NJ Health Insurance
The Legal actions provisions of an accident and sickness policy require - correct answer-An
insured wait at least 60 days after the submission of proof of loss before starting a law suit
Pre-existing conditions are deferred to during this provision - correct answer-Time limit on
certain defenses
Usual reasonable and customary fee - correct answer-Fee charged when medical expense
policies do not state specific benefit amounts, but instead base payments upon charges for
like services in the same geographical area
Insured's disability income policy defines total disability as "the insured's inability to perform
duties of any occupation. This definition is known as - correct answer-"any occupation" and
is more restrictive than other definitions
Conversion provision - correct answer-The right of an employee to exchange his group
insurance for an individual policy within 31 days from the termination of employment
The master policy owner - correct answer-Person who has the responsibility to apply for
coverage, provide information about the group, and maintain the policy and pay the
premiums
Waiver of Premium - correct answer-Endorsement attached to health insurance policy
indicating the insurer will allow the policy to continue in force without further premiums if the
insured is totally and permanently disabled.
Non-contributory group plan - correct answer-100% of eligible employees must be covered
For employees to obtain group coverage without evidence of insurability, they must - correct
answer-Enroll within a specific eligibility period
People eligible for medicare - correct answer-People age 65 or older who are eligible for
social security
People age 65 or older not eligible for social security, but willing to pay a monthly premium
People at any age who have been entitled to disability benefits for 24 months
Primary support for Medicare funded by - correct answer-Social Security payroll taxes
Medicare Part B - Medical Insurance - correct answer-Part of medicare that requires
premium payment by most eligible participants
All Medicare Supplement policies (Medigap) must - correct answer-have the same core
benefits
, Benefits provided under Part A of Medicare - correct answer-Inpatient hospitality care
Skilled nursing facility care
Hospice care
Medicare supplement policies - correct answer-Designed to pay at least some of the health
care costs that medicare will not pay
Medicaid - correct answer-Provides medical benefits for certain low-income people, the
disabled, and for families with dependent children
Requirements for payment of Social Security disability benefits - correct answer-Total and
permanent disability for at least 5 months
Fully insured and disability insured
Expected disability of 12 months or linger or ended in death
NJ Temporary Disability Law - correct answer-Provides for employers and employees to
contribute to a fund through payroll taxes
The social Security disability benefit payable - correct answer-The amount the recipient
would receive at retirement
Dependent of quarters of coverage
The insured's primary insurance amount
Premiums paid for an individual disability policy are tax deductible if - correct answer-Paid by
employer with benefits payable to the employee
When person is eligible for Medicare and Medicaid - correct answer-Medicaid is used as a
supplement
Representation - correct answer-Applicant's answer on a health insurance applicaiton. Could
be something they are not aware of
Maximum amount of any accidental death benefit included under a credit health policy -
correct answer-The amount of outstanding indebtedness at any given time
Partial Disability - correct answer-A benefit of 50% of the monthly disability benefit for up to 6
months
Subscribers - correct answer-The participants in a Blue Cross / Blue Shield plan
The Legal actions provisions of an accident and sickness policy require - correct answer-An
insured wait at least 60 days after the submission of proof of loss before starting a law suit
Pre-existing conditions are deferred to during this provision - correct answer-Time limit on
certain defenses
Usual reasonable and customary fee - correct answer-Fee charged when medical expense
policies do not state specific benefit amounts, but instead base payments upon charges for
like services in the same geographical area
Insured's disability income policy defines total disability as "the insured's inability to perform
duties of any occupation. This definition is known as - correct answer-"any occupation" and
is more restrictive than other definitions
Conversion provision - correct answer-The right of an employee to exchange his group
insurance for an individual policy within 31 days from the termination of employment
The master policy owner - correct answer-Person who has the responsibility to apply for
coverage, provide information about the group, and maintain the policy and pay the
premiums
Waiver of Premium - correct answer-Endorsement attached to health insurance policy
indicating the insurer will allow the policy to continue in force without further premiums if the
insured is totally and permanently disabled.
Non-contributory group plan - correct answer-100% of eligible employees must be covered
For employees to obtain group coverage without evidence of insurability, they must - correct
answer-Enroll within a specific eligibility period
People eligible for medicare - correct answer-People age 65 or older who are eligible for
social security
People age 65 or older not eligible for social security, but willing to pay a monthly premium
People at any age who have been entitled to disability benefits for 24 months
Primary support for Medicare funded by - correct answer-Social Security payroll taxes
Medicare Part B - Medical Insurance - correct answer-Part of medicare that requires
premium payment by most eligible participants
All Medicare Supplement policies (Medigap) must - correct answer-have the same core
benefits
, Benefits provided under Part A of Medicare - correct answer-Inpatient hospitality care
Skilled nursing facility care
Hospice care
Medicare supplement policies - correct answer-Designed to pay at least some of the health
care costs that medicare will not pay
Medicaid - correct answer-Provides medical benefits for certain low-income people, the
disabled, and for families with dependent children
Requirements for payment of Social Security disability benefits - correct answer-Total and
permanent disability for at least 5 months
Fully insured and disability insured
Expected disability of 12 months or linger or ended in death
NJ Temporary Disability Law - correct answer-Provides for employers and employees to
contribute to a fund through payroll taxes
The social Security disability benefit payable - correct answer-The amount the recipient
would receive at retirement
Dependent of quarters of coverage
The insured's primary insurance amount
Premiums paid for an individual disability policy are tax deductible if - correct answer-Paid by
employer with benefits payable to the employee
When person is eligible for Medicare and Medicaid - correct answer-Medicaid is used as a
supplement
Representation - correct answer-Applicant's answer on a health insurance applicaiton. Could
be something they are not aware of
Maximum amount of any accidental death benefit included under a credit health policy -
correct answer-The amount of outstanding indebtedness at any given time
Partial Disability - correct answer-A benefit of 50% of the monthly disability benefit for up to 6
months
Subscribers - correct answer-The participants in a Blue Cross / Blue Shield plan
