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Insurance Licensing Oklahoma Life, Accident, and Health or Sickness Producer Exam Sample Questions (Q18-Q23):

NEW QUESTION # 18
Under the unpaid premium Uniform Optional Provision, if there is an unpaid premium at the time a health claim becomes payable, then the

A. policy is cancelled.
B. claim is delayed until payment of the premium.
C. claim is denied.
D. premium is deducted from the claim.

Answer: D

Explanation:
Theunpaid premium Uniform Optional Provisionin health insurance policies, as recognized in Oklahoma (Title 36 O.S. § 4405), allows the insurer to deduct any unpaid premiums from a claim payment if a claim becomes payable while premiums are overdue. This ensures the policy remains in force and the claim is paid, net of the owed premium.
* Option A: Incorrect. The claim is not denied; the premium is deducted from the payment.
* Option B: Incorrect. The policy is not cancelled; the unpaid premium is addressed via the claim.
* Option C: Correct. The unpaid premium is deducted from the claim payment.
* Option D: Incorrect. The claim is not delayed; the premium is settled with the claim payment.
This question falls under the Prometric content outline section on "Provisions, Options, Exclusions, Riders, Clauses, and Rights," which covers health insurance policy 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 provisions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 19
Which of the following is one of the MAIN tasks of a field underwriter?

A. Approving an individual's policy.
B. Ensure the accuracy and completeness of an individual's medical information.
C. Editing an applicant's report to ensure approval.
D. Obtaining a Medical Information Bureau (MIB) report.

Answer: B

Explanation:
Afield underwriter, typically an insurance producer, gathers initial information from applicants to assess their insurability and ensure the application is accurate and complete. A main task is ensuring the accuracy and completeness of an individual's medical information, as this is critical for the insurer's underwriting decision. Field underwriters do not approve policies or edit reports to guarantee approval; they facilitate the process by providing reliable data.
* Option A: Incorrect. Editing reports to ensure approval is unethical and not a field underwriter's role.
* Option B: Incorrect. Approving policies is the role of the insurer's underwriting department, not the field underwriter.
* Option C: Correct. Ensuring accuracy and completeness of medical information is a key task of a field underwriter.
* Option D: Incorrect. Obtaining an MIB report is typically done by the insurer, not the field underwriter.
This question aligns with the Prometric content outline under "Underwriting," which covers the role of field underwriters.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Underwriting).
Oklahoma Insurance Department, Title 36 O.S. § 1204 (insurance business conduct).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 20
Any person entitled to reimbursement for expenses of health care services and procedures under an Accident and Health Insurance Policy issued by an insurer is

A. a Preferred Provider Organization.
B. an insurer.
C. an insured.
D. a practitioner.

Answer: C

Explanation:
Aninsuredis the person covered by an accident and health insurance policy and entitled to reimbursement for covered health care expenses, as defined in Oklahoma's Insurance Code (Title 36 O.S. § 4401). The insured (or their assignee, e.g., a provider) receives benefits for services like medical treatments or hospital stays.
* Option A: Incorrect. An insurer is the company issuing the policy, not receiving reimbursement.
* Option B: Correct. The insured is entitled to reimbursement for covered health care expenses.
* Option C: Incorrect. A practitioner provides services, not receives policy reimbursements.
* Option D: Incorrect. A PPO is a network of providers, not an individual entitled to benefits.
:
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. § 4401 (health insurance definitions).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 21
Which of the following describes the gatekeeper strategy used by HMOs?

A. The process of obtaining referrals to specialists from primary care physicians.
B. The emphasis on preventing enrollees from using patient services.
C. The refusal of coverage for patients with preexisting conditions.
D. The use of supplemental services on an additional cost basis.

Answer: A

Explanation:
In Health Maintenance Organizations (HMOs), thegatekeeper strategyinvolves a primary care physician (PCP) who coordinates patient care and provides referrals to specialists. This ensures that care is managed efficiently and only necessary specialist visits are authorized, aligning with the HMO's cost-containment model.
* Option A: Incorrect. Refusing coverage for preexisting conditions is unrelated to the gatekeeper role and is regulated by HIPAA, not HMO strategy.
* Option B: Correct. The gatekeeper strategy requires referrals from a PCP to see specialists, a hallmark of HMO plans.
* Option C: Incorrect. HMOs encourage preventive care, not preventing service use, to manage costs.
* Option D: Incorrect. Supplemental services at additional cost are not part of the gatekeeper strategy.
This question falls under the Prometric content outline section on "Health Providers and Products," which covers HMO structures and strategies.
:
Prometric Oklahoma Life, Accident, and Health or Sickness Producer Exam Content Outline (Section:
General Knowledge - Health Providers and Products).
Oklahoma Insurance Department, Title 36 O.S. § 652 et seq. (managed care regulations).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 22
The Oklahoma Insurance Commissioner is REQUIRED to examine domestic insurers' financial condition at LEAST every

A. 2 years.
B. 4 years.
C. 5 years.
D. 6 years.

Answer: C

Explanation:
Under Oklahoma's Insurance Code (Title 36 O.S. § 309.2), the Oklahoma Insurance Commissioner is required to examine the financial condition ofdomestic insurersat least once every5 yearsto ensure solvency and compliance with state regulations. More frequent examinations may occur if issues arise, but 5 years is the minimum requirement.
* Option A: Incorrect. 2 years is too frequent for the minimum requirement.
* Option B: Incorrect. 4 years is not the specified interval.
* Option C: Correct. Examinations are required at least every 5 years.
* Option D: Incorrect. 6 years exceeds the required frequency.
:
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. § 309.2 (examination of insurers).
Standard insurance study guides (e.g., Kaplan, ExamFX) for Oklahoma producer licensing.

NEW QUESTION # 23
......

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