Free Colorado Accident & Health practice questions

Answer: B. Colorado, because she does business there principally and is licensed as a producer there

Colorado's definition of home state has two parts, and both must be met: the producer keeps either a principal residence or a principal place of business in the jurisdiction, and the producer holds a producer license there. Colorado satisfies both, because it is Mara's principal place of business and it licenses her. Wyoming fails the second part because she holds no license there, so residence alone does not make it her home state. The definition treats residence and place of business as alternatives, so a producer need not live and work in the same place. The definition gives a producer no option to simply designate a home state on an application.

Answer: D. Up to 35 percent above the modified community rate, for up to twelve months

Colorado's rate usage statute lets a small employer carrier surcharge a group whose small group insurance was discontinued for nonpayment of premiums or fraud by up to thirty-five percent above the modified community rate when the group reapplies, and lets the carrier apply the increased premium for up to twelve months. Twenty-four months doubles the permitted duration. Fifty percent exceeds the thirty-five percent ceiling. Twenty percent for six months falls below both limits, so it does not state the maximums the question asks for.

Answer: C. Yes, insofar as the commissioner, in sole discretion, deems it necessary or material to the examination

When completing an examination of a company, Colorado's commissioner may examine or investigate any person, or that person's business, to the extent the commissioner in his or her sole discretion considers it necessary or material to the company's examination. The authority is not limited to the licensed company, and the statute conditions it on the commissioner's own judgment of relevance, not on the outside firm's consent or on a prior court order.

Answer: B. It will be reported to the Colorado division of insurance

The statutory warning states that an insurer or agent who knowingly feeds a policyholder or claimant false, incomplete, or misleading information to defraud them over a settlement or award will be reported to the Colorado division of insurance. A district attorney, the attorney general, and a licensing board are not the recipient the warning names.

Answer: A. Yes, because the carrier may add information beyond what the rules require

The statute states that nothing in it stops a carrier from putting information on the standardized, printed card in addition to what the rules require to appear there. A card limited strictly to the listed items misreads that allowance, and the provision attaches no advance-approval step to added content. The allowance is for information added on top of the required content, so it does not let a carrier drop required items such as copayment and deductible amounts.

Answer: B. Investigate further, if the inquiry complies with Colorado's HIV testing statute

Colorado lists, as a form of unfair discrimination, an adverse underwriting decision made on the basis of a nonspecific blood code that the medical information bureau reports. The same subparagraph adds that this prohibition does not stop the insurer from investigating in response to the code, so long as the investigation is conducted in accordance with section 10-3-1104.5, the HIV testing statute. Declining the application because of the code alone, or rating the applicant substandard because of it, is an adverse underwriting decision resting on the code, and the subparagraph contains no exception for giving written notice. The idea that the code bars any further inquiry contradicts the express allowance for a compliant investigation.

Answer: D. At least 10 percent

In a Colorado copayment-only prescription structure, the copayments for the two top drug cost tiers must differ in cost by at least ten percent. Twenty-five percent is a different figure in the same section: the minimum share of a carrier's plans at each metal level that must be offered with a copayment-only structure. Fifty percent is also different: it caps the portion of formulary drugs for a specific condition that may sit on the highest tier. Five percent falls short of the required gap.

Answer: D. As a class 2 misdemeanor

Colorado makes it a class 2 misdemeanor for any person to knowingly or willfully testify falsely about any matter material to an examination or inquiry. The offense is complete with the false testimony itself. A separate provision covers knowingly making false entries in a company's books or filed statements with intent to deceive, and that is also a class 2 misdemeanor, so the testimony offense does not depend on a book entry. The statute sets a misdemeanor, not a felony, and it makes the conduct a criminal offense rather than leaving it solely to license discipline.

Answer: B. Cover and reimburse a single dispensing of the full twelve-month supply

As part of required contraception coverage, Colorado directs the carrier, or a pharmacy benefit manager acting for it, to cover and reimburse a provider or in-network dispensing entity for a single dispensing of contraception meant to last twelve months, as the prescription allows, unless the covered person asks for something different. A ninety-day cap and a requirement of monthly fills both fall short of a one-time twelve-month dispensing. Making the person wait three months before the full supply is covered adds a condition the provision does not contain.

Answer: B. Disability income benefits

Colorado defines the accident and health line as coverage for sickness, bodily injury or accidental death, and states that it may include benefits for disability income. Endowment benefits belong to the definition of the life line. Variable annuities fall under the separate line for variable life and variable annuity products. Coverage against legal liability, including damage to property, is the casualty line.