Montana Course Update April 2022
> Montana Life and Health Addendum
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Life and Health
Addendum: for use with Montana Life and Health online ExamFX courses and study guides version 25542en (Life) and 25543en (Health) per exam content outline updates effective 5/1/2022.
The following are content additions to supplement your existing text unless otherwise indicated:
LIFE:
Introduction
Exam Breakdown – new exam breakdown
Montana Life Insurance
103 Total Questions (86 scored, 17 pretest)
Chapter |
Percentage of Exam |
General Knowledge: |
|
Completing the Application, Underwriting, and Delivering the Policy |
14% |
Types of Life Policies |
17% |
Life Policy Provisions, Options, and Riders |
17% |
Retirement and Other Insurance Concepts |
10% |
State Law: |
|
Montana Regulations Common to All Lines |
29% |
Montana Regulations Pertinent to Life Insurance and Annuities Only |
13% |
Completing the Application, Underwriting, and Delivering the Policy
Gramm-Leach-Bliley Act (GLBA) Privacy
The Gramm-Leach-Bliley Act stipulates that in general, an insurance company may not disclose nonpublic personal information to a nonaffiliated third party except for the following reasons:
- The insurance company clearly and conspicuously discloses to the consumer in writing that information may be disclosed to a third party;
- The consumer is given the opportunity, before the time that information is initially disclosed, to direct that information not be disclosed to the third party; or
- The consumer is given an explanation of how the consumer can exercise a nondisclosure option.
The Gramm-Leach-Bliley Act requires 2 disclosures to a customer (a consumer who has an ongoing financial relationship with a financial institution):
- When the customer relationship is established (i.e. a policy is purchased); and
- Before disclosing protected information.
The customer must also receive an annual privacy disclosure, and have the right to opt out, or choose not to have their private information shared with other parties.
Types of Policies
E. Annuities
Payout Options
Annuity payment options specify how annuity funds are to be paid out. They are very similar to the settlement options used in life insurance that determine how the policy proceeds are distributed to the beneficiaries.
Life Contingency Options - Pure Life vs. Life with Guaranteed Minimum
The life annuity will pay a specific amount for the remainder of the annuitant’s life. With pure life, also known as life-only or straight life, this payment ceases at the annuitant's death (no matter how soon in the annuitization period that occurs). This option provides the highest monthly benefits for an individual annuitant. Under this option, while the annuity payments are guaranteed for the lifetime of the annuitant, there is no guarantee that all the proceeds will be fully paid out.
Under the life with guaranteed minimum settlement option, if the annuitant dies before the principal amount has been paid out, the remainder of the principal amount will be refunded to the beneficiary. This option is also called refund life. It guarantees that the entire principal amount will be paid out.
There are two types of refund life annuities:
- Cash refund — when the annuitant dies, the beneficiary receives a lump-sum refund of the principal minus benefit payments already made to the annuitant. Cash refund option does not guarantee to pay any interest.
- Installment refund — when the annuitant dies, the beneficiary will continue to receive guaranteed installments until the entire principal amount has been paid out.
Note, however, that any unpaid annuity benefits following the death of an annuitant are taxable when paid to the beneficiary.
Life with period (term) certain is another life contingency payout option. Under this option, the annuity payments are guaranteed for the lifetime of the annuitant, and for a specified period of time for the beneficiary. For example, a life income with a 20-year period certain option would provide the annuitant with an income while he is living (for the entire life). If, however, the annuitant dies shortly after payments begin, the payments will be continued to a beneficiary for the remainder of the period (for a total of 20 years).
Single Life vs. Multiple Life
Single life annuities cover one life, and annuity payments are made with reference to one life only. Contributions can be made with a single premium or on a periodic premium basis with subsequent values accumulating until the contract is annuitized.
Multiple life annuities cover 2 or more lives. The most common multiple life annuities are joint life, and joint and survivor.
Joint Life
Joint life is a payout arrangement where two or more annuitants receive payments until the first death among the annuitants, and then payments stop.
Joint and Survivor
The joint and survivor arrangement is a modification of the life income option in that it guarantees an income for two recipients that neither can outlive. Although it is possible for the surviving recipient(s) to receive payments in the same amount as the first recipient to die, most contracts provide that the surviving recipients will receive a reduced payment after the first recipient dies. Most commonly, this option is written as “joint and ½ survivor” or "joint and 2/3 survivor,” in which the surviving beneficiary receives ½ or 2/3 of what was received when both beneficiaries were alive. This option is commonly selected by a couple in retirement. As with the life income option, there is no guarantee that all the proceeds will be paid out if both beneficiaries die shortly after the installments begin.
