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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.
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).
| Program | Key rules |
|---|---|
| Disability Benefits Law | Off-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 York | Employers with 50 or fewer employees, no group coverage in the past 12 months and at least 30% lower-wage workers |
| Child Health Plus | New 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.