Health Insurance Exam PDF

A licensed insurance producer must notify the Department of a change in mailing address within how many days and by what method? A. 30 days, by mail or electronically B. 1 year, either orally or in writing C. 6 months, only electronically D. 5 days, by certified mail What type of licensee represent...

A licensed insurance producer must notify the Department of a change in mailing address within how many days and by what method? A. 30 days, by mail or electronically B. 1 year, either orally or in writing C. 6 months, only electronically D. 5 days, by certified mail What type of licensee represents the insurance company? A. Advisor B. Broker C. Agent D. Consultant Who does an insurance agent represent? A. The insured B. The Department C. Him/herself D. The insurer What phase begins after a new policy is delivered? A. Grace period B. Free-look period C. Elimination period D. Insurability period What is the term used for an applicant's written request to an insurer for the company to issue a contract, based on the information provided? A. Insurance Request Form B. Request for Insurance C. Application D. Policy Request The premium charged for exercising the Guaranteed Insurability Rider is based upon the insured's A. Average age. B. Assumed age. C. Attained age. D. Issue age. Which of the following authorities is in charge of investigating claims held against licensees? A. Governor B. Commissioner C. Federal Bureau of Investigation D. State law enforcement Which provision concerns the insured's duty to provide the insurer with reasonable notice in the event of a loss? A. Notice of Claim B. Loss Notification C. Consideration D. Claims Initiation the insured under a disability income insurance policy changes to a more hazardous occupation after the policy has been issued, and a claim is filed, the insurance company should do which of the following? A. Cancel the policy B. Increase the premium C. Adjust the benefit in accordance with the increased risk D. Exclude coverage for on-the-job injury Contracts that are prepared by one party and submitted to the other party on a take it-or-leave-it basis are classified as A. Unilateral contracts. B. Binding contracts. C. Contracts of adhesion. D. Aleatory contracts. a 12-month period, how many home health care visits must a health insurance policy provide for? A. 90 B. 30 C. 60 D. 120 Which of the following is a statement that is guaranteed to be true, and if untrue, may breach an insurance contract? A. Warranty B. Representation C. Concealment D. Indemnity What is the maximum amount that can be contributed to an MSA of the high-deductible plan for individuals? A.50% B. 35% C. 75% D. 65% The time limit of certain defenses provision prohibits insurers from denying a claim due to misrepresentation, as long as the policy has been in force for at least A. 2 years. B. 5 years. C. 1 year. D. 6 months. Insurance is regulated A. Mostly on a federal level. B. Mostly on a state level. C. Only on the level of social medicine, which is on both state and federal levels. D. Evenly between the state and federal levels. What method do insurers use to protect themselves against catastrophic losses? A. Reinsurance B. Indemnity C. Risk management D. Pro rata liability What type of insurance is sold to small business owners that must meet overhead expenses such as rent or utilities following a disability? A. Business overhead expense B. Buy-sell C. Medical expense coverage D. Key-person disability guaranteed renewable health insurance policy allows the A. Policy to be renewed at time of expiration, but the policy can be canceled for cause during the policy term. B. Insurer to renew the policy to a specified age. C. Policyholder to renew the policy to a stated age and guarantees the premium for the same period. D. Policyholder to renew the policy to a stated age, with the company having the right to increase premiums on the entire class. woman obtains health coverage through the Marketplace on October 1. Two weeks later she finds out that she is 3 months pregnant. Which of the following is true about coverage for pregnancy? A. Pregnancy will only be covered if additional premium is paid. B. Pregnancy will not be covered as a pre-existing condition. C. Pregnancy may be covered with the insurer's special approval. D. Pregnancy will be covered immediately. Which of the following is true regarding elimination periods and the cost of coverage? A. The shorter the elimination period, the lower the cost of coverage B. The longer the elimination period, the lower the cost of coverage C. Elimination periods have no effect on the cost of coverage. D. The longer the elimination period, the higher the cost of coverage 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 A. Fiscal responsibility. B. Fiduciary responsibility. C. Premium accountability. D. Insurance-related conduct. producer or insurer who violates the solicitation regulations can be ordered to pay a fine for each violation of up to A. $5,000. B. $2,000. C. $3,000. D. $1,000. 