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New York Health, Long-Term Care and Medicare Supplement Law: Practice Questions

20 free practice questions with explanations. Pick an answer for each, then check your score.

Exam weight: New York rules in the accident and health sections on the New York Life, Accident and Health agent exam (17-55). Updated 2026-11-04.

Quick study guide

New York law is mixed into every section of the 17-55 outline. These are the health, long-term care and senior rules it cites, with the Insurance Law section or regulation behind each.

Individual policies (Insurance Law 3216)

Required provisions include entire contract (no agent may change or waive the policy), a two-year time limit on certain defenses and a grace period of at least 7 days for weekly premiums, 10 for monthly and 31 for all others. New York's optional cancellation provision allows cancellation only within 90 days after issue, on at least 10 days' notice. Medical expense policies can be nonrenewed only for reasons such as nonpayment or fraud, never because of health (3216(g)).

Children

Medical coverage must cover children to 26, married or not. The young adult option extends it, on request, to an unmarried child through age 29 who has no employer coverage available. A disabled child stays covered past the limiting age if proof is filed within 31 days; newborns are covered from the moment of birth.

Rating, groups and appeals

Individual, small group (1 to 100 employees for policies since 2016) and Medicare supplement coverage must be community rated, with no rating by age, sex, health, tobacco use or occupation, and open to applicants all year (3231, 4317). A departing employee may continue group medical coverage for up to 36 months at no more than 102% of the group rate (3221(m)), or convert by applying within 60 days (3221(e)). A final utilization review denial can go to external appeal within four months (4914).

ProgramKey rules
Disability Benefits LawOff-the-job injury or sickness; benefits from the 8th day, half of wages up to $170 a week (WKC 204), for up to 26 weeks
Healthy New YorkEmployers with 50 or fewer employees, no group coverage in the past 12 months and at least 30% lower-wage workers
Child Health PlusNew York residents under 19, not eligible for Medicaid and uninsured; subsidies up to 400% of the poverty level

Long-term care (Reg 62, 11 NYCRR 52.25)

Individual policies are guaranteed renewable, and Alzheimer's disease can never be excluded. Insurers must offer inflation protection and a nonforfeiture option. Partnership policies (Reg 144, Part 39) must include 3.5% or 5% compound inflation protection unless bought at 80 or older.

Medicare supplement (Reg 193, 11 NYCRR Part 58)

Applicants are accepted all year, whether on Medicare by age or disability. Preexisting-condition exclusions last six months at most. Policies can be ended only for nonpayment or material misrepresentation, and are suspended for up to 24 months on request when the insured qualifies for Medicaid.

Practice questions

  1. Under Insurance Law 3216(d)(1)(C), what is the shortest grace period a New York individual accident and health policy with monthly premiums may provide?

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    Answer: D. The required grace period provision must allow at least 7 days for weekly premium policies, 10 days for monthly premium policies and 31 days for all other policies, and the policy stays in force during it. The 31-day minimum applies to quarterly, semiannual and annual modes, not monthly, and 30 days is not a figure the provision uses. If the insurer reserves the right to refuse renewal, the provision must add that the grace period does not apply once the insurer has given at least 30 days' written notice that it will not renew.

    Source: NY 17-55 outline: Individual Health Insurance Policy General Provisions, grace period (3216(d)(1)(C)); N.Y. Ins. Law § 3216

  2. A New York individual accident and health policy contains the optional cancellation provision worded as Insurance Law 3216(d)(2)(H) requires. Under that provision, the insurer may cancel the policy:

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    Answer: C. New York's wording lets the insurer cancel only within the first 90 days after the date of issue, by written notice stating a cancellation date not less than 10 days later; it must promptly return the pro-rata unearned premium, and cancellation does not affect claims that began earlier. The at-any-time, 5-day version is the older NAIC uniform provision used in many other states, not New York's text. The insured may be given a right to cancel at any time, with a short-rate refund.

