Virginia-Life-Annuities-and-Health-Insurance Virginia Life, Annuities, and Health Insurance Examination Series 11-01 Question and Answers

The investment gain in a tax-sheltered annuity (TSA), which is also known as a 403(b) plan, is not included in the participant's gross income until it is withdrawn. This allows the participant to defer taxes on the investment growth until retirement, when distributions are taken. The other statements about TSAs are accurate: they are funded through voluntary salary reductions, and the annuitant can have an individual account or contract.

Life annuities provide a stream of income during the annuitant’s lifetime. Payments begin after the accumulation period (annuitization) and continue while the annuitant lives. They liquidate a principal sum systematically and protect against longevity risk by pooling risks across many annuitants.

The incorrect statement is B, since benefits start while the annuitant is living, not after death.

Exact Extract (Virginia Annuities Study Guide): “Life annuities are designed to provide income during the lifetime of the annuitant, liquidating principal systematically and protecting against outliving financial resources.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Examination Outline, Section 4.1 Annuity Principles

The purpose of Medicare supplement regulation is to ensure consumer protection, fair marketing, and full disclosure. Policies must clearly explain benefits, costs, and relationship to Medicare coverage. Exact extract: “The intent of the rules is to protect Medicare eligible persons by requiring full disclosure in the sale of accident and sickness insurance policies marketed as Medicare supplements.” These rules prevent misleading practices and ensure seniors understand their coverage.

Common life insurance nonforfeiture options include extended term insurance, reduced paid-up insurance, and cash surrender value. These options allow policyholders to access some of the policy’s value if they decide to stop paying premiums or surrender the policy. A life income annuity is not a nonforfeiture option; rather, it is a type of annuity that provides periodic payments for the annuitant's lifetime.

Under the coordination of benefits provision, when an individual is covered by more than one medical plan, the primary plan (Plan A) pays up to its limit first, and then the secondary plan (Plan B) pays any remaining covered expenses. In this case, since Plan A is primary, it will pay up to its maximum benefit of $4,000. After that, Plan B will pay up to its maximum benefit of $3,000, covering the remaining $2,000 in expenses.

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.

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)

A contingent beneficiary is designated to receive the policy proceeds only if the primary beneficiary is unable to do so, usually due to predeceasing the insured.

Exact Extract (Virginia Life Insurance Study Guide): “Contingent beneficiary—receives benefits if the primary beneficiary dies before the insured.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Beneficiary Designations

Detailed Answer in Step-by-Step Solution:

The health insurance application is signed by the applicant (who provides personal info) and the agent (D), who certifies the information’s accuracy and their role in the process.

The spouse (A) or dependents (B) don’t sign unless they’re co-applicants. An inspection representative (C) is not involved in the application process.

The Virginia study guide specifies that the agent signs the application alongside the applicant to verify the submission and their involvement, per standard industry practice. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Application Process."

Under the conversion option of a group life insurance plan, the insured can convert their coverage to an individual policy without requiring evidence of insurability. This means the individual does not need to prove they are in good health to convert their group coverage to a personal policy. The new policy's premium rate, coverage amount, and duration will vary based on the terms of the conversion option, but no proof of health is required for conversion.

The extended term nonforfeiture option uses the cash value to purchase term insurance for the full face amount ($35,000) for as long a term as the cash value allows. The face amount remains unchanged; only the term length varies.

Exact Extract (Virginia Life Insurance Study Guide): “Extended term—uses cash value to buy term insurance equal to the original face amount for a period determined by cash value.”

References (Virginia Documents / Study Guide):

— Virginia Life Insurance Examination Outline, Nonforfeiture Options

Noncancelable policies guarantee both renewability and level premiums. The insurer cannot raise rates or cancel coverage as long as premiums are paid. Exact extract: “A noncancelable policy may not be canceled nor may premiums be increased by the insurer beyond what is stated in the contract.” This makes noncancelable coverage the most consumer-friendly disability policy type.

Term life insurance provides coverage for a specified period of time and is designed to offer pure death benefit protection without a savings or investment component. One of its defining characteristics is that it does not accumulate cash value. Term policies offer temporary protection and may have level or decreasing face amounts, depending on the policy design. They are also known for having a low initial cost compared to permanent life insurance, making them attractive for short-term needs such as income replacement or debt coverage. Because term life insurance does not build cash value, there is no opportunity for increasing cash values over time. Therefore, increasing cash values is not a characteristic of term life insurance and is the correct exception.

Adjustable life insurance is specifically designed to provide flexibility in both face amount and premium structure, allowing policyowners to adapt coverage as financial needs and objectives change. This flexibility may include adjustments to death benefit levels and premium payments within policy limits.

Term life and modified premium whole life lack this degree of adaptability. Current assumption whole life allows interest rate sensitivity but does not permit the same broad adjustments to coverage structure.

Virginia licensing materials identify adjustable life as a hybrid policy combining features of term and whole life insurance, making option B the correct answer.

Dental indemnity plans reimburse insureds for covered services up to specified amounts. Preventive services such as cleanings, exams, and fluoride treatments are typically covered every six months for both adults and children. These plans generally do not limit members to a network of providers, unlike managed care dental plans, but they do require deductibles and cost-sharing for major restorative work.

