Download NY Accident & Health Insurance Licensing Exam Study Guide (2025) || Questions & Answers and more Exams Insurance law in PDF only on Docsity!
NY Accident & Health Insurance
Licensing Exam Study Guide (2025) ||
Questions & Answers (100% Correct)
The reinsurance agreement that allows the reinsurer an opportunity to reject coverage for individual risks or price them higher due to their higher risk is known as a(n) ___________ agreement. - ANSWER โ Facultative Which section of an insurance policy contains language to assist an insurance company in managing morale and moral hazards - ANSWER - The exclusions The funds assessed to be deposited into the NY Special Disability Fund are deposited with? - ANSWER - The Commissioner of Taxation and Finance Someone has been hired to work for Namee Insurance Company to adjust workers compensation claims in the office. This person works as what type of adjuster? - ANSWER - A staff or adjuster who is working as an employee A products-completed operations claim can be made against products manufacturers, wholesalers, and retailers alleging fault and legal responsibilities except for... - ANSWER - Vicarious liability What is an incorrect statement on liability Part A of a Personal Auto Policy - ANSWER - When Part A limits are exhausted any limits for Uninsured Motorists coverage can be used to pay the entire claim What is not true of a Physician, Surgeon, Dentist form? - ANSWER - It is available to be written on an occurrence form only What is not true of the NY Motor Vehicle Accident Indemnification Corporation? - ANSWER - The injured party must submit all medical bills along with the claim forms within 30 days of the accident that caused the injury How much does NY pay a family for death benefits for the minimum financial responsibility limit? - ANSWER - $50, The minimum coverage amount for UM/UIM in NY is? - ANSWER - $25,000 per person; $50,000 per accident
Part 1 of workers compensation policy covers all but: - ANSWER - Bodily injury caused by employer negligence The NY department has made an exception for claim-made coverage except for what type of risk? - ANSWER - Motor vehicle liability coverage In NY, individual accident and health policies cannot terminate coverage for unmarried dependent handicapped children as long as the policy holder submits proof of incapacity within ___________________ days after the dependent attains the limiting age. - ANSWER - 31 days The relationship of a person who acts on behalf of a company whereby the person's actions can bind the company is known as _______? - ANSWER - law of agency states the principal is responsible for acts of their agents. - ANSWER - law of agency one of the two types of reinsurance agreements which automatically accepts all new risks presented by the ceding company. - ANSWER - Treaty agreement is based upon a reasonable expectation of pecuniary advantage through the continued life of another person and consequent loss by reason of that person's death or a substantial interest engendered by love and affection in the case of individuals closely related by blood or law. - ANSWER - Insurable interest in life insurance When an applicant for life insurance faces potential financial loss in the event of injury or sickness of an insured, it is said the applicant has ______? - ANSWER - Insurable interest refers to the jurisdiction where an insurer was formed or incorporated. - ANSWER - Domicile Waiting period in which a worker must be disabled before applying for social security disability benefits is _____? - ANSWER - 5 months Free look provision for a medicare supplement policy is how many days? - ANSWER - 30 days consists of groups of underwriters called syndicates, each of which specializes in insuring a particular type of risk. - ANSWER - Lloyds of London is not an insurance company where members are individually liable for each risk they assume. - ANSWER - Lloyds of London one of the two types of reinsurance agreements which allow the reinsurer the opportunity to reject risks presented to it or to price them higher based on the risk exposure. - ANSWER - Facultative agreement
All of the following are coverages provided under a Basic Hospital Expense Policy, except: A: Board B: Miscellaneous hospital expenses C: Semi-private room D: Physician/Surgeon expenses - ANSWER - D: Physician/Surgeon expenses are primarily sold to groups whose membership fluctuates to provide medical and surgical benefits in excess of any primary coverage. - ANSWER - Blanket plans Which of the following types of limited policies would a common carrier purchase to provide medical and surgical benefits in excess of any primary coverage? - ANSWER - Blanket Plan If a policy requires the payment of an additional premium for the continuation of coverage for a newborn, the insurer must be notified within _______ days of the date of birth - ANSWER - 31 days Residual Disability Income pays funds to the insured, to make up for what the insured would have earned after returning to work, and while recovering from - ANSWER - total disability Part A of Medicare pays for - ANSWER - hospital expenses