Free Missouri Accident & Health practice questions

Answer: A. The individual did not pay premiums as the coverage terms required

Missouri lets an individual market issuer nonrenew or discontinue coverage only on a short list of grounds, and failure to pay premiums or contributions as the coverage terms require is one of them. Claims experience and a new diagnosis are not on that list. A move is a ground only when a network plan member no longer lives, resides or works in the service area, and only if applied uniformly, so a move to a new home inside the service area does not qualify.

Answer: A. It is allowed, since marital status may be used to define eligibility for dependents' benefits

Section 375.995(4) states that nothing in the section prohibits an insurer from taking an insured's or prospective insured's marital status into account to define who is eligible for dependents' benefits. Requiring a legal marriage before a spouse can be added as a dependent is that use. The section does not bar every reference to marital status; it bars restricting availability, benefits or terms solely on that basis. The dependents' eligibility rule is part of the section itself, so it neither depends on a director-approved rate differential nor is limited to older group contracts.

Answer: D. It is prohibited, since chiropractic care may not cost the insured more than care for other physical conditions.

Missouri's chiropractic coverage section bars a health benefit plan from setting any rate, term or condition that makes access to treatment for a chiropractic condition a heavier financial burden on the insured than access to treatment for another physical health condition. A $50 chiropractic copayment against $25 for other physical conditions is that kind of heavier burden. Disclosing the charge in the certificate does not cure it, and whatever limits a plan may place on which chiropractors it covers, the parity rule still governs what the insured pays. The rule is parity rather than a ban on cost-sharing, so a chiropractic copayment equal to the one for other physical conditions would not offend it.

Answer: B. A group contract issued in 1984 that the insurer amended on November 15, 1987

Section 375.995(3) applies the section to contracts delivered or issued for delivery in Missouri on or after October 1, 1986, and to existing group contracts amended on or after that date. The 1984 group contract was amended on November 15, 1987, so it is covered. The group contract issued in 1985 has never been amended, so the amendment rule does not bring it in. The two individual policies were delivered or issued before October 1, 1986, and the amendment rule reaches only group contracts.

Answer: C. Insurance for sickness, bodily injury or accidental death, which may add disability income

Sec. 375.018(1)(2) describes the accident and health or sickness line as coverage for sickness, bodily injury or accidental death, which may also include disability income benefits. The other choices describe different lines listed in the same subsection: coverage on human lives with endowment and annuity benefits is the life line, coverage against legal liability is the casualty line, and coverage for direct or consequential loss or damage to property is the property line.

Answer: A. Only fraudulent misstatements made by the applicant

Section 376.777 requires the TIME LIMIT ON CERTAIN DEFENSES provision. Once two years have passed from the date of issue, the applicant's misstatements in the application may not be used to void the policy or to deny a claim for a loss or disability beginning after that two-year period, with one exception: fraudulent misstatements. A misstatement found during claim review gets no special treatment, the provision keeps fraudulent misstatements usable rather than barring every misstatement, and it does not single out answers about medical treatment.

Answer: C. The commercial exclusion from the rebate prohibitions does not reach it

Sec. 379.404 excludes commercial property and casualty insurance from the rebate and inducement prohibitions of Sec. 379.356 and Sec. 375.936(9), but its second sentence says that exclusion does not apply to producer commission reductions that are not included in insurance company rate filings. A commission cut that does not appear in the rate filings therefore sits outside the commercial exclusion, even though the policy is commercial. The section sets no condition about prospects versus current clients, or about offering the cut to every client, that would bring such a reduction back inside the exclusion.

Answer: C. Dana must test, because the application came more than ninety days after cancellation

Sec. 375.016(5) excuses an applicant previously licensed for the same lines in another state from the examination only if the applicant is currently licensed there, or if the application is received within ninety days of the prior license's cancellation and the prior state certifies good standing at the time of cancellation. Dana holds no current license and applied 120 days after cancellation, so neither route applies and the examination is required. Good standing alone is not enough, because the timing condition must also be met. Twelve months is the window for reinstating an expired Missouri license under Sec. 375.018(4), not this exemption, and the exemption does not depend on moving to Missouri.

Answer: A. On the producer's birth date, in every second calendar year

Sec. 375.018(3) provides that a producer's license is renewed every two years on the producer's birth date, and that it stays in effect until the director refuses, revokes or suspends it under Sec. 375.141. The statute does not tie renewal to the original issue date, to a fixed calendar date such as January 1, or to the close of a continuing education cycle.

Answer: B. A licensed producer or insurer must act as sponsor and take responsibility for all of the spouse's acts as licensee.

Under Sec. 375.025(2), the director may condition a temporary license on the licensee having a suitable sponsor, either a licensed producer or an insurer, who accepts responsibility for every act of the temporary licensee. The sponsor the subsection describes is a licensed producer or insurer, not an attorney, and the subsection says nothing about guaranteeing business debts. The same subsection bars a temporary license from continuing once the owner or personal representative disposes of the business, so it cannot be kept alive for a buyer. It also lets the director revoke a temporary license when the interests of insureds or the public are endangered, so the revocation power is retained.