考古題網站在近幾年激增，這可能是導致你準備 Insurance Licensing 的 NY-Life-Accident-and-Health 考試認證毫無頭緒。Insurance Licensing NY-Life-Accident-and-Health 考試培訓資料是一些專業人士和通過了的考生用實踐證明瞭的有效的培訓資料，它可以幫助你通過考試認證。告訴各考生一個好消息：Testpdf NY-Life-Accident-and-Health 考古題已經更新，解除了考生的擔憂！現在購買考題將得到一定的優惠！每個考生在準備 Insurance Licensing 認證考試時，都非常苦惱！希望各位考生順利通過考試！
| Section | Weight | Objectives |
|---|---|---|
| New York State Regulations | 20-25% | - Advertising regulations - Licensing requirements and procedures - Fiduciary responsibilities - Consumer protection regulations - NYS Insurance Law requirements - Replacement and churn rules |
| Life Insurance Fundamentals | 25-30% | - Policy riders and endorsements - Dividends and nonforfeiture options - Policy reinstatement - Policy types and provisions - Beneficiary designations |
| General Insurance Principles | 15-20% | - Underwriting principles - Agent/broker duties and ethics - Fair claims settlement practices - Insurance contract fundamentals - Ethical sales practices |
| Accident and Health Insurance | 25-30% | - Major medical coverage - Long-term care insurance basics - Dental and vision insurance basics - Medical expense coverage - Health insurance policy types (individual, group, HMOs) - Disability income insurance |
>> NY-Life-Accident-and-Health參考資料 <<
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問題 #90
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
答案：C
解題說明：
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 .
問題 #91
Which of the following statements is TRUE regarding a waiver of premium rider?
答案：D
解題說明：
The correct answer is A. There will be no change in the policy other than the insured no longer has to pay the premiums on the policy. A waiver of premium rider is a life insurance rider designed to protect the insured when total disability occurs, subject to the rider's terms and waiting period. Once the rider becomes effective, the insurer waives future premium payments , but the policy is treated as though the premiums are still being paid. This means the policy remains in force , and its benefits generally continue without reduction.
That is why the other choices are incorrect. B is incorrect because the policy is not supposed to continue on a reduced basis merely because the insured is disabled; the rider is intended to preserve the policy as contracted.
C is incorrect because unpaid premiums under an active waiver of premium rider are not deducted from the death benefit . D is incorrect because accelerated death benefits are a separate provision or rider, usually triggered by terminal illness or another qualifying condition, not by the waiver of premium rider itself.
Therefore, the true statement is that the policy stays essentially the same, except the insured is relieved from paying premiums while qualifying disability continues.
問題 #92
Which type of policy pays an amount per day for hospitalization directly to the insured regardless of the insured ' s other health insurance?
答案：C
解題說明：
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 .
問題 #93
Which type of group has a constitution and bylaws, is organized and maintained in good faith for purposes other than obtaining insurance, and has insurance for the purpose of covering members and their employees?
答案：B
解題說明：
An association or labor group is a type of eligible group used in group insurance arrangements. These groups are typically formed for professional, trade, or labor-related purposes , not primarily to obtain insurance coverage. To qualify for group insurance, such associations must usually meet certain regulatory standards.
These include having a formal organizational structure , such as a constitution and bylaws , and being organized and maintained in good faith for reasons other than purchasing insurance.
The group insurance coverage is then offered to members of the association and often their employees , allowing individuals who share a common professional or labor affiliation to obtain insurance benefits through the association. Because these organizations already exist for legitimate purposes-such as promoting professional interests, labor representation, or trade development-regulators allow them to sponsor group insurance plans.
The other options do not match the description provided. Credit insurance groups relate to loan repayment protection. Multiple employer groups involve several employers joining together to provide coverage, and employee/employer groups are typical workplace plans sponsored by a single employer. The description given specifically fits an association or labor group .
問題 #94
In accidental injury insurance, the insurance policy, the endorsements, and any relevant papers attached to the policy make up the:
答案：A
解題說明：
The correct answer is B. Entire contract. In accident and health insurance, the entire contract provision states that the policy, together with any attached endorsements, riders, and application materials made part of the policy, constitutes the full legal agreement between the insurer and the insured. This is an important consumer- protection rule because it prevents either party, especially the insurer, from relying on outside statements or documents that were not made part of the policy. In other words, only the documents physically attached to or incorporated into the contract are considered part of the insurance agreement.
This is why the other choices are incorrect. A completed application may become part of the contract only if it is attached, but it is not by itself the full contract. Uniform mandatory policy provisions are required clauses that must appear in accident and health policies, but they are not the name for the full set of policy documents.
A notice of coverage is simply evidence or summary of insurance and is not the legal contract itself.
Therefore, when the question describes the policy, endorsements, and attached papers together, that combination is known as the entire contract .
問題 #95
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