NJ HEALTH AND ACCIDENT INSURANCE ACTUAL EXAM
QUESTIONS AND 100% CORRECT ANSWERS / NEW
JERSEY HEALTH AND ACCIDENT EXAM 2025-2026 WITH
300+ QUESTIONS AND ANSWERS
What is the maximum fine for a producer violating an NJ insurance law for the first time? - CORRECT
ANSWER-$5000
A licensed producer is required to file notice to any changes of address within how many days -
CORRECT ANSWER-30 days
Jonas has disability insurance through his employer. The employer pays 75% of the premium, and
Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? -
CORRECT ANSWER-Taxes must be paid on 75% of the benefits received
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? -
CORRECT ANSWER-File written proof of loss
Which of the following is an example of the insured's consideration? - CORRECT ANSWER-A paid
premium
A(n) _______ insurance company is one that was formed under the laws of a state other than NJ -
CORRECT ANSWER-Foreign
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? -
CORRECT ANSWER-10 days
Insurance licenses are intended to be issued for the purpose of authorizing the transaction of
business with members of the general public and not primarily allowing someone to benefit from
commissions on business that insurers their personal interest. The description of which of the
following? - CORRECT ANSWER-Controlled business
A master contract and certified coverage can be found in which type of policy? - CORRECT ANSWER-
Group
,Medicaid is a government-funded program designed to provide health care to - CORRECT ANSWER-
poor people
Which type of long-term care benefit would be most appropriate for a stroke victim who requires
speech therapy administered at her home? - CORRECT ANSWER-Home Health Care
What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee
to do? - CORRECT ANSWER-In the event of employment termination, group health insurance can be
kept if the employee pays the premiums
Replacement regulation is designed to protect the interests of - CORRECT ANSWER-Policy owners
Continued coverage under COBRA would be provided to all of the following except? - CORRECT
ANSWER-a covered employee is terminated for gross misconduct
A health insurer must be provided with written proof of loss ______ days after the date of loss -
CORRECT ANSWER-90 days
All of the following are factors would affect a health insurance policies premium rate Except -
CORRECT ANSWER-Residential address of the insured
Which of the following is NOT a required provision in an accident and health insurance policy? -
CORRECT ANSWER-Change of occupation (considered optional provision)
Within how many days must a producer notify the Department of Banking and Insurance of a change
in address? - CORRECT ANSWER-30 days
When comparing an HMO, to a PPO, the PPO - CORRECT ANSWER-provides a greater choice of
providers
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's
benefits must - CORRECT ANSWER-be the same and the premium cannot exceed 102%
An agent is required to keep replacement forms on file for at LEAST ______ years. - CORRECT
ANSWER-5 years
,An insurer has the right to recover a payment made to the insured from the negligent party. These
rights are called - CORRECT ANSWER-Subrogation
All advertisements for health insurance shall make clear the identity of the - CORRECT ANSWER-
insurer
Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home
options would best serve him? - CORRECT ANSWER-Assisted living
How many employees must an employer have for a terminated employee to be eligible for COBRA? -
CORRECT 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? - CORRECT ANSWER-US Attorney General
The time limit for filing claim disputes is addressed in which provision of an accident and health
policy? - CORRECT ANSWER-Legal actions
What is the process for a producer voluntarily terminating his/her license? - CORRECT 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 - CORRECT 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? - CORRECT ANSWER-Age 65
Under group health insurance, a certificate of coverage is issued to the - CORRECT ANSWER-
Employee
Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance? -
CORRECT 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? - CORRECT 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 - CORRECT ANSWER-A resident licensee in NJ
In group health care, what is the purpose of the coordination of benefits provision? - CORRECT
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? - CORRECT ANSWER-To control
health claim expenses
An example of rebating would be - CORRECT 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 - CORRECT ANSWER-conditionally renewable
Which of the following MUST contain a "Statement of Policy Cost and Benefit Information"? -
CORRECT ANSWER-Policy Summary
A health insurance policy will typically cover - CORRECT ANSWER-Preventative health services
HIPAA considers which of the following as "individually identifiable health information"? - CORRECT
ANSWER-A person's health claim information
In which of the following situations would the insurer be liable for a loss? - CORRECT 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? - CORRECT ANSWER-Not tax deductible
Written notice for a health claim must be given to the insurer ___ days after the occurrence of the
loss. - CORRECT ANSWER-20
QUESTIONS AND 100% CORRECT ANSWERS / NEW
JERSEY HEALTH AND ACCIDENT EXAM 2025-2026 WITH
