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| Section | Weight | Objectives |
|---|---|---|
| Accident and Health Insurance | 35% | - Health Insurance Basics
|
| Life Insurance Products and Provisions | 30% | - Types of Life Insurance Policies
|
| Insurance Regulation and General Principles | 20% | - Insurance Concepts
|
| Underwriting, Marketing and Sales Practices | 15% | - Sales and Customer Service
|
>> NY-Life-Accident-and-Health学習範囲 <<
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質問 # 97
Who is the beneficiary of a key person insurance policy?
正解:C
解説:
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.
質問 # 98
How long can an insurer exclude coverage for a preexisting condition on a Medicare Supplement Policy?
正解:D
解説:
The correct answer is 6 months . A Medicare Supplement policy , also known as Medigap , may impose a waiting period for coverage of a preexisting condition , but that exclusion period is limited. Under standard Medicare Supplement rules, an insurer may exclude coverage for a preexisting condition for no more than 6 months after the policy's effective date. A preexisting condition generally refers to a condition for which medical advice was given or treatment was recommended or received within a specified period before coverage became effective.
This rule is intended to protect applicants while still allowing insurers limited control over immediate claims related to known medical conditions. In many cases, this exclusion period can also be reduced or eliminated when the applicant has had prior creditable coverage with no significant break in coverage. That is why Medicare Supplement regulations are often tested together with rules about replacement, guaranteed issue, and continuity of coverage.
The other options-12 months, 18 months, and 24 months-are too long for a Medicare Supplement preexisting condition exclusion period. For exam purposes, the maximum exclusion period on a Medigap policy is 6 months , making Choice A correct.
質問 # 99
With respect to a life settlement contract, no person shall directly or indirectly pay a referral or finders fee to any person other than the
正解:B
解説:
The correct answer is life settlement broker . Under New York Insurance Law Article 78 , the life settlement rules prohibit paying a referral or finder's fee to most persons connected with the policyowner, including the owner's physician, attorney, accountant, insurance producer, insurance consultant, or other person providing medical, legal, or financial planning services . The statute specifically states that such compensation may not be paid to any of those persons, or to any other person representing the owner, other than a life settlement broker .
This rule is designed to prevent conflicts of interest and to ensure that recommendations about life settlements are not improperly influenced by side compensation. New York permits compensation only where it is paid in connection with the role of a licensed life settlement broker , because that person is regulated under the state's life settlement framework. The broker is the recognized professional authorized to represent the owner in the transaction and receive compensation in that capacity.
質問 # 100
An insured individual who has been diagnosed with osteoporosis needs therapy in her home. Which type of long-term care benefit would be MOST appropriate for her?
正解:B
解説:
The correct answer is Home health care . Long-term care coverage is designed to provide services for individuals who need ongoing assistance because of chronic illness, disability, or conditions that limit their ability to function independently. When the question specifically states that the insured needs therapy in her home , the most appropriate long-term care benefit is home health care , because this benefit is intended for medical or therapeutic services delivered in the insured's residence.
Home health care can include services such as physical therapy, occupational therapy, speech therapy, part- time nursing care, and assistance with daily functioning , depending on policy terms and the insured's condition. For a person with osteoporosis , in-home therapy may help improve mobility, reduce the risk of falls, and support recovery or maintenance without requiring confinement in a facility.
The other options are less appropriate. Skilled nursing care and intermediate care generally refer to facility- based services, while adult day care provides daytime supervision or assistance outside the home. Since the question emphasizes therapy in the home , the benefit that best fits is C. Home health care .
質問 # 101
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
正解:C
解説:
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 .
質問 # 102
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