pg. 1 NJ Accident and Health Questions with Correct Detailed Answers (Verified) Rated A+
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 - Correct Answer - -disability income insurance
PROVIDES PAYMENT OF REGULAR PERIODIC INCOME SHOULD THE INSURED
BECOME DISABLED FROM ILLNESS OR INJURY
Which of the following is the most common method to supplement Medicare coverage?-group health insurance -employer health insurance -Medicaid -coverage offered by private insurer - Correct Answer - -coverage offered by private insurance policies
MEDICARE SUPPLEMENTAL INSURANCE POLICIES ARE SOLD BY PRIVATE
COMPANIES
HSAs cover current and future qualified healthcare costs. Account beneficiaries can
make tax free withdrawals to cover all of the following EXCEPT:
-retiree health insurance premiums -doctor's fees -prescription and nonprescription medicines -Medigap expenses - Correct Answer - -Medigap expenses 1 / 4
pg. 2 HSAs provide a broad range of tax-free withdrawals including doctor, dentist, hospitals, prescriptions, chiro, labs, PT, x-rays, eyeglasses and contracts, and many more qualified medical expenses.
An insurance policy that is intended to restore to the insured to the same financial status
as before the loss is a contract of:
-adhesion -good faith -indemnity -reasonable expectations - Correct Answer - -indemnity
INSURANCE POLICIES THAT ARE INTENDED TO RESTORE THE INSURED
INSURED TO THE FINANCIAL STATE THE ENJOYED PRIOR TO THE OCCURENCE
OF A LOSS IS CONSIDERED A CONTRACT OF INDEMNITY
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 - Correct Answer - -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 - Correct Answer - -transferring the management of costs to the insureds
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pg. 3
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 - Correct Answer - -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 - Correct Answer - -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 3 / 4
pg. 4 -twisting - Correct Answer - -defamation
DEFAMATION IS AN ORAL OR WRITTEN STATEMENT MALICIOUSLY CRITICAL OF
THE FINANCIAL CONDITION OF A PERSON OR COMPANY
Which of the following requires the claim information to be submitted to the insurer prior to treatment to determine whether the treatment is covered and how much the insured's plan will pay?-consideration provision -concurrent review provision -second opinion provision -pre certification provision - Correct Answer - -pre certification provision
UNDER A PRE-CERTIFICATION REVIEW, THE PHYSICIAN CAN SUBMIT CLAIM
INFORMATION PRIOR TO PROVIDING TREATMENT TO KNOW IN ADVANCE IF
PROCEDURE IS COVERED AND WHAT RATE IT WILL BE PAID
A Basic Hospital Policy pays expenses for:
- hospital room and board
-physician office visits -routine medical treatment -surgical services - Correct Answer - -hospital room and board
BASIC HOSPITAL EXPENSE COVERS HOSPITAL ROOM AND BOARD WITH DAILY
LIMIT OF COVERAGE. BASIC SURGICAL PROCEDURES AND BASIC MEDICAL
COVERS OFFICE VISITS AND ROUTINE MEDICAL TREATMENT
What is the maximum amount of time the insured has to file legal action against the insurer after written proof of loss is provided - Correct Answer - -3 years
THE INSURED MUST WAIT 60 DAYS AFTER PROOF OF LOSS IS FILED WITH THE
INSURER BEFORE LEGAL ACTION CAN BE BROUGHT AGAINST THE COMPANY.
LEGAL ACTION TIME PERIOD LASTS 3 YEARS
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