Examination Content Outlines

Virginia Insurance

Content Outlines



• for examinations taken before September 1, 2009



• for examinations taken on or after September 1, 2009

VIRGINIA Examination Content Outlines

Insurance Supplement Effective Date: July 1, 2008



LIFE & HEALTH b. Revocable and irrevocable

c. Changes

GENERAL KNOWLEDGE d. Common disaster

e. Minor beneficiaries

CONTENT OUTLINE

7. Premium Payment

Product Knowledge, Terms and Concepts a. Modes

b. Grace period

(100 scoreable questions plus 5 pretest questions) c. Automatic premium loan

I. TYPES OF LIFE POLICIES............................................ 9 d. Level or flexible

A. Traditional whole life products 8. Reinstatement

1. Ordinary (straight) life 9. Policy loans, withdrawals, partial surrenders

2. Limited-pay and single-premium life 10. Nonforfeiture options

3. Adjustable life 11. Dividends and dividend options

B. Interest-sensitive life products 12. Incontestability

1. Universal life 13. Assignments

2. Variable whole life 14. Suicide

3. Variable universal life 15. Misstatement of age and gender

4. Interest-sensitive whole life 16. Settlement options

C. Term life C. Policy exclusions

1. Level, decreasing, and increasing term III. LIFE: COMPLETING THE APPLICATION,

2. Special features UNDERWRITING, AND DELIVERING THE POLICY……12

a. Renewable A. Completing the application

b. Convertible 1. Required signatures

D. Annuities 2. Changes in the application

1. Single, level, and flexible premium 3. Consequences of incomplete applications

2. Immediate and deferred 4. Warranties and representations

3. Fixed and variable 5. Collecting the initial premium and issuing the receipt

4. Equity Index 6. Replacement

E. Combination plans and variations 7. Disclosures at point of sale (i.e. HIPAA, HIV consent)

1. Joint life B. Underwriting

2. Survivorship life 1. Insurable interest

II. LIFE: POLICY RIDERS, PROVISIONS, OPTIONS, AND 2. Medical information and consumer reports

EXCLUSIONS… ............................................................. 21 3. Fair Credit Reporting Act

A. Policy riders 4. Risk classification

1. Waiver of premium and waiver of premium with C. Delivering the policy

disability income 1. When coverage begins

2. Guaranteed insurability 2. Explaining the policy and its provisions, riders,

3. Payor benefit exclusions, and ratings to the client

4. Accidental death and/or accidental death and D. Do Not Call List

dismemberment IV. TAXES, RETIREMENT, AND OTHER LIFE INSURANCE

5. Term riders CONCEPTS….................................................................….8

6. Other insureds (e.g., spouse, children, nonfamily) A. Third-party ownership

7. Cost of living B. Group life insurance

B. Policy provisions and options 1. Conversion privilege

1. Entire contract 2. Contributory vs. noncontributory

2. Insuring clause C. Retirement plans

3. Free look 1. Tax-qualified plans

4. Consideration 2. Nonqualified plans

5. Owner’s rights D. Business insurance

6. Beneficiary designations E. Social Security benefits and taxes

a. Primary and contingent F. Tax treatment of insurance premiums,





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proceeds, dividends 12. Change of beneficiary

1. Individual life B. Optional provisions

2. Group life 1. Change of occupation

3. Modified Endowment Contracts (MECs) 2. Misstatement of age

G. Accelerated Death Benefits—Living Benefits 3. Illegal occupation

H. Endowments C. Other provisions and clauses

1. Insuring clause

V. TYPES OF HEALTH POLICIES..................................... 14

2. Free look (10-day, 20-day, etc.)

A. Disability income

3. Consideration clause

1. Individual disability income policy

4. Probationary period

2. Business overhead expense policy

5. Elimination period

3. Business disability buyout policy

6. Waiver of premium

4. Group disability income policy

7. Exclusions

5. Key employee/partner policies

8. Preexisting conditions

B. Accidental death and dismemberment

9. Recurrent disability

C. Medical expense insurance

10. Coinsurance

1. Basic hospital, medical, and surgical policies

11. Deductibles

2. Major medical policies

12. Eligible expenses

3. Comprehensive major medical policies

13. Copayments

4. Health Maintenance Organizations (HMOs)

14. Pre-authorizations and prior approval requirements

5. Preferred provider organizations (PPOs)

15. Usual, reasonable, and customary (URC) charges

6. Service organizations (Blue Plans)

16. Lifetime, annual or per cause maximum benefit limits

7. Point of Service(POS) plans

D. Riders

8. Medical Savings Accounts (MSAs)

1. Impairment rider

9. Flexible Spending Accounts (FSAs)

2. Guaranteed insurability rider

10. Health Reimbursement Accounts (HRAs)

3. Multiple indemnity rider (double, triple)

11. High Deductible Health Plans (HDHPs) and related

E. Rights of renewability

Health Savings Accounts (HSAs)

1. Noncancelable

12. Consumer Driven Health Plans (CDHPs)

2. Cancelable

D. Medicare supplement policies

3. Guaranteed renewable

E. Group insurance

4. Conditionally renewable

1. Group conversion

5. Optionally renewable

2. Differences between individual and group

6. Period of time for renewal

contracts

3. General concepts VII. HEALTH: SOCIAL INSURANCE....................................3

4. COBRA A. Medicare

5. HIPAA 1. Primary, secondary payor

F. Long Term Care 2. Medicare parts A,B,C,D

1. Group conversion B. Medicaid

2. Group/voluntary LTC contracts C. Social Security benefits

3. Service days vs. calendar days

VIII. OTHER HEALTH INSURANCE CONCEPTS.................4

G. Cancer (for specified diseases) plans

A. Total, partial, and residual disability

H. Critical illness plans

B. Owner’s rights

I. Worksite (employer-sponsored) Plans

C. Dependent children benefits

VI. HEALTH POLICY PROVISIONS, CLAUSES, D. Primary and contingent beneficiaries

AND RIDERS.................................................................. 20 E. Modes of premium payments (annual, semiannual,

A. Mandatory provisions etc.)

1. Entire contract F. Nonduplication and coordination of benefits

2. Time limit on certain defenses (incontestable) (e.g., primary vs. excess)

3. Grace period G. Occupational vs. nonoccupational

4. Reinstatement H. Tax treatment of premiums and proceeds of

5. Notice of claim insurance contracts (e.g., disability income and

6. Claim forms medical expenses, etc.)

7. Proof of loss I. Managed care

8. Time of payment of claims J. Workers Compensation

9. Payment of claims K. Subrogation

10. Physical examination and autopsy

IX. HEALTH: FIELD UNDERWRITING PROCEDURES .....9

11. Legal actions

A. Completing application and obtaining



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necessary signatures Ref: 38.2-1821.1, 1822

B. Explaining sources of insurability information 2. Agent Appointment

(e.g., MIB Report, Fair Credit Reporting a. Agent appointment

Act, etc.) Ref: 38.2-1825, 1833

C. Initial premium payment and receipt and b. Cancellation of appointment

consequences of the receipt (e.g. medical Ref: 38.2-1833-1834.1

examination, etc.) c. Termination notification

D. Submitting application (and initial premium if Ref: 38.2-1825, 1833-34.1

collected) to company for underwriting 3. Maintaining a license

E. Assuring delivery of policy and related documents to a. Continuing education

client Ref: 38.2-1866, 1868.1 to 1871

F. Explaining policy and its provisions, riders, b. Change of address

exclusions, and ratings to clients Ref: 38.2-1826(A) (D)

G. Replacement c. Appointment renewal

H. Contract law Ref: 38.2-1834

1. Requirements of forming a contract 4. License suspension, revocation or denial

2. Insurable interest Ref: 38.2-1821, 1831, 1832

3. Warranties and representations C. Fiduciary responsibilities ......................................3-4

4. Unique aspects of the health contract Ref: 38.2-1813

a. Conditional D. Commissions and compensation..........................2

b. Unilateral Ref: 38.2-310, 1812, 1812.2

c. Adhesion E. Felony convictions/ administrative actions .........1

Ref: 38.2-1826(B)

F. Record Retention.. ..................................................1-2

LIFE & HEALTH Ref: 38-2-1809B

G. Marketing practices ................................................6

VIRGINIA SPECIFIC 1. Rebating

Ref: 38.2-509

CONTENT OUTLINE 2. Misrepresentation

State Statutes, Rules and Regulations Ref: 38.2-502, 512

3. Defamation

(40 scoreable questions plus 5 pretest questions)

Ref: 38.2-504

Ref: All references are to sections in Title 38.2 unless

4. False advertising

otherwise indicated

Ref: 38.2-503

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO 5. Boycott, Coercion and intimidation

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY Ref: 38.2-505

AND PERSONAL LINES INSURANCE…...................... 25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1600, 1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 II. VIRGINIA STATUTES AND REQUIREMENTS PERTINENT

TO LIFE INSURANCE ONLY .........................................5

B. Agent Licensing….. ................................................ 7

A. Life Insurance and Annuity Marketing Practices

1. Types of Licenses

Ref: 14 VAC 5-40-10 to 60

a. Insurance agent

1. Purpose

Ref: 38.2-1800.1, 1820, 1822(A),(B)

2. Definitions

b. Consultant

3. Agents’ responsibilities

Ref: 38.2-1837-1839

4. Insurer’s responsibilities

c. Business entities

B. Suitability in Annuity Transactions

Ref: 38.2-1820, 1822 (C, E)

Ref. 14 VAC 5-45-10

d. Temporary insurance agents

C. Replacement

Ref: 38.2-1830

Ref: 14 VAC 5-30- 10 to 70

e. Exceptions

1. Purpose



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2. Definitions Ref: 38.2-3431 to 38.2-3437; 14 VAC 5-234-10 to 100

3. Exemptions

K. Virginia Family Access to Medical Insurance

4. Duties of agent

Security Plan (FAMIS)

5. Duties of replacing insurance company

Ref: RL 32.1 to 351

D. Accelerated benefits

Ref: 38.2-3115.1; 14 VAC 5-70

E. Group Life

Ref: 38.2-3318.1

1. Eligible groups

2. Conversion

Ref: 38.2-3332 through 3334

F. Policy Loans

Ref: 38.2-3308

G. Viatical Settlements

1. Purpose

Ref: 14 VAC 5-71-10

2. Broker authority and licensing

Ref: 38.2-1865.1, 38.2-6001, 14 VAC 5-71-40

3. Disclosure

Ref: 38.2-6005, 6007, 14 VAC 5-71-35

4. General rules and prohibited practices

Ref: 38.2-6008, 6009;14 VAC 5-71-90 and 92

H. Military Sales

Ref: 14 VAC 5-420-10 to 20



III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO HEALTH INSURANCE ONLY .................................. 10

A. Medicare supplements

Ref: 38.2-3600 through 38.2-3609; 14 VAC 5-170-10 to 210

B. Long term care

Ref: 38.2-5200-5210; 14 VAC 5-200-10-210

1. Long Term Care Partnership

Ref: 14 VAC 5-200-205

C. Advertising

Ref: 14 VAC 5-90-10 to 180

D. Preexisting conditions

Ref: 38.2-3520

E. Minimum standards for Individual Policies

Ref: § 38.2-3516,

1. Purpose

Ref: 38.2-3516

2. Disclosure

Ref: 14 VAC 5-140-80

3. Replacement

Ref: 14 VAC 5-140-90

F. Health Insurance Portability and

Accountability Act (HIPAA)

Ref: 38.2-3430.1 to 38.2-3430.9, 38.2-3432.1 to 38.2-3432.3

G. Group Insurance

1. Conversion

Ref: 38.2-3416, 3541

2. Preexisting conditions

38.2-3432.3

H. Defined groups

Ref: 38.2-3521.1

I. Health Maintenance Organizations (HMOs)

Ref: 38.2-4300 to 38.2-4323; 14 VAC 5-211-10 to 280



J. Small employer





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T. Negligence

PROPERTY & CASUALTY

III. PROPERTY POLICY PROVISIONS AND CONTRACT

GENERAL KNOWLEDGE LAW….............................................................................11

A. Declarations

CONTENT OUTLINE B. Insuring agreement

Product Knowledge, Terms and Concepts C. Conditions

D. Exclusions

(100 scoreable questions plus 10 pretest questions)

E. Definition of the insured

Note: To the extent that the specific contracts, forms, and endorsements

F. Duties of the insured

dealt with in this outline are available in standardized versions, outline

G. Obligations of the insurance company

references are to items developed by (1) Insurance Services Office; (2)

H. Mortgagee rights

National Council on Compensation Insurance; (3) Surety Association of

I. Proof of loss

America.

