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NY state insurance license practice
exam questions/answers study guide
Under what circumstance does an accident and health insurer have the right to request an autopsy?
- When the claim exceeds an amount specified in the policy
- When 2 days have passed after death
- When not prohibited by state law
- When consent is given by the beneficiary
- When not prohibited by state law
Which of the following accurately describes the "time limit on certain defenses"?
- After a stated period of time, claims cannot be denied due to material misrepresentation on the application
- All claims can be disputed after two years
- An insured cannot file a lawsuit within 90 days of the claim being filed
- The right to return an accident and health policy must be within 10 days of policy delivery
- After a stated period of time, claims cannot be denied due to material misrepresentation on the application
Patrick purchased a long-term care policy. He has a health condition for which medical treatment was recommended by a physician within 6 months prior to the policy's effective date. This condition is called a(n)
- antecedent condition
- pre-existing condition
- hazardous condition
- grandfathered condition
- pre-existing condition
Which of the following describes coverage for the Medicare Part B coinsurance?
- Only a Long-term care policy will cover Medicare Part B coinsurance
- A Medicare Supplement optional benefit
- A Medicare Supplement core benefit
- Medicare Part B does not require a coinsurance so no additional coverage is needed
- A Medicare Supplement core benefit
Larry has a Major Medical Expense policy for his family with a $1,000 per family/per year deductible and an 80/20 coinsurance provision. If Larry's family files four claims of $400, $800, $100, and $700 in one year, how much will the insurance company pay?
- Limited insurer
- Confined insurer
- Captive insurer
- Captive insurer
Notice of information practices must be given to a policyholder at least
- every year
- every two years
- every three years
- every four years
- Every three years
What is the elimination period of an individual disability policy?
- Time period an insured must wait before coverage begins
- Time period a disabled person must wait before benefits are paid
- Time period after the policy issue date in which the provisions are still contestable
- The point in time when benefits are no longer payable
- Time period a disabled person must wait before benefits are paid
An individual long-term policy must be renewable
- To age 65
- To age 75
- To age 85
- For life
- For life
When the New York Superintendent of Insurance examines a licensee's insurance records, the primary purpose is to determine
- The licensee's sales volume
- The solvency of the licensee's personal accounts
- The number of insurers represented
- The licensee's compliance with state insurance law regulations
- The licensee's compliance with state insurance law regulations
- Charge higher premiums than applied under the replaced policy
- Require a physical examination
- Provide a lesser benefit than was available under the replaced policy
- Impose a new pre-existing conditions exclusion
Accident and health insurance standard provisions require that
- The policy, endorsements, and attached papers constitute the entire contract
- Policies contain a coordination of benefits provision
- Nonpayment of premium by the due date constitutes irrevocable cancellation by insured
- The time for payment of claims may be waived by the insured
- The policy, endorsements, and attached papers constitute the entire contract
Why does New York law require an insurance agent to examine the existing Medicare Supplement policies of a prospective insured?
- To uncover instances of unfair trade practices
- To increase the agent's practical knowledge of insurance
- To monitor insurance company compliance
- To determine the suitability of potential changes
- To determine the suitability of potential changes
An insured must notify an insurer of a medical claim within how many days after an accident?
- 20 days
A reciprocal insurer typically has an administrator who manages the premiums collected from the group's members. This administrator is called a(n)
- reciprocal commissioner
- attorney general
- attorney-in-fact
- reciprocal director
- attorney-in-fact
- State and federal income taxes
- Benefits he receives from workers compensation
- Total household income
- Assistance he receives from friends and family
- Benefits he receives from workers compensation
A prepaid dental plan has an agreement in place with a network of dentists which
- allows the dentists to determine the deductible and coinsurance amounts
- accepts an established amount as payment in full for the dental services rendered
- requires all the dentists to be located within the same state
- must cover 100% of all orthodontic treatments
- accepts an established amount as payment in full for the dental services rendered
The agreement in which hospitals and physician groups in a specific area contract with an insurance company to provide medical care at predetermined costs is
- Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Designated Provider Organization (DPO)
- Professional Service Organization (PSO)
- Preferred Provider Organization (PPO)
Medicare Part A does NOT provide coverage for
- inpatient room and board
- prescriptions administered while an inpatient
- the first 3 pints of blood
- skilled nursing facility care
- The first 3 pints of blood
Under the Fair Credit Reporting Act, which statement is true?
