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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Underwriting, Marketing and Sales Practices | 15% | - Application and Underwriting Procedures
|
| Topic 2: Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Topic 3: Life Insurance Products and Provisions | 30% | - Policy Provisions, Riders and Options
|
| Topic 4: Accident and Health Insurance | 35% | - Government Health Programs
|
>> NY-Life-Accident-and-Health Prüfungsinformationen <<
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31. Frage
Which of the following CORRECTLY identifies the favorable income tax treatment afforded to annuities?
Antwort: A
Begründung:
The correct answer is C. Gains are taxed only on distribution. One of the major advantages of annuities is their tax-deferred growth . During the accumulation phase , the interest, dividends, or investment gains generated inside the annuity contract are not taxed annually . Instead, taxation is deferred until the policyholder begins taking withdrawals or receiving annuity payments. At that time, the portion of the payment representing earnings or gains becomes taxable as ordinary income. This tax deferral allows the funds inside the annuity to grow more efficiently because earnings can continue to compound without being reduced by yearly taxation.
The other options are incorrect. A is incorrect because annuity earnings are not tax deductible each year. B is also incorrect because earnings are not partially tax-exempt; rather, they are tax-deferred until distribution. D is incorrect because not all distributions are fully taxable. When annuity payments begin, part of each payment represents a return of the owner ' s principal (cost basis) and is not taxed, while only the earnings portion is subject to income tax. Therefore, the favorable tax treatment of annuities is that taxation on gains occurs only when distributions are taken
32. Frage
Medicaid provides which coverage that Medicare does NOT?
Antwort: A
Begründung:
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 .
33. Frage
In addition to the application, MIB, or consumer reports, underwriters can acquire information from all of the following EXCEPT
Antwort: A
Begründung:
Life insurance underwriting relies on multiple sources to evaluate an applicant's insurability and assign an appropriate risk classification. Beyond the application, the Medical Information Bureau (MIB), and consumer reports, insurers commonly obtain additional medical information through medical questionnaires (supplemental health questions), attending physician statements (APS) from the applicant's doctor, and physical examinations (often including measurements, vitals, and sometimes lab work) when required by the insurer's underwriting guidelines. These tools help confirm medical history, clarify conditions disclosed on the application, and verify current health status so the insurer can make a fair underwriting decision.
However, insurers generally do not obtain information through genetic testing as part of routine underwriting.
Licensing materials typically treat genetic testing as an excluded underwriting source because of legal and regulatory protections that restrict requesting or using genetic test results in insurance decisions. Therefore, while questionnaires, APS reports, and physical exams are standard underwriting information sources, genetic testing is the exception.
34. Frage
Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if
Antwort: B
Begründung:
The Affordable Care Act (ACA) requires health plans to maintain a formal internal claims and appeals process and to provide access to external review when appropriate. A key consumer protection under the ACA is that, after a claim is denied (an "adverse benefit determination"), the covered person must be given a reasonable opportunity to appeal. Standard ACA claims-and-appeals rules provide a specific filing window for an internal appeal: the insured generally has up to 180 days from receipt of the denial notice to submit the appeal. If an appeal request is made after that deadline, the insurer (or plan) may treat it as untimely and can refuse to accept it as a valid internal appeal.
The other options do not reflect ACA requirements. ACA appeals are not limited by a minimum dollar amount like $500, and plans cannot impose an appeal fee as a condition of filing. Also, ACA rules do not set a
"three appeals per year" cap; appeal rights are tied to adverse determinations, not an annual quota. Therefore, the insurer may refuse only if the appeal is filed more than 180 days after denial.
35. Frage
Which of the following services must be provided by a health benefit plan issued on or after January 1, 2014?
Antwort: C
Begründung:
The correct answer is D. Preventive health services. Health benefit plans issued on or after January 1, 2014 became subject to the Affordable Care Act's essential health benefit and preventive-service requirements for non-grandfathered coverage in the individual and small-group markets. Those rules require coverage for specified preventive services without cost-sharing when provided in accordance with federal guidelines. New York's post-2014 marketplace coverage materials likewise explain that plans must include the ACA's required essential health benefits, which include preventive and wellness services.
The other options are not the mandatory general requirement described in this question. Adult eye care and adult dental care are not universally required as core benefits in the same way preventive services are; the ACA's pediatric services category specifically includes pediatric vision and dental, not broad adult routine vision or dental as mandatory across all such plans. Long-term care services are also not one of the essential health benefits that every post-2014 health benefit plan must provide. Therefore, among the choices given, the service that must be provided is preventive health services
36. Frage
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