Ohio Insurance Regulation
10%of exam
General Insurance Concepts
5%of exam
Life Insurance + Annuities
29%of exam
Federal Tax Considerations
8%of exam
Life TaxAnnuity TaxIRAMEC1035 Exchange
Health, Disability, Group
36%of exam
ProvisionsDisabilityMedical PlansHMO/PPOGroupDental
Senior + Special-Needs
8%of exam
MedicareMedigapLTCADLsSenior Rules
Quick Facts
- Exam
- Series 11-35
- License
- Life + A&H
- Body
- PSI / ODI
- Questions
- 150 scored
- Time
- 150 minutes
- Pass
- 70%
- Fee
- $49 exam
- Prelicense
- 20+20 hours
- CE
- 24 hrs/2 yrs
- Ethics CE
- 3 of 24 hours
STOLI
Stranger-Originated Life Insurance: illegal in Ohio
No interestInvestor-fundedOhio prohibitsInsurable interest required
Free Look: Replace vs New
Replacement
- 30 days minimum
- Existing policy swap
- Forms required
Non-replacement
- 10 days standard
- New coverage
- Simple delivery
Replacement extends window
Ohio Rule Picker
- Agent license→ODI(ORC 3905)
- Background check→BCI + FBI(ORC 3905.051)
- Transact business→Appointment(Insurer files)
- CE due→Birth month(Every two years)
- Address change→Notify ODI(Within 30 days)
- Suspected fraud→ODI Fraud(Mandatory report)
- Life replacement→Forms + 30-day(Free look)
- Annuity senior sale→Suitability(Best interest)
Exam Map
- Series
- 11-35 combined
- Scored
- 150 questions
- Time
- 150 minutes
- Pass
- 70%
- Fee
- $49
- ODI
- State regulator
- PSI
- Exam vendor
- Title 39
- Insurance code
Free Look Numbers
Ten standard; thirty if replacing life
10 days new30 days replaceRefund premium
Licensing Path
- Age
- 18 minimum
- Prelicense
- 20 hours/line
- Cert validity
- 180 days
- Fingerprint
- BCI + FBI
- ORC 3905.051
- Background statute
- Exam fee window
- Valid one year
- Application
- Via NIPR/ODI
- Appointment
- Insurer authority
Ohio CE 24/3
Twenty-four CE; three must be ethics
24 hours total3 ethicsEvery 2 yearsBirth month end
License Maintenance
- CE total
- 24 hours
- Ethics
- 3 hours required
- Cycle
- Every 2 years
- Renew by
- Birth month end
- Late period
- One month grace
- Late fee
- $50
- Address change
- Within 30 days
- Records
- Maintain transactions
Unfair Practices
- Misrepresentation
- False statement
- Twisting
- Misleading replacement
- Churning
- Same insurer churn
- Rebating
- Illegal inducement
- Defamation
- False insurer attack
- Coercion
- Forced purchase
- Boycott
- Restraint of trade
- Unfair claims
- Bad-faith settlement
Ohio Life Rules
- Replacement
- Disclose existing
- Free look
- 10 days minimum
- Replacement free look
- 30 days life
- Annuity suitability
- Best interest rule
- Senior protections
- ORC 3905.59-60
- Buyer guide
- Required disclosure
- Policy summary
- Life disclosure
- STOLI
- Illegal in Ohio
Ohio Guaranty Limits
- Life death benefit
- $300,000
- Life cash value
- $250,000
- Annuity present value
- $250,000
- Health basic
- $100,000
- Major medical
- $500,000
- LTC limit
- $300,000
- Per-person aggregate
- $300,000
- Sales pitch
- Prohibited use
Contract Elements
OACCL: Offer, Accept, Consider, Capacity, Legal
OfferAcceptanceConsiderationCapacityLegal purpose
General Concepts
- Pure risk
- Loss only
- Speculative
- Loss or gain
- Insurable interest
- Loss stake
- Indemnity
- Restore loss
- Adhesion
- Take or leave
- Aleatory
- Unequal exchange
- Utmost good faith
- Full disclosure
- Subrogation
- Recover from third
Agency + Authority
- Express
- Written authority
- Implied
- Job necessary
- Apparent
- Client believes
- Ratification
- Insurer accepts
- Principal
- Insurer is
- Agent
- Represents insurer
- Broker
- Represents client
- Fiduciary
- Trust duty
Insurer Types
- Stock
- Shareholder owned
- Mutual
- Policyholder owned
- Fraternal
- Lodge membership
- Reciprocal
- Member exchange
- Domestic
- Ohio chartered
- Foreign
- Other US state
