The Virginia study guide describes the COLA rider as an optional feature in disability income policies, increasing benefits based on inflation indices like the CPI. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Insurance Riders."

Adjustable life insurance is a flexible premium policy designed to let a policyowner adapt coverage as needs change. The Virginia life insurance consumer guide describes adjustable life as combining an insurance protection element and a cash value element, with components separated and reported to the policyowner. That cash value element is a key feature: as cash value accumulates in permanent life policies, policy loan provisions are commonly available as a standard policy option, and Virginia’s life policy provision framework includes policy loans among the standard policy features tested for state licensing. Therefore, the statement that the policyowner is not permitted to take policy loans “even if the policy has a cash value” is the incorrect (EXCEPT) statement.

The other statements align with the purpose of adjustable life: it is designed to meet changing insurance needs, and it permits changes in the plan of coverage (for example, adjusting face amount or premium structure within policy limits). When the policyowner requests an increase in the amount of insurance, insurers commonly require evidence of insurability for the increased portion to manage adverse selection and maintain underwriting integrity—consistent with standard underwriting and application procedures addressed in Virginia exam content.

An application for individual health insurance must be in writing and becomes part of the insurance contract. The information provided in the application, along with any attachments, helps form the basis of the policy. If any statements or answers in the application are found to be false or misrepresented, the insurer may have grounds for denying a claim.

Juvenile life insurance often includes a payor benefit rider, which waives premiums if the policy owner (usually a parent) dies or becomes disabled before the child reaches adulthood. Exact extract: “The payor benefit rider is typically attached to juvenile policies, ensuring coverage continues without premium payment if the payor dies or is disabled.”

Adjustable life insurance (Virginia Code § 38.2-3113.1) allows flexibility in face amount and premiums, effectively shifting between term (lower cost, no cash value) and whole life (higher cost, cash value) features while in force (option A). Option B is false; nonforfeiture options include cash, reduced paid-up, or extended term. Option C is false; settlement options (e.g., lump sum) apply as with other policies. Option D is wrong; it’s life insurance, not an annuity. The study guide likely explains this adaptability—e.g., increasing premiums to build cash value (whole life)—making A the true statement.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for group health plans like major medical (B), dental (C), and HMOs (D) result in tax-free benefits under IRC Section 106.

Disability income (A) benefits are taxable if the employer pays the premium, per IRS rules, unlike medical benefits.

The Virginia study guide, aligned with IRS regulations, notes that employer-funded disability income benefits are taxable to the recipient, while medical, dental, and HMO benefits remain tax-free. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

Group credit life insurance is typically structured as decreasing term insurance. This means the death benefit decreases over time, generally in line with the outstanding balance of a loan or debt that the insurance is intended to cover. It is commonly used for loans, such as mortgages, where the liability decreases as the debt is paid down.

An unfair claims settlement practice occurs when insurers do not properly or promptly investigate and settle legitimate claims. This is a key element of unfair practices, as insurers are required by law to act in good faith when handling claims. Failing to promptly investigate or settle legitimate claims is considered unethical and unfair, as it delays rightful compensation and causes unnecessary hardship for policyholders.

The other options may describe improper actions, but failing to promptly investigate and settle claims is more directly tied to unfair practices under the insurance regulations.

Straight whole life insurance provides permanent protection until death or policy maturity (typically age 100 or 120). It does not end at age 65.

Exact Extract (Virginia Life Insurance Study Guide): “Straight whole life insurance—permanent protection, level premiums payable for life, with guaranteed cash values, nonforfeiture options, and face amount payable at maturity.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Whole Life Insurance

In the context of Health Maintenance Organizations (HMOs), self-referral typically allows members to directly seek certain care or specialists without the need for a referral from their primary care physician (PCP). In HMO models, there are provisions where, in certain circumstances, members can decide to see a specialist without the formal referral process. This ability may be restricted or require prior approval depending on the specific plan provisions, but generally, members cannot arbitrarily make decisions about seeing specialists or obtaining certain health services without consulting the HMO guidelines. The best option here reflects the ability of the member to "decide" when a specialist is needed within the structure of self-referral.