    Source: NY 17-55 outline: Individual Health Insurance Policy General Provisions, cancellation (3216(d)(2)(H)); N.Y. Ins. Law § 3216

  3. Priya, 28, is unmarried, lives in New York and is not eligible for any employer health plan. Her parents' individual hospital and medical policy covers children to age 26. Under New York's young adult option (Insurance Law 3216(a)(4)(C)), Priya:

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    Answer: A. An insurer issuing hospital, medical or surgical coverage for dependent children must make available, and extend if the policyholder asks, coverage for an unmarried child through age 29 who is not insured by or eligible for an employer health plan and who lives, works or resides in New York or the insurer's service area (3216(a)(4)(C)); group policies have the same option under 4235(f)(1)(B). It applies regardless of financial dependence, so tax-dependent status is irrelevant, and student status is not required. The separate rule covering children to 26 applies whether or not the child is married.

    Source: NY 17-55 outline: Medical Plans, dependent child age limit (3216(a)(4); 4235(f)); N.Y. Ins. Law § 3216; N.Y. Ins. Law § 4235

  4. Leah's son has a developmental disability that began in childhood and makes him incapable of self-sustaining employment. He is unmarried and chiefly dependent on her. Under Insurance Law 3216(c)(4)(A), his coverage under her individual health policy continues past the limiting age if she:

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    Answer: B. Coverage of an unmarried child who is incapable of self-sustaining employment because of mental illness, developmental disability or physical handicap, who became so before the limiting age and is chiefly dependent on the policyholder, does not end while the policy stays in force and the condition continues, provided proof of incapacity is submitted within 31 days of the child's reaching the limiting age. No new underwriting or separate policy is required, and a longer six-month window is not what the statute gives. Group policies carry the same 31-day rule (4235(f)).

    Source: NY 17-55 outline: Medical Plans, policy extension for handicapped children (3216(c)(4)(A)); N.Y. Ins. Law § 3216

  5. An insurer is pricing a small group medical policy in New York, which must be community rated under Insurance Law 3231. Which factor may it use to set a different rate?

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    Answer: A. Community rated means the premium for everyone covered by a policy form is the same, based on the whole pool's experience, without regard to age, sex, health status, tobacco usage or occupation (3231(a)(4)); the superintendent must, however, permit separate community rates for reasonable geographic regions approved in the rate filing (3231(c)(1)). Individuals and small groups must also be accepted all year and cannot be terminated because of claims experience. For policies issued or renewed on or after January 1, 2016, 3231(a)(1) defines a small group as 1 to 100 employees, not counting spouses and dependents; the older Reg 145 definition (11 NYCRR 360.2(f)) still reads 2 to 50.

    Source: NY 17-55 outline: Accident and Health Insurance Basics, community rating of policies and definition of small group (4317; Reg 145, Part 360); N.Y. Ins. Law § 3231; N.Y. Ins. Law § 4317; 11 NYCRR 360.2 (Regulation 145, definitions)

  6. Marco is covered under his employer's insured group medical plan in New York. The employer has 12 employees, so federal COBRA does not apply. Marco quits his job. Under Insurance Law 3221(m), he may continue the group coverage for up to:

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    Answer: A. New York requires group hospital, surgical and medical policies to let an employee whose coverage ends with employment continue it without evidence of insurability for up to 36 months (3221(m)(4)), at no more than 102% of the group rate (3221(m)(3)). He must ask in writing within 60 days after the later of the termination or the notice of his right (3221(m)(2)), and continuation ends early if he becomes entitled to Medicare or covered by another group plan without a preexisting-condition limit. Federal COBRA does not apply to plans of employers that normally had fewer than 20 employees (29 U.S.C. 1161(b)); when it does apply, New York requires the policy to offer continuation up to 36 months in total to someone entitled to less under federal law (3221(m)(6)).

    Source: NY 17-55 outline: Group Health and Blanket Insurance, continuation of coverage under COBRA and New York continuations; N.Y. Ins. Law § 3221; 29 U.S.C. § 1161 (COBRA small-employer exception)

  7. Ana's group hospital and medical coverage ended when she left her job, and her employer gave her written notice of the conversion privilege on her last day. Under Insurance Law 3221(e), to get an individual converted policy without evidence of insurability she must apply within:

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    Answer: C. A group hospital, medical or surgical policy must let an employee whose coverage ends because employment or the policy terminates obtain a converted policy without evidence of insurability on application within 60 days after the termination (3221(e)(1)), unless the employer replaced the plan with similar continuous coverage. Notice of the privilege is due within 15 days before or after termination; if it comes 15 to 90 days late, the time to convert runs 45 days from the notice, and if no notice is given within 90 days the privilege ends at 90 days (3221(e)(6)(A)). The converted coverage takes effect on the date the group coverage ended.

