NJ Health and Accident Prep Exam Questions Answered Correctly., Exams of Nursing

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NJ Health and Accident Prep Exam

Questions Answered Correctly.

In what form do disability income policies typically pay benefits - Answer Periodic income The Mandatory health policy provision states that the policy, including endorsements and attached papers, constitutes - Answer The entire insurance contract between the parties The entire contract includes the actual policy and the - Answer application employer sponsored group health insurance provides coverage for which of the following - Answer Alcoholism The term which describes the fact that both parties of a contract may not receive the same value is referred to as - Answer Aleatory Tom has a home health care benefit and is confined to his home. Which of these is NOT typically covered

• Answer Full-time nursing care A Medicare Supplement policy can be cancelled by the insurer for - Answer Nonpayment Credit Accident and Health plans are designed to - Answer help pay off existing loans during periods of disability A payment system for health care in which the provider is paid for each service given is called - Answer fee-for-service An insurance company ONLY pay a sales commission to - Answer individuals licensed by the state

Ken is a producer who has obtained Consumer Information Reports under false pretenses. Under the Fair Credit Reporting Act, what is the maximum penalty that may be imposed on Ken? - Answer $5000 and 1 year imprisonment A closed network plan offers a primary physician copay of $25. If a subscriber chooses a primary care physician outside of the network, the subscriber will likely pay - Answer 100% of the billed amount What is the maximum fine for a producer violating an NJ insurance law for the first time? - Answer $ A licensed producer is required to file notice to any changes of address within how many days - Answer 30 days Jonas has disability insurance through his employer. The employer pays 75% of the premium, and Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? - Answer Taxes must be paid on 75% of the benefits received After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? - Answer File written proof of loss Which of the following is an example of the insured's consideration? - Answer A paid premium A(n) _______ insurance company is one that was formed under the laws of a state other than NJ - Answer Foreign Kathy pays a monthly premium on her health insurance policy. How long is her grace period? - Answer 10 days Insurance licenses are intended to be issued for the purpose of authorizing the transaction of business with members of the general public and not primarily allowing someone to benefit from commissions on business that insurers their personal interest. The description of which of the following? - Answer Controlled business

A master contract and certified coverage can be found in which type of policy? - Answer Group Medicaid is a government-funded program designed to provide health care to - Answer poor people Which type of long-term care benefit would be most appropriate for a stroke victim who requires speech therapy administered at her home? - Answer Home Health Care What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee to do? - Answer In the event of employment termination, group health insurance can be kept if the employee pays the premiums Replacement regulation is designed to protect the interests of - Answer Policy owners Continued coverage under COBRA would be provided to all of the following except? - Answer a covered employee is terminated for gross misconduct A health insurer must be provided with written proof of loss ______ days after the date of loss - Answer 90 days All of the following are factors would affect a health insurance policies premium rate Except - Answer Residential address of the insured Which of the following is NOT a required provision in an accident and health insurance policy? - Answer Change of occupation (considered optional provision) Within how many days must a producer notify the Department of Banking and Insurance of a change in address? - Answer 30 days When comparing an HMO, to a PPO, the PPO - Answer provides a greater choice of providers Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must - Answer be the same and the premium cannot exceed 102%

An agent is required to keep replacement forms on file for at LEAST ______ years. - Answer 5 years An insurer has the right to recover a payment made to the insured from the negligent party. These rights are called - Answer Subrogation All advertisements for health insurance shall make clear the identity of the - Answer insurer Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him? - Answer Assisted living How many employees must an employer have for a terminated employee to be eligible for COBRA? - Answer 20 An agent has committed an insurance crime that violates US CODE 1033 (interstate commerce). Who would be responsible for the prosecution of this crime? - Answer US Attorney General The time limit for filing claim disputes is addressed in which provision of an accident and health policy? - Answer Legal actions What is the process for a producer voluntarily terminating his/her license? - Answer Returning his/her license to the Banking and Insurance Department Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the - Answer employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan At what age will a person normally enroll with an insurance carrier under a Part C Medicare Advantage Plan? - Answer Age 65 Under group health insurance, a certificate of coverage is issued to the - Answer Employee

Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance? - Answer Medicare in-hospital deductible XYZ Company has applied for group health insurance for its employees. What information would the insurer's underwriters likely use to determine the appropriate coverage and final premium rate given to the group? - Answer Experience rating When a producer, domiciled in New York, with an office location in NJ, elects NJ as their resident state, he is acting as - Answer A resident licensee in NJ In group health care, what is the purpose of the coordination of benefits provision? - Answer Determines what is paid by the primary and secondary insurers in the event of a claim Which of the following is the purpose of medical cost management? - Answer To control health claim expenses An example of rebating would be - Answer A producer who shares commission with a client A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called - Answer conditionally renewable Which of the following MUST contain a "Statement of Policy Cost and Benefit Information"? - Answer Policy Summary A health insurance policy will typically cover - Answer Preventative health services HIPAA considers which of the following as "individually identifiable health information"? - Answer A person's health claim information In which of the following situations would the insurer be liable for a loss? - Answer The insured suffered an injury as an innocent bystander

How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes? - Answer Not tax deductible Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. - Answer 20 A person covered with an individual health plan - Answer is issued a policy Which of the following statements is NOT true regarding a Critical Illness Plan? - Answer Coverage is limited to a single devastating disease What amount will be paid under a policy where the insured misstated his/her age? - Answer An amount the premium would have purchased at the correct age All Medicare Supplement policies MUST contain which provision? - Answer Pre-existing conditions may only be excluded from coverage for a maximum of 6 months Low-frequency diseases can be exclusively covered by what kind of health insurance policies? - Answer Limited policies In group medical expense health insurance plan, coverage for alcoholism is treated as? - Answer Treated as any other illness, sickness, or disease An insurance producer is issued a(n) ______ as evidence of authority - Answer license Which of the following is NOT included under a health benefit plan? - Answer Hospital indemnity plan Once an accident and health insurance policy has been in force for ___ year(s), the policy may NOT be contested by the insurer - Answer 2 years A medicare supplement policy must NOT contain benefits which - Answer duplicate Medicare benefits

The Commissioner may - Answer establish continuing education requirements Signatures for an insurance application MUST be obtained by the producer from all of the following sources EXCEPT - Answer the beneficiary David submits a $500 claim for medical expenses. There is a past due amount owed for insurance premiums of $200. As a result, the insurer only pays $300 for the claim. The deduction came as a result of which provision? - Answer unpaid provision Who is the individual paid on a fee-for-service basis? - Answer Provider A producer's secretary who solicits prospects on the telephone - Answer must be licensed as a producer Insurance advertisements in a local newspaper are regulated by? - Answer Department of Banking and Insurance Johan the producer charged a fee to a sales prospect for analyzing insurance coverages. According to NJ law, a reasonable relationship must exist between the fee and the - Answer Substance of the services performed What is the free-look period of a Medicare Supplement policy? - Answer 30 days Which of the following is an example of defamation? - Answer Using derogatory about an insurance company's financial condition All of the following are included as part of a contract in the entire contract provision EXCEPT the - Answer changes made by the producer A health insurance policy that allows an insurer to change the policy owner's premiums, but NOT cancel the policy is called a(n) - Answer guaranteed renewable policy

Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be - Answer Optionally renewable According to the principle of Utmost Good Faith, the insured will answer questions on the application to the best of their knowledge and pay the required premium, while the insurer will deal fairly with the insured and it's - Answer promise made An insurer must furnish to a claimant forms for filling proof of loss within ____ days upon receiving a notice of claim - Answer 15 days A person who is a nonsmoker, of average weight, and in excellent health would most likely be in which risk classification? - Answer Preferred An agent is an individual that represents whom? - Answer Licensed producer who has written contract to represent an insurer Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered - Answer Noncancellable In NJ, group health insurance may be offered to all of these groups EXCEPT - Answer College seminar participants Jerry voluntarily terminated his producer's license. If he changes his mind, his license may be reinstate during the same license period IF - Answer he completes a new license application An insured MUST submit proof of loss on a health insurance claim within how many days after the date of loss? - Answer 90 days In contrast to a guaranteed renewable policy, a noncancellable policy - Answer may never raise premiums A medical provider that accepts Medicare Assignment must - Answer accept payment based upon a defined Medicare schedule as payment in full

