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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health Insurance | 35% | - Government Health Programs
|
| Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
| Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Underwriting, Marketing and Sales Practices | 15% | - Sales and Customer Service
|
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NEW QUESTION # 59
Which of the following is described when a selected group of practitioners, in a certain area, agrees to provide services at a pre-arranged cost on a fee-for-service basis?
Answer: B
Explanation:
The correct answer is A. preferred provider organization. A Preferred Provider Organization (PPO) is a health care arrangement in which an insurer or plan contracts with a selected network of doctors, hospitals, and other providers in a geographic area to deliver medical services at negotiated or reduced charges . Federal and New York sources describe PPOs as networks of participating providers that agree to furnish care at discounted rates, while patients generally retain the flexibility to use non-network providers at a higher cost. That matches the question's description of a selected group of practitioners agreeing to provide services at a pre- arranged cost on a fee-for-service basis . ( HealthCare.gov ) The other options do not fit this definition. An indemnity organization traditionally reimburses covered losses and does not depend on a contracted provider network with prearranged fees. A risk purchasing group is associated with liability insurance purchasing arrangements, not standard health provider networks. Coalition group is not the recognized term for this managed care structure. Therefore, the correct description is a preferred provider organization . ( Department of Financial Services )
NEW QUESTION # 60
A single contract for group medical insurance issued to an employer is known as
Answer: B
Explanation:
In group medical insurance, the insurer issues one main contract to the sponsoring entity-commonly an employer-covering the eligible group of employees. This single contract is called the master policy . The employer (or group sponsor) is the policyholder of the master contract, and it contains the controlling provisions: eligibility rules, benefits, limitations, exclusions, premium requirements, renewal provisions, and administrative terms.
Employees covered under the plan do not usually receive their own individual policies. Instead, each insured employee receives a certificate of insurance (sometimes called a certificate), which summarizes the essential coverage provisions and the benefits available to that employee under the master policy. The certificate is evidence of coverage, but it is not the controlling contract; the master policy governs.
Option A ("group policy") is a generic phrase and can refer broadly to group insurance, but the specific term for the single contract issued to the employer is master policy . Option C is not a standard insurance term, and option D is incorrect because a "certificate" is issued to employees, not as the primary contract.
NEW QUESTION # 61
The cause of a loss is called
Answer: C
Explanation:
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 .
NEW QUESTION # 62
Clark will be doing business as an agent. When MUST he be appointed by the insurer?
Answer: A
Explanation:
The correct answer is B. Within 15 days of signing the agency contract. In New York, when an insurer authorizes a licensed insurance producer to act as its agent , the insurer must make the formal appointment within the time required by state insurance law. The appointment is tied to the establishment of the agency relationship, which begins when the insurer and the producer enter into the agency contract . New York licensing rules require the insurer to notify the state of that appointment within the required 15-day period.
The other choices are incorrect because appointment is not based on the date the producer submits a license application, and it does not have to occur at the exact same moment the license application is filed. It is also unrelated to the timing of commission payments. The appointment requirement exists so the state can identify which insurers a producer is authorized to represent as an agent. Therefore, once Clark signs the agency agreement and is authorized to act on behalf of the insurer, the insurer must complete the appointment process within 15 days of signing the agency contract .
NEW QUESTION # 63
Who would NOT be covered under an additional insured rider attached to a life insurance policy?
Answer: C
Explanation:
The correct answer is Employees . An additional insured rider on a life insurance policy is generally used to extend coverage to certain family members of the primary insured, rather than to unrelated business associates or workers. In standard life insurance practice, these riders commonly apply to persons who have a close family relationship with the insured, such as a spouse , minor children , and in some cases other qualifying dependents . The purpose is to provide limited additional life insurance protection under one policy for members of the insured's household or dependent family unit.
Employees do not fall within the normal scope of an additional insured rider on an individual life insurance policy. Coverage for employees is ordinarily handled through group life insurance , employer-sponsored plans
, or separate business-related insurance arrangements, not through a family rider attached to a personal life insurance contract.
This question tests the distinction between family-type dependent coverage and employment-related coverage
. Since a spouse, minor children, and dependent parents may be considered dependents for rider purposes, the choice that would not be covered under this rider is employees .
NEW QUESTION # 64
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