NJ Health and Accident Questions and Answers Verified 100% Correct

NJ Health and Accident Questions and Answers Verified 100% Correct Within how many days must a producer notify the Department of Banking and Insurance of a change in address? - ANSWER -30 days When comparing an HMO, to a PPO, the PPO - ANSWER -provides a greater choice of providers Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's benefits must - ANSWER -be the same and the premium cannot exceed 102% An agent is required to keep replacement forms on file for at LEAST ______ years. - ANSWER -5 years An insurer has the right to recover a payment made to the insured from the negligent party. These rights are called - ANSWER -Subrogation All advertisements for health insurance shall make clear the identity of the - ANSWER -insurer Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home options would best serve him? - ANSWER -Assisted living How many employees must an employer have for a terminated employee to be eligible for COBRA? - ANSWER -20 An agent has committed an insurance crime that violates US CODE 1033 (interstate commerce). Who would be responsible for the prosecution of this crime? - ANSWER -US Attorney General The time limit for filing claim disputes is addressed in which provision of an accident and health policy? - ANSWER -Legal actions What is the process for a producer voluntarily terminating his/her license? - ANSWER -Returning his/her license to the Banking and Insurance Department Under the Health Insurance Portability and Accountability Act (HIPAA), the employee's new Group Health Plan will verify Creditable Coverage so that the - ANSWER -employee's waiting period for coverage of a preexisting condition can be reduced under the new employer's health plan At what age will a person normally enroll with an insurance carrier under a Part C Medicare Advantage Plan? - ANSWER -Age 65 Under group health insurance, a certificate of coverage is issued to the - ANSWER -Employee Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance? - ANSWER -Medicare in-hospital deductible XYZ Company has applied for group health insurance for its employees. What information would the insurer's underwriters likely use to determine the appropriate coverage and final premium rate given to the group? - ANSWER Experience rating When a producer, domiciled in New York, with an office location in NJ, elects NJ as their resident state, he is acting as - ANSWER -A resident licensee in NJ In group health care, what is the purpose of the coordination of benefits provision? - ANSWER -Determines what is paid by the primary and secondary insurers in the event of a claim Which of the following is the purpose of medical cost management? - ANSWER To control health claim expenses An example of rebating would be - ANSWER -A producer who shares commission with a client A health insurance policy where the insurer has the right to terminate the policy for reasons other than the insured's health is called - ANSWER -conditionally renewable Which of the following MUST contain a "Statement of Policy Cost and Benefit Information"? - ANSWER -Policy Summary A health insurance policy will typically cover - ANSWER -Preventative health services HIPAA considers which of the following as "individually identifiable health information"? - ANSWER -A person's health claim information In which of the following situations would the insurer be liable for a loss? - ANSWER -The insured suffered an injury as an innocent bystander How are premiums paid by the insured for personally owned disability income insurance treated for tax purposes? - ANSWER -Not tax deductible Written notice for a health claim must be given to the insurer ___ days after the occurrence of the loss. - ANSWER -20 A person covered with an individual health plan - ANSWER -is issued a policy Which of the following statements is NOT true regarding a Critical Illness Plan? - ANSWER -Coverage is limited to a single devastating disease What amount will be paid under a policy where the insured misstated his/her age? - ANSWER -An amount the premium would have purchased at the correct age