The recurrent disability provision allows a relapse of the same disability within a specified time (usually 6 months) to be treated as a continuation of the prior disability, avoiding a new elimination period. Exact extract: “Recurrent disability is one which results from the same cause as a prior disability and occurs within a stated period; it is considered a continuation of the prior claim.”

Virginia law requires agents to promptly notify the Bureau of Insurance if they discontinue the use of an assumed name or trade name under which they were licensed.

Exact Extract (Virginia Producer Regulations): “An agent who conducts business under an assumed or fictitious name shall notify the Bureau of Insurance when such name is no longer used.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-1822 (Use of assumed or fictitious names)

A simplified employee pension (SEP) plan is a retirement plan that allows employers to make tax-deductible contributions to individual retirement accounts established for employees. Under IRS regulations, employer contributions to a SEP plan are limited to a maximum of 25% of an employee’s compensation, subject to an overall annual dollar limit. SEP plans are popular among small businesses because they are easy to establish and administer and have minimal reporting requirements. Contributions are made solely by the employer, not the employee, and must be allocated using the same percentage of compensation for all eligible employees. The exam tests the maximum allowable percentage of pay, which is 25%.

Virginia requires that the Medicare Supplement Buyer’s Guide be delivered at the time of application. This ensures applicants have all necessary information before purchase decisions.

Exact Extract (Virginia Medicare Supplement Regulations): “An outline of coverage and buyer’s guide shall be provided to all applicants at the time of application.”

References (Virginia Documents / Study Guide):

— Virginia Administrative Code 14VAC5-170-150 (Disclosure requirements for Medicare Supplement policies)

If an individual’s occupation is considered illegal, it may result in a denial of a disability income claim. Insurance companies generally do not cover risks associated with illegal activities or occupations, as these are deemed outside the scope of insurable risks. Such an occupation could lead to the insurer refusing to pay claims related to disabilities arising from that illegal activity.

Policy loans are not prohibited in universal life insurance. In fact, one of the key features of universal life insurance is the ability to take loans against the accumulated cash value. The other options are correct: a mortality charge is deducted from the policy’s cash value, the policy specifies how premiums are divided between expenses and savings, and withdrawals may be allowed but can be subject to surrender charges.

When all named beneficiaries predecease the insured, the policy proceeds revert to the insured’s estate. This allows settlement under probate unless otherwise directed by policy terms.

Exact Extract (Virginia Life Insurance Study Guide): “If no living beneficiary is designated at the time of the insured’s death, proceeds are payable to the estate of the insured.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Beneficiary Succession

Universal life insurance is a flexible type of permanent life insurance. The policyowner may be able to increase the death benefit, but this is typically subject to proof of insurability (such as a medical exam). Universal life allows adjustments to premiums and death benefits within policy limits. The interest credited is guaranteed at a minimum rate set by the insurer, not tied to the CPI. Coverage does not automatically terminate at retirement.

Detailed Answer in Step-by-Step Solution:

The proof of loss is a formal statement of a claim, and standard health insurance policies require it within 90 days of the loss (C), unless the policy specifies otherwise or state law extends it.

Options A (30 days) and B (60 days) are too short for most policies, while D (120 days) exceeds the typical requirement.

The Virginia study guide aligns with the NAIC model laws, stating that proof of loss must typically be filed within 90 days of the loss, though insurers may accept later submissions if not prejudicial. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Claims Provisions."

Indemnity dental insurance plans generally cover treatments directly related to dental health, such as fillings, root canal treatments, extractions, and certain preventive treatments like fluoride treatments for children under 16. However, dietary counseling and instructions are typically not covered under indemnity dental plans as they fall outside the scope of dental treatment.

Virginia Code § 38.2-3100 et seq. defines immediate annuities as contracts starting payments within one year of purchase, typically funded with a lump sum. Option C fits: retirees with savings (e.g., $200,000 from a 401(k)) buy immediate annuities for instant income. Option A (tax deduction) applies to contributions to qualified plans, not immediate annuities, which use after-tax funds unless from a rollover. Option B (tax-sheltered annuity) refers to 403(b) plans, not immediate annuities. Option D (accumulate funds) suits deferred annuities, not immediate ones. The study guide likely contrasts immediate (C) with deferred annuities (D), using examples like a 65-year-old converting a lump sum to monthly payments, making C the typical buyer.