Exact Extract (Virginia Dental Plan Filing Requirements): “Preventive dental services—cleanings, exams, fluoride treatments—covered once every six months.”

References (Virginia Documents / Study Guide):

— Virginia SCC Product Checklist: Individual Stand-Alone Dental Plan Organizations

— Virginia Health Insurance Study Guide, Indemnity vs. Managed Care Plans

Uniform policy provisions are mandated by law and cannot be deleted. Underwriting actions include issuing, rejecting, or adding riders. Exact extract: “Insurers may not delete or alter mandatory uniform provisions.”

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)

Detailed Answer in Step-by-Step Solution:

A single premium whole life policy is a type of permanent life insurance where the entire premium for the policy’s lifetime coverage is paid in one lump sum at issuance.

Unlike policies with recurring premiums (e.g., monthly or annual), this single payment funds the policy for the insured’s full life (D).

Options A (one month) and B (one year) apply to term or recurring premium policies.

Option C (to age 65) might relate to limited-pay policies, not single premium ones.

Per the Virginia study guide, a single premium whole life policy requires one payment upfront, providing coverage for the insured’s entire life and building immediate cash value. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance Policies."

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.

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.

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.

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

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.

Medicare provides home health care benefits for individuals who are homebound and need skilled nursing or therapy services. Custodial care, hospice care, and long-term nursing home stays are covered under different provisions.

Exact Extract (Virginia Medicare Study Guide): “Home health care—Medicare pays for part-time or intermittent skilled care for patients confined to the home.”

References (Virginia Documents / Study Guide):

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

The "Usual, Customary, and Reasonable" (UCR) charges method is used to address geographical variation in medical costs. Under this method, the insurer will pay the amount based on what is considered usual and customary for a particular region or area. This ensures that payments reflect regional variations in healthcare pricing, making it more adaptable to different areas. Fee schedules apply fixed amounts for services, experience rating relates to group insurance, and capitation involves paying a set fee per person for services rendered.

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

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

Most group disability income insurance policies exclude coverage for disability resulting from military service. Disabilities caused by active duty in the military are typically covered under separate government programs, such as Veterans Affairs (VA) benefits. Commercial airline crashes, injuries at home, and automobile accidents are typically covered under group disability policies, though specifics may vary by policy.

Whole life insurance provides permanent coverage, builds guaranteed cash value, and allows for policy loans. However, it has a higher initial premium cost compared to term life insurance. Therefore, the statement that whole life has lower initial costs is incorrect.

Exact Extract (Virginia Life Insurance Study Guide): “Whole life insurance provides long-term protection, guaranteed cash values, and policy loans. Premiums are higher than term insurance for equivalent coverage.”

References (Virginia Documents / Study Guide):

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

Virginia Code § 38.2-5202 allows a guaranteed insurability option in LTC insurance, letting the insured buy additional coverage later (option A) without proving insurability, typically at set intervals or life events (e.g., inflation adjustment). Option B (replace with another insurer) isn’t a policy feature; it’s a market action. Option C (lifetime extension) confuses with benefit periods, not insurability. Option D (fixed premium) relates to non-cancelable policies, not this rider. The study guide likely describes this with examples—e.g., adding $1,000 monthly benefit at age 70—emphasizing future flexibility, making A the correct ability.

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.

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.

Detailed Answer in Step-by-Step Solution:

A 30-year decreasing term policy (B) reduces its death benefit over time, matching the declining balance of a 30-year mortgage, making it ideal for this purpose.

30-payment whole life (A) is permanent with level benefits. 30-year level term (C) maintains a constant benefit. 30-year endowment (D) builds cash value and pays out at maturity, not tied to a mortgage.

The Virginia study guide describes decreasing term insurance as tailored for obligations like mortgages, with the benefit decreasing as the debt is paid off. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance."

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 Code § 38.2-503 prohibits unfair or deceptive advertising in insurance, including Accident and Sickness policies. Terms like “reductions” (option A), “exclusions” (option B), and “pre-existing conditions” (option C) are factual policy features that must be disclosed clearly under Virginia Administrative Code 14VAC5-41-10 et seq., ensuring transparency. However, “unlimited benefits” (option D) is misleading if untrue, as all policies have limits (e.g., maximum benefits or coverage caps). Advertising “unlimited benefits” without substantiation violates Virginia’s rules against exaggerated or false claims, risking consumer deception. The study guide likely warns against such terms, citing examples where insurers faced penalties for overstating coverage, making D the prohibited choice.

A nonoccupational disability income policy covers accidents and sicknesses occurring off the job. Disabilities caused while performing work-related duties are excluded, since they are covered by workers’ compensation instead.

Exact Extract (Virginia Disability Insurance Study Guide): “Nonoccupational policies exclude coverage for work-related disabilities, which are handled under workers’ compensation.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Disability Income Insurance Exclusions

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.