J. Notice of claim

I. TYPES OF PROPERTY POLICIES ............................... 25 K. Appraisal

A. Personal lines L. Other Insurance Provision

1. Dwelling and contents (DP forms) M. Assignment

2. Homeowners (HO forms) N. Subrogation

3. Mobile Homes O. Elements of a contract

B. Commercial lines P. Warranties, representations, and concealment

1. Commercial property Q. Binders

a. Commercial building and personal property R. Sources of insurability information

form S. Fair Credit Reporting Act

b. Causes of loss forms

IV. TYPES OF CASUALTY POLICIES, BONDS, AND

c. Business income

RELATED TERMS… ......................................................23

d. Extra expense A. Commercial general liability

2. Commercial Package Policy (CPP)

1. Basic Hazards

3. Equipment Breakdown Coverage

a. Premises and Operations

4. Businessowners Policy (BOP) b. Products and Completed Operations

C. Inland marine

c. Independent Contractors

1. Personal floaters

d. Insured contracts

2. Commercial floaters 2. Commercial General Liability Coverage Forms

3. Nationwide Definition

a. Coverage A: Bodily Injury and Property

D. Others

Damage Liability

1. Flood (1) Occurrence

2. Earthquake

(2) Claims Made

II. PROPERY: INSURANCE TERMS AND RELATED (a) Extended Reporting Periods: Basic

CONCEPTS .................................................................... 14 and Supplemental

A. Insurance (b) Retroactive Date

B. Insurable interest b. Coverage B: Personal Injury and Advertising

C. Risk Injury

D. Hazard c. Coverage C: Medical Payments

E. Peril d. Supplemental Payments

F. Loss e. Who is an insured

1. Direct f. Limits

2. Indirect g. Conditions (The candidate also should be

G. Proximate cause familiar with ISO’s Common Policy

H. Deductible Conditions)

I. Indemnity h. Definitions

J. Actual cash value B. Automotive: personal auto and business auto

K. Replacement cost 1. Liability

L. Limits of liability 2. Medical Payments

M. Coinsurance/Insurance to value 3. Physical damage (collision and other than

N. Accident collision/comprehensive)

O. Occurrence 4. Uninsured motorists

P. Cancellation 5. Underinsured motorists

Q. Nonrenewal 6. Who is an insured

R. Vacancy and unoccupancy 7. Types of Auto

S. Liability a. Owned



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b. Non-owned B. Insuring agreement

c. Hired C. Conditions

d. Temporary Substitute D. Exclusions and Limitations

8. Garage Coverage Form, including E. Definition of the insured

Garagekeepers insurance F. Duties of the insured after a loss

C. Workers Compensation insurance, Employers G. Cancellation and nonrenewal provisions

Liability insurance, and Related Issues H. Additional (supplementary) payments

(This section does not deal with specifics of state I. Proof of loss

law, which are addressed elsewhere in this outline.) J. Notice of claim

1. Standard policy concepts K. Arbitration

2. Work-related vs. non-work-related L. Other insurance

3. Other states’ insurance M. Subrogation

D. Crime N. Compliance with provisions of Fair Credit Reporting

1. Employee Theft Act

2. Inside the Premises-Theft of Money and O. Claims made policy form

Securities P. Salvage

3. Inside the Premises-Robbery or Safe Burglary of Q. Loss settlement provisions including consent to

Other Property settle a loss

4. Inside the Premises - Robbery or Burglary of Other

Property

E. Surety Bonding PROPERTY & CASUALTY

1. Definitions

a. Obligee VIRGINIA SPECIFIC

b. Principal

c. Surety

CONTENT OUTLINE

F. Professional liability State Statutes, Rules and Regulations

1. Errors and Omissions

(35 scoreable questions plus 5 pretest questions)

G. Umbrella/Excess liability

Ref: All references are to sections in Title 38.2 unless

V. CASUALTY: INSURANCE TERMS AND RELATED otherwise indicated

CONCEPTS .................................................................... 15

A. Risk I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY

B. Hazard

AND PERSONAL LINES INSURANCE..........................25

C. Indemnity

A. State Corporation Commission/ Commissioner of

D. Insurable interest

Insurance…..............................................................3

E. Actual cash value

1. General powers

F. Negligence

Ref: 38.2-200

G. Liability

2. Rules and regulations, orders

H. Accident

Ref: 38.2-223

I. Occurrence

3. Examinations

J. Burglary

Ref: 38.2-515, 1317, 1809A

K. Robbery

4. Penalties

L. Theft

Ref: 38.2-218, 219, 1823, 1831

M. Mysterious disappearance

B. Agent Licensing…...................................................5

N. Binders

1. Types of Licenses

O. Warranties

a. Insurance agent

P. Representations

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Q. Concealment

b. Consultant

R. Bodily injury liability

Ref: 38.2-1837-1839

S. Property damage liability

c. Business entities

T. Personal injury liability

Ref: 38.2-1820, 1822 (C, E)

U. Limits of liability

d. Temporary insurance agents

V. Deductibles

Ref: 38.2-1830

W. Insured contract

e. Exceptions

X. Deposit Premium/Audit

Ref: 38.2-1821.1, 1822

Y. Certificate of Insurance

2. Agent Appointment

VI. CASUALTY POLICY PROVISIONS............................... 12 a. Agent appointment

A. Declarations Ref: 38.2-1825, 1833





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b. Cancellation of appointment Ref: 38.2-2206; § 46.2-472; 38.2-2202

Ref: 38.2-1833, 1834.1 2. Virginia Automobile Insurance Plan (assigned

c. Termination notification risk)

Ref: 38.2-1825, 1833, 1834.1 Ref: 46.2-464 to 471

3. Maintaining a license a. Insurance company’s participation

a. Continuing education b. Insured’s participation

Ref: 38.2-1866, 1868.1 to 1871 3. Financial responsibility

b. Change of address Ref: 46.2-472; 46.2-316

Ref: 38.2-1826(A) (D) 4. Omnibus Clause

c. Appointment renewal Ref: 38.2-2204

Ref: 38.2-1834 - 5. Medical Expense/Loss of Income Protection

4. License suspension, revocation or denial Ref: 38.2-2201

Ref: 38.2-1821, 1831, 1832 6. Rental Reimbursement Coverage

C. Fiduciary responsibilities ..................................... 3-4 Ref: 38.2-2230

Ref: 38.2-1813

D. Commissions and compensation ......................... 2 B. Renewal, nonrenewal, and cancellation ...............2

Ref: 38.2-310, 1812, 1812.2 Ref: 38.2-231, 2208

E. Felony convictions/ administrative actions ......... 1 C. Workers Compensation…. ......................................1

Ref: 38.2-1826(B) (C) 1. Employment covered

F. Record Retention.................................................... 3 Ref: RL 65.2-101, 300

Ref: 38-2-1809B 2. Virginia Workers’ Compensation Plan

G. Marketing practices ................................................ 6 Ref: 65.2-820

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504

4. False advertising

Ref: 38.2-503

5. Boycott, Coercion and intimidation

Ref: 38.2-505

6. Unfair discrimination

Ref:38.2-508

7. Twisting

Ref: 38.2-1831(5)

H. Virginia Insurance Guaranty Association…….. ... .0-1

Ref: 38.2-1600

I. Insurance Information and Privacy Protection…. .0-1

Ref: 38.2-600 to 620

1. Adverse Underwriting Decisions



II. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO PROPERTY INSURANCE ONLY............................. 3

A. Virginia Property Insurance Association (FAIR Plan)

Ref: 38.2-2700 to 2702

1. Purpose

2. Definition

3. Establishment

B. Renewal, nonrenewal, and cancellation

Ref: 38.2-2113, 2114, 38.2-2105

C. Optional coverages

Ref: 38.2-2120, 2124

1. Ordinance or law

2. Water Sewer Backup



III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO CASUALTY INSURANCE ONLY ............................. 7

A. Auto…………………………………………… ............ 4

1. Uninsured/Underinsured motorists coverage



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c. Automatic premium loan

LIFE- GENERAL KNOWLEDGE d. Level or flexible

8. Reinstatement

CONTENT OUTLINE 9. Policy loans, withdrawals, partial surrenders

10. Nonforfeiture options

Product Knowledge, Terms and Concepts

11. Dividends and dividend options

(50 scoreable questions plus 5 pretest questions) 12. Incontestability

13. Assignments

I. TYPES OF POLICIES .................................................... 9

14. Suicide

A. Traditional whole life products

15. Misstatement of age and gender

1. Ordinary (straight) life

16. Settlement options

2. Limited-pay and single-premium life

C. Policy exclusions

3. Adjustable life

B. Interest-sensitive life products III. COMPLETING THE APPLICATION, UNDERWRITING,

1. Universal life AND DELIVERING THE POLICY……............................…12

2. Variable whole life A. Completing the application

3. Variable universal life 1. Required signatures

4. Interest-sensitive whole life 2. Changes in the application

C. Term life 3. Consequences of incomplete applications

1. Level, decreasing, and increasing term 4. Warranties and representations

2. Special features 5. Collecting the initial premium and issuing the receipt

a. Renewable 6. Replacement

b. Convertible 7. Disclosures at point of sale (i.e. HIPAA, HIV consent)