    Source: NY 17-55 outline: Group Health and Blanket Insurance, conversion privilege (3221(e)); N.Y. Ins. Law § 3221

  8. A New York health plan has issued a final adverse determination, after utilization review, denying a procedure as not medically necessary. Under Insurance Law 4914, how long does the insured have to request an external appeal?

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    Answer: C. The insured has four months to initiate an external appeal after receiving notice of the final adverse determination, or after the plan and insured agree to waive the internal appeal (4914(b)(1)). The external appeal agent decides within 30 days (4914(b)(2)), or within 72 hours if delay would pose an imminent or serious threat to health (4914(b)(3)). Utilization review itself is a medical necessity review made before, during or after services are delivered, that is prospective, concurrent or retrospective review (4900(h)); 45 days is the minimum time a plan must allow to file an internal appeal (4904(c)).

    Source: NY 17-55 outline: Medical Plans, utilization review (Art. 49); N.Y. Ins. Law § 4914; N.Y. Ins. Law § 4900; N.Y. Ins. Law § 4904

  9. Under Insurance Law 4303(j)(3), a non-grandfathered contract issued by a New York health service or medical expense indemnity corporation that provides hospital, surgical or medical coverage must cover preventive services rated A or B by the U.S. Preventive Services Task Force:

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    Answer: A. Section 4303(j)(3) requires coverage, not subject to annual deductibles or coinsurance, for A- or B-rated Task Force preventive services, immunizations recommended by the CDC's Advisory Committee on Immunization Practices, HRSA-supported preventive care for children and additional HRSA-supported preventive care for women. Separately, 4303(j)(2) defines required preventive and primary care for children from birth through age 19, such as well-child visits and immunizations, but that is in addition to the adult rule, not a limit on it. The law does not condition this coverage on a referral.

    Source: NY 17-55 outline: Medical Plans, preventive care services (4303(j)); N.Y. Ins. Law § 4303

  10. An employee of a covered New York employer breaks a leg skiing on a weekend and cannot work. Under the Disability Benefits Law (Workers' Compensation Law 204 and 205), statutory disability benefits:

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    Answer: B. DBL benefits are payable beginning with the eighth day of disability (WKC 204(1)) and for no more than 26 weeks, less any paid family leave taken, in 52 consecutive weeks (WKC 205(1)(a)). The law covers injury or sickness not arising out of employment (WKC 201(9)); a work injury falls under workers' compensation instead. The weekly benefit is half the employee's average weekly wage up to the statutory maximum, which WKC 204(2)(b) currently sets at $170, and employees become eligible after four consecutive weeks with a covered employer (WKC 203).

    Source: NY 17-55 outline: Government Insurance Plans, New York State Disability Benefits Law; N.Y. Workers' Comp. Law § 204; N.Y. Workers' Comp. Law § 205; N.Y. Workers' Comp. Law § 201; N.Y. Workers' Comp. Law § 203

  11. Which employer meets the Insurance Law 4326 definition of a qualifying small employer that can buy Healthy New York coverage?

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    Answer: D. A qualifying small employer has no more than 50 employees, had no expense-reimbursed or prepaid group health coverage for its employees in the 12 months before applying, and has at least 30% of its employees earning annual wages at or below a level that started at $30,000 and is adjusted every July 1 (4326(c)(1)). The 75-employee firm is too large, the shop had group coverage within 12 months, and the practice has too few lower-wage workers. The employer must pay at least 50% of the premium and offer coverage to all lower-wage employees (4326(l)), and the contract must insure at least 50% of employees (4326(c)(2)).

    Source: NY 17-55 outline: Government Insurance Plans, Healthy New York (4326); N.Y. Ins. Law § 4326

  12. A 15-year-old New York resident has no health insurance and is not eligible for Medicaid. Her household income is 300% of the federal poverty level. Under Public Health Law 2510 and 2511, Child Health Plus:

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    Answer: B. An eligible child for Child Health Plus is under age 19 (PBH 2510(4)), and a subsidy is available to a child who lives in a household with income at or below 400% of the non-farm federal poverty level, is not eligible for Medicaid, has no other health coverage and is a New York resident (PBH 2511(2)). A child who is eligible for Medicaid does not qualify for the subsidy, so the second option reverses the rule. Coverage runs to age 19, not 18, and no employer contribution is involved.