With _______, the patient must pay 20% of covered charges plus the deductible - ANSWER - Medicare Part B -after 1st 3 pints of blood -general nursing and hospital services -semi-private hospital room -post-hospital skilled nursing care - ANSWER - Medicare Part A covers: Act that was implemented in order to protect consumers from questionable Medicare Supplement Policy marketing practices? - ANSWER - NAIC Model Law requires all Medicare Supplement policies to be standardized. - ANSWER - NAIC Model Law Benefits are funded by a combination of taxes and premium dollars and coverage is elective - ANSWER - Medicare Part B An insured is hospitalized for at least 3 days. How long will Medicare pay for confinement in a skilled nursing facility? - ANSWER - up to 100 days Right to examine is the same as: - ANSWER - the free look period
-Payment of Claims -Proof of Loss -Time limit on Certain Defenses -Legal Actions etc. - ANSWER - Mandatory Uniform Provisions of Accident and Health Policies Pre-certification, Mandatory Second Surgical Opinion, and Concurrent Review - ANSWER - Case Management Provisions Renewable with adjustable premiums, by classification only - ANSWER - Guaranteed renewable means The federal law that governs employer-sponsored employee retirement and welfare and benefit plans - ANSWER - ERISA (Employee Retirement Income Security Act) provides protections for participants and beneficiaries in employee benefit plans (participant rights), including providing access to plan information. - ANSWER - ERISA (Employee Retirement Income Security Act) -provides continuation of coverage for 29 months for the disabled -provides continuation of coverage for 36 months for a surviving spouse -provides continuation of coverage for 36 months for an individual losing dependent status -reduction in hours below the minimum required for participation -applies to employers with 20 or more employees -termination of employment for 18 months - ANSWER - COBRA (Consolidated Omnibus Budget Reconciliation Act) When an insurer relies on the prior claims history of the group to be insured in determining the rate to be charged - ANSWER - experience rating are usually NOT subject to federal income tax - ANSWER - Long-Term Care Benefits are DEDUCTIBLE by the company paying the premiums as a business expense. - ANSWER - Group Accidental Death and Dismemberment premiums ________ income benefits received by an employee are subject to taxation in proportion to the amount of premium that the employer paid. That income attributable to the employee's premium is not taxable. - ANSWER - Disability is a license issued to an insurance company authorizing it to transact insurance in this state - ANSWER - Certificate of Authority How many days does the insured have to notify the insurer, in writing, that a loss has occurred? - ANSWER - 20 days
Under the New York required benefits for those entities providing hospital, surgical or medical expense coverage, skilled nursing facility care must provide continued care and treatment of a person under the care of a physician if they have been in a hospital at least _____ immediately preceding admittance to the facility. - ANSWER - 3 days The Superintendent may examine the books and records of any insurer based on the - ANSWER - authority granted by state Any authorized or acknowledged agent of an insurer, a fraternal benefit society, or an HMO, and any representative of such an agent, who solicits, negotiates, or sells an insurance, HMO, or annuity contract, other than as a licensed broker. - ANSWER - insurance agent An insurance agent, insurance broker, reinsurance intermediary, excess lines broker, or any other person required to be licensed under the laws of this state to sell, solicit or negotiate insurance. - ANSWER โ Producer Medical coverage under a personal auto policy will cover the insured if he/she is injured while: - ANSWER - Passenger on a bus. EXPLANATION: Personal auto medical coverage is available to the policyholder or a family member (resident relative) injured while occupying, or as a pedestrian, struck by a motor vehicle or trailer designed for use on public roads. It also covers any other persons while they are occupying your motor vehicle. It does not cover injuries sustained while riding in vehicles not intended for use on public roads such as trains, subways and airplanes. Which of the following best describes "no release or walk-away" release? - ANSWER - The bills are paid and no attempt to obtain a separate release is made.. EXPLANATION: The bills presented are paid with no attempt to obtain a separate release, although the wording on the draft or check may also serve as a form of release. After a certain amount of time has passed with no further contact with the claimant, the file is considered closed. The minimum coverage required in New York for uninsured motorists bodily injury is: - ANSWER - $25,000 per person, $50,000 per accident. is correct. EXPLANATION: New York state law established the minimum coverage limits of $25,000 per person, $50,000 per accident and up to $50,000 per person, and $100,000 per accident for death.