When money is transferred directly from one IRA into another IRA of the same type (a direct rollover), it is considered a nontaxable event. This means no taxes are owed on the transfer at the time of the transaction, as long as the transfer is made directly between financial institutions and not to the account holder personally. Taxes would only apply when funds are eventually withdrawn from the IRA.

When the owner of a life insurance policy reserves the right to change the beneficiary, it is referred to as a revocable designation. A revocable beneficiary designation allows the policyholder to change the beneficiary at any time without the consent of the current beneficiary. This flexibility is in contrast to an irrevocable designation, where the beneficiary cannot be changed without their consent.

A revocable beneficiary designation allows the policyowner to change beneficiaries at any time without the consent of the existing beneficiary. This right remains solely with the policyowner.

Exact Extract (Virginia Health Insurance Study Guide): “Revocable beneficiaries—policyowner retains the right to change the beneficiary designation at will.”

References (Virginia Documents / Study Guide):

— Virginia Life & Health Insurance Examination Outline, Beneficiary Designations

Virginia Code § 38.2-3100 et seq. governs deferred annuities, where a surrender charge (option A) is a penalty for early withdrawal, starting high (e.g., 7-10%) and declining over a surrender period (e.g., 7-10 years) until it reaches zero. Option B (front-end sales load) is a one-time fee deducted upfront, not diminishing over time. Option C (guaranteed interest rate) is a fixed return (e.g., 2%), stable or adjustable, not disappearing. Option D (expense charge) covers ongoing costs (e.g., mortality and expense fees), typically level, not phased out. The study guide likely illustrates this with a table—e.g., 10% year 1, 9% year 2, 0% year 10—emphasizing surrender charges as a liquidity deterrent, making A the matching feature.

The notice of claim is the first step in initiating a health insurance claim. The insured must provide this notice to the insurer within the time limit specified in the policy, or as soon thereafter as reasonably possible. This notice typically includes basic information about the claim, and additional documentation, such as medical bills or a physician's diagnosis, may be required later in the process.

Detailed Answer in Step-by-Step Solution:

Life insurance policies must include a misstatement of age clause (B), grace period clause (C), and incontestability clause (D) as standard provisions under state law.

The waiver of premium clause (A) is optional, typically a rider, not a required provision.

The Virginia study guide lists mandatory life insurance provisions (e.g., grace period, incontestability, misstatement of age) but notes that waiver of premium is an optional benefit, not required. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

The automatic premium loan provision is an optional feature found in many cash value life insurance policies. Its purpose is to prevent a policy from lapsing when the policyowner fails to pay a premium by the end of the grace period. If the policy has sufficient cash value, the insurer will automatically issue a policy loan in the amount needed to cover the overdue premium. This loan is secured by the policy’s cash value and accrues interest according to the policy’s loan terms. Over time, unpaid loan balances and interest may reduce the policy’s cash value and death benefit. This provision differs from a waiver of premium, which waives premiums due to disability, and from options that purchase additional insurance. The automatic premium loan simply uses the policy’s existing value to keep coverage in force.

Business Overhead Expense (BOE) insurance is designed to cover the fixed overhead expenses of a business when the business owner becomes disabled. This includes things like payroll, rent, utilities, and other operational costs. It ensures that the business can continue to operate during the owner's period of disability. Workers compensation insurance, on the other hand, provides coverage for employees' work-related injuries, while BOE is specifically for business owners.

Detailed Answer in Step-by-Step Solution:

The Medicare Supplement open enrollment period (6 months starting the first month a person is 65 and enrolled in Medicare Part B) guarantees issuance of a policy without regard to health status (D).

Premiums (A), benefits (B), and exclusions (C) are standardized and not altered during this period due to health.

The Virginia study guide states that during the Medicare Supplement open enrollment, insurers must issue policies without medical underwriting, ensuring access regardless of health. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Supplement Insurance."