- Alien
- Outside US
- Surplus lines
- Nonadmitted carrier
Term vs Whole Life
Term
- Temporary
- No cash value
- Lowest premium
Whole
- Permanent
- Cash value
- Level premium
Duration drives choice
Life Product Picker
- Income replacement→Term life(Low premium)
- Mortgage payoff→Decreasing term(Face declines)
- Refund desire→ROP term(Higher cost)
- Lifetime guarantee→Whole life(Cash value)
- Flexible premium→Universal life(Adjustable)
- Market growth→Variable life(Securities license)
- Flexible + market→VUL(Both features)
- Estate liquidity→Survivorship life(Second-die)
Life Products
- Level term
- Level face/premium
- Decreasing term
- Face declines
- ROP term
- Premium refund
- Whole life
- Permanent + cash
- Limited pay
- Short premium years
- Universal life
- Flexible premium
- Variable life
- Separate accounts
- VUL
- Flexible + variable
Universal vs Variable UL
UL
- Flexible premium
- Insurer credits
- Fixed accounts
VUL
- Flexible + market
- Separate accounts
- Securities license
Investment risk differs
Life Provisions
- Entire contract
- Policy + application
- Insuring clause
- Coverage promise
- Free look
- Refund review window
- Grace period
- Late-pay window
- Reinstatement
- Restore lapse
- Incontestability
- Two-year limit
- Suicide
- Two-year exclusion
- Assignment
- Transfer rights
Riders + Options
- Waiver of premium
- Disability waiver
- GIR
- Future purchase right
- Payor benefit
- Owner disability
- ADB
- Accidental death extra
- Term rider
- Extra temporary
- Accelerated benefit
- Terminal advance
- LTC rider
- Care benefit
- Cost of living
- Inflation adjust
Nonforfeiture
- Cash surrender
- Take cash
- Reduced paid-up
- Smaller permanent
- Extended term
- Default option
- Policy loan
- Borrow cash value
- Automatic loan
- Premium auto pay
- Dividends
- Participating only
- Cash dividend
- Check option
- Paid-up adds
- Buy small policies
Settlement Options
- Lump sum
- Single payout
- Interest only
- Keep principal
- Fixed period
- Pay set years
- Fixed amount
- Set dollar pay
- Life income
- Lifetime payout
- Life with period
- Guaranteed minimum
- Joint and survivor
- Two-life payout
- Refund life
- Balance to heir
Annuities
- Single premium
- One payment
- Flexible premium
- Multiple payments
- Immediate
- Pays within year
- Deferred
- Pays later
- Fixed
- Guaranteed rate
- Variable
- Separate accounts
- Indexed
- Index formula
- Annuitization
- Payout phase
1035 Exchange vs Withdrawal
1035
- Like-kind swap
- Tax deferred
- Basis carries
Withdrawal
- Cash out
- Gain taxed
- Possible penalty
Swap defers, cash taxes
Tax Rules
- Death benefit
- Income tax free
- Cash value growth
- Tax deferred
- Policy loan
- Not taxable
- Surrender gain
- Ordinary income
- Annuity exclusion
- Cost recovery
- 1035 exchange
- Tax-free swap
- MEC
- Overfunded life
- MEC distribution
- LIFO + penalty
MEC vs Non-MEC
MEC
- Fails 7-pay
- LIFO taxation
- Pre-59.5 penalty
Non-MEC
- Passes 7-pay
- FIFO basis first
- Loans tax-free
Overfunding triggers MEC
Qualified Plans
- Traditional IRA
- Pre-tax growth
- Roth IRA
- Tax-free growth
- 401(k)
- Employer deferral
- SEP
- Small employer
- SIMPLE
- Small employer match
- RMD age
- Required at 73
- Early withdrawal
- 10% penalty under 59.5
- Rollover
- Plan-to-plan move
Health Claims Flow
Notice, claim forms, proof, payment, suit
Notice 20 daysForms 15 daysProof 90 daysPay dueLegal action
HMO vs PPO vs POS
HMO
- Gatekeeper PCP
- In-network only
- Lowest cost
PPO
- No referrals
- Out-network allowed
- Higher cost
POS blends both
Health Product Picker
- Lost income→Disability income(Earnings replace)
- Business bills→BOE(Overhead)
- Broad medical→Major medical(Comprehensive)
- Tight cost→HMO(Network)
- Provider choice→PPO(Flexible)
- HSA pairing→HDHP(Tax advantaged)