D. Annuities B. Underwriting

1. Single, level, and flexible premium 1. Insurable interest

2. Immediate and deferred 2. Medical information and consumer reports

3. Fixed and variable 3. Fair Credit Reporting Act

4. Equity Index 4. Risk classification

E. Combination plans and variations C. Delivering the policy

1. Joint life 1. When coverage begins

2. Survivorship life 2. Explaining the policy and its provisions, riders,

exclusions, and ratings to the client

II. POLICY RIDERS, PROVISIONS, OPTIONS, AND D. Do Not Call List

EXCLUSIONS… ............................................................. 21

A. Policy riders IV. TAXES, RETIREMENT, AND OTHER INSURANCE

1. Waiver of premium and waiver of premium with CONCEPTS….................................................................….8

disability income A. Third-party ownership

2. Guaranteed insurability B. Group life insurance

3. Payor benefit 1. Conversion privilege

4. Accidental death and/or accidental death and 2. Contributory vs. noncontributory

dismemberment C. Retirement plans

5. Term riders 1. Tax-qualified plans

6. Other insureds (e.g., spouse, children, nonfamily) 2. Nonqualified plans

7. Cost of living D. Business insurance

B. Policy provisions and options E. Social Security benefits and taxes

1. Entire contract F. Tax treatment of insurance premiums,

2. Insuring clause proceeds, dividends

3. Free look 1. Individual life

4. Consideration 2. Group life

5. Owner’s rights 3. Modified Endowment Contracts (MECs)

6. Beneficiary designations G. Accelerated Death Benefits—Living Benefits

a. Primary and contingent H. Endowments

b. Revocable and irrevocable

c. Changes

d. Common disaster LIFE-VIRGINIA SPECIFIC

e. Minor beneficiaries

7. Premium Payment CONTENT OUTLINE

a. Modes

State Statutes, Rules and Regulations

b. Grace period

(40 scoreable questions plus 5 pretest questions)



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Ref: All references are to sections in Title 38.2 unless 4. False advertising

otherwise indicated Ref: 38.2-503

5. Boycott, Coercion and intimidation

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

Ref: 38.2-505

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY

AND PERSONAL LINES INSURANCE…...................... 25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 II. VIRGINIA STATUTES AND REQUIREMENTS PERTINENT

B. Agent Licensing….. ................................................ 7 TO LIFE INSURANCE ONLY .........................................15

1. Types of Licenses A. Life Insurance and Annuity Marketing

a. Insurance agent Practices.. ................................................................3

Ref: 38.2-1800.1, 1820, 1822(A),(B) Ref: 14 VAC 5-40-10 to 60

b. Consultant 1. Purpose

Ref: 38.2-1837-1839 2. Definitions

c. Business entities 3. Agents’ responsibilities

Ref: 38.2-1820, 1822 (C, E) 4. Insurer’s responsibilities

d. Temporary insurance agents B. Suitability in Annuity Transactions .......................3

Ref: 38.2-1830 Ref. 14 VAC 5-45-10

e. Exceptions C. Replacement............................................................3

Ref: 38.2-1821.1, 1822 Ref: 14 VAC 5-30- 10 to 70

2. Agent Appointment 1. Purpose

a. Agent appointment 2. Definitions

Ref: 38.2-1825, 1833 3. Exemptions

b. Cancellation of appointment 4. Duties of agent

Ref: 38.2-1833-1834.1 5. Duties of replacing insurance company

c. Termination notification D. Accelerated benefits ..............................................1

Ref: 38.2-1825, 1833-1834.1 Ref: 38.2-3115.1; 14 VAC 5-70

3. Maintaining a license E. Group Life ................................................................2

a. Continuing education Ref: 38.2-3318.1

Ref: 38.2-1866, 1868.1 to 1871 1. Eligible groups

b. Change of address 2. Conversion

Ref: 38.2-1826(A)(D) Ref: 38.2-3332 through 38.2-3334

c. Appointment renewal F. Policy Loans ...........................................................1

Ref: 38.2-1834 Ref: 38.2-3308

4. License suspension, revocation or denial G. Viatical Settlements ...............................................2

Ref: 38.2-1821, 1831, 1832 1. Purpose

C. Fiduciary responsibilities ..................................... 3-4 Ref: 14 VAC 5-71-10

Ref: 38.2-1813 2. Broker authority and licensing

D. Commissions and compensation ......................... 2 Ref: 38.2-1865.1, 38.2-6001, 14 VAC 5-71-40

Ref: 38.2-310, 1812, 1812.2 3. Disclosure

E. Felony convictions/ administrative actions ......... 1 Ref: 14 VAC 5-71-35, 38.2-6005, 6007

Ref: 38.2-1826(B)(C) 4. General rules and prohibited practices

F. Record Retention.................................................... 1-2 Ref: 38.2-6008, 6009; 14 VAC 5-71-90 and 92

Ref: 38-2-1809B H. Military Sales

G. Marketing practices ................................................ 6 Ref: 14VAC5-420-10 to 20

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504



Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S9

11. Legal actions

HEALTH 12. Change of beneficiary

GENERAL KNOWLEDGE B. Optional provisions

1. Change of occupation

CONTENT OUTLINE 2. Misstatement of age

3. Illegal occupation

Product Knowledge, Terms and Concepts

C. Other provisions and clauses

(50 scoreable questions plus 5 pretest questions) 1. Insuring clause

2. Free look (10-day, 20-day, etc.)

I. TYPES OF POLICIES .................................................... 14 3. Consideration clause

A. Disability income 4. Probationary period

1. Individual disability income policy

5. Elimination period

2. Business overhead expense policy

6. Waiver of premium

3. Business disability buyout policy 7. Exclusions

4. Group disability income policy

8. Preexisting conditions

5. Key employee/partner policies

9. Recurrent disability

B. Accidental death and dismemberment 10. Coinsurance

C. Medical expense insurance

11. Deductibles

1. Basic hospital, medical, and surgical policies

12. Eligible expenses

2. Major medical policies 13. Copayments

3. Comprehensive major medical policies

14. Pre-authorizations and prior approval requirements

4. Health Maintenance Organizations (HMOs)

15. Usual, reasonable, and customary (URC) charges

5. Preferred provider organizations (PPOs) 16. Lifetime, annual or per cause maximum benefit limits

6. Service organizations (Blue Plans)

D. Riders

7. Point of Service(POS) plans

1. Impairment rider

8. Medical Savings Accounts (MSAs) 2. Guaranteed insurability rider

9. Flexible Spending Accounts (FSAs)

3. Multiple indemnity rider (double, triple)

10. Health Reimbursement Accounts (HRAs)

E. Rights of renewability

11. High Deductible Health Plans (HDHPs) and related 1. Noncancelable

Health Savings Accounts (HSAs)

2. Cancelable

12. Consumer Driven Health Plans (CDHPs)

3. Guaranteed renewable

D. Medicare supplement policies 4. Conditionally renewable

E. Group insurance

5. Optionally renewable

1. Group conversion

6. Period of time for renewal

2. Differences between individual and group

contracts III. SOCIAL INSURANCE ....................................................3

3. General concepts A. Medicare

4. COBRA 1. Primary, secondary payor

5. HIPAA 2. Medicare parts A,B,C,D

F. Long Term Care B. Medicaid

1. Group conversion C. Social Security benefits

2. Group/voluntary LTC contracts IV. OTHER INSURANCE CONCEPTS ................................4

3. Service days vs. calendar days A. Total, partial, and residual disability

G. Cancer (for specified diseases) plans B. Owner’s rights

H. Critical illness plans C. Dependent children benefits

I. Worksite (employer-sponsored) Plans D. Primary and contingent beneficiaries

II. POLICY PROVISIONS, CLAUSES, AND RIDERS........ 20 E. Modes of premium payments (annual, semiannual,

A. Mandatory provisions etc.)

1. Entire contract F. Nonduplication and coordination of benefits

2. Time limit on certain defenses (incontestable) (e.g., primary vs. excess)

3. Grace period G. Occupational vs. nonoccupational

4. Reinstatement H. Tax treatment of premiums and proceeds of

5. Notice of claim insurance contracts (e.g., disability income and

6. Claim forms medical expenses, etc.)

7. Proof of loss I. Managed care

8. Time of payment of claims J. Workers Compensation

9. Payment of claims K. Subrogation

10. Physical examination and autopsy V. FIELD UNDERWRITING PROCEDURES ......................9



Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S10

A. Completing application and obtaining e. Exceptions

necessary signatures Ref: 38.2-1821.1, 1822

B. Explaining sources of insurability information 2. Agent Appointment

(e.g., MIB Report, Fair Credit Reporting a. Agent appointment

Act, etc.) Ref: 38.2-1825, 1833

C. Initial premium payment and receipt and b. Cancellation of appointment

consequences of the receipt (e.g. medical Ref: 38.2-1833-1834.1

examination, etc.) c. Termination notification

D. Submitting application (and initial premium if Ref: 38.2-1825, 1833-1834.1

collected) to company for underwriting 3. Maintaining a license

E. Assuring delivery of policy and related documents to a. Continuing education

client Ref: 38.2-1866, 1868.1 to 1871

F. Explaining policy and its provisions, riders, b. Change of address

exclusions, and ratings to clients Ref: 38.2-1826(A)(D)

G. Replacement c. Appointment renewal

H. Contract law Ref: 38.2-1834

1. Requirements of forming a contract 4. License suspension, revocation or denial

2. Insurable interest Ref: 38.2-1821, 1831, 1832

3. Warranties and representations C. Fiduciary responsibilities ......................................3-4

4. Unique aspects of the health contract Ref: 38.2-1813

a. Conditional D. Commissions and compensation..........................2

b. Unilateral Ref: 38.2-310, 1812, 1812.2

c. Adhesion E. Felony convictions/ administrative actions .........1

Ref: 38.2-1826(B)

F. Record Retention.. ..................................................1-2

HEALTH Ref: 38-2-1809B

G. Marketing practices ................................................6

VIRGINIA SPECIFIC 1. Rebating

Ref: 38.2-509

CONTENT OUTLINE 2. Misrepresentation

State Statutes, Rules and Regulations Ref: 38.2-502, 512

3. Defamation

(40 scoreable questions plus 5 pretest questions)

Ref: 38.2-504

Ref: All references are to sections in Title 38.2 unless

4. False advertising

otherwise indicated

Ref: 38.2-503

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO 5. Boycott, Coercion and intimidation

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY Ref: 38.2-505

AND PERSONAL LINES INSURANCE…...................... …25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO HEALTH INSURANCE ONLY ..................................15

B. Agent Licensing….. ................................................ 7

A. Medicare supplements…........................................2

1. Types of Licenses

Ref: 38.2-3600 through 3609; 14 VAC 5-170-10 to 210

a. Insurance agent

B. Long term care….....................................................2-3

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Ref: 38.2-5200-5210; 14 VAC 5-200-10-210

b. Consultant

1. Long Term Care Partnership

Ref: 38.2-1837-1839

Ref: 14 VAC 5-200-205

c. Business entities

C. Advertising…...........................................................2

Ref: 38.2-1820, 1822 (C, E)

