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| Section | Objectives |
|---|---|
| Insurance Fundamentals | - Principles of insurance and risk management
|
| Accident and Health Insurance | - Policy features and provisions
|
| State Regulations (New York) | - Licensing requirements
|
>> NY-Life-Accident-and-Health Test Tutorials <<
For Insurance Licensing professionals, passing the New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 exams such as the NY-Life-Accident-and-Health Exam is essential to achieve their dream professional life. However, passing the New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 (NY-Life-Accident-and-Health) Exam is not an easy task, especially for those with busy schedules who need time to prepare well for the NY-Life-Accident-and-Health Exam. To ensure success on the NY-Life-Accident-and-Health Exam, you need Insurance Licensing NY-Life-Accident-and-Health Exam Questions that contain all the relevant information about the exam.
NEW QUESTION # 88
What is an insurer ' s liability when it is discovered after an insured dies that the insured ' s age on the policy was misstated?
Answer: B
Explanation:
The correct answer is C . In life insurance, when the insured's age has been misstated, the policy is not voided solely because of that error. Instead, the insurer applies the misstatement of age provision , which adjusts the amount payable to the amount of insurance that the premium actually paid would have purchased at the insured's correct age . Since age is one of the most important factors in determining life insurance premiums, an incorrect age means the premium collected may have been too high or too low for the coverage originally stated.
If the insured understated age, the premiums paid would have purchased less coverage at the correct older age, so the death benefit is reduced proportionately. If the insured overstated age, the premiums paid may have purchased more coverage , and the benefit could be increased accordingly. This adjustment method preserves fairness to both the insurer and the policyowner by matching benefits to the premium that should have applied.
The policy does not become entirely unenforceable, and the insurer does not simply pay the full face amount without adjustment. Therefore, the proper liability is a prorated amount based on the correct age , making Option C correct
NEW QUESTION # 89
What information must be included in the statement accompanying an insurance claim payment made by an insurer?
Answer: D
Explanation:
When an insurer issues a claim payment, New York claims-handling standards require that the payment be accompanied by an explanation that clearly identifies what the payment represents . A key required item is the coverage under which the payment is being made , so the claimant (or insured) can understand the basis for the payment and how it relates to the policy's benefits. This helps avoid confusion when a policy includes multiple coverages, benefit limits, deductibles, copayments/coinsurance, or when only part of a claim is payable. Stating the applicable coverage (for example, hospital confinement, major medical, disability income, accidental death, etc.) supports transparency and aligns with fair claims settlement practices by showing that the insurer is paying according to the policy provisions.
The other options are not required elements of the payment statement. Insurers are not required to list all claimants, disclose reinsurance arrangements (which are typically not visible to policyholders), or include the agent's name and address as part of the claim payment explanation. The essential requirement tested here is identifying the coverage supporting the payment.
NEW QUESTION # 90
Under the grace period, an insured submits a $300 claim for medical expenses. The insurer notes that the insured has a past due premium of $100, and as a result, the insurer only pays $200. Which of the following provisions covers this situation?
Answer: D
Explanation:
The correct answer is Unpaid premium . In accident and health insurance, the unpaid premium provision permits the insurer to deduct any premium that is due and unpaid from a claim payment when a loss occurs during the grace period. The grace period allows coverage to remain in force for a limited time after the premium due date, giving the insured an opportunity to make the overdue payment without immediate lapse of coverage. However, if a claim is submitted during that period, the insurer has the right to subtract the outstanding premium from the amount otherwise payable.
In this question, the insured submits a $300 claim , but because $100 in premium is overdue , the insurer pays only $200 . That is exactly how the unpaid premium provision operates.
The other choices do not fit. Payment of claims refers to how and to whom claims are paid, not deduction of overdue premium. Misstatement of age applies when an incorrect age affects premium or benefits. Payment actions is not the standard policy provision being tested here. Therefore, the correct answer is A. Unpaid premium .
NEW QUESTION # 91
When MUST a newborn child be covered under an existing health insurance policy?
Answer: A
Explanation:
The correct answer is A. Immediately. Under accident and health insurance provisions, newborn children must be covered from the moment of birth under an existing health insurance policy that provides dependent coverage. This requirement ensures that medical expenses related to the newborn's birth and any immediate medical needs are eligible for coverage without delay. The rule is designed to protect infants during the critical period immediately following birth, when medical care is commonly required.
Although coverage begins immediately at birth , most policies and state insurance rules allow the policyholder a limited period-often 30 or 31 days -to formally notify the insurer and add the newborn as a dependent while maintaining continuous coverage from birth. If the policyholder completes the enrollment within that period and pays any additional premium required, coverage remains effective retroactively to the date of birth.
Therefore, the key concept tested in accident and health licensing materials is that a newborn child must be covered immediately upon birth , even though administrative enrollment to formally add the child may occur within a specified time period afterward. This makes "Immediately" the correct answer.
NEW QUESTION # 92
Which of the following statements is TRUE concerning classification of risks?
Answer: B
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 # 93
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