New York Insurance Test

Which of the following is NOT an exclusion in a long-term care policy?

Care for incurable conditions

Which of the following contracts enables the business owner who becomes disabled to transfer the business to a new owner and receive payment?

Disability Buy-Sell

A specified coverage plan would provide coverage for which of the following

Dread disease insurance

A circumstance that increases the probability of a loss is called a

Hazard

If there was a conflict between a policy provision and state statues the policy

It may be altered to conform to the statutes. The Conformity with State Statutes Provision states that any conflicting provisions must be changed. Although this is technically an optional provision, many states require its inclusion in insurance policies.

Which of the following is not considered a limited policy?

Major medical expense insurance

When members use the services of a preferred provider organization they are typically

PPO

In most cases, enrollment in which medicare coverage part requires no premium and is automatic for individuals who receive social security benefits?

Part A

Which of the following medicare plans allows participants to choose to receive their benefits through a managed health care plan?

Part C

Knowingly accepting insurance business from an individual who is not licensed to provide that business may result in

The Superintendent may suspend, revoke, or refuse to continue the license of a producer, consultant, adjuster, or life settlement broker

The insured, who is 59 years of age decides to replace a long-term care policy they had for five years for a new policy. Which of the following is true of the insurer?

The replacement insurer will not honor previous exclusions that had previously been satisfied under the original policy.

L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?

$900 (deductible + 20% of the bill after the deductible [20% of $2,000])

Which of the following is an example of an unfair claim settlement practice?

-Trying to discourage a claimant from arbitrating a claim by implying that arbitration might result in an award lower than the amount offered -Failure to promptly settle a claim when liability has been clearly established After a claim has been adjusted and is found to be covered under the policy, the insurer must pay the claim upon receipt of a signed proof of loss.

Insurance agents have duties and responsibilities to

-help clients settle any claims on their insurance -identifying sales opportunities for insurance plans and overseeing a portfolio of clients

Some states have laws ensuring that health insurance coverages are available at a reasonable cost and under reasonable conditions for small employers. Small employers are defined as having no more than

100 employees

For group medical and dental expense insurance, what percentage of premium paid by the employer is deductible as a business expense?

100%

What is the maximum amount of co-insurance in New York's major medical plans?

25 %

Dependent children can be covered under an individual's group plan up to what age?

26

The Patient Protection and Affordable Care Act mandates that insurers provide coverage for adult children up to the age of?

26

Group health contracts must cover mentally or physically dependent children till when

29

for at least how many years MUST an insurance producer

3 years

When an accident and health policy requires payment of an additional premium to provide coverage for a newborn baby, how many days after the birth is the first payment due?

31 days

An employer offers a short-term disability plan to its employees. How much of a given employee's income would be covered under the plan?

70%

Social security total disability is the inability to engage in any gainful activity due to physical or mental disability for at least how many months?

12 months

When will claims related to preexisting conditions be covered when getting a new job?

6 months

Which of the following events, if any, will terminate guaranteed renewable insurance coverage?

A guaranteed renewable insurance coverage cannot be terminated

Affordable Care Act Percentage

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

Under the fair credit reporting act, all of the following are considered to be negative information about a consumer except A. late payments B. failure to pay off a loan C. Disputes regarding consumer report information D. Tax delinquencies

Disputes regarding consumer report information

Individuals who are eligible for medicare on the first day of the month

If you qualify for Premium-free Part A: Your Part A coverage starts the month you turn 65. (If your birthday is on the first of the month, coverage starts the month before you turn 65.)

Medicare Advantage is known as?

Medicare Part C

Primary consideration in replacing a health insurance policy

Pre-existing conditions

Which of the following is described when a selected group of practitioners in a certain area agrees to provide services at pre-arranged cost on a fee-for-service basis?

Preferred provider organizations (PPO)

Which of the following documents describes the coverage, conditions, and limitations found in the master policy of a group contact?

The certificate of coverage and benefits

Which statement is true if a member suffers a broken leg while outside the Health insuring corporation (HIC) service area?

The injury will be covered as an emergency health service

Who of the following is required to be licensed as an insurance producer?

a business entity soliciting insurance

Effective January 1, 2014, all qualified health plans (i.e., those that conform to PPACA) must provide the following essential health benefits (EHBs) that cover an array of basic medical services:

ambulatory patient services emergency services hospitalization maternity and newborn care mental health and substance abuse disorder services prescription drugs rehabilitation services and devices laboratory services preventive and wellness services chronic disease management pediatric services

In a hospital indemnity plan, an elimination period refers to the number of days

an insured must wait before becoming eligible to receive benefits for each hospital stay

Medicare Part B covers

doctor's charges

when marketing to groups for health insurance who should be issued certificate as proof of coverage

employer

In order to be a licensed life settlement broker, a person must submit what to the Superintendent to be used for a criminal background check?

fingerprints

Which of the following is a mechanism to ensure a policy does not lapse?

grace period

All of the following preventive care services are provided by health insuring corporation primary care physicians except

hearing screenings for adults

A 65-year employee who works for an employer with 24 employees is disabled on the job. The employee had fully recovered and returned to work. Which health coverage is primary?

his employers group plan

What are benefits under the health New York program?

inpatient and outpatient hospital services physician services maternity care preventive health services diagnostic services mental health services chiropractic care prescription drugs ambulance emergency services

An application for an insurance must be accompanied by

insurer

The MAIN difference between occupational coverage and nonoccupational coverage is that occupational coverage

is mainly for hazardous occupations

Accident only is what type of policy

limited policies

Health insurance policies that can be purchased to cover specific low frequency diseases are

limited policies

Which of the following benefits is NOT provided under the Healthy New York program?

mental health

The primary difference between a non-cancelable policy and a guaranteed renewable policy is that only with a non-cancelable policy can the insurer

non-cancelable policies cannot have a premium change

When does New York cybersecurity regulation require the agency to conduct penetration tests again?

once a year

For three weeks next month a company's employees will choose to enroll or remain enrolled in their HMO or change health plans. What is this situation called?

open enrollment

Which of the following clauses states that insureds are totally disabled when they cannot perform their

own occupation

Under workers' compensation, injured employees are covered for all of the following losses except

pain and suffering

Disability policies most often pay benefits in the form of

periodic income

Under a long-term care inflation rider, the benefit levels

periodically increase without proof of insurability

The primary purpose of respite care is to

provide temporary relief for a primary caregiver

The main purpose of insurance is to

reduce risk

according to affordable act care, essential health benefits do NOT include which of the following categories

routine vision care for adults

In broad terms, the types of support and services generally associated with long term care policies are provided at which three levels of care?

services rendered at home, at adult care centers, or in nursing homes

Group disability-income insurance usually involves

short-term disability policies

Which rider allows the wife of the insured to be added to the primary insured's coverage?

spouse term rider

Members of Blue Cross and Blue Shield are known as

subscribers

Under the affordable care act, insurer may refuse to accept an internal appeal on a denied claim if

the insured is unable to pay an appeal fee

According to the affordable care act, essential health benefits do not include which of the following categories

they do cover emergency, pregnancy, and laboratory

Dependent children can continue to be covered under a parent's medical contract after reaching age 23 if

unmarried and a full-time student

When a provider does not have an agreement with the insurer for payment, they will be reimbursed

usual, customary, and reasonable fee

When managing a health insurance plan for a group the insurers administrative cost for each insured person

varies among all groups members

An insurer's intentional relinquishment of a known right is

a waiver