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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health Insurance | 25-30% | - Health insurance policy types (individual, group, HMOs) - Disability income insurance - Long-term care insurance basics - Dental and vision insurance basics - Major medical coverage - Medical expense coverage |
| Topic 2: New York State Regulations | 20-25% | - Advertising regulations - Replacement and churn rules - NYS Insurance Law requirements - Licensing requirements and procedures - Fiduciary responsibilities - Consumer protection regulations |
| Topic 3: Life Insurance Fundamentals | 25-30% | - Dividends and nonforfeiture options - Policy types and provisions - Policy riders and endorsements - Beneficiary designations - Policy reinstatement |
| Topic 4: General Insurance Principles | 15-20% | - Underwriting principles - Agent/broker duties and ethics - Ethical sales practices - Fair claims settlement practices - Insurance contract fundamentals |
>> Valid NY-Life-Accident-and-Health Test Notes <<
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NEW QUESTION # 15
Which of the following statements is TRUE regarding a waiver of premium rider?
Answer: C
Explanation:
The correct answer is A. There will be no change in the policy other than the insured no longer has to pay the premiums on the policy. A waiver of premium rider is a life insurance rider designed to protect the insured when total disability occurs, subject to the rider's terms and waiting period. Once the rider becomes effective, the insurer waives future premium payments , but the policy is treated as though the premiums are still being paid. This means the policy remains in force , and its benefits generally continue without reduction.
That is why the other choices are incorrect. B is incorrect because the policy is not supposed to continue on a reduced basis merely because the insured is disabled; the rider is intended to preserve the policy as contracted.
C is incorrect because unpaid premiums under an active waiver of premium rider are not deducted from the death benefit . D is incorrect because accelerated death benefits are a separate provision or rider, usually triggered by terminal illness or another qualifying condition, not by the waiver of premium rider itself.
Therefore, the true statement is that the policy stays essentially the same, except the insured is relieved from paying premiums while qualifying disability continues.
NEW QUESTION # 16
A 65-year-old employee who works for an employer with 24 employees is disabled on the job. The employee has fully recovered and returned to work. Which health coverage is primary?
Answer: A
Explanation:
When an injury or illness is work-related ("on the job") , the primary payer for medical expenses and related benefits is workers' compensation . Workers' compensation laws are designed to provide benefits for occupational injuries and diseases, including payment for necessary medical treatment and, when applicable, lost-time/indemnity benefits. This priority applies regardless of the employee's age and is not determined by the size of the employer's group plan (the "24 employees" detail is often relevant to certain coordination rules such as Medicare secondary payer, but it does not override workers' compensation responsibility for job- related injuries). The fact that the employee has recovered and returned to work does not change which coverage is primary for the injury event-medical bills connected to that occupational injury are still handled first under workers' compensation. Medicaid is needs-based coverage and would not be primary when another legally responsible payer exists. Likewise, an individual plan or the employer's group plan typically coordinates benefits only after workers' compensation for occupational claims.
NEW QUESTION # 17
A policyowner may choose to have his/her life insurance policy dividends do all of the following EXCEPT
Answer: B
Explanation:
The correct answer is B. accumulate without interest. In participating life insurance policies, dividends are not guaranteed, but when paid they may usually be applied in several standard ways. Common dividend options include taking the dividend in cash , using it to reduce the next premium , leaving it with the insurer to accumulate at interest , or using it to purchase paid-up additions , which increase the policy's death benefit and cash value. These are traditional dividend options tested in life insurance licensing materials.
The key word in this question is "without interest." If dividends are left with the insurer to accumulate, they normally accumulate at interest , not without interest. Therefore, that choice is the exception. Option A is a valid use of dividends because they can offset premium payments. Option C is also valid because the insurer may pay dividends directly to the policyowner in cash. Option D is valid because dividends can buy additional insurance protection , usually in the form of paid-up additions. For that reason, the only incorrect dividend use listed is accumulate without interest .
NEW QUESTION # 18
The following statement refers to which type of clause? "We have issued the policy in consideration of the representations in your application and payment of the first-term premium."
Answer: C
Explanation:
The quoted statement describes the consideration clause because it identifies the items of value exchanged between the parties that make the insurance contract valid. In life insurance, the insurer's consideration is the promise to provide coverage under the terms of the policy, and the applicant's consideration is typically the statements or representations made in the application along with the payment of the initial premium . That is exactly what the statement says: the policy is issued in reliance on the application representations and the first premium payment.
This is different from the contestability clause , which explains the insurer's right to challenge the policy during a limited period, usually for material misrepresentation. It is also different from a whole contract clause , which states that the policy and attached application together form the entire contract. A concealment clause is not the standard clause being described here. On licensing exams, whenever a question quotes wording about the policy being issued "in consideration of" the application and premium, the correct answer is the consideration clause .
NEW QUESTION # 19
Who is the beneficiary of a key person insurance policy?
Answer: D
Explanation:
The correct answer is Employer . In a key person insurance policy , the business purchases life insurance on the life of an employee, owner, or executive whose services are considered especially valuable to the company. In this arrangement, the business is the policyowner , pays the premiums, and is also named as the beneficiary . If the key person dies, the death benefit is paid to the employer to help offset the financial loss that may result from the death of that important individual.
The purpose of key person insurance is to protect the business against losses such as reduced revenues, replacement and training costs, disruption of operations, loss of credit, or the expense of finding a suitable successor . The policy is not intended primarily to provide personal family protection for the insured employee; that would normally be handled by an individually owned life insurance policy.
The other choices are incorrect because the employee, the insured's spouse, or a business partner would not ordinarily be the beneficiary unless the policy were structured differently from a standard key person arrangement. In the typical and tested form of key person insurance, the employer is the beneficiary.
NEW QUESTION # 20
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