PSI - NY Life, Accident and Health Practice Exam 17-55, Just my cards + 199+ 75 ( TEST) (LOT) | 527 expert curated questions and answers

Which policy provision permits the policy owner to take a specified number of days to examine the contract, and allows for cancellation and a full refund if the policy owner rejects the terms or costs?

Free Look

When will a policy pay on a UCR basis?

When particular benefits are not listed on a payment schedule

Which type of rider reimburses health and social service expenses incurred in a convalescent or nursing home facility?

long term care rider

Which of the following is exempted from the incontestability provision in insurance policies?

Fraudulent misstatements

What does first dollar coverage mean?

As soon as covered medical expenses are incurred, the policy begins to pay

What is the waiver of premium provision?

In a long term care contract, the premium is waived after the insured has been confined for a specific period of time

According to the Time Payment of Claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT

for claims involving periodic payments

Which is a disadvantage to a flexible premium annuity?

the actual amount of the annuity benefit cannot be determined in advance

When a policy or certificate containing an accelerated benefit provision is applied for or delivered, the producer is responsible for providing that applicant a summary of coverage that includes all of the following EXCEPT

a detailed and comprehensive summary of the accelerated benefit

which one of the following represents an advantage of obtaining a policy loan versus a withdrawal?

the loan is not taxed while a withdrawal is taxed for amounts above the contract cost basis

How does a noncancelable policy differ from a guaranteed renewable policy?

with the non cancelable policy the insurer may increase premiums only based on the terms of the policy

What does it mean if a health policy is conditionally renewable?

Insurer may elect NOT to renew only under the conditions specified in the policy

When the suicide clause is inserted in a life insurance contract, death by suicide is not covered during the policy's initial:

2 year period

What does coinsurance mean?

The insurer and the insured share expenses over the deductible.

Which of the following must be given to the insurer within 20 days after occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible?

Notice of claim

The right to change the beneficiary or dispose of the policy or its benefits in any manner one chooses is reserved to the policy owner UNLESS which of the following is true?

The policy owner has named an irrevocable beneficiary

Which of the following refers to how often a premium is paid?

Mode

All of the following are common exclusions from loss found in disability income policies EXCEPT for that incurred while

Committing a misdemeanor

At which point are contractual death benefit settlement options determined and by whom are they determined?

At the time the policy is purchased by the owner of the policy

All of the following are ownership rights EXCEPT

Switching the policy from one insured to another

All of the following are TRUE regarding incomplete applications EXCEPT

The incomplete application can be accepted with the missing information added later

A consumer report used to determine eligibility for insurance may include all of the following EXCEPT

Medical underwriting exam

All of the following are required signatures on a life insurance application EXCEPT

The minor in a juvenile policy

Why are insurance policies considered conditional contracts?

Certain conditions need to be met to make the contract legally enforceable.

When does insurable interest come into play in a life insurance policy?

when the applicant for the policy is not the insured

Which of the following occurs immediately after the application is submitted and the initial premium paid?

the underwriting process begins

Obtaining consumer information reports under false pretenses is prosecutable by which of the following?

Fair Credit Reporting Act

What is the purpose of Stranger-originated life insurance (STOLI)?

the policy is originated primarily or solely for the purpose of resale

All of the following are classifications of risk EXCEPT

non-nicotine

What specific new procedures does the USA Patriot Act require of insurance companies?

Establish an anti-money laundering program

What procedure is used by an insurer to protect itself in the event a dispute arises and the applicant and the agent do not recall the changes that were made in a completed application?

The applicant and possibly the agent initial any changes made.

What is a MIB report?

medical information on an applicant for assessing life or health insurance risk

How do warranties differ from representations?

a warranty is guaranteed to be true, a representation is believed to be true to the best of one's knowledge.

If the insurer wishes to share an applicant's HIV status, the applicant must be given full notice of all of the following EXCEPT

the treatment procedures that are covered by the policy.

Which of the following was specifically designed to address STOLI and IOLI practices?

NCOIL Act

Why is rehabilitation considered worthy of federal help under workers' compensation?

it reduces insurance losses and helps regain the worker's dignity

In a case where an individual's health is insured by both their own policy and their spouse's policy, which policy pays in the event of an illness?

The individual's policy pays first, the spouse's policy pays the remaining up to coverage amount.

The group conversion option is allowed for all of the following EXCEPT

during the annual benefits enrollment period.

What type of insurance should a company purchase if it wants to insure the life of its CEO?

key person insurance

All of the following are tax qualified retirement plans EXCEPT

Section 529 plan.

