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| Section | Weight | Objectives |
|---|---|---|
| Life Insurance Fundamentals | 25-30% | - Policy riders and endorsements - Policy types and provisions - Beneficiary designations - Policy reinstatement - Dividends and nonforfeiture options |
| New York State Regulations | 20-25% | - Consumer protection regulations - Licensing requirements and procedures - Advertising regulations - Replacement and churn rules - NYS Insurance Law requirements - Fiduciary responsibilities |
| Accident and Health Insurance | 25-30% | - Long-term care insurance basics - Dental and vision insurance basics - Medical expense coverage - Health insurance policy types (individual, group, HMOs) - Major medical coverage - Disability income insurance |
| General Insurance Principles | 15-20% | - Underwriting principles - Insurance contract fundamentals - Fair claims settlement practices - Ethical sales practices - Agent/broker duties and ethics |
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NEW QUESTION # 91
Which of the following statements is TRUE concerning classification of risks?
Answer: A
Explanation:
The true statement is D. Preferred risks pay a lower premium than standard risks. In life insurance underwriting, applicants are commonly grouped into classifications such as preferred, standard, and substandard (or rated) . A preferred risk is an insured who presents a lower-than-average likelihood of loss compared with a standard applicant, so that class generally receives more favorable premium rates. The NAIC glossary defines a preferred risk as an applicant whose likelihood of loss is lower than that of the standard applicant, which directly supports the lower-premium result.
The other choices are false. Substandard applicants are not "never" issued policies ; many are issued coverage, but usually at a higher premium through a rating . A rated policy means the insurer has charged extra because of higher risk, so it does not merit a lower premium. Likewise, a preferred individual is not issued a rated policy; preferred status reflects better-than-standard risk, while rated or substandard status reflects higher-than-standard risk. New York DFS's Life, Accident and Health exam outline includes classification of risks as a tested underwriting topic, consistent with this principle.
NEW QUESTION # 92
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: C
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 # 93
Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if
Answer: C
Explanation:
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.
NEW QUESTION # 94
If the premium is not paid at the time of application, a Statement of Good Health MUST be signed by the policyowner at the time of
Answer: C
Explanation:
The correct answer is policy delivery . In life insurance underwriting and policy issuance procedures, when the initial premium is not collected at the time of the application , the policy does not immediately become effective. Because there may be a period of time between the application date and the delivery of the policy, the insurer requires confirmation that the applicant's health status has not changed during that time.
To address this, the policyowner must sign a Statement of Good Health at the time the policy is delivered.
This statement verifies that the insured's health condition remains substantially the same as it was at the time of application and that no significant illness, injury, or medical treatment has occurred since the application was submitted. The purpose is to ensure that the risk evaluated by the insurer during underwriting is still accurate before coverage becomes effective.
If the applicant had paid the first premium at the time of application and received a conditional receipt, this additional statement might not be required. However, when the premium is unpaid, the Statement of Good Health must be completed at policy delivery , making Choice C correct.
NEW QUESTION # 95
Which of the following groups is NOT eligible for the Healthy New York Program?
Answer: C
Explanation:
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.
NEW QUESTION # 96
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