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NJ ACCIDENT AND HEALTH PRODUCER EXAM
According to the Time Payment of Claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT:
- if the insured is able to eventually return to work -if the death is suicide or due to a pre existing condition -when the policy is in the incontestability period -for claims involving periodic payments - Precise Answer โโfor claims involving periodic payments INSURERS MUST PAY LUMP SUM CLAIMS IMMEDIATELY AFTER RECEIVING PROOF OF LOSS What does coinsurance mean?
- a policy covers the insured and the any additional named persons -the insurer and the insured share expenses over the deductible -the insurer and the insured share ALL expenses -the policy owner holds multiple policies through the same insurer - Precise Answer โโThe insurer and the insured share expenses over the deductible COINSURANCE IS THE SHARING BETWEEN THE INSURER AND THE INSURED OF COVERED EXPENSES THAT EXCEED THE DEDUCTIBLE AMOUNT. THE SHARING ENDS WHEN THE "STOP LOSS LIMIT" IS REACHED The life insurance policy will not be truly effect until all of the following occur EXCEPT: -the statement of good health is obtained by the insurer -the first premium is collected -the policy is delivered to the applicant -the producer has explained the policy to the client - Precise Answer โโ-the producer has explained the policy to the client
EFFECTIVE DATE BASED ON :
-APP DATE
-IF PREMIUM HAS BEEN PAID
-IF A STATEMENT OF GOOD HEALTH MUST BE OBTAINED IF PREMIUM WAS NOT SUBMITTED WITH
APPLICATION
Which of the following coverage types pays a monthly cash benefit following the elimination period for total disability due to accident or sickness? -credit disability -works comp disability -recurrent disability -disability income - Precise Answer โโ-disability income insurance PROVIDES PAYMENT OF REGULAR PERIODIC INCOME SHOULD THE INSURED BECOME DISABLED FROM ILLNESS OR INJURY The period beginning at the time of an insured loss that an insured must wait before benefits are payable is called the: -probationary period -benefit period -elimination period -grace period - Precise Answer โโ-elimination period THE TIME PERIOD STARTING AT THE TIME OF LOSS, SUCH AS A DISABILITY, THAT AN INSURED MUST WAIT BEFORE BENEFITS ARE PAYABLE Managed care plans increase efficiency by all of the following EXCEPT: -transferring the management of costs to the insureds -controlling inpatient admissions and length of stay -increasing beneficiary cost sharing
-defamation -twisting - Precise Answer โโ-defamation DEFAMATION IS AN ORAL OR WRITTEN STATEMENT MALICIOUSLY CRITICAL OF THE FINANCIAL CONDITION OF A PERSON OR COMPANY Which of the following requires the claim information to be submitted to the insurer prior to treatment to determine whether the treatment is covered and how much the insured's plan will pay? -consideration provision -concurrent review provision -second opinion provision -pre certification provision - Precise Answer โโ-pre certification provision UNDER A PRE CERTIFICATION REVIEW, THE PHYSICIAN CAN SUBMIT CLAIM INFORMATION PRIOR TO PROVIDING TREATMENT TO KNOW IN ADVANCE IF PROCEDURE IS COVERED AND WHAT RATE IT WILL BE PAID A Basic Hospital Policy pays expenses for:
- hospital room and board -physician office visits -routine medical treatment -surgical services - Precise Answer โโ-hospital room and board BASIC HOSPITAL EXPENSE COVERS HOSPITAL ROOM AND BOARD WITH DAILY LIMIT OF COVERAGE. BASIC SURGICAL PROCEDURES AND BASIC MEDICAL COVERS OFFICE VISITS AND ROUTINE MEDICAL TREATMENT What is the maximum amount of time the insured has to file legal action against the insurer after written proof of loss is provided - Precise Answer โโ-3 years THE INSURED MUST WAIT 60 DAYS AFTER PROOF OF LOSS IS FILED WITH THE INSURER BEFORE LEGAL ACTION CAN BE BROUGHT AGAINST THE COMPANY. LEGAL ACTION TIME PERIOD LASTS 3 YEARS What is the difference between misrepresentation and fraud - Precise Answer โโMisrepresentation is a representation that is actually false, but fraud is an intentional act designed to deceive
MISREPRESENTATION THINK MISTAKE
Which of the following determines whether a person passes the financial test to qualify for Medicaid -federal guidelines -the SS Administration
- state law
- Americans with Disabilities Act - Precise Answer โโ-state law MEDICAID ELIGIBILITY IS BASED ON INCOME DEPENDING ON THE STATE All of the following are elements of an uninsurable loss EXCEPT: -expected losses are measurable -expected losses will be accidental -types of losses that occur can be expected -affordable premiums can be charged - Precise Answer โโ-affordable premiums can be charged INSURABLE LOSSES CAN BE EXPECTED, MUST BE MEASURABLE, GENERATE AFFORDABLE PREMIUMS, AND ARE ACCIDENTAL IN NATURE In which of the following does a covered employee agree to a reduction in compensation so the amount can be used to cover medical expenses?: -health reimbursement account (HRA) -consumer driven health plan (CDHP) -flexible spending account (FSA) -healthcare savings account (HSA) - Precise Answer โโFSA FSA IS A FORM OF CAFETERIA PLAN BENEFIT FUNDED BY SALARY REDUCTION AND EMPLOYER CONTRIBUTIONS which of the following may be thought of as a time deductible rather than a dollar deductible in a disability income policy because benefits are not payable during that time? - Precise Answer โโ- elimination period the TIME period an individual must be disabled before benefits become payable
-an arbitration agreement is signed at the time of the signing of the application -the applicant and possibly the producer initial any changes made -the applicant and the producer sign a documents that outlines changes made - Precise Answer โโ Which rider will protect against inflation by increasing disability income benefits annually after the start of disability -return of premium -waiver of premium -cost of living adjustment -future increase option - Precise Answer โโ-cost of living adjustment INCREASE IN BENEFITS AFTER CLAIM BEGINS TO PROTECT AGAINST INFLATION Which one of the following is particularly important for an insurance producer to explain to a client upon delivery of a life insurance policy?: -loan interest rates -the effective date -premium due dates -any exclusions - Precise Answer โโ-any exclusions DURING THE DELIVERY APPOINTMENT, THE PRODUCER WILL REVIEW THE POLICY WITH THE POLICY OWNER TO ENSURE OWNER UNDERSTANDS POLICY, RIDERS, AND EXCLUSIONS The primary purpose of Health Reimbursement Accounts (HRAs) is to assist -employees who work for small companies to pay medical expenses on high coinsurance policies -covered employees on standard group health insurance plans by using after tax contributions to fund an account to pay medical expenses -employees who choose not to participate in the group health coverage provided by their employer by reimbursing expenses -covered employees with the payment of medical expenses on a high deductible plan funded through pre tax contributions - Precise Answer โโ-covered employees on standard group health insurance plans by using after tax contributions to fund an account to pay medical expenses
HRAs consists of funds set aside by employees for qualified medical expense. Funded by Employer. Health insurance policies include a uniform provision that give the insurer the right, at its own expense, to do which of the following? - Precise Answer โโperform an autopsy When will a dental policy pay on a UCR basis? - Precise Answer โโwhen particular benefits are not listed on a payment schedule NONSCHEDULED DENTAL PLANS PAY OUT ON USUAL, CUSTOMARY, AND REASONABLE (UCR). Which of the following must be given to the insurer within 20 days after occurrence or commencement - Precise Answer โโproof of loss WRITTEN NOTICE OF CLAIM MUST BE GIVEN TO THE INSURER WITHIN 20 DAYS AFTER THE OCCURRENCE OR COMMENCEMENT OF ANY LOSS COVERED BY THE POLICY, OR AS SOON THEREAFTER When would dependent children's benefits for SS disability payments end? -when the disabled worker dies -when the dependent reaches age 18 or 19 if still in high school -when the number of children exceeds the maximum family size -when the benefits extend beyond the initial 2 year period - Precise Answer โโ-when the dependent reaches age 18 or 19 if still in high school UNMARRIED DEPENDENT CHILDREN UNDER 18, OR 19 IF STILL IN HIGH SCHOOL, ARE ELIGIBLE FOR UP TO 50% OF THE EMPLOYEE'S DISABILITY BENEFIT a group conversion option may be used in all the following instances EXCEPT: -loss of coverage due to loss of employment -a life changing event, such as marriage, divorce, or childbirth -the termination of the master policy -loss of eligibility on the part of a class of insureds. - Precise Answer โโ- a life changing event such as marriage, divorce, or childbirth