Ref: 14 VAC 5-90-10 to 180

d. Temporary insurance agents

D. Preexisting conditions… ........................................1

Ref: 38.2-1830

Ref: 38.2-3520



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S11

E. Minimum standards for Individual Policies … ..... 1

Ref: § 38.2-3516,

1. Purpose

§ 38.2-3516

2. Disclosure

Ref: 14 VAC 5-140-80

3. Replacement

Ref: 14 VAC 5-140-90

F. Health Insurance Portability and Accountability Act

(HIPAA)... ................................................................. 0-1

Ref: 38.2-3430.1 to38.2-3430.9, 38.2-3432.1 to38.2-3432 .3

G. Group Insurance…. ................................................ 2-3

1. Conversion

Ref: 38.2-3416, 3541

2. Preexisting conditions

38.2-3432.3

H. Defined groups.. ..................................................... 1

Ref: 38.2-3521.1

I. Health Maintenance Organizations (HMOs).. ....... 1

Ref: 38.2-4300 to 38.2-4323; 14 VAC 5-211-10 to 280



J. Small employer….................................................... 1

Ref: 38.2-3431 to 38.2-3437; 14 VAC 5-234-10 to 100



K. Virginia Family Access to Medical Insurance

Security Plan (FAMIS)…......................................... 1

Ref: RL 32.1 to 351









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S12

T. Liability

PERSONAL LINES- U. Negligence

GENERAL KNOWLEDGE V. Theft

W. Burglary

Product Knowledge, Terms, and Concepts X. Robbery

(75 questions plus 11 pretest questions) Y. Mysterious disappearance

Z. Binders

I. TYPES OF PROPERTY POLICIES …… ....................... 10

AA. Bodily injury liability

A. Property: Personal lines

BB. Property damage liability

1. Dwelling and contents (DP forms)

CC. Personal injury liability

2. Homeowners (HO forms)

DD. Certificate of insurance

B. Inland marine

EE. Risk management

1. Personal floaters

FF. Professional designations

C. Others types of property policies

1. Flood IV. PROPERTY AND CASUALTY POLICY PROVISIONS AND

2. Personal Watercraft CONTRACT LAW ..........................................................24

3. Earthquake A. Declarations

4. Mobile Homes B. Insuring agreement

C. Conditions

II. TYPES OF CASUALTY POLICIES................................ 13 D. Exclusions

A. Personal Automobile

E. Definitions

1. Liability F. Duties of the insured after a loss

2. Medical Payments

G. Obligations of the insurance company

3. Physical damage (collision and other than

H. Mortgagee rights

collision) I. Proof of loss

4. Uninsured motorists

J. Notice of claim

5. Underinsured motorists

K. Appraisal

6. Who is an insured L. Other Insurance

7. Types of Auto

M. Assignment

a. Owned

N. Subrogation

b. Temporary substitute O. Elements of a contract

8. Use and Eligibility of Auto

P. Sources of underwriting information

B. Personal Liability

Q. Compliance with provisions of Fair Credit

C. Umbrella/Excess Liability Reporting Act

D. Other Personal Exposures

R. Cancellation and Nonrenewal provisions

1. Errors and Ommissions

S. Additional (supplementary) payments

III. PROPERTY AND CASUALTY INSURANCE TERMS AND T. Loss settlement provisions including consent

RELATED CONCEPTS ………………………………..28 to settle a loss

A. Insurable interest U. Limitations

B. Risk V. Representations and misrepresentations

C. Hazard W. Concealment

D. Peril X. Arbitration

E. Loss Y. Coinsurance

1. Direct Z. Endorsements

2. Indirect AA. Premium Payments

F. Proximate cause BB. Effective dates of coverage

G. Deductible

H. Indemnity

I. Actual cash value

PERSONAL LINES-

J. Replacement cost VIRGINIA SPECIFIC

K. Limits of liability

L. Pair and set clause CONTENT OUTLINE

M. Extensions of coverage

State Statutes, Rules and Regulations

N. Additional coverages

O. Accident (32 scoreable questions)

P. Occurrence Ref: All references are to sections in Title 38.2 unless

Q. Vacancy and unoccupancy otherwise indicated

R. Right of salvage

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

S. Abandonment LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY



Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S13

AND PERSONAL LINES INSURANCE………………… 25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1600

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A J. Adverse Underwriting Decisions…. .......................0-1

4. Penalties Ref: 38.2-610, 612

Ref: 38.2-218, 219, 1823; 1831

II. VIRGINIA STATUTES AND REGULATIONS PERTINENT

B. Agent Licensing….. ................................................ 7

TO PERSONAL LINES INSURANCE ONLY .................7

1. Types of Licenses

A. Virginia Property Insurance Association (FAIR

a. Insurance agent

Plan)………………………….. ...................................1

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Ref: 38.2-2700 to 2702

b. Consultant

1. Purpose

Ref: 38.2-1837-1839

2. Definition

c. Business entities

3. Establishment

Ref: 38.2-1820, 1822 (C, E)

B. Auto…………………… .............................................4

d. Temporary insurance agents

1. Uninsured/Underinsured motorists coverage

Ref: 38.2-1830

Ref: 38.2-2206; § 46.2-472; 38.2-2202

e. Exceptions

2. Virginia Automobile Insurance Plan (assigned

Ref: 38.2-1821.1, 1822

risk)

2. Agent Appointment

Ref: 46.2-464 to 471

a. Agent appointment

a. Insurance company’s participation

Ref: 38.2-1825, 1833

b. Insured’s participation

b. Cancellation of appointment

3. Financial responsibility

Ref: 38.2-1833-1834.1

Ref:RL 46.2-472; 46.2-316

c. Termination notification

4. Omnibus Clause

Ref: 38.2-1825, 1833-34.1

Ref: 38.2-2204

3. Maintaining a license

- 5. Medical Expense/Loss of Income Protection

a. Continuing education

Ref: 38.2-2201

Ref: 38.2-1866, 1868.1 to 1871

6. Rental Reimbursement Coverage

b. Change of address

Ref: 38.2-2230

Ref: 38.2-1826(A)(D)

c. Appointment renewal

C. Renewal, nonrenewal, and cancellation…............2

Ref: 38.2-1834

Ref: 612, 2208, 2105, 2212-2114, 2126 (F)(G), 2234

4. License suspension, revocation or denial

D. Optional Property coverages...............................0-1

Ref: 38.2-1821, 1831, 1832

Ref: 38.2-2120, 2124

C. Fiduciary responsibilities ..................................... 3-4

1. Ordinance or law

Ref: 38.2-1813

2. Water Sewer Backup

D. Commissions and compensation ......................... 2

Ref: 38.2-310, 1812, 1812.2

E. Felony convictions/ administrative actions ......... 1

Ref: 38.2-1826(B) (C)

F. Record Retention.................................................... 1-2

Ref: 38-2-1809B

G. Marketing practices ................................................ 6

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504

4. False advertising

Ref: 38.2-503

5. Boycott, Coercion and intimidation

Ref: 38.2-505





Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S14

TITLE INSURANCE G. Financing Statements

H. Powers of Attorney

CONTENT OUTLINE VII. VIRGINIA STATUTES AND REGULATIONS COMMON TO

Product Knowledge, Terms, and Concepts ALL LINES OF INSURANCE ........................................8

State Statutes, Rules and Regulations A. State Corporation Commission / Commissioner of

Insurance

(75 scoreable questions, plus 10 pretest questions) 1. General powers

I. TITLE INSURANCE TERMS AND CONCEPTS ............ 15 Ref: 38.2- 200

A. Commitment 2. Examinations

B. Policy Ref: 38.2-515, 1317, 1809(A)

C. Exception 3. Cease and desist order

D. Requirement Ref: 38.2-219

E. Endorsement 4. Penalties

F. Insurer/Underwriter Ref: 38.2-218, 1823; 1831

G. Chain of Title B. License and registration

H. Closing and Settlement 1. Title agent

I. Title Agent Ref: 38.2-1814.1, 1820, 1822,1836

J. Search and Examination 2. Appointment

K. Premium rates a. Agent appointment

Ref: 38.2-1825, 1833

II. TITLE INSURANCE POLICIES...................................... 13

b. Cancellation of appointment

A. Types of Policies

Ref: 38.2-1833 to 1834.1

1. Owners

c. Termination notification

a. ALTA Forms

Ref: 38.2-1825, 1833 to 1834.1

2. Loan

3. Maintaining a license

3. Construction Loan

a. Continuing education

B. Policy Provisions

Ref: 38.2-1866, 1868.1 to 1871

1. Covered risks

b. Change of address

2. Terms and Conditions

Ref: 38.2-1826(A)(D)

3. Exclusions

c. Appointment renewal

C. Endorsements

Ref: 38.2-1834

III. REAL ESTATE OWNERSHIP........................................ 9 4. License suspension, revocation or denial

A. Joint Tenancy Ref: 38.2-1821, 1831, 1832

B. Tenants In Common C. Fiduciary responsibilities and trust accounts

C. Fee Simple Ref: 38.2-1813, 4601.1

D. Life Estate D. Commissions and compensation

E. Lease Hold Ref: 38.2-1812

F. Legal Entities E. Felony convictions/ administrative actions

Ref: 38.2-1826(B)

IV. RIGHTS AND INTERESTS ............................................ 10

F. Marketing practices

A. Easement and Right of Way

1. Rebating

B. Liens

Ref: 38.2-509

1. Voluntary

2. Misrepresentation

2. Involuntary

Ref: 38.2-502, 512

3. Attachment of liens and judgments

3. Defamation

C. Covenants, Conditions, and Restrictions

Ref: 38.2-504

D. Adverse possesion

4. False advertising

V. LEGAL DESCRIPTIONS................................................ 3 Ref: 38.2-503

A. Platted and Unplatted 5. Boycott, Coercion and intimidation

B. Metes and Bounds Ref: 38.2-505

C. Lot and Block 6. Unfair discrimination

Ref:38.2-508

VI. METHODS OF TRANSFER/CONVEYANCES............... 9

7. Illegal kickbacks and referrals

A. Warranty Deeds

Ref: 38.2-4614, 38.2-1821.1 (B) 8

B. Quitclaim Deeds

G. Insurance Information and Privacy Protection

C. Mortgages

Ref: 38.2-600 to 620

D. Foreclosure

H. Retention of Records

E. Estate

Ref: 38.2-1809(B)

F. Assumption deeds



Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S15

VIII. VIRGINIA RULES AND STATUTES PERTINENT TO TITLE

INSURANCE................................................................... 8

A. Consumer Real Estate Settlement Protection Act

Ref: 6.1-2.19 to 2.29; 14 VAC 5-395-10 to 90

B. Real Estate Settlement Protection Act

Ref. 12USC Section 2600

C. Insured Closing Protection









Virginia Insurance Supplement - Examination Content Outlines Effective July 1, 2008



