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| Section | Weight | Objectives |
|---|---|---|
| General Insurance Principles | 15-20% | - Agent/broker duties and ethics - Fair claims settlement practices - Insurance contract fundamentals - Underwriting principles - Ethical sales practices |
| New York State Regulations | 20-25% | - Advertising regulations - Consumer protection regulations - Licensing requirements and procedures - NYS Insurance Law requirements - Fiduciary responsibilities - Replacement and churn rules |
| Accident and Health Insurance | 25-30% | - Disability income insurance - Major medical coverage - Dental and vision insurance basics - Medical expense coverage - Long-term care insurance basics - Health insurance policy types (individual, group, HMOs) |
| Life Insurance Fundamentals | 25-30% | - Policy riders and endorsements - Beneficiary designations - Policy reinstatement - Dividends and nonforfeiture options - Policy types and provisions |
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NEW QUESTION # 12
Some states have laws ensuring that health insurance coverages are available at a reasonable cost and under reasonable conditions for small employers. Small employers are defined as having no more than
Answer: B
Explanation:
The correct answer is 100 employees . In accident and health insurance licensing material, "small employer" or "small group" generally refers to an employer with 1 to 100 employees for purposes of small-group health insurance market rules. These laws are intended to make coverage more available and affordable for smaller businesses that may not have the bargaining power of large employers. They are commonly associated with protections involving availability of coverage, renewal standards, rating limitations, and fair underwriting conditions in the small-group market.
This question tests recognition of the standard upper limit used in modern health insurance regulation for a small employer group. The other options-75, 150, and 200-do not match the commonly tested definition.
In exam context, the purpose is to distinguish small-group health coverage from large-group coverage, because different rules may apply to eligibility, premium determination, and mandated access. So, when a health insurance question asks how many employees a "small employer" may have under these types of laws, the expected answer is no more than 100 employees .
NEW QUESTION # 13
Which type of policy pays an amount per day for hospitalization directly to the insured regardless of the insured ' s other health insurance?
Answer: A
Explanation:
The correct answer is Hospital indemnity . A hospital indemnity policy is a form of limited benefit health insurance that pays a fixed dollar amount for each day the insured is confined in a hospital. The benefit is paid directly to the insured , not necessarily to the hospital or physician, and it is paid regardless of any other health insurance coverage the insured may have. This means the insured may use the money for hospital bills, deductibles, coinsurance, lost income, transportation, or any other expenses resulting from illness or injury.
This type of policy differs from major medical insurance, which reimburses covered medical expenses subject to deductibles, copayments, and policy limits. It also differs from Medigap , which is designed specifically to supplement Medicare, and from blanket coverage , which insures groups without naming specific individuals.
Although "limited-amount per diem" describes a style of benefit, the established policy name used in licensing materials for a daily hospitalization benefit paid directly to the insured is hospital indemnity .
Therefore, the policy that pays a stated daily amount for hospitalization regardless of other coverage is A.
Hospital indemnity .
NEW QUESTION # 14
With respect to a life settlement contract, no person shall directly or indirectly pay a referral or finders fee to any person other than the
Answer: C
Explanation:
The correct answer is life settlement broker . Under New York Insurance Law Article 78 , the life settlement rules prohibit paying a referral or finder's fee to most persons connected with the policyowner, including the owner's physician, attorney, accountant, insurance producer, insurance consultant, or other person providing medical, legal, or financial planning services . The statute specifically states that such compensation may not be paid to any of those persons, or to any other person representing the owner, other than a life settlement broker .
This rule is designed to prevent conflicts of interest and to ensure that recommendations about life settlements are not improperly influenced by side compensation. New York permits compensation only where it is paid in connection with the role of a licensed life settlement broker , because that person is regulated under the state's life settlement framework. The broker is the recognized professional authorized to represent the owner in the transaction and receive compensation in that capacity.
NEW QUESTION # 15
According to the Affordable Care Act, a child can remain on a parent ' s health benefit plan until the child
Answer: C
Explanation:
The correct answer is reaches age 26 . The Affordable Care Act (ACA) introduced a major change in health insurance dependent coverage rules by requiring most health insurance plans that provide dependent coverage to allow children to stay on their parent's health insurance policy until they reach age 26 . This rule applies to both individual and employer-sponsored health plans .
One important feature of this regulation is that eligibility does not depend on the child's marital status, student status, financial independence, or residence . This means a young adult may still remain covered under the parent's plan even if the child is married, living independently, or no longer attending school. The goal of this provision is to reduce the number of uninsured young adults who may otherwise lose coverage after finishing school or aging out of traditional dependent eligibility requirements.
The other options are incorrect because dependent coverage does not automatically end when the child marries, graduates from college, or turns age 19 . The ACA clearly sets the maximum age for dependent coverage at 26 years old , making Option C the correct answer.
Because the owner's physician, accountant, and insurance consultant are all specifically barred from receiving such referral compensation, the only correct option is D. life settlement broker .
NEW QUESTION # 16
With respect to small group health benefit plans, a carrier may discontinue coverage or may refuse to renew such a plan if the employer
Answer: B
Explanation:
Under New York small group health benefit plan rules, carriers generally must renew coverage for an employer group, but there are specific exceptions where a carrier is permitted to discontinue or refuse renewal
. One of the primary permitted reasons is nonpayment of premium -if the employer does not pay required premiums within the policy's allowed timeframes (including any required grace period), the carrier may terminate or nonrenew coverage because the group is no longer meeting the contractual payment obligation.
The other options do not typically qualify as valid statutory reasons for nonrenewal in the small group market.
Merely employing fewer than 15 full-time employees is not a trigger for termination (small group status is based on employer size definitions, but size alone doesn't justify cancellation). Filing for bankruptcy is not, by itself, a standard guaranteed-renewability exception. Having supplemental coverage with another carrier also does not allow a carrier to cancel, because employers may coordinate coverage arrangements. Therefore, the only option that matches an allowed discontinuance/nonrenewal basis is failure to pay premiums before the end of the grace period .
NEW QUESTION # 17
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