- Custodial care→LTC policy(ADL triggers)
- Lump-sum trigger→Critical illness(Specified events)
Health Products
- Major medical
- Broad coverage
- HMO
- Gatekeeper network
- PPO
- Preferred network
- POS
- Referral hybrid
- HDHP
- Pairs with HSA
- Disability income
- Replace earnings
- BOE
- Business expenses
- AD&D
- Accident benefits
Health Provisions
- Entire contract
- Policy contents
- Time limit
- Defense limit
- Grace period
- Late-pay window
- Notice claim
- 20 days notice
- Proof loss
- 90 days proof
- Payment claims
- Benefits paid
- Legal actions
- Suit timing
- Renewability
- Continuation right
Health Cost Sharing
- Premium
- Monthly payment
- Deductible
- Before plan pays
- Coinsurance
- Cost percentage
- Copayment
- Fixed cost share
- Out-of-pocket max
- Annual cap
- URC
- Usual charge
- Preauthorization
- Advance approval
- Elimination
- Disability waiting
Disability Income
- Own occupation
- Strictest definition
- Any occupation
- Broadest definition
- Total disability
- Cannot work
- Partial
- Limited duties
- Residual
- Income loss based
- Probationary
- Pre-coverage wait
- Elimination period
- Days before pay
- Benefit period
- How long paid
Group Coverage
- Master policy
- Employer holds
- Certificate
- Member evidence
- Open enrollment
- Set sign-up window
- Eligibility
- Hours/tenure rule
- Conversion
- Individual switch
- COBRA
- Federal continuation
- Ohio continuation
- State 12 months
- Small employer
- 2-50 employees
Medicare ABCD
A hospital, B medical, C advantage, D drugs
A: HospitalB: MedicalC: AdvantageD: Drugs
Medicare A vs B vs C vs D
A + B
- Original Medicare
- Hospital + medical
- Federal pays
C + D
- Private insurer
- Advantage + drugs
- Bundled options
Public vs private
Medicare/Medigap Picker
- Hospital stay→Part A(Auto at 65)
- Doctor visits→Part B(Premium owed)
- Bundle benefits→Part C(Advantage plan)
- Drug coverage→Part D(Standalone)
- Fill gaps→Medigap(Supplements A+B)
- Lowest premium→Plan N(Some copays)
- Best coverage→Plan G(No new F)
- First eligible→Medigap OEP(6-month window)
Medicare Parts
- Part A
- Hospital insurance
- Part B
- Medical insurance
- Part C
- Advantage plans
- Part D
- Prescription drugs
- Eligibility
- Age 65 or disability
- IEP
- Initial enrollment 7 mo
- AEP
- Oct 15-Dec 7
- OEP Medigap
- 6-month guarantee
Medicare vs Medicaid
Medicare
- Age/disability
- Federal program
- Earned entitlement
Medicaid
- Need based
- State + federal
- Income tested
Age vs poverty
Long-Term Care
- Skilled care
- RN supervised
- Intermediate
- Occasional skilled
- Custodial
- Daily living help
- ADLs
- Bathing/eating/etc
- Trigger
- Two ADLs lost
- Home care
- In-house services
- Adult day care
- Community center
- Respite care
- Caregiver relief
Common Traps
Insurable Interest Timing
Required at issue ≠ Not required at claim
Free-Look Window
10 days non-replace ≠ 30 days replacement
MEC Loan Taxation
Non-MEC loan: tax-free ≠ MEC loan: taxable
Replacement Definition
Existing policy swap ≠ Not simple comparison
Medigap vs Advantage
Medigap supplements A+B ≠ Advantage replaces them
Appointment Required
License qualifies producer ≠ Appointment authorizes selling
STOLI Illegal
Stranger-funded life ≠ Lacks insurable interest
Guaranty Sales Pitch
Safety net only ≠ Cannot advertise
Last Minute
- 1.Series 11-35 = 150 questions
- 2.150 minutes; 70% pass
- 3.Exam fee $49; PSI
- 4.Prelicense 20+20 hours
- 5.Certificates valid 180 days
- 6.ORC 3905.051 = fingerprints
- 7.CE = 24/2 years, 3 ethics
- 8.Renew by birth month end
- 9.Free look: 10 new; 30 replace
- 10.MEC: LIFO + 10% under 59.5
- 11.1035 exchange = tax-deferred swap
- 12.Medigap OEP = 6 months
- 13.STOLI prohibited in Ohio
- 14.Address change within 30 days
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