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? A. Home health care B. Residential care C. Hospice D. Remote health care What is the purpose of coinsurance provisions? A. To share liability among different insurance companies B. To have the insured pay premiums to more than one company C. To guarantee payment to the doctors and hospitals D. To help the insurance company to prevent overutilization of the policy Maurice's health insurance plan covers practically all types of medical expenses. Maurice's insurer provides first-dollar coverage for basic benefits, but applies a deductible for major benefits and then pays 80/20 coinsurance. What type of coverage does Maurice have? A. Combined medical B. Comprehensive major medical C. Combined major medical D. Customized medical agent offers his client free tickets to a sporting event in exchange for the purchase of an insurance policy. The agent is guilty of A. Controlled business. B. Twisting. C. Coercion. D. Rebating. of the following are considered limited lines of authority EXCEPT A. Bail bonds. B. Travel insurance. C. Surplus lines. D. Credit insurance. Which of the following is another name for a primary care physician in an HMO? A. Gatekeeper B. Subscriber C. Referring physician D. Specialist 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? A. 7 B. 10 C. 14 D. 31 a health care plan has characteristics of an HMO and PPO, what type of plan is it? A. POS В. НІРАА C. MET D. FSA The Department can run a report on a specific producer that lists his or her license information, current license status, and the types of insurance that he or she can transact. What is the name of this report? A. Certification of license status report B. Investigative consumer report C. Producer's report D. MIB report The annual contribution limit of a Dependent Care Flexible Spending Account is set by A. The employer. B. The insured. C. The insurer. D. The IRS. Which of the following is considered a presumptive disability under a disability income policy? A. Loss of hearing in one ear B. Loss of one eye C. Loss of one hand or one foot D. Loss of two limbs Provided that it is a first offense, what is the maximum penalty for failing to respond to a subpoena? A. $100 B. $5,000 C. $500 D. $10,000 Which provision states how much time must pass between two like illnesses in order for the second one to be covered under a new set of benefits? A. Relapse Provision B. Corridor Clause C. Disability Relapse Clause D. Recurrent Disability Provision What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application? A. As long as the policy is in force B. 1 year after the effective policy date C. 6 months after the effective policy date D. 90 days after the effective policy date An insured is involved in a car accident. In addition to less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will the insured receive Presumptive Disability benefits? A. Partial benefits B. Full benefits C. No benefits D. Full benefits until the blindness lifts Which of the following statements is true regarding coinsurance? A. The larger the percentage that is paid by the insured, the lower the required premium will be. B. The smaller the percentage that is paid by the insured, the lower the required premium will be. C. The larger the percentage that is paid by the insured, the higher the required premium will be. D. The smaller the percentage that is paid by the insured, the more consistent the required premium will be. Which of the following statements regarding Business Overhead Expense policies is NOT true? A. Premiums paid for BOE are tax-deductible. B. Benefits are usually limited to six months. C. Leased equipment expenses are covered by the plan. D. Any benefits received are taxable to the business. Employers can reduce health plan costs by coupling a Health Reimbursement Account (HRA) with A. An IRA. B. Nothing; HRAs cannot be coupled with any other health plan. C. A low deductible health plan. D. A high deductible health plan. Which of the following is NOT covered by Health Maintenance Organizations (HMOs)? A. Routine physicals B. Immunizations C. Elective services D. Well-baby care 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? A. The Health Care Quality Act B. The Individual Health Coverage Program C. The New Jersey Standard Health Care Program D. The New Jersey Insurance Guaranty Association All of the following are advertisements EXCEPT A. Brochures. B. Television commercials. C. A discussion of an insurer's policies on the radio. D. Booklets. 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? A. Insurance Regulation Board B. Governor C. Commissioner D. NAIC Applicants for surplus lines authority must fulfill all of the following requirements ЕХСЕРТ A. Be a New Jersey resident. B. Pass an insurance licensing exam. C. Hold a property and casualty license. D. Hold a bond as a condition for licensure. What is the minimum age that an insurance producer can be licensed in New Jersey? A. 16 B. 18 C. 19 D. 21 The insurance policy, together with the policy application and any added riders form what is known as a(n) A. Contract of adhesion. B. Entire contract. C. Certificate of coverage. D. Blanket policy. 