S16

VIRGINIA Examination Content Outlines

Insurance Supplement Effective Date: September 1, 2009



LIFE & HEALTH b. Revocable and irrevocable

c. Changes

GENERAL KNOWLEDGE d. Common disaster

e. Minor beneficiaries

CONTENT OUTLINE

7. Premium Payment

Product Knowledge, Terms and Concepts a. Modes

b. Grace period

(100 scoreable questions plus 5 pretest questions) c. Automatic premium loan

I. TYPES OF LIFE POLICIES............................................ 9 d. Level or flexible

A. Traditional whole life products 8. Reinstatement

1. Ordinary (straight) life 9. Policy loans, withdrawals, partial surrenders

2. Limited-pay and single-premium life 10. Nonforfeiture options

3. Adjustable life 11. Dividends and dividend options

B. Interest-sensitive life products 12. Incontestability

1. Universal life 13. Assignments

2. Variable whole life 14. Suicide

3. Variable universal life 15. Misstatement of age and gender

4. Interest-sensitive whole life 16. Settlement options

C. Term life C. Policy exclusions

1. Level, decreasing, and increasing term III. LIFE: COMPLETING THE APPLICATION,

2. Special features UNDERWRITING, AND DELIVERING THE POLICY……12

a. Renewable A. Completing the application

b. Convertible 1. Required signatures

D. Annuities 2. Changes in the application

1. Single, level, and flexible premium 3. Consequences of incomplete applications

2. Immediate and deferred 4. Warranties and representations

3. Fixed and variable 5. Collecting the initial premium and issuing the receipt

4. Equity Index 6. Replacement

E. Combination plans and variations 7. Disclosures at point of sale (i.e. HIPAA, HIV consent)

1. Joint life B. Underwriting

2. Survivorship life 1. Insurable interest

II. LIFE: POLICY RIDERS, PROVISIONS, OPTIONS, AND 2. Medical information and consumer reports

EXCLUSIONS… ............................................................. 21 3. Fair Credit Reporting Act

A. Policy riders 4. Risk classification

1. Waiver of premium and waiver of premium with C. Delivering the policy

disability income 1. When coverage begins

2. Guaranteed insurability 2. Explaining the policy and its provisions, riders,

3. Payor benefit exclusions, and ratings to the client

4. Accidental death and/or accidental death and D. Do Not Call List

dismemberment IV. TAXES, RETIREMENT, AND OTHER LIFE INSURANCE

5. Term riders CONCEPTS….................................................................….8

6. Other insureds (e.g., spouse, children, nonfamily) A. Third-party ownership

7. Cost of living B. Group life insurance

B. Policy provisions and options 1. Conversion privilege

1. Entire contract 2. Contributory vs. noncontributory

2. Insuring clause C. Retirement plans

3. Free look 1. Tax-qualified plans

4. Consideration 2. Nonqualified plans

5. Owner’s rights D. Business insurance

6. Beneficiary designations E. Social Security benefits and taxes

a. Primary and contingent F. Tax treatment of insurance premiums,





Virginia Insurance Supplement - Examination Content Outlines Effective September 1, 2009



S1

proceeds, dividends 12. Change of beneficiary

1. Individual life B. Optional provisions

2. Group life 1. Change of occupation

3. Modified Endowment Contracts (MECs) 2. Misstatement of age

G. Accelerated Death Benefits—Living Benefits 3. Illegal occupation

H. Endowments C. Other provisions and clauses

1. Insuring clause

V. TYPES OF HEALTH POLICIES..................................... 14

2. Free look (10-day, 20-day, etc.)

A. Disability income

3. Consideration clause

1. Individual disability income policy

4. Probationary period

2. Business overhead expense policy

5. Elimination period

3. Business disability buyout policy

6. Waiver of premium

4. Group disability income policy

7. Exclusions

5. Key employee/partner policies

8. Preexisting conditions

B. Accidental death and dismemberment

9. Recurrent disability

C. Medical expense insurance

10. Coinsurance

1. Basic hospital, medical, and surgical policies

11. Deductibles

2. Major medical policies

12. Eligible expenses

3. Comprehensive major medical policies

13. Copayments

4. Health Maintenance Organizations (HMOs)

14. Pre-authorizations and prior approval requirements

5. Preferred provider organizations (PPOs)

15. Usual, reasonable, and customary (URC) charges

6. Service organizations (Blue Plans)

16. Lifetime, annual or per cause maximum benefit limits

7. Point of Service(POS) plans

D. Riders

8. Medical Savings Accounts (MSAs)

1. Impairment rider

9. Flexible Spending Accounts (FSAs)

2. Guaranteed insurability rider

10. Health Reimbursement Accounts (HRAs)

3. Multiple indemnity rider (double, triple)

11. High Deductible Health Plans (HDHPs) and related

E. Rights of renewability

Health Savings Accounts (HSAs)

1. Noncancelable

12. Consumer Driven Health Plans (CDHPs)

2. Cancelable

D. Medicare supplement policies

3. Guaranteed renewable

E. Group insurance

4. Conditionally renewable

1. Group conversion

5. Optionally renewable

2. Differences between individual and group

6. Period of time for renewal

contracts

3. General concepts VII. HEALTH: SOCIAL INSURANCE....................................3

4. COBRA A. Medicare

5. HIPAA 1. Primary, secondary payor

F. Long Term Care 2. Medicare parts A,B,C,D

1. Group conversion B. Medicaid

2. Group/voluntary LTC contracts C. Social Security benefits

3. Service days vs. calendar days

VIII. OTHER HEALTH INSURANCE CONCEPTS.................4

G. Cancer (for specified diseases) plans

A. Total, partial, and residual disability

H. Critical illness plans

B. Owner’s rights

I. Worksite (employer-sponsored) Plans

C. Dependent children benefits

VI. HEALTH POLICY PROVISIONS, CLAUSES, D. Primary and contingent beneficiaries

AND RIDERS.................................................................. 20 E. Modes of premium payments (annual, semiannual,

A. Mandatory provisions etc.)

1. Entire contract F. Nonduplication and coordination of benefits

2. Time limit on certain defenses (incontestable) (e.g., primary vs. excess)

3. Grace period G. Occupational vs. nonoccupational

4. Reinstatement H. Tax treatment of premiums and proceeds of

5. Notice of claim insurance contracts (e.g., disability income and

6. Claim forms medical expenses, etc.)

7. Proof of loss I. Managed care

8. Time of payment of claims J. Workers Compensation

9. Payment of claims K. Subrogation

10. Physical examination and autopsy

IX. HEALTH: FIELD UNDERWRITING PROCEDURES .....9

11. Legal actions

A. Completing application and obtaining



Virginia Insurance Supplement - Examination Content Outlines Effective September 1, 2009



S2

necessary signatures Ref: 38.2-1821.1, 1822

B. Explaining sources of insurability information 2. Agent Appointment

(e.g., MIB Report, Fair Credit Reporting a. Agent appointment

Act, etc.) Ref: 38.2-1825, 1833

C. Initial premium payment and receipt and b. Cancellation of appointment

consequences of the receipt (e.g. medical Ref: 38.2-1833-1834.1

examination, etc.) c. Termination notification

D. Submitting application (and initial premium if Ref: 38.2-1825, 1833-34.1

collected) to company for underwriting 3. Maintaining a license

E. Assuring delivery of policy and related documents to a. Continuing education

client Ref: 38.2-1866, 1868.1 to 1871

F. Explaining policy and its provisions, riders, b. Change of address

exclusions, and ratings to clients Ref: 38.2-1826(A) (D)

G. Replacement c. Appointment renewal

H. Contract law Ref: 38.2-1834

1. Requirements of forming a contract 4. License suspension, revocation or denial

2. Insurable interest Ref: 38.2-1821, 1831, 1832

3. Warranties and representations C. Fiduciary responsibilities ......................................1-2

4. Unique aspects of the health contract Ref: 38.2-1813

a. Conditional D. Commissions and compensation..........................2

b. Unilateral Ref: 38.2-310, 1812, 1812.2

c. Adhesion E. Felony convictions/ administrative actions .........1

Ref: 38.2-1826(B)

F. Record Retention.. ..................................................1-2

LIFE & HEALTH Ref: 38-2-1809B

G. Marketing practices ................................................6

VIRGINIA SPECIFIC 1. Rebating

Ref: 38.2-509

CONTENT OUTLINE 2. Misrepresentation

State Statutes, Rules and Regulations Ref: 38.2-502, 512

3. Defamation

(40 scoreable questions plus 5 pretest questions)

Ref: 38.2-504

Ref: All references are to sections in Title 38.2 unless

4. False advertising

otherwise indicated

Ref: 38.2-503

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO 5. Boycott, Coercion and intimidation

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY Ref: 38.2-505

AND PERSONAL LINES INSURANCE…...................... 23 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1600, 1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 II. VIRGINIA STATUTES AND REQUIREMENTS PERTINENT

TO LIFE INSURANCE ONLY…...................................... 7

B. Agent Licensing….. ................................................ 7

A. Life Insurance and Annuity Marketing Practices

1. Types of Licenses

Ref: 14 VAC 5-40-10 to 60

a. Insurance agent

1. Purpose

Ref: 38.2-1800.1, 1820, 1822(A),(B)

2. Definitions

b. Consultant

3. Agents’ responsibilities

Ref: 38.2-1837-1839

4. Insurer’s responsibilities

c. Business entities

B. Suitability in Annuity Transactions

Ref: 38.2-1820, 1822 (C, E)

Ref. 14 VAC 5-45-10

d. Temporary insurance agents

C. Replacement

Ref: 38.2-1830

Ref: 14 VAC 5-30- 10 to 70

e. Exceptions

1. Purpose



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2. Definitions Ref: 38.2-3431 to 38.2-3437; 14 VAC 5-234-10 to 100

3. Exemptions

K. Virginia Family Access to Medical Insurance

4. Duties of agent

Security Plan (FAMIS)

5. Duties of replacing insurance company

Ref: RL 32.1 to 351

D. Accelerated benefits

Ref: 38.2-3115.1; 14 VAC 5-70

E. Group Life

Ref: 38.2-3318.1

1. Eligible groups

2. Conversion

Ref: 38.2-3332 through 3334

F. Policy Loans

Ref: 38.2-3308

G. Viatical Settlements

1. Purpose

Ref: 14 VAC 5-71-10

2. Broker authority and licensing

Ref: 38.2-1865.1, 38.2-6001, 14 VAC 5-71-40

3. Disclosure

Ref: 38.2-6005, 6007, 14 VAC 5-71-35

4. General rules and prohibited practices

Ref: 38.2-6008, 6009;14 VAC 5-71-90 and 92

H. Military Sales

Ref: 14 VAC 5-420-10 to 20



III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO HEALTH INSURANCE ONLY .................................. 10

A. Medicare supplements

Ref: 38.2-3600 through 38.2-3609; 14 VAC 5-170-10 to 210

B. Long term care

Ref: 38.2-5200-5210; 14 VAC 5-200-10-210

1. Long Term Care Partnership

Ref: 14 VAC 5-200-205

C. Advertising

Ref: 14 VAC 5-90-10 to 180 ; 14 VAC 5-43-10 to30

D. Preexisting conditions

Ref: 38.2-3520

E. Minimum standards for Individual Policies

Ref: § 38.2-3516,

1. Purpose

Ref: 38.2-3516

2. Disclosure

Ref: 14 VAC 5-140-80

3. Replacement

Ref: 14 VAC 5-140-90

F. Health Insurance Portability and

Accountability Act (HIPAA)

Ref: 38.2-3430.1 to 38.2-3430.9, 38.2-3432.1 to 38.2-3432.3

G. Group Insurance

1. Conversion

Ref: 38.2-3416, 3541

2. Preexisting conditions

38.2-3432.3

H. Defined groups

Ref: 38.2-3521.1

I. Health Maintenance Organizations (HMOs)

Ref: 38.2-4300 to 38.2-4323; 14 VAC 5-211-10 to 280



J. Small employer





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T. Negligence

PROPERTY & CASUALTY

III. PROPERTY POLICY PROVISIONS AND CONTRACT

GENERAL KNOWLEDGE LAW….............................................................................11

A. Declarations

CONTENT OUTLINE B. Insuring agreement

Product Knowledge, Terms and Concepts C. Conditions

D. Exclusions

(100 scoreable questions plus 10 pretest questions)

E. Definition of the insured

Note: To the extent that the specific contracts, forms, and endorsements

F. Duties of the insured

dealt with in this outline are available in standardized versions, outline

G. Obligations of the insurance company

references are to items developed by (1) Insurance Services Office; (2)

H. Mortgagee rights

National Council on Compensation Insurance; (3) Surety Association of

I. Proof of loss

America.