Detailed Answer in Step-by-Step Solution:

The buyer’s guide for Medicare Supplement insurance must be provided to the consumer at the time of application (B) to ensure they understand the policy’s benefits and limitations before committing.

Option A (replacement only) is incorrect; the guide is required for all sales, though additional notices apply for replacements.

Option C (prior to payment) is too vague and not a specific requirement.

Option D (first-time buyer) is not a condition under Virginia or federal rules.

Per the Virginia study guide, agents must deliver the buyer’s guide at the time of application for Medicare Supplement policies, as mandated by federal and state regulations to promote informed decisions. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Medicare Supplement Insurance Regulations."

The incontestability clause in health insurance policies generally provides that after two years from the date of issue, the insurer cannot deny a claim or void coverage due to material misrepresentation in the application, except in cases of fraud. This ensures that policyholders have long-term protection from policy rescission due to innocent mistakes.

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.

Medical expense claim forms generally focus on the occurrence, character, and extent of the loss to determine the eligibility and amount of benefits. The employee's annual salary is not typically included on the claim form unless the claim relates to a disability or income replacement policy, but not for medical expense claims.

The Virginia Life, Accident and Sickness Insurance Guaranty Association exists to protect policyholders, insureds, and beneficiaries when a licensed insurer becomes insolvent. Insolvency occurs when an insurer is unable to meet its financial obligations. In such cases, the guaranty association may provide coverage benefits up to statutory limits to ensure consumers do not lose all protection. The association does not protect against normal business events such as mergers, demutualization, or the sale of company assets. Its sole purpose is to provide a safety net in the event of insurer failure. This protection helps maintain public confidence in the insurance system.

If a health insurance policy provision conflicts with the statutes of Virginia, the provision must be amended to conform to the minimum statutory requirements. This ensures that the policy complies with state law and that the insured receives the protection mandated by Virginia's insurance regulations. Provisions that do not meet these requirements are typically adjusted to align with legal standards.

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.

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.

Fixed annuities are designed to credit interest at a rate that is no lower than the contract’s guaranteed rate. This guaranteed rate is specified at the time of the contract and ensures that the policyholder will receive at least this minimum interest rate, regardless of market conditions. The fixed annuity’s interest rate can be higher depending on the insurer's performance, but it cannot fall below the guaranteed rate.

Virginia Code § 38.2-1833 defines an “appointment” as a formal authorization by an insurer for a licensed agent to act on its behalf in transacting insurance. An insured (option A) is the policyholder or beneficiary and has no role in representing the insurer. An employee of the insurer (option B) may work internally but isn’t automatically appointed to sell insurance unless they hold an agent’s license and an appointment, which isn’t implied here. A consultant (option C), under Virginia Code § 38.2-1837, advises on insurance but doesn’t transact it unless also licensed and appointed as an agent, making this a less direct fit. Only an agent (option D), licensed under Virginia Code § 38.2-1819 and appointed per § 38.2-1833, is required to hold an appointment to represent an insurer. The study guide emphasizes that appointments link licensed agents to specific insurers, solidifying D as the correct choice.

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."

Single premium whole life insurance is funded with one lump-sum premium that immediately creates both cash value and nonforfeiture value. Because the entire premium is paid upfront, a significant portion is allocated to the policy reserve, making options A, B, and C correct.

Whole life insurance has fixed premiums by definition. Once the single premium is paid, no additional premiums are required, regardless of inflation or economic conditions. Therefore, option D is incorrect and is the correct “EXCEPT” answer.

Virginia exam materials emphasize that whole life policies provide guaranteed premiums, guaranteed death benefits, and guaranteed cash value growth, which distinguishes them from flexible or adjustable policies.

The free look period allows a policyowner to review a newly issued life insurance policy and cancel it within a specified number of days after delivery for a full refund of premiums paid. Virginia requires this consumer protection provision to ensure buyers have time to examine policy terms and confirm suitability.

A grace period applies to late premium payments, not policy cancellation. Discovery and probationary periods are not standard life insurance provisions. The free look period strengthens consumer confidence and transparency in the insurance marketplace, making option D correct.

The insuring clause in a health insurance policy is a key provision that outlines the general terms of the coverage provided by the insurer. It typically includes a broad description of what the policy covers and the conditions under which benefits will be paid. It does not contain a list of specific hospitals, nor does it detail how premiums are determined or act as part of the application.

Medical expense insurance typically excludes coverage for injuries or sickness resulting from military duty. This exclusion is common across most health insurance policies and aligns with the understanding that military personnel are covered under separate government programs (e.g., Veterans Affairs or military health insurance). The other options, such as terminal diseases, dread diseases, or tropical diseases, are not universally excluded, though they may have specific policy restrictions or coverage limits.

Under the paid-up life insurance nonforfeiture option, the policy’s cash value is used to purchase a reduced amount of fully paid-up whole life insurance. Because no further premiums are due, the face amount is less than the original policy, making option C correct.

Term insurance is associated with the extended term option, not paid-up insurance. Riders such as accidental death benefits typically terminate at lapse.

Virginia exam materials emphasize reduced paid-up insurance as a permanent solution that preserves lifetime coverage at a lower death benefit.

