Questões de Texas Statutes - Accident and Health Only

1. TDI-PEARSONVUE — 2026

A Medicare supplement policy in Texas must meet certain loss ratio standards. These standards are designed to ensure what?

1. A)That agents receive adequate commissions
2. B)That a sufficient percentage of premiums is returned to policyholders as benefits
3. C)That insurers maintain a minimum profit margin
4. D)That policies are sold only to eligible Medicare beneficiaries

Gabarito: B

Loss ratio standards require that a specified percentage of premiums collected must be paid out as benefits to policyholders, protecting consumers from policies that provide minimal benefits relative to premiums charged.

2. TDI-PEARSONVUE — 2026

Before conducting an HIV/AIDS test on an applicant for health insurance, a Texas insurer must:

1. A)Obtain written informed consent from the applicant
2. B)Notify the Texas Department of Insurance within 24 hours
3. C)Provide test results to the applicant's physician only
4. D)Wait 30 days after policy application before testing

Gabarito: A

Texas law requires authorization and written informed consent before conducting AIDS/HIV testing for insurance purposes. This protects the applicant's privacy and ensures they understand the testing.

3. TDI-PEARSONVUE — 2026

Before conducting an AIDS test on an applicant for health insurance in Texas, what must the insurer or its agent obtain?

1. A)Verbal consent witnessed by two parties
2. B)Written authorization and informed consent from the applicant
3. C)Court order permitting the medical examination
4. D)Approval from the Texas Department of Insurance

Gabarito: B

Texas law requires written authorization and informed consent before conducting AIDS testing. Verbal consent or other forms are insufficient.

4. TDI-PEARSONVUE — 2026

Under Texas law, what is the minimum standard for Medicare supplement policies?

1. A)They must cover all Medicare deductibles and coinsurance
2. B)They must follow standardized plan designs approved by the Commissioner
3. C)They must provide prescription drug coverage equivalent to Medicare Part D
4. D)They must be guaranteed issue during any month of the year

Gabarito: B

Texas Insurance Code 1652 establishes minimum standards for Medicare supplement policies, including requirements for standardized plan designs that must be approved by the Commissioner to ensure consumer protection and comparability.

5. TDI-PEARSONVUE — 2026

A long-term care insurance applicant in Texas receives a policy outline before application. This outline must contain what information?

1. A)Only the premium amount and payment schedule
2. B)Key features, benefits, limitations, and exclusions of the policy
3. C)The insurer's financial ratings only
4. D)A list of all long-term care facilities in Texas

Gabarito: B

Long-term care insurance regulations require that applicants receive a policy outline describing key features, benefits, limitations, and exclusions to make informed decisions.

6. TDI-PEARSONVUE — 2026

A small employer group in Texas has 8 eligible employees. How many employees must participate in the group health plan for the group to meet minimum participation requirements?

1. A)100% of eligible employees must participate
2. B)At least 75% of eligible employees must participate
3. C)At least 50% of eligible employees must participate
4. D)Participation requirements do not apply to groups under 10 employees

Gabarito: B

Texas small group health insurance regulations generally require at least 75% participation of eligible employees, though exceptions exist for employees with other coverage.