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Insurance Licensing

New York Accident and Health Insurance Agent/Broker Examination Practice Test

This practice page addresses accident and health insurance concepts used to interpret policy benefits and cost sharing. Its questions cover hospitalization benefit periods, deductibles, coinsurance, out-of-pocket limits, and usual, customary, and reasonable (UCR) charges, along with provisions that affect when and how coverage applies.

Exam overview

Exam providerNew York State Department of Financial Services
Exam codeNot listed
CategoryInsurance Licensing

About the New York Accident and Health Insurance Agent/Broker Examination Exam

Working with health insurance policies requires distinguishing a benefit limit from a time limit and determining how covered expenses are divided between the insurer and insured. Questions in this bank also address medical loss ratios and the role of a state guaranty association, concepts that relate to insurer performance and protection for covered policies. Contract provisions such as grace periods, incontestability, extensions of benefits, and proof of loss shape premium payment, coverage continuation, and claim documentation. Practice interpreting these clauses in context: identify the event or deadline each provision addresses, then connect it to the policyholder’s coverage or claim. These skills are relevant when explaining policy terms, reviewing benefit calculations, and assessing whether a claim follows the stated contract conditions.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

Which statement best describes a health insurance policy’s benefit period in a hospitalization plan?

  1. AIt is the span of time during which the plan’s defined benefits may be payable for a covered period of illness or confinement
  2. BIt is the time an applicant has to decide whether to accept an issued policy
  3. CIt is the period during which an insurer must investigate every claim
  4. DIt is the number of days before an application becomes effective
Show answerCorrect answer: A

A benefit period specifies a period used by the policy to determine when certain benefits are available or how they apply. Its exact meaning varies by policy wording.

Question 2

What does an insurer’s medical loss ratio generally compare?

  1. AClaims and certain quality-improvement spending with premium revenue
  2. BAn insured’s assets with the amount of the deductible
  3. CAn agent’s commissions with the number of policies sold
  4. DHospital charges with a patient’s household income
Show answerCorrect answer: A

A medical loss ratio generally measures the share of premium revenue used for covered medical claims and, where applicable, qualifying quality-improvement activities. Specific definitions depend on applicable rules.

Question 3

What is the main role of a state insurance guaranty association in relation to covered insurance policies?

  1. ATo provide limited protection under applicable law if a member insurer becomes insolvent
  2. BTo set the medical treatment decisions for every insured person
  3. CTo guarantee investment returns on all insurance products
  4. DTo approve every claim before the insurer reviews it
Show answerCorrect answer: A

State guaranty associations may provide limited protection for certain covered claims when a member insurer becomes insolvent, subject to statutory eligibility and limits. They are not a guarantee of all policy benefits.

Question 4

A health policy includes a usual, customary, and reasonable (UCR) limit. What does this limit generally help determine?

  1. AThe maximum amount the insurer recognizes for a covered service in a geographic area
  2. BThe number of days an insured must wait before coverage begins
  3. CThe percentage of premium returned when a policy is canceled
  4. DThe minimum number of providers an insured must visit each year
Show answerCorrect answer: A

A UCR limit generally bases the recognized charge for a service on customary fees for similar services in the relevant area. A provider may charge more than that amount, potentially leaving the insured responsible for the excess, subject to the policy and applicable law.

Question 5

Under a health insurance policy with a coinsurance provision, how is the insured’s share of covered costs commonly calculated after the deductible is satisfied?

  1. AAs a percentage of covered expenses, as stated in the policy
  2. BAs a fixed amount paid once for the entire policy term
  3. CAs the full amount of every covered expense
  4. DAs a percentage of the policy’s face amount
Show answerCorrect answer: A

Coinsurance commonly divides covered expenses between the insurer and insured according to stated percentages, subject to policy terms and limits.

Question 6

What is the primary purpose of a health insurance policy’s grace period?

  1. ATo let the insurer reconsider whether to issue the policy after a claim
  2. BTo provide extra time to pay a premium after its due date before coverage lapses, subject to policy terms
  3. CTo allow the insured to change beneficiaries after a disability
  4. DTo postpone every claim payment until the policy anniversary
Show answerCorrect answer: B

A grace period gives the policyholder additional time to pay an overdue premium. The policy’s terms and applicable law govern whether and how coverage continues during that period.

Question 7

Which statement best describes a health insurance policy’s incontestability provision after it has been in force for the stated period?

  1. AIt generally limits the insurer’s ability to void the policy based on application misstatements, subject to stated exceptions and applicable law
  2. BIt prevents the insured from ever changing coverage
  3. CIt guarantees payment of every claim, regardless of policy terms
  4. DIt allows the insurer to cancel the policy at any time without notice
Show answerCorrect answer: A

An incontestability provision generally restricts an insurer’s ability to contest a policy based on misstatements once the specified period has passed. Its operation is subject to the contract language, exceptions, and governing law.

How to use this practice test

Access the practice questions for free. Each session presents up to 20 random questions from the 50-question bank, covering policy provisions, benefit calculations, and related insurance concepts. Results appear after the session; use missed or uncertain answers to identify terms and calculations that need closer review.

Preparation tips

  • Work through sample cost-sharing calculations in order: apply the deductible, calculate the insured’s coinsurance share, and check how the out-of-pocket maximum affects further covered costs.
  • Compare hospitalization benefit periods with policy limits and time-based provisions so you can distinguish how long benefits may apply from how much coverage is available.
  • For grace-period, incontestability, extension-of-benefits, and proof-of-loss questions, identify the policy event each clause governs and the action or deadline it creates.
  • Practice explaining what a UCR limit helps determine and how it can affect the amount considered for a covered service.
  • Separate the medical loss ratio’s comparison of insurer spending from the guaranty association’s role concerning covered policies.
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