300+ QUESTIONS AND ANSWERS
What is the maximum fine for a producer violating an NJ insurance law for the first time? - CORRECT
ANSWER-$5000
A licensed producer is required to file notice to any changes of address within how many days -
CORRECT ANSWER-30 days
Jonas has disability insurance through his employer. The employer pays 75% of the premium, and
Jonas pays the other 25%. What is Jonas's tax liability for any benefits paid from the disability plan? -
CORRECT ANSWER-Taxes must be paid on 75% of the benefits received
After an insured gives notice of loss, what must he/she do if the insurer does not furnish forms? -
CORRECT ANSWER-File written proof of loss
Which of the following is an example of the insured's consideration? - CORRECT ANSWER-A paid
premium
A(n) _______ insurance company is one that was formed under the laws of a state other than NJ -
CORRECT ANSWER-Foreign
Kathy pays a monthly premium on her health insurance policy. How long is her grace period? -
CORRECT ANSWER-10 days
Insurance licenses are intended to be issued for the purpose of authorizing the transaction of
business with members of the general public and not primarily allowing someone to benefit from
commissions on business that insurers their personal interest. The description of which of the
following? - CORRECT ANSWER-Controlled business
A master contract and certified coverage can be found in which type of policy? - CORRECT ANSWER-
Group
,Medicaid is a government-funded program designed to provide health care to - CORRECT ANSWER-
poor people
Which type of long-term care benefit would be most appropriate for a stroke victim who requires
speech therapy administered at her home? - CORRECT ANSWER-Home Health Care
What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an employee
to do? - CORRECT ANSWER-In the event of employment termination, group health insurance can be
kept if the employee pays the premiums
Replacement regulation is designed to protect the interests of - CORRECT ANSWER-Policy owners
Continued coverage under COBRA would be provided to all of the following except? - CORRECT
ANSWER-a covered employee is terminated for gross misconduct
A health insurer must be provided with written proof of loss ______ days after the date of loss -
CORRECT ANSWER-90 days
All of the following are factors would affect a health insurance policies premium rate Except -
CORRECT ANSWER-Residential address of the insured
Which of the following is NOT a required provision in an accident and health insurance policy? -
CORRECT ANSWER-Change of occupation (considered optional provision)
Within how many days must a producer notify the Department of Banking and Insurance of a change
in address? - CORRECT ANSWER-30 days
When comparing an HMO, to a PPO, the PPO - CORRECT ANSWER-provides a greater choice of
providers
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a terminated employee's
benefits must - CORRECT ANSWER-be the same and the premium cannot exceed 102%
An agent is required to keep replacement forms on file for at LEAST ______ years. - CORRECT
ANSWER-5 years
,An insurer has the right to recover a payment made to the insured from the negligent party. These
rights are called - CORRECT ANSWER-Subrogation
All advertisements for health insurance shall make clear the identity of the - CORRECT ANSWER-
insurer
Bill requires some nursing care and supervision but NOT full-time care. Which of these nursing home
options would best serve him? - CORRECT ANSWER-Assisted living
How many employees must an employer have for a terminated employee to be eligible for COBRA? -
CORRECT 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? - CORRECT ANSWER-US Attorney General
The time limit for filing claim disputes is addressed in which provision of an accident and health
policy? - CORRECT ANSWER-Legal actions
What is the process for a producer voluntarily terminating his/her license? - CORRECT 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 - CORRECT 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? - CORRECT ANSWER-Age 65
Under group health insurance, a certificate of coverage is issued to the - CORRECT ANSWER-
Employee
Which of these gaps in Medicare coverage is addressed with Medicare Supplemental Insurance? -
CORRECT 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? - CORRECT 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 - CORRECT ANSWER-A resident licensee in NJ
In group health care, what is the purpose of the coordination of benefits provision? - CORRECT
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? - CORRECT ANSWER-To control
health claim expenses
An example of rebating would be - CORRECT 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 - CORRECT ANSWER-conditionally renewable
Which of the following MUST contain a "Statement of Policy Cost and Benefit Information"? -
CORRECT ANSWER-Policy Summary
A health insurance policy will typically cover - CORRECT ANSWER-Preventative health services
HIPAA considers which of the following as "individually identifiable health information"? - CORRECT
ANSWER-A person's health claim information
In which of the following situations would the insurer be liable for a loss? - CORRECT 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? - CORRECT ANSWER-Not tax deductible
Written notice for a health claim must be given to the insurer ___ days after the occurrence of the
loss. - CORRECT ANSWER-20
