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New York Life, Accident and Health Insurance
Exam 2024/2025 Top Exam With Practice
Questions And Answers A Graded
Accidental Death Insurance An insurance policy that provides payment if the insured's death is the result of an accident. Accumulation Period The time over which the annuitant makes payments or investments in an annuity, and when those payments earn interest tax deferred. Acquired Immunodeficiency Syndrome (AIDS) An infectious and incurable disease caused by the human immunodeficiency virus (HIV). Activities of Daily Living (ADLs) Activities individuals must do every day such as moving about, getting dressed, eating, bathing, etc.
Actual Cash Value (ACV) The required amount to pay damages or for property loss, which is calculated based on the property's current replacement value minus depreciation. Actual Charge The amount a physician or supplier actually bills for a particular service or supply. Actuary - A person trained in the technical aspects of insurance and related fields, particularly in the mathematics of insurance; a person who, on behalf of the company, determines the mathematical probability of loss. Adhesion A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of the insured. Adjustable Life Life insurance which permits changes in the face amount, premium amount, period of protection, and the duration of the premium payment period. Adjuster A representative of an insurance company who investigates and acts on the behalf of the company to obtain agreements for the amount of the insurance claim.
Agent An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of an insurer. Agent's Authority Special powers granted to an agent by his or her agency contract. Aleatory - A contract in which participating parties exchange unequal amounts. Insurance contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the insurer will pay in the event of a loss. Alien Insurer An insurance company that is incorporated outside the United States. Alzheimer's Disease - A disease that causes the victim to become dysfunctional due to degeneration of brain cells causing severe memory loss. Ancillary Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia, and lab work, but not hospital room and board expenses. Annual Statement
A detailed financial report that an insurance company must submit every year to the insurance department of state(s) in which it conducts business. Annuity A contract that provides income for a specified period of years, or for life. Apparent Authority The appearance or the assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created. Applicant A person making application for, or offering him/herself or another to be insured under an insurance contract. Application A document that provides information for underwriting purposes. After the policy is issued, any unanswered questions are considered waived by the insurer. Approved Amount The amount Medicare determines to be reasonable for a service that is covered under part B of Medicare.
Avoidance A method of dealing with risk by deliberately keeping away from it (e.g. if a person wanted to avoid the risk of being killed in an airplane crash, he/she might choose never to fly in a plane). Back End Load a fee charged at the time of a sale, transfer or withdrawal from an annuity or a life insurance policy. Accelerated Benefits Riders attached to life insurance policies which allow death benefits to be used to cover nursing or convalescent home expenses. Accident An unplanned, unforeseen event which occurs suddenly and at an unspecified place. Accident Insurance - A type of insurance that protects the insured against loss due to accidental bodily injury. Accidental Bodily Injury Unplanned, unforeseen traumatic injury to the body.
Accidental Death and Dismemberment (AD&D) An insurance policy which pays a specified amount or a specified multiple of the insured's benefit if the insured dies, loses his/her sight, or loses two limbs due to an accident. Accidental Death Benefits A policy rider that states that the cause of death will be analyzed to determine if it complies with the policy description of accidental death. Basic Hospital Expense Insurance Coverage that provides benefits for room, board and miscellaneous hospital expenses for a certain number of days during a hospital stay. Basic Illustration A ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and nonguaranteed elements. Basic Medical Expense Insurance Coverage for doctor visits, x-rays, lab tests, and emergency room visits; benefits, however, are limited to specified dollar amounts.
Broker An individual who represents an insured in the process of purchasing and negotiating a contract of insurance. Buy-Sell Agreement A legal contract that determines what will be done with a business in the event that an owner dies or becomes disabled. Buyer's Guide A booklet that describes insurance policies and concepts, and provides general information to help an applicant make an informed decision. Cafeteria Plan A selection of health care benefits from which an employee may choose the ones that he/she needs. Capital Amount A percentage of the principal amount of a policy paid to the insured if he/she suffered the loss of an appendage.
