NJ Health Insurance Test: Chapter 5 Exam Questions with Correct Answers 100% Verified by
Experts| 2025/2026 Latest Update
Adjusted gross income gross income (all income from whatever sources) minus adjustments
to income
Affordable Care Act (ACA or PPACA) a federal law that mandates increased preventive,
educational, and community-based health care services, and that established the Health
Insurance Marketplace to make health coverage available to any uninsured individuals
Estate a person's net worth
Overinsurance insurance that exceeds in amount the actual value of the person or property
insured or insurance in a greater amount than the insured can afford
Tax deductible a qualified expense that may reduce the amount of income subject to
taxation
Taxable subject to taxation
change of beneficiary provision This is a provision that permits the insured to change the
beneficiary as often as she wants, except for policies in which the beneficiary is irrevocable.
the Affordable Care Act mandates that every insurer that offers health insurance policies that
provide coverage for dependent children of the insured must provide that coverage for the
children up to the age 26
when might a policy not terminate coverage for a child after the age of 26 if the child is
dependent upon the insured and is incapable of self-support because of physical or mental
handicap
,Proof of the child's dependency is required within how many days of the child turning 26 31
days
Proof of the child's dependency is required how often after initial proof after 2 years of
initial proof, it is required annually
primary beneficiary The person who is named as first to receive benefits from a policy.
if the primary beneficiary should die before the benefits become payable who are the benefits
payable to a contingent or secondary beneficiary
what happens if no beneficiary is designated the benefits will be placed in the deceased's
estate
what happens if multiple primary beneficiaries are named to a policy each individual will
receive a proportionate percentage of the death benefit
what provision must be included if an individual health insurance policy provides a death
benefit change of beneficiary provision
Higher Frequency = Higher Premium
In regard to insurance premiums, what does mode refer to the frequency the policyowner
pays the premium
what frequency's is the premium able to be paid annually, semi-annually, quarterly, or
monthly
, coordination of benefits (COB) provision Designed to avoid duplication of benefit payments
and overinsurance when an individual is covered under multiple group health insurance plans.
what does the coordination of benefits (COB) provision limit the total amount of claims paid
from all insurers covering the patient to no more than the total allowable medical expenses
what does the coordination of benefits (COB) provision establish which plan is the primary
plan, or the plan that is responsible for providing the full benefit amounts as it specifies
Once the primary plan has paid its full promised benefit, the insured submits the claim to who
the secondary, or excess, provider for any additional benefits payable (including deductibles
and coinsurance)
Loss - Amount covered by Primary Plan = Amount covered by Secondary Plan
will the total amount the insured receives exceed the costs incurred or the total maximum
benefits available under all plans no. never
what does coordination of benefits provision ensure benefits are not paid in excess of the
total losses incurred
what happens if a married couple both have group coverage in which they are each named as
dependents on the other's policy - the person's own group coverage will be considered
primary
- the secondary coverage (the spouses' coverage) will pick up where the first policy left off
what happens if both parents name their children as dependents under their group policies -
the order of payment will usually be determined by the birthday rule (the coverage of the
parent whose birthday is earlier in the year will be considered primary) and sometimes gender
rule (father is primary)
Experts| 2025/2026 Latest Update
Adjusted gross income gross income (all income from whatever sources) minus adjustments
to income
Affordable Care Act (ACA or PPACA) a federal law that mandates increased preventive,
educational, and community-based health care services, and that established the Health
Insurance Marketplace to make health coverage available to any uninsured individuals
Estate a person's net worth
Overinsurance insurance that exceeds in amount the actual value of the person or property
insured or insurance in a greater amount than the insured can afford
Tax deductible a qualified expense that may reduce the amount of income subject to
taxation
Taxable subject to taxation
change of beneficiary provision This is a provision that permits the insured to change the
beneficiary as often as she wants, except for policies in which the beneficiary is irrevocable.
the Affordable Care Act mandates that every insurer that offers health insurance policies that
provide coverage for dependent children of the insured must provide that coverage for the
children up to the age 26
when might a policy not terminate coverage for a child after the age of 26 if the child is
dependent upon the insured and is incapable of self-support because of physical or mental
handicap
,Proof of the child's dependency is required within how many days of the child turning 26 31
days
Proof of the child's dependency is required how often after initial proof after 2 years of
initial proof, it is required annually
primary beneficiary The person who is named as first to receive benefits from a policy.
if the primary beneficiary should die before the benefits become payable who are the benefits
payable to a contingent or secondary beneficiary
what happens if no beneficiary is designated the benefits will be placed in the deceased's
estate
what happens if multiple primary beneficiaries are named to a policy each individual will
receive a proportionate percentage of the death benefit
what provision must be included if an individual health insurance policy provides a death
benefit change of beneficiary provision
Higher Frequency = Higher Premium
In regard to insurance premiums, what does mode refer to the frequency the policyowner
pays the premium
what frequency's is the premium able to be paid annually, semi-annually, quarterly, or
monthly
, coordination of benefits (COB) provision Designed to avoid duplication of benefit payments
and overinsurance when an individual is covered under multiple group health insurance plans.
what does the coordination of benefits (COB) provision limit the total amount of claims paid
from all insurers covering the patient to no more than the total allowable medical expenses
what does the coordination of benefits (COB) provision establish which plan is the primary
plan, or the plan that is responsible for providing the full benefit amounts as it specifies
Once the primary plan has paid its full promised benefit, the insured submits the claim to who
the secondary, or excess, provider for any additional benefits payable (including deductibles
and coinsurance)
Loss - Amount covered by Primary Plan = Amount covered by Secondary Plan
will the total amount the insured receives exceed the costs incurred or the total maximum
benefits available under all plans no. never
what does coordination of benefits provision ensure benefits are not paid in excess of the
total losses incurred
what happens if a married couple both have group coverage in which they are each named as
dependents on the other's policy - the person's own group coverage will be considered
primary
- the secondary coverage (the spouses' coverage) will pick up where the first policy left off
what happens if both parents name their children as dependents under their group policies -
the order of payment will usually be determined by the birthday rule (the coverage of the
parent whose birthday is earlier in the year will be considered primary) and sometimes gender
rule (father is primary)