Detailed Answer in Step-by-Step Solution:

The accumulation period (D) is the phase in a deferred annuity where premiums are paid to build value before payouts begin.

The liquidation period (A) is not a standard term here; it might imply payout but isn’t correct.

The annuity period (B) is when payments are received, not paid.

Period certain (C) refers to a payout option, not premium payment phase.

The Virginia study guide defines the accumulation period as the time during which premium payments are made into a deferred annuity, accumulating value until the payout phase. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Annuities."

Under Virginia law, a group life insurance plan must insure all eligible employees if the employer pays the entire premium. This is a requirement to ensure fairness and equal coverage for all employees, as employer-paid premiums typically result in mandatory participation. If the employee contributes to the premium, participation may be optional. The other options do not trigger the requirement to insure all eligible employees.

Detailed Answer in Step-by-Step Solution:

The entire contract clause includes the policy and the attached application (B), ensuring all terms and representations are part of the agreement.

The premium receipt (A) is temporary, the waiver rider (C) is optional, and the declaration page (D) is part of the policy, not separate.

The Virginia study guide states that the entire contract provision encompasses the policy and attached application, defining the full legal agreement. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Policy Provisions."

An automatic premium loan provision is typically found in whole life insurance policies. This provision allows the insurer to automatically pay the premium from the cash value of the policy if the policyholder fails to pay the premium on time. This is a feature unique to permanent life insurance, like whole life, where the policy builds cash value over time. Credit insurance, decreasing term, and level term policies generally do not include such provisions because they are term-based policies and do not accumulate cash value.

A joint life insurance policy insures two lives under one policy and pays the death benefit at the first insured’s death. After payment, the policy terminates.

This type of policy is commonly used to cover joint financial obligations such as business partnerships or mortgages.

Option B describes survivorship (second-to-die) life insurance, not joint life. Insurable interest is required at policy issue, not at death. Therefore, option A is correct.

Virginia insurance law (Title 38.2, Chapter 18) recognizes three types of agent authority: express, implied, and apparent. Express authority (option B) is explicitly granted by the insurer in the agency agreement (e.g., soliciting policies), per Virginia Code § 38.2-1800 et seq. Implied authority (option C) is unwritten power to perform incidental acts necessary for express duties (e.g., collecting premiums). Apparent authority (option A) arises when a third party reasonably believes the agent has authority based on the insurer’s actions (e.g., providing branded materials), binding the insurer legally. Option D (residual authority) is not a recognized term in Virginia insurance or agency law; “residual” might relate to markets or benefits elsewhere, but not agent authority. The study guide likely outlines these three authorities with examples, excluding D as a fabricated or irrelevant concept, making it the exception.

Virginia Code § 38.2-1820 requires licensees (agents, agencies, or other entities) operating under an assumed or fictitious name to register that name with the Bureau of Insurance. This ensures transparency and consumer protection by linking all business names to the licensed entity. The statute specifies notification either at the time of license application or within 30 calendar days after adopting the assumed name, making option A correct. This timeline allows the Bureau to update records promptly without undue delay. Option B (60 days from first policy sale) introduces an unrelated trigger—policy sales—and extends the period beyond Virginia’s requirement, making it incorrect. Option C (license renewal) delays notification unnecessarily, as renewals occur biennially (Virginia Code § 38.2-1822), conflicting with the need for timely registration. Option D (30 days before discontinuing the name) is illogical; notification is required when adopting, not abandoning, a name. The study guide likely stresses this 30-day rule to ensure compliance with Virginia’s licensing oversight, reinforcing A as the precise answer based on regulatory intent and practice.

An accelerated benefit rider allows the policyholder to access a portion of the death benefit while they are still alive, typically in cases where the insured is diagnosed with a terminal illness and is expected to die within a certain period (usually six months). This rider provides financial assistance during the policyholder’s final stages of life, allowing them to cover medical expenses or other costs. It does not apply for minor surgeries or long-term rehabilitation.

