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| Section | Objectives |
|---|---|
| Accident and Health Insurance | - Health insurance products
|
| State Regulations (New York) | - Licensing requirements
|
| Insurance Fundamentals | - Principles of insurance and risk management
|
>> NY-Life-Accident-and-Health Quizfragen Und Antworten <<
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50. Frage
Which of the following statements is TRUE regarding a waiver of premium rider?
Antwort: C
Begründung:
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.
51. 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: B
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 .
52. Frage
On or after January 1, 2014, employers with no more than 25 full time equivalent employees (FTEs) with average annual wages of less than $50,000 may be eligible for a tax credit of up to how much of the premiums paid by the employer?
Antwort: A
Begründung:
Beginning January 1, 2014 , the Affordable Care Act (ACA) expanded the Small Employer Health Insurance Tax Credit to encourage small employers to offer health coverage. Under the post-2014 rules referenced in licensing materials, an eligible small employer with no more than 25 full-time equivalent (FTE) employees and average annual wages under $50,000 may qualify for a credit of up to 50% of the employer's premium contribution (with a lower maximum generally applying to eligible tax-exempt employers). The credit is designed to offset part of the cost of providing group health insurance, and eligibility and the credit amount depend on meeting the size and wage thresholds and contributing toward employee premiums.
The maximum percentage is important: 50% is the "up to" cap used for small employers under the ACA framework on or after 2014, making option C correct. The other options are distractors because they understate or overstate the statutory maximum credit percentage available to qualifying small employers during that period.
53. Frage
A single contract for group medical insurance issued to an employer is known as
Antwort: D
Begründung:
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.
54. Frage
A policyowner may choose to have his/her life insurance policy dividends do all of the following EXCEPT
Antwort: C
Begründung:
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 .
55. Frage
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