New Jersey Health
What is the typical deductible for basic surgical expense insurance?
$0
An employee insured under a group health plan has been paying $25 monthly premium for his group health coverage. The employer has been contributing $75, for the total monthly cost of $100. If the employee leaves the company, what would be his maximum monthly premium for COBRA coverage?
$102
L has a major medical policy with a $500 deductible and 80/20 coinsurance. L is hospitalized and sustains a $2,500 loss. What is the maximum amount that L will have to pay?
$900 (deductible + 20% of the bill after the deductible {20% of$2000})
IN all health care plans under the Affordable care act (ACA), how many essential benefit categories are there?
10
The Commissioner believes that a licensee has violated an insurance regulation and decides to conduct a hearing, How long of a notice must the Commissioner provide the licensee?
10 days
Individuals who itemized deductions can claim deductions for medical expenses not covered by health insurance that exceed what percent of their adjusted gross income?
10%
For how many days of skilled nursing facility care will Medicare pay benefits?
100
Under the affordable care act, what percentage of preventative care must be covered without cost sharing?
100%
How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state?
12
A person is covered under 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? A. 7 B. 10 C. 14 D. 31
14 days
Which of the following disability income policies would have the highest premium?
15 day waiting period/10 yr benefit period
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?
18 months
HIPAA applies to groups of
2 or more
COBRA applies to employees with at least
20 employees
An employee group with which of the following number of employees would qualify for a medical savings account?
23 employees
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying?
25%
Licensee must file with the Department a branch office registration form within how many days before business is first conducted there?
30
What is the maximum age for qualifying for a catastrophic plan?
30
How long us the free-look period with a Medicare supplement policy?
30 days
What is the period of coverage for events such as death or divorce under COBRA?
36 months
A "certificate of license status" report can be run on any currently licensed New Jersey producer, but can only contain information on formal disciplinary actions taken within the past
4 years
How many days does a producer have to remit the collected premiums to the insurer?
5 business days
In cases where a producer's license has been revoked, the producer must wait for how long before applying for reinstatement?
5 years
Insurers must maintain files containing all of their advertisements for
5 years
How long must producers and insurers maintain records of management of funds for insurance policies?
5 years after the termination of coverage
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?
50/50
A Medicare supplement contract cannot define a "pre-existing condition" more restrictively than a condition for which medical advice was given or treatment recommended within how many months of the effective date of coverage?
6 months
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?
6 months
Medicare supplement policies cannot establish a new deductible or waiting period for the recurrence of a condition for which treatment was given within
6 months
What is the minimum age for Medicare supplement policy coverage?
65
What percentage of eligible employees must participate on a small employer group health insurance plan?
75%
Under the uniform required provisions, proof of loss under a health insurance policy normally should be filed within
90 days of a loss
a deductible is
A specified dollar amount that the insured must pay first before the insurance company will pay the policy benefits.
When the insured purchased his health policy he was a window washer. He has since changed occupations and now manages a library. If the insurer is notified of the insured's change of occupation, the insurer should
Adjust the benefit in accordance with the decreased risk
Long-term insurance policies must cover which of the following?
Alzheimer's disease
When an insured purchased her disability income policy, she misstated her age to the agent. She told the agent that she was 30 years old, when in fact she was 37. If the policy contains the optional misstatement of age provision
Amounts payable under the policy will reflect the insured correct age.
What is a foreign insurer?
An insurer with a home office in another state
What is the term used for a written request for a insurer to issue an insurance contract based on the provided information?
Application
Under a Key Person disability income policy, premium payments
Are made by the business and are not tax deductible
A small hardware store owner is involved in a car accident that renders him totally disabled for half a year. Which type of insurance would help him pay for expense of the company during the time of his disability?
Business overhead expense policy
How is the Insurance Guaranty Associated funded?
By its members- authorized insurers
Kevin and Nancy are married; Kevin is the primary breadwinner and has a health insurance policy that covers both him and his wife. Nancy has an illness that requires significant medical attention. Kevin and Nancy decide to legally separate, which means that Nancy will no longer be eligible for health insurance coverage under Kevin. Which of the following options would be best for Nancy at this point?
COBRA
Which of the following is true regarding inpatient hospital care for HMO?
Care can be provided outside of the service area.
In accordance with the Administrative Procedure Act, what entity has the authority to make and enforce rules and regulations to implement and carry out the purposes of the Insurance laws of New Jersey?
Commissioner
An applicant for an individual health policy failed to complete the application properly. Before being able to complete the application and pay the initial premium, she is confined to a hospital. This will not be covered by insurance because she not met the conditions specified in the
Consideration clause
If an employee terminates her employment, which of the following provisions would allow her to continue health coverage under an individual policy if requested within 31 days?
Conversion
Under the New Jersey Temporary Disability Law a "covered individual" is any person who has been out of work less than 2 weeks or who is employed by a
Covered employer
Because of the history of cancer in her family, Julie purchased a policy that specifically covers the expense of treating cancer. Her policy would be classified as what type of policy?
