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| Section | Weight | Objectives |
|---|---|---|
| General Insurance Principles | 15-20% | - Ethical sales practices - Underwriting principles - Agent/broker duties and ethics - Insurance contract fundamentals - Fair claims settlement practices |
| New York State Regulations | 20-25% | - Licensing requirements and procedures - Advertising regulations - Replacement and churn rules - NYS Insurance Law requirements - Consumer protection regulations - Fiduciary responsibilities |
| Accident and Health Insurance | 25-30% | - Dental and vision insurance basics - Medical expense coverage - Disability income insurance - Long-term care insurance basics - Major medical coverage - Health insurance policy types (individual, group, HMOs) |
| Life Insurance Fundamentals | 25-30% | - Policy riders and endorsements - Dividends and nonforfeiture options - Beneficiary designations - Policy types and provisions - Policy reinstatement |
>> NY-Life-Accident-and-Health的中問題集 <<
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質問 # 114
Predicting an individual ' s future earning potential and determining how much of that amount would be devoted to his dependents incorporates the
正解：B
解説：
The correct answer is human life value approach . In life insurance planning, the human life value approach is used to estimate the economic value of an insured person's future earnings to those who depend on that income. It focuses on the idea that an individual's life has an insurable value based on the amount of income he or she is expected to earn in the future and the portion of that income that would have been used to support dependents. This method is commonly applied when determining how much life insurance is needed to replace the financial contribution of a wage earner.
Under this approach, factors such as current earnings, future earning capacity, years until retirement, inflation, taxes, and personal living expenses are considered. The amount available to dependents is then projected to help establish an appropriate death benefit.
The other options do not fit this definition. The needs approach centers on the survivors' financial needs after death, not strictly on future income value. "Loss exposure" and "salary projection" are not the standard life insurance need-analysis terms tested for this concept. Therefore, the correct answer is human life value approach .
質問 # 115
The difference between the face value of a life insurance policy and its cash value is the
正解：A
解説：
The correct answer is C. net amount. In life insurance, the difference between a policy's face amount and its cash value is commonly referred to in licensing terminology as the net amount at risk , and exam questions often shorten that phrase to net amount . This represents the portion of the death benefit the insurer is actually risking at a given time because the cash value already belongs to the policyowner and offsets part of the insurer's exposure. As cash value increases over the life of a permanent policy, the insurer's net amount at risk generally decreases. NAIC life insurance regulatory material describes the amount subtracted from the policy's face value to determine the net amount at risk , which is consistent with this concept. ( NAIC ) The other options are not correct insurance terms for this relationship. Market value applies more to investments or securities. Assumed amount is not the standard term used in life insurance contract analysis.
Term value is also incorrect because term insurance generally does not build cash value. Therefore, the recognized answer is net amount , meaning the policy's net amount at risk . ( NAIC )
質問 # 116
Insurance agents have duties and responsibilities to the insured and the insurer. Which of the following responsibilities does an agent owe the insured during the policy year?
正解：B
解説：
During the policy year, an agent's continuing responsibilities to the insured are commonly described as policyowner service duties. A key part of that service is assisting the insured with the claims process - helping the insured understand what is covered, how to complete claim forms, what documentation is needed, where and when to submit the claim, and following up when additional information is requested. This ongoing service obligation supports timely claim handling and helps the insured access benefits promised under the contract.
The other options do not represent responsibilities an agent owes the insured. Agents do not report paid claims to the Insurance Department as part of normal duties; claim reporting and market conduct oversight are handled through insurer compliance and regulatory processes. Agents also do not work with rating bureaus to establish insurer ratings-insurer ratings are produced by independent rating organizations and based on financial/claims performance, not agent activity. Finally, an agent is not obligated (and generally should not) pay an insured's premiums; doing so can create improper financial arrangements and is outside normal agent duties. Therefore, helping the insured file and follow up on claims is the correct responsibility.
質問 # 117
Long-term care policies MUST cover which of the following conditions?
正解：A
解説：
Long-term care (LTC) insurance is intended to cover services needed when an insured cannot perform activities of daily living (ADLs) or suffers a cognitive impairment that requires substantial supervision for health and safety. A core regulatory and policy design principle is that LTC benefits must be available for qualifying impairments regardless of whether the cause is physical or cognitive . Alzheimer's disease is a leading cause of cognitive impairment and is specifically recognized in LTC training materials as a condition LTC policies must cover when it results in the required level of functional or cognitive limitation. In practice, Alzheimer's often triggers eligibility through the cognitive impairment standard, even when the insured can still perform some ADLs, because supervision is needed to protect the individual from threats to health and safety.
The other options are commonly associated with policy exclusions rather than required coverage. LTC policies frequently exclude losses related to war or acts of war , and they may exclude intentionally self- inflicted injuries . Alcoholism or drug addiction is not treated as a mandatory covered condition in the same way; coverage depends on policy terms and is often limited or excluded. Therefore, the condition LTC policies must cover is Alzheimer's disease .
質問 # 118
Which of the following services must be provided by a health benefit plan issued on or after January 1, 2014?
正解：C
解説：
The correct answer is D. Preventive health services. Health benefit plans issued on or after January 1, 2014 became subject to the Affordable Care Act's essential health benefit and preventive-service requirements for non-grandfathered coverage in the individual and small-group markets. Those rules require coverage for specified preventive services without cost-sharing when provided in accordance with federal guidelines. New York's post-2014 marketplace coverage materials likewise explain that plans must include the ACA's required essential health benefits, which include preventive and wellness services.
The other options are not the mandatory general requirement described in this question. Adult eye care and adult dental care are not universally required as core benefits in the same way preventive services are; the ACA's pediatric services category specifically includes pediatric vision and dental, not broad adult routine vision or dental as mandatory across all such plans. Long-term care services are also not one of the essential health benefits that every post-2014 health benefit plan must provide. Therefore, among the choices given, the service that must be provided is preventive health services
質問 # 119
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