    Source: NY 17-55 outline: Government Insurance Plans, Child Health Plus eligibility and benefits; N.Y. Pub. Health Law § 2510; N.Y. Pub. Health Law § 2511

  13. Under Regulation 62 (11 NYCRR 52.25(b)(2)), which exclusion may a New York long-term care insurance policy NOT contain?

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    Answer: C. A New York LTC policy may limit or exclude coverage only as the regulation lists: a preexisting-condition limit of no more than six months for conditions treated or advised within six months before coverage, mental or nervous disorders, alcoholism and drug addiction, conditions arising from war, a felony, riot, military service, suicide or self-inflicted injury or non-fare aviation, certain government or family-provided services, and care outside the United States and its possessions. The mental or nervous disorder exclusion expressly cannot be used to exclude or limit benefits for Alzheimer's disease or demonstrable organic brain disease (52.25(b)(2)(ii)). The policy also cannot require a prior hospital stay before nursing home or home care benefits are paid (52.25(c)(1)(i)).

    Source: NY 17-55 outline: Long-Term Care Insurance, exclusions (Reg 62, Part 52.25(b)(2)); 11 NYCRR 52.25 (Regulation 62)

  14. At the time of purchase, a New York long-term care insurer must offer an inflation protection option at least as favorable as one of the forms in 11 NYCRR 52.25(c)(3). Which option meets that standard?

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    Answer: B. The insurer must offer protection no less favorable than annual increases of 5% or in proportion to the Consumer Price Index for All Urban Consumers, compounded annually; a guaranteed right to buy periodic increases without evidence of insurability as long as the option has not been declined three consecutive times; or coverage of a specified percentage of actual or reasonable charges (52.25(c)(3)). Simple 3% growth, an option lost after one refusal and a one-time bump are all less favorable. The disclosure statement must include a graph comparing level and increasing benefits over at least 20 years (52.25(c)(6)), and the policy must also offer a nonforfeiture value such as reduced paid-up insurance (52.25(c)(7)).

    Source: NY 17-55 outline: Long-Term Care Insurance, inflation protection (Reg 62, Part 52.25(c)(3)) and nonforfeiture benefits (52.25(c)(7)); 11 NYCRR 52.25 (Regulation 62)

  15. Under the New York State Partnership for Long-Term Care's 3/6/50 plan design (11 NYCRR 39.3), an insured who uses only home care benefits can receive a lifetime maximum of at least:

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    Answer: D. The 3/6/50 design requires at least 36 months of nursing home coverage and lets the insured substitute two home care days for one nursing home day, so using home care alone yields a lifetime maximum of 72 months (39.3(b)(1) and (b)(2)(ii)). The 50 refers to the minimum home care benefit of at least 50% of the minimum nursing home daily benefit (the minimum dollar amounts are adjusted each year). 100 is the longest elimination period a qualified policy may use, in days (39.3(b)(12)).

    Source: NY 17-55 outline: Long-Term Care Insurance, New York State Partnership for Long Term Care (Reg 144, Part 39); 11 NYCRR 39.3 (Regulation 144, 3/6/50 plan design)

  16. Which statement about inflation protection in a qualified New York State Partnership for Long-Term Care policy is correct?

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    Answer: C. Qualified Partnership policies must provide lifetime inflation protection of 3.5% or 5% compounded annually, with the insured choosing which, and it is mandatory except for a policy bought at or after age 80 (for example 39.3(b)(8) and 39.5(b)(11)). Ordinary LTC policies only have to offer inflation protection (52.25(c)(3)). Partnership premiums must also be level, with no step-rate or automatic increases, apart from form-wide rate increases the superintendent approves. A buyer who later moves should know that a New York policy marketed as protecting all assets protects only an amount equal to benefits paid in a reciprocal state (39.8(a)(7)).

