Simulation Exam - Health Insurance
What is the maximum allowed value of a gift that an agent can give to an insured without violating the regulation on rebating?
$100
A producer or insurer who violates the solicitation regulations can be ordered to pay a fine for each violation of up to
$2,000
What is the typical deductible for basic surgical expense insurance?ductible
0$
How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state?
12
A licensed insurance producer must notify the Department of a change in mailing address within how many days and by what method?
30 days, by mail or electronically
Within how many days must a producer report claims to the insurer?
5 business days
Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?
5 months
A medicare supplement policy cannot deny or limit coverage for a claim for losses incurred more than how many months from the effective date of coverage?
6
What percentage of eligible employees must participate on a small employer group health insurance plan?
75%
Which of the following policies is NOT required to include coverage for alcoholism?
A Medicare supplement policy
if the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following?
Adjust the benefit in accordance with the increased risk
Which of the following is a duty of the Commissioner of insurance in this state?
Amend rules and regulations
Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy?
An individual who was previously covered by group health insurance for 6 months is eligible.
An agent makes a mistake on the application and then corrects his mistake by physically entering the necessary information. Who must then initial that change?
Applicant
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care?
Attending physician
If an insurer meets the state's financial requirements and is approved to transact business in the state, it is considered what type of insurer?
Authorized
How is the Insurance Guaranty Association funded?
By its members - authorized insurers
Which of the following is authorized to appoint and remove officers and other personnel employed within the Department?
Commissioner
Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as
Contracts of adhesion.
Under the New Jersey Temporary Disability Law, a "covered individual" is any person who has been out of work for less than 2 weeks or who is employed by a
Covered employer.
Which type of insurance provides funds for a business organization to purchase the business interest of a disabled partner?
Disability Buy-Sell
Because of the history of cancer in her family, Julie purchased a policy that specifically covers the expense of treating cancer. Her policy would be classified as what type of policy?
Dread Disease Policy
In a disability policy, the probationary period refers to the time
During which illness-related disabilities are excluded from coverage.
Which of the following is NOT true regarding a flexible spending account?
It does not have limits on contributions.
Individual health insurance policies must provide all of the following benefits for the treatment of alcoholism EXCEPT
Limited hospital policy benefits.
In a Disability Income policy, all of the following are considered presumptive disabilities EXCEPT
Loss of one eye.
The company has issued a policy and delivered it to Producer B on May 1st, Monday. By what date must the policy be delivered to the insured?
May 10th (within 10 calendar days)
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in
Medicare Part A.
Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?
Pay a special deductible on his major medical policy
Which of the following describes taxation of individual disability income insurance premiums and benefits?
Premiums are not tax deductible, and benefits are not taxable.
What type of care is Respite care?
Relief for a major care giver
Which of the following would be a qualifying event as it relates to COBRA?
Termination of employment due to downsizing
What program was established by New Jersey to guarantee access to health coverage for individuals and small employers, regardless of health status, age, claims history, or other risk factors?
The Individual Health Coverage Program
Workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from
Work-related disabilities.
Which of the following is NOT a factor in determining qualifications for Social Security disability benefits?
Worker's occupation
An insurance company makes a statement that its policies are guaranteed by the existence of the insurance guaranty association, that would be considered
an unfair trade practice
what is the maximum period f time in which an insurer may contest fraudulent misstatements made in a health insurance application?
as long as the policy is in force
when an insurance producer negotiates for an insurance contract on behalf of a client the producer is acting as a
broker
Which of the following is the legal name of a corporation or partnership under which a license conducts insurance business
business name
An insurance contract requires that both the insured and the insurer meet certain conditions in order for the contract to be enforceable. what contract characteristic does this describe?
conditional
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy, if requested within 31 days?
conversion
what entity has the authority to make changes to an insurance policy?
insurers executive officer
Which of the following statements is NOT true concerning medicaid
it consists of 3 parts: PART A- hospitalization, B-DOc's services, C- Disability income
A term health policy is
nonrenewable
What is NOT considered an insurance transaction
obtaining an insurance license
what is true regarding obtaining underwriting sources
the applicant must be informed of the sources contacted and how the information is gathered
which provision states that the insurance company must pay Medical expense claims immediately
time of payment of claims
