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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Life Insurance Products and Provisions | 30% | - Policy Provisions, Riders and Options
|
| Topic 2: Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Topic 3: Underwriting, Marketing and Sales Practices | 15% | - Sales and Customer Service
|
| Topic 4: Accident and Health Insurance | 35% | - Policy Provisions and Claims
|
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NEW QUESTION # 56
Some states have laws ensuring that health insurance coverages are available at a reasonable cost and under reasonable conditions for small employers. Small employers are defined as having no more than
Answer: D
Explanation:
The correct answer is 100 employees . In accident and health insurance licensing material, "small employer" or "small group" generally refers to an employer with 1 to 100 employees for purposes of small-group health insurance market rules. These laws are intended to make coverage more available and affordable for smaller businesses that may not have the bargaining power of large employers. They are commonly associated with protections involving availability of coverage, renewal standards, rating limitations, and fair underwriting conditions in the small-group market.
This question tests recognition of the standard upper limit used in modern health insurance regulation for a small employer group. The other options-75, 150, and 200-do not match the commonly tested definition.
In exam context, the purpose is to distinguish small-group health coverage from large-group coverage, because different rules may apply to eligibility, premium determination, and mandated access. So, when a health insurance question asks how many employees a "small employer" may have under these types of laws, the expected answer is no more than 100 employees .
NEW QUESTION # 57
Stranger originated life insurance violates which of the following statutory requirements?
Answer: A
Explanation:
Stranger-originated life insurance (STOLI) arrangements violate the fundamental legal requirement of insurable interest . In life insurance, the policyowner must have a legitimate interest in the continued life of the insured at the time the policy is issued. This usually exists when there is a close family relationship or a lawful economic interest, such as a business relationship where the death of the insured would cause financial loss. STOLI attempts to evade this rule by having a third party with no true insurable interest initiate or finance a policy for the purpose of benefiting from the insured's death.
That is why C. Insurable interest is the correct answer. The problem with STOLI is not trust ownership itself, since trusts may be used legally in life insurance planning when properly established. It is also not primarily about rescission rights or commission sharing. The key statutory violation is that the policy is effectively procured by or for someone who lacks a lawful interest in the insured's continued life. New York licensing materials treat this as contrary to public policy and inconsistent with lawful life insurance underwriting standards.
NEW QUESTION # 58
A company may insure an employee with specialized skills under a key employee disability insurance policy.
Which of the following statements is TRUE?
Answer: D
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 # 59
Which of the following is a life insurance contract written on the life of an individual?
Answer: D
Explanation:
The correct answer is D. Single-Life Insurance. A single-life insurance policy is a contract that covers one individual only . The death benefit is paid when that one insured person dies, provided the policy is in force.
This is the most basic and common form of life insurance coverage and is used when protection is needed on the life of one person, such as a wage earner, business owner, or parent. Because the contract is based on only one insured life, underwriting, premium calculation, and benefit payment are all tied to that single person's age, health, and policy terms.
The other choices are incorrect. A. Insurance is too broad and is not a specific type of life insurance contract.
B). Survivorship Policy covers two lives and typically pays upon the second death , not on a single individual alone. C. Joint Life Contract also covers two people , usually paying on the first death . Since the question asks for a policy written on the life of an individual , the proper term is Single-Life Insurance .
NEW QUESTION # 60
HICs usually structure copayments to discourage:
Answer: B
Explanation:
The correct answer is Non-emergency visits to the emergency room . In health insurance and managed care concepts, Health Insurance Companies (HICs) and managed care plans often use copayment structures to influence how insureds use medical services. One common goal is to discourage the unnecessary use of high- cost services , especially the emergency room for conditions that are not true emergencies. Because emergency room treatment is generally far more expensive than treatment in a physician's office, urgent care center, or other outpatient setting, insurers frequently apply higher copayments to non-emergency ER use.
This cost-sharing design encourages insureds to seek appropriate care in the most cost-effective setting while preserving emergency room access for genuine emergencies. Preventive care is generally encouraged rather than discouraged, and many plans reduce or waive cost-sharing for preventive services. Prescription drugs and outpatient X-rays may involve copayments or other cost-sharing, but they are not the classic services targeted by higher copays for utilization control in this context.
For exam purposes, when a question asks what copayment structures are usually designed to discourage, the expected answer is non-emergency emergency room visits .
NEW QUESTION # 61
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