In insurance terminology, per Virginia Code § 38.2-100 et seq., a hazard (option A) is a condition increasing the likelihood or severity of a loss from a covered peril (e.g., smoking increases fire risk). Option B (peril) is the cause of loss (e.g., fire, theft). Option C (exposure) is the extent of potential loss, not the condition itself. Option D (risk) is the broader uncertainty of loss, encompassing hazards and perils. The study guide likely differentiates these with examples—e.g., icy roads (hazard) causing a crash (peril)—highlighting hazard’s role in amplifying loss probability, making A the exact match.

With a decreasing term life insurance policy, the premium remains level, but the amount of coverage decreases annually. This type of policy is often used to cover debts that decrease over time, such as a mortgage. Since the coverage amount drops each year, premiums are not reduced — they remain the same throughout the policy term.

Under most health insurance policies, the insured is required to provide written proof of loss within 30 days of the occurrence of the loss. This allows the insurer to promptly evaluate the claim and ensure that it is processed without unnecessary delays. Some policies may allow extensions under special circumstances, but the general rule is that proof of loss must be provided within 30 days.

Group credit life insurance does not insure the life of an individual for personal benefit. Instead, it insures a debtor’s obligation, with the creditor as beneficiary. The purpose is to pay off a loan balance if the borrower dies, not to provide income protection to survivors.

Employer group plans and association group plans insure individuals within a defined group, and equity indexed universal life insures a specific individual with cash value linked to an equity index. Therefore, those options do insure individual lives.

Virginia licensing materials clearly distinguish credit life insurance as debt protection rather than personal life insurance, making option C the correct answer.

In an HMO, members designate a primary care physician (PCP) who coordinates care and issues referrals to specialists. This gatekeeper function is a hallmark of HMO plans.

Exact Extract (Virginia HMO Study Guide): “HMO members select a primary care physician responsible for providing and coordinating all medical care.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, HMO Characteristics

Business overhead expense insurance is designed to cover the fixed business expenses, such as rent, utilities, and employee salaries, if the business owner becomes disabled and cannot work. This insurance ensures that the business can continue to operate in the owner's absence, covering regular business expenses but not providing a direct income replacement to the business owner.

Detailed Answer in Step-by-Step Solution:

A group health insurance contract is a legal agreement between the employer (policyholder) and the insurance company (C), with employees as covered participants, not direct parties to the contract.

Option A (employer and employees) is the employment relationship, not the insurance contract. Option B (employee and insurer) applies to individual policies. Option D (all three) overcomplicates the contractual relationship.

The Virginia study guide states that group insurance contracts are issued to the employer or group sponsor, who contracts with the insurer, while employees receive certificates of coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance."

Medical expense claim forms are designed to gather information relevant to the medical loss itself—its occurrence, character, and extent. Employee salary is not part of the standard claim form for medical expense policies.

Exact Extract (Virginia Health Insurance Study Guide): “Claim forms must provide space for details of the occurrence, character, and extent of loss but do not request information unrelated to medical expenses, such as salary.”

References (Virginia Documents / Study Guide):

— Virginia Uniform Health Policy Provisions

The 10-day free look provision in individual health insurance policies allows the insured to review their policy after purchase. If they are unsatisfied with the policy, they can cancel it within 10 days and receive a full refund of premiums. This provision is distinct from a grace period (which allows for late payment) and does not apply only when no premium has been paid. A surrender charge typically applies to cash-value policies, not health insurance.

Only distributions from qualified employer-sponsored retirement plans (like 401(k)s or pensions) are eligible for rollover into an IRA. Personal savings, lottery winnings, or insurance death benefits do not qualify. Exact extract: “Eligible rollover distributions from qualified plans may be directly transferred or rolled over into an IRA within 60 days to preserve tax-deferred status.” This ensures retirement funds remain tax-deferred until later withdrawal.

Under federal law, an insurance agent may face imprisonment for embezzling money from an insurance company. This is a serious offense that involves misappropriating or stealing funds entrusted to the agent. Other options, such as selling insurance with a nonresident license or inducing a client to sign an application, may result in administrative penalties or fines, but embezzlement can lead to criminal prosecution and prison time.

