NJ Health Insurance Questions and
Complete Solutions Graded A+
The Legal actions provisions of an accident and sickness policy require - Answer: An insured wait at least
60 days after the submission of proof of loss before starting a law suit
Pre-existing conditions are deferred to during this provision - Answer: Time limit on certain defenses
Usual reasonable and customary fee - Answer: Fee charged when medical expense policies do not state
specific benefit amounts, but instead base payments upon charges for like services in the same
geographical area
Insured's disability income policy defines total disability as "the insured's inability to perform duties of
any occupation. This definition is known as - Answer: "any occupation" and is more restrictive than other
definitions
Conversion provision - Answer: The right of an employee to exchange his group insurance for an
individual policy within 31 days from the termination of employment
The master policy owner - Answer: Person who has the responsibility to apply for coverage, provide
information about the group, and maintain the policy and pay the premiums
Waiver of Premium - Answer: Endorsement attached to health insurance policy indicating the insurer
will allow the policy to continue in force without further premiums if the insured is totally and
permanently disabled.
Non-contributory group plan - Answer: 100% of eligible employees must be covered
For employees to obtain group coverage without evidence of insurability, they must - Answer: Enroll
within a specific eligibility period
People eligible for medicare - Answer: People age 65 or older who are eligible for social security
, People age 65 or older not eligible for social security, but willing to pay a monthly premium
People at any age who have been entitled to disability benefits for 24 months
Primary support for Medicare funded by - Answer: Social Security payroll taxes
Medicare Part B - Medical Insurance - Answer: Part of medicare that requires premium payment by
most eligible participants
All Medicare Supplement policies (Medigap) must - Answer: have the same core benefits
Benefits provided under Part A of Medicare - Answer: Inpatient hospitality care
Skilled nursing facility care
Hospice care
Medicare supplement policies - Answer: Designed to pay at least some of the health care costs that
medicare will not pay
Medicaid - Answer: Provides medical benefits for certain low-income people, the disabled, and for
families with dependent children
Requirements for payment of Social Security disability benefits - Answer: Total and permanent disability
for at least 5 months
Fully insured and disability insured
Expected disability of 12 months or linger or ended in death
Complete Solutions Graded A+
The Legal actions provisions of an accident and sickness policy require - Answer: An insured wait at least
60 days after the submission of proof of loss before starting a law suit
Pre-existing conditions are deferred to during this provision - Answer: Time limit on certain defenses
Usual reasonable and customary fee - Answer: Fee charged when medical expense policies do not state
specific benefit amounts, but instead base payments upon charges for like services in the same
geographical area
Insured's disability income policy defines total disability as "the insured's inability to perform duties of
any occupation. This definition is known as - Answer: "any occupation" and is more restrictive than other
definitions
Conversion provision - Answer: The right of an employee to exchange his group insurance for an
individual policy within 31 days from the termination of employment
The master policy owner - Answer: Person who has the responsibility to apply for coverage, provide
information about the group, and maintain the policy and pay the premiums
Waiver of Premium - Answer: Endorsement attached to health insurance policy indicating the insurer
will allow the policy to continue in force without further premiums if the insured is totally and
permanently disabled.
Non-contributory group plan - Answer: 100% of eligible employees must be covered
For employees to obtain group coverage without evidence of insurability, they must - Answer: Enroll
within a specific eligibility period
People eligible for medicare - Answer: People age 65 or older who are eligible for social security
, People age 65 or older not eligible for social security, but willing to pay a monthly premium
People at any age who have been entitled to disability benefits for 24 months
Primary support for Medicare funded by - Answer: Social Security payroll taxes
Medicare Part B - Medical Insurance - Answer: Part of medicare that requires premium payment by
most eligible participants
All Medicare Supplement policies (Medigap) must - Answer: have the same core benefits
Benefits provided under Part A of Medicare - Answer: Inpatient hospitality care
Skilled nursing facility care
Hospice care
Medicare supplement policies - Answer: Designed to pay at least some of the health care costs that
medicare will not pay
Medicaid - Answer: Provides medical benefits for certain low-income people, the disabled, and for
families with dependent children
Requirements for payment of Social Security disability benefits - Answer: Total and permanent disability
for at least 5 months
Fully insured and disability insured
Expected disability of 12 months or linger or ended in death