Detailed Answer in Step-by-Step Solution:

For unintentional violations in Virginia, the maximum penalty is $1,000 per occurrence, with an aggregate cap of $10,000 (C), per state insurance regulations.

Options A, B, and D deviate from this standard penalty structure.

The Virginia study guide, per Virginia Code, sets unintentional violation penalties at up to $1,000 per act, with a $10,000 total cap, escalating for willful violations. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Penalties and Enforcement."

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.

In a deferred annuity, benefit payments to the annuitant typically begin when the contract matures. Maturity occurs at a specified time, such as the annuitant’s retirement age or another defined period. The annuity may then begin making periodic payments to the annuitant or a beneficiary, depending on the terms of the contract.

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.”

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.

Detailed Answer in Step-by-Step Solution:

Agents assist underwriting by collecting application data (A), obtaining additional info (C), and reporting material facts (D), but determining the final rate classification (B) is the insurer’s underwriter’s role, not the agent’s.

Rate classification involves risk assessment, which is beyond an agent’s authority.

The Virginia study guide specifies that agents facilitate underwriting by providing accurate information, while the insurer’s underwriters set rates based on that data. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Underwriting Process."

Long-term care insurance is designed to provide coverage for services that assist individuals who are unable to care for themselves due to chronic illness, disability, or aging, even if hospitalization is not required. This can include home health care, nursing home care, and other non-hospital care services. Medicare primarily covers hospitalization and some health-related services but not long-term care. Major medical covers broader health care costs, and disability income provides income replacement rather than care services.

In long-term care (LTC) insurance, the elimination period, per Virginia Code § 38.2-5202, is the waiting period between the onset of a qualifying condition (e.g., confinement due to inability to perform ADLs) and the start of benefit payments. It’s akin to a deductible in days (e.g., 30, 60, or 90 days), during which the insured must cover costs. Option D correctly names this period. Option A (trial period) isn’t a standard LTC term. Option B (exclusion period) might confuse with pre-existing condition exclusions, but it’s not the waiting period for benefits. Option C (qualifying period) could imply eligibility determination, but “elimination period” is the precise industry term. The study guide likely defines this as a cost-sharing feature, with examples illustrating how longer periods reduce premiums, solidifying D as the answer.

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.

Detailed Answer in Step-by-Step Solution:

Term life insurance’s primary advantage is its lower initial premium (D) compared to whole life for the same death benefit, due to its temporary nature and lack of cash value.

Option A (same cost) is false; term is cheaper. Option B (cost-effective long-term) is incorrect; premiums rise with renewals. Option C (permanent) applies to whole life, not term.

The Virginia study guide highlights that term life insurance offers affordable initial premiums for temporary coverage, making it attractive for short-term needs compared to whole life. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Types of Life Insurance."

Accidental death benefit (ADB) riders pay an additional death benefit if death results from accidental causes. It is not automatically included in every policy and requires an additional premium. Exact extract: “The accidental death benefit rider provides extra coverage in the event of accidental death and is available only by payment of an additional premium.” It does not affect cash values or nonforfeiture options.

Field underwriting refers to the duties carried out by the insurance agent during the application process. Unlike home office underwriting, which relies on medical exams and reports, the agent is in personal contact with the applicant and is responsible for gathering correct information.

Exact Extract (Virginia Life & Health Insurance Study Guide): “Field underwriting—conducted by the agent, includes personal contact with the applicant, observing general character, and ensuring application completeness.”

References (Virginia Documents / Study Guide):

— Virginia Life & Health Insurance Examination Outline, Underwriting Principles

In life insurance, the applicant is the person who applies for coverage and is usually the policyowner. The insured is the person whose life is covered, and the beneficiary is the person or entity designated to receive the death benefit. When a person applies for insurance on their own life, they are both the applicant and the insured, and they typically become the policyowner. In this scenario, Kim applies for the policy on Kim’s own life, making Kim the applicant and policyowner. Chris is named only as the beneficiary. None of the other answer choices correctly identify these roles based on the information provided.

A mutual insurance company is owned by its policyholders rather than shareholders. When the company’s operating results are favorable, dividends may be declared and paid to policyholders as a return of excess premium.

These dividends are not guaranteed and are not considered taxable income in most cases, as they are treated as a refund of premium. Shareholders receive dividends only in stock insurance companies. Beneficiaries receive death benefits, and producers receive commissions, not dividends.

Virginia exam content highlights ownership structure as the key distinction between mutual and stock insurers, making option A correct.

Virginia adopts the Accident and Sickness advertising standards that define “advertisement” broadly (print, online, audiovisual, etc.), but specifically carve out employer announcements about available group coverage. Exact extract: “Advertisement means any printed, published, audio/visual, or descriptive literature used to solicit the public… including material on an insurer’s website.” “The term does not include general announcements by an employer to its employees that a plan of coverage is available.”

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."

The federal estate tax is the tax cost typically associated with death. It is imposed on the estate of a deceased person, and it applies to the transfer of assets above a certain threshold. Life insurance proceeds are generally not taxable to beneficiaries; however, if the policy is part of the estate, the proceeds may be subject to estate taxes. Excise taxes and state sales taxes are not typically related to death.

Most medical expense policies contain a war exclusion, denying benefits for losses resulting from war or military action. Auto accidents, sporting accidents, and tropical diseases are generally covered if not otherwise excluded.

Exact Extract (Virginia Health Insurance Study Guide): “Common exclusions include war, military service, self-inflicted injury, and experimental procedures.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Common Exclusions

Virginia Code § 38.2-3109 allows life insurance riders to extend coverage. A family term rider (option C) attaches to a primary policy (e.g., the breadwinner’s) and provides term insurance for all family members—spouse and children—under one supplement, often with a single premium. Option A (spouse term rider) covers only the spouse, not children. Option B (children’s term rider) insures only children, excluding the spouse. Option D (survivorship term rider) isn’t a standard term; “survivorship” typically refers to joint life policies paying at the second death, not family coverage. The study guide likely describes the family term rider as a cost-effective way to insure dependents, with examples showing level term benefits for each member, making C the accurate answer.

Virginia Code § 38.2-5207 and 14VAC5-200-185 outline marketing standards for long-term care (LTC) insurance to protect consumers. Option A (twisting)—misrepresenting a policy to induce replacement—is prohibited as an unfair practice (Virginia Code § 38.2-502). Option C (high pressure tactics)—aggressive sales forcing quick decisions—violates ethical standards and is banned (14VAC5-200-40). Option B (replacing existing coverage) is incorrect as stated; replacement itself isn’t prohibited but requires disclosure via a replacement notice (14VAC5-200-75), making it regulated, not banned outright—however, the question implies unauthorized or deceptive replacement, which is prohibited. Option D (cold lead advertising)—soliciting via broad, unsolicited leads (e.g., mailers)—is permitted if it complies with disclosure rules and isn’t deceptive (14VAC5-200-50). The study guide likely lists twisting and high pressure as unethical, with examples like misstating benefits, while allowing cold lead ads with proper labeling (e.g., “advertisement”), making D the exception.

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."

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

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

Cancellation, per Virginia Code § 38.2-3106 (life) and § 38.2-3508 (health), is the voluntary termination of a policy by the insured or insurer. Options A, B, and C aren’t standard terms for this action in Virginia insurance law. The study guide defines cancellation as a deliberate act, distinct from lapse (nonpayment) or nonrenewal, making D the correct term.

Virginia Code § 38.2-3505 requires disability income policies to include a misstatement of age provision. If an applicant misstates their age, the insurer adjusts benefits to what the paid premium would have purchased at the correct age, rather than voiding or canceling the policy. Option A reflects this adjustment process. Option B is false; the insurer remains liable, adjusting claims rather than denying them outright. Option C is incorrect; immediate cancellation isn’t standard unless fraud is proven (Virginia Code § 38.2-309), and age misstatements are typically clerical errors, not fraud. Option D is wrong; voiding from inception requires material misrepresentation with intent to deceive, not a simple age error. The study guide likely explains this clause as a fairness mechanism, protecting both parties, making A the correct answer.

A joint and survivor annuity is designed to provide income for two people, typically spouses, and payments continue until both annuitants have died. This feature makes it especially suitable for retirement planning when ongoing income is needed for a surviving spouse.

When the first annuitant dies, payments continue to the survivor, often at the same or a reduced level depending on the contract terms. Only after the second annuitant’s death do payments cease. Therefore, option A is correct.

Options B, C, and D incorrectly describe other annuity structures. Beneficiaries are generally relevant only if a refund or period-certain option applies. Joint and survivor annuities are a core topic in Virginia annuity education because of their longevity risk protection.

A beneficiary designation by class identifies beneficiaries as a group rather than by individual names. Common class designations include children, grandchildren, or surviving spouse. “All children of the insured” is a classic example because it includes all individuals who meet that description at the time of the insured’s death, even if the number of children changes over time. A specified parent, a named shareholder, or the insured’s estate are not class designations. The estate is a legal entity, not a class of individuals, and naming a specific person does not constitute a class designation.

In the context of health insurance, particularly dental coverage, Virginia Code § 38.2-3407.1 et seq. governs mandated benefits, though dental specifics often appear in policy riders or standalone plans. Orthodontics (option A) is the branch of dentistry focused on preventing and correcting irregularities of the teeth and jaws using mechanical devices like braces or aligners, precisely matching the question’s description. Endodontics (option B) deals with the tooth’s interior (e.g., root canals), not mechanical correction of alignment. Periodontics (option C) addresses gum diseases and supporting structures, not tooth positioning. Prosthodontics (option D) involves replacing missing teeth with prosthetics (e.g., dentures), not correcting irregularities mechanically. The study guide likely defines these terms in a health insurance section, emphasizing orthodontics’ role in alignment correction—both preventive (e.g., avoiding bite issues) and corrective—making A the clear answer. Examples like braces for malocclusion reinforce this distinction from other specialties.

Coinsurance is a cost-sharing arrangement where, after the deductible is met, the insured pays a percentage of covered expenses and the insurer pays the rest. A common split is 80/20, where the insurer pays 80% and the insured pays 20% until the maximum out-of-pocket limit is reached.

