NY Law + Ethics
11%of exam
Life Insurance
26%of exam
Annuities + Tax
14%of exam
Fixed / Variable / IndexedReg 60 ReplacementTaxation + MEC1035 ExchangeLife Settlement
Health + Disability
27%of exam
Guaranteed IssueCommunity RatingDBL + PFLTimothy's LawHMO / PPO
Senior, LTC + Govt
22%of exam
Medicare A / B / C / DMedigap Year-RoundLTC PartnershipGuaranty Fund $500KGovernment Plans
Quick Facts
- Exam
- NY L&H (17-55)
- Credential
- Life, Accident & Health
- Questions
- 150 MCQ
- Time
- 150 min (2.5 hr)
- Pass
- 70%
- Fee
- $33 (PSI)
- Regulator
- NY DFS
- Pre-license
- 40 hours
- Pass rate
- ~60% first try
NY Reg Numbers
60=Replace | 187=Best-interest | 64=Claims
60: replacement disclosure187: best interest64: claim practices
Reg 60 vs Reg 187
Reg 60
- Replacement disclosure
- Policy comparison
- 60-day free look
Reg 187
- Best-interest standard
- Care + disclosure
- Recommendation basis
Replacement vs recommendation
NY Number Picker
- Replacement disclosure→Reg 60
- Best-interest standard→Reg 187
- Claim practices→Reg 64
- New life free look→10 days
- Replacement free look→60 days
- Incontestable or suicide→2 years
- Grace period→31 days
NY DFS + Insurance Law
- DFS
- Insurance + banking mergedNY
- Superintendent
- Governor-appointed, Senate-confirmed
- Insurance Law
- Statute from legislature
- Title 11 NYCRR
- Superintendent regulations
- Prior-approval
- DFS approves formsNY
- Agent vs broker
- Insurer vs client
Agent vs Broker
Agent
- Represents insurer
- Appointed by carrier
- Knowledge imputed
Broker
- Represents client
- Shops the market
- Places coverage
Insurer vs consumer
Licensing + Continuing Ed
- Pre-license
- 40 hours (20+20)
- Ethics hours
- 4 of 40
- Cert exam
- 70%, 90 minutes
- Fingerprints
- IdentoGO vendor
- Renewal
- Every 2 years
- CE hours
- 15 per cycleNY
- CE topics
- Ethics, law, DEI
Twisting vs Churning
Twisting
- Different insurer
- Misrepresentation
- Induce replacement
Churning
- Same insurer
- Own policies
- Generate commissions
Across vs within
Ethics + Unfair Practices
- Twisting
- Misrepresent to replace
- Churning
- Replace own policies
- Rebating
- Unlawful inducement (2324)
- Commingling
- Mixing premium funds
- Defamation
- False injurious statements
- Reg 64
- Unfair claim practices
- Willful penalty
- $5,000 per violation
Life Policy Timelines
10 free look | 2yr contest | 31 grace
10: new free look2yr: incontestable + suicide31: grace period60: replacement free look
Term vs Whole Life
Term
- Temporary period
- No cash value
- Lowest premium
Whole life
- Permanent coverage
- Builds cash value
- Level premium
Temporary vs permanent
Life Policy Picker
- Low-cost temporary→Term(No cash value)
- Lifetime + cash value→Whole life
- Flexible premium→Universal life
- Market growth→Variable life(Securities license)
- Guaranteed income later→Annuity
- Terminal illness cash→Accelerated rider
Life Insurance Types
- Term
- Temporary, no cash
- Whole life
- Permanent, level premium
- Universal life
- Flexible premium, adjustable
- Variable life
- Sub-account investment risk
- VUL
- Variable + universal
- Endowment
- Pays at maturity
Life Policy Provisions
- Free look
- 10 days newNY
- Incontestability
- 2 years
- Suicide clause
- 2-year exclusion
- Grace period
- 31 days
- Reinstatement
- 3 years, evidence
- Misstatement age
- Adjust benefit, not void
- Readability
- 45 Flesch minimumNY
Riders + Options
- Waiver premium
- Disability pays premium
- Accelerated benefit
- Early terminal payout
- Guaranteed insurability
- Buy without underwriting
- ADB
- Double accidental death
- Nonforfeiture
- Guaranteed cash values
- Beneficiary
- Revocable or irrevocable
Fixed vs Variable Annuity
Fixed
- Guaranteed rate
