NY Series 17-52 ACTUAL EXAM COMPLETE QUESTIONS
AND CORRECT DETAILED ANSWERS WITH SIMPLIFIED
RATIONALES GRADED A+ PASS GUARANTEED BY
ACEMAERKET
Question:
A man works for Company A and his wife works for Company B. Both spouses are covered
under their own employer’s health plans, which also cover the other spouse. If the husband
files a claim, which insurance is primary?
Choices:
A. The wife’s insurance
B. The insurance through his company
C. Both plans pay equally
D. Medicare
Correct Answer:
The insurance through his company
Rationale:
Under coordination of benefits rules, a person’s own employer-sponsored plan is always
primary over coverage as a dependent.
Health Insurance Plans
Question:
A medical insurance plan in which the health care provider is paid a regular fixed amount for
providing care and does not receive additional compensation based on procedures
performed is called what?
Choices:
A. Indemnity plan
B. Major medical plan
C. Prepaid plan
D. Fee-for-service plan
Correct Answer:
Prepaid plan
,Rationale:
A prepaid plan pays providers a fixed amount regardless of services rendered, encouraging
cost control.
Premium Rating Methods
Question:
A rating method in which the premium is the same for all covered persons, regardless of age,
sex, or health status, is known as what?
Choices:
A. Experience rating
B. Community rating
C. Attained-age rating
D. Modified rating
Correct Answer:
Community rating
Rationale:
Community rating spreads risk evenly by charging the same premium to everyone in a
group.
Life Insurance Underwriting
Question:
An individual applies for a life insurance policy but forgets past medical history due to a head
injury. The insurer later discovers undisclosed drug abuse history after issuing the policy.
What will most likely occur?
Choices:
A. The policy will be voided
B. The policy will be rescinded
C. The policy will not be affected
D. Benefits will be reduced
Correct Answer:
The policy will not be affected
Rationale:
Because the applicant was competent and did not intentionally misrepresent information,
and the contestability period has passed, the policy remains valid.
,Disability Insurance
Question:
An insured permanently loses use of a leg and temporarily becomes blind due to an
accident, but vision returns after one month. To what extent will presumptive disability
benefits be paid?
Choices:
A. Full benefits
B. Partial benefits
C. Benefits for loss of leg only
D. No benefits
Correct Answer:
No benefits
Rationale:
Presumptive disability requires permanent loss of specific functions. Temporary blindness
does not qualify.
Policy Delivery Requirements
Question:
When must an Outline of Coverage be delivered to the applicant?
Choices:
A. Within 30 days of policy issue
B. At claim time
C. At the time of application or upon delivery of the policy
D. At policy renewal
Correct Answer:
At the time of application or upon delivery of the policy
Rationale:
Regulations require applicants to receive an outline early so they understand coverage
before acceptance.
Insurance Fundamentals
Question:
For insurance purposes, how is risk defined?
, Choices:
A. The certainty of loss
B. The chance of profit
C. The uncertainty or chance of loss
D. A guaranteed expense
Correct Answer:
The uncertainty or chance of loss
Rationale:
Insurance exists to protect against uncertain financial loss.
Group Health Insurance
Question:
In a contributory health insurance plan, what percentage of eligible employees must
participate?
Choices:
A. 25%
B. 40%
C. 50%
D. 75%
Correct Answer:
50%
Rationale:
To prevent adverse selection, at least half of eligible employees must participate in
contributory plans.
Continuation of Coverage
Question:
If an employee terminates employment, which provision allows continuation of health
coverage under an individual policy if requested within 60 days?
Choices:
A. Reinstatement
B. Conversion
C. Extension of benefits
D. Probationary clause
AND CORRECT DETAILED ANSWERS WITH SIMPLIFIED
RATIONALES GRADED A+ PASS GUARANTEED BY
ACEMAERKET
Question:
A man works for Company A and his wife works for Company B. Both spouses are covered
under their own employer’s health plans, which also cover the other spouse. If the husband
files a claim, which insurance is primary?
Choices:
A. The wife’s insurance
B. The insurance through his company
C. Both plans pay equally
D. Medicare
Correct Answer:
The insurance through his company
Rationale:
Under coordination of benefits rules, a person’s own employer-sponsored plan is always
primary over coverage as a dependent.
Health Insurance Plans
Question:
A medical insurance plan in which the health care provider is paid a regular fixed amount for
providing care and does not receive additional compensation based on procedures
performed is called what?
Choices:
A. Indemnity plan
B. Major medical plan
C. Prepaid plan
D. Fee-for-service plan
Correct Answer:
Prepaid plan
,Rationale:
A prepaid plan pays providers a fixed amount regardless of services rendered, encouraging
cost control.
Premium Rating Methods
Question:
A rating method in which the premium is the same for all covered persons, regardless of age,
sex, or health status, is known as what?
Choices:
A. Experience rating
B. Community rating
C. Attained-age rating
D. Modified rating
Correct Answer:
Community rating
Rationale:
Community rating spreads risk evenly by charging the same premium to everyone in a
group.
Life Insurance Underwriting
Question:
An individual applies for a life insurance policy but forgets past medical history due to a head
injury. The insurer later discovers undisclosed drug abuse history after issuing the policy.
What will most likely occur?
Choices:
A. The policy will be voided
B. The policy will be rescinded
C. The policy will not be affected
D. Benefits will be reduced
Correct Answer:
The policy will not be affected
Rationale:
Because the applicant was competent and did not intentionally misrepresent information,
and the contestability period has passed, the policy remains valid.
,Disability Insurance
Question:
An insured permanently loses use of a leg and temporarily becomes blind due to an
accident, but vision returns after one month. To what extent will presumptive disability
benefits be paid?
Choices:
A. Full benefits
B. Partial benefits
C. Benefits for loss of leg only
D. No benefits
Correct Answer:
No benefits
Rationale:
Presumptive disability requires permanent loss of specific functions. Temporary blindness
does not qualify.
Policy Delivery Requirements
Question:
When must an Outline of Coverage be delivered to the applicant?
Choices:
A. Within 30 days of policy issue
B. At claim time
C. At the time of application or upon delivery of the policy
D. At policy renewal
Correct Answer:
At the time of application or upon delivery of the policy
Rationale:
Regulations require applicants to receive an outline early so they understand coverage
before acceptance.
Insurance Fundamentals
Question:
For insurance purposes, how is risk defined?
, Choices:
A. The certainty of loss
B. The chance of profit
C. The uncertainty or chance of loss
D. A guaranteed expense
Correct Answer:
The uncertainty or chance of loss
Rationale:
Insurance exists to protect against uncertain financial loss.
Group Health Insurance
Question:
In a contributory health insurance plan, what percentage of eligible employees must
participate?
Choices:
A. 25%
B. 40%
C. 50%
D. 75%
Correct Answer:
50%
Rationale:
To prevent adverse selection, at least half of eligible employees must participate in
contributory plans.
Continuation of Coverage
Question:
If an employee terminates employment, which provision allows continuation of health
coverage under an individual policy if requested within 60 days?
Choices:
A. Reinstatement
B. Conversion
C. Extension of benefits
D. Probationary clause
