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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Exam Sample Questions (Q125-Q130):

NEW QUESTION # 125
A PRIMARY difference between precertification provision and concurrent review is that only the precertification provision

A. occurs before the treatment is provided.
B. is designed to be a cost containment measure.
C. involves a review by the insurance company.
D. requires the consent of the patient.

Answer: A

Explanation:
Precertification(or preauthorization) is a process where the insurer reviews and approves certain medical treatments or procedures before they are provided, ensuring they are medically necessary and covered.
Concurrent reviewoccurs during the treatment, monitoring ongoing care (e.g., hospital stays) to ensure continued necessity. The primary difference is timing: precertification happens before treatment, while concurrent review happens during treatment.
* Option A: Incorrect. Both precertification and concurrent review are cost containment measures, so this is not unique to precertification.
* Option B: Incorrect. Both processes involve review by the insurance company.
* Option C: Incorrect. Neither typically requires patient consent beyond agreeing to the policy terms.
* Option D: Correct. Precertification occurs before treatment, distinguishing it from concurrent review.
This question aligns with the Prometric content outline under "Provisions, Options, Exclusions, Riders, Clauses, and Rights," which covers health insurance utilization management.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Accident and Health Insurance).
Oklahoma Insurance Department, Title 36 O.S. § 6060.3 (utilization review standards).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 126
A group major medical policy is written with a $1,000 deductible, 80/20 coinsurance, and an out-of-pocket maximum of $3,000. The insured goes into the hospital for a covered procedure. The total cost of the procedure is $5,000. How much does the insured have to pay towards the $5,000 total?

A. $3,000
B. $1,800
C. $5,000
D. $1,000

Answer: A

Explanation:
To calculate the insured's payment:
* Deductible: The insured pays the first $1,000 of the $5,000 procedure cost.
* Remaining cost: $5,000 - $1,000 = $4,000.
* Coinsurance: The policy has 80/20 coinsurance, so the insurer pays 80% ($3,200) and the insured pays
20% ($800) of the $4,000.
* Total paid by insured: $1,000 (deductible) + $800 (coinsurance) = $1,800.
* Out-of-pocket maximum: The policy's $3,000 out-of-pocket maximum caps the insured's total payments. Since $1,800 is less than $3,000, the insured pays $1,800. However, the question asks for the total paid "towards the $5,000," and the out-of-pocket maximum of $3,000 suggests a cap on total liability for covered expenses. In this context, the correct interpretation is that the insured's payment is capped at the out-of-pocket maximum if applicable, but standard calculation yields $1,800, and the answer options suggest a possible intent for the maximum.
Upon review, the correct calculation yields $1,800 (Option C), but the out-of-pocket maximum of $3,000 (Option B) may be the intended answer if the question implies the maximum liability. Given the standard insurance calculation,Option C ($1,800)is mathematically correct, butOption B ($3,000)aligns with the out- of-pocket maximum as a potential cap. Since the calculation is clear, we selectC.
Corrected answer: C
Explanation of Calculation:
* Deductible: $1,000.
* Coinsurance: 20% of $4,000 = $800.
* Total: $1,000 + $800 = $1,800.
* The out-of-pocket maximum ($3,000) is not reached, so the insured pays $1,800.
* Option A: Incorrect. The insured does not pay the full $5,000 due to insurer contributions.
* Option B: Incorrect. The $3,000 out-of-pocket maximum is not reached; the calculated payment is
$1,800.
* Option C: Correct. The insured pays $1,800 based on the deductible and coinsurance.
* Option D: Incorrect. The $1,000 deductible alone does not account for coinsurance.
This question aligns with the Prometric content outline under "Provisions, Options, Exclusions, Riders, Clauses, and Rights," which covers health insurance cost-sharing provisions.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Accident and Health Insurance).
Oklahoma Insurance Department, Title 36 O.S. § 6060.3 (health insurance policy provisions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 127
What is it called when a health insurance policy terminates and the policyholder is allowed to receive benefits past the termination date of the policy?

A. extension of benefits.
B. qualifying event.
C. duration of coverage.
D. notification statement.

Answer: A

Explanation:
Anextension of benefitsprovision in health insurance allows a policyholder to continue receiving benefits for a covered condition (e.g., disability or hospitalization) after the policy terminates, typically if the condition began while the policy was in force. This is a standard provision in group and individual health insurance policies in Oklahoma, ensuring continuity of care for specific circumstances.
* Option A: Incorrect. A qualifying event relates to COBRA or other continuation coverage triggers, not post-termination benefits.
* Option B: Incorrect. Duration of coverage refers to the policy term, not benefits after termination.
* Option C: Correct. Extension of benefits allows benefits to continue after policy termination.
* Option D: Incorrect. A notification statement is unrelated to benefit continuation.
This question aligns with the Prometric content outline under "Provisions, Options, Exclusions, Riders, Clauses, and Rights," which covers health insurance benefit provisions.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Accident and Health Insurance).
Oklahoma Insurance Department, Title 36 O.S. § 4405 (health insurance policy provisions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 128
How many employees are REQUIRED before an employer is subject to COBRA?

A. 20 employees
B. 30 employees
C. 50 employees
D. 31 employees

Answer: A

Explanation:
TheConsolidated Omnibus Budget Reconciliation Act (COBRA), as regulated under federal law (29 U.S.
C: § 1161 et seq.), requires employers with20 or more employeesto offer continuation of group health insurance coverage to employees and their dependents after certain qualifying events (e.g., termination of employment). This applies to private-sector employers and is enforced in Oklahoma.
* Option A: Correct. COBRA applies to employers with 20 or more employees.
* Option B: Incorrect. 30 employees is not the threshold.
* Option C: Incorrect. 31 employees is not the specific requirement.
* Option D: Incorrect. 50 employees is unrelated to COBRA's threshold.
This question aligns with the Prometric content outline under "State Insurance Statutes, Rules, and Regulations," which covers federal laws like COBRA.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section: State- Specific Knowledge - Oklahoma Insurance Statutes).
Oklahoma Insurance Department, Title 36 O.S. § 6060.3 (health insurance regulations).
COBRA, 29 U.S.C. § 1161 et seq.

NEW QUESTION # 129
Term life insurance is more appropriate than whole life insurance when the

A. maximum protection is needed, but the insured cannot afford premium payments for permanent insurance.
B. policyowner desires an accumulation of cash values.
C. policyowner wants to borrow against the life insurance policy values.
D. insured needs low cost permanent life insurance protection.

Answer: A

Explanation:
Term life insuranceprovides coverage for a specific period (e.g., 10, 20 years) at a lower premium cost than whole life insurance, making it ideal for individuals needing maximum death benefit protection but unable to afford the higher premiums of permanent insurance. Unlike whole life, term life does not accumulate cash value or allow policy loans.
* Option A: Incorrect. Borrowing against policy values requires cash value, available in whole life, not term life.
* Option B: Incorrect. Cash value accumulation is a feature of whole life, not term life.
* Option C: Correct. Term life is appropriate for maximum protection at a lower cost when permanent insurance premiums are unaffordable.
* Option D: Incorrect. Term life is not permanent insurance; whole life provides permanent coverage.
This question falls under the Prometric content outline section on "Life Products," which covers the suitability of term versus whole life insurance.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Life Insurance).
Oklahoma Insurance Department, Title 36 O.S. § 4002 (definitions of life insurance products).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 130
......

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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Exam Sample Questions (Q125-Q130):

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