Why is relying solely on employer group life insurance generally considered inadequate for most individual's needs?

It is financially insufficient to cover end of life expenses.

For an individual long-term care policy there is an annual dollar limit for tax deductions that is based on which of the following?

age

When can the premiums of an individually owned health insurance policy be deducted from the individual's income tax?

when the taxpayer's medical expenses exceed 7.5% of adjusted gross income during a taxable year

In noncontributory plans, which percentage of eligible members must participate?

100%

Short term disability insurance generally only covers injuries due to which of the following?

Non-occupational injuries

Managed care plans increase efficiency by all of the following means EXCEPT

transferring the management of costs to the insureds.

Under which situation must insurable interest exist between the applicant and insured at the time of application?

When a third-party applicant names themselves beneficiary

Which of the following is characteristic of a nonqualified plan?

plan does not meet federal guidelines for tax benefits

In a home healthcare benefit, all of the following are eligible expenses EXCEPT

blood transfusions

All of the following are requirements to qualify for Social Security disability benefits EXCEPT when

unable to work in occupation in which the worker was trained or educated

How long after being entitled to disability benefits will an individual be eligible to receive Medicare benefits?

2 years

Which of the following amends the Social Security Act to make Medicare secondary to group health plans?

TEFRA

Which of the following is TRUE of a point of service plan?

A patient's care is coordinated by an in-network primary care physician.

A group conversion option may be used in all the following instances EXCEPT

a life-changing event, such as marriage, divorce, or childbirth

Which problem was universal life insurance designed to address?

low interest rates during periods of high inflation

Compared to basic hospital, medical and surgical policies, which type of insurance provides broader coverage, fewer gaps, higher individual benefits, and higher policy maximums?

major medical insurance

Current assumption whole life policies are sensitive to which of the following?

interest rates

Which is the major reason why long term care insurance is becoming increasingly important?

As life expectancy increases, the chances of needing long term care also increase

Which of the following is defined as the dollar amount beyond which the insured no longer participates in payment of medical expenses?

Stop Loss Limit

Which is the primary purpose of Health Reimbursement Accounts (HRAs)?

To assist covered employees with the payment of medical expenses on a high deductible plan funded through pre-tax contributions.

States generally define a true "group" for insurance as requiring a minimum of how many participants?

10

When should a buy-sell agreement include a provision for the buy-out of an owner's business interest in the event of a disability?

When there is a buy-sell agreement funded with life insurance to buyout the interest of a deceased owner or partner.

Which type of life policy can be continued year after year without a required medical examination but rates are dependent on the insured's current age?

renewable term

Which of the following is true about a decreasing term life policy?

The face amount reaches zero at policy expiration.

Which of the following is TRUE of the limited pay whole life policy?

Coverage continues after the policy is paid-up.

Which of the following is a characteristic of Preferred Provider Organizations (PPOs)?

prearranged costs for services rendered

All of the following are characteristics of variable whole life EXCEPT

there is no guaranteed minimum death benefit.

Which of the following policy types is considered double indemnity?

accidental death

Which of the following lists the three common types of permanent individual life insurance?

Variable Life, Whole Life, Universal Life

Which of the following is TRUE for a flexible premium annuity?

The purchaser has the option to vary the amount of each premium payment falling between a minimum and maximum amount.

Which type of annuity covers two or more annuitants and provides monthly income only until the first annuitant dies?

Joint Life Annuity

Which of the following coverage types pays a monthly cash benefit following the elimination period for total disability due to accident or sickness?

Disability income insurance

In which of the following does a covered employee agree to a reduction in compensation so the amount can be used to cover medical expenses?

Flexible Spending Account (FSA)

Which of the following is covered by a dread disease policy?

illnesses that do not occur frequently but incur significant costs when they do occur

Which insurance plans are commonly offered through the worksite (employer sponsored) EXCEPT?

Medicare

Process 2103 (d-i)

1. The Superintendent may issue a license to any person, firm or corporation who has complied with the requirements of the Insurance Code, authorizing the licensee to act as agent of any authorized insurer. Every individual applicant for a license under this section and every proposed sub-licensee must be 18 years of age or older at the time of issuance of such license. The person must submit to and pass a written examination required by the Superintendent.

Producer Definition (2101(k))

An insurance producer means an insurance agent, insurance broker, reinsurance intermediary, excess lines broker, or any other person required to be licensed under the insurance laws of this state to sell, solicit or negotiate insurance.

