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

1. In a health insurance policy, an insured has an out-of-pocket limit of $10,000, a deductible of $500, and an
80%/20% coinsurance. The insured incurs $50,000 of covered losses in an accident. How much will the insurer have to pay?

A) $39,600
B) $35,500
C) $49,500
D) $40,000

2. What information must be included in the statement accompanying an insurance claim payment made by an insurer?

A) The agent ' s name and address
B) A list of all claimants involved
C) The coverage under which the payment is being made
D) The reinsurance carrier involved

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

A) an absolute fee.
B) a non-scheduled plan customary fee.
C) a usual, customary, and reasonable fee.
D) a relative fee.

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

A) Medicaid
B) his employer ' s group plan
C) an individual plan
D) workers ' compensation

5. What is an insurer ' s liability when it is discovered after an insured dies that the insured ' s age on the policy was misstated?

A) The insurer is not liable to pay any amount due to the insured ' s misstatement of age.
B) The insurer must pay a prorated amount of the policy based on the amount of insurance the insured ' s premiums would have bought if purchased at the correct age.
C) The insurer must pay the full amount as stated in the policy, as age is not considered a relevant factor.
D) The insurer must pay the full amount of the policy, minus any additional premiums the insurance company would have paid based on the insured ' s actual age.

Solutions: