Guarantee Exam(2)

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

Private Duty Nursing Care

An insurance agent visits a potential client who seems to be uninterested so the agent guarantees higher dividends that he knew would be possible. What is this

Misrepresentation- misrep is the act of portraying sales material that is false, misleading, or deceptive to policy benefits/terms, etc.

The benefits in Medical expense insurance are

Received income tax free by the individual

Applicants for surplus lines authority must do all of the following EXCEPT

Posses a cert of authority in this state-A surplus lines agent is a person or org that is allowed to write business in NJ for insurance companies that do not possess a cert of authority in NJ if no auth insurers in NJ offer the specific type of insruance in questions. Prop and casualty license is required.

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

90 days

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.

Insurers CANNOT transact insurance in this state without a

Certificate of Authority

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

LEGAL

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.

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 files with the Department

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

The insurer

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

Protect the general publick- Persons involced in the transaction of insurance must meet certain standards in terms of knowledge of insurance and character

What does the application of contract adhesion mean?

Since the insured does not participate in preparing the contract, any ambiguities would be resolved in favor of the insured- The insurer prepares the policy and submits it to the insured on a take-it-or-leave it basis. Bc the insured does not have input in drafting the policy but simply adheres to the terms of the policy, the policy is classified as a contract of adhesion. Any uncertain terms will be interpreted in favor of the insured.

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

Groups of one or more-Legislation took effect that ensures portability of group insurance coverage and includes benefits that affect small employers, self-employed, pregnant women, and the mentally ill. HIPAA applies to groups of two or more.

All of the following are abilityies of NJ life and health guaranty assoc in the event of insurer insolvency EXCEPT

Guardianship of all physical properties, docs, and effects of the insurer- The NJ H&G Assoc protect policy owners, insureds, a nd beneficiaries when insurers fail to perform contractual obligations due to insolvency. It may provide money, pledges, guarantees, or loan money to the impaired insurer; assume payment of the impaired insurer's contractual obligation; and may impose policy liens, moratoriums on payments.

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- No producer license will be issued to a business entity operated by a person who has had his/he license revoked the PAST 10YRS

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

Within 20 days

A Major medical expense policy would exclude coverage for all of the follow treatment EXCEPT

Drug addition- treatment for drug and alcohol addiction is provided on a limited basis

The minimum age for obtaining a medicare supplement policy is

age 65