Health Insurance Exam Questions and Answers: NY Series 17-52 2025, Exams of Insurance Economics

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NY SERIES 17- 52 2025

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1. How many eligible employees must be included in a contributory health insurance plan? Answer: 50%
2. A man works for Company A, and his wife works for Company B. The spouses are covered by health plans through their respective companies that also cover the other spouse. If the husband files a claim, what is true? Answer: The insurance through his company is primary.
3. What is the period of coverage for events such as death or divorce under COBRA? Answer: 36 months.
4. Twenty-five days after a health insurance policy is delivered, the policyowner decides that she would like to return the policy and receive a refund of premium. Which of the following is true? Answer: The policyowner will not receive a refund because the free-look period is over.
5. An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits? Answer: No benefits.
6. For the purpose of insurance, risk is defined as: Answer: The uncertainty or chance of loss.
7. Which of the following is an example of a producer's fiduciary duty? Answer: The trust that a client places in the producer in regard to handling premiums.
8. Which of the following is NOT true of basic medical expense plans? Answer: Coverage for catastrophic medical expenses.
9. Which of the following is NOT a feature of a noncancellable policy? Answer: The insurer may terminate the contract only at renewal for certain conditions.
10. What is the best way to change an application? Answer: Start over with a fresh application.
11. On a major medical insurance policy, the amount that an insured must pay on a claim before the insurer will pay is known as: Answer: Deductible.

and learns of his history one year later. What will probably happen? Answer: The policy will not be affected.

23. The purpose of managed care health insurance plans is to: Answer: Control health insurance claims expenses.
24. To attain currently insured status under Social Security, a worker must have earned at least how many credits during the last 13 quarters? Answer: 6 credits.
25. If seeking repayment of Medicaid funds per the Medicaid Estate Recovery Act would cause a hardship to survivors, states may: Answer: Waive the estate recovery requirement.
26. The insuring clause of a disability policy usually states all of the following EXCEPT: Answer: The method of premium payment.
27. Which of the following statements regarding Business Overhead Expense policies is NOT true? Answer: Benefits are usually limited to six months.
28. At what point must an Outline of Coverage be delivered? Answer: At the time of application or upon delivery of the policy.
29. A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called: Answer: Prepaid plan.
30. Medicaid provides all of the following benefits EXCEPT: Answer: Income assistance for work-related injury.
31. What would a physician utilize if he/she wanted to know if a treatment is covered under an insured's plan and at what rate it will be paid? Answer: Prospective review.
32. Which of the following programs expands individual public assistance programs for people with insufficient income and resources? Answer: Medicaid.
33. When the policy premium wasn't submitted with the application, what should the agent obtain from the insured upon policy delivery? Answer: A statement of good health.

34. The Patient Protection and Affordable Care Act includes all of the following provisions EXCEPT: Answer: Individual tax deduction for premiums paid.
35. Pertaining to insurance, what is the definition of a fiduciary responsibility? Answer: Promptly forwarding premiums to the insurance company.
36. Which of the following persons would qualify for Medicare Part A? Answer: Anyone who has permanent kidney failure.
37. A rating method in which the premium is the same for all covered persons, regardless of age, sex, or health status is referred to as: Answer: Community rating.
38. What is the purpose of Medigap policies? Answer: To cover expenses for Medicare deductibles and coinsurance.
39. Under which of the following circumstances may the uniform individual accident and sickness policy provisions be changed? Answer: If the change is more favorable to the policyholder.
40. In an HMO policy, one of the main responsibilities of the primary care physician (PCP) as a gatekeeper is to do which of the following? Answer: Help control costs.
41. Short term Answer: less than 2 years. 42.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? Answer: Free Look 43.When will a policy pay on a UCR basis? Answer: When particular benefits are not listed on a payment schedule. 44.Which type of rider reimburses health and social service expenses incurred in a convalescent or nursing home facility? Answer: Long term care rider. 45.Which of the following is exempted from the incontestability provision in insurance policies? Answer: Fraudulent misstatements. 46.What does first dollar coverage mean? Answer: As soon as covered medical expenses are incurred, the policy begins to pay.

