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Health Final Exam - NJ Accident and Health Questions with
Correct Answers
1.The Commissioner must approve: Continuing education courses
2. Employer sponsored group health insurance provides coverage for which of the following? Self-inflicted injuries cosmetic surgery custodial care alcoholism: alcoholism
- A Medicare supplement policy can be cancelled by the insurer for: Nonpay- ment 4.Which entity is responsible for regulating insurance advertising in NJ?: New Jersey Department of Banking and Insurance 5. Which of the following are retained at the expense of an insurance buyer to give advice on insurance needed by the buyer? Brokers and consultants Insurance prospectors Third-party adminstrators Agents: Brokers and consultants
- Written notice for a health claim must be given to the insurer days after the occurrence of the loss.: 20 7. In which of the following situations would the insurer be liable for a loss? a) The insured skipped a payment beyond the 31 day grace period b) The insured was injured while participating in an illegal occupation c) The insured was given a notice of cancellation from the insurer d) The insured suffered an injury as an innocent bystander during a bank robbery: d) The insured suffered an injury as an innocent bystander during a bank robbery
- When a Medicare supplement policy is purchased during the open enroll- ment period: The policy must be issued regardless of health status
- In what form do disability income policies typically pay benefits?: Periodic income 10. What is considered to be the primary reason for buying life insurance?: -
Provide death benefits 11.A newborn is required to be covered for days from the moment of birth: 30 12.Once an accident and health insurance policy has been in force for year(s), the policy may NOT be contested by the insurer: 2
13. A doctor who accepts Medicare assignment agrees to which of the follow- ing
- Doctor may charge up to a maximum of 15% more than Medicare pays for the service
- Doctor is not bound by Medicare's limitations on charges
- Doctor cannot charge more than Medicare's scheduled coverage
- Doctor bills the Medicare beneficiary directly for services performed: Doctor cannot charge more than Medicare's scheduled coverage 14.What is issued to each employee with an employer health plan?: Certificate 15.What is the tax liability for employer contributions in Health Savings Ac- counts (HSA's)?: No tax payment needed 16. All of these are considered sources of information that can assist an underwriter in determining whether or not to accept a risk EXCEPT Agent's report Medical Information Bureau (MIB) Inspection reports National Association of Insurance Underwriters: National Association of Insur- ance Underwriters 17.In NJ, health insurance advertisements are required to contain the: insur- ance company's name 18.Replacement regulation is designed to protect the interests of: Policyown- ers 19.The Commissioner of Insurance is appointed by: The governor 20.Which type of plan would be most appropriate for an individual on Medicare and is concerned that Medicare will NOT pay for charges exceeding the approved amount?: Medicare supplement plan F 21. Which of the following is NOT a common exclusion for a medical expense policy? Physical therapy Act of war
24.A producer has recently died and leaves behind a spouse. In order for the producer's insurance business to continue, the Department of Banking and Insurance may issue to the producer's spouse a(n): temporary insurance license 25.Pierre the producer receives a premium for an individual health insurance policy. Pierre MUST remit the premium to his insurer within business days of receipt: 7 26.Nina just passed her NJ insurance licensing examination. She is RE- QUIRED to apply for a producer's license within months: 12 27.Which of the following MUST contain a "statement of policy cost and benefit information"?: Policy Summary 28.The department of banking and insurance can make information pertaining to a producers license available through: Certificate of License Status Report 29.Intentional withholding of material facts that would affect an insurance policy's validity is called a(n): Concealment 30.Under the NJ Continuance of Benefits law, notice to extend coverage is required within how many days of a qualifying event?: 30
31. Which of the following does Medicare Part D cover? Intensive care coverage Doctor visits Prescription drugs Hospital coverage: Prescription drugs 32.Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance?: Medicare in-hospital deductible 33. Under group health insurance, a certificate of coverage is issued to the: - employee 34.Claims payable to a Disability Income insured, even when the insured can continue to work, are the result of a: Presumptive disability 35.A dread disease policy is considered to be a type of: Limited health insur- ance policy 36.How often must an insurance producer's license in NJ be renewed?: every 2 years 37.Which type of disability would be less than total impairment and equal to permanent impairment?: Permanent partial disability 38.An insurance consultant is BEST defined as a(n): Producer who charges fees for advice 39.Kathy pays a monthly premium on her health insurance policy. How
long is her grace period?: 10 days
49.When an insured changes to a more hazardous occupation, which disabil- ity policy provision allows an insurer to adjust policy benefits and rates?: - Change of occupation provision
50. Which of the following would be considered a possible applicant and contract policyholder for group health benefits? A. Human resource department B. Employer C. Insured employee D. Insurance company: Employer 51. Continuing education credits may be approved for which of the following? Pre-licensing education motivational education sales and marketing education ethics: Ethics 52.Field underwriting performed by the producer involves: Completing the application and collecting the initial premium 53. Which of the following actions may an insurance company NOT do in a health policy that contains a guaranteed renewable premium benefit? Stop renewing policy when the insured reaches a specified age Cancel policy if premiums are not paid Increase the premiums on an individual basis Increase the premiums on the basis of an entire classification: Increase the premiums on an individual basis 54. Which of the following is NOT a type of Medicare Advantage Plan? HMO PPO PFFS SSDI: SSDI 55. Coordination of benefits regulation applies to all of the following plans except A. Group vision plan B. Preferred Provider Organization plan C. Self-funded group health plan
