Texas General Lines Life, Accident & Health Course Notes

Match the client’s loss exposure first, then compare benefit trigger, breadth of coverage, network rules, and total cost. Keep plan type (HMO/PPO/POS/HDHP) separate from account type (HSA/HRA/FSA).

• Choosing the lowest premium without evaluating cost sharing.

• Name the risk before choosing the product.

Life and annuity questions are feature-matching problems. For life insurance, identify duration, premium flexibility, cash value, market risk, and death trigger. For annuities, classify funding, when income begins, and how value is credited.

• Assuming 'permanent' means a universal policy cannot lapse.

• Life: duration → funding → value/risk → death trigger.

Know who controls the policy, what event triggers each provision, and the economic result. Riders change stated coverage; exclusions limit stated coverage.

• Confusing grace period with reinstatement.

• Ask: who controls it, what triggers it, what changes?

Health provisions are a workflow: contract terms → premium status → claim notice/forms/proof → payment → legal action. Cost-sharing questions add arithmetic: allowed expense → deductible → coinsurance/copay → limits.

• Calling proof of loss 'notice of claim.'

• Build the claim timeline.

Texas common-rule questions are actor-and-duty questions: identify the licensee, applicant, insurer, commissioner, or unlicensed person, then apply the exact authority, deadline, or prohibited conduct.

• Assuming sponsorship creates license authority.

• Texas numbers: 180 temp / 40 training / 24 CE per two years.

Application/underwriting questions reward clean process: complete and correct the application transparently, handle premium/receipts exactly as authorized, identify replacement, protect private information, report changed risk, and explain the issued policy accurately.

• Treating premium payment as automatic effective coverage.

• Before submission = application integrity.

Retirement/other-life questions mix ownership and planning with tax treatment. Identify owner/insured/beneficiary, planning purpose, qualifying event, and the exact tax event.

• Calling life settlement 'cash surrender.'

• Owner / insured / beneficiary: label them.

Field underwriting = accurately gather and transmit risk facts, handle premium/receipt correctly, protect underwriting information, report changes, and deliver the issued contract. The producer does not make the insurer’s final risk-classification decision.

• Confusing licensing facts with field-underwriting duties.

• Facts in, no filtering.

Texas A&H state questions require plan classification before rule application. Small-group, Medicare Supplement, LTC, mandated-benefit, testing, Marketplace, and employer rules do not all apply to the same plans.

• Applying Chapter 1501 to every health plan.

• Classify market first.

Medicare: A = hospital/facility, B = medical/doctors/outpatient, C = Medicare Advantage private-plan route, D = prescription drugs. Medicaid is a joint federal-state program, not 'the outpatient part of Medicare.'

• Calling Part C Medigap.

• Match the service first.

Texas life-only questions are statute-and-contract questions. Focus on required/prohibited provisions, truthful illustrations, annuity best-interest duties, replacement, group/credit life, conversion, and nonforfeiture.

• Calling projections guarantees.

• Texas life: contract + statute.

Other-health questions test how coverages interact, what disability definition applies, and who controls/receives/pays under the policy. Tax and cost consequences depend on the exact facts.

• Confusing COB with subrogation.

• Who pays first? = COB. Who can recover? = subrogation.

Texas HMO questions start with Chapter 843, the evidence of coverage, and network status, then check enrollment/cancellation procedures and any emergency or statutory protection.

• Treating EOC as if physical possession alone creates coverage.

• Run: service → emergency? → network? → EOC → statute.