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NJ HEALTH INSURANCE EXAM
Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing 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
Answer:
Include the phrase "this is a paid endorsement" Question 3: Regarding health insurance coverage for a dependent with physical or mental handicap, insurers must
Answer:
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
Answer:
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
Answer:
-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
Answer:
-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
Answer:
precertification
Question 10: Managed care concepts involve
Answer:
precertification for a hospital stay
Question 11: How do insurance companies handle a change of occupation provision
Answer:
they adjust the benefits to the amount that the premium provides for the new job
Question 12: Malingering
Answer:
Pretending to still be sick to extend benefits
Question 13: Medicare eligibility
Answer:
-65+ -On social security disability for more than 24 months
Question 14: Medicare B
Answer:
-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,
Answer:
-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
Answer:
-Specified Disease -Critical illness
Question 18: Basic Hospital Plan covers
Answer:
-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
Answer:
Major Medical Question 20: Long term care insurance typically provides what type of renewal provision?
Answer:
Guaranteed renewable
Question 21: Characteristic of a staff model HMO
Answer:
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
Answer:
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: Guaranteed Renewable
Answer:
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:
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