health insurance exam
6
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?
Is renewable at the insured's option to a specified age.
A guaranteed renewable disability insurance policy
Insurable interest and consent
A life insurance policy has a legal purpose if both of which of the following elements exist?
Guaranteed
A new employee who meets HIPAA eligibility requirements must be issued health coverage on what basis?
Nonresident producers may not conduct business under any name besides legal names.
A nonresident licensed producer decides to conduct business under an assumed name. Which of the following is true?
14
A person is covered under the Temporary Disability Law for a given illness. The illness subsides but then relapses. What is the maximum number of days that can pass between the bouts of illness before the two illnesses are classified as having two different disability periods?
10 calendar days
A producer received a group master policy and certificates for delivery to the insured. Within how many days must the policy and certificates be delivered?
until its terminated
A producer's appointment lasts for how long?
Disability income
A waiver of premium provision may be included with which kind of health insurance policy?
A discussion of an insurer's policies on the radio.
All of the following are advertisements EXCEPT
Number of family dependents.
All of the following are the most common variations in a Long-Term Care policy EXCEPT
A resident producer licensed for Property and Casualty insurance applying for a Life insurance license.
All of the following candidates for a resident producer license may be exempted from the examination requirement EXCEPT
It is a compulsory program.
All of the following statements about Medicare Part B are correct EXCEPT
Neither approved the application nor issued the policy
An applicant for a health insurance policy returns a completed application to her agent, along with a check for the first premium. She receives a conditional receipt two weeks later. Which of the following has the insurer done by this point?
Workers Compensation
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?
Time of Payment of Claims
An insured notifies the insurance company that he has become disabled. What provision states that claims must be paid immediately upon written proof of loss?
The capital amount in a lump sum
An insured who has an Accidental Death and Dismemberment policy loses her left arm in an accident. What type of benefit will she most likely receive from this policy?
The organization will need to obtain a nonresident business entity license, and its producers will need to obtain nonresident licenses
An organization licensed as a producer business entity based in New York would like to transact insurance in New Jersey. Which of the following is true?
Conditions.
Because an insurance policy is a legal contract, it must conform to the state laws governing contracts which require all of the following elements EXCEPT
Presumptive disability
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?
Contracts of adhesion.
Contracts that are prepared by one party and submitted to the other party on a take-it-or-leave-it basis are classified as
5 business days
How many days does a producer have to remit the collected premiums to the insurer?
12 credits
If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits?
Broader in general.
In comparison to a policy that uses the accidental means definition, a policy that uses the accidental bodily injury definition would provide a coverage that is
Elimination period.
In disability income insurance, the time between the onset of an injury or sickness and when benefits begin is known as the
Genetic characteristic.
In insurance terms, if a person has a chromosomal defect that may predispose him/her to a disease, this is called
All providers will have the same coverage options and conditions for each plan.
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
Limited hospital policy benefits.
Individual health insurance policies must provide all of the following benefits for the treatment of alcoholism EXCEPT
The applicant must experience a financial loss due to an accident or sickness that befalls the insured.
Insurable interest can be best described by which of the following?
30
Licensees must file with the Department a branch office registration form within how many days before business is first conducted there?
Not taxable since the IRS treats them as a return of a portion of the premium paid.
On a participating insurance policy issued by a mutual insurance company, dividends paid to policyholders are
5 months
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?
50/50
Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?
When the amount payable under Social Security is more than the amount payable under the rider.
Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT
Fiduciary responsibility.
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
18 months
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?
Principal sum
Under the Accidental Death and Dismemberment (AD&D) coverage, what type of benefit will be paid to the beneficiary in the event of the insured's accidental death?
Covered employer.
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
A statement that is sufficiently clear to identify the insured and the nature of the claim.
Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain
Legal benefits
Under workers compensation, which of the following benefits are NOT included?
An agreement between a ceding insurer an assuming insurer
What is reinsurance?
Conditionally renewable
What is the contract provision that allows the insurer to nonrenew health coverage if certain events occur?
Probationary period
What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered?
The Individual Health Coverage Program
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?
Renewal provision
Which health insurance provision describes the insured's right to cancel coverage?
It is solely a federally administered program.
Which of the following is INCORRECT concerning Medicaid?
Contracting with insurance companies
Which of the following is NOT a characteristic or a service of an HMO plan?
Coverage for dependents
Which of the following is NOT an exclusion in medical expense insurance policies?
It is nonrenewable.
Which of the following is true regarding a term health policy?
Care can be provided outside of the service area.
Which of the following is true regarding inpatient hospital care for HMO members?
Property and Casualty
Which of the following licenses is required for a surplus lines producer?
Impairment rider
Which of the following riders would NOT increase the premium for a policyowner?
Notice of Claim
Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss?
The individual member
Who chooses a primary care physician in an HMO?
