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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance Regulation and General Principles | 20% | - New York Insurance Code and Laws
|
| Topic 2: Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
| Topic 3: Underwriting, Marketing and Sales Practices | 15% | - Sales and Customer Service
|
| Topic 4: Accident and Health Insurance | 35% | - Health Insurance Basics
|
>> NY-Life-Accident-and-Health Antworten <<
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85. Frage
Under the Affordable Care Act, an insurer may place dollar limits on coverage for
Antwort: A
Begründung:
The correct answer is D. routine adult dental services. The Affordable Care Act (ACA) prohibits health insurers from placing lifetime or annual dollar limits on coverage for Essential Health Benefits (EHBs) .
These essential health benefits include services such as laboratory services, mental health and substance use disorder services, and maternity and newborn care . Because these categories are designated as essential health benefits, insurers are not allowed to impose annual or lifetime dollar caps on them under ACA- compliant health plans.
However, routine adult dental services are not included in the ACA's list of essential health benefits . While pediatric dental services are included as an essential health benefit category, routine dental coverage for adults is generally offered as an optional or separate benefit. Because it is not classified as an essential health benefit under the ACA, insurers may legally apply dollar limits or other coverage limitations to routine adult dental services depending on the policy design.
Therefore, under ACA regulations applicable to health insurance policies and marketplace plans beginning in
2014, dollar limits are prohibited for essential health benefits but may still apply to non-essential benefits , such as routine adult dental care .
86. Frage
Which of the following is an example of risk sharing?
Antwort: B
Begründung:
Risk sharing is a risk management technique in which a group combines resources so that losses experienced by a few are spread across many. The classic insurance concept behind this is pooling : each participant contributes money to a common fund, and the fund is used to pay covered losses as they occur. Option B describes this directly- pooling money to cover malpractice exposures -because malpractice losses can be unpredictable and potentially severe, and sharing them across a group reduces the financial impact on any one member.
The other options describe different risk management methods. Option A (not purchasing a car) is risk avoidance -eliminating the exposure entirely. Option C (installing sprinklers) is risk reduction/loss control , lowering the frequency or severity of loss. Option D (purchasing an insurance policy) is primarily risk transfer
, shifting the financial consequences of specified losses to an insurer in exchange for a premium. Because only option B reflects spreading losses among a group through pooling, it is the best example of risk sharing .
87. Frage
The limitation expressed in limited payment policies is a limit on the number of annual premiums or the
Antwort: C
Begründung:
The correct answer is age beyond which premiums will no longer be required . A limited-payment life insurance policy is a form of permanent life insurance designed so that the insured pays premiums for only a specified period of time , rather than for their entire lifetime. The limitation refers either to a fixed number of premium payments (for example, 10-pay or 20-pay life) or to a specific age at which premium payments stop
, such as Life Paid-Up at Age 65. After the required premium period ends, the policy remains fully in force for the remainder of the insured's lifetime , and the death benefit continues without any additional premium obligations.
This structure is attractive to policyholders who want to complete their premium payments during their working years and avoid paying premiums later in life, such as during retirement. Although premiums for limited-payment policies are typically higher than those for ordinary life policies , they allow the policy to become fully paid-up earlier .
The other choices are incorrect because limited-payment provisions do not limit policy benefits, policy loan amounts, or the interest credited to policy cash values. The limitation strictly concerns the duration of premium payments .
88. Frage
Which of the following groups is NOT eligible for the Healthy New York Program?
Antwort: B
Begründung:
The correct answer is A. Large employers. The Healthy New York Program was designed by New York State to make health insurance more affordable for individuals and small businesses that typically have difficulty obtaining reasonably priced coverage. The program targets small employers , generally those with a limited number of employees, as well as sole proprietors and certain working individuals who are uninsured . By providing subsidized coverage options, the program helps these groups access basic health insurance protection.
Under the program guidelines used in New York Life, Accident and Health licensing materials, eligibility includes small businesses , self-employed individuals , and working uninsured individuals who meet specific income and employment criteria. These groups are considered eligible because they often lack access to affordable group coverage through large employer-sponsored plans.
Large employers , however, are not eligible for the Healthy New York Program. Large companies typically have access to standard group health insurance markets and therefore are not the intended beneficiaries of this subsidized program. Because the program specifically focuses on small businesses and uninsured workers, large employers are excluded from eligibility , making option A the correct answer.
89. Frage
Group long-term disability benefit amounts are usually limited to what percentage of the participant ' s income?
Antwort: A
Begründung:
Group long-term disability (LTD) insurance is designed to replace a portion of an employee's income when a disabling sickness or injury prevents the employee from working for an extended period. Because disability benefits are intended to reduce financial hardship while also discouraging overinsurance (where someone could receive more income disabled than working), group LTD plans typically set benefits as a percentage of pre-disability earnings . In standard A & H licensing materials, the most common benefit level used in group LTD is 60% of the participant's income , often expressed as 60% of gross monthly earnings (sometimes coordinated with other income benefits and subject to a maximum monthly cap).
This 60% level is commonly used because it balances meaningful income replacement with the fact that certain work-related expenses may decrease during disability, and because taxes may affect net take-home pay depending on who paid the premium (employer vs. employee). Higher percentages like 80% or 100% are generally not typical for group LTD due to moral hazard concerns and plan design limits, while 40% is more common in some short-term disability arrangements or minimal designs. Therefore, the usual limit is 60% .
90. Frage
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