Fraternal Benefit Society has each of the following characteristics EXCEPT - Answer Exist For Profit The New Jersey Life and Health Guaranty Association is - Answer funded by assessments on member companies Who would make the final determination on whether or not an insurance advertisement is misleading? - Answer Banking and Insurance Commissioner Which of these may NOT be used in a health insurance advertisements - Answer An insurance company's trademark instead of the company's actual name Which of the following is NOT a common exclusion for a medical expense policy? - Answer Physical Therapy Which of the following is NOT a duty of the Commissioner? - Answer Establish insurer rates NJ insurance law requires eligible individuals to make an election to continue health insurance benefits within a MAXIMUM of _____ days after coverage termination - Answer 60 days The Commissioner issues a subpoena to a producer. The producer decides not to respond. Which course of action must be taken by the Commissioner? - Answer Commissioner may impose an administrative penalty All _____ policies must be guaranteed renewable. - Answer long term care Which of the following situations would be suitable for a temporary work authority - Answer When an applicant passes a licensing examination and answers all background questions negatively A newborn is required to be covered for _____ days from the moment of birth - Answer 30 days An underwriter's primary responsibility to an insurer is to protect against - Answer adverse selection

Which type of coverage pay an amount per day for hospitalization directly to the insured regardless of the insured's other health insurance? - Answer Hospital indemnity Producers selling insurance in NJ, while having a residence and business address outside of the state, are? - Answer Non-resident producers A producer must notify the Commissioner within _____ days of a felony conviction. - Answer 30 days In NJ, health insurance advertisements are required to contain the - Answer Insurance company's name Which of the following is NOT considered advertising? - Answer A rating from a rating service company, such as A.M. Best What is considered advertising - Answer An illustration A sales presentation Direct mailing from an agency What is issued to each employee of an employer health plan? - Answer Certificate What type of policy where the insurer can send a notice to the insured that the policy has been cancelled in the middle of the term is called - Answer Cancelable In order to obtain a producer's license, the application must be received by the Department within what period of time listed below? - Answer 12 months after passing the state exam Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability. What kind of rider is this? - Answer Guaranteed insurability rider which of the following statements regarding group disability insurance is TRUE? - Answer it provides benefits for non occupational illnesses and injuries

what percentage of a participants income are group long term disability benefit amounts typically limited to? - Answer 60% When the principle gives the agent authority in writing, it's referred to as - Answer express authority Which of the following statements correctly regarding an individual applying for life or health insurance?

• Answer The applicant's medical history may be analyzed and reported An accident and health insurer has just received written proof of loss from one of its insureds. The insured must now wait 60 days before - Answer bringing legal action against the insurer When an insured changes to a more hazardous occupation, which disability provision allows an insurer to adjust policy benefits and rates? - Answer Change of occupation provision Lorenzo is self-employed with an S corporation. He is unmarried and had a net profit for the tax year. What are the tax ramifications of his health insurance premiums paid for the year? - Answer 100% of his health insurance costs can be deducted from his gross income Craig submits a $500 claim for medical expenses. With a past due premium of $100, the insurer pays $400. Which of the Uniform Optional Provisions covers this situation? - Answer Unpaid premium the treasurer of XYZ Insurance Company discovers that the treasurer's Company is being investigated by the banking and insurance commissioner. Because the company is in weak financial condition, the treasure instructs the company claims manager to delay recording several large claims settlement. In this situation, the treasure may be found guilty of which of the following actions? - Answer Making false financial statements