Virginia Code § 38.2-3501 governs health insurance applications, requiring accuracy and applicant consent. Changes or corrections by an agent (e.g., fixing a misspelled name) must be initialed by the applicant (option B) to verify agreement, as the application becomes part of the contract (Virginia Code § 38.2-3503). Option A (agent) initialing alone risks unauthorized alterations. Option C (physician) is irrelevant; medical input isn’t standard for application edits. Option D (underwriter) assesses, not corrects, applications post-submission. The study guide likely stresses this consumer protection rule, with examples—e.g., an agent correcting a birthdate, initialed by the applicant—ensuring transparency, making B the correct party.

Detailed Answer in Step-by-Step Solution:

Reinsurance (C) is a process where one insurer (the ceding company) transfers part or all of its risk to another insurer (the reinsurer) to reduce exposure.

A reciprocal contract (A) involves mutual insurance exchanges, not risk transfer between insurers.

Coinsurance (B) refers to shared risk between the insurer and policyholder, not between insurers.

A captive contract (D) involves a company insuring itself through a subsidiary, not transferring risk to another insurer.

The Virginia study guide defines reinsurance as a contractual arrangement allowing insurers to mitigate risk by transferring it to another insurer, a common practice in the industry. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Insurance Company Operations."

Detailed Answer in Step-by-Step Solution:

Medical expense insurance covers healthcare costs, while disability insurance replaces lost income, together protecting against medical costs and earning power loss (B).

Death benefits (A) are for life insurance. Dismemberment (C) is specific to AD&D. Rehabilitation (D) may be included but isn’t primary.

The Virginia study guide defines the core purpose of medical expense and disability insurance as mitigating financial loss from healthcare and income interruption. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Health Insurance Basics."

Reinsurance is a legitimate risk management tool used between insurers. Misrepresentation, fraudulent advertising, and illegal inducements are specifically prohibited as unfair trade practices in Virginia.

Exact Extract (Virginia Unfair Trade Practices Act): “Unfair practices include misrepresentation, false advertising, and offering unlawful inducements. Reinsurance is not an unfair practice.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-500 et seq. (Unfair Trade Practices Act)

Universal life (Virginia Code § 38.2-3113.1) features: Option A is true; a mortality charge funds the death benefit, deducted monthly from cash value. Option B is true; expense charges are disclosed (e.g., admin fees). Option D is true; loans reduce the cash value earning interest. Option C is false; death benefits are generally tax-free under IRC § 101(a)(1), not ordinary income, unless an exception (e.g., transfer for value) applies, which isn’t standard. The study guide likely contrasts universal life mechanics—e.g., $50 monthly mortality charge—with tax-free benefits, making C the exception.

Monthly life annuity benefit payments received from a tax-sheltered annuity (TSA) are taxed as ordinary income in the year received. While contributions to a TSA may be made on a tax-deferred basis, the income received upon distribution is subject to income tax, as it represents earnings on the original tax-deferred contributions.

A major medical policy is designed as a comprehensive health policy, covering a wide range of expenses, including hospital, surgical, physician, and prescription costs. It provides broader coverage than limited benefit plans such as dental or vision policies. Workers’ compensation is not considered a general health policy because it specifically covers occupational injuries.

Exact Extract (Virginia Health Insurance Study Guide): “Major medical insurance—provides comprehensive coverage for hospital, physician, surgical, and other medical expenses, subject to deductibles and coinsurance. Distinguished from limited health expense policies (dental, vision).”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Section 2.2 Comprehensive vs. Limited Policies

Detailed Answer in Step-by-Step Solution:

Medicare Part B eligibility generally requires enrollment in or eligibility for Part A (B), which covers hospital insurance and is tied to age (65+) or disability status, not just retirement (A) or insurability (C).

"Fully insured" under Social Security (D) relates to benefits but isn’t a direct Part B requirement.

The Virginia study guide states that Medicare Part B is available to those eligible for Part A, typically U.S. citizens or residents aged 65 or disabled, regardless of other factors. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Eligibility."

