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A comprehensive set of questions and answers related to the nj health and accident insurance exam for the years 2025 and 2026. It covers various topics including policy provisions, regulations, and key concepts in health insurance. The material is designed to help individuals prepare for the exam by testing their knowledge of important insurance principles and practices. It includes questions on disability income policies, mandatory health policy provisions, employer-sponsored group health insurance, and more. This study guide is useful for anyone seeking to pass the nj health and accident insurance exam. It offers a structured approach to learning and reinforcing key concepts, making it an effective tool for exam preparation. The questions cover a wide range of topics, ensuring a thorough understanding of the subject matter. Well-organized and easy to follow, making it an excellent resource for exam preparation.
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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 The entire contract includes the actual policy and the application employer sponsored group health insurance provides coverage for which of the following Alcoholism
The term which describes the fact that both parties of a contract may not receive the same value is referred to as Aleatory Tom has a home health care benefit and is confined to his home. Which of these is NOT typically covered Full-time nursing care 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
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 A(n) _______ insurance company is one that was formed under the laws of a state other than NJ Foreign
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? 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? Controlled business A master contract and certified coverage can be found in which type of policy? Group Medicaid is a government-funded program designed to provide health care to
A health insurer must be provided with written proof of loss ______ days after the date of loss 90 days All of the following are factors would affect a health insurance policies premium rate Except Residential address of the insured Which of the following is NOT a required provision in an accident and health insurance policy? 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? 30 days ! When comparing an HMO, to a PPO, the PPO
provides a greater choice of providers Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must be the same and the premium cannot exceed 102% ! An agent is required to keep replacement forms on file for at LEAST ______ years. 5 years ! An insurer has the right to recover a payment made to the insured from the negligent party. These rights are called Subrogation All advertisements for health insurance shall make clear the identity of the insurer
What is the process for a producer voluntarily terminating his/her license? 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 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? Age 65 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 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 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
HIPAA considers which of the following as "individually identifiable health information"? A person's health claim information 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 Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. 20 A person covered with an individual health plan is issued a policy
Which of the following statements is NOT true regarding a Critical Illness Plan? Coverage is limited to a single devastating disease 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 All Medicare Supplement policies MUST contain which provision? 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? Limited policies !
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 What is the free-look period of a Medicare Supplement policy? 30 days Which of the following is an example of defamation? 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 changes made by the producer
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