owner UNLESS which of the following is true? Answer: The policy owner has named an irrevocable beneficiary. 58.Which of the following refers to how often a premium is paid? Answer: Mode. 59.All of the following are common exclusions from loss found in disability income policies EXCEPT for that incurred while: Answer: Committing a misdemeanor. 60.At which point are contractual death benefit settlement options determined and by whom are they determined? Answer: At the time the policy is purchased by the owner of the policy. 61.All of the following are ownership rights EXCEPT: Answer: Switching the policy from one insured to another. 62.All of the following are TRUE regarding incomplete applications EXCEPT: Answer: The incomplete application can be accepted with the missing information added later. 63.A consumer report used to determine eligibility for insurance may include all of the following EXCEPT: Answer: Medical underwriting exam. 64.All of the following are required signatures on a life insurance application EXCEPT: Answer: The minor in a juvenile policy. 65.Why are insurance policies considered conditional contracts? Answer: Certain conditions need to be met to make the contract legally enforceable. 66.When does insurable interest come into play in a life insurance policy? Answer: When the applicant for the policy is not the insured. 67.Which of the following occurs immediately after the application is submitted and the initial premium paid? Answer: The underwriting process begins. 68.Obtaining consumer information reports under false pretenses is prosecutable by which of the following? Answer: Fair Credit Reporting Act. 69.What is the purpose of Stranger-originated life insurance (STOLI)? Answer: The policy is originated primarily or solely for the purpose of resale. 70.All of the following are classifications of risk EXCEPT: Answer: Non-nicotine.

71.What specific new procedures does the USA Patriot Act require of insurance companies? Answer: Establish an anti-money laundering program. 72.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? Answer: The applicant and possibly the agent initial any changes made. 73.What is a MIB report? Answer: Medical information on an applicant for assessing life or health insurance risk. 74.How do warranties differ from representations? Answer: A warranty is guaranteed to be true, a representation is believed to be true to the best of one's knowledge. 75.If the insurer wishes to share an applicant's HIV status, the applicant must be given full notice of all of the following EXCEPT: Answer: The treatment procedures that are covered by the policy. 76.Which of the following was specifically designed to address STOLI and IOLI practices? Answer: NCOIL Act. 77.Why is rehabilitation considered worthy of federal help under workers' compensation? Answer: It reduces insurance losses and helps regain the worker's dignity. 78.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? Answer: The individual's policy pays first, the spouse's policy pays the remaining up to coverage amount. 79.The group conversion option is allowed for all of the following EXCEPT: Answer: During the annual benefits enrollment period. 80.What type of insurance should a company purchase if it wants to insure the life of its CEO? Answer: Key person insurance. 81.All of the following are tax-qualified retirement plans EXCEPT: Answer: Section 529 plan. 82.Why is relying solely on employer group life insurance generally considered inadequate for most individual's needs? Answer: It is financially insufficient to cover end of life expenses.

96.Which problem was universal life insurance designed to address? Answer: Low interest rates during periods of high inflation. 97.Compared to basic hospital, medical, and surgical policies, which type of insurance provides broader coverage, fewer gaps, higher individual benefits, and higher policy maximums? Answer: Major medical insurance. 98.Current assumption whole life policies are sensitive to which of the following? Answer: Interest rates. 99.Which is the major reason why long-term care insurance is becoming increasingly important? Answer: As life expectancy increases, the chances of needing long-term care also increase.

100. Which of the following is defined as the dollar amount beyond which the insured no longer participates in payment of medical expenses? Answer: Stop Loss Limit.
101. Which is the primary purpose of Health Reimbursement Accounts (HRAs)? Answer: To assist covered employees with the payment of medical expenses on a high deductible plan funded through pre-tax contributions.
102. States generally define a true "group" for insurance as requiring a minimum of how many participants? Answer: 10.
103. 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? Answer: When there is a buy-sell agreement funded with life insurance to buy out the interest of a deceased owner or partner.
104. 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? Answer: Renewable term.
105. Which of the following is true about a decreasing term life policy? Answer: The face amount reaches zero at policy expiration.
106. Which of the following is TRUE of the limited pay whole life policy? Answer: Coverage continues after the policy is paid-up.