Annuities Certain (Types)
In contrast with life contingency benefit payment options, annuities certain are short-term annuities that limit the amounts paid to a certain fixed period or until a certain fixed amount is liquidated.
With fixed-period installments, the annuitant selects the time period for the benefits, and the insurer determines how much each payment will be, based on the value of the account and future earnings projections. This option pays for a specified amount of time only, whether or not the annuitant is living.
With fixed-amount installments, the annuitant selects how much each payment will be, and the insurer determines how long the benefits will be paid by analyzing the value of the account and future earnings. This option pays a specific amount until funds are exhausted, whether or not the annuitant is living.
Life Policy Provisions, Riders and Options
C. Beneficiary Designations
Designation by Class
A class of beneficiary is using a designation such as "my children." This term can be vague if the insured has been married more than once, has adopted children, or has children out of wedlock.
An example of a class that is less vague is "children of the union of Jane Smith and James Smith." Many insurers encourage the insured to name each child specifically and to state the percentage of benefit they are to receive.
When naming beneficiaries, it is most prudent to be specific by naming each individual and by designating the exact amount to be given for that individual. Two class designations are available for use when an insured chooses to "group" the beneficiaries: per capita and per stirpes. Per capita, meaning by the head, evenly distributes benefits among the living named beneficiaries. Per stirpes, meaning by the bloodline, distributes the benefits of a beneficiary who died before the insured to that beneficiary's heirs.
D. Policy Riders – additional riders
Disability Income
With the disability income rider, in the event of disability the insurer will waive the policy premiums and pay a monthly income to the insured. The amount paid is normally based on a percentage of the face amount of the policy to which it is attached.
Cost of Living
The cost of living rider addresses the inflation factor by automatically increasing the amount of insurance without evidence of insurability from the insured. The face value of the policy may be increased by a cost of living factor tied to an inflation index such as the Consumer Price Index (CPI).
HEALTH
Introduction
Exam Breakdown – new exam breakdown
Montana Accident and Health Insurance Examination
102 Total Questions (92 scored, 10 pretest)
Chapter |
Percentage of Exam |
General Knowledge: |
|
Field Underwriting Procedures |
9% |
Types of Health Policies |
17% |
Health Policy Provisions, Clauses, and Riders |
16% |
Social Insurance |
7% |
Other Insurance Concepts |
6% |
State Law: |
|
Montana Regulations Common to All Lines |
27% |
Montana Regulations Pertinent to Disability (A&H) Insurance Only |
18% |
Types of Health Policies
A. Medical Expense Insurance
Health Reimbursement Accounts (HRAs)
Health Reimbursement Accounts (HRAs) consist of funds set aside by employers to reimburse employees for qualified medical expenses, such as deductibles or coinsurance amounts. Employers qualify for preferential tax treatment of funds placed in an HRA in the same way that they qualify for tax advantages by funding an insurance plan. Employers can deduct the cost of a health reimbursement account as a business expense.
The following are key characteristics of HRAs:
- They are contribution healthcare plans, not defined benefit plans;
- Not a taxable employee benefit;
- Employers' contributions are tax deductible;
- Employees can roll over unused balances at the end of the year;
- Employers do not need to advance claims payments to employees or healthcare providers during the early months of the plan year;
- Provided with employer dollars, not employee salary reductions;
- Permit the employer to reduce health plan costs by coupling the HRA with a high-deductible (and usually lower-cost) health plan; and
- Balance the group purchasing power of larger employers and smaller employers.
HRAs are open to employees of companies of all sizes; however, the employer determines eligibility and contribution limits.
An HRA has no statutory limit. Limits may be set by employer, and rollover at the end of the year based on employer discretion. Former employees, including retirees, can have continued access to unused HRAs, but this is done at the employer's discretion. HRAs remain with the originating employer and do not follow an employee to new employment.
D. Long-Term Care
Eligibility for Benefits
Normally to be eligible for benefits from a long-term care policy, the insured must be unable to perform some of the activities of daily living (ADLs). Activities of daily living include bathing, dressing, toileting, transferring positions (also called mobility), continence, and eating.
LIFE AND HEALTH
Montana Statutes, Rules, and Regulations Common to All Lines
B. Insurance Commissioner and Department
2. Examination of Records
Examination of Records and Hearings
The examiner must file a verified written report with the Department of Insurance within 60 days after completion of the examination. On receipt, the Department must transmit the report to the examined company, as well as a notice that gives the company an opportunity to make a written submission or rebuttal with respect to any matters contained in the examination report within 30 days of receipt of notice.