56. 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. This deduction came as a result of which provision?- : Unpaid provision 57.The commissioner may: Establish continuing education requirements 58.A proposed insured for a health insurance policy was treated for heart disease within the past year. When applying for health insurance, the heart disease treatment: Indicates a preexisting condition 59.An example of an unfair method of competition is: overstating the benefits of an insurance policy 60.An applicant's character and personal habits can be obtained for under- writing purposes from which source?: Investigative consumer report 61. The Do not call registry offers exemptions for calls placed from all of the following except charities political organizations insurance sales calls surveys: insurance sales calls 62.XYZ company is looking to replace their existing group health coverage with another plan. The replacing insurer is REQUIRED to: Accept all individuals eligible under the previous plan 63.A(n) insurance company is one that was formed under the laws of a state other than NJ: Foreign 64. Which of the following situations would be suitable for temporary work authority? When a producers license is suspended and an appeal date is set When an applicant completes a prelicensing course When an applicant passes a licensing examination and answers all back- ground questions negatively When an applicant fails the licensing examination and is waiting to take another test: When an applicant passes a licensing examination and answers all background questions negatively 65.In order for a contract to be valid, it must: contain an offer and acceptance
66.When does a health insurance policy typically become effective?: When the initial premium is collected and policy is issued 67.Richard owns an insurance policy that is renewable only at the option of the insurance company. His policy is considered to be:: Optionally renewable
this injury would make him eligible for benefits under which provision?: Partial disability 81.A medicare supplement basic benefit is: the first 3 pints of blood per year
82.Reinstatement of an individual health insurance plan requires?: payment of premium without proof of insurability 83.If an employee contributes 50% toward the disability plan premium provid- ed by an employer, what would be considered the taxable income of a $1,000 monthly disability benefit?: $ 84.A beneficiary change can occur: normally at any time during the policy term 85.When are group disability benefits considered to be tax-free to the in- sured?: When the recipient pays the premiums 86.The election of COBRA for continuation of health coverage will: maintain the same coverage and increase premium 87.Jerry voluntarily terminated his producer's license. If he changes his mind, his license may be reinstated during the same license period IF: He completes a new license application 88.An insured has a stop-loss limit of $5,000, a deductible of $500, and an 80/20 coinsurance. The insured incurs $25,000 of covered losses. How much will the insured have to pay?: $5, 89.A common exclusion with Vision plans is: lasik surgery
90. Which of the following is NOT a required provision in an accident and health insurance policy? legal actions grace period change of occupation reinstatement: change of occupation 91.All advertisements for health insurance shall make clear the identity of the: Insurer 92.A policyholder has a major medical plan with a 80%/20% coinsurance and a deductible of $75. If the insured has previously met her deductible and receives a bill for $175, how much will the insurer pay?: $140 Because the insured has previously met her deductible, the eligible expenses for a claim is the entire $175. The insurance company pays 80% of $175, or $140. 93.An agent is required to keep replacement forms on file for at LEAST years: 5 94.An insurance company needs to obtain personal information from a third party concerning an applicant. Which law do all insurers and their producers need to comply with?: Fair credit reporting act
96.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 97.A branch office registration form is required to be filed at least days before selling insurance out of that branch: 30 98.In New Jersey, an insurer is required to maintain files of all published and printed advertisements for?: 5 years from the date of last use 99.Disability Income plans which require that the insurer can NEVER change or alter premium rates are usually considered: Noncancellable
- Medicare Part A does not pay for medical benefits provided for the treat- ment in a skilled nursing facility beyond: 100 days
- According to HIPAA, when an insured individual leaves an employer and immediately begins working for a new company that offers group health insurance, the individual: Is eligible for coverage upon hire 102. An insurer must furnish to a claimant forms for filing proof of loss within days upon receiving a notice of claim.: 15 days
- Which of the following is MANDATORY coverage for all group health care service contracts?: Treatment for alcoholism
- A health insurance policy that allows an insurer to change the policy own- er's premiums, but NOT cancel the policy is called a(n): Guaranteed renewable policy
- The name of the insurance companies represented by the producer: is available to the public 106. Which of the following does Coordination of Benefits allow? -Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid -Allows both a group health plan and individual health plan to coordinate their benefit payments -Allows the deductible to be spread out between all the health providers -Allows each health provider to pay 100% of the claim: Allows the secondary payor to reduce their benefit payments so no more than 100% of the claim is paid 107. All of the following are included as part of a contract in the entire contract provision EXCEPT the riders application
changes made by the producer policy: changes made by the producer
- of this claim is the insured responsible for?: $
- A producer must notify the commissioner within days of a felony conviction: 30 119. All of the following are functions of an insuring clause EXCEPT States the conditions under which the policy will pay Outlines the kind of benefits provided Primarily describes the free-look period Provides the policy's scope and limits of coverage: Primarily describes the free-look period
- After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms?: File a written proof of loss 121. Which of the following circumstances requires an individual to be a licensed producer? Discussing premiums with a potential insured setting up sales appointments following up with a policyowner about a change in address conduct an agency sales meeting: Discussing premiums with a potential insured
- Which type of clause describes the following statement: "We have issued the policy in consideration of the representations in your applications and payment of the first-term premium".: Consideration clause
- Who would make the final determination on whether or not an insurance advertisement is misleading?: Banking and Insurance commissioner 124. In contrast to a guaranteed renewable policy, a noncancellable policy: - May never raise premiums
- A health insurer must be provided with written proof of loss days after the date of loss: e
