NY Series 17-52 Questions and Answers 100% Pass

NY Series 17-52 Questions and Answers 100% Pass How many eligible employees must be included in a contributory health insurance plan? 50% A man works for Company A and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, The insurance through his company is primary. What is the period of coverage for events such as death or divorce under COBRA? 36 months Twenty-five days after a health insurance policy is delivered, the policyowner decides that she would like to return the policy and receive a refund of premium. Which of the following is true? The policyowner will not receive a refund because the free-look period is over. An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits? No benefits For the purpose of insurance, risk is defined as The uncertainty or chance of loss. Which of the following is an example of a producer's fiduciary duty? The trust that a client places in the producer in regard to handling premiums. Which of the following is NOT true of basic medical expense plans? Coverage for catastrophic medical expenses Which of the following is NOT a feature of a noncancellable policy? The insurer may terminate the contract only at renewal for certain conditions. What is the best way to change an application? Start over with a fresh application On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as Deductible. Which of the following is correct about a group health insurance policy issued in New York? It cannot exclude newborn children from coverage. Which of the following is NOT a characteristic of a group long-term disability plan? The benefit can be up to 50% of one's yearly income. In which Medicare supplemental policies are the core benefits found? All plans When benefits are paid directly to the insured under a health insurance policy, the policy provides benefits on what type of basis? Reimbursement If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 60 days? Conversion To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan? 18 months Under which of the following disability income plans would the benefits be subject to income tax? Group Under the Affordable Care Act, a special enrollment period allows an individual to enroll in a qualified health plan within how many days of a qualifying event? 60 days Which of the following individuals must pass a written examination to be licensed as a life insurance agent? A resident of New York wishing to transact business in New York When an insurer offers services like preadmission testing, second opinions regarding surgery, and preventative care, which term would best apply? Case management provision An individual applies for a life policy. Two years ago he suffered a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. He has also been hospitalized for drug abuse, but does not remember this when applying for insurance. The insurer issues the policy and learns of his history one year later. What will probably happen? The policy will not be affected. The purpose of managed care health insurance plans is to Control health insurance claims expenses. To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters? 6 credits If seeking repayment of Medicaid funds per the Medicaid Estate Recovery Act would cause a hardship to survivors, states may Waive the estate recovery requirement. The insuring clause of a disability policy usually states all of the following EXCEPT The method of premium payment. Which of the following statements regarding Business Overhead Expense policies is NOT true? Benefits are usually limited to six months. At what point must an Outline of Coverage be delivered? At the time of application or upon delivery of the policy A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called Prepaid plan. Medicaid provides all of the following benefits EXCEPT Income assistance for work-related injury. What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid? Prospective review Which of the following programs expands individual public assistance programs for people with insufficient income and resources? Medicaid When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery? A statement of good health The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT Individual tax deduction for premiums paid. Pertaining to insurance, what is the definition of a fiduciary responsibility? Promptly forwarding premiums to the insurance company Which of the following persons would qualify for Medicare Part A? Anyone who has permanent kidney failure A rating method in which the premium is the same for all covered persons, regardless of age, sex, or health status is referred to as Community rating What is the purpose of Medigap policies? To cover expenses for Medicare deductibles and coinsurance Under which of the following circumstances may the uniform individual accident and sickness policy provisions be changed? If the change is more favorable to the policyholder In an HMO policy, one of the main responsibilities of the primary care physician (PCP) as a gatekeeper is to do which of the following? Help control costs Short term less than 2 years