New Jersey Health

An insurer's license to transact insurance business in this state but whose articles of incorporation are registered in Canada is considered what type of insurer?

Alien

Which of the following statements is NOT true regarding health insurance policy provisions?

All additional provisions written by insurers are cataloged by their respective states

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

Which of the following provisions gives an employee the right to exchange group insurance for an individual policy within a certain number of days from termination of employment?

Conversion provision

Which of the following meets the insured's personal needs and is provided by non medical personnel

Custodial care

The presumptive disability provision assumes that the insured is totally disabled upon loss of all of the following EXCEPT

Feeling

An insurer incorporated under the laws of another state but doing business in this state is considered:

Foreign

Under HIPAA portability which of the following are not protected under required benefits

Groups of one or more

Which of the following describes the renewability of a Medicare supplement policy

Guaranteed renewable permanently

Which act was introduced to reduce the cost of health care by utilizing preventative care?

HMO

An insured has an individual disability income policy with a 30-day elimination period. He becomes disabled on June 1st for 15 days. When will he collect on his disability income payments?

He won't collect anything

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?

Home Health Care

In New Jersey, benefits for treatment of alcoholism must be included in health insurance policies providing:

If a contract provides hospital and medical expense benefits, and if the treatment is recommend by a doctor.

Which of the following is NOT correct concerning taxation of disability income benefits?

If paid by the individual, the premiums are tax deductible

With a conditionally renewable policy, the premiums are more likely to be:

Increased

The general business of transacting, including soliciting, negotiation, or communicating with the insureds is know as what:

Insurance-related conduct

All advertisements are the legal responsibility of the

Insurer

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

Insurer

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

Insurer insolvency

Riley reads in agreement on the first page of her policy, which includes a list of losses that will be covered by her and sure. What is the name of this agreement?

Insuring clause

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

Intermediate care

What happens to the copy of the application for health insurance once the policy is issued?

It becomes part of the entire contract

Who is obligated to make sure all questions are answers and all necessary signatures are collected on the application?

The agent

A man is an attorney when he applies for a health policy. He decides to become a professional bungee jumper. He files a claim. What should happen?

The insurance company will pay the claim according to the benefits available if the correct premium has been paid.

An insurer decides to terminate the appointment of one of its producers and notify the commissioner 29 days after the fact. On the 9th day after the decision, the producer violates a regulation of the insurance code, and a policyowner wants to hold the insurer legally responsible. which of the following is true?

The insurer will be held legally responsible

Which of the following statements concerning the Medical Information Bureau is correct?

The medical information Bureau assists underwriters in evaluating and classifying risks

If an applicant submits the initial premium with an application which action constitutes acceptance

The underwriters approve the application

An employee is covered under COBRA. His previous premium payment was $100 per month. His employer now collects $102 each month. Why does the employer collect an extra $2?

To cover the employers administration cost

What is the purpose of requiring licenses for persons who transact insurance

To protect the general public

What is the purpose of a benefit schedule?

To state what and how much is covered in the plan.

Which of the following statements is INCORRECT regarding the definition of total disability?

Total disability is the inability to perform partial duties of any occupation for which a person is suited by reason of education, training or experience.

Which of the following elements of an insurance contract requires paying premium and providing a statement of a good health?

Consideration

Regarding the consideration clause, which of the following is NOT correct?

Consideration of the insurer and insured must be equal

A core Medicare supplement policy (Policy A) will cover all of the following expenses except

Part A Deductible

A producer or insurer who violates the solicitation regulations can be ordered to pay a maximum fine of

$2,000

Under the common accident provision, how many deductibles would be paid if five family members covered under the same major medical policy are injured in the same accident?

1

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

An insurance producer dies, and his wife takes over his business temporarily through an agreement with another producer. what is the maximum time that she can do this:

180 days

According to the Time Limit of Certain Defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years?

2 years

Applicants for an individual producer license must submit proof of completing a certain number of hours approved continuing education credits. How many hours are required?

24

A Medicare Supplement policy must have a free-look period of at least

30 days

A producer must notify the department of a change of business address within how man days?

30 days

Sue's license was revoked 1 year ago. she would like to reinstate it. how much longer will she have to wait before she can apply for reinstatement:

4 more years

Joe, age 63, was disabled and can no longer work. He meets the Social Security definition of total disability. How many work credits must Joe have accumulated to have the status of fully insured?

40

Insurers must keep all advertisements on file for at least how long?

5 years

Partial disability usually pays what percent of the total disability benefit?

50%

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 health care provider within what period of time?

7 days of that determination

A disability income policy has a waiting period of 7 days. If the insured is disabled for 15 days, how many days of benefits will the policy pay?

