health and accident guaranteed exam

the minimum age for obtaining a Medicare supplement policy is

age 65

a lender who conditions approval of a loan on the condition that the borrow purchase from that lender may be guilty of

coercion

which of the following has the authority to issue regulations as are deemed necessary or desirable to establish minimum standards for the form, content, and sale of individual and group health insurance policies?

commissioner

what happens to the copy of the application for health insurance once the policy was issued?

it becomes part of the entire contract

The benefits in Medical expense insurance are

Received income tax free by the individual

if a licensee wants to transact insurance under a different name than that listed on his or her producer's license, which of the following must occur?

the change must be filed with the Department

an insured needs ongoing treatment for a diabetic condition. under PPACA, which of the following is correct?

the condition must be covered under the insured's plan

Which entity has the option of including optional provisions in a health insurance policy?

the insurer

An employee dies having 6 quarters of coverage during the previous 13-quarter period. What status of coverage does the employee have under Social Security?

Currently insured

Variable insurance and variable annuities are regulated by

SEC, FINRA and Departments of Insurance

for a contract to be enforceable by law, the purpose of the contract must be

legal and not against public policy

what is the purpose of requiring licenses for persons who transact insurance?

protect the general public

an insured purchased a health insurance policy with a renewability clause that staes the policy is "Guaranteed Renewable". This means that as long as the required premiums are paid, the policy will continue until the insured

reaches age 65

when one insurer buys insurance from another company to minimize the effects of catastrophic losses, they are

reinsuring

insured have the right to do which of the following if they have NOT received the proper claim form within 15 days of their notice to the insurer of a covered loss under a major medical policy?

submit the description in their own words on a plain sheet of paper

there is a particular type of insurer that no insurer in New Jersey offers. In order for New Jersey residents to obtain this Insurance, they will need to be covered by

surplus lines insurers(certificate of authority not required)

an insurer is attempting to determine the insurability of an applicant and decides to obtain medical information from several different sources. which of the following must be notified of the investigation?

the applicant

what is the purpose of a disability buy-sell agreement?

to allow the business buyout in case of the owner's disability

what is the purpose of the impairment rider in a health insurance policy?

to exclude coverage for a specific impairment

a husband and wife both incur expenses that are attributed to a single major medical insurance deductible. which type of deductible do they have in their policy?

family

under HIPAA portability, which of the following are NOT protected under required benefits?

groups of one or more

in the U.S vs South-Esstern Underwriters Association, which of the following was the decision of the Supreme Court?

insurance is interstate commence and is therefore subject to regulation by the federal government

what does the state Life and Health Insurance Guaranty Association guard against?

insurer insolvency

an example of an alien insurer doing business in this state is one formed under the laws of

mexico

an insurance company that is owned by the policyholders is called a

mutual insurer

an insured wants to cancel her health insurance policy. which portion of the contract would explain cancellation rights?

renewability provision

guaranteed renewable provision

similar to the noncancellable provision, with the exception that the insurer can increase the policy premium on the policy anniversary date

an applicant is found to have a gene that predisposes him to heart disease, despite the fact that he has not yet shown any signs of heart disease. he applies for an individual health insurance policy. how can this genetic predisposition affect his contract?

term of coverage may be altered??

a policy that provides for home health care benefits must cover a minimum of how many visits?

60

under the mandatory uniform provision Legal Actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to

60 days after proof of loss has been submitted

when can an insured initiate legal action against the insurer?

60 days after submitting proof of loss

if some of an electronically submitted claim cannot be adjudicated due to missing data, the insurer must electronically notify the heath care provider within what period of time?

7 days of that determination

Which of the following best defines the Probationary Period in group health policies?

A specified peroid of time that a person joining a group has to wait before becoming eligible for coverage.

Multiple indemnity

a provision or rider found in some life insurance policies or accidental death policies under which certain benefits are doubled or tripled when death of the insured was due to certain specified circumstances

Residual benefit

amount is based on the proportion of income actually lost due to a business interruption caused by the insured's disability

all of the following health insurance disability benefits are income tax free EXCEPT

employer-paid group disability

guaranteeing future dividends is considere to be an unfair or deceptive act known as

misrepresentation

Producer licenses will NOT be issued to business entities in which of the following case?

One partner's license was revoked in the previous 5 years

Which of the following best describes the type of care provided by HMOs?

Preventive- HMOs emphasize preventive health care as a method of reducing medical expenses by early detection of health problems before they may require major more costly treatment.

an insurer can decide not to renew an optionally renewable policy

on the premium due dates or the anniversary

under the Payment of Claims provision, to whom will the insured's benefits be paid if the insured is deceased?

the insured's primary beneficiary

Guaranteed Insurability Rider

will allow the insured to purchase additional amounts of disability income coverage without evidence of insurability

under the temporary disability law, two periods of disability due to the same cause and separation by not more than 14 days will be considered

one continuous period of disability, as long as the insured earned wages during the 14-day period with any employer between the periods of disability

a stock insurer is defined as an insurer

owned by its stockholders

an applicant for surplus lines must do all of the following EXCEPT

possess a certificate of authority in this state

HIPAA groups apply to

two or more

which of the following provisions is NOT mandatory for health insurance policies issued in this state?

unpaid premiums?

all advertisements are the legal responsibility of

the insurer

which of the following entities is considered the principal?

the insurer issuing a policy

an insurer decides to terminate the appointment of one of its producers and notifies the commissioner 29 days after the facts. on the 9th day after the decision, the producer violates a regulation of the insurance code, and a policy owner wants to hold the insurer legally responsible. which of the following is true?

the insurer will be held legally responsible

which of the following is a requirement for replacement of health policies?

the old policy must stay in force until the new policy

if an applicant submits the initial premium with an application, which action constitutes acceptance?

the underwriters approve the application

medicare is a health insurance program for all of the following individuals EXCEPT

those with low income and low assets

Under the mandatory uniform provision "notice of claim", written notice of a claim must be submitted to the insurer within what time parameter?

