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Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 Sample Questions (Q65-Q70):

NEW QUESTION # 65
The policy provision describing the responsibilities of the master policyowner is in

A. individual medical policies.
B. group health policies.
C. certificate of coverage.
D. individual health policies.

Answer: B

Explanation:
The correct answer is A. group health policies . In a group health insurance plan , the actual contract is issued to the master policyowner , usually an employer, association, or trust. Because that party owns the master contract, the policy contains provisions describing the policyowner's responsibilities, such as premium remittance, eligibility administration, enrollment procedures, and notice requirements. Those duties belong in the group policy itself , not in the individual evidence given to insured members.
A certificate of coverage is provided to each covered employee or member to summarize benefits, exclusions, and rights under the group plan, but it is not the master contract and does not serve as the document that sets out the policyowner's contractual responsibilities. Choices C and D are incorrect because individual health or individual medical policies are issued directly to an individual policyowner, so there is no separate "master policyowner" structure as found in group insurance.
On licensing examinations, whenever the question refers to the master policyowner , it is a strong indicator that the subject is group insurance , making group health policies the correct choice.

NEW QUESTION # 66
What is the purpose of the Accelerated Death Benefit Rider?

A. To increase the death benefit by a stated percentage.
B. To adjust the death benefit to keep up with inflation.
C. To decrease the tax liability of the insured ' s estate.
D. To provide for the early payment of the death benefit for a terminally ill insured.

Answer: D

Explanation:
The Accelerated Death Benefit Rider is designed to allow an insured who is terminally ill to receive all or part of the policy's death benefit before death . This rider is intended to help with serious financial needs that can arise at the end of life, such as medical expenses, long-term care costs, hospice care, or other personal obligations. Because the benefit is paid early, the amount ultimately payable to the beneficiary at the insured's death is typically reduced by the amount accelerated, plus any applicable charges.
This rider does not increase the death benefit by a stated percentage, so A is incorrect. It is also not primarily intended to reduce estate taxes, making C incorrect. Choice D describes a cost-of-living or inflation-related adjustment feature, not an accelerated death benefit. In licensing materials, the key phrase tied to this rider is early payment of the death benefit due to terminal illness . Therefore, the correct answer is B , because the rider's main purpose is to give the insured access to policy proceeds while still living when specific qualifying conditions are met

NEW QUESTION # 67
A policyowner suffers an injury that renders him incapable of performing one or more important job duties.
Any decrease in income resulting from his injury would make him eligible for benefits under which provision?

A. Partial disability.
B. Presumptive disability.
C. Flat amount disability.
D. Nondisabling injury.

Answer: A

Explanation:
This situation describes a disability that does not completely prevent the insured from working, but does reduce the insured's ability to perform significant or "material" duties of the occupation , resulting in a loss of income . Under accident and health disability income concepts, that is the definition of partial disability , which pays benefits when the insured can work in a limited capacity (or perform only some duties) and suffers measurable earnings reduction. "Nondisabling injury" is typically a limited benefit that applies when an injury does not create disability as defined by the policy (often paying a small scheduled amount for medical/accidental injuries without inability to work). "Presumptive disability" refers to severe, specified losses (such as loss of sight, hearing, speech, or limbs) that trigger total disability benefits regardless of work capacity. "Flat amount disability" does not match the key clue in the question-eligibility based on decreased income -because partial disability provisions specifically tie benefits to reduced ability to work and corresponding earnings loss.

NEW QUESTION # 68
If an insured under a life insurance policy dies with an outstanding loan balance then the death benefit will

A. not be paid until the loan is repaid.
B. be paid less the amount of the loan but not the interest.
C. be paid less the amount of the loan interest but not the principal.
D. be reduced by the amount of the loan and interest owed.

Answer: D

Explanation:
The correct answer is A. be reduced by the amount of the loan and interest owed. In permanent life insurance policies that build cash value, the policyowner may borrow against that cash value. However, if the insured dies before the loan is repaid, the insurer does not require the beneficiary to repay the loan first. Instead, the insurer deducts the outstanding loan balance plus any accrued interest from the death proceeds before paying the beneficiary. New York Life's consumer guidance states that the total outstanding loan balance, including accrued loan interest, reduces the life insurance benefit .
This makes the other options incorrect. B is wrong because the death benefit is still paid; it is simply reduced , not withheld until repayment. C is incorrect because both the principal and interest are deducted, not just the principal. D is also incorrect because the insurer deducts the entire indebtedness , not just interest. NAIC policy loan guidance is consistent with this principle by treating the policy loan plus accrued interest as part of the amount offset against policy proceeds at death.

NEW QUESTION # 69
Which of the following is described when a selected group of practitioners, in a certain area, agrees to provide services at a pre-arranged cost on a fee-for-service basis?

A. risk purchasing group
B. preferred provider organization
C. coalition group
D. indemnity organization

Answer: B

Explanation:
The correct answer is A. preferred provider organization. A Preferred Provider Organization (PPO) is a health care arrangement in which an insurer or plan contracts with a selected network of doctors, hospitals, and other providers in a geographic area to deliver medical services at negotiated or reduced charges . Federal and New York sources describe PPOs as networks of participating providers that agree to furnish care at discounted rates, while patients generally retain the flexibility to use non-network providers at a higher cost. That matches the question's description of a selected group of practitioners agreeing to provide services at a pre- arranged cost on a fee-for-service basis . ( HealthCare.gov ) The other options do not fit this definition. An indemnity organization traditionally reimburses covered losses and does not depend on a contracted provider network with prearranged fees. A risk purchasing group is associated with liability insurance purchasing arrangements, not standard health provider networks. Coalition group is not the recognized term for this managed care structure. Therefore, the correct description is a preferred provider organization . ( Department of Financial Services )

NEW QUESTION # 70
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