8 days

according to the metal level classification of health insurance, what percentage of health care costs will be covered under the gold plan

80%

Which of the following statements is INCORRECT concerning business operations in a branch office in New Jersey:

A branch office certificate expires 2 years from the date of filling, regardless of the producers own license expiration

Which of the following would be required to become licensed as an insurance producer?

A customer service representative who solicits no more than one policy a year

In health insurance, what is coinsurance?

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

Which of the following best describes a rebate?

A producer returning part of her commission to her client, as an inducement to buy

Who is considered a nonresident agent

An agent who is licensed in another state, but is allowed to transact insurance in this state.

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

Refusing to pay claims without conducting a reasonable investigation based upon all available information is an example of

An unfair claims practice

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

Annually

Answers to questions in an insurance application are called representations and as such they are

Believed to be true to the best of the applicant's knowledge

If a dentist was off work for 4 months due to disability, his dental assistant's salary would be covered by:

Business Overhead insurance

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

By requiring that the insurance be incidental to the group

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

Complete 20 hours of education for each line of insurance in which the applicant intends to transact, including education regarding state-specific regulations.

A dread disease policy would cover which of the following:

Cancer

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

Charging the insured higher premiums based on her race

A lender who conditions approval of a loan on the condition that the borrower purchase insurance from that lender may be guilty of:

Coercion

Several insurance consumers have violated the insurance laws of new jersey. who has the power to conduct investigations and hold hearings if deemed necessary

Commissioner

To be valid an insurance policy must have all of the following except

Consideration

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

Defamation

A major medical expense policy would exclude coverage for all of the following treatments EXCEPT

Drug addiction

An important fact about the financial status of an insurer was deliberately withheld. which of the following terms describes this action:

False financial statement

Which of the following time periods is the general enrollment period for Medicare Part B?

January 1 through March 31 each year

An insured was seriously injured in a skiing accident that required him to be hospitalized for 5 weeks. His medical expense policy covers all of the following except:

Loss of income while hospitalized

Which of the following would NOT be considered a limited coverage policy?

Major medical expense insurance

Which of the following used to be called Medicare + Choice Plans?

Medicare Advantage Plans

What is the primary difference between Medigap and Medicare Select policies quizlet?

Medicare SELECT policies contain restricted network provisions

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

Misrepresentation

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

Mode of the premium payment

Following a covered loss, the Time Payment of Claims Provision requires that an insurance company pay disability income benefits no less frequently than:

Monthly

An insurer can decide to not renew an Optionally Renewable policy

On the premium due dates

Which statement best describes agreement as it relates to Insurance contracts?

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

With respect to the entire contract clause in health policies, who has the authority to make changed to an existing policy?

Only an executive officer of the company

A stock insurer is defined as an insurer

Owned by its stockholders

Which of the following is consideration on the part of an insurer?

Paying a claim

An applicant for surplus lines authority must do all of the following except

Possess a certificate of authority in this state

Ed is covered under a health plan provided by his employer. He was told that his insurance would pay the majority of the covered expenses if he would choose to see a provider in his plans list. If Ed chose to be treated by a provider who was not on the list, his portion of the bill would be greater. Ed is covered under a/an

Preferred Provider Plan

The frequency and the amount of the premium payments are known as what?

Premium mode

New individual members of an HMO must choose a

Primary Care Physician

Medicare part A services do not include which of the following?

Private duty nursing / Outpatient hospital treatment

An insured purchased a health insurance policy with a renewability clause that states 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

Which of the following could most likely be issues a resident producer license?

Sally lives in a neighboring state but has an office in New Jersey

HMOs are known as what type of plans?

Service

An insured was diagnosed two years ago with kidney cancer. She was treated with surgeries and chemotherapy and is not in remission. She also has a 30 year smoking history. The insured is not healthy enough to work and has just started a full-time job. Which describes the health insurance that she will most likely receive?

She would be covered under her employer's group health insurance plan, without higher premiums.

What does the application of contract of adhesion mean?

Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured.

Which of the following actions does NOT constitute false advertising?

Stating that dividends are not guaranteed

In contrasting stock insurers with mutual insurers, which statement is true?

Stock insurers are owned by the shareholders and issue nonparticipating policies

Insureds have the right to do which of the following if they have NOT received the proper claim forms 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

If a basic medical insurance plans benefits are exhausted, what type of plan will then begin covering those losses?

Supplementary major medical

An applicant for a licensee desperately wants to become an insurance agent, but cannot pass the state licensing exam. his twin brother offers to take the test under the application name and passes. one year later this gets discovered. What will the Commissioner's action be?

The Commissioner can revoke the license

An employee that becomes ineligible for group coverage because of termination of employment or change in status, must exercise extensions of benefits under COBRA

Within 60 days

most group medical expense plans contain a provision which is designed to discourage over-insurance and avoid the duplication of benefits. this provision is known as

coordination of benefits