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ACCIDENT INSURANCE AND NJ HEALTH EXAM
WITH 100% COMPLETE SOLUTIONS RATED A (
QUESTIONS AND CORRECT ANSWERS) | EXPERT
VERIFIED(2025 UPDATE)
Under |the |Health |Insurance |Portability |and |Accountability |Act |(HIPAA), |the |employee's |new |Group |Health |Plan |will |verify |Creditable |Coverage |so |that |the employee's |waiting |period |for |coverage |of |a |preexisting |condition |can |be |reduced |under |the |new |employer's |health |plan In |NJ, |health |insurance |advertisements |are |required |to |contain |the Insurance |company's |name In |which |of |the |following |situations |would |the |insurer |be |liable |for |a |loss? 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? Not |tax |deductible An |agent |is |required |to |keep |replacement |forms |on |file |for |at |LEAST | years.
5 |years Written |notice |for |a |health |claim |must |be |given |to |the |insurer | days |after|the |occurrence |of |the |loss. 20 How |many |employees |must |an |employer |have |for |a |terminated |employee |to |be |eligible |for |COBRA? 20 A |person |covered |with |an |individual |health |plan is |issued |a |policy Bill |requires |some |nursing |care |and |supervision |but |NOT |full-time |care. |Which |of |these |nursing |home |options |would |best |serve |him? Assisted |living At |what |age |will |a |person |normally |enroll |with |an |insurance |carrier |under |a |Part |C |Medicare |Advantage |Plan? Age | 65
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? Experience |rating Under |group |health |insurance, |a |certificate |of |coverage |is |issued |to |the Employee Which |of |these |gaps |in |Medicare |coverage |is |addressed |with |Medicare |Supplemental |Insurance? Medicare |in-hospital |deductible When |a |producer, |domiciled |in |New |York, |with |an |office |location |in |NJ, |elects |NJ |as |their |resident |state, |he |is |acting |as A |resident |licensee |in |NJ In |group |health |care, |what |is |the |purpose |of |the |coordination |of |benefits |provision? 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? To |control |health |claim |expenses Which |of |the |following |MUST |contain |a |"Statement |of |Policy |Cost |and |Benefit |Information"? Policy |Summary An |example |of |rebating |would |be A |producer |who |shares |commission |with |a |client A |health |insurance |policy |will |typically |cover Preventative |health |services What |amount |will |be |paid |under |a |policy |where |the |insured |misstated |his/her |age? An |amount |the |premium |would |have |purchased |at |the |correct |age
An |insurance |producer |is |issued |a(n) | as |evidence |of |authority license Which |of |the |following |is |NOT |included |under |a |health |benefit |plan? 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 2 |years A |medicare |supplement |policy |must |NOT |contain |benefits |which |duplicate |Medicare |benefits The |Commissioner |may establish |continuing |education |requirements Signatures |for |an |insurance |application |MUST |be |obtained |by |the |producer |from |all |of |the |following |sources |EXCEPT 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? unpaid |provision Who |is |the |individual |paid |on |a |fee-for-service |basis? |Provider A |producer's |secretary |who |solicits |prospects |on |the |telephone |must |be |licensed |as |a |producer Insurance |advertisements |in |a |local |newspaper |are |regulated |by? |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 Substance |of |the |services |performed
promise |made An |insurer |must |furnish |to |a |claimant |forms |for |filling |proof |of |loss |within | |days |upon |receiving |a |notice |of |claim 15 |days A |person |who |is |a |nonsmoker, |of |average |weight, |and |in |excellent |health |would |most |likely |be |in |which |risk |classification? Preferred An |agent |is |an |individual |that |represents |whom? 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 Noncancellable In |NJ, |group |health |insurance |may |be |offered |to |all |of |these |groups |EXCEPT |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 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? 90 |days In |contrast |to |a |guaranteed |renewable |policy, |a |noncancellable |policy |may |never |raise |premiums A |medical |provider |that |accepts |Medicare |Assignment |must accept |payment |based |upon |a |defined |Medicare |schedule |as |payment |in |full Fraternal |Benefit |Society |has |each |of |the |following |characteristics |EXCEPT |Exist |For |Profit The |New |Jersey |Life |and |Health |Guaranty |Association |is |funded |by |assessments |on |member |companies
The |Commissioner |issues |a |subpoena |to |a |producer. |The |producer |decides |not |to |respond. |Which |course |of |action |must |be |taken |by |the |Commissioner? Commissioner |may |impose |an |administrative |penalty All | policies |must |be |guaranteed |renewable. |long |term |care Which |of |the |following |situations |would |be |suitable |for |a |temporary |work |authority 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 | 30 |days An |underwriter's |primary |responsibility |to |an |insurer |is |to |protect |against |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? Hospital |indemnity
Producers |selling |insurance |in |NJ, |while |having |a |residence |and |business |address |outside |of |the |state, |are? Non-resident |producers A |producer |must |notify |the |Commissioner |within | days |of |a |felony |conviction. 30 |days Which |of |the |following |is |NOT |considered |advertising? A |rating |from |a |rating |service |company, |such |as |A.M. |Best What |is |considered|advertising |An |illustration A |sales |presentation Direct |mailing |from |an |agency What |is |issued |to |each |employee |of |an |employer |health |plan? |Certificate
When |the |principle |gives |the |agent |authority |in |writing, |it's |referred |to |as |express |authority Which |of |the |following |statements |correctly |regarding |an |individual |applying |for |life |or |health |insurance? 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 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? 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? 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? 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? Making |false |financial |statements In |what |form |do |disability |income |policies |typically |pay |benefits |Periodic |income The |Mandatory |health |policy |provision |states |that |the |policy, |including |endorsements |and |attached |papers, |constitutes The |entire |insurance |contract |between |the |parties An |insurer |has |the |right |to |recover |a |payment |made |to |the |insured |from |the |negligent |party. |These |rights |are |called Subrogation
A |Medicare |Supplement |policy |can |be |cancelled |by |the |insurer |for |Nonpayment Credit |Accident |and |Health |plans |are |designed |to |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 fee-for-service An |insurance |company |ONLY |pay |a |sales |commission |to |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? $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
100% |of |the |billed |amount What |is |the |maximum |fine |for |a |producer |violating |an |NJ |insurance |law |for |the |first |time? $ A |licensed |producer |is |required |to |file |notice |to |any |changes |of |address |within |how |many |days 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? 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? File |written |proof |of |loss Which |of |the |following |is |an |example |of |the |insured's |consideration? |A |paid |premium
