NY LAH Practice Exam

A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim?

Claim is denied if his policy contains the Illegal Occupation provision

What process will the insurance company use to monitor the insured's hospital stay to make sure that everything is proceeding according to schedule?

Concurrent review

Which of the following provisions must be included on the first page of a Medicare supplement policy, which states the insurer's right to change premium amounts?

Continuation provision

The type of policy that can be changed from one that does not accumulate cash value to the one that does is a...

Convertible Term Policy

The type of insurance sold to a debtor and designed to pay the amount due on a loan if the debtor dies before the loan is repaid is called

Credit life

Which of the following is NOT allowed in credit life insurance?

Creditor requiring that a debtor buys insurance from a certain insurer

Disability income policies can provide coverage for a loss of income when returning to work after recovering from total disability. What is the name of this policy?

Residual disability

An agent in another state wants to become an agent in New York. The other state gives the same privileges to New York agents wanting to be licensed in that state as it does its own agents. New York, therefore, extends the privileges of its agents to the prospective agent of the other state. What is this called?

Reciprocity

Under the Fair Credit Reporting Act, if a consumer challenges the accuracy of the information contained in a consumer or investigative report, the reporting agency must

Respond to the consumer's complaint.

A policyowner who is also the insured wants to name her husband as the beneficiary of her life policy. She also wishes to retain all of the rights of ownership. The policyowner should have her husband named as the

Revocable beneficiary

An applicant has a history of heart disease in his family, so he would like to buy a health insurance policy that strictly covers heart disease. What type of policy is this?

Specified coverage

In order to be a licensed life settlement broker, a person must complete which of the following requirements?

Submit fingerprints

After three years of making payments into a flexible premium deferred annuity, the owner decides to surrender the annuity. The insurer returns all the premium payments to the owner, except for a predetermined percentage. What is this percentage called?

Surrender charge

A producer is helping a married couple determine the financial needs of their children in the event one or both should die prematurely. This is a personal use of life insurance known as

Survivor protection

All of the following would be different between qualified and non-qualified retirement plans EXCEPT

Taxation on accumulation

All of the following entities regulate variable life policies EXCEPT

The Guaranty Association

What is the maximum age for qualifying for a catastrophic plan?

30 years old

What is the purpose of the New York State Partnership for LTC?

It combines LTC insurance and Medicaid to help people prepare for nursing home care

All of the following statements are true regarding installments for a fixed period annuity settlement option EXCEPT

It is a life contingency option

Which of the following is true of a children's rider added to an insured's permanent life insurance policy?

It is term coverage that is convertible to permanent insurance at or prior to the child reaching the maximum coverage age.

Which of the following is true about the premium on the children's rider in a life insurance policy?

It remains the same no matter how many children are added to the policy

If a contract provides a set amount of income for two or more persons with the income stopping upon the first death of the insured, it is called a...

Joint life annuity

Life expectancy is used in the calculation of which of the following?

Life settlements

A policyowner is reading a statement on the first page of his health insurance policy, which says "this is a limited policy." What is the name of this statement?

Limited Policy Notice

Who might receive dividends from a mutual insurer?

Policyholders

An employer has sponsored a qualified retirement plan for its employees where the employer will contribute money whenever a profit is realized. What is this called?

Profit sharing plan

In respect to the consideration clause, which of the following is consideration on the part of the Insurer?

Promising to pay in accordance with the contract terms

A couple owns a life insurance policy with a Children's Term rider. Their daughter is reaching the maximum age of dependent coverage, so she will have to convert to permanent insurance in the near future. Which of the following will she need to provide for proof of insurability?

Proof of insurability is not required

Under which provision can a physician submit claim information prior to providing treatment?

Prospective Review

Which state has jurisdiction over a group policy that covers individuals that reside in more than one state?

The state in which the policy was delivered

The Omnibus Budget Reconciliation Act of 1990 (BRA) requires that large group health plans must provide primary coverage for disabled individuals under

Age 65 who are not retired

What is the maximum fine for violating a cease and desist order?

$5,000

The life insurance policy clause that prevents an insurance company from denying payment of a death claim after a specified period of time is known as the

Incontestability clause

If a hearing is scheduled for a producer who has violated regulations regarding unfair trade practices, the Superintendent must send a prior notice within how many days of the hearing?

10 days

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

Which of the following must the patient pay under Medicare Part B?

20% of covered charges above the deductible

In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, how man days should be allowed for payment?

30 days of birth

Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months?

30 months

The inflation protection feature in long-term care policies issued in this state must provide protection for inflation at what percent annually?

5%

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

According to the Medical Loss Ratio (MLR), what is the minimum percentage of health coverage premium that must be applied to actual medical care in an individual health plan?

80%

An insured pays a $100 premium every month for his insurance coverage, yet the insurer promises to pay $10.000 for a covered loss. What characteristic of an insurance contract does this describe?

Aleatory

A hospital indemnity policy will pay

A benefit for each day the insured is in a hospital

An independent adjuster may include which of the following?

A firm who acts on behalf of the insurer

An insured carries health insurance with two different providers and is covered on an expense incurred basis. He has an appendectomy and files the claims to both insurers. Neither company is notified in advance that the insurer has other coverage. What should each insurer pay?

A proportionate amount

An insured pays $1,200 annually for her life insurance premium. The insured applies this year's $300 worth of accumulated dividends to the next year's premium, thus reducing it to $900 What option does this describe?

Accumulation at Interest

All of the following are essential benefits required to be included in all health plans purchased in the Marketplace EXCEPT

Adult dental care

In which Medicare supplemental policies are the core benefits found?

All plans

Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?

An individual who was previously covered by group health insurance for 6 months is eligible.

