A third-party administrator generates claim and enrollment records while administering a health plan for an insurer. Under Connecticut law, who owns those records?

The insurer that uses the administrator's services

A Connecticut insurance producer plans to do business under a trade name rather than the producer's legal name. When must the commissioner be notified?

Before the producer begins using the trade name

A Connecticut producer is prosecuted for a crime in another state. Under Connecticut law, which event starts the period for reporting the prosecution to the commissioner?

The initial pretrial hearing date

An insurer pays its third-party administrator a fee that covers enrollment processing for a group plan. The administrator then adds a separately itemized enrollment processing charge to the premiums it collects from insured members. Under Connecticut law, is the added charge proper?

No, to the extent the insurer has already paid for that enrollment processing

An applicant for a Connecticut individual health insurance plan had a genetic test showing a variant linked to a heart condition, but the condition has never been diagnosed. How does Connecticut's preexisting conditions statute treat that genetic information?

Not as a condition at all, because no diagnosis of the related condition has been made

An insured's individual health policy in Connecticut is a managed care plan. For purposes of the state's mandate covering diagnosis and treatment of mental or nervous conditions, what are the benefits payable for covered treatment?

The payments agreed on in the contract between the managed care organization and the provider

A carrier plans to offer a specified disease policy in Connecticut for the first time. It wants the policy treated as supplemental coverage that falls outside the definition of a health insurance plan in Connecticut's preexisting condition statute. When must the carrier file the required information and statement with the commissioner for this new policy?

At least 30 days before the policy is first issued or delivered in the state

The commissioner denies a producer license application and sends the applicant a written notice stating the reason. Under Connecticut law, how long does the applicant have to demand a hearing in writing, and how soon must the hearing then be held?

30 days after the notice to demand; hearing within 20 days after the request is received

Connecticut requires certain individual health insurance policies to cover the diagnosis and treatment of mental or nervous conditions. For this mandate, the statute defines mental or nervous conditions by reference to which source?

The latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual

A life and health producer learns that Insurer A and Insurer B are both owned and controlled by the same parent holding company, although neither insurer owns any stock of the other. Under the Title 38a definitions, how are Insurer A and Insurer B related?

They are affiliates, because each is under common control with the other.

Free Connecticut Accident & Health practice questions

10 questions · no signup
Nothing is saved.

Real questions with the answer, the reasoning and the source.