Who Should be Licensed (2101(k)(1))

1. The term "insurance producer" does not include: An officer, director or employee of a licensed insurer, fraternal benefit society or health maintenance organization or of a licensed insurance producer, provided that the officer, director or employee does not receive any commission on policies written or sold to insure risks residing, located or to be performed in this state and:

(a) the officer, director or employee's activities are executive, administrative, managerial, clerical or a combination of these, and are only indirectly related to the sale, solicitation or negotiation of insurance;

(b) the officer, director or employee's function relates to underwriting, loss control, Inspection or the processing, adjusting, investigating or settling of a claim on a contract of Insurance; or (c) the officer, director or employee is acting in the capacity of a special agent or agency supervisor assisting licensed insurance producers where the person's activities are limited to providing technical advice and assistance to licensed insurance producers and do not include the sale, solicitation or negotiation of insurance.

Home State (2101(l))

Home state means the District of Columbia or any state or territory of the United States in which an insurance producer maintains his, her or its principal place of residence or principal place of business and is licensed to act as an insurance producer.

Negotiate (2101(m))

Negotiate or negotiation means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from licensed insurers, fraternal benefit societies or health maintenance organizations for purchasers.

Sell (2101(n))

Sell or sale means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of a licensed insurer, fraternal benefit society or health maintenance organization.

Solicit (2101(o)) -

Solicit or solicitation means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular licensed insurer, fraternal benefit society or health maintenance organization.

Agent 2101(a)

In this section, insurance agent means any authorized or acknowledged agent of an insurer, fraternal benefit society or health maintenance organization issued a certificate of authority pursuant to the public health law, and any sub-agent or other representative of such an agent, who acts as such in the solicitation of, negotiation for, or sale of, an insurance, health maintenance organization or annuity contract, other than as a licensed insurance broker.

Agent 2101(k)

insurance producer means an insurance agent, insurance broker, reinsurance intermediary, excess lines broker, or any other person required to be licensed under the insurance laws of this state to sell, solicit or negotiate insurance.

The applicant must be at least 18 years of age at the time of license issuance.

An examination is required for each applicant, except where noted for applicants with a change in residency moving to New York (see code 2103 below).

Brokers 2101(c)

a licensed insurance representative who does not represent a specific insurance company, but places business among various companies. Legally, the broker is usually regarded as a representative of the insured rather than the insuring company.

Brokers 2101(h)

any licensed attorney at law of this state.

Consultants (2107)

The Superintendent may issue an insurance consultant's license to any person, firm, association or corporation who or which has complied with the requirements of this chapter with respect to either: life insurance, meaning all of those kinds of insurance authorized. Any such license issued to a firm or association shall authorize only the members of such firm or association named in such license as sub-licensees to act individually as consultants there under, and any such license issued to a corporation shall authorize only the officers and directors thereof named in such license as sub-licensees to act individually as consultants there under.

Adjuster 2101(g)

The Superintendent may, in his discretion require an applicant for a license under this section to present evidence, in such form as he prescribes, that such applicant has been employed, for a period which he deems reasonable, by an insurer, an independent adjuster or a public adjuster, in the performance of duties which in his opinion would provide the applicant with a satisfactory preliminary training for the duties and responsibilities which would evolve upon him as a licensee under this section. The term independent adjuster means any person, firm, association or corporation who for money, commission or any other thing of value, acts in this state on behalf of an insurer in the work of investigating and adjusting claims arising under insurance contracts issued by such insurer and who performs such duties required by such insurer as are incidental to such claims and also includes any person who for compensation or anything of value investigates and adjusts claims on behalf of any independent adjuster.

Adjuster 2108

Adjusters will be licensed as either independent adjusters, or as public adjusters. The Superintendent may prescribe the types of independent adjusters' licenses according to the kind or kinds of insurance claims which the licensee is to be authorized to investigate and adjust. No adjuster may act on behalf of an insurer unless licensed as an independent adjuster, and no adjuster may act on behalf of an insured unless licensed as a public adjuster. A public adjuster works on behalf of the insured for a fee.

Nonresident 2101(d)

In this section, non-resident insurance agent means an individual who is a non-resident of this state and who is licensed or authorized to act as an insurance agent in the state in which he resides, or in which he or the firm or association of which he is a member or employee, or the corporation, of which he is an officer, director, or employee maintains an office as an insurance agent.

Nonresident 2101(e)

In this section, "non-resident insurance broker", means an individual who is a non-resident of this state and who is licensed or authorized to act as an insurance broker in the state in which he resides, or in which he, or the firm or association of which he is a member or employee, or the corporation, of which he is an officer, director or employee maintains an office as an insurance broker.