Within 30 days after the deadline for rebuttals, the Commissioner will review the report and any rebuttals and order one of the following:
- Adopt the examination report as filed or with modifications and corrections;
- Rejecting the examination report with directions to obtain additional data, documentation, information, or testimony; or
- Calling for an investigative hearing with at least 20 days' notice to obtain additional data, documentation, information, and testimony.
Conflict of Interest
The Commissioner may not appoint an examiner if the examiner, directly or indirectly, has a conflict of interest, is affiliated with the management or owns a pecuniary (money) interest in any person to be examined. This does not automatically prevent an examiner from being:
- A policyholder or claimant under an insurance policy;
- A grantor of a mortgage on his/her own residence;
- An investment owner in share of regulated diversified investment companies; or
- A settlor (one who makes a settlement) or beneficiary of a blind trust into which impermissible holdings have been placed.
C. Licensing Requirements
5. Termination of Licenses
Notice Following Suspension or Revocation – addition to the existing text
Upon suspension, revocation, or refusal of a license, the Commissioner must notify the licensee or applicant by mail addressed to the licensee or applicant at the last-known address in the Commissioner’s records. The notice is considered in effect once mailed.
A lapsed license may be reinstated if the licensee pays a reinstatement fee and files certification of completion of continuing education requirements within 1 year of the lapse.
Penalty for Acting Without a License – text revised as follows:
A person found to be transacting insurance without a license is subject to a fine of up to $25,000 for insurers and up to $5,000 for producers and adjusters. The fine is in addition to all other penalties imposed by the laws of this state and must be collected by the commissioner in the name of the state of Montana.
A nonresident insurance producer who violates Montana’s licensing laws is subject to a fine of up to $50,000 for each violation and may have the Montana nonresident license revoked or suspended for up to 5 years.
Montana Statutes & Rules Pertinent to Life and Annuities Only
D. Group Life
1. Eligible Groups – last paragraph is revised as follows:
Employee life insurance is a plan of insurance where individual policies are issued to the employees of an employer. The policy must cover at least 2 employees at the date of issue.
Labor union group life insurance insures members of a labor union. All members of the labor union are eligible for coverage under the plan. The policy must cover at least 25 members at the date of issue.
In either of these cases, premiums can be paid in full by the policyholder or partially by the policyholder and the employees or members.
Property and Casualty
Addendum: for use with Montana Property and Casualty online ExamFX courses and study guide version 25544en/25545en, per exam content outline updates effective 5/1/2022.
The following are content additions to supplement your existing text unless otherwise indicated:
PROPERTY:
Introduction
Exam Breakdown – new exam breakdowns
Montana Property Insurance
92 Total Questions (82 scored, 10 pretest)
Time Limit: 2 hours
Passing Score: 75%
CHAPTER |
PERCENTAGE OF EXAM |
General Knowledge: |
|
Insurance Terms and Related Concepts |
18% |
Policy Provisions and Contract Law |
16% |
Types of Policies |
27% |
State Law: |
|
Montana Statutes and Rules Common to All Lines |
30% |
Montana Statutes and Rules Common to Property and Casualty Insurance Only |
4% |
Montana Statutes and Rules Pertinent to Property Insurance Only |
5% |
Policy Provisions and Contract Law
D. Provisions and Clauses
Policy Territory
The policy territory defines the location where coverage will be provided.
Types of Property Policies
B. Commercial Lines
Cyber First-Party Coverage
With an ever-growing reliance on technology, it is no surprise that cyberattacks and data breaches are more common than ever. Businesses that obtain and store personal, financial, or otherwise sensitive data are prone to extortion and fraud. To protect businesses and consumers, cyber insurance is made available to businesses, designed to lessen the financial impact resulting from cyberattacks and data breaches.
Cyber security insurance is broken into the following coverage types:
- First-party cyber insurance — Protects businesses from damages resulting from cyber losses to the business' own network or system; and
- Third-party cyber insurance — Covers legal expenses for lawsuits resulting from a business's inability to properly secure consumer data.
Examples of losses covered by a first-party cyber policy include:
- Business interruption and lost revenue;
- Customer notifications;
- Credit monitoring services for affected customers;
- Ransom payments to extortionists holding data hostage; and
- Costs associated with public relation campaigns.
