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| Section | Objectives |
|---|---|
| Topic 1: Accident and Health Insurance | - Policy features and provisions
|
| Topic 2: State Regulations (New York) | - Ethics and compliance
|
| Topic 3: Insurance Fundamentals | - Insurance contract law basics
|
>> NY-Life-Accident-and-Health試験 <<
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質問 # 117
In reference to life insurance in contract law, a person MOST likely will have an insurable interest in insuring a person ' s life if
正解:B
解説:
The correct answer is B. the interest exists at the time of application. In life insurance contract law, the principle of insurable interest requires that the policyowner must have a legitimate financial or emotional interest in the continued life of the insured. This requirement is designed to prevent wagering on human life and to ensure that insurance is purchased for protection rather than speculation. For life insurance policies, the insurable interest must exist at the time the policy is applied for or issued , but it does not need to exist at the time of the insured's death .
Examples of insurable interest include relationships where financial loss would occur if the insured dies, such as spouses, parents and children, business partners, or employers insuring key employees . The other options are incorrect because A states that insurable interest must exist at death, which is not required in life insurance. C is incorrect because a distant family relationship alone may not create a clear financial or legal insurable interest. D is also incorrect because not every business relationship automatically establishes insurable interest; the relationship must involve a genuine potential financial loss. Therefore, the key requirement is that insurable interest must exist when the policy is applied for .
質問 # 118
The cause of a loss is called
正解:D
解説:
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 .
質問 # 119
Medicaid provides which coverage that Medicare does NOT?
正解:B
解説:
The correct answer is custodial care . Medicaid is a government health assistance program for individuals who meet certain income and resource requirements , and one of its important features is that it may provide coverage for long-term custodial care , particularly in a nursing home or similar setting for eligible individuals. Custodial care generally refers to assistance with activities of daily living , such as bathing, dressing, eating, and moving about, rather than treatment intended to cure or improve a medical condition.
Medicare, by contrast, is primarily designed to cover acute care and medically necessary services. It does cover services such as ambulance transportation , inpatient hospital services , and certain forms of inpatient psychiatric care , subject to policy limits and eligibility requirements. However, Medicare generally does not pay for ongoing custodial care when that is the only type of care needed.
This distinction is commonly tested in accident and health insurance licensing exams because it highlights the difference between medical insurance for acute or skilled care and public assistance coverage for long-term support needs . Therefore, the service Medicaid provides that Medicare does not is custodial care .
質問 # 120
Who is the beneficiary of a key person insurance policy?
正解:C
解説:
The correct answer is Employer . In a key person insurance policy , the business purchases life insurance on the life of an employee, owner, or executive whose services are considered especially valuable to the company. In this arrangement, the business is the policyowner , pays the premiums, and is also named as the beneficiary . If the key person dies, the death benefit is paid to the employer to help offset the financial loss that may result from the death of that important individual.
The purpose of key person insurance is to protect the business against losses such as reduced revenues, replacement and training costs, disruption of operations, loss of credit, or the expense of finding a suitable successor . The policy is not intended primarily to provide personal family protection for the insured employee; that would normally be handled by an individually owned life insurance policy.
The other choices are incorrect because the employee, the insured's spouse, or a business partner would not ordinarily be the beneficiary unless the policy were structured differently from a standard key person arrangement. In the typical and tested form of key person insurance, the employer is the beneficiary.
質問 # 121
At the time of an insured ' s death, a per capita distribution of policy proceeds are paid to
正解:C
解説:
The correct answer is the named living primary beneficiaries . In life insurance beneficiary designations, per capita means "by the head," or equally among the living members of the named class or group . When policy proceeds are distributed per capita, each living beneficiary at the same beneficiary level receives an equal share of the death benefit. If one of the named primary beneficiaries dies before the insured, that deceased beneficiary's share is not passed to that beneficiary's estate or descendants unless the policy specifically provides otherwise. Instead, the proceeds are divided equally among the remaining living primary beneficiaries .
This is what distinguishes per capita from per stirpes . Under per stirpes, the share of a deceased beneficiary would pass down to that beneficiary's descendants. But under per capita, only the surviving named beneficiaries in the class receive the proceeds.
The other options are incorrect because a deceased beneficiary's estate does not automatically receive the share, the children of a deceased primary beneficiary are not paid under per capita unless specifically named, and contingent beneficiaries are paid only if no primary beneficiaries survive. Therefore, D is correct.
質問 # 122
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