Nonresident 2103(g)(5)

In the discretion of the Superintendent, no written insurance examination will be required of any individual seeking to be named as a licensee or sub-licensee who is a non-resident insurance agent.

Nonresident 2103(g)(11)

No written insurance examination will be required of any individual who applies for an insurance agent license in this state who was previously licensed for the same line or lines of authority in another state, provided, however, that the applicant's home state grants non-resident licenses to residents of this state on the same basis. Such individual shall also not be required to complete any prelicensing education. This exemption is only available if the person is currently licensed in that state or if the application is received within 90 days of the date of cancellation of the applicant's previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state's producer database records, maintained by the National Association of Insurance Commissioners, its affiliates or subsidiaries indicate that the producer is or was licensed in good standing for the line of authority requested. An individual or entity licensed in another state that moves to this state must make an application within 90 days of establishing legal residence to become a resident licensee. No prelicensing education or examination will be required of that person to obtain any line of authority previously held in the prior state except where the Superintendent determines otherwise by regulation.

Nonresident 2136 - Reciprocity

The Superintendent shall waive any requirements for a nonresident license applicant otherwise applicable under this chapter if:

(a) the applicant has a current and valid license in his or her home state and is in good standing in his or her home state;

(b) the applicant has submitted a completed application in the form prescribed by the Superintendent or submitted the application for licensure submitted to his or her home state;

(c) the applicant has paid the fees required by this chapter; and

(d) the applicant's home state awards nonresident insurance producer licenses to residents of this state on the same basis as provided in this subsection.

Business Entities 2101(p)

A business entity means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity.

Business Entities 2103(e)

Before any original insurance agent's license is issued to a business entity, there must be on file in the office of the Superintendent an application by the prospective licensee in such form or forms and supplements, and containing information the Superintendent prescribes and for each business entity, the sub-licensee or sub-licensees named in the application must be designated responsible for the business entity's compliance with the insurance laws, rules and regulations of this state.

Temporary License (2109; Regs. 9, 18, 29, Part 20.1)

A temporary license may be issued in the case of death, service in armed forces or disability. The Superintendent may issue a temporary insurance agent's or insurance broker's license, or both, without requiring the applicant to pass a written insurance examination or to satisfy certain requirements except as to age in the following cases:

(1) In the event of the death of a person who at the time of his death was a licensed accident and health insurance agent;

(a) to the executor or administrator of the estate of such deceased agent or broker;

(b) to a surviving next of kin of such deceased agent or broker, where no administrator of his estate has been appointed and no executor has qualified under his duly probated will;

(c) to the surviving member or members of a firm or association, which at the time of the death of a member was such a licensed insurance agent or licensed insurance broker; or

(d) to an officer or director of a corporation upon the death of the only officer or director who was qualified as a sub-licensee or to the executor or administrator of the estate of such deceased officer or director;

(2) to any person who may be designated by a person licensed pursuant to this chapter as an insurance agent, or an insurance broker, or both, and who is absent because of service in any branch of the armed forces of the United States.

(3) to the next of kin of a person who has become totally disabled and prevented from pursuing any of the duties of his or her occupation, and who at the commencement of his or her disability the license or licenses may be issued for a term not exceeding 90 days from the death of such additional term or terms of 90 days each, not exceeding in the aggregate 15 months.

The Superintendent may issue renewal licenses for an additional term or terms of 90 days each exceeding the a

Renewal (2103(j); Reg. 5, Part 21.2)

All individual insurance agent licenses must be renewed every two years. Individual licenses are issued with an expiration date determined by the date of birth:

The license of an agent born in an even numbered year will expire on the agent's birthday in an even numbered year.

The license of an agent born in an odd numbered year will expire on the agent's birthday in an odd numbered year

Adjuster licenses are not determined on a birth date renewal. Adjuster licenses expire on December 31st of even-numbered years.

Resident Licensees

All licensed agents, brokers, consultants and public adjusters must complete continuing education (CE) requirements as a condition of renewing these licenses. Licensees must complete 15 credits of approved continuing education during each biennial licensing period.

After your license has been renewed the first time, continuing education (CE) will always be required upon subsequent renewal or relicensing applications. Credits must be accumulated during the renewal period, which begins with the effective date of the license and ends with the expiration date. CE must be completed before processing the renewal or relicensing application.

Assumed Names (2102(f))

Licensees must notify the Superintendent upon changing his, her or its legal name. Except for an individual licensee's own legal name, no licensee may use any name, in conducting a business regulated by this article that has not been previously approved by the Superintendent.