1.A third-party administrator generates claim and enrollment records while administering a health plan for an insurer. Under Connecticut law, who owns those records?
Answer: A. The insurer that uses the administrator's services
Sec. 38a-720c(a)(2) gives ownership of the records a third-party administrator generates about an insurer's business to that insurer (or other person using the administrator). The administrator keeps only a right of continued access so it can meet its contractual obligations to the insurer, insureds or claimants; creating the records does not make it the owner. The statute does not assign ownership to the commissioner or to the covered individuals.
Source
Conn. Gen. Stat. Sec. 38a-720c(a)(2) (Maintenance of and access to books and records)
Choose an answer to see the explanation.
2.A Connecticut insurance producer plans to do business under a trade name rather than the producer's legal name. When must the commissioner be notified?
Answer: D. Before the producer begins using the trade name
A producer doing business under any name other than the producer's legal name must notify the commissioner prior to using that assumed name. Notice within 30 days after first use or at the next renewal comes after the name is already in use, and notice only when someone asks may never be given at all. The obligation is triggered before the name is used.
Source
Conn. Gen. Stat. Sec. 38a-702i (Notice to commissioner re use of assumed name)
Choose an answer to see the explanation.
3.A Connecticut producer is prosecuted for a crime in another state. Under Connecticut law, which event starts the period for reporting the prosecution to the commissioner?
Answer: B. The initial pretrial hearing date
Connecticut sets the reporting period for a criminal matter at thirty days, and the clock starts at the initial pretrial hearing date. The final disposition of the case is the trigger for the separate duty to report administrative actions, and neither the date of the complaint nor the renewal cycle starts the clock.
Source
Conn. Gen. Stat. Sec. 38a-702o(b) (Producer to report administrative actions and criminal prosecutions to commissioner)
Choose an answer to see the explanation.
4.An insurer pays its third-party administrator a fee that covers enrollment processing for a group plan. The administrator then adds a separately itemized enrollment processing charge to the premiums it collects from insured members. Under Connecticut law, is the added charge proper?
Answer: D. No, to the extent the insurer has already paid for that enrollment processing
Sec. 38a-720h(b) bars a third-party administrator from making additional charges for services to the extent the insurer or other person using the administrator has already paid for those services. The insurer already pays for enrollment processing, so a second charge to members for the same work is improper. The same subsection does require each collected item and its reason to be identified and shown separately, but itemizing a charge does not make a duplicate charge permissible. The subsection offers no exception for member consent, and keeping the charge at or below the insurer's fee still bills twice for a service already paid for.
Source
Conn. Gen. Stat. Sec. 38a-720h(b) (Disclosures)
Choose an answer to see the explanation.
5.An applicant for a Connecticut individual health insurance plan had a genetic test showing a variant linked to a heart condition, but the condition has never been diagnosed. How does Connecticut's preexisting conditions statute treat that genetic information?
Answer: C. Not as a condition at all, because no diagnosis of the related condition has been made
Conn. Gen. Stat. Sec. 38a-476(a)(3) provides that genetic information is not to be treated as a condition when there is no diagnosis of the condition the information relates to. Without a diagnosis, the test result cannot be the basis of a preexisting condition, whenever the test was performed. Nothing in the definition creates a twelve-month period or lets an underwriter's assessment stand in for a diagnosis. Separately, subsection (b) bars individual and group health insurance plans from imposing a preexisting conditions provision on any individual.
Source
Conn. Gen. Stat. Sec. 38a-476(a)(3) (Preexisting condition coverage)
Choose an answer to see the explanation.
6.An insured's individual health policy in Connecticut is a managed care plan. For purposes of the state's mandate covering diagnosis and treatment of mental or nervous conditions, what are the benefits payable for covered treatment?
Answer: A. The payments agreed on in the contract between the managed care organization and the provider
Conn. Gen. Stat. Sec. 38a-488a(a)(2) defines benefits payable as usual, customary and reasonable charges for necessary treatment, but makes an exception for a managed care plan, as defined in Sec. 38a-478: there, benefits payable means the payments agreed on in the contract between the managed care organization and the provider. The usual, customary and reasonable measure is therefore the general rule that does not apply to this insured's plan. The definition does not use the provider's full billed charges. Per capita cost appears in subsection (i), which limits the state's lien on coverage proceeds for a person admitted to a state institution; it is not a measure of benefits payable.
Source
Conn. Gen. Stat. Sec. 38a-488a(a)(2) (Mandatory coverage for the diagnosis and treatment of mental or nervous conditions)
Choose an answer to see the explanation.
7.A carrier plans to offer a specified disease policy in Connecticut for the first time. It wants the policy treated as supplemental coverage that falls outside the definition of a health insurance plan in Connecticut's preexisting condition statute. When must the carrier file the required information and statement with the commissioner for this new policy?
Answer: B. At least 30 days before the policy is first issued or delivered in the state
Connecticut's preexisting condition statute excludes specified disease and limited benefit policies from its definition of a health insurance plan only if the carrier files a yearly certification with the commissioner by March first. That certification states the policies are sold as supplemental insurance rather than as a replacement for hospital or medical expense coverage, and it includes a summary of each policy with its premium rates. For a policy offered in the state for the first time on or after October 1, 1993, the carrier must also file that information and statement at least 30 days before the policy is issued or delivered. A 60-day lead time is longer than the statute sets. Filing within 30 days after the first issue, or waiting for the next March first certification once sales have started, places the filing after issue, when the statute requires it beforehand.
Source
Conn. Gen. Stat. Sec. 38a-476(a)(1)(B)(iii) (Preexisting condition coverage)
Choose an answer to see the explanation.
8.The commissioner denies a producer license application and sends the applicant a written notice stating the reason. Under Connecticut law, how long does the applicant have to demand a hearing in writing, and how soon must the hearing then be held?
Answer: C. 30 days after the notice to demand; hearing within 20 days after the request is received
Sec. 38a-702k(b) applies when the commissioner denies an application or nonrenews a producer license. The commissioner must notify the applicant or licensee and give the reason in writing. The applicant may then demand a hearing in writing within 30 days after that notice, and the hearing must be held within 20 days after the commissioner receives the request. Each wrong choice misstates one or both of those two periods.
Source
Conn. Gen. Stat. Sec. 38a-702k(b) (Denial, nonrenewal or revocation of producer licenses)
Choose an answer to see the explanation.
9.Connecticut requires certain individual health insurance policies to cover the diagnosis and treatment of mental or nervous conditions. For this mandate, the statute defines mental or nervous conditions by reference to which source?
Answer: D. The latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual
Under Connecticut's mental health mandate for individual policies, mental or nervous conditions means the mental disorders that the latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defines. The statute then carves certain items out of that definition, such as intellectual disability, specific learning disorders and caffeine-related disorders. The World Health Organization's classification is not the reference the statute names, and the statute does not leave the list to a commissioner regulation. It also points to the most recent edition rather than freezing the definition at whatever edition applied when the policy was first issued.
Source
Conn. Gen. Stat. Sec. 38a-488a(a)(1)(A) (Mandatory coverage for the diagnosis and treatment of mental or nervous conditions)
Choose an answer to see the explanation.
10.A life and health producer learns that Insurer A and Insurer B are both owned and controlled by the same parent holding company, although neither insurer owns any stock of the other. Under the Title 38a definitions, how are Insurer A and Insurer B related?
Answer: C. They are affiliates, because each is under common control with the other.
Connecticut defines an affiliate as a person that controls, is controlled by, or is under common control with another person, whether directly or through one or more intermediaries. Two insurers controlled by the same parent are under common control, so each is an affiliate of the other. Common control is enough, so the definition does not require either insurer to control the other directly or to own a majority of the other's stock, and it contains no requirement about where the two companies are domiciled.
Source
Conn. Gen. Stat. Sec. 38a-1(1) (Definitions)
Choose an answer to see the explanation.