Dread disease policy
An insured is hospitalized with a back injury. Upon checking his disability income policy, he learns that he will not be eligible for benefits for at least 30 days. This indicates that his policy is written with a 30-day
Elimination period
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
Fiduciary responsibility
Which of the following is an eligibility requirement for Social Security disability income benefits?
Fully insured status
Regarding long-term care coverage, as the elimination period gets shorter, the premium,
Gets higher
AS it pertains to group health insurance, COBRA stipulates that
Group coverage must be extended for terminated employees up to a certain period of time at the employers expense.
A new employee who meets
Guaranteed
An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits?
Have accumulated 6 work credits in the past 3 years.
Medical Savings Accounts (MSA) are available to small business employees and self-employed individuals who have
High deductible health insurance
What are the three types of enrollment period for Medicare Part A?
Initial enrollment, general enrollment and special enrollment
Producer's and insurer's actions related to insurance transactions, from selling insurance to processing claims are referred to as
Insurance-related conduct
The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the
Insuring clause
What statement best describes the free look provision?
It allows the insured to return the policy within 10 days for a full refund pf premiums if dissatisfied for any reason.
Which of the following is NOT true of a major medical health insurance policy?
It is designed to pay o a first dollar expense basis
What type of health insurance policy provides an employer with funds to train a replacement if a valued employee becomes disabled?
Key Person Disability
Which of the following provisions allows an insured to sue an insurance company for non payment of claim?
Legal Action
The company has issued a policy and delivered it to Producer B on May 1st, Monday. By what date must the policy be delivered to the insured?
May 10th (within 10 calendar days)
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in
Medicare Part A
Medicare advantage is also known as
Medicare Part C
An insurance producer is selling a Medicare supplement policy to Bob the applicant. Bob is worried that if his health changes, his policy will not be renewed. What can you tell him?
Medicare supplement policies are guaranteed renewable.
Under the Affordable Care Act, which classification applies to health plans based on the amount of covered costs?
Metal level classification
Which of the following premium modes would result in the highest annual cost for an insurance policy?
Monthly
Medical savings accounts are only available to groups of how many employees?
No more than 50
Under which of the following organizations are the practicing providers compensated on a Fee-for-service basis?
PPO
Which of the following provisions is mandatory for health insurance policies?
Physical examination and autopsy
Regarding the taxation of Business Overhead policies,
Premiums are deductible, and benefits are taxed
Insurers may change which of the following on a guaranteed renewable health insurance policy?
Rates by class
What method do insurers use to protect themselves against catastrophic losses?
Reinsurance
What type of care is Respite care?
Relief for a major care giver
Disability income policies can provide coverage for a loss of income when returning to work only part time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability?
Residual disability
To cancel an insurance producer license, the producer must
Send the license to the Insurance Department and request cancellation.
Which of the following special policies covers unusual risks that are NOT normally includes under Accidental Death and Dismemberment coverage?
Special Risk Policy
An insured has endured multiple surgeries and hospitalizations for an illness during the summer months. Her insurer no longer bills her for medical expenses. What term best describes the condition she has met?
Stop-loss limit
The transfer of an insured's right to seek damages from a negligent party to the insurer is found I which of the following clauses
Subrogation
Your client wants to know what the tax implications are for contributions to a Health Savings Account. You should advice her that the contributions are
Tax deductible
What program was establish 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?
The Individual Health Coverage Program
What is the entire contract in health insurance underwriting?
The application and the policy issued
A husband and wife are insured under group health insurance plans at their own place of employment, ad as dependents under their spouse's coverage. If one of them incurs hospital expenses, how will those expenses likely be paid?
The benefits will be coordinated
The period of time immediately following a disability during which benefits are not payable is
The elimination period
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met?
The insured must have first been hospitalized for consecutive days
Which of the following definitions would make it easier to qualify for total disability benefits?
The more liberal "own occupation"
An applicant for a producer's license has successfully completed all of the steps necessary to obtain the license. The soon-to-be producer does not want to wait until he receives his license in order to begin working. Which of the following is possible>
The person can obtain a temporary work authority
which provision states that the insurance company must pay Medical Expense claims immediatey
Time of payment of Claims
A producers appointment lasts for how long?
Until it is terminated
When may an insured deduct unreimbursed medical expenses paid under a long-term care policy?
When the expenses exceed a certain percentage of the insured's adjusted gross income
When should an agent obtain a Statement pf Good Heath from the insured?
When the premium was paid upon policy delivery and not at the time of application
While a clam is pending an insurance company may require
an independent examination as often as reasonably required
Qualified medical expenses paid for participants in a Medical Savings Account (MSA) are.
not taxable
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?
offer the supplement policy on a guaranteed issue basiss
Which of the following terms best describes the specified dollar amount beyond which the insured no longer participates in the sharing of expenses?
stop-loss limit
Who determines the eligibility and contributions limits of an HRA?
the employer
An HSA holder who is 65 years old decides o use the money in the account for a nonhealthy expense. Which of the following is true?
there will be a tax
When an insurer issues an individual health insurance policy that is guaranteed renewable, the insurer agrees
to renew the policy until the insured has reached age 65