Exact Extract (Virginia Health Insurance Study Guide): “Coinsurance—after the deductible has been satisfied, the insured and insurer share covered expenses in a stated ratio (e.g., 80/20).”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Major Medical Policy Provisions

An independent agent is one who may represent multiple insurance companies, offering a variety of policies from different insurers. This contrasts with exclusive agents who typically represent only one insurer. Independent agents are not tied to a single company and can offer more choices to their clients. The other options are not defining characteristics of independent agents.

Detailed Answer in Step-by-Step Solution:

The coordination of benefits (COB) provision prevents overinsurance (B) by ensuring that total payments from multiple group plans don’t exceed 100% of covered expenses, avoiding duplication.

It doesn’t affect dependent coverage (A), probationary periods (C), or waiting periods (D), which are unrelated to claim payments.

The Virginia study guide describes COB as a mechanism to coordinate payments among multiple insurers, reducing overinsurance and ensuring fair claim distribution. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Health Insurance Provisions."

The concept of "reasonable expectations" states that the insured is entitled to the coverage under a policy that a sensible and prudent buyer would expect it to provide. This means that the insurer must honor the expectations of the insured based on the policy's terms, even if the wording is unclear or ambiguous, as long as those expectations are reasonable.

A restorative dental procedure refers to treatments that restore the function and integrity of a tooth, typically after damage or decay. A filling is a common restorative procedure, where the dentist repairs a cavity. An extraction removes a tooth, while a root canal treats infection within the tooth, and fitting dentures replaces missing teeth, all of which are not categorized as restorative procedures but are considered reparative or replacement treatments.

Agents may collect premiums but cannot personally cash or deposit checks as if they were funds of their own. Exact extract: “Agents must forward funds promptly to insurers and may not treat premiums as personal assets.”

Virginia Code § 38.2-3106 governs life insurance delivery, where insurers may require a statement of good health (option B) at policy issuance to confirm no material health changes occurred since the application (e.g., a new cancer diagnosis). This signed document protects the insurer from undisclosed risks between underwriting and delivery, potentially voiding coverage if false (subject to incontestability, § 38.2-3105). Option A (disclosure notice) relates to privacy or policy terms, not health updates. Option C (conditional receipt) is issued at application with premium payment, providing temporary coverage, not a delivery requirement. Option D (notice of information practices) informs about data use (per § 38.2-604), not health status. The study guide likely illustrates this with a scenario—e.g., an insured signing to confirm no heart attack post-application—making B the standard practice.

Medicare Part A is generally available at age 65, but younger individuals may qualify if they have received Social Security disability benefits for at least 24 months.

Exact Extract (Virginia Medicare Study Guide): “Individuals under age 65 become eligible for Medicare Part A after receiving Social Security disability benefits for 24 months.”

References (Virginia Documents / Study Guide):

— Virginia Health Insurance Examination Outline, Medicare Eligibility

Automatic premium loans use policy cash value to keep coverage in force, and interest is charged on the borrowed amount. Exact extract: “The automatic premium loan uses policy values to pay overdue premiums; interest is charged on the loan balance.”

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.

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.

When a Medicare Supplement insurance policy is being replaced, the agent and the applicant must sign the notice of replacement. This is a requirement to ensure that the applicant understands that they are replacing their existing coverage with new insurance. The agent's signature verifies that the applicant was informed of the potential consequences and differences between the old and new policies. This protects both the insurer and the insured by maintaining a clear record of the replacement process.

Virginia Code § 38.2-510 regulates unfair claim settlement practices, enforced by the State Corporation Commission’s Bureau of Insurance—a state insurance department (option D). This includes timely claim processing and fair payment, with penalties for violations. Option A (IRS) oversees tax compliance, not insurance claims. Option B (NAIC) develops model laws and guidelines (e.g., Unfair Claims Settlement Practices Act), but lacks enforcement power; states adopt and regulate these standards. Option C (claims adjusters) are practitioners, not regulators. The study guide likely emphasizes Virginia’s Bureau as the authority, citing examples like investigating delayed claims, aligning with state-level oversight under § 38.2-200 et seq., making D the correct regulator.

Detailed Answer in Step-by-Step Solution:

Group health underwriting considers average age (A), claims history (B), and occupation type (D) to assess risk, but marital status (C) is typically irrelevant for group policies, unlike individual underwriting.

The Virginia study guide notes that group underwriting focuses on collective risk factors like age, claims experience, and occupation, not personal details like marital status. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Group Insurance Underwriting."

Virginia Code § 38.2-3500 et seq. governs major medical plans, which cover catastrophic costs like hospital expenses (option A), physicians’ visits (option C), and surgical expenses (option D). Option B (custodial care)—non-medical assistance with daily living (e.g., bathing)—is typically excluded, as it’s not “medically necessary” under standard definitions (Virginia Code § 38.2-3407.10). The study guide likely lists inclusions (A, C, D) with examples—e.g., $5,000 for surgery—versus exclusions like custodial care, covered by LTC policies instead, making B the usual exception.

