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New York Accident & Health Insurance Adjuster Exam 2025|| Questions & Answers (100%), Exams of Insurance law

California Institute of Technology (Caltech)Insurance law

In group accident and health insurance, a group with a high average age usually has? - ANSWER - Above average total accident and health claims. The accounting measurement of the insurer's future obligations to its policyholders is? - ANSWER - Reserves Unless an individual has previously received benefits, Social Security disability income benefits have a waiting period ? - ANSWER - 5 full consecutive calendar months Which type of accident and health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury? - ANSWER - Medical expense A social organization which is licensed to issue insurance ONLY to its members is an example of which type of insurer? - ANSWER - Fraternal

Typology: Exams

2024/2025

Available from 06/22/2025

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New York Accident & Health Insurance
Adjuster Exam 2025|| Questions &
Answers (100% Correct)
In group accident and health insurance, a group with a high average age usually has? -
ANSWER - Above average total accident and health claims.
The accounting measurement of the insurer's future obligations to its policyholders is? -
ANSWER - Reserves
Unless an individual has previously received benefits, Social Security disability income
benefits have a waiting period ? - ANSWER - 5 full consecutive calendar months
Which type of accident and health insurance should be purchased by a person who
wants coverage for hospital bills in the event of accidental injury? - ANSWER - Medical
expense
A social organization which is licensed to issue insurance ONLY to its members is an
example of which type of insurer? - ANSWER - Fraternal
An agent who unintentionally makes misleading statements to a prospect for
replacement of accident and health insurance may be found liable on the basis of? -
ANSWER - Professional errors and omissions
A mandatory second surgical opinion provision typically would encourage all of the
following EXCEPT? - ANSWER - Higher total accident and health plan costs for an
employer
Concurrent review is a form of utilization review that is performed? - ANSWER - During
the course of the patient's treatment
Employer-sponsored group long-term care insurance generally has all of the following
characteristics EXCEPT? - ANSWER - Noncancelable.
An electrocardiogram records the electrical activity of the:? - ANSWER - heart
When insurers utilize provisions in dental plans such as limited benefits for late
enrollees, a reduced maximum annual benefit, and longer eligibility periods before
coverage becomes effective, insurers are attempting to: - ANSWER - Minimize adverse
selection
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Download New York Accident & Health Insurance Adjuster Exam 2025|| Questions & Answers (100%) and more Exams Insurance law in PDF only on Docsity!

New York Accident & Health Insurance

Adjuster Exam 2025|| Questions &

Answers (100% Correct)

In group accident and health insurance, a group with a high average age usually has? - ANSWER - Above average total accident and health claims. The accounting measurement of the insurer's future obligations to its policyholders is? - ANSWER - Reserves Unless an individual has previously received benefits, Social Security disability income benefits have a waiting period? - ANSWER - 5 full consecutive calendar months Which type of accident and health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury? - ANSWER - Medical expense A social organization which is licensed to issue insurance ONLY to its members is an example of which type of insurer? - ANSWER - Fraternal An agent who unintentionally makes misleading statements to a prospect for replacement of accident and health insurance may be found liable on the basis of? - ANSWER - Professional errors and omissions A mandatory second surgical opinion provision typically would encourage all of the following EXCEPT? - ANSWER - Higher total accident and health plan costs for an employer Concurrent review is a form of utilization review that is performed? - ANSWER - During the course of the patient's treatment Employer-sponsored group long-term care insurance generally has all of the following characteristics EXCEPT? - ANSWER - Noncancelable. An electrocardiogram records the electrical activity of the:? - ANSWER - heart When insurers utilize provisions in dental plans such as limited benefits for late enrollees, a reduced maximum annual benefit, and longer eligibility periods before coverage becomes effective, insurers are attempting to: - ANSWER - Minimize adverse selection

What is the minimum number of the "core group" of essential health benefits mandated by ACA for both individual plans and group plans? - ANSWER - One objective of a concurrent review provision in group accident and health insurance is to? - ANSWER - Monitor length of stay in the hospital once the patient is admitted. For groups with high prior claims experience, an insurer would be likely to? - ANSWER - Expect high future claims experience Antigen is the medical term for? - ANSWER - An infectious agent Why would an insurer limit the combined amount of disability income benefits under multiple policies purchased by an insured from the same or another company? - ANSWER - To prevent the insured from receiving a benefit amount which might make becoming disabled financially attractive. Periodontics includes all of the following EXCEPT? - ANSWER - dentures A contract offered for acceptance or rejection without negotiation is called? - ANSWER

