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A series of multiple choice questions and answers related to the nj accident and health producer exam. It covers various topics such as claims payment, coinsurance, disability income, and health insurance policies. Useful for individuals preparing for the exam, offering insights into key concepts and potential exam questions.
Typology: Exams
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According to the Time Payment of Claims provision, the insurer must make the payment immediately after receiving proof of loss EXCEPT:
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:
Which of the following determines whether a person passes the financial test to qualify for Medicaid -federal guidelines -the SS Administration
-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?