J. Notice of claim

I. TYPES OF PROPERTY POLICIES ............................... 25 K. Appraisal

A. Personal lines L. Other Insurance Provision

1. Dwelling and contents (DP forms) M. Assignment

2. Homeowners (HO forms) N. Subrogation

3. Mobile Homes O. Elements of a contract

B. Commercial lines P. Warranties, representations, and concealment

1. Commercial property Q. Binders

a. Commercial building and personal property R. Sources of insurability information

form S. Fair Credit Reporting Act

b. Causes of loss forms

IV. TYPES OF CASUALTY POLICIES, BONDS, AND

c. Business income

RELATED TERMS… ......................................................23

d. Extra expense A. Commercial general liability

2. Commercial Package Policy (CPP)

1. Basic Hazards

3. Equipment Breakdown Coverage

a. Premises and Operations

4. Businessowners Policy (BOP) b. Products and Completed Operations

C. Inland marine

c. Independent Contractors

1. Personal floaters

d. Insured contracts

2. Commercial floaters 2. Commercial General Liability Coverage Forms

3. Nationwide Definition

a. Coverage A: Bodily Injury and Property

D. Others

Damage Liability

1. Flood (1) Occurrence

2. Earthquake

(2) Claims Made

II. PROPERTY: INSURANCE TERMS AND RELATED (a) Extended Reporting Periods: Basic

CONCEPTS .................................................................... 14 and Supplemental

A. Insurance (b) Retroactive Date

B. Insurable interest b. Coverage B: Personal Injury and Advertising

C. Risk Injury

D. Hazard c. Coverage C: Medical Payments

E. Peril d. Supplemental Payments

F. Loss e. Who is an insured

1. Direct f. Limits

2. Indirect g. Conditions (The candidate also should be

G. Proximate cause familiar with ISO’s Common Policy

H. Deductible Conditions)

I. Indemnity h. Definitions

J. Actual cash value B. Automotive: personal auto and business auto

K. Replacement cost 1. Liability

L. Limits of liability 2. Medical Payments

M. Coinsurance/Insurance to value 3. Physical damage (collision and other than

N. Accident collision/comprehensive)

O. Occurrence 4. Uninsured motorists

P. Cancellation 5. Underinsured motorists

Q. Nonrenewal 6. Who is an insured

R. Vacancy and unoccupancy 7. Types of Auto

S. Liability a. Owned



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b. Non-owned B. Insuring agreement

c. Hired C. Conditions

d. Temporary Substitute D. Exclusions and Limitations

8. Garage Coverage Form, including E. Definition of the insured

Garagekeepers insurance F. Duties of the insured after a loss

C. Workers Compensation insurance, Employers G. Cancellation and nonrenewal provisions

Liability insurance, and Related Issues H. Additional (supplementary) payments

(This section does not deal with specifics of state I. Proof of loss

law, which are addressed elsewhere in this outline.) J. Notice of claim

1. Standard policy concepts K. Arbitration

2. Work-related vs. non-work-related L. Other insurance

3. Other states’ insurance M. Subrogation

D. Crime N. Compliance with provisions of Fair Credit Reporting

1. Employee Theft Act

2. Inside the Premises-Theft of Money and O. Claims made policy form

Securities P. Salvage

3. Inside the Premises-Robbery or Safe Burglary of Q. Loss settlement provisions including consent to

Other Property settle a loss

4. Inside the Premises - Robbery or Burglary of Other

Property

E. Surety Bonding PROPERTY & CASUALTY

1. Definitions

a. Obligee VIRGINIA SPECIFIC

b. Principal

c. Surety

CONTENT OUTLINE

F. Professional liability State Statutes, Rules and Regulations

1. Errors and Omissions

(35 scoreable questions plus 5 pretest questions)

G. Umbrella/Excess liability

Ref: All references are to sections in Title 38.2 unless

V. CASUALTY: INSURANCE TERMS AND RELATED otherwise indicated

CONCEPTS .................................................................... 15

A. Risk I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY

B. Hazard

AND PERSONAL LINES INSURANCE..........................25

C. Indemnity

A. State Corporation Commission/ Commissioner of

D. Insurable interest

Insurance…..............................................................3

E. Actual cash value

1. General powers

F. Negligence

Ref: 38.2-200

G. Liability

2. Rules and regulations, orders

H. Accident

Ref: 38.2-223

I. Occurrence

3. Examinations

J. Burglary

Ref: 38.2-515, 1317, 1809A

K. Robbery

4. Penalties

L. Theft

Ref: 38.2-218, 219, 1823, 1831

M. Mysterious disappearance

B. Agent Licensing…...................................................5

N. Binders

1. Types of Licenses

O. Warranties

a. Insurance agent

P. Representations

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Q. Concealment

b. Consultant

R. Bodily injury liability

Ref: 38.2-1837-1839

S. Property damage liability

c. Business entities

T. Personal injury liability

Ref: 38.2-1820, 1822 (C, E)

U. Limits of liability

d. Temporary insurance agents

V. Deductibles

Ref: 38.2-1830

W. Insured contract

e. Exceptions

X. Deposit Premium/Audit

Ref: 38.2-1821.1, 1822

Y. Certificate of Insurance

2. Agent Appointment

VI. CASUALTY POLICY PROVISIONS............................... 12 a. Agent appointment

A. Declarations Ref: 38.2-1825, 1833





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b. Cancellation of appointment Ref: 38.2-2206; § 46.2-472; 38.2-2202

Ref: 38.2-1833, 1834.1 2. Virginia Automobile Insurance Plan (assigned

c. Termination notification risk)

Ref: 38.2-1825, 1833, 1834.1 Ref: 46.2-464 to 471

3. Maintaining a license a. Insurance company’s participation

a. Continuing education b. Insured’s participation

Ref: 38.2-1866, 1868.1 to 1871 3. Financial responsibility

b. Change of address Ref: 46.2-472; 46.2-316 (C)

Ref: 38.2-1826(A) (D) 4. Omnibus Clause

c. Appointment renewal Ref: 38.2-2204

Ref: 38.2-1834 - 5. Medical Expense/Loss of Income Protection

4. License suspension, revocation or denial Ref: 38.2-2201

Ref: 38.2-1821, 1831, 1832 6. Rental Reimbursement Coverage

C. Fiduciary responsibilities ..................................... 3-4 Ref: 38.2-2230

Ref: 38.2-1813

D. Commissions and compensation ......................... 2 B. Renewal, nonrenewal, and cancellation ...............2

Ref: 38.2-310, 1812, 1812.2 Ref: 38.2-231, 2208

E. Felony convictions/ administrative actions ......... 1 C. Workers Compensation…. ......................................1

Ref: 38.2-1826(B) (C) 1. Employment covered

F. Record Retention.................................................... 3 Ref: RL 65.2-101, 300

Ref: 38-2-1809B 2. Virginia Workers’ Compensation Plan

G. Marketing practices ................................................ 6 Ref: 65.2-820

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504

4. False advertising

Ref: 38.2-503

5. Boycott, Coercion and intimidation

Ref: 38.2-505

6. Unfair discrimination

Ref:38.2-508

7. Twisting

Ref: 38.2-1831(5)

H. Virginia Insurance Guaranty Association…….. ... .0-1

Ref: 38.2-1600

I. Insurance Information and Privacy Protection…. .0-1

Ref: 38.2-600 to 620

1. Adverse Underwriting Decisions



II. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO PROPERTY INSURANCE ONLY............................. 3

A. Virginia Property Insurance Association (FAIR Plan)

Ref: 38.2-2700 to 2702

1. Purpose

2. Definition

3. Establishment

B. Renewal, nonrenewal, and cancellation

Ref: 38.2-2113, 2114, 38.2-2105

C. Optional coverages

Ref: 38.2-2120, 2124

1. Ordinance or law

2. Water Sewer Backup



III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO CASUALTY INSURANCE ONLY ............................. 7

A. Auto…………………………………………… ............ 4

1. Uninsured/Underinsured motorists coverage



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c. Automatic premium loan

LIFE- GENERAL KNOWLEDGE d. Level or flexible

8. Reinstatement

CONTENT OUTLINE 9. Policy loans, withdrawals, partial surrenders

10. Nonforfeiture options

Product Knowledge, Terms and Concepts

11. Dividends and dividend options

(50 scoreable questions plus 5 pretest questions) 12. Incontestability

13. Assignments

I. TYPES OF POLICIES .................................................... 9

14. Suicide

A. Traditional whole life products

15. Misstatement of age and gender

1. Ordinary (straight) life

16. Settlement options

2. Limited-pay and single-premium life

C. Policy exclusions

3. Adjustable life

B. Interest-sensitive life products III. COMPLETING THE APPLICATION, UNDERWRITING,

1. Universal life AND DELIVERING THE POLICY……............................…12

2. Variable whole life A. Completing the application

3. Variable universal life 1. Required signatures

4. Interest-sensitive whole life 2. Changes in the application

C. Term life 3. Consequences of incomplete applications

1. Level, decreasing, and increasing term 4. Warranties and representations

2. Special features 5. Collecting the initial premium and issuing the receipt

a. Renewable 6. Replacement

b. Convertible 7. Disclosures at point of sale (i.e. HIPAA, HIV consent)