In Virginia, an insurance agent’s license remains active for 30 calendar days without an appointment. During this period, the agent may not transact insurance business until an appointment is in place.

Appointments link the agent to an insurer and authorize the agent to act on the insurer’s behalf. Virginia regulations require insurers to file appointments promptly, and failure to secure an appointment within the allowed timeframe may result in license inactivity.

This rule ensures regulatory oversight and consumer protection by confirming that agents operate only under authorized insurer relationships.

An outline of coverage must be given to all applicants at the time of application. This document clearly describes the benefits, services, copayments, deductibles, exclusions, limitations, and premium details so that consumers can make informed choices. Virginia regulations require insurers to deliver this document in a standard format prescribed by the Bureau of Insurance.

Exact Extract (Virginia Medicare Supplement Regulations): “Issuers shall provide an outline of coverage to all applicants at the time the application is presented… It shall include a description of benefits, services, exclusions, copayments, deductibles, and premiums.”

References (Virginia Documents / Study Guide):

— Virginia Administrative Code 14VAC5-170-150 (Required disclosure provisions – Outline of Coverage)

— Code of Virginia §38.2-3606 (Outline of Coverage requirement)

Ordinary whole life pays the face amount at maturity (traditionally age 100 or 120) if the insured is still alive, or upon earlier death. Term policies have no maturity value.

Exact Extract (Virginia Life Insurance Study Guide): “Ordinary whole life—pays the face amount at death or at policy maturity if the insured survives to that date.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Whole Life Characteristics

Flexible premium life insurance, such as universal life (Virginia Code § 38.2-3113.1), allows the policyowner to adjust premium payments within policy limits (e.g., minimum to maintain coverage, maximum for tax advantages), offering flexibility over fixed-premium plans like whole life. Option A correctly identifies the policyowner as the decision-maker. Option B (contingent beneficiary) is false; beneficiaries have no control over premiums. Options C and D tie adjustments to economic indices (CPI, interest rates), but Virginia law and standard policies don’t grant insurers unilateral premium-changing rights based on these factors—flexibility is the policyowner’s prerogative, subject to cash value sufficiency. The study guide likely contrasts this with traditional policies, using examples of skipped or increased payments, confirming A as the defining trait.

Virginia Code § 38.2-3432.1, aligned with the Affordable Care Act (ACA), mandates guaranteed renewability for small employer health plans (1-50 employees in Virginia). Insurers can deny renewal for nonpayment of premiums (option A), insufficient participants (option B, e.g., falling below one eligible employee), or fraud (option D), per Virginia Code § 38.2-3407. However, option C—overuse of services (high claims)—a—is not a permissible reason for denial, as renewability cannot be based on claims experience or health status. The study guide emphasizes this protection under Virginia’s small group market rules, making C the exception.

Virginia Code § 38.2-5200 defines Activities of Daily Living (ADLs) in long-term care (LTC) insurance as basic self-care tasks triggering benefits if the insured can’t perform them (typically 2 of 6). Option D lists common ADLs: dressing, eating, bathing, and mobility (often with toileting and transferring), aligning with federal and Virginia standards (e.g., HIPAA). Option A (age, sex, income, occupation) is underwriting data, not ADLs. Option B (health providers) is unrelated to functional ability. Option C (family members) might confuse beneficiaries, not ADLs. The study guide likely lists ADLs with examples—e.g., needing help bathing due to arthritis—emphasizing their role in LTC eligibility, making D the precise answer.

Virginia requires an incontestability clause in life policies. After a policy has been in force for two years, it becomes incontestable except for nonpayment of premium.

Exact Extract (Virginia Law): “A life insurance policy shall be incontestable after it has been in force during the lifetime of the insured for two years, except for nonpayment of premiums.”

References (Virginia Documents / Study Guide):

— Code of Virginia §38.2-3107 (Incontestability clause requirement)

Detailed Answer in Step-by-Step Solution:

Excess charges in Medicare occur when a provider charges more than the Medicare-approved amount, and the insured (D) is responsible for the difference unless covered by supplemental insurance.

The Social Security Administration (A) and CMS (B) administer Medicare, not pay claims.

