NJ HEALTH INSURANCE EXAM

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NJ HEALTH INSURANCE EXAM

Qs and Ans - Expert- Explanation - ing score -100 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: Once an insured major medical policy reaches its stop loss limit, the insured will be required to pay how much of the additional covered expenses?

Answer:

Question 2: If a spokesperson is paid for making an endorsement of a health insurance plan, the ad must

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Include the phrase "this is a paid endorsement" Question 3: Regarding health insurance coverage for a dependent with physical or mental handicap, insurers must

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continue coverage as long as the person remains dependent on the insured Question 4: Major medical may include a type of deductible where the insured pays a new deductible for each different event that causes a medical expense to be incurred

Answer:

per-cause deductible

Question 5: Presumptive (catastrophic) disability

Answer:

-often written with a disability policy -disability of the insured will be presumed to be Total & Permanent upon loss of sight, loss of the use of 2+ limbs, loss of hearing, loss of speech

Question 6: Recurrent disability

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recurs due to the same benefit or related cause of loss within 6 months of the back to work date, no elimination period upon recurrence

Question 7: Consumer-driven health plans are characterized by

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-choices given to the consumer as to how benefit dollars are used -pre-tax dollars for qualified medical expenses -arranged through an employment group

Question 8: Common characteristics of an HMO

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-emphasis on preventative care -network based benefits Question 9: Mary smith is required to seek approval from her PCP before consulting with a specialist about her back pain. Mary is subject to

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precertification

Question 10: Managed care concepts involve

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precertification for a hospital stay

Question 11: How do insurance companies handle a change of occupation provision

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they adjust the benefits to the amount that the premium provides for the new job

Question 12: Malingering

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Pretending to still be sick to extend benefits

Question 13: Medicare eligibility

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-65+ -On social security disability for more than 24 months

Question 14: Medicare B

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-Medical insurance benefits -Physician and surgeon services -diagnostic tests -PT -Some preventative health screenings -Diabetes screening -Unlimited home health describes under A -outpatient services and supplies

Question 15: once an individual health insurance policy is reinstated,

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-loss due to illness is covered after a period of 10 days -accidental injuries are covered immediately upon reinstatement Question 16: Worker's comp benefits are provided for injuries and illnesses that are

Answer:

occupational

Question 17: Miscellaneous Medical Expense policy types

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-Specified Disease -Critical illness

Question 18: Basic Hospital Plan covers

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-daily hospital room & board -miscellaneous hospital services -Hospital outpatient services Question 19: Physician's expenses for nonsurgical care rendered in the hospital and for visits to a physician's office would be covered under

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Major Medical Question 20: Long term care insurance typically provides what type of renewal provision?

Answer:

renewable

Question 21: Characteristic of a staff model HMO

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the health service charges a flat fee for medical care provided at its own clinic Question 22: Individual and group medical insurance provide coverage for a newborn child

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at the moment of birth Question 23: A Medicare supplement contract may not deny a claim due to preexisting conditions if it is incurred more than

Answer:

• months from the effective date of the coverage

Question 24: Renewable

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Carrier can't cancel or non-renew a policy, can raise premium tho Question 25: The privilege of purchasing an individual policy without proof of insurability within a certain number of days is

Answer:

conversion