  • contract adhesion How does the Medicare Supplement at-home recovery services benefit differ from the Medicare home health care benefit? - ANSWER - The Medicare Supplement benefit covers assistance with daily living A mandatory second surgical opinion provision typically would encourage all of the following EXCEPT? - ANSWER - higher total accident and health plan cost for an employer Which of the following is a requirement for an act of terrorism to be certified according to the Terrorism Risk Insurance Extension Act of 2005? - ANSWER - The total loss in property and casualty damages must exceed $5 million. Medicaid is funded by state governments and by? - ANSWER - federal All of the following are typical benefit periods for long-term disability income insurance EXCEPT? - ANSWER - one year By applying the principle of indemnity, an insured should be prevented from? - ANSWER - profit from loss A new Medicare Part A "benefit period" is available after an insured has been out of a hospital or other facility for at least? - ANSWER - 60 days What is the maximum period of imprisonment for conviction of unfair and deceptive insurance practices? - ANSWER - 15 years

Which of the following correctly describes Medicaid? - ANSWER - Provides medical benefits for certain low-income people, for the disabled, and for families with dependent children Which of the following describes the individual covered by insurance? - ANSWER - insured Joann Larson, an adjuster, has had administrative action taken against her in another jurisdiction. What must she do? - ANSWER - Report the final disposition of the matter to the Insurance Superintendent within 30 days What are the lifetime dollar limits on the essential benefits provided under ACA? - ANSWER - There are no lifetime dollar limits on essential benefits. The heartbeat is controlled by? - ANSWER - The peripheral nervous system What is the name of a health care delivery system providing prepaid doctor and hospital care, emphasizing preventive care, and charging a fixed periodic fee to its enrolled members? - ANSWER - Health Maintenance Organization Assume that you are talking to a person who says that he owns 20 shares of stock in an insurance company. You know that this insurance company is a: - ANSWER - Stock insurer The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called: - ANSWER - Non- occupational coverage Which of the following is the required time period that the insured must file a written proof of loss? - ANSWER - Within 90 days of loss, or as soon as reasonably possible

. Which of the following statements about changes to insurance contracts is most correct? - ANSWER - An agent is never permitted to make a change in policy wording. . An insurance professional that is accused of dishonesty or breach of trust involving interstate commerce under the Federal Fraud and False Statement Regulation of the United States Code (USC 1033) will be prosecuted by: - ANSWER - The U.S. Attorney general . Many medical expense policies do not state a specific unit or dollar amount for items such as room and board or surgical procedures. Instead, payment for similar services provided in the same location are based on: - ANSWER - Usual, reasonable and customary

What is the purpose of "navigators" associated with the state insurance exchanges? - ANSWER - To provide information about the available health plans offered by the ACA and assist with enrollment An employer that self-funds its group medical plan may limit its claims exposure by purchasing: - ANSWER - Stop-loss insurance The period between a loss and the beginning of benefit payments in disability income insurance is known as: - ANSWER - Elimination period An employer may require employee contributions for all of the following types of plans, EXCEPT: - ANSWER - A workers compensation plan. Individual long term care insurance policies must provide the right to return the policy within ____ to obtain a premium refund if he or she is not satisfied. - ANSWER - 30 days

. If an insurance company accepts a special class risk: - ANSWER - The premium will be higher than for a normal risk. The optional health insurance policy provision "other insurance with this insurer" is specifically designed to: - ANSWER - Limit the claim risk with any one individual insured by the company.. . Which of the following reimburses its insureds for covered medical expenses? - ANSWER - Commercial insurers.. If an insurance company covered an excluded loss, it may have to continue paying other claims for such losses because of the: - ANSWER - Estoppel rule An individual who is considered chronically ill must be recertified as such: - ANSWER - annually.. Which of the following may be used by an insurer to prevent duplication of benefits? - ANSWER - Coordination of benefits provision The Affordable Care Act requires plans and issuers that offer coverage to children on a parent's plan to make the coverage available until the adult child reaches the age of: - ANSWER - 26 Failure to disclose known facts when completing an application for insurance is an act of: - ANSWER - Concealment . Resident adjusters in New York must maintain a _____ surety bond with the Superintendent for the purpose of assuring faithful performance of the licensee. - ANSWER - $1,

Temporary License - ANSWER - Can be issued to spouse of deceased or next of kim from a disability Tremination of License - ANSWER - Can be done by superintendent for: -providing incorrect or misleading materially untreu info in licesne app -violating any insurance laws

