EXAM EF HEALTH
A noncontributory group disability income plan has a 30-day waiting period and offers benefits of $2,000 a month. If an employee is unable to work for 7 months due to a covered disability, the employee will receive (Choose from the following options) 1. $14,000, none of which is taxable. 2. $14,000, all of which is taxable. 3. $12,000, none of which is taxable. 4. $12,000, all of which is taxable.
$12,000, all of which is taxable.
What are the penalties for the first, second, and any subsequent violation of the New Jersey Fraud Prevention Act, respectively? (Choose from the following options) 1. $25,000; $50,000; $100,000 2. $5,000; $10,000; $15,000 3. $1,000; $5,000; $10,000 4. $10,000; $15,000; $20,000
$5,000; $10,000; $15,000
A policy with a 31-day grace period implies (Choose from the following options) 1. The policy benefits must be paid within 31 days after a claim is submitted. 2. The policy will not lapse for 31 days if the premium is not paid when due. 3. The policyholder may return the policy for a full refund within 31 days. 4. The policy is incontestable after 31 days of delivery.
. The policy will not lapse for 31 days if the premium is not paid when due.
A client has a new individual disability income policy with a 20-day probationary period and a 30-day elimination period. Ten days later, the client breaks their leg and is off work for 45 days. How many days of disability benefits will the policy pay? 1. 10 days 2. 15 days 3. 25 days 4. 45 days
15 days
The Commissioner believes that an insurance rule or regulation has been violated, and decides to call a disciplinary hearing. How many days before a hearing must the Commissioner issue a notice to the person charged with a violation? (Choose from the following options) 1. 20 days 2. 30 days 3. 7 days 4. 10 days
10 days
To be eligible under HIPAA regulations, for how long should an individual converting to an individual health plan have been covered under the previous group plan? 1. 18 months 2. 5 years 3. 12 months 4. 63 days
18 months
Insurers must maintain files containing all of their advertisements for (Choose from the following options) 1. 4 years. 2. 5 years. 3. 2 years. 4. 3 years.
5 years
If a person violates a cease and desist order, the Commissioner can turn the matter over to the New Jersey Superior Court for further legal action and can assess a fine for each violation of up to (Choose from the following options) 1. $10,000. 2. $1,000. 3. $3,000. 4. $5,000.
5,000
Medicare supplement policies cannot establish a new deductible or waiting period for the recurrence of a condition for which treatment was given within (Choose from the following options) 1. 24 months. 2. 6 months. 3. 9 months. 4. 12 months.
6 months
When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should (Choose from the following options) 1. Return any unearned premium. 2. Increase the premium. 3. Adjust the benefit in accordance with the decreased risk. 4. Replace the policy with a new one.
Adjust the benefit in accordance with the decreased risk.
Long-term care insurance policies must cover which of the following? (Choose from the following options) 1. All mental disorders 2. Treatment of alcoholism 3. Injuries caused by an act of war 4. Alzheimer's disease
Alzheimer's disease
What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided? (Choose from the following options) 1. Policy Request 2. Insurance Request Form 3. Request for Insurance 4. Application
Application
Which of the following is the legal name of a corporation or partnership under which a licensee conducts insurance business? (Choose from the following options) 1. Legal name 2. Name of reference 3. Business name 4. Assumed name
Business name
The provision that provides for the sharing of expenses between the insured and the insurance company is (Choose from the following options) 1. Deductible. 2. Divided cost. 3. Coinsurance. 4. Stop-loss.
Coinsurance
A waiver of premium provision may be included with which kind of health insurance policy? (Choose from the following options) 1. Basic medical 2. Hospital indemnity 3. Dread disease 4. Disability income
Disability Income
In which of the following locations would skilled care most likely be provided? (Choose from the following options) 1. In an institutional setting 2. At the patient's home 3. In an outpatient setting 4. At a physician's office
In an institutional setting
Which renewal option does NOT guarantee renewal and allows the insurance company to refuse renewal of a policy at any premium due date? (Choose from the following options) 1. Noncancellable 2. Optionally renewable 3. Conditionally renewable 4. Guaranteed renewable
Optionally renewable
Giving a client an inducement to a sale not stated in the policy is an unlawful practice known as (Choose from the following options) 1. Twisting. 2. Unlawful distribution of dividends. 3. Coercion. 4. Rebating.