-return of premium -cost of living adjustment -change of occupation -future increase option - Precise Answer โโ-future increase option THE FIO RIDER ALLOWS THE INSURED TO INCREASE BENEFITS AT SPECIFIED FUTURE TIMES BASED ON ATTAINED AGE RATES AND AN INCREASE IN INCOME Under a Medicare Supplement Policy, preexisting conditions CANNOT be excluded after how many months from the effective date of the policy?: -3 months -6 months -18 months -12 months - Precise Answer โโ-6 months PREEXISTING CONDITIONS CANNOT BE EXCLUDED AFTER 6 MONTHS FROM THE EFFECTIVE DATE OF COVERAGE Compared to basic hospital, medical and surgical policies, which type of insurance provides broader coverage, fewer gaps, higher individual benefits, and higher policy maximums?: -medicaid insurance -major medical insurance -ltci -supplemental medical insurance - Precise Answer โโ-major medical insurance MAOJR MEDICAL IS CHARACTERIZED BY HIGH MAX LIMITS, BLANKET COVERAGE, COINSURANCE AND A DEDUCTIBLE A life insurance policy may be returned for a cancellation and a full refund if it is returned NO later than -30 days after receipt by the policyholder -30 days after the issue -10 days after issue -20 days after receipt by the policyholder - Precise Answer โโ-20 days after receipt by the policyholder
Which rider will protect against inflation by increasing disability income benefits annually after the start of a disability? -waiver of premium -FIO -return of premium -cost of living adjustment - Precise Answer โโ-cost of living adjustment THE COST OF LIVING ADJUSTMENT RIDER WILL PROVIDE AN INCREASE IN BENEFITS AFTER A CLAIM BEGINS TO PROTECT AGAINST INFLATION All of the following are requirements to qualify for SS disability benefits EXCEPT when: -totally and permanently disabled -unable to work in the occupation in which the worker was trained or educated -the disability is expected to last for 12 months or end in death -credited with the appropriate number of quarters coverage - Precise Answer โโ-unable to work in the occupation in which the worker was trained or educated SS BENEFITS ELIGIBILITY IS BASEED ON 40 QUARTER CREDITS, LENGTH OF DISABILITY Which of the following is the most common method to supplement Medicare coverage? -group health insurance -employer health insurance -Medicaid -coverage offered by private insurer - Precise Answer โโ-coverage offered by private insurance policies MEDICARE SUPPLEMENTAL INSURANCE POLICIES ARE SOLD BY PRIVATE COMPANIES HSAs cover current and future qualified healthcare costs. Account beneficiaries can make tax free withdrawals to cover all of the following EXCEPT: -retiree health insurance premiums -doctor's fees -prescription and nonprescription medicines
What is the waiver of premium provision or rider?
- Precise Answer โโit waives the premium after the insured has been disabled for a specific period of time WAIVER OF PREMIUM PROVIDES FOR FUTURE PREMIUMS TO BE WAIVED AFTER THE STATED WAITING PERIOD HAS ELAPSED AND FOR AS LONG AS DISABILITY Under the free look provision, an insured may cancel a policy and receive a full refund within 10 days of the date that the: -insurance company issued the policy -producer took the application -producer delivered the policy - Precise Answer โโ-producer delivered the policy THE FREE LOOK PERIOD GIVES THE POLICY OWNER THE ABILITY TO RETURN A POLICY WITHIN 10 DAYS OF DELIVERY TO RECEIVE ALL PREMIUMS PAID. THE POLICY IS CONSIDERED NULL AND VOID When can the premiums of an individually owned health insurance policy be deducted from the individual's income tax? - Precise Answer โโ-when the taxpayer's medical expenses exceed 7.5% of AGI during a taxable year
