NJ HEALTH AND ACCIDENT INSURANCE
ACTUAL EXAM QUESTIONS AND 100%
CORRECT ANSWERS / NEW JERSEY 2025
EXAM
1. Under the New Jersey Individual Health Coverage Program (IHC), what is the
primary purpose?
A) To provide coverage only for state employees
B) To guarantee the availability and renewability of individual health insurance policies
C) To mandate that all insurers charge the same premium
D) To eliminate pre-existing condition clauses entirely
Correct Answer: B
Rationale: The NJ IHC Program was established to ensure that individuals can obtain
and renew health insurance coverage regardless of their health status.
2. In New Jersey, what is the maximum permitted pre-existing condition exclusion
period for individual health insurance policies (if the applicant did not have prior
creditable coverage)?
A) 6 months
B) 12 months
C) 18 months
D) 24 months
Correct Answer: B
Rationale: Under NJ law (and mirroring ACA for individual plans where applicable), the
maximum look-back period is 6 months, but the exclusion period can extend up to 12
months if no prior creditable coverage exists to reduce it.
,3. What is the "birthday rule" in New Jersey regarding health insurance?
A) Premiums decrease on the insured’s birthday
B) For a newborn child, the parent whose birthday falls first in the calendar year is
responsible for adding the child to their policy
C) Coverage for children ends on their 19th birthday
D) The policy anniversary date is reset to the insured’s birthday
Correct Answer: B
Rationale: The NJ Birthday Rule is a specific regulation that determines which parent’s
insurance plan is primary for a newborn child when both parents have coverage.
4. According to NJ law, how long must an insurer cover a newborn child
automatically from the moment of birth?
A) 15 days
B) 30 days
C) 60 days
D) 31 days
Correct Answer: B
Rationale: In New Jersey, coverage for a newborn is automatic for the first 30 days. The
parent must notify the insurer within that period to continue coverage.
5. What is the mandatory "Continuation of Coverage" period (State Continuation)
in New Jersey for group health plans?
A) 18 months (COBRA only)
B) 36 months
C) 12 months
D) 6 months
Correct Answer: B
Rationale: NJ State Continuation (Mini-COBRA) requires insurers to offer continuation
of coverage for up to 36 months for employees of employers with 2 to 49 employees
(who are not subject to federal COBRA).
,6. Which of the following is NOT a required provision in NJ individual health
insurance policies?
A) Time Limit on Certain Defenses
B) Physical Examination and Autopsy
C) Guaranteed Issue
D) Legal Actions
Correct Answer: C
Rationale: While many plans in NJ are Guaranteed Issue due to ACA and state
mandates, it is not a "required policy provision" listed in the standard 12 mandatory
provisions; it is a market conduct/eligibility rule. The 12 mandatory provisions (e.g., Time
Limit on Defenses, Legal Actions) are required in the contract language.
7. In New Jersey, what is the minimum loss ratio requirement for individual health
insurance policies?
A) 50%
B) 55%
C) 60%
D) 65%
Correct Answer: D
Rationale: NJ law generally requires individual health insurance policies to have a loss
ratio of at least 65% (meaning 65 cents of every premium dollar must be paid out in
claims).
8. The New Jersey Individual Health Coverage Program (IHC) Board has the
authority to:
A) Set premium rates for all insurers
B) Standardize policy forms and rate bands
C) Deny claims for individual policyholders
D) Regulate life insurance agents
, Correct Answer: B
Rationale: The IHC Board standardizes policy forms into "HMO," "Indemnity," and
"Point of Service" categories and establishes rate bands to limit how much insurers can
vary premiums based on age and geography.
9. Under NJ law, an insurer may rescind a health insurance policy only if:
A) The insured missed a premium payment by 10 days
B) The insured filed a frivolous claim
C) The insured committed fraud or intentional misrepresentation in the application
D) The insured turned 65
Correct Answer: C
Rationale: Rescission (canceling a policy retroactively) is strictly limited to cases of fraud
or intentional misrepresentation. It cannot be done for unintentional errors.
10. What is the "portability" requirement in New Jersey health insurance?
A) The policy can be sold to another person
B) The insured can take the policy with them if they move out of state
C) Credit for prior coverage must be given to reduce pre-existing condition waiting
periods
D) The agent can transfer the policy to another company without underwriting
Correct Answer: C
Rationale: Portability refers to the reduction or elimination of pre-existing condition
exclusion periods based on prior creditable coverage (HIPAA/State laws).
11. In NJ, when must a Medicare Supplement (Medigap) policy be guaranteed
issue for an individual turning 65?