Within 20 days

when must an insurer report to the commisioner a listing of individuals who have more than one Medicare supplement policy in force?

annually

a producer or insurer who violates solicitation regulations can pay a maximum fine of

$2,000

if an insured is injured while committing an illegal act and the insured's health policy contains the illegal occupation provision, what percentage of the claim will be paid

0%

Which is true about a spouse term rider?

The rider is level term insurance; available for a limited time; usually expiring at 65

which is the following is NOT an indicator of a competent party?

business profession

Insurers CANNOT transact insurance in this state without a

certificate of authority

which of the following would be an example of an insurer participating in the unfair trade practice of discrimination?

charging the insurer higher premiums based on their race

what must an applicant do before being admitted to the state licensing examination?

complete 20 hours of prelicensing education

policy delivery refers to the delivery of

completed insurance policy to the policy owner

if an insured pays a health insurance premium each month, how long would the grace period be under the policy?

10 days

the commissioner investigates claims filed against a licensee and finds that the licensee has chronically violated several insurance regulations. the commissioner decides to hold a hearing. what is the minimum amount of notice that the licensee must be given for the hearing?

10 days

When a whole life policy is surrendered for its nonforfeiture value, what is the automatic option?

extended term

which of the following describes the relationship between principal sum and a capital sum?

a capital sum is a percentage of a principal sum

which of the following types of care could be provided at a community center?

adult day care

The benefits from a business overhead expense insurance policy

Are limited to covered expenses and are taxable to the business

which of the following is NOT a medicaid qualifier?

Insurability

riley reads an agreement on the first page of her policy which includes a list of losses that will be covered by her insurer. what is the name of this agreement?

insuring clause

a licensee changes his business address. within how many days must the commissioner be notified?

30 days

In accident and health policies issued in the state, an insured must submit proof of loss within how many days?

90 days

In health insurance, what is coinsurance

A percentage of the cost of service that the insured and the insurer share

Which of the following would NOT trigger the payment of Accelerate Death Benefits?

Being permantly disabled

In addition to participation requirement, how does an insurer guard against adverse selection from underwriting group health?

By requiring that the insurance be incident to the group

an elimination(waiting) period may NOT have to be satisfied for a disability in which of the following?

an insured suffers a relapse of a prior disability within 6-months of the initial covered disability

a dentist is off work for 4 months due to a disability. His dental assistant's salary would be covered by

Business overhead insurance

An individual receives a lump-sum inheritance. He'd like to use the money to create a lifetime income since he'll be retiring soon. He purschase an annuity and wishes to receive payments beginning in 2 months. What did he buy?

Single premium immediate annuity; one premium payment

What does the application of contract adhesion mean?

The insurer prepares the policy and submits it to the insured on a take-it-or-leave it basis

during a policy solicitation, an insurer exaggerates the financial condition of one of its competitors, and makes it sound worse than it is. this is an example of an unfair trade practice of

defamation

the "stop-loss" feature on a major medical policy is intended to

establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in the calendar year

which of the following describes the renewability of a Medicare Supplement Policy?

guaranteed renewable

in new jersey, benefits for the treatment of alcoholism are included in an accident and health policy

if a contract provides hospital or medical expense benefits, and if the treatment is reccomended by a doctor

right after an insured reinstated his major medical policy, he was involved in an accident that required hospitalization. when would this accident be covered upon reinstatement of the policy?

immediately

which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitive care?

intermediate care

which of the following beneficiary designations cannot be changed by an insured without first receiving the consent of the beneficiary?

irrevocable

what advantage does the "recurrent disability" provision provide to the insured under a disability income policy

it eliminates the imposition of an elimination period for a separate disability

if a business wants to make sure it will be able to cover losses due to the disability of its top employee, the business should get which type of insurance?

key person disability income

an insurance agent visits a potential client and explains various types of policies. the customer displays a lack of interest, so the agent guarantees higher dividends than he knows would be possible. which term describes what the agent has done?

misrepresentation

In health insurance, the length of the grace period varies according to the

mode of the premium payment

The guaranteed purchase option is also referred to as the

Future increase option

The Waiver of Cost rider is found in what type of insurance?

Universal Life

which of the following best defines the unfair trade practice of rebating?

offering an inducement of something not specified in the policy

which statement best describes agreement as it relates to insurance contracts?

one party accepts the exact terms of the other party's offer

an agreement that is enforceable by law is known as what kind of contract?

Legal?

Mike is the owner of a deferred annuity. He pays $100 in premium on the first day of the month. Which of the following terms best describe his premium payment arrangement

Level

HMO members pay a small fee when they see their primary care physician. This fee is called a

copay

an insured reads his policy and is under the impression that a particular loss will be covered. the insurer, however, insists that the loss will not be covered. what authority will settle this dispute?

court system

which of the following meets the insured's personal needs, and is provided by a nonmusical personnel?

custodial care