NJ Accident and Health Producer PRACTICE EXAMS

NJ Accident and Health Producer
PRACTICE EXAMS
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

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
-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

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

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

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

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