107. Which of the following is a characteristic of Preferred Provider Organizations (PPOs)? Answer: Prearranged costs for services rendered.
108. All of the following are characteristics of variable whole life EXCEPT: Answer: There is no guaranteed minimum death benefit.
109. Which of the following policy types is considered double indemnity? Answer: Accidental death.
110. Which of the following lists the three common types of permanent individual life insurance? Answer: Variable Life, Whole Life, Universal Life.
111. Which of the following is TRUE for a flexible premium annuity? Answer: The purchaser has the option to vary the amount of each premium payment falling between a minimum and maximum amount.
112. Which type of annuity covers two or more annuitants and provides monthly income only until the first annuitant dies? Answer: Joint Life Annuity.
113. Which of the following coverage types pays a monthly cash benefit following the elimination period for total disability due to accident or sickness? Answer: Disability income insurance.
114. 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? Answer: Flexible Spending Account (FSA).
115. Which of the following is covered by a dread disease policy? Answer: Illnesses that do not occur frequently but incur significant costs when they do occur.
116. Which insurance plans are commonly offered through the worksite (employer-sponsored) EXCEPT? Answer: Medicare.
117. If an insurance company obtains an investigative consumer report on a prospective insured, it MUST inform the prospect that it is permitted to do so under which of the following Federal laws? Answer: The Fair Credit Reporting Act.
118. What is the Fair Credit Reporting Act? Answer: Established procedures that consumer-reporting agencies

131. What is the primary qualifier for Medicaid? Answer: Financial need.
132. What is Medicare part B? Answer: Medical insurance that covers outpatient medical services; services from doctors and other health care providers, home health care, medical equipment.
133. Which statement regarding Medicare is FALSE? Answer: Part A paid for following your retirement.
134. What is Medicare part A? Answer: Hospital insurance; inpatient hospital stays, care in skilled nursing facility, hospice care, and some home health care.
135. Under the Medicare Part B home health care benefit, all of the following are eligible expenses EXCEPT: Answer: Blood transfusions.
136. Under Medicare supplement Policy, preexisting conditions CANNOT be excluded after how many months from the effective date of the policy? Answer: 6 months.
137. Which of the following plans can be purchased to provide coverage in place of Medicare Parts A and B combined? Answer: Medicare Advantage (part C).
138. Which part of Medicare is also known as Medicare Advantage? Answer: Part C.
139. What part of Medicare covers prescription drugs? Answer: Part D.
140. Which of the following is the most common method to supplement Medicare coverage? Answer: Coverage offered by private insurers.
141. A woman is diagnosed with Alzheimer's 3 months before she applies for a Medicare Supplement policy. Can her condition be excluded under her MSP? Answer: Yes, but her condition will be covered after 6 months.
142. What is the primary purpose of a Medicare Supplement policy (MSP)? Answer: To pay for many of the medical expenses that Medicare coverage does not. (Fill in the gaps in Medicare).
143. What is the purpose of a Medicare Supplement policy (MSP)? Answer: Pay for medical expenses not covered by Medicare. (Fill in coverage holes).

144. Which statement concerning Medicare Supplement policies (MSP) is FALSE? Answer: They eliminate the need to purchase PART B OF Medicare.
145. What is the primary purpose of a Medicare Supplement Policy? Answer: To fill in the gaps of Medicare.
146. A preexisting condition under a Medicare Supplement policy must have occurred and/or been treated within how many months of the effective date of the MSP? Answer: 6 months.
147. Medicare Supplement policies can exclude coverage on preexisting conditions for up to how many months? Answer: 6 months.
148. In comparing Medicare Supplement policies (MSP), what is the difference between Plan A and Plan G? Answer: Plan G offers more benefits.
149. What is a required feature of a Medicare Supplement Policy? Answer: Basic core benefits.
150. Which of the following is CORRECT about Medicaid? Answer: It is a public program assisting individuals with insufficient income to pay for medical care.
151. What is Medicaid? Answer: A federal and state-funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.
152. Which of the following determines whether a person passes the financial test to qualify for Medicaid? Answer: State law.
153. Eligibility for Medicaid benefits is primarily based upon which factor? Answer: Income and net worth.
154. Sherri qualifies for Medicaid even though she has assets of $250,000. What type of Long Term policy does Sherri have? Answer: Long-term care partnership policy.
155. Which is the minimum number of the 6 Activities of Daily Living (ADL) an insured must be incapable of performing in order to trigger the benefits of a Long Term Care Policy? Answer: 2.
156. HIPAA applies to groups of how many participants? Answer: 2.