D. Annuities B. Underwriting

1. Single, level, and flexible premium 1. Insurable interest

2. Immediate and deferred 2. Medical information and consumer reports

3. Fixed and variable 3. Fair Credit Reporting Act

4. Equity Index 4. Risk classification

E. Combination plans and variations C. Delivering the policy

1. Joint life 1. When coverage begins

2. Survivorship life 2. Explaining the policy and its provisions, riders,

exclusions, and ratings to the client

II. POLICY RIDERS, PROVISIONS, OPTIONS, AND D. Do Not Call List

EXCLUSIONS… ............................................................. 21

A. Policy riders IV. TAXES, RETIREMENT, AND OTHER INSURANCE

1. Waiver of premium and waiver of premium with CONCEPTS….................................................................….8

disability income A. Third-party ownership

2. Guaranteed insurability B. Group life insurance

3. Payor benefit 1. Conversion privilege

4. Accidental death and/or accidental death and 2. Contributory vs. noncontributory

dismemberment C. Retirement plans

5. Term riders 1. Tax-qualified plans

6. Other insureds (e.g., spouse, children, nonfamily) 2. Nonqualified plans

7. Cost of living D. Business insurance

B. Policy provisions and options E. Social Security benefits and taxes

1. Entire contract F. Tax treatment of insurance premiums,

2. Insuring clause proceeds, dividends

3. Free look 1. Individual life

4. Consideration 2. Group life

5. Owner’s rights 3. Modified Endowment Contracts (MECs)

6. Beneficiary designations G. Accelerated Death Benefits—Living Benefits

a. Primary and contingent H. Endowments

b. Revocable and irrevocable

c. Changes

d. Common disaster LIFE-VIRGINIA SPECIFIC

e. Minor beneficiaries

7. Premium Payment CONTENT OUTLINE

a. Modes

State Statutes, Rules and Regulations

b. Grace period

(40 scoreable questions plus 5 pretest questions)



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Ref: All references are to sections in Title 38.2 unless 4. False advertising

otherwise indicated Ref: 38.2-503

5. Boycott, Coercion and intimidation

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

Ref: 38.2-505

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY

AND PERSONAL LINES INSURANCE…...................... 25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection….1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 II. VIRGINIA STATUTES AND REQUIREMENTS PERTINENT

B. Agent Licensing….. ................................................ 7 TO LIFE INSURANCE ONLY .........................................15

1. Types of Licenses A. Life Insurance and Annuity Marketing

a. Insurance agent Practices.. ................................................................3

Ref: 38.2-1800.1, 1820, 1822(A),(B) Ref: 14 VAC 5-40-10 to 60

b. Consultant 1. Purpose

Ref: 38.2-1837-1839 2. Definitions

c. Business entities 3. Agents’ responsibilities

Ref: 38.2-1820, 1822 (C, E) 4. Insurer’s responsibilities

d. Temporary insurance agents B. Suitability in Annuity Transactions .......................3

Ref: 38.2-1830 Ref. 14 VAC 5-45-10

e. Exceptions C. Replacement............................................................3

Ref: 38.2-1821.1, 1822 Ref: 14 VAC 5-30- 10 to 70

2. Agent Appointment 1. Purpose

a. Agent appointment 2. Definitions

Ref: 38.2-1825, 1833 3. Exemptions

b. Cancellation of appointment 4. Duties of agent

Ref: 38.2-1833-1834.1 5. Duties of replacing insurance company

c. Termination notification D. Accelerated benefits ..............................................1

Ref: 38.2-1825, 1833-1834.1 Ref: 38.2-3115.1; 14 VAC 5-70

3. Maintaining a license E. Group Life ................................................................2

a. Continuing education Ref: 38.2-3318.1

Ref: 38.2-1866, 1868.1 to 1871 1. Eligible groups

b. Change of address 2. Conversion

Ref: 38.2-1826(A)(D) Ref: 38.2-3332 through 38.2-3334

c. Appointment renewal F. Policy Loans ...........................................................1

Ref: 38.2-1834 Ref: 38.2-3308

4. License suspension, revocation or denial G. Viatical Settlements ...............................................2

Ref: 38.2-1821, 1831, 1832 1. Purpose

C. Fiduciary responsibilities ….................................. ..1-2 Ref: 14 VAC 5-71-10

Ref: 38.2-1813 2. Broker authority and licensing

D. Commissions and compensation ......................... 2 Ref: 38.2-1865.1, 38.2-6001, 14 VAC 5-71-40

Ref: 38.2-310, 1812, 1812.2 3. Disclosure

E. Felony convictions/ administrative actions ......... 1 Ref: 14 VAC 5-71-35, 38.2-6005, 6007

Ref: 38.2-1826(B)(C) 4. General rules and prohibited practices

F. Record Retention.................................................... 1-2 Ref: 38.2-6008, 6009; 14 VAC 5-71-90 and 92

Ref: 38-2-1809B H. Military Sales

G. Marketing practices ................................................ 7 Ref: 14VAC5-420-10 to 20

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504



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11. Legal actions

HEALTH 12. Change of beneficiary

GENERAL KNOWLEDGE B. Optional provisions

1. Change of occupation

CONTENT OUTLINE 2. Misstatement of age

3. Illegal occupation

Product Knowledge, Terms and Concepts

C. Other provisions and clauses

(50 scoreable questions plus 5 pretest questions) 1. Insuring clause

2. Free look (10-day, 20-day, etc.)

I. TYPES OF POLICIES .................................................... 14 3. Consideration clause

A. Disability income 4. Probationary period

1. Individual disability income policy

5. Elimination period

2. Business overhead expense policy

6. Waiver of premium

3. Business disability buyout policy 7. Exclusions

4. Group disability income policy

8. Preexisting conditions

5. Key employee/partner policies

9. Recurrent disability

B. Accidental death and dismemberment 10. Coinsurance

C. Medical expense insurance

11. Deductibles

1. Basic hospital, medical, and surgical policies

12. Eligible expenses

2. Major medical policies 13. Copayments

3. Comprehensive major medical policies

14. Pre-authorizations and prior approval requirements

4. Health Maintenance Organizations (HMOs)

15. Usual, reasonable, and customary (URC) charges

5. Preferred provider organizations (PPOs) 16. Lifetime, annual or per cause maximum benefit limits

6. Service organizations (Blue Plans)

D. Riders

7. Point of Service(POS) plans

1. Impairment rider

8. Medical Savings Accounts (MSAs) 2. Guaranteed insurability rider

9. Flexible Spending Accounts (FSAs)

3. Multiple indemnity rider (double, triple)

10. Health Reimbursement Accounts (HRAs)

E. Rights of renewability

11. High Deductible Health Plans (HDHPs) and related 1. Noncancelable

Health Savings Accounts (HSAs)

2. Cancelable

12. Consumer Driven Health Plans (CDHPs)

3. Guaranteed renewable

D. Medicare supplement policies 4. Conditionally renewable

E. Group insurance

5. Optionally renewable

1. Group conversion

6. Period of time for renewal

2. Differences between individual and group

contracts III. SOCIAL INSURANCE ....................................................3

3. General concepts A. Medicare

4. COBRA 1. Primary, secondary payor

5. HIPAA 2. Medicare parts A,B,C,D

F. Long Term Care B. Medicaid

1. Group conversion C. Social Security benefits

2. Group/voluntary LTC contracts IV. OTHER INSURANCE CONCEPTS ................................4

3. Service days vs. calendar days A. Total, partial, and residual disability

G. Cancer (for specified diseases) plans B. Owner’s rights

H. Critical illness plans C. Dependent children benefits

I. Worksite (employer-sponsored) Plans D. Primary and contingent beneficiaries

II. POLICY PROVISIONS, CLAUSES, AND RIDERS........ 20 E. Modes of premium payments (annual, semiannual,

A. Mandatory provisions etc.)

1. Entire contract F. Nonduplication and coordination of benefits

2. Time limit on certain defenses (incontestable) (e.g., primary vs. excess)

3. Grace period G. Occupational vs. nonoccupational

4. Reinstatement H. Tax treatment of premiums and proceeds of

5. Notice of claim insurance contracts (e.g., disability income and

6. Claim forms medical expenses, etc.)

7. Proof of loss I. Managed care

8. Time of payment of claims J. Workers Compensation

9. Payment of claims K. Subrogation

10. Physical examination and autopsy V. FIELD UNDERWRITING PROCEDURES ......................9



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S10

A. Completing application and obtaining e. Exceptions

necessary signatures Ref: 38.2-1821.1, 1822

B. Explaining sources of insurability information 2. Agent Appointment

(e.g., MIB Report, Fair Credit Reporting a. Agent appointment

Act, etc.) Ref: 38.2-1825, 1833

C. Initial premium payment and receipt and b. Cancellation of appointment

consequences of the receipt (e.g. medical Ref: 38.2-1833-1834.1

examination, etc.) c. Termination notification

D. Submitting application (and initial premium if Ref: 38.2-1825, 1833-1834.1

collected) to company for underwriting 3. Maintaining a license

E. Assuring delivery of policy and related documents to a. Continuing education

client Ref: 38.2-1866, 1868.1 to 1871

F. Explaining policy and its provisions, riders, b. Change of address

exclusions, and ratings to clients Ref: 38.2-1826(A)(D)

G. Replacement c. Appointment renewal

H. Contract law Ref: 38.2-1834

1. Requirements of forming a contract 4. License suspension, revocation or denial

2. Insurable interest Ref: 38.2-1821, 1831, 1832

3. Warranties and representations C. Fiduciary responsibilities … ..................................1-2

4. Unique aspects of the health contract Ref: 38.2-1813

a. Conditional D. Commissions and compensation..........................2

b. Unilateral Ref: 38.2-310, 1812, 1812.2

c. Adhesion E. Felony convictions/ administrative actions .........1

Ref: 38.2-1826(B)

F. Record Retention.. ..................................................1-2

HEALTH Ref: 38-2-1809B

G. Marketing practices….............................................7

VIRGINIA SPECIFIC 1. Rebating

Ref: 38.2-509

CONTENT OUTLINE 2. Misrepresentation

State Statutes, Rules and Regulations Ref: 38.2-502, 512

3. Defamation

(40 scoreable questions plus 5 pretest questions)

Ref: 38.2-504

Ref: All references are to sections in Title 38.2 unless

4. False advertising

otherwise indicated

Ref: 38.2-503

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO 5. Boycott, Coercion and intimidation

LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY Ref: 38.2-505

AND PERSONAL LINES INSURANCE…...................... …25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1700, 1715

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A 1. Adverse Underwriting Decisions

4. Penalties

Ref: 38.2-218, 219, 1823; 1831 III. VIRGINIA STATUTES AND REGULATIONS PERTINENT

TO HEALTH INSURANCE ONLY ..................................15

B. Agent Licensing….. ................................................ 7

A. Medicare supplements…........................................2

1. Types of Licenses

Ref: 38.2-3600 through 3609; 14 VAC 5-170-10 to 210

a. Insurance agent

B. Long term care….....................................................2-3

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Ref: 38.2-5200-5210; 14 VAC 5-200-10-210

b. Consultant

1. Long Term Care Partnership

Ref: 38.2-1837-1839

Ref: 14 VAC 5-200-205

c. Business entities

C. Advertising…...........................................................2

Ref: 38.2-1820, 1822 (C, E)

Ref: 14 VAC 5-90-10 to 180; 14 VAC 5-43-10 to30

d. Temporary insurance agents

D. Preexisting conditions… ........................................1

Ref: 38.2-1830

Ref: 38.2-3520



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E. Minimum standards for Individual Policies … ..... 1