Rebating
Before a customer's agent delivers his policy, the insurer makes a last-minute change to the policy. The agent informs the customer of this change, and he accepts it. What must the agent do now? (Choose from the following options) 1. The agent must notify the beneficiary of the change in policy. 2. If the change would affect the premium, the agent must have the customer sign a statement acknowledging the change. 3. The agent should ask the customer to sign a statement acknowledging that he is aware of the change. 4. Nothing. After the explanation, the agent is not legally bound to do anything else.
The agent should ask the customer to sign a statement acknowledging that he is aware of the change.
The insuring clause of a disability policy usually states all of the following EXCEPT (Choose from the following options) 1. The types of losses covered. 2. The method of premium payment. 3. The identities of the insurance company and the insured. 4. That insurance against loss is provided.
The method of premium payment
HIPAA applies to groups of (Choose from the following options) 1. At least 100. 2. More than 2, fewer than 50. 3. 2 or more. 4. At least 10.
2 or more
Under the New Jersey Temporary Disability Law, a "covered individual" is any person who is employed by a covered employer, or who has been out of work for less than 1. 3 weeks. 2. 4 weeks. 3. 1 week. 4. 2 weeks.
2 weeks
Under the New Jersey Temporary Disability Law, a "covered individual" is any person who is employed by a covered employer, or who has been out of work for less than (Choose from the following options) 1. 4 weeks. 2. 1 week. 3. 2 weeks. 4. 3 weeks.
2 weeks.
Applicants for an individual producer license must submit proof of completing 24 hours of continuing education credits during the previous (Choose from the following options) 1. 4 years. 2. 5 years. 3. 2 years. 4. 3 years.
2 years
An insured is visited by a physical therapist and an occupational therapist, in a joint effort at his home. How many of these team visits may the insured have in a year? (Choose from the following options) 1. 30 2. 40 3. 50 4. 60
60
In a 12-month period, how many home health care visits must a health insurance policy provide for? (Choose from the following options) 1. 90 2. 120 3. 30 4. 60
60
What is the minimum age for Medicare supplement policy coverage? (Choose from the following options) 1. 55 2. 60 3. 65 4. 70
65
Which of the following would be an example of a limited accident and health insurance policy? (Choose from the following options) 1. A dread disease policy 2. An accidental death and dismemberment policy 3. A Medicare policy 4. A long-term care policy
A dread disease policy
How is emergency care covered for a member of an HMO? (Choose from the following options) 1. A member of an HMO may receive care at any emergency facility, at the same cost as if in his or her own service area. 2. HMOs have salaried member physicians, but they do not cover emergency care. 3. An HMO emergency specialist will cover the patient. 4. A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area.
A member of an HMO can receive care in or out of the HMO service area, but care is preferred in the service area.
Which is NOT a characteristic of group health insurance? (Choose from the following options) 1. Group coverage may be converted to individual coverage if the group contract is ended. 2. The actual policy is called the "master contract". 3. A policy is issued to each insured individual. 4. Dependents of insureds can be covered under group health plans.
A policy is issued to each insured individual.
All of the following candidates for a resident producer license may be exempted from the examination requirement EXCEPT (Choose from the following options) 1. A nonresident producer in good standing who is moving to this state. 2. A resident producer licensed for Property and Casualty insurance applying for a Life insurance license. 3. A professional who holds a Certified Financial Planner (CFP) designation. 4. A person in public employment in the insurance field whose license terminated 10 months ago.
A resident producer licensed for Property and Casualty insurance applying for a Life insurance license.
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? 1. Coverage options and conditions are developed for average individuals. 2. All providers will have the same coverage options and conditions for each plan. 3. Coverage options and conditions comply with the law, but will vary from provider to provider. 4. All plans must include basic benefits A-N.