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? A. If he pays an extra premium, his policy will stay in effect. B. Medicare supplement policies are guaranteed renewable for the first 10 years of the policy. C. Medicare supplement policies are not renewed, regardless of a person's health. D. Medicare supplement policies are guaranteed renewable. All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT A. An offer of employment. B. Dividends from a mutual insurer. C. An offer to share in commissions generated by the sale. D. Stocks, securities, or bonds. Rob is being treated by a physical therapist in his apartment for a disorder which, if he were not treated there, would have to be treated on an inpatient basis in the hospital. What kind of care is this? A. Remote health care B. Home health care C. Satellite health care D. Residential health care Which of the following is authorized to appoint and remove officers and other personnel employed within the Department? A. Commissioner B. Governor C. Insurance Officer Regulation Board D. Department of Insurance A small business owner is the insured under a disability policy that funds a buy-sell agreement. If the owner dies or becomes disabled, the policy would provide which of the following? A. The business manager's salary B. The rent money for the building C. Disability insurance for the owner D. Cash to the owner's business partner to accomplish a buyout How are employer contributions to Health Reimbursement Accounts treated in regards to taxation? A. They are excluded from all taxation. B. They are tax deductible. C. They are taxed as a regular business expense. D. They are treated as income tax for the employer. Which of the following would qualify as a competent party in an insurance contract? A. The applicant has a prior felony conviction. B. The applicant is intoxicated at the time of application. C. The applicant is under the influence of a mind-impairing medication at the time of application. D. The applicant is a 12-year-old student. Which is true regarding obtaining underwriting sources? A. The insurer does not need to inform the applicant of how the information is gathered; informing only of the source is sufficient. B. The applicant must be informed of the sources contacted and how the information is being gathered. C. The insurer only needs to inform the applicant of how the information is being gathered; it is not necessary to disclose the sources. D. It is illegal to obtain information from outside sources in order to determine an applicant's insurability. Medicare supplement policies cannot establish a new deductible or waiting period for the recurrence of a condition for which treatment was given within A. 24 months. B. 9 months. C. 12 months. D. 6 months. An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would A. Deny the claim. B. Pay the claim. C. Hold the claim as pending until the end of the grace period. D. Pay half of her claim because the insured had an outstanding premium. of the following are true regarding Key Employee Disability Income insurance ЕХСЕРТ A. Benefits are taxable to the employer. B. The employer owns the policy. C. Premiums are not tax deductible for the employer. D. Benefits are paid to the employer to retrain a new person. An insurer goes bankrupt and is unable to pay on any of its insureds' claims. Which of the following will happen? A. The claims will be paid by the state Department of Insurance. B. The claims will be paid by the state Life and Health Guaranty Association. C. The claims will be paid by a nationally-based program. D. The insureds will not be paid. Which of the following individuals is eligible for a Health Savings Account? A. A child claimed as a dependent on her parent's tax returns B. A person eligible for Medicare C. A person insured under a high-deductible health plan D. A person insured under a group health insurance plan This arrangement specifies who will purchase a disabled partner's interest in the event the partner becomes disabled. A. Employee benefit plan B. Business overhead expense C. Key-person insurance D. Disability buyout Medicare Part D provides A. Medical insurance. B. Private fee-for-service plans. C. Hospital insurance. D. Prescription drug benefit. All of the following qualify for Medicare Part A EXCEPT A. Anyone who is at the end stage of renal disease. B. Anyone who is over 65, not covered by Social Security, and is willing to pay premium. C. Anyone who is willing to pay a premium. D. Anyone that qualifies through Social Security. If an insurer and insured have a dispute about whether a particular loss is covered under a policy, which authority will settle the dispute? A. Consumer Protection Agency B. Commissioner C. Federal Insurance Regulation Board D. Court system An agent makes a mistake on the application and then corrects his mistake by physically entering the necessary information. Who must then initial that change? A. Applicant B. Executive officer of the company C. Insured D. Agent An insurance producer is acting as a broker when he or she negotiates for an insurance contract on behalf of A. A client. B. The insurer. C. A financial institution. D. Another insurance producer. Which of the following is NOT a duty of the Commissioner? A. Suspending or revoking