Virginia law treats a licensed agent as the agent of the insurer that issued the insurance sold, solicited, or negotiated by that agent in controversies between the insured (or beneficiary) and the insurer. This statutory framework reflects the principle that, when the agent is acting within the scope of authority granted by the insurer (the “agency contract” authority), the insurer is responsible to the consumer for those acts in the transaction. That is why option A is the best answer among the choices presented.

The other options are inconsistent with Virginia’s allocation of responsibility. The insurer is not automatically “exempt” simply because an agent makes a misrepresentation; misrepresentations can create insurer responsibility in disputes with insureds, and the law’s default is that the agent is the insurer’s agent in such controversies. Nor does the insurer “transfer all liability” to the agent—agency status means the insurer can be bound by and accountable for authorized acts. Finally, limiting responsibility to “express authority only” is too narrow: agency authority in practice includes the authority actually granted and recognized in the insurer-agent relationship in the sale/solicitation/negotiation context addressed by Virginia statute. The statute’s consumer-protection focus is to prevent insurers from avoiding responsibility when their agents act on their behalf in insurance transactions.

Needs analysis is a method used in life insurance planning to identify the specific needs of the individual and their dependents in case of death or disability. It includes assessing income, debt, future expenses (such as education), and existing coverage. The analysis helps determine the appropriate amount of life insurance coverage. While it involves estimating future expenses, including Social Security benefits, it does not ignore them but rather incorporates them in calculating overall needs.

The needs approach calculates the amount of life insurance a client should have by analyzing family financial obligations—such as income replacement, education costs, debts, and funeral expenses. This approach ensures sufficient coverage to meet survivors’ future needs.

Exact Extract (Virginia Life Insurance Study Guide): “The needs approach considers the financial needs of survivors to determine the appropriate amount of life insurance coverage, including income, debt repayment, education funding, and final expenses.”

References (Virginia Documents / Study Guide):

— Virginia Life & Annuities Insurance Examination Outline, Section 2.1 Needs approach

Detailed Answer in Step-by-Step Solution:

Disability income insurance covers loss of income from accidental injuries (D), provided they aren’t excluded.

Self-inflicted injuries (A), military service injuries (B), and war-related disabilities (C) are standard exclusions in most policies.

The Virginia study guide specifies that disability income insurance pays for accidental or illness-related income loss, excluding self-inflicted, military, or war-related causes. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Disability Income Insurance."

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.

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.

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.

Rebating is an unfair trade practice where an agent offers a portion of their commission or any other inducement to encourage the insured to purchase a policy. This is considered illegal because it could mislead the buyer into making a purchase based on incentives rather than the suitability of the policy for their needs.

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.

Keogh plans, established under the Internal Revenue Code, are retirement plans for self-employed individuals and small businesses, also known as HR 10 plans (option B) after the 1962 legislation (H.R. 10) creating them. They allow tax-deferred contributions, similar to qualified plans. Option A (Section 457 plans) applies to government and nonprofit employees, not self-employed individuals. Option C (403(b) plans) is for nonprofit employees (e.g., teachers), distinct from Keogh’s self-employed focus. Option D (Section 2503(c) trusts) relates to gifting for minors, not retirement. The study guide likely contrasts Keogh (HR 10) with other plans in a retirement section, noting its tax benefits and eligibility, confirming B as the correct synonym.

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.

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 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.

Medicare supplement policies in Virginia are guaranteed renewable. This means the insurer cannot cancel coverage as long as premiums are paid on time, regardless of the insured’s health status or claim history. Exact extract: “Every Medicare supplement policy shall be guaranteed renewable and may not be terminated except for nonpayment of premium or material misrepresentation.” This provides strong consumer protection for seniors relying on supplemental coverage.

Detailed Answer in Step-by-Step Solution:

Employer-paid premiums for qualified long-term care insurance are treated as a business expense and are tax-deductible for the employer (B), provided the plan meets IRS requirements.

These premiums are not included in the employee’s gross income (A), as they are tax-exempt benefits under IRC Section 106.

Employees cannot deduct these premiums (C) since they are employer-paid.

Reimbursement (D) does not apply.

The Virginia study guide, aligned with IRS rules, notes that employer-paid premiums for qualified long-term care insurance are deductible as a business expense and excluded from employees’ taxable income. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Taxation of Insurance Benefits."

Virginia Code § 38.2-4303 defines the HMO model, where the primary care physician (PCP, option A) acts as the gatekeeper, delivering preventive (e.g., vaccines) and routine care (e.g., checkups), and coordinating referrals. Option B (medical director) oversees HMO operations, not direct care. Option C (routine care physician) isn’t a standard term; the PCP fills this role. Option D (provider association) might imply a network, but care comes from the individual PCP, not a collective. The study guide likely explains the PCP’s central role with examples—e.g., a member seeing their PCP for a flu shot—highlighting HMO cost-control via this structure, making A the correct provider.

The free-look provision ensures policyholders may review their contract and, if dissatisfied, return it for a full refund. Exact extract: “The insured may return the policy within 10 days of delivery for a full refund of all premiums.”

