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Insurance Licensing NY-Life-Accident-and-Health Exam Syllabus Topics:

SectionWeightObjectives
Accident and Health Insurance35%- Government Health Programs
  • 1. New York State Specific Programs
    • 2. Medicare and Medicaid
      - Health Insurance Basics
      • 1. Group vs Individual Coverage
        • 2. Medical Expense and Disability Income
          - Policy Provisions and Claims
          • 1. Coordination of Benefits
            • 2. Eligibility and Enrollment
              Underwriting, Marketing and Sales Practices15%- Application and Underwriting Procedures
              • 1. Risk Classification and Selection
                - Sales and Customer Service
                • 1. Suitability and Disclosure Requirements
                  Life Insurance Products and Provisions30%- Types of Life Insurance Policies
                  • 1. Term, Whole Life, Universal Life
                    • 2. Annuities and Retirement Products
                      - Policy Provisions, Riders and Options
                      • 1. Beneficiary Designations
                        • 2. Non-forfeiture Values and Dividends
                          Insurance Regulation and General Principles20%- Insurance Concepts
                          • 1. Contract Law and Policy Structure
                            • 2. Risk Management and Insurable Interest
                              - New York Insurance Code and Laws
                              • 1. Unfair Trade Practices
                                • 2. Licensing Requirements and Procedures
                                  • 3. Producer Responsibilities and Ethics

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                                    Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 Sample Questions (Q74-Q79):

                                    NEW QUESTION # 74
                                    An annuitant dies during the accumulation period. What happens to the cash value in the annuity?

                                    Answer: A

                                    Explanation:
                                    During the accumulation period of an annuity, the contract owner is building value through premium payments and interest/earnings. If the annuitant dies before annuitization begins , the annuity does not simply disappear and the insurer does not "keep" the funds. Instead, the contract's value is paid out as a death benefit
                                    , which is generally based on the annuity's cash value (account value) , subject to the contract's terms (for example, adjustments for surrender charges may or may not apply depending on the product). The payment is made to the named beneficiary on the contract, which is why beneficiary designation is important for annuities just as it is for life insurance.
                                    Option B would apply only if there is no living beneficiary (or no valid beneficiary designation), in which case proceeds may be paid to the owner's estate. Option C is incorrect because the IRS is not the recipient of the cash value; taxes may be due on taxable gains, but proceeds are payable to beneficiaries/estate. Therefore, the correct answer is that the cash value is paid to the beneficiary.


                                    NEW QUESTION # 75
                                    An insurer monitors the care an insured is receiving in the hospital to be sure that everything is proceeding according to schedule. This BEST describes

                                    Answer: B

                                    Explanation:
                                    This situation describes concurrent review , a type of utilization management performed while the insured is actively receiving care , such as during an inpatient hospital stay. In concurrent review, the insurer (or its utilization review organization) monitors the ongoing treatment plan to confirm that services remain medically necessary , appropriate in intensity, and consistent with expected treatment timelines (for example, whether continued hospitalization is justified or whether discharge planning is appropriate). This differs from precertification (prior authorization) , which occurs before a service is provided to approve planned hospitalization, procedures, or certain high-cost services. It also differs from claims adjudication , which is the process of evaluating a submitted claim after services are rendered to determine payable benefits under the policy (applying deductibles, coinsurance, exclusions, and coverage limits). "Benefit checking" is not the standard term used for this managed care function. Because the question emphasizes monitoring care "in the hospital" and ensuring it proceeds according to schedule during the stay, the best match is concurrent review .


                                    NEW QUESTION # 76
                                    The cause of a loss is called

                                    Answer: B

                                    Explanation:
                                    In insurance terminology, the cause of a loss is known as a peril . A peril is the specific event or cause that results in damage, injury, or financial loss. Common examples of perils include fire, theft, accident, illness, disability, or death . In life and health insurance, the insured event-such as death in life insurance or sickness and accidental injury in health insurance-is considered the peril that triggers the insurer's obligation to pay benefits under the policy. Insurance policies are designed to provide financial protection against losses that result from covered perils.
                                    It is important to distinguish a peril from other related insurance concepts. A hazard is a condition or situation that increases the likelihood or severity of a loss caused by a peril. Hazards are typically categorized as physical hazards (such as icy roads or faulty wiring), moral hazards (dishonesty or fraudulent behavior), and morale hazards (carelessness because of insurance coverage). An exposure refers to the possibility of loss, while risk refers to the uncertainty regarding the occurrence of a loss. Therefore, the term that specifically describes the direct cause of a loss is a peril .


                                    NEW QUESTION # 77
                                    Which of the following producers, who have been licensed for a full biennial period, MUST complete continuing education requirements as a condition of renewing a license in New York?

                                    Answer: C

                                    Explanation:
                                    The correct answer is A. Personal Lines agents. In New York, licensed insurance producers who hold standard producer licenses for a full biennial licensing period are generally required to complete continuing education in order to renew their licenses. A Personal Lines agent is a regular insurance producer license classification and is therefore subject to the state's continuing education requirement once licensed for the full renewal cycle. This requirement helps ensure that licensed producers remain current on insurance laws, ethical standards, coverage updates, and regulatory responsibilities.
                                    The other choices do not fit as well in this question. Independent adjusters are licensed in a different capacity and are not classified as producers in the same way as agents and brokers for this question's purpose. Baggage agents and travel accident agents are limited-line licensees, and these limited categories are generally not the standard producer class targeted by the full continuing education renewal requirement tested in New York licensing materials.
                                    Because the question specifically asks which producer must complete continuing education after a full biennial period, the best and correct choice is Personal Lines agents .


                                    NEW QUESTION # 78
                                    If an annuitant dies during the accumulation period, his or her beneficiary will receive

                                    Answer: D

                                    Explanation:
                                    The correct answer is A. the greater of the accumulated cash value or the total premiums paid. During the accumulation period of an annuity, funds are being paid into the contract and grow on a tax-deferred basis. If the annuitant dies before the annuity has been annuitized, the contract does not simply disappear. Instead, the beneficiary is generally entitled to a death benefit . In standard annuity contract treatment used in licensing materials, that death benefit is usually the greater of the contract's accumulated value or the total premiums paid , less any withdrawals or outstanding charges if applicable under the contract terms.
                                    This rule protects the beneficiary from receiving less than the value built into the contract and also helps ensure that the owner's contributions are not lost if death occurs before the payout phase begins. The other choices are incorrect. B is wrong because the beneficiary is not limited to the lesser amount. C is incorrect because annuities do provide value upon death during accumulation. D is also incorrect because the beneficiary does not receive both amounts added together; rather, the benefit is based on whichever is greater
                                    . Therefore, the proper answer is A .


                                    NEW QUESTION # 79
                                    ......

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