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PRE-FINAL EXAM - NEW YORK LIFE, ACCIDENT AND
HEALTH|2025-2026|QS & AS|A+ GRADED
What happens when an initial offer is answered with a counteroffer? Initial offer is void According to the Affordable Care Act (ACA), dependent children may remain on their parent's plan until what age? Age 26 The premiums paid by an employer for his employee's group life insurance are usually considered to be tax-deductible to the employer A family group accident and health insurance policy must continue coverage for each unmarried child at least until age 19
A life insurance beneficiary died after receiving only six payments under the policy's life income settlement option. What happens with the remaining balance of the death proceeds? Kept by the insurance company When an individual is planning to protect his family with life insurance, one method of doing so is called needs analysis. What exactly does needs analysis involve? Identifies the needs of an individual and the individual's dependents A retired couple would like to maximize the income derived from their combined life savings and have it payable until they both die. Which annuity would be their best choice? Joint and survivor annuity Major medical plans typically exclude coverage for which of the following benefits? Custodial care
According to the Affordable Care Act (ACA), the proportion of premium revenues spent on clinical services and quality improvements is called the Medical Loss Ratio A material change in a modified endowment contract (MEC) results in the seven pay test, adjusted for cash value, applies again How many days notice does the Affordable Care Act require insurers to give before rescinding coverage? 30 What determines how much an annuitant is paid for a variable annuity? The market value variations of the securities backing it Accident and health insurance standard provisions require that
The policy, endorsements, and attached papers constitute the entire contract Agreements made by terminally ill persons to sell their life insurance policies at a discount in order to pay medical expenses are called Life Settlements An employee requested that the balance of her 401(k) account be sent directly to her in one lump sum. Upon receipt of the distribution, she immediately had the funds rolled over into an IRA. What is the tax consequence of the distribution sent to this employee? Distribution is subject to federal income tax withholding A characteristic of preferred provider organizations (PPO) is If service is obtained outside the PPO, benefits are reduced and costs increase Which of the following accurately describes a participating insurance policy?
Under the New York Disability Benefits Law, cash payments are provided to workers who are unable to work because of injury or illness that Occurred on the job A policyowner suffers a covered accident and health insurance loss on June 30 and submits the proof of loss to the insurer July 10. If the policyowner cancelled the coverage on July 2, how will the insurance company handle the claim? Claim must be paid after proof of loss is received Claim must be paid after proof of loss is received Paid-up policy that offers lifetime protection All of the following are unfair claims settlement practices EXCEPT An attempt to settle a claim by arbitration Ambiguities in insurance contracts are typically interpreted in favor of the insured. This rule is referred to as
Reasonable expectations According to the Affordable Care Act (ACA), insurers can no longer deny health coverage due to pre-existing conditions unless that plan is a(n) Grandfathered plan The Affordable Care Act (ACA) established "exchanges" in order to assist individuals and small businesses when making their health insurance purchases The policy provision that permits an employee to change from group life coverage to an individual life policy is called the conversion provision In New York, reducing benefits for a newborn child under an accident and health plan is Prohibited in any form
In what situation could an insurance policy's coverage be modified? Applicant is a substandard risk What type of life insurance policy covers two or more persons and pays the face amount upon the death of the first insured? Joint life A group-owned insurance company that is formed to assume and spread the liability risks of its members is known as a risk retention group Which provision makes the application part of the annuity contract? Entire Contract clause Which of the following is NOT guaranteed in a whole life policy?
Dividend scale Omar is covered by a disability income policy. He is hurt while performing an occupation more hazardous than the occupation listed in his policy. The policy's change of occupation provision will have what effect? Reduce the benefit level Terry receives long-term physical therapy at her residence. What type of insurance would cover this service? home health care A life insurance producer licensed in New York is authorized to Solicit, receive and forward applications to the insurer An association which maintains a facility that displays offers and counteroffers for purchasers or sellers of life settlement contracts is known as a
Home health care benefits typically do NOT include coverage for Prescription medication In a disability income contract, an insured is considered to be totally disabled under the presumptive disability provision if he/she loses the ability to speak Which of these pays an income to two or more annuitants until the death of the last annuitant? Joint and survivor annuity New York workers compensation laws exclude benefits for disabilities caused by Intentional, self-inflicted injuries occurring on the job An individual long-term policy must be renewable For life
Straight whole life insurance can be accurately described in all of these statements EXCEPT Policy protection normally expires at age 65 Which of the following does a Medicare Advantage enrollee typically pay for? Small co-pay per visit or per service Long Term Care policies will usually pay for eligible benefits using which of the following methods? Expense incurred Emily is disabled. In order to become eligible for Social Security disability income benefits, she must be fully insured, according to Social Security
What kind of arrangement gives the policyowner the right to change the beneficiary? Revocable designation Jill has a group health plan with an employer that covers employees in more than one state. Which of the following aspects is NOT affected by the state regulatory jurisdiction established for this plan? Continuation of coverage under COBRA Which of the following is NOT subject to the promise to pay in an insuring clause? How the premium is calculated The amount received for a life insurance policy in a life settlement is Less than the death benefit Pete is covered by a group health insurance plan which covers employees in multiple states. This plan is governed by the laws of which state?
Where the master contract was issued Which of the following best describes the presumptive disability provision? Waives the typical total disability requirements Which of the following is NOT an allowable exclusion for long-term care insurance policies? Care for incurable conditions False advertising of an insurance policy is an example of misrepresentation Employer-paid qualified long-term care insurance premiums are typically Excluded from the employee's gross income.
Decreases premium Which of the following is NOT a valid contract exchange? "An annuity exchanged for a life insurance policy". The 1035 exchange does not allow for an annuity to be exchanged for a life insurance policy. This is not considered an equal exchange and will be taxed. Which of these factors does NOT influence an individual's need for life insurance? Self-maintenance expenses Which benefit supplement added to a life insurance policy insures an entire family? Family term rider Dan has a major medical expense policy with a $200 deductible and an 80/20 coinsurance provision. He incurs covered medical expenses of $100 in November and $400 in January. Under the carryover provision, what will the insurer pay?
The Carryover provision permits expenses incurred during the last 3 months of the calendar year to be carried over into the new year if needed to satisfy the deductible for the next year. In this case, the insurer would have to pay $240. ($100 + $400=$500 covered medical expenses; $500 - $200 deductible = $300. $300 X 80% = $240 payable by insurer) What does a 401(k) plan generally provide its participants? Salary-deferral option The interest paid during an annuity's payout period is considered Taxable as ordinary income A "premature" distribution from a modified endowment contract (MEC) incurs a penalty tax of 10%
