NY state insurance license practice exam questions/answers GRADE A+ SOLUTIONS

Under what circumstance does an accident and health insurer have the right to request an autopsy? 1. When the claim exceeds an amount specified in the policy 2. When 2 days have passed after death 3. When not prohibited by state law 4. When consent is given by the beneficiary 3. When not prohibited by state law Which of the following accurately describes the "time limit on certain defenses"? 1. After a stated period of time, claims cannot be denied due to material misrepresentation on the application 2. All claims can be disputed after two years 3. An insured cannot file a lawsuit within 90 days of the claim being filed 4. The right to return an accident and health policy must be within 10 days of policy delivery 1. After a stated period of time, claims cannot be denied due to material misrepresentation on the application Patrick purchased a long-term care policy. He has a health condition for which medical treatment was recommended by a physician within 6 months prior to the policy's effective date. This condition is called a(n) 1. antecedent condition 2. pre-existing condition 3. hazardous condition 4. grandfathered condition 2. pre-existing condition Which of the following describes coverage for the Medicare Part B coinsurance? 1. Only a Long-term care policy will cover Medicare Part B coinsurance 2. A Medicare Supplement optional benefit 3. A Medicare Supplement core benefit 4. Medicare Part B does not require a coinsurance so no additional coverage is needed 3. A Medicare Supplement core benefit Larry has a Major Medical Expense policy for his family with a $1,000 per family/per year deductible and an 80/20 coinsurance provision. If Larry's family files four claims of $400, $800, $100, and $700 in one year, how much will the insurance company pay? 1. $500 2. $800 3. $1,000 4. $1,200 2. $800 (($400 + $800 + $100 + $700 = $2,000. The insurance company pays 80% of $1,000 (outstanding balance after deductible is paid), or $800.)) Long-term care policies issued in New York must provide benefits for at least 1. 6 months 2. 12 months 3. 18 months 4. 24 months 2. 12 months Which of the following types of insurers limits the exposures it writes to those of its owners? 1. Restricted insurer 2. Limited insurer 3. Confined insurer 4. Captive insurer 4. Captive insurer Notice of information practices must be given to a policyholder at least 1. every year 2. every two years 3. every three years 4. every four years 3. Every three years What is the elimination period of an individual disability policy? 1. Time period an insured must wait before coverage begins 2. Time period a disabled person must wait before benefits are paid 3. Time period after the policy issue date in which the provisions are still contestable 4. The point in time when benefits are no longer payable 2. Time period a disabled person must wait before benefits are paid An individual long-term policy must be renewable 1. To age 65 2. To age 75 3. To age 85 4. For life 4. For life When the New York Superintendent of Insurance examines a licensee's insurance records, the primary purpose is to determine 1. The licensee's sales volume 2. The solvency of the licensee's personal accounts 3. The number of insurers represented 4. The licensee's compliance with state insurance law regulations 4. The licensee's compliance with state insurance law regulations Medicare supplement insurance that provides a preventative medical care benefit will often cover 1. respite care 2. hospitalization 3. custodial care 4. yearly physical examinations 4. yearly physical examinations A family group accident and health insurance policy must continue coverage for each unmarried child at least until age 1. 16 2. 18 3. 19. 4. 21 3. 19 When long-term care insurance is replaced, the insurer issuing the new policy cannot 1. impose a new pre-existing conditions exclusion 2. Charge higher premiums than applied under the replaced policy 3. Require a physical examination 4. Provide a lesser benefit than was available under the replaced policy 1. Impose a new pre-existing conditions exclusion Accident and health insurance standard provisions require that 1. The policy, endorsements, and attached papers constitute the entire contract 2. Policies contain a coordination of benefits provision 3. Nonpayment of premium by the due date constitutes irrevocable cancellation by insured 4. The time for payment of claims may be waived by the insured 1. The policy, endorsements, and attached papers constitute the entire contract Why does New York law require an insurance agent to examine the existing Medicare Supplement policies of a prospective insured? 1. To uncover instances of unfair trade practices 2. To increase the agent's practical knowledge of insurance 3. To monitor insurance company compliance 4. To determine the suitability of potential changes 4. To determine the suitability of potential changes An insured must notify an insurer of a medical claim within how many days after an accident? 1. 10 2. 20 3. 30 4.40 2. 20 days A reciprocal insurer typically has an administrator who manages the premiums collected from the group's members. This administrator is called a(n) 1. reciprocal commissioner 2. attorney general CONTINUED.......