All providers will have the same coverage options and conditions for each plan.
Which of the following is a duty of the Commissioner of insurance in this state? (Choose from the following options) 1. Amend rules and regulations 2. Imprison Insurance Code violators 3. Establish insurance rates 4. Appoint individual producers
Amed rules and regulations
Under HIPAA, which of the following is INCORRECT regarding eligibility requirements for conversion to an individual policy? (Choose from the following options) 1. The gap of coverage for eligibility is a period of 63 or less days. 2. An individual who was previously covered by group health insurance for 6 months is eligible. 3. An individual who has used up COBRA continuation coverage is eligible. 4. An individual who doesn't qualify for Medicare may be eligible.
An individual who was previously covered by group health insurance for 6 months is eligible.
Which of the following statements is true concerning the alteration of optional policy provisions? (Choose from the following options) 1. Once any kind of provision is written, it cannot be changed. 2. An insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder. 3. An insurer may change the wording of optional provisions, regardless of its effect on the policyholder. 4. An insurer may change the wording of optional policy provisions that would adversely affect the policyholder but must first receive state permission before the change goes into effect.
An insurer may change the wording of optional provisions, as long as the change does not adversely affect the policyholder.
What is a branch office? (Choose from the following options) 1. An office in this state where the licensee conducts insurance business, other than a principal office 2. The licensee's principal office 3. The insurer's principal office in this state 4. The insurer's office in another state where nonresident producers conduct business
An office in this state where the licensee conducts insurance business, other than a principal office
What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application? (Choose from the following options) 1. 90 days after the effective policy date 2. 6 months after the effective policy date 3. 1 year after the effective policy date 4. As long as the policy is in force
As long as the policy is in force
In a replacement situation, all of the following must be considered EXCEPT (Choose from the following options) 1. Exclusions. 2. Assets. 3. Benefits. 4. Limitations.
Assets
A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expenses of the company during the time of his disability? (Choose from the following options) 1. Key person insurance 2. Disability buy-sell agreement 3. Business disability policy 4. Business overhead expense policy
Business overhead expense policy
A man is injured while robbing a convenience store. How does his major medical policy handle the payment of his claim? (Choose from the following options) 1. 50% of claim will be paid. 2. If the man is not convicted, he will get 75% of his claim paid. 3. The claim is paid in full. 4. Claim is denied if his policy contains the Illegal Occupation provision.
Claim is denied if his policy contains the Illegal Occupation provision.
In accordance with the Administrative Procedure Act, what entity has the authority to make and enforce rules and regulations to implement and carry out the purposes of the Insurance laws of New Jersey?
Commissioner
Which authority is responsible for establishing standards for the content of health insurance policies? (Choose from the following options) 1. Federal Board of Insurance Regulation 2. Commissioner 3. Department of Banking and Insurance 4. Insurance Regulation Commission
Commissioner
If a violation of the New Jersey insurance code were to occur, a cease and desist order and/or penalty may be issued. Who may issue a cease and desist order? (Choose from the following options) 1. Insurance Company 2. Governor 3. Commissioner 4. Department of Banking and Insurance
Commissoner
What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur? (Choose from the following options) 1. Conditionally renewable 2. Optionally renewable 3. Noncancellable 4. Guaranteed renewable
Conditionally renewable
When a producer was reviewing a potential customer's coverage written by another company, the producer made several remarks that were maliciously critical of that other insurer. The producer could be found guilty of (Choose from the following options) 1. Discrimination. 2. Nothing, unless the remarks were in writing 3. Defamation. 4. Misrepresentation.
Defamation
Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer? (Choose from the following options) 1. Disability Income 2. Major Medical 3. Dental Expense 4. Basic Medical Expense
Disability Income
This arrangement specifies who will purchase a disabled partner's interest in the event he or she becomes disabled. (Choose from the following options) 1. Employee benefit plan 2. Disability buyout 3. Business overhead expense 4. Key-person insurance
Disability buyout
When twin brothers applied for life insurance from Company A, the company found that while neither of them smoked and both had a very similar lifestyle, one of the twins was in a much stronger financial position than the other. Because of this, the company charged him a higher rate for his insurance. This practice is considered (Choose from the following options) 1. Twisting. 2. Controlled business. 3. Adverse selection. 4. Discrimination.
