NJ Health and Accident Questions and Answers | Study Guide | Grade A+

NJ Health and Accident Questions and
Answers | Study Guide | Grade A+
• What does coinsurance mean?
- a policy covers the insured and the any additional named persons
-the insurer and the insured share expenses over the deductible
-the insurer and the insured share ALL expenses
-the policy owner holds multiple policies through the same insurer -✓✓The insurer and
the insured share expenses over the deductible

COINSURANCE IS THE SHARING BETWEEN THE INSURER AND THE INSURED
OF COVERED EXPENSES THAT EXCEED THE DEDUCTIBLE AMOUNT. THE
SHARING ENDS WHEN THE "STOP LOSS LIMIT" IS REACHED

• The life insurance policy will not be truly effect until all of the following occur EXCEPT:
-the statement of good health is obtained by the insurer
-the first premium is collected
-the policy is delivered to the applicant
-the producer has explained the policy to the client -✓✓-the producer has explained the
policy to the client

EFFECTIVE DATE BASED ON :
-APP DATE
-IF PREMIUM HAS BEEN PAID
-IF A STATEMENT OF GOOD HEALTH MUST BE OBTAINED IF PREMIUM WAS NOT
SUBMITTED WITH APPLICATION

• Which of the following coverage types pays a monthly cash benefit following the
elimination period for total disability due to accident or sickness?
-credit disability
-works comp disability
-recurrent disability
-disability income -✓✓-disability income insurance

PROVIDES PAYMENT OF REGULAR PERIODIC INCOME SHOULD THE INSURED
BECOME DISABLED FROM ILLNESS OR INJURY

• The period beginning at the time of an insured loss that an insured must wait before
benefits are payable is called the:
-probationary period
-benefit period
-elimination period
-grace period -✓✓-elimination period

, THE TIME PERIOD STARTING AT THE TIME OF LOSS, SUCH AS A DISABILITY,
THAT AN INSURED MUST WAIT BEFORE BENEFITS ARE PAYABLE

• Managed care plans increase efficiency by all of the following EXCEPT:
-transferring the management of costs to the insureds
-controlling inpatient admissions and length of stay
-increasing beneficiary cost sharing
-selectively contracting with health care providers -✓✓-transferring the management of
costs to the insureds

MANAGED CARE PLANS ARE DESIGNED TO USE COST SAVING SERVICES BY
USING CLOSED NETWORKS AND MANAGING HEALTH CARE WITH THESE
NETWORKS

• Under an individual policy, and insured who CANNOT perform the duties of his/her
own occupation for a specific period of time is:
-totally disabled
-permanently disabled
-residually disabled
-occupationally disabled -✓✓-totally disabled

TOTAL DISABILITY IS DEFINED AS THE INABILITY OF INSURED TO PERFORM
ALL THE DUTIES OF HIS REGULAR OCCUPATION FOR THE FIRST 24 MONTHS
AFTER A LOSS

• How do most disability policies handle the case of a recurrent disability occurring at
least 90 days after the first claim?
-it is excluded from coverage because benefits have already been paid
-it must be handled as a new claim for a new period of disability
-it is handled as a continuation of the existing claim
-it must be handled as new claim for a new period of disability, requiring a new
elimination period -✓✓-it must be handled as a new claim for a new period of disability,
requiring a new elimination period

RECURRENT DISABILITY PROVISION PROTECTS INSURED WHO BECOMES
DISABLED AGAIN FOR THE SAME OR RELATED CAUSE WITHIN A SPECIFIC TIME
PERIOD. MOST HAVE A 90 DAY TIME PERIOD

• A producer who makes false statements about the financial condition of an insurer
may be found guilty of
-fraud
-unfair discrimination
-defamation
-twisting -✓✓-defamation
DEFAMATION IS AN ORAL OR WRITTEN STATEMENT MALICIOUSLY CRITICAL OF
THE FINANCIAL CONDITION OF A PERSON OR COMPANY