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."

The application is the primary underwriting source for personal data and risk assessment. It provides the insured’s age, health, occupation, and lifestyle factors. Exact extract: “The application is a written request to the company for a contract and is the source of the insurer’s underwriting information.”

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)

Home health care insurance covers long-term physical therapy or nursing services provided at the insured's residence. This type of insurance helps pay for the costs associated with receiving medical care in the home, such as nursing services, physical therapy, or assistance with activities of daily living. Nursing home insurance, on the other hand, covers care provided in a facility, not at home.

The "accelerated benefit" provision allows a policyholder to access a portion of the life insurance death benefit while still alive, typically due to a terminal illness or other qualifying condition. This means that the amount advanced as an accelerated benefit will be subtracted from the total death benefit that will be paid to the beneficiaries after the insured's death.

“Conditionally renewable” policies guarantee renewal as long as certain conditions listed in the contract are met. These conditions may include factors such as reaching a certain age or maintaining occupation class, but not health status or claims history. Exact extract: “A conditionally renewable policy may be nonrenewed only on grounds stated in the policy; health deterioration or claims experience may not be a reason for nonrenewal.” This gives insurers some flexibility while protecting consumers from arbitrary termination.

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.

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.

Disability buy-sell insurance funds a business partner’s buyout if one becomes disabled, per Virginia Code § 38.2-3100 et seq. Option C is true; proceeds are typically tax-free under IRC § 104(a)(3) as insurance benefits, not income, if premiums aren’t deducted. Option A is false; the policyowner (e.g., a partner or business) is often the beneficiary to fund the buyout. Option B is false; benefits go to the business or partner, not the disabled individual, who may receive separate disability income coverage. Option D is false; premiums aren’t tax-deductible (IRC § 265), preserving tax-free proceeds. The study guide likely explains this with scenarios—e.g., $500,000 paid tax-free to buy out a disabled partner—highlighting tax treatment, making C the true statement.

Detailed Answer in Step-by-Step Solution:

A continuous premium whole life policy requires premiums for the insured’s lifetime (A), while a limited payment policy has a set payment period (e.g., 20 years).

Settlement options (B), mortality tables (C), and dividends (D) are similar across both types.

The Virginia study guide distinguishes continuous premium whole life (lifelong payments) from limited payment whole life (fixed-term payments), both providing permanent coverage. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Whole Life Insurance."

Virginia Code § 38.2-3508 defines a cancelable health policy as one either party—the insured or insurer—can terminate before its term ends, with notice (e.g., 30 days). Option C reflects this mutual right. Option A (insurer only) and option B (insured only) are too restrictive; cancelable policies aren’t unilateral. Option D (arbitration committee) isn’t a standard mechanism; cancellation follows policy terms, not third-party rulings. The study guide likely contrasts cancelable with non-cancelable policies, using examples like an insurer canceling for nonpayment or an insured canceling due to better rates, making C the correct scope.

Detailed Answer in Step-by-Step Solution:

False advertising includes exaggerating dividends (A), misrepresenting benefits (B), or claiming a policy is a stock (C), all deceptive practices.

Comparing benefits with a competitor (D) is permissible if accurate and not misleading, thus not inherently false advertising.

The Virginia study guide, per state law, prohibits deceptive advertising but allows factual comparisons with competitors, provided they are truthful. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Unfair Trade Practices."

Detailed Answer in Step-by-Step Solution:

Needs analysis (A) assesses an individual’s and dependents’ financial requirements (e.g., income replacement, debts) to determine appropriate life insurance coverage.

It doesn’t eliminate interest/inflation estimates (B), require underwriter collaboration (C), or ignore Social Security (D), which is often factored in.

The Virginia study guide describes needs analysis as a planning tool to calculate insurance needs based on personal and family financial obligations, including potential Social Security benefits. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Life Insurance Planning."

During the contestable period (typically the first two years of a life insurance policy), insurers may rescind a policy for material misrepresentation, fraud, or material concealment. These actions affect underwriting decisions and risk evaluation and are grounds for rescission under Virginia law.

However, misstatement of age is treated differently. Virginia-required policy provisions mandate that if the insured’s age is misstated, the insurer does not rescind the policy. Instead, benefits are adjusted to reflect what the premium would have purchased at the correct age. This makes option A the correct exception.

This distinction protects consumers from harsh outcomes for honest mistakes while still preserving insurer rights against intentional deception. Misstatement-of-age clauses are standard in life insurance policies and are specifically excluded from contestability rescission rules.

Detailed Answer in Step-by-Step Solution:

A trustee-to-trustee transfer (A) avoids the 20% mandatory tax withholding required when funds are distributed to the participant and rolled over within 60 days.

Options B (lost funds) and C (time) are incidental, not primary benefits. Option D (penalty tax) is irrelevant; rollovers aren’t penalized if timely.

The Virginia study guide, per IRS rules, notes that direct trustee-to-trustee transfers bypass withholding, preserving the full amount for reinvestment. Reference: Virginia Life, Annuities, and Health Insurance study guide, section on "Retirement Plans."