The other 347 questions are $29.

Lifetime access, the full timed simulator, drills on the areas that cost you marks, and a readiness score that tells you when to book. One payment, nothing recurring, nothing else to buy.

Take the free scored exam See what access includes

The scored exam is free, 20 questions in 30 minutes, and needs an account. These 10 do not.

1.A third-party administrator generates claim and enrollment records while administering a health plan for an insurer. Under Connecticut law, who owns those records?

2.A Connecticut insurance producer plans to do business under a trade name rather than the producer's legal name. When must the commissioner be notified?

3.A Connecticut producer is prosecuted for a crime in another state. Under Connecticut law, which event starts the period for reporting the prosecution to the commissioner?

4.An insurer pays its third-party administrator a fee that covers enrollment processing for a group plan. The administrator then adds a separately itemized enrollment processing charge to the premiums it collects from insured members. Under Connecticut law, is the added charge proper?

5.An applicant for a Connecticut individual health insurance plan had a genetic test showing a variant linked to a heart condition, but the condition has never been diagnosed. How does Connecticut's preexisting conditions statute treat that genetic information?

6.An insured's individual health policy in Connecticut is a managed care plan. For purposes of the state's mandate covering diagnosis and treatment of mental or nervous conditions, what are the benefits payable for covered treatment?

8.The commissioner denies a producer license application and sends the applicant a written notice stating the reason. Under Connecticut law, how long does the applicant have to demand a hearing in writing, and how soon must the hearing then be held?

9.Connecticut requires certain individual health insurance policies to cover the diagnosis and treatment of mental or nervous conditions. For this mandate, the statute defines mental or nervous conditions by reference to which source?

10.A life and health producer learns that Insurer A and Insurer B are both owned and controlled by the same parent holding company, although neither insurer owns any stock of the other. Under the Title 38a definitions, how are Insurer A and Insurer B related?

The other 347 questions are $29.