Ref: § 38.2-3516,

1. Purpose

§ 38.2-3516

2. Disclosure

Ref: 14 VAC 5-140-80

3. Replacement

Ref: 14 VAC 5-140-90

F. Health Insurance Portability and Accountability Act

(HIPAA)... ................................................................. 0-1

Ref: 38.2-3430.1 to38.2-3430.9, 38.2-3432.1 to38.2-3432 .3

G. Group Insurance…. ................................................ 2-3

1. Conversion

Ref: 38.2-3416, 3541

2. Preexisting conditions

38.2-3432.3

H. Defined groups.. ..................................................... 1

Ref: 38.2-3521.1

I. Health Maintenance Organizations (HMOs).. ....... 1

Ref: 38.2-4300 to 38.2-4323; 14 VAC 5-211-10 to 280



J. Small employer….................................................... 1

Ref: 38.2-3431 to 38.2-3437; 14 VAC 5-234-10 to 100



K. Virginia Family Access to Medical Insurance

Security Plan (FAMIS)…......................................... 1

Ref: RL 32.1 to 351









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S12

T. Liability

PERSONAL LINES- U. Negligence

GENERAL KNOWLEDGE V. Theft

W. Burglary

Product Knowledge, Terms, and Concepts X. Robbery

(75 questions plus 11 pretest questions) Y. Mysterious disappearance

Z. Binders

I. TYPES OF PROPERTY POLICIES …… ....................... 10

AA. Bodily injury liability

A. Property: Personal lines

BB. Property damage liability

1. Dwelling and contents (DP forms)

CC. Personal injury liability

2. Homeowners (HO forms)

DD. Certificate of insurance

B. Inland marine

EE. Risk management

1. Personal floaters

FF. Professional designations

C. Others types of property policies

1. Flood IV. PROPERTY AND CASUALTY POLICY PROVISIONS AND

2. Personal Watercraft CONTRACT LAW ..........................................................24

3. Earthquake A. Declarations

4. Mobile Homes B. Insuring agreement

C. Conditions

II. TYPES OF CASUALTY POLICIES................................ 13 D. Exclusions

A. Personal Automobile

E. Definitions

1. Liability F. Duties of the insured after a loss

2. Medical Payments

G. Obligations of the insurance company

3. Physical damage (collision and other than

H. Mortgagee rights

collision) I. Proof of loss

4. Uninsured motorists

J. Notice of claim

5. Underinsured motorists

K. Appraisal

6. Who is an insured L. Other Insurance

7. Types of Auto

M. Assignment

a. Owned

N. Subrogation

b. Temporary substitute O. Elements of a contract

8. Use and Eligibility of Auto

P. Sources of underwriting information

B. Personal Liability

Q. Compliance with provisions of Fair Credit

C. Umbrella/Excess Liability Reporting Act

D. Other Personal Exposures

R. Cancellation and Nonrenewal provisions

1. Errors and Omissions

S. Additional (supplementary) payments

III. PROPERTY AND CASUALTY INSURANCE TERMS AND T. Loss settlement provisions including consent

RELATED CONCEPTS ………………………………..28 to settle a loss

A. Insurable interest U. Limitations

B. Risk V. Representations and misrepresentations

C. Hazard W. Concealment

D. Peril X. Arbitration

E. Loss Y. Coinsurance

1. Direct Z. Endorsements

2. Indirect AA. Premium Payments

F. Proximate cause BB. Effective dates of coverage

G. Deductible

H. Indemnity

I. Actual cash value

PERSONAL LINES-

J. Replacement cost VIRGINIA SPECIFIC

K. Limits of liability

L. Pair and set clause CONTENT OUTLINE

M. Extensions of coverage

State Statutes, Rules and Regulations

N. Additional coverages

O. Accident (32 scoreable questions)

P. Occurrence Ref: All references are to sections in Title 38.2 unless

Q. Vacancy and unoccupancy otherwise indicated

R. Right of salvage

I. VIRGINIA STATUTES AND REGULATIONS COMMON TO

S. Abandonment LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY



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AND PERSONAL LINES INSURANCE………………… 25 6. Unfair discrimination

A. State Corporation Commission/ Commissioner of Ref:38.2-508

Insurance… ............................................................. 3 7. Twisting

1. General powers Ref: 38.2-1831(5)

Ref: 38.2-200 H. Virginia Insurance Guaranty Association…….. ....0-1

2. Rules and regulations, orders Ref: 38.2-1600

Ref: 38.2-223 I. Insurance Information and Privacy Protection…. .0-1

3. Examinations Ref: 38.2-600 to 620

Ref: 38.2-515, 1317, 1809A J. Adverse Underwriting Decisions…. .......................0-1

4. Penalties Ref: 38.2-610, 612

Ref: 38.2-218, 219, 1823; 1831

II. VIRGINIA STATUTES AND REGULATIONS PERTINENT

B. Agent Licensing….. ................................................ 7

TO PERSONAL LINES INSURANCE ONLY .................7

1. Types of Licenses

A. Virginia Property Insurance Association (FAIR

a. Insurance agent

Plan)………………………….. ...................................1

Ref: 38.2-1800.1, 1820, 1822(A),(B)

Ref: 38.2-2700 to 2702

b. Consultant

1. Purpose

Ref: 38.2-1837-1839

2. Definition

c. Business entities

3. Establishment

Ref: 38.2-1820, 1822 (C, E)

B. Auto…………………… .............................................4

d. Temporary insurance agents

1. Uninsured/Underinsured motorists coverage

Ref: 38.2-1830

Ref: 38.2-2206; § 46.2-472; 38.2-2202

e. Exceptions

2. Virginia Automobile Insurance Plan (assigned

Ref: 38.2-1821.1, 1822

risk)

2. Agent Appointment

Ref: 46.2-464 to 471

a. Agent appointment

a. Insurance company’s participation

Ref: 38.2-1825, 1833

b. Insured’s participation

b. Cancellation of appointment

3. Financial responsibility

Ref: 38.2-1833-1834.1

Ref:RL 46.2-472; 46.2-316 (C)

c. Termination notification

4. Omnibus Clause

Ref: 38.2-1825, 1833-34.1

Ref: 38.2-2204

3. Maintaining a license

- 5. Medical Expense/Loss of Income Protection

a. Continuing education

Ref: 38.2-2201

Ref: 38.2-1866, 1868.1 to 1871

6. Rental Reimbursement Coverage

b. Change of address

Ref: 38.2-2230

Ref: 38.2-1826(A)(D)

c. Appointment renewal

C. Renewal, nonrenewal, and cancellation…............2

Ref: 38.2-1834

Ref: 612, 2208, 2105, 2212-2114, 2126 (F)(G), 2234

4. License suspension, revocation or denial

D. Optional Property coverages...............................0-1

Ref: 38.2-1821, 1831, 1832

Ref: 38.2-2120, 2124

C. Fiduciary responsibilities ..................................... 3-4

1. Ordinance or law

Ref: 38.2-1813

2. Water Sewer Backup

D. Commissions and compensation ......................... 2

Ref: 38.2-310, 1812, 1812.2

E. Felony convictions/ administrative actions ......... 1

Ref: 38.2-1826(B) (C)

F. Record Retention.................................................... 1-2

Ref: 38-2-1809B

G. Marketing practices ................................................ 6

1. Rebating

Ref: 38.2-509

2. Misrepresentation

Ref: 38.2-502, 512

3. Defamation

Ref: 38.2-504

4. False advertising

Ref: 38.2-503

5. Boycott, Coercion and intimidation

Ref: 38.2-505





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TITLE INSURANCE D. Foreclosure

E. Estate

CONTENT OUTLINE F. Assumption Deeds

G. Financing Statements

Product Knowledge, Terms, and Concepts H. Powers of Attorney

State Statutes, Rules and Regulations

VII. VIRGINIA STATUTES AND REGULATIONS COMMON TO

(75 scoreable questions, plus 10 pretest questions) ALL LINES OF INSURANCE ........................................8

I. TITLE INSURANCE TERMS AND CONCEPTS ............ 15 A. State Corporation Commission / Commissioner of

A. Commitment Insurance

B. Policy 1. General powers

C. Exception Ref: 38.2- 200

D. Requirement 2. Examinations

E. Endorsement Ref: 38.2-515, 1317, 1809(A)

F. Insurer/Underwriter 3. Cease and desist order

G. Chain of Title Ref: 38.2-219

H. Closing and Settlement 4. Penalties

I. Title Agent Ref: 38.2-218, 1823; 1831

J. Search and Examination B. License and registration

K. Premium rates 1. Title agent

L. Closing Protection Letters Ref: 38.2-1814.1, 1820, 1822,1836

2. Appointment

a. Agent appointment

II. TITLE INSURANCE POLICIES...................................... 13

Ref: 38.2-1825, 1833

A. Types of Policies

b. Cancellation of appointment

1. Owners

Ref: 38.2-1833 to 1834.1

a. ALTA Forms

c. Termination notification

2. Loan

Ref: 38.2-1825, 1833 to 1834.1

3. Construction Loan

3. Maintaining a license

B. Policy Provisions

a. Continuing education

1. Covered risks

Ref: 38.2-1866, 1868.1 to 1871

2. Terms and Conditions

b. Change of address

3. Exclusions

Ref: 38.2-1826(A)(D)

C. Endorsements

c. Appointment renewal

III. REAL ESTATE OWNERSHIP........................................ 9 Ref: 38.2-1834

A. Joint Tenancy 4. License suspension, revocation or denial

B. Tenants In Common Ref: 38.2-1821, 1831, 1832

C. Fee Simple C. Fiduciary responsibilities and trust accounts

D. Life Estate Ref: 38.2-1813, 4601.1

E. Lease Hold D. Commissions and compensation

F. Legal Entities Ref: 38.2-1812

E. Felony convictions/ administrative actions

IV. RIGHTS AND INTERESTS ............................................ 10

Ref: 38.2-1826(B)

A. Easement and Right of Way

F. Marketing practices

B. Liens

1. Rebating

1. Voluntary

Ref: 38.2-509

2. Involuntary

2. Misrepresentation

3. Attachment of liens and judgments

Ref: 38.2-502, 512

4. Statute of Limitations

3. Defamation

C. Covenants, Conditions, and Restrictions

Ref: 38.2-504

D. Adverse possession

4. False advertising

V. LEGAL DESCRIPTIONS................................................ 3 Ref: 38.2-503

A. Platted and Unplatted 5. Boycott, Coercion and intimidation

B. Metes and Bounds Ref: 38.2-505

C. Lot and Block 6. Unfair discrimination

Ref:38.2-508

VI. METHODS OF TRANSFER/CONVEYANCES............... 9

7. Illegal kickbacks and referrals

A. Warranty Deeds

Ref: 38.2-4614, 38.2-1821.1 (B) 8

B. Quitclaim Deeds

G. Insurance Information and Privacy Protection

C. Mortgages



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S15

Ref: 38.2-600 to 620

H. Retention of Records

Ref: 38.2-1809(B)



VIII. VIRGINIA RULES AND STATUTES PERTINENT TO TITLE

INSURANCE................................................................... 8

A. Consumer Real Estate Settlement Protection Act

Ref: 6.1-2.19 to 2.29; 14 VAC 5-395-10 to 90

B. Real Estate Settlement Protection Act

Ref. 12USC Section 2600









Virginia Insurance Supplement - Examination Content Outlines Effective September 1, 2009



S16