A) 6 months before and 6 months after enrolling in Part B
B) Only during the Annual Enrollment Period (Oct 7 – Dec 15)
C) Only if the individual has a terminal illness
D) 30 days after birth
ACTUAL EXAM QUESTIONS AND 100%
CORRECT ANSWERS / NEW JERSEY 2025
EXAM
1. Under the New Jersey Individual Health Coverage Program (IHC), what is the
primary purpose?
A) To provide coverage only for state employees
B) To guarantee the availability and renewability of individual health insurance policies
C) To mandate that all insurers charge the same premium
D) To eliminate pre-existing condition clauses entirely
Correct Answer: B
Rationale: The NJ IHC Program was established to ensure that individuals can obtain
and renew health insurance coverage regardless of their health status.
2. In New Jersey, what is the maximum permitted pre-existing condition exclusion
period for individual health insurance policies (if the applicant did not have prior
creditable coverage)?
A) 6 months
B) 12 months
C) 18 months
D) 24 months
Correct Answer: B
Rationale: Under NJ law (and mirroring ACA for individual plans where applicable), the
maximum look-back period is 6 months, but the exclusion period can extend up to 12
months if no prior creditable coverage exists to reduce it.
,3. What is the "birthday rule" in New Jersey regarding health insurance?
A) Premiums decrease on the insured’s birthday
B) For a newborn child, the parent whose birthday falls first in the calendar year is
responsible for adding the child to their policy
C) Coverage for children ends on their 19th birthday
D) The policy anniversary date is reset to the insured’s birthday
Correct Answer: B
Rationale: The NJ Birthday Rule is a specific regulation that determines which parent’s
insurance plan is primary for a newborn child when both parents have coverage.
4. According to NJ law, how long must an insurer cover a newborn child
automatically from the moment of birth?
A) 15 days
B) 30 days
C) 60 days
D) 31 days
Correct Answer: B
Rationale: In New Jersey, coverage for a newborn is automatic for the first 30 days. The
parent must notify the insurer within that period to continue coverage.
5. What is the mandatory "Continuation of Coverage" period (State Continuation)
in New Jersey for group health plans?
A) 18 months (COBRA only)
B) 36 months
C) 12 months
D) 6 months
Correct Answer: B
Rationale: NJ State Continuation (Mini-COBRA) requires insurers to offer continuation
of coverage for up to 36 months for employees of employers with 2 to 49 employees
(who are not subject to federal COBRA).
,6. Which of the following is NOT a required provision in NJ individual health
insurance policies?
A) Time Limit on Certain Defenses
B) Physical Examination and Autopsy
C) Guaranteed Issue
D) Legal Actions
Correct Answer: C
Rationale: While many plans in NJ are Guaranteed Issue due to ACA and state
mandates, it is not a "required policy provision" listed in the standard 12 mandatory
provisions; it is a market conduct/eligibility rule. The 12 mandatory provisions (e.g., Time
Limit on Defenses, Legal Actions) are required in the contract language.
7. In New Jersey, what is the minimum loss ratio requirement for individual health
insurance policies?
A) 50%
B) 55%
C) 60%
D) 65%
Correct Answer: D
Rationale: NJ law generally requires individual health insurance policies to have a loss
ratio of at least 65% (meaning 65 cents of every premium dollar must be paid out in
claims).
8. The New Jersey Individual Health Coverage Program (IHC) Board has the
authority to:
A) Set premium rates for all insurers
B) Standardize policy forms and rate bands
C) Deny claims for individual policyholders
D) Regulate life insurance agents
, Correct Answer: B
Rationale: The IHC Board standardizes policy forms into "HMO," "Indemnity," and
"Point of Service" categories and establishes rate bands to limit how much insurers can
vary premiums based on age and geography.
9. Under NJ law, an insurer may rescind a health insurance policy only if:
A) The insured missed a premium payment by 10 days
B) The insured filed a frivolous claim
C) The insured committed fraud or intentional misrepresentation in the application
D) The insured turned 65
Correct Answer: C
Rationale: Rescission (canceling a policy retroactively) is strictly limited to cases of fraud
or intentional misrepresentation. It cannot be done for unintentional errors.
10. What is the "portability" requirement in New Jersey health insurance?
A) The policy can be sold to another person
B) The insured can take the policy with them if they move out of state
C) Credit for prior coverage must be given to reduce pre-existing condition waiting
periods
D) The agent can transfer the policy to another company without underwriting
Correct Answer: C
Rationale: Portability refers to the reduction or elimination of pre-existing condition
exclusion periods based on prior creditable coverage (HIPAA/State laws).
11. In NJ, when must a Medicare Supplement (Medigap) policy be guaranteed
issue for an individual turning 65?
A) 6 months before and 6 months after enrolling in Part B
B) Only during the Annual Enrollment Period (Oct 7 – Dec 15)
C) Only if the individual has a terminal illness
D) 30 days after birth