In a shared-care policy, the benefits of 2 LTC policies....

Are split between the couple who signed the contract

At what point must an Outline of Coverage be delivered?

At the time of application or upon delivery of the policy

Which of the following protects the insured from an unintentional policy lapse due to a nonpayment of premium?

Automatic premium loan

In which of the following scenarios will repayment of funds take place per the Medicaid Estate Recovery Act?

Before her death, a 23-year-old was living in a long-term nursing facility paid for with Medicaid funds

A policy available to business owners that provides payment for normal business expenses in the event that the owner is disabled is called

Business Overhead Expense

A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability?

Business overhead expense policy

A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following?

Cash to the owner's business partner to accomplish a buyout

What type of benefit plan for group health insurance will provide coverage in the event of a catastrophic illness or injury?

Catastrophic Care Benefit Plan

When must an IRA be completely distributed when a beneficiary is not named?

December 31 of the year that contains the fifth anniversary of the owner's death

When a producer was reviewing a potential customer's coverage written by another company, the producer made several remarks that were maliciously critical of that other insurer. The producer could be found guilty of

Defamation

Which of the following is NOT a cost-saving service in a medical plan?

Denial of coverage

An insured has medical insurance coverage through 2 different providers, both covering the same expenses on an expense-incurred basis. Neither company knows in advance that the insured has coverage through any other insurers. The insured submits a claim to both insurers, How should the claim be handled?

Each insurer should pay a proportionate share of the claim.

OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage?

End-stage renal failure

The authority granted to an agent through the agent's contract is referred to as

Express authority

An agent selling variable annuities must be registered with...

FINRA

Under a 20-pay whole life policy, in order for the policy to pay the death benefit to a beneficiary, the premiums must be paid

For 20 vears or until death, whichever occurs first

When doing business in this state, an insurance company that is formed under the laws of another state is known as which type of insurer?

Foreign

All of the following are business uses of life insurance EXCEPT

Funding against company's general financial loss

Which of the following coverages is NOT monitored by the Employee Retirement Income Security Act (ERISA)?

Golden parachutes

According to the nonforfeiture law, if the owner decides to surrender a deferred annuity prior to annuitization, the owner is entitled to which of the following?

Guaranteed surrender value

An individual purchased a life insurance policy on his life naming his wife as primary beneficiary, and their daughter as contingent beneficiary. Under what circumstances could the daughter collect the death benefit?

If the primary beneficiary predeceases the insured

Upon the submission of a death claim under a life insurance policy, when should the insurer pay the policy benefit?

Immediately after receiving written proof of loss

The premium of a survivorship life policy compared with that of a joint life policy would be

Lower

Which of the following is NOT true regarding the needs approach method of determining the value of an individual's life?

Need is predicted using the number of years until the insured's retirement

According to the Insurance Frauds Prevention Act, will the person who suspects a fraudulent transaction be penalized for reporting it to the Superintendent?

No, as long as the act is reported in good faith

Which renewal provision(s) must be included in a long-term care policy issued to an individual?

Noncancellable and guaranteed renewable

When is the annual open enrollment for state insurance exchanges?

November 1 - January 31

Which option is being utilized when the insurer accumulates dividends at interest and then uses the accumulated dividends, plus interest, and the policy cash value to pay the policy up early?

Paid-up option

Which of the following statements is INCORRECT concerning Medicare Part B coverage?

Part B coverage is provided free of charge when an individual turns age 65

What type of policy contains a coverage that is only activated upon the insured's losses reaching a certain level?

Partially funded plan

An insured purchased a life policy in 2010 and died in 2020. The insurance company discovers at that time that the insured had misstated information about her insurance history on the application. What will the insurer do?

Pay the death benefit

The causes of loss insured against in an insurance policy are known as

Perils

Health plan metal classes

Platinum = 90% Gold = 80% Silver = 70% Bronze = 60%

Which of the following does NOT have to be disclosed in a long-term care (TC) policy?

The aggregate amount of premiums due

Upon the death of the insured, the primary beneficiary discovers that the insured chose the interest only settlement option. What does this mean?

The beneficiary will only receive payments of the interest earned on the death benefit

Who is the owner and who is the beneficiary on a Key Person Life Insurance policy?

The employer is the owner and beneficiary

In a disability policy, the elimination (or waiting) period refers to the period between

The first day of disability and the day the insured starts receiving benefits.

Which of the following is TRUE regarding variable annuities?

The funds are invested in the company's general account

An insured has a heart attack 40 days after his new health insurance policy goes into effect. He has a quadruple bypass surgery and a long hospital stay. As a result, the insurer cancels the policy with a written notice 80 days after the effective policy date. Which of the following is true?

The insurer is cancelling the insured's policy on illegal grounds

Which of the following is NOT a feature of a non-cancellable policy?

The insurer may terminate the contract only at renewal for certain conditions

An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true?

The pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off.

Which of the following statements regarding conditional receipts is true?

They are temporary insuring agreements

All of the following statements about Medicare supplement insurance policies are correct EXCEPT

They cover the cost of extended nursing home care

For what reason may a life insurance producer backdate a life insurance policy?

To avoid an increase in premium rate for the insured

For which of the following reasons can a temporary license be issued?

To service existing business

Which of the following would least likely be considered a legitimate need that would be paid by insurance proceeds?

Vacation travel expenses

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

A health insurance policy may cover all of the following risks EXCEPT

War-related injuries

If an applicant for a life insurance policy and person to be insured by the policy are two different people, the underwriter would be concerned about

Whether an insurable interest exists between the individuals

In a group life insurance policy, the employer may select all of the following EXCEPT

the beneficiary

Child Health Plus provides health insurance for children

Whose families meet income guidelines