Das erfahrungsreiche Experten-Team hat die Schulungsmaterialien, die speziell für Insurance Licensing NY-Life-Accident-and-Health Prüfung ist, bearbeitet. Durch die Schulungsmaterialien und das Lernen von Fast2test ist es leichter, die Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung zu bestehen. Fast2test verspricht, dass Sie die Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung 100% zum ersten Mal bestehen können. Die von uns bietenden Prüfungsfragen und Antworten werden sicher in der Prüfung vorkommen. Wenn Sie unsere Hilfe wählen, versprechen wir Ihnen, dass Fast2test Ihnen die genauen und umfassenden Prüfungsmaterialien und einen einjährigen kostenlosen Update-Service bieten.
| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Accident and Health Insurance | 35% | - Government Health Programs
|
| Topic 2: Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
| Topic 3: Underwriting, Marketing and Sales Practices | 15% | - Sales and Customer Service
|
| Topic 4: Insurance Regulation and General Principles | 20% | - New York Insurance Code and Laws
|
>> NY-Life-Accident-and-Health Exam Fragen <<
In den letzten Jahren hat die Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung großen Einfluß aufs Alltagsleben geübt. Aber die Kernfrage ist, wie man die Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung einmalig bestehen. Die Antwort ist, dass Sie die Schulungsunterlagen zur Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung von Fast2test benutzen sollen. Mit Fast2test können Sie Ihre erste Zertifizierungsprüfung bestehen. Worauf warten Sie noch?Kaufen Sie die Schulungsunterlagen zur Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung von Fast2test, Sie werden sicher mehr bekommen, was Sie wünschen.
40. Frage
Upon receipt of notice of claim, the insurance company will furnish to the claimant such forms for filing proof of loss within how many days?
Antwort: D
Begründung:
In Accident and Health insurance policies, the Claims Provisions section outlines the procedures that must be followed when a loss occurs. One of the standard provisions concerns the insurer's responsibility after receiving a notice of claim from the insured or beneficiary. Once the insurer receives this notice, the company must provide the claimant with the necessary claim forms used to submit proof of loss . According to standard policy provisions used in health insurance contracts, the insurer is required to furnish these forms within 15 days after receiving the notice of claim.
These forms allow the claimant to provide detailed information regarding the loss, such as the nature of the injury or illness, dates of treatment, medical provider information, and other documentation required to process the claim. If the insurer fails to provide the forms within the required 15-day period , the claimant may still satisfy the proof-of-loss requirement by submitting a written statement describing the occurrence, character, and extent of the loss within the time allowed by the policy. This rule ensures that claim processing cannot be delayed simply because the insurer did not send the official forms in time.
41. Frage
With respect to small group health benefit plans, a carrier may discontinue coverage or may refuse to renew such a plan if the employer
Antwort: B
Begründung:
Under New York small group health benefit plan rules, carriers generally must renew coverage for an employer group, but there are specific exceptions where a carrier is permitted to discontinue or refuse renewal
. One of the primary permitted reasons is nonpayment of premium -if the employer does not pay required premiums within the policy's allowed timeframes (including any required grace period), the carrier may terminate or nonrenew coverage because the group is no longer meeting the contractual payment obligation.
The other options do not typically qualify as valid statutory reasons for nonrenewal in the small group market.
Merely employing fewer than 15 full-time employees is not a trigger for termination (small group status is based on employer size definitions, but size alone doesn't justify cancellation). Filing for bankruptcy is not, by itself, a standard guaranteed-renewability exception. Having supplemental coverage with another carrier also does not allow a carrier to cancel, because employers may coordinate coverage arrangements. Therefore, the only option that matches an allowed discontinuance/nonrenewal basis is failure to pay premiums before the end of the grace period .
42. Frage
An insurer monitors the care an insured is receiving in the hospital to be sure that everything is proceeding according to schedule. This BEST describes
Antwort: A
Begründung:
This situation describes concurrent review , a type of utilization management performed while the insured is actively receiving care , such as during an inpatient hospital stay. In concurrent review, the insurer (or its utilization review organization) monitors the ongoing treatment plan to confirm that services remain medically necessary , appropriate in intensity, and consistent with expected treatment timelines (for example, whether continued hospitalization is justified or whether discharge planning is appropriate). This differs from precertification (prior authorization) , which occurs before a service is provided to approve planned hospitalization, procedures, or certain high-cost services. It also differs from claims adjudication , which is the process of evaluating a submitted claim after services are rendered to determine payable benefits under the policy (applying deductibles, coinsurance, exclusions, and coverage limits). "Benefit checking" is not the standard term used for this managed care function. Because the question emphasizes monitoring care "in the hospital" and ensuring it proceeds according to schedule during the stay, the best match is concurrent review .
43. Frage
Which statement is NOT a characteristic of a Group Life Insurance Plan?
Antwort: C
Begründung:
The correct answer is C. Individual underwriting. A Group Life Insurance Plan is designed to provide coverage to a number of people under a single policy, usually employees of an employer or members of an association. One of its key characteristics is that the insurer issues a master contract to the policyholder, such as the employer, while each covered member receives a certificate of insurance as evidence of coverage.
Group plans may also include probationary periods , especially for new employees, to require a certain length of service before coverage becomes effective.
What group life insurance generally does not involve is individual underwriting for each member. Unlike individual life insurance, where each applicant's health history, occupation, and personal risk factors are carefully evaluated, group life insurance is commonly written on a group basis . Eligibility is determined by membership in the group rather than detailed medical underwriting of each person, especially for amounts within the plan's basic coverage limits. Therefore, the statement that is not a characteristic of a Group Life Insurance Plan is individual underwriting .
Thought for 8s
44. Frage
Under the Affordable Care Act, insurers MUST offer plans within health insurance exchanges that meet distinct levels of coverage. What metal tier is REQUIRED to have an actuarial value of 70% with covered individuals paying 30% through deductibles, co-pays, and other cost sharing features?
Antwort: D
Begründung:
Under the Affordable Care Act (ACA), qualified health plans offered on the individual and small-group exchanges are categorized into metal tiers based on actuarial value (AV) -the percentage of expected average medical costs the plan is designed to pay for a standard population. The ACA's standard tiers are Bronze (60% AV) , Silver (70% AV) , Gold (80% AV) , and Platinum (90% AV) . A plan with a 70% actuarial value is therefore a Silver Plan , meaning that, on average, the insurer pays about 70% of covered healthcare expenses and covered individuals pay about 30% through deductibles, copayments, coinsurance, and other cost-sharing (not including premiums).
This question's wording matches the defining feature of the Silver tier: 70/30 cost-sharing on average . Gold and Platinum tiers have higher actuarial values (so lower expected cost sharing), while Bronze has a lower actuarial value (higher expected cost sharing). Therefore, the required tier at 70% AV is the Silver Plan .
45. Frage
......
Sie können im Internet teilweise die Fragenkatalogen zur Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung von Fast2test kostenlos herunterladen. Dann werden Sie mehr Vertrauen in unsere Produkte haben. Sie können sich dann gut auf Ihre Insurance Licensing NY-Life-Accident-and-Health Zertifizierungsprüfung vorbereiten. Schicken bitte schnell die Produkte von Fast2test in den Warenkorb.
NY-Life-Accident-and-Health Zertifizierungsfragen: https://de.fast2test.com/NY-Life-Accident-and-Health-premium-file.html