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

SectionObjectives
Accident and Health Insurance- Health insurance products
  • 1. Hospital and medical expense coverage
    • 2. Disability income insurance
      - Policy features and provisions
      • 1. Elimination periods and benefit limits
        • 2. Coordination of benefits
          Insurance Fundamentals- Insurance contract law basics
          • 1. Elements of a valid contract
            • 2. Policy provisions and clauses
              - Principles of insurance and risk management
              • 1. Risk classification and pooling of risk
                • 2. Insurable interest and indemnity concepts
                  State Regulations (New York)- Ethics and compliance
                  • 1. Unfair trade practices
                    • 2. Producer responsibilities and conduct
                      - Licensing requirements
                      • 1. Pre-licensing education requirements
                        • 2. Application and background checks

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                          Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 Sample Questions (Q31-Q36):

                          NEW QUESTION # 31
                          When a provider does NOT have an agreement with the insurer for payment, they will be reimbursed

                          Answer: D

                          Explanation:
                          When a medical provider does not have a contract or payment agreement with an insurer (often called a nonparticipating or out-of-network provider), the insurer generally does not pay based on a negotiated contract rate. Instead, reimbursement is commonly determined using a UCR methodology- Usual, Customary, and Reasonable charges. "Usual" refers to the typical charge a provider makes for a service;
                          "customary" reflects what providers in the same geographic area commonly charge for that service; and
                          "reasonable" considers whether the charge is appropriate given the circumstances and local market norms.
                          Under many major medical plans, the insurer pays a percentage of the UCR amount (subject to deductibles and coinsurance), and the patient may be responsible for any difference between the provider's billed charge and the insurer's allowed UCR amount (often referred to as balance billing , where permitted).
                          The other choices do not match standard insurer payment terminology: "absolute" and "relative" fee are not the typical reimbursement basis described for noncontracted providers, and "non-scheduled plan customary fee" is not the recognized standard method used in these plan provisions.


                          NEW QUESTION # 32
                          What is an insurer ' s liability when it is discovered after an insured dies that the insured ' s age on the policy was misstated?

                          Answer: B

                          Explanation:
                          The correct answer is C . In life insurance, when the insured's age has been misstated, the policy is not voided solely because of that error. Instead, the insurer applies the misstatement of age provision , which adjusts the amount payable to the amount of insurance that the premium actually paid would have purchased at the insured's correct age . Since age is one of the most important factors in determining life insurance premiums, an incorrect age means the premium collected may have been too high or too low for the coverage originally stated.
                          If the insured understated age, the premiums paid would have purchased less coverage at the correct older age, so the death benefit is reduced proportionately. If the insured overstated age, the premiums paid may have purchased more coverage , and the benefit could be increased accordingly. This adjustment method preserves fairness to both the insurer and the policyowner by matching benefits to the premium that should have applied.
                          The policy does not become entirely unenforceable, and the insurer does not simply pay the full face amount without adjustment. Therefore, the proper liability is a prorated amount based on the correct age , making Option C correct


                          NEW QUESTION # 33
                          If a partner of a company becomes permanently disabled, which type of plan will allow the other partner to acquire the disabled partner's interest in the company?

                          Answer: B

                          Explanation:
                          A disability buy-sell agreement (often funded with disability buyout insurance) is specifically designed to address the business ownership problem created when an owner/partner becomes totally and permanently disabled . The agreement establishes, in advance, the terms under which the non-disabled partner(s) can purchase the disabled partner's ownership interest , providing an orderly transfer of control and a fair method to determine the buyout price. The insurance component supplies the cash needed to complete the purchase so the remaining partner is not forced to borrow, liquidate assets, or disrupt operations to raise funds. By contrast, long-term disability and employee disability coverage are aimed at replacing personal income for the disabled individual, not transferring ownership interests. Business overhead expense insurance reimburses ongoing fixed business expenses (rent, utilities, certain salaries) during the owner's disability; it helps keep the business running but does not create a mechanism for one partner to acquire the other partner's share.
                          Therefore, the provision that enables acquisition of the disabled partner's interest is the disability buy-sell agreement.


                          NEW QUESTION # 34
                          Term life insurance differs from permanent life insurance in that MOST often, term life insurance

                          Answer: B

                          Explanation:
                          Term life insurance is temporary protection designed to provide a death benefit only if death occurs during a stated "term" (such as 10, 20, or 30 years). This is the core distinction from permanent life insurance, which is intended to last for the insured's lifetime (to age 100/121 depending on the policy) as long as required premiums are paid. Term insurance typically offers the largest face amount for the lowest initial premium because it is focused on pure death benefit protection and generally does not build cash value . By contrast, permanent policies (whole life, universal life) combine insurance protection with cash value accumulation and are structured for long-duration coverage. Option A is incorrect because term life usually accumulates no cash value (not "a smaller cash value"). Option B is incorrect because term often has a shorter premium-paying horizon aligned to the term period. Option D is not "most often" true: some term policies are renewable, but renewability depends on contract provisions and is not automatic in all cases.


                          NEW QUESTION # 35
                          A company may insure an employee with specialized skills under a key employee disability insurance policy.
                          Which of the following statements is TRUE?

                          Answer: B

                          Explanation:
                          The correct answer is A. The business is the applicant. In key employee disability insurance (also called key person disability income), the purpose of coverage is to protect the business against financial loss if an employee with unique skills, knowledge, or production value becomes disabled. New York's Life, Accident and Health Agent/Broker examination content outline specifically includes "Business disability insurance" and "Key person disability income" as tested topics, confirming that this is a recognized business-use disability coverage concept in the New York licensing curriculum.
                          Under this arrangement, the business applies for and owns the policy , pays the premiums, and is generally the beneficiary of any benefits payable because the loss being insured is the company's loss, not the employee's family loss. Industry explanations of key person disability insurance are consistent on this point: the key employee is the insured , while the company buys the coverage and makes the premium payments .
                          That makes the other options incorrect. The employee's spouse is not the beneficiary, the employee usually does not pay the premium, and the employee is not the applicant.


                          NEW QUESTION # 36
                          ......

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