  • stealing money
  • having been convicted of a felony
  • any dihonest practices
  • Have a producer or life settlement license denied or revoked in any other state
  • Forging
  • Failing to comply with child support payments To terminate a license, a superintendent must - ANSWER - provide a written notice to the licensee of a hearing before the license an be suspended. For a broker, its not less than 10 days after notice is provided for the hearing. If there's an action against the producer, he must notify the super within 30 days. You cant go into another state and start practicing either Appointment and Termination of Appointment - ANSWER - All insureres myst file a ciertificate of appointment in order to appoint insurance agents. Then you have 15 days to appoint a producer from the date the agency contract is executed. If you've been fired, you have 30 days to tell the super why you were fired and then the super has 15 days to send the info back to you confirming it, Change of Address time frame - ANSWER - a licensee has 30 days to inform dept of insurance Reporting of Action - ANSWER - must report to dept of insurance w in 30 days of any administrative action Continuing Ed - ANSWER - must to 15 hrs every 2 years Powers of the Superintendent - ANSWER - he has the power to promote the public welfare and administer and enforce all laws appointed by the governor Not responsible for assessing punitive damages to thos who break insurance laws. (this is the responsibility of the state legislative bodies
  • Can suspend, revoke or non renew the liceses but only after a hearing
  • Examine and regulate an inusrance co for solvency and examine the books -issue insurance licenses
  • regulate and approve life and health insurance rates
  • direct insurance department hearings based on grievances from sonsumers or consumer rights organizations
  • if the super thinkgs that a hearing is necessary, he has to give 10 days written notice of hearing to the licensee
  • regulate all advertising
  • determine reserve amounts
  • issue a cease and desist order - if there's a violation of stat law, can also fine up to 5k for every violation
  • report illegalities to the attorney general who will prosecute
  • conduct hearings; failure to appear is a misdemeanor Defined Violation - ANSWER - performing an act prohibited by NY Statutes Determined Violation - ANSWER - a violation that's been determined after hearing Rebating - ANSWER - ie kickbacks, or incentives or consideratin for business. Cant give anything worth more than $15. Any violation is subject to $500 penalty Discrimination - ANSWER - Cant do it. cant do aids test without consent. Cant perform any tests without telling the person what they are for. Twisting - ANSWER - comparing 1 policy with another to induce that person to switch policies. Penalties / Fines - ANSWER - a violation is a misdeamenor and carries a $500 fine. Failure to pay within 20 days could result in license suspension.
  • 50k fine if you knowingly with the intent to deceive make any flase material statements or reports
  • if the insurer's solvency is is put at risk because of false statements, the person could go to jail for 15 years Advertising - ANSWER - must contiain the name of the insurance company Fiduciary Responsibilities - ANSWER - Agen cannot comingle funds with their own bank account but the can establish a separate bank account to collect premiums, pay refunds, funds to advance premiums on behalf of policy owners. Must remit premium payments to the insurance company immediately sharing commissions - ANSWER - Cannot to it unless it is a licensed agent of that insurer. Cannot pay for stuff unless its been kept for 3 years. Defamation of insurer - ANSWER - anyone engaged in defamation is guilty of a misdemeanor punishable by a fine of not more than 1k, a year of prison or both, Complaint records - ANSWER - must be kept for 3 years Contolled Business - ANSWER - An agent can write their own policies and get a commission but hte cant do it if its more than 10% of overall commission fees
  • coannot inclue the fact that the life insurance company guaranty corp will protect a consumers interest in a life insurance policy
  • can not guarantee that a dividend is guaranteed Insurance compay guaranty corp - ANSWER - - covers individual and group life policies indiviaul annuities and individual and group health policies for up to 500k for each policy holder or beneficiary Accellerated Death benefits can effect - ANSWER - whether you get public assistance program help
  • information about the effects on the policy of accellerated death benefits must be shown to the policy holder Life settlment - ANSWER - the sale transfer assignment or bequest of the death benefit or ownership of a life insurance policy by the owner where an insured does not have a catastrophic or life threatening illness (different than a viatical settlement)
  • cannot be used as collateral for a loan Life Settlement provider - ANSWER - any individual, corporation, partnership or firm who pays a sum to the owner of a life insurane contract in return for the ownership of the contract
  • must have a license
  • can be brokered (but you need a license to broker too) Life Settlement info that must be provided to potential seller are - ANSWER - - there are alternatives to ife settlement contracts incuding accelerated death benefits
  • some of the proveeds of a life settlement my be taxable
  • procceds from a life settlement could be subjet to the claims of creditors
  • proceeds could affect elegibility for public assistance
  • the owner has a right to rescind the contract util 15 days after recept of the life settlement proceeds by the owner
  • proceeds must be sent w in 3 days of the settlement provider getting all the signed paperwork
  • other parts of the life contract may be forfeited (ie accelerated benefits)
  • settlement provider is required to provide a consumer info booklet
  • the seller may get called to make sure he's still alive Timothy's Law - ANSWER - every group or individua policy issued in Y that includes inpatient medical expense care whether issued by an insurer, hmo, home service corp, helath service forp or small plan must include biologically based mental illness covererage (ie biological disorder of the brain) for no less than 30 days of active treatment per calendar year. Mammography screening - ANSWER - Every policy that covers hospital surgical or medical care must provide coverage for ammography screening for breast cancer

long Term Plan insurance plans must have: - ANSWER - - a residential health care facility beneift (ie daily benefit for custodial care

  • a home health care benefit including personal care, 24 hr skilled nursing care and respite care services
  • coverage for at least 24 months
  • arrangements for managed care including re-assessment and referral programs, utilization controls and approved providers