Discrimination
All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT (Choose from the following options) 1. An offer to share in commissions generated by the sale. 2. Dividends from a mutual insurer. 3. An offer of employment. 4. Stocks, securities, or bonds.
Dividends from a mutual insurer.
A policy which covers medical costs related to a specific condition is called a (Choose from the following options) 1. Condition-Specific Policy. 2. Specific Condition Policy. 3. Limited Coverage Policy. 4. Dread Disease Policy.
Dread Disease Policy
Items stipulated in the contract that the insurer will not provide coverage for are found in the
Exclusions
The requirement that agents must account for all insurance funds collected, and are not permitted to comingle those funds with their own is known as (Choose from the following options) 1. Fiscal responsibility. 2. Fiduciary responsibility. 3. Premium accountability. 4. Insurance-related conduct.
Fiduciary responsibility.
All of the following would be covered under the Temporary Disability Law EXCEPT (Choose from the following options) 1. Fred suffered a compound fracture of his arm because of a forklift accident at work. 2. Bob had to have his leg amputated after suffering from a snake bite while vacationing in a national forest. 3. George suffered a concussion after falling off of his roof while doing maintenance work on his house. 4. All of the above would be covered.
Fred suffered a compound fracture of his arm because of a forklift accident at work.
Which provision allows the policyholder a period of time, while coverage is in force, to examine a health insurance policy and determine whether or not to keep it? (Choose from the following options) 1. Probationary Period 2. Free Look Period 3. Grace Period 4. Elimination Period
Free Lock Period
What phase begins after a new policy is delivered? (Choose from the following options) 1. Grace period 2. Free-look period 3. Insurability period 4. Elimination period
Free-look period
A Medicare supplement plan must have at least which of the following renewal provisions? (Choose from the following options) 1. Nonrenewable 2. Noncancellable 3. Guaranteed renewable 4. Conditionally renewable
Guaranteed renewable
An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits? (Choose from the following options) 1. Have accumulated 40 work credits 2. Have reached the age of 25. 3. Have accumulated 6 work credits in the past 3 years 4. Have accumulated 20 work credits in the past 10 years
Have accumulated 6 work credits in the past 3 years
All of the following are among the Commissioner's broad powers EXCEPT (Choose from the following options) 1. Report to the Governor about the Department's operations. 2. Formulate and adopt rules and regulations of companies and licensees. 3. Have interest in insurance companies regulated by the Department. 4. Appoint and remove officers employed within the Department.
Have interest in insurance companies regulated by the Department.
Applicants for surplus lines authority must fulfill all of the following requirements EXCEPT (Choose from the following options) 1. Hold a property and casualty license. 2. Pass an insurance licensing exam. 3. Hold a bond as a condition for licensure. 4. Be a New Jersey resident.
Hold a bond as a condition for licensure
Rob is being treated by a physical therapist in his apartment for a disorder which, if he were not treated there, would have to be treated on an inpatient basis in the hospital. What kind of care is this? (Choose from the following options) 1. Satellite health care 2. Home health care 3. Residential health care 4. Remote health care
Home health care
Which of the following refers to nursing and other health care services rendered to a person in his or her residence on a part-time or intermittent basis? (Choose from the following options) 1. Hospice 2. Remote health care 3. Home health care 4. Residential care
Home health care
Individual health insurance policies must provide all of the following benefits for the treatment of alcoholism EXCEPT (Choose from the following options) 1. Confinement as an inpatient at a licensed residential treatment facility. 2. Limited hospital policy benefits. 3. Inpatient care in a hospital for alcoholism. 4. Treatment at a detoxification facility.
Limited hospital policy benefits.