licenses of Insurance Code violators B. Developing insurance rates C. Establishing a system of insurer and producer examinations D. Enforcing the Insurance Code Which of the following would indicate a contractual relationship between a producer and an insurance company? A. Producer's license B. Implied authority C. A verbal agreement D. A signed contract Insurers must maintain files containing all of their advertisements for A. 5 years. B. 4 years. C. 2 years. D. 3 years. An insured pays a monthly premium of $100 for her health insurance. What would be the duration of the grace period under her policy? A. 7 days B. 60 days C. 31 days D. 10 days An insurance company has published a brochure that inaccurately portrays the advantages of a particular insurance policy. What is this an example of? A. Defamation B. Unfair claims C. False advertising D. Twisting When twin brothers applied for life insurance from Company A, the company found that while neither of them smoked and both had a very similar lifestyle, one of the twins was in a much stronger financial position than the other. Because of this, the company charged him a higher rate for his insurance. This practice is considered A. Adverse selection. B. Controlled business. C. Discrimination. D. Twisting. While a claim is pending, an insurance company may require A. The insured to be examined only once annually. B. An independent examination as often as reasonably required. C. The insured to be examined only within the first 30 days. D. An independent examination only once every 45 days. 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 A. Return any unearned premium. B. Replace the policy with a new one. C. Increase the premium. D. Adjust the benefit in accordance with the decreased risk. What is a definition of a unilateral contract? A. One-sided: only one party makes an enforceable promise. B. Two or more parties go into a contract understanding there may be an unequal exchange of value. C. One author: the company wrote the contract; the insured must accept it as written. D. If one party makes a condition, the other party can counteroffer. In respect to the consideration clause, which of the following is consideration on the part of the insurer? A. Promising to pay in accordance with the contract terms B. Offering an unconditional contract C. Offering a secondary policy to the applicant D. Explaining policy revisions to the applicant Which of the following would NOT be considered an unfair and deceptive practice? A. Defamation B. Controlled business C. Misrepresentation D. Rebating A Health insurance policy lapses but is reinstated within an acceptable timeframe. How soon from the reinstatement date will coverage for accidents become effective? A. After 31 days B. After 21 days C. Immediately D. After 14 days What statement best describes the free look provision? A. It allows the proposed insured to carefully look over the application prior to filling it out. B. It allows for the proposed insured to carefully look over the policy before applying for it. C. It allows the company to obtain an inspection and medical examination on the proposed insured prior to issuing the policy. D. It allows the insured to return the policy within 10 days for a full refund of premiums if dissatisfied for any reason. Under the New Jersey Temporary Disability Law, a "covered individual" is any person who is employed by a covered employer, or who has been out of work for less than A. 3 weeks. B. 1 week. C. 2 weeks. D. 4 weeks. Under which of the following circumstances would a nonresident producer NOT required to complete CE hours in New Jersey? A. Any time nonresident producers satisfy CE requirements in their home state B. If a waiver is received from the Commissioner C. Under no circumstances: all producers must meet CE requirements in this state D. If the producer's home state has the same CE requirements and the producer satisfies them Insurers may change which of the following on a guaranteed renewable health insurance policy? A. Coverage B. Individual rates C. Rates by class D. No changes are permitted. Concerning Medicare Part B, which statement is INCORRECT? A. It provides partial coverage for medical expenses not fully covered by Part A. B. It is fully funded by Social Security taxes (FICA). C. It offers limited prescription drug coverage. D. It is known as medical insurance. Which of the following has the authority to issue regulations as are deemed necessary or desirable to establish minimum standards for the form, content, and sale of individual and group health insurance policies? A. NAIC B. Commissioner C. Federal Insurance Regulation Board D. Department of Banking and Insurance How long is the free-look period with a Medicare supplement policy? A. 15 days B. 10 days C. 20 days D. 30 days If an insured changes the premium payment mode from monthly to annually, what happens to the total premium? A. Doubles B. Decreases C. Increases D. Stays the same In the event a policy lapses due to nonpayment of premium, within how many days would the policy be automatically reinstated once the outstanding premium is paid? A. 25 days B. 45 days C. 10 days D. 30 days