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| Section | Objectives |
|---|---|
| State Regulations (New York) | - Licensing requirements
|
| Accident and Health Insurance | - Health insurance products
|
| Insurance Fundamentals | - Insurance contract law basics
|
>> NY-Life-Accident-and-Health합격보장 가능 덤프자료 <<
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질문 # 115
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?
정답：B
설명：
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 .
질문 # 116
An insured individual purchases a disability policy with a waiver of premium rider on January 1. The individual is disabled on June 1. On July 1, he receives proof of permanent and total disability, and submits a claim. He begins receiving benefits on July 15. When are his premiums waived?
정답：D
설명：
A waiver of premium rider on a disability policy is designed to keep coverage in force by waiving required premium payments once the insured becomes totally disabled , subject to the policy's conditions (such as required proof and any waiting/elimination period stated in the rider). The key concept tested is that waiver is tied to the date the disability begins , not the date proof is submitted or the date benefit checks start. Proof of disability (submitted July 1) is the administrative step that allows the insurer to approve the waiver, but the waiver itself applies because the insured has been disabled since June 1 . In standard disability provisions, if premiums are paid while the claim is being evaluated (or during any waiting period), those premiums are typically refunded once the waiver is approved, because the rider treats premiums as waived back to the disability start date (or back to the end of any stated waiting period, depending on the contract). Since June 1 is the onset of total disability, that is when the premium waiver is considered effective for purposes of this question.
질문 # 117
The statement, " Any person who knowingly and with intent to defraud any insurer or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty... " MUST appear in all New York
정답：D
설명：
The correct answer is applications for insurance and on all claim forms . Under New York insurance law , insurers are required to include a fraud warning statement on certain insurance documents to help prevent fraudulent insurance activities. This warning informs applicants and claimants that knowingly providing false information or concealing material facts for the purpose of misleading an insurer constitutes insurance fraud , which is a criminal offense and may also lead to civil penalties.
The regulation specifically requires that this fraud notice appear on all insurance applications and claim forms used within the state. The purpose is to ensure that individuals are clearly informed of the legal consequences of submitting false information when applying for insurance coverage or when filing a claim. By placing the warning directly on these documents, New York aims to discourage fraudulent behavior and strengthen compliance with insurance regulations.
The other options are incorrect because the fraud warning requirement does not apply broadly to general insurance communications, public documents, or credit applications. Instead, the law targets the two most critical documents where fraud might occur- insurance applications and claim forms .
질문 # 118
Which type of annuity guarantees a level benefit payment?
정답：D
설명：
The correct answer is Fixed . A fixed annuity guarantees a level benefit payment because the insurer promises to pay a stated amount or to credit a guaranteed rate of interest, which produces predictable and stable income payments. This makes fixed annuities especially suitable for individuals who want security, stability, and certainty of income , particularly during retirement.
In contrast, a variable annuity does not guarantee level payments because its benefits fluctuate based on the performance of the underlying investment accounts, usually separate accounts invested in securities. As investment results rise or fall, the annuity payment amount can increase or decrease. "Universal" is not the standard annuity classification used to describe guaranteed level income payments, and "Limited Life" is not a recognized annuity type for this purpose.
This question tests the distinction between guaranteed income and market-dependent income . In life insurance and annuity licensing materials, fixed annuities are consistently associated with guaranteed principal, guaranteed interest, and predictable benefit payments . Therefore, when asked which type of annuity guarantees a level benefit payment, the correct and expected answer is D. Fixed .
질문 # 119
An annuity that guarantees a given number of income payments, whether or not the annuitant is alive to receive them, is referred to as
정답：C
설명：
The correct answer is A. a life annuity certain. A life annuity certain combines two features: it provides income for the life of the annuitant , but it also guarantees that payments will continue for at least a specified minimum period or number of payments, even if the annuitant dies before all of those guaranteed payments have been made. In that case, the remaining guaranteed payments are paid to the designated beneficiary or recipient for the rest of the certain period. This is why the question emphasizes that the payments continue whether or not the annuitant is alive to receive them .
This distinguishes it from a straight life annuity, which stops payments at the annuitant's death and provides no further benefits. The other choices are not the standard insurance term used for this annuity arrangement.
Assured life annuity , guaranteed survivor annuity , and irrevocable endowed annuity are not the recognized licensing terms that match this definition. In annuity terminology used in life insurance studies, the correct name for an annuity that guarantees a stated number of payments while still being based on life income is a life annuity certain .
질문 # 120
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Insurance Licensing NY-Life-Accident-and-Health인증시험에 응시하고 싶으시다면 좋은 학습자료와 학습 가이드가 필요합니다.Insurance Licensing NY-Life-Accident-and-Health시험은 it업계에서도 아주 중요한 인증입니다. 시험패스를 원하신다면 충분한 시험준비는 필수입니다.
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