GUARANTEE EXAM - HEALTH INSURANCE

employee is insured by a group major medical plan that is provided through her employer. The employer contributes 75% of the premium and the employee contributes the remaining 25%. If the insured recelved a benefit from this policy in the amount of $1,000, how much of this benefit would be taxed as Income?

0$

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

1

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

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

24

A terminated employee who wants to convert her group health coverage to individual coverage without providing evidence of insurability must do this within

31 days.

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

When can an insured initiate legal action against the insurer?

60 days after submitting proof of loss

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

7 days

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

7 days of that determination

Under the mandatory uniform provision Proof of Loss, the claimant must submit proof of loss within what time period after e loss?

90 days

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

90 days

Anindividual is approaching retirement age and is concerned about having proper coverage should he have to be placed in a Long-Term Care (LTC) facility. Hils agen him that LTC policies would provide necessary coverage at all of the following levels EXCEPT

Acute.

Which of the followinatatements is NOT true regartding health insurance policy provisions?

Alladditional provisions written by insurers are cataloged by thelr respective states.

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 prlor disability within 6-months of the Initlal covered disability

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

Annually

An applicant glves her agent a completed application and the initial premlum. What can the agent Issue her that acknowledges the Initial premium payment?

Conditional Recelpt

All of the following are features of a health insurance plan purchased on the health insurance marketplace EXCEPT

Dollar limits on essential benefits.

A Major Medical Expense pollcy would exclude coverage for all of the follow treatments EXCEPT

Drug addiction.

The Uniform Provision Law that prevents an insurance company from altering Its agreement with a pollcyholder by referring to documents or other Items not contair in the policy is called the

Entire Cintract provision

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 a calendar year.

producer's license can be suspended or revoked for all of the following actions EXCEPT

Failure to generate commissions.

the following are abilities of the New Jersey Life and Health Guaranty Association in the event of insurer Insolvency EXCEPT

Guardianship of all physical properties, documents, and effects of Insurer.

Which of the following is NOT a Medicaid qualifier?

Insurability

Which of the following is NOT a Medicaid quallfier?

Irisurability

Medicare Part B covers all of the following EXCEPT

Long-term care services.

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

Major medical expense insurance

Which of the following acts stated that the federal government would not regulate insurance as long as the states did an adequate Job of regulating the Industry?

McCarran-Ferguson Act

Ifaninsured is Injured while committing an illegal act and his health pollcy contalns the llegal Occupation provislon, what percentage of the daim will be pald?

Nothing

An insurer can decide to not renew an Optionally Renewable policy

On premium due dates,

Under the Temporary Disability Law, two periods of disability due to the same cause and separated 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 the same employer before the first period of disablity

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

One partner's lcense was revoked in the previous 5 yeors.

of the following statements about mutual insurance companles are correct EXCEPT

Policy dividends issued by mutual companies are guaranteed and not taxable,

Anapplicant for surplus lines authority must do all of the following EXCERT

Possess a certificate of authority In this state.

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

Preventive

Which of the following Is NOT mandatory under the Uniform Provislons Law as applied to accident and health pollcles?

Probationary Perlod

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

Protect the general public

#1. What does the application of contract of adhesion mean?

Since the Insured does not participate in preparing the contract, any amblguities would be resolved in favor of the Insured

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

The Insurer

Aninsured 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.

Employers may require the employees to contribute to the premlum payments.

The partles that hold a group health Insurance contract are the employees and the employer

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

The underwriters approve the application

All of the following are minimum standards of Medicare supplements EXCEPT

They may duplicate coverage provided by Medicare,

Medicare is a health insurance program for all the following individuals EXCEPT

Those with low income and low assets.

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

To exclude coverage for a specific impairment

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 education, training or experience.

If an insured is not entirely satisfied with a policy issued, the insured may return it to the insurance company and receilve a refund of the entire premium pald, at which of the following times?

Within 10 days of when the policy was dellvered

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

branch office certificate expires 2 years from the date of filing. regardless of the producer's own license expiration

Which of the following best describes a Major Medical Expense Policy?

provides catastrophic medical coverage beyond basic benefits on a usual, customary and reasonable basis.