170. Which level of Long Term Care must be provided occasionally by a skilled practitioner following doctor's orders? Answer: Intermediate care.
171. What is the minimum level of renewability for a Long Term Care policy as required by State Law? Answer: Guaranteed renewable.
172. According to the National Association of Insurance Commissioner's Model Law regulating the sale of Long Term Care insurance, your first year's commission on an LTC sale could be no more than what amount if your second year's renewal commission is $400? Answer: $800 (double).
173. Which is NOT required by a Long Term Care contract? Answer: Prior hospitalization.
174. Which is NOT an Activity of Daily Living as defined by a Long Term Care policy? Answer: Driving.
175. What is also known as ambulatory care? Answer: Outpatient care.
176. What is covered by a Long Term Care policy? Answer: Alzheimer's.
177. Which is NOT a benefit of a Long Term Care policy? Answer: Acute (serious) hospital care.
178. What peril (risk) does a Long Term Care insurance policy cover? Answer: Aging.
179. What is the highest level of care under a Long Term Care policy? Answer: Skilled nursing care.
180. Which is TRUE concerning the replacement requirements for either an LTC (Long Term Care) or an MSP (Medicare Secondary Payer)? Answer: The Notice to Applicant Regarding Replacement must be delivered to the policy owner prior to the issuance or delivery of the policy.
181. Which statement is TRUE concerning a Long Term Care policy? Answer: The policy may be issued on a guaranteed renewable basis.

182. What coverage is designed for the inability to perform the Activities of Daily Living (ADLs)? Answer: Long-term care.
183. Which is the major reason why long-term care insurance is becoming increasingly important? Answer: As life expectancy increases, the chances of needing long-term care also increase.
184. The policy that is designed to provide nursing home benefits on an extended basis for NOT less than 12 consecutive months is: Answer: Long-term care.
185. Which is NOT a benefit paid by a Medical Expense policy? Answer: Pain, suffering.
186. Which of the following, by definition, provides benefits for expenses incurred as a result of in-hospital medical treatment and surgery as well as certain outpatient expenses such as doctor's visits, laboratory tests, and diagnostic services? Answer: Hospitalization insurance.
187. Which of the following policies provides a specified income benefit if an insured person becomes incapable of working? Answer: Disability Income.
188. Dakota has a sedentary computer job, and so being active is important. To support an active lifestyle, Dakota eats well, does not smoke, and regularly exercises, which has resulted in a clean medical history. A life insurer gives Dakota a discounted rate; given the classification is most likely what type of risk? Answer: Preferred (Healthy/good).
189. Jonnie works on a fishing boat for most of the week, and when docked, passes the time at the local bar drinking and smoking. Even though Jonnie has a family history of diabetes, eating healthy and exercise are not priorities. A life insurer charges Jonnie the standard premium for a higher attained age; given the classification is most likely what type of risk? Answer: Substandard (unhealthy).
190. Which rating provides the least expensive premium? Answer: Preferred.
191. Which is NOT a reason why someone may receive a rated or substandard rating on their policy? Answer: Age.
192. Chris is driving at a high rate of speed when the vehicle leaves the road, collides with a tree, and causes Chris to be treated

of the following could account for the difference EXCEPT the: Answer: Elimination period.

205. Lynn owns a Comprehensive Major Medical policy with a $1,000 Base Plan, a $500 Corridor Deductible, and an 80/ Coinsurance Clause. If she incurs medical bills of $5,500 following a covered illness, how much will the company pay? Answer: $4,200.
206. A claimant must complete and return the claim forms within how many days of the loss or as soon thereafter as reasonably possible? Answer: 90 days.
207. All life insurance and health insurance contracts contain all of the following EXCEPT: Answer: Immaterial representations.
208. The primary purpose of Health Reimbursement Accounts (HRAs) is to assist covered employees with the payment of medical expenses on a high deductible plan funded through pre-tax contributions. Answer: True.
209. Evan's Major Medical policy is reinstated on February 1. When he suffers a heart attack on February 6th, he files a claim. How should the company handle the claim? Answer: The claim is denied due to a 10-day probationary period.
210. What is a moral hazard? Answer: Consumer attitude or behavior that leads to a higher utilization of health care services when the services are covered by insurance.
211. Which of the following is an example of a moral hazard? Answer: Filing a false insurance claim.
212. Upon the issuance of a conditional receipt for a renewal when the premium is paid AFTER the time granted by the insurer, what is the maximum amount of time for reinstatement of the policy? Answer: 45 days.
213. A Basic Hospital Policy pays expenses for: Answer: Hospital room and board.
214. Homogeneous: Answer: Of a similar kind.
215. Heterogeneous: Answer: Different; dissimilar.

216. In order to make an accurate determination of the relative risk of an applicant for a health policy, an underwriter would need to be able to examine a: Answer: Large number of homogeneous risks.