Richard has been advised by the New York Superintendent of Insurance to cease and desist in the performance of certain infractions of the Insurance Code. He has had a hearing and been issued a cease and desist order. He continues to violate the cease and desist order. He can be fined a penalty of up to: - ANSWER - 5,000 per violation. EXPLANATION: Richard is subject to a penalty of up to $5,000 for each violation. If an insured has more than one auto policy with the same insurer that provides uninsured motorists coverage, which of the following statements about the recovery of benefits is correct? - ANSWER - Total recovery is restricted to the highest limits of those coverages.. EXPLANATION: Only the highest limit would apply. In some states, however, stacking of limits is permitted wherein if the insured insures more than one vehicle, the limits can be combined. After receiving an inquiry from the New York Department of Insurance regarding a claim, an insurer must respond within: - ANSWER - 10 business days A New York licensee subject to an administrative action in another jurisdiction or governmental agency must report such action to the Superintendent within: - ANSWER
- 30 days.. Oliver Dogwood was in an auto accident which destroyed his car. While investigating the accident, Adjuster Doright found that Mr. Dogwood paid $1,000 for the vehicle. After checking with others he found the same vehicle with an asking price of $1,700, a retail price of $2,150 and a dealer price of $1,750. What amount will Mr. Dogwood receive? - ANSWER - Mr. Dogwood will receive $2,150 plus any sales tax. The insured is required to pay retail price plus sales tax. In insurance terms, the party who has been wronged is known as the _____ party, and the person causing the injury is the _____ party. - ANSWER - third / first. EXPLANATION: The third party would be the claimant and the person committing the wrongful act would be the first party. The second party is the insurance company. Bodily injury claims are usually classified as types of damages. Which of the following is considered "exemplary" damages? - ANSWER - Punitive Damages. EXPLANATION: Punitive damages (also known as exemplary damages) are damages intended to reform or deter the defendant and others from engaging in similar conduct which formed the basis of the lawsuit. An example would be a driver going 120 miles per hour in a
both policies apply to an accident on the same basis, how much of a $100,000 liability loss will Company A pay under its BAP? - ANSWER - $80,000.. EXPLANATION: The two companies provide a combined limit of $125,000. Company A provides 80% of the limits in place. In case of a $100,000 loss, company A would pay $80,000. If a person is qualified to receive benefits from the Motor Vehicle Accident Indemnification Corporation and are injured by an owner of a vehicle that can be identified, how many days do they have to file a claim? - ANSWER - 180 Which of the following would NOT be excluded from coverage under Section D, auto physical damage under the Personal Auto Policy? - ANSWER - A car telephone stolen from Mr. Cranbury's car. According to the commercial auto policy definitions, an "accident:" - ANSWER - Includes continuous or repeated exposure to the same conditions.. Transportation expenses under the auto physical damage coverage would be considered: - ANSWER - An indirect loss.. EXPLANATION: Transportation expenses in case of a physical damage loss to a covered auto would be considered an indirect loss. The direct loss is the damage to the vehicle. What information would not normally be found on an insurance binder? - ANSWER - The conditions and general exclusions of the insurance contract is correct. EXPLANATION: Conditions and general exclusions will be stated in the actual insurance policy. An insurance binder legally represents the policy while it is being prepared by the insurer. Binders typically contain only the policy specifications and the insured parties. A trailer leased by the named insured from another business is a covered auto under the insured's BAP. While the trailer is connected to a covered truck-tractor owned by the insured, the BAP provides: - ANSWER - Primary liability coverage on the trailer.. EXPLANATION: The BAP would provide primary liability coverage on the trailer in this instance. For physical damage to be covered on this loss the insured would need to have the endorsement, Trailer Interchange Coverage. Tom Smith was at-fault in an automobile accident. Which of the coverages listed would apply to the lost wages incurred by a passenger injured in the other vehicle? - ANSWER
EXPLANATION:
Lost wages are also known as "compensatory damages" and are sometimes called "special damages." These are expenses where the dollar costs are readily apparent such as lost wages, medical expenses, etc. They are covered under the bodily injury coverage. Which of the following statements is false concerning "no-fault" auto insurance? - ANSWER - Negligence must be proved.. EXPLANATION: In no-fault, a threshold is usually established for injuries where negligence does not have to be proved. In cases where there have been permanent injuries the right to sue is still retained.