- Insurer bears risk
- No securities license
Variable
- Sub-account risk
- Owner bears risk
- Securities license
Guaranteed vs market
Annuities
- Fixed
- Guaranteed interest rate
- Variable
- Sub-account market risk
- Indexed
- Index-linked interest
- Immediate
- Payout within year
- Deferred
- Accumulate then pay
- Annuitization
- Convert to income
- Annuity free look
- 10 days newNY
Taxation + Life Settlement
- Death benefit
- Income-tax-free
- Cash value
- Tax-deferred growth
- MEC
- Taxed LIFO, penalty
- Annuity gains
- Ordinary income
- Exclusion ratio
- Nontaxable return portion
- 1035 exchange
- Tax-free swap
- STOLI
- Illegal, no interestNY
DBL Benefit Numbers
50% | $170 cap | 26 weeks | 7 days
50%: of wage$170: weekly max26: weeks max7: day wait
DBL vs PFL
DBL
- Own off-job illness
- 50% up to $170
- Employer-funded
PFL
- Family care leave
- 67% of wage
- Employee-funded
Self vs family
NY Health Insurance Rules
- Guaranteed issue
- Cannot deny coverageNY
- Community rating
- No age pricingNY
- Guaranteed renewable
- Insurer must renew
- Timothy's Law
- Mental health parityNY
- Age 29
- Dependent extensionNY
- External appeal
- DFS independent review
HMO vs PPO
HMO
- Network only
- Gatekeeper PCP
- Lower cost
PPO
- Out-of-network allowed
- No referral
- Higher cost
Restricted vs flexible
Disability + Statutory Benefits
- DBL pays
- 50% AWW, $170NY
- DBL max
- 26 weeks
- DBL waiting
- 7 days
- PFL pays
- 67% AWWNY
- PFL max
- 12 weeks
- Workers comp
- On-job injury
- Elimination period
- Disability waiting time
Health Plan Types
- HMO
- Network, gatekeeper PCP
- PPO
- Out-of-network allowed
- COBRA
- 20+ staff, 18 months
- Mini-COBRA
- Under 20, 36 monthsNY
- Small group
- 1-100 employeesNY
- HSA
- High-deductible savings
NY Medigap Rules
Year-round issue | Community-rated | No age
Issue: any dayRated: communityAge: not a factor
Senior + Health Picker
- Hospital inpatient→Medicare A
- Doctor visits→Medicare B
- Fill Medicare gaps→Medigap
- Custodial daily care→LTC insurance
- Off-job disability→DBL(NY statutory)
- Bonding new child→PFL(NY statutory)
Medicare + Medigap
- Part A
- Hospital inpatient
- Part B
- Doctor, outpatient
- Part C
- Advantage plans
- Part D
- Prescription drugs
- Medigap
- Supplements Medicare gaps
- NY Medigap
- Year-round guaranteed issueNY
- Plans C, F
- Closed after 2020
LTC Benefit Trigger
2 ADLs or cognitive impairment
ADLs: bathing, eating, dressingCognitive: dementiaTrigger: 2 of 6
LTC + Guaranty Fund
- LTC training
- 8-hour course requiredNY
- Benefit trigger
- 2 ADLs or cognitive
- Partnership
- Medicaid asset protectionNY
- Total asset
- All assets disregardedNY
- Dollar-for-dollar
- Protects benefits paid
- Security Fund
- $500K per lifeNY
Common Traps
Reg 60 Timelines
20-day = insurer data ≠ 60-day = free look
Statute vs Regulation
Law = legislature ≠ Reg = Superintendent
Suicide Payout
Within 2 years: premiums ≠ After 2 years: face
Best Interest Not Fiduciary
Reg 187 = best interest ≠ Not full fiduciary
Twisting vs Churning
Twisting = other insurer ≠ Churning = same insurer
NY Community Rating
NY: no age rating ≠ ACA: age band allowed
DBL vs PFL
DBL = own illness ≠ PFL = family care
Last Minute
- 1.150 questions, 150 minutes
- 2.Pass mark = 70%
- 3.40 pre-license hours required
- 4.Reg 60 = replacement disclosure
- 5.Reg 187 = best interest
- 6.Reg 64 = claim practices
- 7.New life free look = 10 days
- 8.Replacement free look = 60 days
- 9.Incontestable and suicide = 2 years
- 10.Grace period = 31 days
- 11.DBL 50%, PFL 67%
- 12.Security Fund = $500K limit
- 13.NY Medigap = year-round issue
- 14.Twisting across, churning within
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