    Source: NY 17-55 outline: Long-Term Care Insurance, New York State Partnership for Long Term Care (Reg 144, Part 39); 11 NYCRR 39.3 (Regulation 144); 11 NYCRR 39.5 (Regulation 144); 11 NYCRR 39.8 (Regulation 144, disclosure)

  17. Ruth, 62, has been on Medicare because of a disability for three years. She now applies for a Medicare supplement policy in New York. Under 11 NYCRR 58.1(i), the issuer:

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    Answer: D. New York's open enrollment rule says an issuer may not deny or condition a Medicare supplement policy, or vary its price, because of an applicant's health status, claims experience, receipt of health care or medical condition, and applicants must be accepted at all times throughout the year for any plan the issuer offers (58.1(i)(1)). The rule applies whether a person is on Medicare by reason of age or disability (58.1(i)(2)). The year-round right also comes from the community rating and open enrollment law (Ins. Law 3231(a)(2)), so a six-month window does not limit it. An issuer may still apply a preexisting-condition limitation within the limits of 58.1(b)(3).

    Source: NY 17-55 outline: Private Insurance for Senior Citizens and Special Needs Individuals, Medicare supplement open enrollment (Reg 193, Part 58); 11 NYCRR 58.1; N.Y. Ins. Law § 3231

  18. Under 11 NYCRR 58.1(b)(3), the most restrictive preexisting-condition limitation a New York Medicare supplement policy may contain is one that excludes a condition:

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    Answer: C. The only permissible preexisting-condition limitation excludes coverage for no more than six months after the effective date, and only for a condition for which medical advice was given or treatment was recommended or received from a physician within six months before the effective date (58.1(b)(3)(i)). The issuer must credit prior creditable coverage, including Medicare supplement, Medicare select and Medicare Advantage, if it was continuous to a date not more than 63 days before the new coverage began (58.1(b)(3)(ii)). People with a federal guaranteed-issue right who apply in time cannot be given any preexisting-condition exclusion (58.1(i)(4)).

    Source: NY 17-55 outline: Private Insurance for Senior Citizens and Special Needs Individuals, New York regulations and required provisions (Reg 193, Part 58); 11 NYCRR 58.1

  19. Under 11 NYCRR 58.1, a New York issuer may cancel or nonrenew a Medicare supplement policy only for:

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    Answer: C. Every Medicare supplement policy must be guaranteed renewable, and the issuer has no unilateral right to change its provisions except to match Medicare cost-sharing changes, meet minimum standards or revise premiums on a class basis (58.1(b)(1)). It may not cancel or nonrenew for any reason other than nonpayment of premium or material misrepresentation, and never because of health status (58.1(c)(1) and (2)). An insured who becomes entitled to Medicaid can have benefits and premiums suspended for up to 24 months by notifying the issuer within 90 days (58.1(c)(7)(i)).

    Source: NY 17-55 outline: Private Insurance for Senior Citizens and Special Needs Individuals, renewability (Reg 193, Part 58); 11 NYCRR 58.1

  20. Two New Yorkers, ages 66 and 84, buy the same Medicare supplement policy form from the same insurer in the same rating region. Under Insurance Law 3231, the insurer:

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    Answer: C. New York requires individual Medicare supplement coverage to be community rated (3231(a)(1)), which for Medicare supplement means the premium for everyone covered by a policy or contract form is the same, based on the experience of that form's whole pool, without regard to age, sex, health status, tobacco usage or occupation (3231(a)(4)). Attained-age and issue-age rating, common in other states, are therefore not used, and tobacco surcharges are barred too. Insurers can still change rates for the whole form with the superintendent's approval, and may use separate rates for approved geographic regions (3231(c)(1)).

    Source: NY 17-55 outline: Accident and Health Insurance Basics, community rating of policies (4317; Reg 145, Part 360); N.Y. Ins. Law § 3231; N.Y. Ins. Law § 4317

Where these questions come from: New York Life, Accident and Health agent exam outline (series 17-55, PSI candidate information bulletin updated 28 Apr 2023), sections: Accident and Health Insurance Basics (5%), Individual Health Insurance Policy General Provisions (4%), Medical Plans (6%), Group Health and Blanket Insurance (5%), Government Insurance Plans (5%), Long-Term Care (LTC) Insurance (6%) and Private Insurance for Senior Citizens and Special Needs Individuals (6%). See how we write questions.