Which of the following would be considered false advertising? (Choose from the following options) 1. Implying that the agent is the insurer 2. Stating the differences in benefits between Whole Life Insurance and Term Life Insurance 3. Stating that a policy has limitations and exclusions 4. Failing to include premiums in sales materials
Implying that the agent is the insurer
In an optionally renewable policy, the insurer has which of the following options? (Choose from the following options) 1. Alter the due date so the policy can be cancelled sooner 2. Shorten the notice that the insured receives 3. Increase premiums 4. Increase the grace period
Increase premiums
The Medical Information Bureau (MIB) was created to protect (Choose from the following options) 1. Medical examiners that perform insurance physical examinations. 2. Insurance companies from adverse selection by high risk persons. 3. Insurance departments from lawsuits by policyowners. 4. Insureds from unreasonable underwriting requirements by the insurance companies.
Insurance companies from adverse selection by high risk persons.
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the (Choose from the following options) 1. Probationary period. 2. Insuring clause. 3. Incontestability clause. 4. Consideration clause.
Insuring Clause
A woman's health insurance policy dictates which doctors she is allowed to see. Her health providers share an assumed risk for their patients and encourage preventive care. What best describes the health system that the woman is using? (Choose from the following options) 1. Managed care 2. Comprehensive health 3. Major medical 4. Group health
Managed care
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? (Choose from the following options) 1. May 2nd (immediately) 2. May 31st (within a month) 3. May 10th (within 10 calendar days) 4. May 12, Friday (within 10 business days)
May 10th (within 10 calendar days)
A contract between a producer and an insurance company (Choose from the following options) 1. Is considered noncancellable until it expires. 2. Must be in writing and signed by both parties. 3. Can be in writing or a verbal agreement. 4. Must be signed at least by one party.
Must be in writing and signed by both parties.
The primary eligibility requirement for Medicaid benefits is based upon (Choose from the following options) 1. Whether the claimant is insurable on the private market. 2. Age. 3. Number of dependents. 4. Need.
Need
A participating insurance policy may do which of the following? (Choose from the following options) 1. Provide group coverage 2. Pay dividends to the stockholder 3. Require 80% participation 4. Pay dividends to the policyowner
Pay dividends to the policyowner
Which of the following applies to partial disability benefits? (Choose from the following options) 1. Payment is based on termination of employment. 2. Benefits are reduced once an insured is no longer under a doctor's care. 3. Payment is limited to a certain period of time. 4. An insured is entitled to a principal sum benefit for the partial loss of a limb.
Payment is limited to a certain period of time.
A nonresident licensed producer decides to conduct business under an assumed name. Which of the following is true? (Choose from the following options) 1. The assumed name must be filed with the NAIC, the Commissioner of the domicile state, and the Commissioner of the state for which the nonresident producer is licensed. 2. Nonresident producers may not conduct business under any name besides legal names. 3. The assumed name must be submitted on the Uniform Assumed Title form, with the appropriate fee. 4. Nonresident producers need to take no action before conducting business under an assumed name.
Nonresident producers may not conduct business under any name besides legal names.
Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? (Choose from the following options) 1. Notice of Claim 2. Loss Notification 3. Claims Initiation 4. Consideration
Notice of Claim
All of the following would be considered an insurance transaction EXCEPT (Choose from the following options) 1. Negotiating coverage. 2. Obtaining an insurance license. 3. Soliciting a policy. 4. Advising a policyholder regarding a claim.
Obtaining an insurance license.
Which of the below statements is FALSE regarding the process of completing and signing an application? (Choose from the following options) 1. Only the insured is required to sign the application. 2. If the applicant and insured are two different people, both need to sign the application. 3. If a policy is issued, the application becomes a part of the contract. 4. The application itself is completed by an agent and medical examiner (if required).
Only the insured is required to sign the application.