- The consumer who was investigated must be advised that credit, insurance, or employment was denied because of
the unfavorable report
- Disclosure of the name of the reporting agency is prohibited
- The consumer must initiate legal action to remove unfavorable information from the report
- A reporting agency must furnish an investigative report to any person who requests the information
Which term describes the elimination of a hazard?
- Risk avoidance
- Risk retention
- Risk transference
- Risk pooling
- Risk avoidance
Which of the following does a Medicare Advantage enrollee typically pay for?
- Retainer fee
- Annual deductibles
- Small co-pay per visit or per service
- Capitation
- Small co-pay per visit or per service
A policyowner suffers an injury that renders him incapable of performing one or more important job duties. Any decrease in income resulting from this injury would make him eligible for benefits under which provision?
- Partial disability
- Nondisabling injury
- Presumptive disability
- Flat amount disability
- Partial disability
How many days notice does the Affordable Care Act require insurers to give before rescinding coverage?
- 30 days
Home health care benefits typically do NOT include coverage for
- Nursing care
- Wheelchairs
- Marriage partners
The main role of accident and health and disability insurance is to
- protect against on-the-job injuries and illnesses
- protect against medical care costs and the loss of earning power
- protect against the premature death of the insured
- protect against accidents
- protect against medical care costs and the loss of earning power
Accident and health insurance standard provisions require that
- The policy, endorsements, and attached papers constitute the entire contract
- Policies contain a coordination of benefits provision
- Nonpayment of premium by the due date constitutes irrevocable cancellation by insured
- The time for payment of claims may be waived by the insured
- The policy, endorsements, and attached papers constitute the entire contract
With regard to the use of nonpublic personal information, the phrase opt out means
- Agents have no obligation to notify customers
- Customers can ignore insurance company notices
- Agents must discontinue using private information
- Customers must be given the chance to stop disclosure
- Customers must be given the chance to stop disclosure
EXCEPT for fraud, the time after issuance of a policy during which an insurance company may contest a health insurance claim due to the statements on an application is
- 10 days
- 90 days
- 2 years
- 5 years
- 2 years
Where is the difference between a standard risk and a substandard risk reflected?
- backdating
- coverage is not offered
- An unfair claims settlement practice
Why were Exchanges implemented by the Affordable Care Act (ACA)?
- To create a one-stop market for standardized health insurance plans
- Provide an additional stream of income for the Federal government
- To enforce every U.S citizen to purchase health insurance
- Assist in the conversion of individual policies to government mandated plans
- To create a one-stop market for standardized health insurance plans
Which of the following best describes the tax treatment of medical expense policies for the self- employed?
- 100% of medical expense plan premiums are tax deductible
- 50% of medical expense plan premiums are tax deductible
- 7.5% of medical expense plan premiums are tax deductible
- 0% of medical expense plan premiums are tax deductible
- 100% of medical expense plan premiums are tax deductible
What is the length of the free look period when a Medicare Supplement insurance policy is replaced?
- 10 days
- 20 days
- 30 days
- 40 days
- 30 days
In New York, an insurer providing small employer group medical plans may discontinue an employer's coverage if
- The insurer no longer offers the plan to any employer
- The employer has poor claims experience
- The employer declares bankruptcy
- The insurer's service area has too few providers
- The insurer no longer offers the plan to any employer
When a Medicare Supplement insurance policy is being replaced, who must sign the notice of replacement?
- The home office underwriter