CASUALTY
Introduction
Exam Breakdown – new exam breakdown
Montana Casualty Insurance Examination
97 Total Questions (87 scored, 10 pretest)
Time Limit: 2 hours 15 minutes
Passing Score: 75%
CHAPTER |
PERCENTAGE OF EXAM |
General Knowledge: |
|
Insurance Terms and Related Concepts |
17% |
Policy Provisions |
14% |
Types of Policies, Bonds and Related Terms |
26% |
State Law: |
|
Montana Statutes and Rules Common to All Lines |
29% |
Montana Statutes and Rules Common to Property and Casualty Insurance Only |
4% |
Montana Statutes and Rules Pertinent to Casualty Insurance Only |
10% |
Types of Casualty Policies, Bonds, and Related Terms
B. Automotive: Personal Auto and Business Auto
Business Auto
Mobile Equipment
Under the business auto coverage form, mobile equipment is covered for liability insurance when being carried or towed by a covered auto. If a land vehicle that fits the definition of mobile equipment, but because of where or how it is being used becomes subject to compulsory insurance as if it were an auto, an insured could potentially have a coverage problem. For example, a bulldozer is required to have compulsory insurance because to get from one part of a job site to another, it must drive on a public road. If the insured has a Symbol 7 (Specified Auto) listed on the Declarations, that bulldozer would need to be included on the insured's vehicle schedule to be covered for liability. If it is not listed, a solution would be to use this endorsement. The bulldozer would be specifically described in the endorsement and granted coverage.
Covered autos liability coverage does not apply to bodily injury, property damage, or covered pollution cost or expense resulting from the operation of any machinery or equipment that is on, attached to, or part of any of the covered autos.
F. Professional Liability
Liquor Liability
Liquor liability (also known as dram shop liability) refers to the exposure that bars, restaurants, and other similar establishments face due to the selling, distributing, manufacturing, or serving of alcoholic beverages. Liquor liability provides protection in the event of action brought against the insured for selling liquor to a customer who is later involved in an accident and suffers bodily injury or property damage.
Businesses of manufacturing, distributing, selling, serving, or furnishing alcoholic beverages all may have liability exposure to actions under state or local statutes that establish responsibilities for those injuries arising from the distribution or use of alcoholic beverages and causing injuries to the user or caused to others by the user.
Businessowners Policy (BOP) – please refer to the online course, (“Types of Casualty Policies, Bonds, and Related Terms” chapter) for complete text
Montana Statutes, Rules, and Regulations Pertinent to Casualty Only
D. Workers Compensation
2. Claims and Benefits
If an employee is approved to return to work, but it unable to return in full capacity, resulting in an actual wage loss, the worker may be qualified for temporary partial disability benefits. These benefits are made up of the difference between the worker's average weekly wage at the time of the injury and the actual weekly wages earned while the worker is temporarily partially disabled, not to exceed the worker's temporary total disability benefit rate. Workers who refuse an offer for a modified or alternative position, with a wage equivalent or higher than the wage received at the time of injury, are not eligible for temporary partial disability benefits.
Benefits may be available for serious disfigurement of the face, head, or neck, up to a maximum of $2,500.
Disclosure
Upon submitting a claim, an injured employee must file all reasonable information required for an insurer to process the claim. The employee's attending physician is responsible for providing all relevant health care information, including past history of complaints of or treatment of a condition similar to that presented in a claim, or other conditions associated with the same body part. If death results from an injury, beneficiaries seeking benefits are responsible for submitting proof of death, proof of relationship, a certificate of the attending physician, and other relevant documentation required by the Department.
Claim Approval and Denial
Insurers must accept or deny workers compensation claims within 30 days of receipt of claim. Upon denial of a claim, an insurer must inform the claimant and the Department in writing of the denial. In the event a claim is reopened, an insurer must provide notice to the employer within 14 days of the reopening of a claim.
PROPERTY AND CASUALTY:
Montana Statutes, Rules, and Regulations Common to All Lines
B. Insurance Commissioner and Department
2. Examination of Records
Examination Reports and Hearings
The examiner must file a verified written report with the Department of Insurance within 60 days after completion of the examination. On receipt, the Department must transmit the report to the examined company, as well as a notice that gives the company an opportunity to make a written submission or rebuttal with respect to any matters contained in the examination report within 30 days of receipt of notice.
Within 30 days after the deadline for rebuttals, the Commissioner will review the report and any rebuttals and order one of the following:
- Adopt the examination report as filed or with modifications and corrections;
- Rejecting the examination report with directions to obtain additional data, documentation, information, or testimony; or
- Calling for an investigative hearing with at least 20 days' notice to obtain additional data, documentation, information, and testimony.
Conflict of Interest
The Commissioner may not appoint an examiner if the examiner, directly or indirectly, has a conflict of interest, is affiliated with the management or owns a pecuniary (money) interest in any person to be examined. This does not automatically prevent an examiner from being:
- A policyholder or claimant under an insurance policy;
- A grantor of a mortgage on his/her own residence;
- An investment owner in share of regulated diversified investment companies; or
- A settlor (one who makes a settlement) or beneficiary of a blind trust into which impermissible holdings have been placed.