Which renewability provision allows an insurer to terminate a policy for any reason, and to increase the premiums for any class of insureds? (Choose from the following options) 1. Cancellable 2. Guaranteed renewable 3. Optionally renewable 4. Conditionally renewable
Optionally renewable
With respect to the Consideration Clause, which of the following would be considered consideration on the part of the applicant for insurance? (Choose from the following options) 1. Providing warranties on the application 2. Notice of policy cancellation 3. Payment of premium 4. Promise to renew the policy at the end of the policy period
Payment of premium
Who might receive dividends from a mutual insurer? (Choose from the following options) 1. Subscribers 2. Stockholders 3. Agents 4. Policyholders
Policyholders
Certain conditions, such as dismemberment or total and permanent blindness, will automatically qualify the insured for full disability benefits. Which disability policy provision does this describe? (Choose from the following options) 1. Dismemberment disability 2. Partial disability 3. Residual disability 4. Presumptive disability
Presumptive disability
All of the following professional designations are recognized by the Department as acceptable substitutes for education and examination requirements EXCEPT (Choose from the following options) 1. Chartered Property/Casualty Underwriter (CPCU) 2. Chartered Financial Consultant (ChFC) 3. Chartered Life Underwriter (CLU) 4. Professional Insurance Agent (PIA)
Professional Insurance Agent (PIA)
Shelia has an embolism in her brain. After a week-long hospitalization and subsequent bed rest, she is allowed to work again. Three months later, she develops a second brain embolism. Which provision would determine whether a new set of benefits would cover the second embolism? (Choose from the following options) 1. Relapse Clause 2. Corridor Clause 3. Recurrent Disability Provision 4. Elimination Period Provision
Recurrent Disability Provision
The Federal Fair Credit Reporting Act (Choose from the following options) 1. Regulates consumer reports. 2. Protects customer privacy. 3. Regulates telemarketing. 4. Prevents money laundering.
Regulates consumer reports
Which is true regarding obtaining underwriting sources? (Choose from the following options) 1. The insurer only needs to inform the applicant of how the information is being gathered; it is not necessary to disclose the sources. 2. It is illegal to obtain information from outside sources in order to determine an applicant's insurability. 3. The applicant must be informed of the sources contacted and how the information is being gathered. 4. The insurer does not need to inform the applicant of how the information is gathered; informing only of the source is sufficient.
The applicant must be informed of the sources contacted and how the information is being gathered.
Which of the following special policies covers unusual risks that are NOT normally included under Accidental Death and Dismemberment coverage? (Choose from the following options) 1. Specified Disease Policy 2. Credit Disability 3. Special Risk Policy 4. Limited Risk Policy
Special Risk Policy
Which of the following is a person or organization that is allowed to write business in New Jersey for insurance companies that do not possess a certificate of authority in New Jersey, if no authorized insurers in New Jersey offer the specific type of insurance in question? (Choose from the following options) 1. Unauthorized broker 2. Fiduciary agent 3. Surplus lines agent 4. Insurance intermediary
Surplus lines agent
An insurer goes bankrupt and is unable to pay on any of its insureds' claims. Which of the following will happen? (Choose from the following options) 1. The claims will be paid by a nationally-based program. 2. The claims will be paid by the state Life and Health Guaranty Association. 3. The claims will be paid by the state Department of Insurance. 4. The insureds will not be paid.
The claims will be paid by the state Life and Health Guaranty Association.
An insurer goes bankrupt and is unable to pay on any of its insureds' claims. Which of the following will happen? (Choose from the following options) 1. The insureds will not be paid. 2. The claims will be paid by a nationally-based program. 3. The claims will be paid by the state Life and Health Guaranty Association. 4. The claims will be paid by the state Department of Insurance.
The claims will be paid by the state Life and Health Guaranty Association.
The Paul vs. Virginia case was decided in 1869. To what extent does the Supreme Court's decision still apply to insurance today? (Choose from the following options) 1. The decision has changed. Insurance and securities are now regulated by the same federal agency. 2. It still stands in full. Insurance is not considered to be interstate commerce, and is not subject to regulation by the federal government. 3. It still stands in full. Insurance and securities are still regulated by two distinct agencies. 4. The decision has changed. Insurance is considered to be interstate commerce, and is subject to regulation by the federal government.
The decision has changed. Insurance is considered to be interstate commerce, and is subject to regulation by the federal government.