Carriers Organizations that process claims and pay benefits in an insurance policy Cash Value The amount to which a policyowner is entitled if the policy is surrendered before maturity. Cease and Desist Order A demand of a person to stop committing an action that is in violation of a provision. Certificate A statement (or booklet) that confirms that a policy has been written and that describes the coverage in general. Certificate of Authority A document that authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact. It is illegal for an insurance company to transact insurance without this certificate.
Commingling A practice in which a person in a fiduciary capacity illegally mixes his/her personal funds with funds he/she is holding in trust. Commission The payment made by insurers to agents or brokers for the sale and service of policies. Commissioner (Superintendent, Director) The chief executive and administrative officer of a state insurance department. Comprehensive Policy A plan that provides a package of health care services, including preventive care, routine physicals, immunization, outpatient services and hospitalization. Comprehensive Major Medical - A combination of basic coverage and major medical coverage that features low deductibles, high maximum benefits, and coinsurance. Concealment The withholding of known facts which, if material, can void a contract. Conditional Contract - A type of an agreement in which both parties must perform certain duties and follow rules of conduct to make the contract enforceable.
Consideration The binding force in a contract that requires something of value to be exchanged for the transfer of risk. The consideration on the part of the insured is the representations made in the application and the payment of premium; the consideration on the part of the insurer is the promise to pay in the event of loss. Consideration Clause A part of the insurance contract that states that both parties must give something of value for the transfer of risk, and specifies the conditions of the exchange. Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 The law that provides for the continuation of group health care benefits for the insured for up to 18 months if he/she terminates employment or is no longer eligible, and for the insured's dependents for up to 36 months in cases of loss of eligibility due to death of the insured, divorce, or attainment of the limiting age. Consumer Reports Written and /or oral statements regarding a consumer's credit, character, reputation, or habits collected by a reporting agency from employment records, credit reports, and other public sources. Contract An agreement between two or more parties enforceable by law.
Coverage The inclusion of causes of loss (perils) which are covered within a scope of a policy. Credit Life Insurance - A special type of coverage written to pay off the balance of a loan in the event of the death of the debtor. CSO Table (The Commissioner's Standard Ordinary Table) A mortality table used in life insurance that mathematically predicts the likelihood of death. Custodial Care-Care that is rendered to help an insured complete his/her activities of daily living. Death Benefit The amount payable upon the death of the person whose life is insured. Decreasing Term A type of life insurance that features a level premium and a death benefit that decreases each year over the duration of the policy.
Deductible The portion of the loss that is to be paid by the insured before any claim benefits may be paid by the insurer. Defamation An unfair trade practice in which one agent or insurer makes an injurious statement about another with the intent of harming the person's or company's reputation. Dependent A person who relies on another for support and maintenance. Director (Commissioner, Superintendent) The head of the state department of insurance. Disability A physical or mental impairment, either congenital or resulting from an injury or sickness. Disability Income Insurance
The amount of the premium for which the policy protection has been given. Effective Date The date when an insurance policy begins (also known as the inception date). Eligibility Period The period of time in which an employee may enroll in a group health care plan without having to provide evidence of insurability. Elimination Period A waiting period that is imposed on the insured from the onset of disability until benefit payments begin. Emergency An injury or disease which occurs suddenly and requires treatment within 24 hours. Employee Retirement Income Security Act (ERISA) The act that stipulates federal standards for private pension plans.
Endodontics An area of dentistry that deals with diagnosis, prevention and treatment of the dental pulp within natural teeth at the root canal. Endorsement A form changing the provisions of and attached to a life insurance policy (also known as a rider). Endow to reach the maturity date or time at which the face amount equals cash values. Enrollment Period The amount of time an employee has to sign up for a contributory group health plan. Errors and Omissions Policy (E&O) A professional liability insurance that protects the insurer from claims by the insured for errors or oversights on the part of the insurer. Estoppel
