NY Laws, Rules and Regulations Flashcards
Producers licenses are issued for a term of __ years
2 years
Fee for license each year
$40
Must report nae, address, or email change to state superintendent within __ days
30 days
Temporary producer license may be issued without an examination for up to ___ days, renewable up to a total of ___ months.
90 days
15 months
Must report an administrative action against a producer within __ days
30 days
Total CE credits required every 2 years
15 credits
Superintendent must give __ days in advanced notice of a hearing
10 days
Civil penalty’s must be paid within __ days.
120 days
Fine for violating a cease and desist order
$5,000
$___ per violation fine for agent vialations
$500
$__ max fine for agent violations
$2,500
WILLFUL violation penalty fine (FRAUD)
$1,000 per violation
Information must be provided within ___ days of Superintendents request
15 days
$___ fine per day for failure to provide information
$500
$10,000 max fine for failure to provide information to superintendent
$10,000
$___ fine for failing to respond to Superintendent five times in a five year period
$50,000
Insurers must file ANNUAL statement of solvency by
March 1st
Maximum fine for failure to filed = $___
$25,000
Insurer must repond to claimants within ___ days
15 days
Insurer must file a notice of appointment within __ days of the agency contract date or first insurance application.
15 days
An insurer that terminates an appointment must notify superintendent within __ days
30 days
Termination notice must be sent to producer within __ days after notifying the superintendent
15 days
Written disclosures must be maintained for ___ years
3 years
Policy records must be maintained for ___ years
6 years
Maximum civil penalty for insurance fraud
$5,000
Fraudulant acts must be reported within __ days
30 days
Life insurance grace period is
31 days
Contesability period of a policy is
2 years
Reinstatement period within ___ years
3 years
Free-look period (right to examine)
10 days
Free -look period for replacement contracts is
60 days
replacing insurers must notify the existing insurer within ___ days of recieving the application
10 days
replacing insurer must keep copies of sales material, notices, and disclosures for __ years
6 years
Policy cannot be backdated more than ___ months
6 months
Health insurance grace period for weekly premium payments
7 days
Health insurance grace period for monthly premium payments
10 days
Health insurance grace period for all other premium payment modes
31 days
Insurer may cancel a health insurance policy within the first 90 days with atleast ___ days notice
10 days
Free look period for accident & health insurance policies
10 days
Free look period for Medicare advantage, Medicare supplements and long term care insurance
30 days
Married and unmarried children may be considered dependent and eligible for benefits until attaining age __
age 26
Dependent coverage may be extended to unmarried children through age ___ if the child lives or works in new York and is not eligible for employer health benefit plan as an employee
AGE 29
To extend coverage for a newborn child, notification and premium payment must be recieved within ___ days of birth.
30 days
Coverage for handicapped dependent child may be extending beyond the limiting age if proof of dependents incapacity is received within ___ days of reaching limiting age
31 days
NY LTC requires coverage for not less than ___ consecutive months
24
LTC - minimum inflation protection % that must be offered in NY
5% compound
Conversion Privilege - Group policy conversion to individual policy within ___ days of coverage termination
60 days
NYS Disability Benefits Law - Maximum length of disability benefits in NY
26 weeks
Medicare Supplements - Maximum pre-existing conditions exclusion period
6 mos
NYS Disability Benefits Law- Maximum benefits per week
$170 per week
Medicare supplement first year commission can be no more than __% of the commission paid for selling or servicing the policy in the second year
200%
An individual who commits a fraudulent insurance act may be subject to a civil penalty of up to
$5,000
Fiduciary responsibility of insurance agents in regards to premium payments
Premium money not remitted immediately to insurers is to be deposited in an appropriately identified account in a New York bank
Insurers must provide insureds with a notice explaining their privacy policies at least
once a year
Suicide clause =
two years from the date the policy was issued
Annuity grace period for missed premium payments
31 days
Guaranteed Minimum Withdrawal Benefit (GMWB) Clause in annuities
used in DEFERRED annuities (especially variable annuities) - in order to protect contract owners against potential market lossess. Owners may withdraw an amount equal to a percentage of their principal on an annual basis.
Accelerated Benefit Riders qualifying event
doctors opinion that terminal illness will result in death within 12 mos
Advertisements must contain
full name of the insurer
city of its principal office
Policy summaries must include the following:
-tables for the first 5 policy years and every fifth year thereafter
- guaranteed components of the policy
- net payment indices for 10 and 20 years
- name and address of both the insurer and the producer
When must an insured be provided a copy of the insurance Buyers Guide
at the time of the application
Common life insurance exclusions
- Suicide
- Aviation accidents
-military service during war
Reg 187 requires a producer to
act in the best interest of the consumer when recommending an in-force transaction or sales transactions to a consumer
Reg BI regulations do not apply to what type of transactions?
- ERISA plans
- government 457 plans
- deferred comp plans
- credit life insurance sold on a group basis
- corporation policies when benefits are paid to the business
- life settlement contracts
Insurance licenses for business entities expire on
June 30th of odd-numbered years
Individual insurance licenses expire on
the individual’s birthday every other year.
if birthday = odd year –> renew every odd year
License renewals filed less than 60 days prior to the license expiration date shall be subject to a $__ late filing fee
$10
Maximum life insurance limits for juveniles in NYS
insurer may issue a LI policy on a minor under age 14.5
total amt of life insurance may not exceed $50k or 50% of the amount of LI in force upon life of the applicant at the date of issue. Whichever is greator
Required provisions of accident and health insurance
- Entire Contract
- incontestability clause
- grace period clause
- reinstatement clause
Policy’s delivered by mail have a free look period of
30 days
Guaranteed renewable provision
insured has the right to continue insurance by timely payment of premiums and the insurer may not change the policy
premium rates may be revised on a class basis
NYS Long-Term Care Tax Credit
allows individuals to take a credit against taxes due in the amount of 20% of the premium paid during that tax year for a LTC policy.
Long Term Car insurance policy riders
Return of premium rider = provides policyowners with a refund of all or some of the premiums in certain circumstances
Shared Care rider - available for married couples.
Minimum benefit standards for Qualified NYS LTC policies
- nursing home coverage lasting minimum of 36 mos
- must provide benefits for atleast 50% of the current minimum home care benefit.
- respite care 14 days of coverage
- must offer lifetime inflation protection of 5% compounded annually
- elimination periods no greater than 100 days
Medicaid Estate Recovery Act (OBRA 1993) - NYS partnership for LTC
After the long-term care policy benefit maximums have been reached, insureds will then use Medicaid Extension.
- insured will contribute income toward the cost of their care but may protect their assets from recovery
Total ASset protection plans = allows policy owners to protect all of their assets.
dollar for dollar asset protection plan - provide limited protection. Plans protect assets equal to the amount of insurance benefits paid out. Unprotected assets in excess of the amount of partnership benefits received must be spent down, in order for the insured to be eligible for Medicaid benefits.
Definition of small employer
businessess that employ between 1 and 50 employees
Community rating
premiums for all persons in the covered group is the same based on the experience of the entire pool of risks covered by the policy.
NYS Disability Benefits Law (DBL)
Mandates benefits for employees who suffer nonoccupational disabilities (workers comp covers occupational disabilities)
Employees that are excluded under the Disability Benefits Law:
- employees that work from home
- minor child of employer
- farm laborers
- priests, rabbis
- independent contractors
- employees that work less than 45 days/yr
- railroad and marritime employees
- golf caddies
- real estate brokers or sales associates
- part-time students
Employee eligibility for NYS disability benefits law -
- employee must have been employed for atleast 4 consequtive weeks before the disability
Disability Benefits Law - Benefit payments
- benefit period may not extend beyond 26 weeks
- 7 day elimination period
- first payment is due on 14th day of disability
- payable on biweekly basis
- weekly benefit = to 50% of wage, but no more than $170/hr
- disability proof may be required weekly
Employee contribution for NYS DBL
Employee contributions are calculated at .5% of wages paid.
Every medicare supplement policy must be
guaranteed renewable
NY State of Health
is an organized marketplace designed to help people shop for an enroll in health insurance. 4 tiers: (platinum, gold, silver, bronze)
Qualified Health Benefit Plans on the marketplace(QHPs) are required to cover the 10 essential health benefits (EHBs)
Family and Medical LEave Act (FMLA)
federal law that entitles eligible employees who work for covered employers to take up to 12 weeks of unpaid, job-protected leave for any of the following reasons:
- birth, care for newly adopted/foster child
- care for member with serious health conditions
- medical leave for serious health condition
- assist an active deployed family member on military duty
FMLA in New YORK
- covered employees may take up to 10 weeks of PAID family leave
- employees receive up to 55% of their average weekly wage.
NYS Medicaid Child Health Plus
provides subsidies to pay for medical care for individual who are not covered by health insurance and who meet low-income tests based on povery levels.
FSA contribution limit
$2,850 & not subject to ANY tax
HSA contribution limits
Family coverage = $7,300
Individual = $3,650
Major medical insurance provides coverage for each covered person for services up to a max
$100,000.
subject to deductible and coinsurance up to 25%
Managed Care cost containment/utilization review methods
Prospective review - requires preapproval before the subscriber can be admitted. (second surgical opinion)
Concurrent - insurer monitors a subscribers hospital stay while in progress to anticipate any changes in his medical condition
Retrospective review - occurs after medical services in question have been provided.
State-driven programs of NYS
- Child health plus
- Medicaid
- Disability Benefit Law
Medicare is a __-driven program
federal
