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NJ Health and Accident Questions and Answers 100% Pass
Question : According to the Time Payment of Claims provision,
the insurer must make the payment immediately after receiving
proof of loss EXCEPT:
if the insured is able to eventually return to work -if the death is suicide or due to a pre existing condition -when the policy is in the incontestability period -for claims involving periodic payments
CORRECT ANSWER : for claims involving periodic payments
INSURERS MUST PAY LUMP SUM CLAIMS
IMMEDIATELY AFTER RECEIVING PROOF OF LOSS
Question : What does coinsurance mean?
a policy covers the insured and the any additional named persons -the insurer and the insured share expenses over the deductible -the insurer and the insured share ALL expenses
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-the policy owner holds multiple policies through the same insurer
CORRECT ANSWER : The insurer and the insured share
expenses over the deductible COINSURANCE IS THE
SHARING BETWEEN THE INSURER AND THE INSURED
OF COVERED EXPENSES THAT EXCEED THE
DEDUCTIBLE AMOUNT. THE SHARING ENDS WHEN
THE "STOP LOSS LIMIT" IS REACHED
Question : The life insurance policy will not be truly effect until
all of the following occur EXCEPT:
-the statement of good health is obtained by the insurer -the first premium is collected -the policy is delivered to the applicant -the producer has explained the policy to the client
CORRECT ANSWER : the producer has explained the policy
to the client EFFECTIVE DATE BASED ON : -APP DATE -IF
PREMIUM HAS BEEN PAID -IF A STATEMENT OF GOOD
HEALTH MUST BE OBTAINED IF PREMIUM WAS NOT
SUBMITTED WITH APPLICATION
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Question : 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
Question : 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
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DISABILITY, THAT AN INSURED MUST WAIT BEFORE
BENEFITS ARE PAYABLE
Question : 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 MANAGED CARE PLANS ARE DESIGNED
TO USE COST SAVING SERVICES BY USING CLOSED
NETWORKS AND MANAGING HEALTH CARE WITH
THESE NETWORKS
Question : 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
