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Insurance Licensing NY-Life-Accident-and-Health Exam Syllabus Topics:

Section	Weight	Objectives
Accident and Health Insurance	35%	- Health Insurance Basics 1. Medical Expense and Disability Income 2. Group vs Individual Coverage - Government Health Programs 1. New York State Specific Programs 2. Medicare and Medicaid - Policy Provisions and Claims 1. Coordination of Benefits 2. Eligibility and Enrollment
Underwriting, Marketing and Sales Practices	15%	- Application and Underwriting Procedures 1. Risk Classification and Selection - Sales and Customer Service 1. Suitability and Disclosure Requirements
Insurance Regulation and General Principles	20%	- New York Insurance Code and Laws 1. Producer Responsibilities and Ethics 2. Unfair Trade Practices 3. Licensing Requirements and Procedures - Insurance Concepts 1. Risk Management and Insurable Interest 2. Contract Law and Policy Structure
Life Insurance Products and Provisions	30%	- Policy Provisions, Riders and Options 1. Beneficiary Designations 2. Non-forfeiture Values and Dividends - Types of Life Insurance Policies 1. Term, Whole Life, Universal Life 2. Annuities and Retirement Products

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Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 Sample Questions (Q76-Q81):

NEW QUESTION # 76
A Medicare Supplement policy must NOT contain benefits which

A. are covered by Workers Compensation.
B. charge additional premiums.
C. duplicate Medicare benefits.
D. cover more than Medicare coverage.

Answer: C

Explanation:
A Medicare Supplement policy (Medigap) is designed specifically to fill the gaps in coverage left by Medicare Parts A and B . These policies are standardized and regulated to ensure that they supplement, rather than replace or duplicate, Medicare benefits. The purpose of Medigap coverage is to help pay for certain out- of-pocket expenses , such as deductibles, copayments, coinsurance, and other costs that original Medicare does not fully cover. Because of this purpose, Medicare Supplement policies are not allowed to duplicate benefits that Medicare already provides . If a benefit were duplicated, it would violate the fundamental principle that Medigap policies are intended only to supplement existing Medicare coverage , not provide overlapping payments for the same services.
Option A is incorrect because insurers may charge premiums for the coverage provided under the policy.
Option C is incorrect because Medigap plans may include benefits that help pay expenses beyond Medicare's basic coverage limits (such as additional hospital days). Option D is incorrect because Workers' Compensation operates separately and is not the defining restriction placed on Medigap benefits. Therefore, Medicare Supplement policies must not duplicate Medicare benefits .

NEW QUESTION # 77
Under the Affordable Care Act, insurer may refuse to accept an internal appeal on a denied claim if

A. the appeal is filed more than 180 days after the claim denial.
B. the insured is unable to pay an appeal fee.
C. the insured has submitted three appeals within the calendar year.
D. the claim is under $500.

Answer: A

Explanation:
The Affordable Care Act (ACA) requires health plans to maintain a formal internal claims and appeals process and to provide access to external review when appropriate. A key consumer protection under the ACA is that, after a claim is denied (an "adverse benefit determination"), the covered person must be given a reasonable opportunity to appeal. Standard ACA claims-and-appeals rules provide a specific filing window for an internal appeal: the insured generally has up to 180 days from receipt of the denial notice to submit the appeal. If an appeal request is made after that deadline, the insurer (or plan) may treat it as untimely and can refuse to accept it as a valid internal appeal.
The other options do not reflect ACA requirements. ACA appeals are not limited by a minimum dollar amount like $500, and plans cannot impose an appeal fee as a condition of filing. Also, ACA rules do not set a
"three appeals per year" cap; appeal rights are tied to adverse determinations, not an annual quota. Therefore, the insurer may refuse only if the appeal is filed more than 180 days after denial.

NEW QUESTION # 78
Which of the following is a basic benefit of Medicare Supplemental insurance?

A. At-home recovery.
B. Basic drugs limit of $1,250.
C. First 3 pints of blood each year.
D. Preventive care.

Answer: C

Explanation:
Medicare Supplement insurance (Medigap) is designed to fill gaps in Original Medicare (Parts A and B) by paying certain out-of-pocket expenses that Medicare does not pay in full. A commonly tested basic Medigap benefit is coverage for the first 3 pints of blood each year . Under Original Medicare, a beneficiary may be responsible for the cost of the first three pints of blood in a calendar year (unless replaced or covered under specific circumstances). Medigap policies include this "first three pints" coverage as part of the standardized core benefits, helping reduce the beneficiary's exposure to unexpected hospital or outpatient blood costs.
The other choices are not considered standard "basic" Medigap benefits. "At-home recovery" and certain
"preventive care" enhancements have been associated with limited or older plan designs rather than being universally basic. "Basic drugs limit of $1,250" reflects older outpatient prescription concepts that are largely associated with pre-Part D benefit structures and not a core Medigap basic benefit in the way the blood coverage is. Therefore, the correct basic benefit is the first 3 pints of blood each year .

NEW QUESTION # 79
Which of the following statements BEST describes a single premium cash value policy?

A. It provides for only one premium to be paid without evidence of insurability.
B. It requires only one payment to make the policy paid up.
C. It requires the policyowner to pay one premium annually.
D. It waives one future premium if the owner becomes disabled.

Answer: B

Explanation:
A single premium cash value life insurance policy is a form of permanent insurance that is fully funded with one lump-sum premium payment at the time of purchase. After that single payment is made, the policy is considered paid-up , meaning no additional premiums are required to keep the coverage in force for the policy' s duration (as long as no loans/withdrawals or other actions cause lapse). Because it is permanent insurance, it is designed to build cash value , and the death benefit remains in effect subject to the contract terms.
Option B is incorrect because "only one premium without evidence of insurability" describes a guaranteed insurability-type concept, not single premium funding; single premium policies still require underwriting at issue. Option C describes a waiver of premium benefit (typically waiving premiums during disability), not a single premium policy. Option D describes an annual premium mode (payment frequency), not a one-time premium. Therefore, the best description is that it requires only one payment to make the policy paid up.

NEW QUESTION # 80
An insured owns a whole life policy that has accumulated cash value. Which of the following statements is true about the policy ' s cash value?

A. It is subject to fluctuations of the company ' s overall performance.
B. The policy ' s cash value is viewed as investment growth and therefore subject to taxation for each calendar year.
C. The cash value is not guaranteed.
D. The growth of the policy ' s cash value is not subject to income tax while the policy is in force.

Answer: D

Explanation:
The correct answer is B. The growth of the policy's cash value is not subject to income tax while the policy is in force. Whole life insurance is a form of cash value life insurance . As premiums are paid, part of the premium funds the death benefit and expenses, while part builds cash value inside the policy. Under standard life insurance taxation principles, that internal cash value buildup generally grows on a tax-deferred basis , meaning it is not taxed annually while it remains within the policy. The NAIC explains that whole life policies build cash value over time and that this value grows without being taxed currently, and IRS guidance similarly distinguishes taxable situations from ordinary in-force policy growth.
The other choices are incorrect. A is wrong because whole life cash value is not normally taxed each calendar year. C is more characteristic of variable life , where values fluctuate with investment performance. D is incorrect because traditional whole life generally provides guaranteed minimum cash values under the contract, subject to policy terms and continued premium payment; New York DFS whole life product guidance reflects that whole life operates on a guaranteed basis and includes cash surrender value provisions.

NEW QUESTION # 81
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