Providers (C) may charge excess but don’t absorb it unless they accept assignment.

The Virginia study guide explains that Medicare beneficiaries bear excess charges unless a provider accepts Medicare assignment or a Medigap policy covers them. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Basics."

The doctrine of reasonable expectations holds that insurance contracts will be interpreted as a reasonable person would expect, even if fine print suggests otherwise. Exact extract: “Under the principle of reasonable expectations, coverage is interpreted in line with what a prudent policyholder would believe was provided.” This prevents insurers from denying claims based on obscure or technical language.

A POS plan blends characteristics of HMOs and PPOs/indemnity plans. Like an HMO, members choose a primary care physician, but they can also go out-of-network and receive partial reimbursement (similar to indemnity coverage). Exact extract: “POS plans combine features of HMOs and indemnity plans, permitting members to seek care within the network or outside the network at higher cost-sharing.” This flexibility allows broader provider choice while controlling costs through the HMO model.

Virginia Code § 38.2-1826(C) requires licensees, including insurance agents, to report any felony conviction to the State Corporation Commission’s Bureau of Insurance within 30 calendar days of the final disposition (option C). “Final disposition” means the court’s conclusive ruling—e.g., sentencing after a guilty plea. This rule ensures the Bureau can assess the agent’s fitness to retain their license, protecting the public from untrustworthy practitioners. Option A (10 days) is too short and not specified in Virginia law for this purpose. Option B (20 days) lacks statutory support and falls between standard reporting periods. Option D (60 days) exceeds the mandated timeline, delaying oversight. The study guide likely highlights this 30-day deadline in a licensing compliance section, with examples—e.g., an agent convicted of fraud on June 1 must report by July 1—aligning with Virginia’s adoption of NAIC standards for licensee integrity (Virginia Code § 38.2-1800 et seq.), making C the precise requirement.

Before an applicant is tested for HIV, they must sign a consent form that acknowledges their understanding of the test and the potential implications of the results. This is required by law to ensure that the test is done voluntarily and that the applicant is aware of their rights. The other options, such as paying for the test or providing evidence of insurability, are not required before HIV testing.

Virginia requires licensees to report felony convictions within 30 days. Exact extract: “A licensed agent shall report to the Commission any felony conviction within 30 calendar days.”

Virginia insurance regulations require insurers and agents to protect consumer privacy while also allowing insureds access to their personal information. When an insured submits a written request to review personal information collected by the insurer or agent, the request must be addressed within 45 business days. This timeframe ensures consumers have reasonable access to their records while allowing insurers sufficient time to retrieve and verify the information. The regulation balances consumer rights with administrative practicality. Shorter or longer timeframes are not consistent with Virginia insurance privacy requirements, making 45 business days the correct response.

HMOs emphasize preventive care to control costs and maintain wellness, including immunizations, checkups, and screenings. Exact extract: “Health Maintenance Organizations emphasize preventive health services as a primary means of controlling health costs.”

Level term life insurance provides a fixed premium for a specified period, even though the risk of death increases as the insured ages. This is possible because premiums are averaged over the term of the policy.

In the early years, the insured pays more than the actual mortality cost, while in later years the cost of insurance exceeds the premium paid. This averaging mechanism allows the premium to remain level throughout the term.

Evidence of insurability is not required annually, the face amount does not necessarily decrease, and no additional lump-sum premium is required. Virginia exam materials consistently emphasize premium averaging as the reason level premiums are possible, making option D correct.

A second surgical opinion provision in health insurance policies typically requires the insured to seek a second opinion before undergoing certain elective surgeries. This provision is meant to ensure that the surgery is medically necessary and that there are no alternative treatments. The cost of the second opinion may or may not be covered depending on the policy, but the key requirement is that a second opinion must be obtained for elective procedures.

Under the Affordable Care Act (ACA), Essential Health Benefits (EHB) include a variety of categories such as hospitalization, laboratory services, and preventive care services. However, adult dental services are not included as one of the ACA's required essential benefits, though they may be offered as part of a separate plan or rider. This distinction is important as it affects coverage requirements and benefits for different age groups.