NY Independent General Adjuster Pre Test – GRADED A – New York Department of Financial Services (DFS) Independent Adjuster – 202 6 /20 27 Edition – Verified Questions and Answers

NY Independent General Adjuster Pre Test – GRADED A – New York Department of Financial Services (DFS) Independent Adjuster – 202 6 /20 27 Edition – Verified Questions and Answers One objective of a concurrent review provision in group accident and health insurance is to? Monitor length of stay in the hospital once the patient is admitted. For groups with high prior claims experience, an insurer would be likely to? Expect high future claims experience Antigen is the medical term for? An infectious agent Why would an insurer limit the combined amount of disability income benefits under multiple policies purchased by an insured from the same or another company? To prevent the insured from receiving a benefit amount which might make becoming disabled financially attractive. Periodontics includes all of the following EXCEPT? dentures A contract offered for acceptance or rejection without negotiation is called ? contract adhesion How does the Medicare Supplement at-home recovery services benefit differ from the Medicare home health care benefit? The Medicare Supplement benefit covers assistance with daily living A mandatory second surgical opinion provision typically would encourage all of the following EXCEPT? higher total accident and health plan cost for an employer Which of the following is a requirement for an act of terrorism to be certified according to the Terrorism Risk Insurance Extension Act of 2005? The total loss in property and casualty damages must exceed $5 million. Medicaid is funded by state governments and by? federal All of the following are typical benefit periods for long-term disability income insurance EXCEPT? one year By applying the principle of indemnity, an insured should be prevented from? profit from loss A new Medicare Part A "benefit period" is available after an insured has been out of a hospital or other facility for at least? 60 days What is the maximum period of imprisonment for conviction of unfair and deceptive insurance practices? 15 years Group accident and health insurance usually is written to cover? People working for the same employer In group accident and health insurance, a group with a high average age usually has? Above average total accident and health claims. The accounting measurement of the insurer's future obligations to its policyholders is? Reserves Unless an individual has previously received benefits, Social Security disability income benefits have a waiting period ? 5 full consecutive calendar months Which type of accident and health insurance should be purchased by a person who wants coverage for hospital bills in the event of accidental injury? Medical expense A social organization which is licensed to issue insurance ONLY to its members is an example of which type of insurer? Fraternal An agent who unintentionally makes misleading statements to a prospect for replacement of accident and health insurance may be found liable on the basis of? Professional errors and omissions A mandatory second surgical opinion provision typically would encourage all of the following EXCEPT? Higher total accident and health plan costs for an employer Concurrent review is a form of utilization review that is performed? During the course of the patient's treatment Employer-sponsored group long-term care insurance generally has all of the following characteristics EXCEPT? Noncancelable. An electrocardiogram records the electrical activity of the:? heart When insurers utilize provisions in dental plans such as limited benefits for late enrollees, a reduced maximum annual benefit, and longer eligibility periods before coverage becomes effective, insurers are attempting to: Minimize adverse selection What is the minimum number of the "core group" of essential health benefits mandated by ACA for both individual plans and group plans? The insurance commissioner will deal with those who violate insurance laws through the issuance of a cease and desist order. If this order is ignored or violated, a penalty of _____ can be imposed. A fine of $10,000 for each violation. The penalty is the result of violating a cease and desist order imposed by the department of insurance. The monetary penalty in most states is up to $10,000 for each violation. However, this may vary from state to state. Please refer to your state law supplement to confirm this penalty in your state. . An insurer may represent that its investments are: Conservative. Any other representation is prohibited. How are employers, employing 50 to 99 full-time employees affected by ACA? They are required to report on their workers and health coverage in this year of 2015, but have until the year 2016 before any employer responsibilty payments could apply. is correct. These employers are not required to provide The Affordable Care Act mandates all employers employing ____ or more full-time employees must provide health care insurance for their workforce. An employer that does not comply will: 50 / be required to make an employer-shared responsibility payment to the IRS. . Approved Medicare supplement plans must be guaranteed renewable and: I. The insurer may not cancel the policy solely on the basis of the health of the insured. II. The insurer may only cancel a policy for non-payment of premiums or misrepresentation Both I and II . All of the following are optional provisions in individual health insurance policies, EXCEPT: Notice of claim What is the minimum size group that mandates serious mental illness coverage be included in the health plan? 50 or more employees A joint at the wrist is referred to as the: carpal Which definition of total disability is more favorable to the insured? Own occupation . Which of the following specifically describes a type of policy intended to cover extended residence in a nursing home? Long term care policies Which of the following correctly describes Medicaid? Provides medical benefits for certain low-income people, for the disabled, and for families with dependent children Which of the following describes the individual covered by insurance? insured Joann Larson, an adjuster, has had administrative action taken against her in another jurisdiction. What must she do? Report the final disposition of the matter to the Insurance Superintendent within 30 days What are the lifetime dollar limits on the essential benefits provided under ACA? There are no lifetime dollar limits on essential benefits. The heartbeat is controlled by? The peripheral nervous system What is the name of a health care delivery system providing prepaid doctor and hospital care, emphasizing preventive care, and charging a fixed periodic fee to its enrolled members? Health Maintenance Organization Assume that you are talking to a person who says that he owns 20 shares of stock in an insurance company. You know that this insurance company is a: Stock insurer The coverage provided by a disability income policy that does not pay benefits for losses occurring as the result of the insured's employment is called: Non-occupational coverage Which of the following is the required time period that the insured must file a written proof of loss? Within 90 days of loss, or as soon as reasonably possible . Which of the following statements about changes to insurance contracts is most correct? An agent is never permitted to make a change in policy wording. . An insurance professional that is accused of dishonesty or breach of trust involving interstate commerce under the Federal Fraud and False Statement Regulation of the United States Code (USC 1033) will be prosecuted by: The U.S. Attorney general . Many medical expense policies do not state a specific unit or dollar amount for items such as room and board or surgical procedures. Instead, payment for similar services provided in the same location are based on: Usual, reasonable and customary What is the purpose of "navigators" associated with the state insurance exchanges? To provide information about the available health plans offered by the ACA and assist with enrollment An employer that self-funds its group medical plan may limit its claims exposure by purchasing: Stop-loss insurance The period between a loss and the beginning of benefit payments in disability income insurance is known as: Elimination period An employer may require employee contributions for all of the following types of plans, EXCEPT: A workers compensation plan. Individual long term care insurance policies must provide the right to return the policy within ____ to obtain a premium refund if he or she is not satisfied. 30 days . If an insurance company accepts a special class risk: The premium will be higher than for a normal risk. The optional health insurance policy provision "other insurance with this insurer" is specifically designed to: Limit the claim risk with any one individual insured by the company.. . Which of the following reimburses its insureds for covered medical expenses? Commercial insurers.. If an insurance company covered an excluded loss, it may have to continue paying other claims for such losses because of the: Estoppel rule An individual who is considered chronically ill must be recertified as such: annually.. Which of the following may be used by an insurer to prevent duplication of benefits? Coordination of benefits provision The Affordable Care Act requires plans and issuers that offer coverage to children on a parent's plan to make the coverage available until the adult child reaches the age of: 26 Failure to disclose known facts when completing an application for insurance is an act of: Concealment . Resident adjusters in New York must maintain a _____ surety bond with the Superintendent for the purpose of assuring faithful performance of the licensee. $1,000 In order to obtain group health insurance without providing evidence of insurability, what are eligible individuals generally required to do? Enroll within a specified eligibility period Due to an injury, Harry has lost 40% of his income. He now works only three days per week. His disability income plan pays 40% of his total disability benefit. Harry has what type of benefit? residual disability