Which statement is NOT true regarding underwriting group health insurance? (Choose from the following options) 1. The group is assessed individually for insurability. 2. The premium can be made retroactive for the year. 3. The cost of the policy is partially determined by the ratio of males to females in the group. 4. Everyone in the group is covered, regardless of their medical history.
The group is assessed individually for insurability.
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? (Choose from the following options) 1. The New Jersey Insurance Guaranty Association 2. The New Jersey Standard Health Care Program 3. The Individual Health Coverage Program 4. The Health Care Quality Act
The individual Health Coverage Program
An insurer hires an advertising agency to create an advertisement for a health insurance policy. The public complains that the way the advertisement presents the policy is misleading because of certain photographs that the advertiser put on the commercial. Who will be held liable for this? (Choose from the following options) 1. The advertiser 2. The insurer 3. The Department of Banking and Insurance 4. All of the above
The insurer
Which of the following is NOT a feature of a guaranteed renewable provision? (Choose from the following options) 1. The insured has a unilateral right to renew the policy for the life of the contract. 2. Coverage is not renewable beyond the insured's age 65. 3. The insured's benefits cannot be reduced. 4. The insurer can increase the policy premium on an individual basis.
The insurer can increase the policy premium on an individual basis.
Which of the following is NOT a feature of a noncancellable policy? (Choose from the following options) 1. The insured has the right to renew the policy for the life of the contract. 2. The insurer may terminate the contract only at renewal for certain conditions. 3. The premiums cannot be increased beyond the amount stated in the policy. 4. The guarantee to renew coverage usually applies until the insured reaches certain age.
The insurer may terminate the contract only at renewal for certain conditions.
Which of the following statements is true regarding coinsurance? (Choose from the following options) 1. The smaller the percentage that is paid by the insured, the more consistent the required premium will be. 2. The larger the percentage that is paid by the insured, the lower the required premium will be. 3. The larger the percentage that is paid by the insured, the higher the required premium will be. 4. The smaller the percentage that is paid by the insured, the lower the required premium will be.
The larger the percentage that is paid by the insured, the lower the required premium will be.
6. Which of the following is true regarding license cancellation and reinstatement? (Choose from the following options) 1. The producer must allow it to lapse. After that point, it can be reinstated any time within the next 2 years, provided that the continuing education requirements have been met. 2. The license needs to be returned to the Insurance Department. Once this occurs, it cannot be reinstated. 3. The producer must complete a brief interview with the Commissioner's Office. The license may then be reinstated within 1 year. 4. The license needs to be returned to the Insurance Department. It can be reinstated by filling out an application and paying a fee.
The license needs to be returned to the Insurance Department. It can be reinstated by filling out an application and paying a fee.
Which of the following statements is most correct concerning the changing of an irrevocable beneficiary? (Choose from the following options) 1. They can be changed only with the written consent of that beneficiary. 2. They may be changed at any time. 3. They can never be changed. 4. They may be changed only on the anniversary date of the policy.
They can be changed only with the written consent of that beneficiary.
Which of the following best describes the purpose of Coordination of Benefits regulations? (Choose from the following options) 1. They discourage overinsurance and avoid duplication of benefits by permitting a reduction of benefits when a person is covered by more than one plan. 2. They discourage people from purchasing temporary insurance or dread disease plans. 3. They allow people who are insured under two or more health plans to collect full benefits from each plan. 4. They encourage people to purchase two or more health plans by allowing duplication of benefits under certain circumstances.
They discourage overinsurance and avoid duplication of benefits by permitting a reduction of benefits when a person is covered by more than one plan.
A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as (Choose from the following options) 1. Benefit schedule. 2. Gatekeepers. 3. Usual, customary and reasonable. 4. Relative-value schedule.
Usual, customary and reasonable.
An employee is injured in a construction accident, rendering him unable to work for a year. Which of the following plans would provide him with medical expense coverage and income assistance? 1. Long-term Care 2. Social Security Disability 3. Workers Compensation 4. Major Medical Insurance
Workers Compensation