NJ State Accident and Health License
Questions and Complete Solutions
Graded A+
Surplus Lines - Answer: any type of insurance for which there is no available market within the state, and
the coverage must be placed with a non admitted insurer
Conditional Contract - Answer: A contract that one or more parties must perform only under certain
conditions.
Inspection Report - Answer: General report of the applicant's finances, character, morals, work, hobbies,
and other habits.
Statement of Good Health - Answer: Required if no premium with application, if health changed- agent
can't deliver policy
Basic Hospital Expense Insurance - Answer: Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay. No physician or
surgeon expenses.
usual, customary, and reasonable (UCR) - Answer: setting fees by comparing usual fees, customary fees,
and reasonable fees in a geographic area.
Blanket Plans - Answer: Health plans that insure a group of individuals participating in the same activity,
such as a group of high school seniors going on a class trip, or a soccer team. Provides additional
coverage in excess of primary coverage.
Part B of Medicare - Answer: Government-subsidized voluntary insurance for physician services and
outpatient services.
Mandatory Uniform Provisions - Answer: The Mandatory Uniform Provisions were developed by the
NAIC and must, by law, be included in every individual accident and health insurance policy. Different
, wording may be used as long as it is at least as favorable as the original wording. No additional
provisions may be included which otherwise restrict or modify a uniform provision. There are 12
Mandatory Provisions that are designed to protect the insured's interests.
Convert group coverage to individual - Answer: You have 31 days
disability income insurance personally owned - Answer: premiums paid are not tax deductible and
benefits are not taxable
Medical Expense Insurance personally owned - Answer: premiums and unreimbursed medical expenses
that exceed 10% of income may be tax deductible; benefits received are not taxable
long-term care insurance personally owned - Answer: premiums paid exceed 10% of income or 7.5% for
those 65+ may be tax deductible benefits are not taxable.
disability income insurance employer paid - Answer: tax deductible for employer, premiums paid by
employee are after tax. benefits received are taxable based on % premiums employee paid
dependent child in NJ. not ACA specific - Answer: may be age 30 or younger and unmarried but cannot
have other coverage.
licensee moves business - Answer: must be reported within 30 days of the move
Corridor Deductible - Answer: A Major Medical deductible that applies between benefits paid by the
Basic plan and the start of the Major Medical benefits
supplemental major medical - Answer: elimates the insured from having to pay any deductible.
social security waiting period - Answer: 5 months
Impairment Rider - Answer: Excludes coverage for a specific ailment or condition that otherwise would
be covered (e.g., previous back injury)
Questions and Complete Solutions
Graded A+
Surplus Lines - Answer: any type of insurance for which there is no available market within the state, and
the coverage must be placed with a non admitted insurer
Conditional Contract - Answer: A contract that one or more parties must perform only under certain
conditions.
Inspection Report - Answer: General report of the applicant's finances, character, morals, work, hobbies,
and other habits.
Statement of Good Health - Answer: Required if no premium with application, if health changed- agent
can't deliver policy
Basic Hospital Expense Insurance - Answer: Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay. No physician or
surgeon expenses.
usual, customary, and reasonable (UCR) - Answer: setting fees by comparing usual fees, customary fees,
and reasonable fees in a geographic area.
Blanket Plans - Answer: Health plans that insure a group of individuals participating in the same activity,
such as a group of high school seniors going on a class trip, or a soccer team. Provides additional
coverage in excess of primary coverage.
Part B of Medicare - Answer: Government-subsidized voluntary insurance for physician services and
outpatient services.
Mandatory Uniform Provisions - Answer: The Mandatory Uniform Provisions were developed by the
NAIC and must, by law, be included in every individual accident and health insurance policy. Different
, wording may be used as long as it is at least as favorable as the original wording. No additional
provisions may be included which otherwise restrict or modify a uniform provision. There are 12
Mandatory Provisions that are designed to protect the insured's interests.
Convert group coverage to individual - Answer: You have 31 days
disability income insurance personally owned - Answer: premiums paid are not tax deductible and
benefits are not taxable
Medical Expense Insurance personally owned - Answer: premiums and unreimbursed medical expenses
that exceed 10% of income may be tax deductible; benefits received are not taxable
long-term care insurance personally owned - Answer: premiums paid exceed 10% of income or 7.5% for
those 65+ may be tax deductible benefits are not taxable.
disability income insurance employer paid - Answer: tax deductible for employer, premiums paid by
employee are after tax. benefits received are taxable based on % premiums employee paid
dependent child in NJ. not ACA specific - Answer: may be age 30 or younger and unmarried but cannot
have other coverage.
licensee moves business - Answer: must be reported within 30 days of the move
Corridor Deductible - Answer: A Major Medical deductible that applies between benefits paid by the
Basic plan and the start of the Major Medical benefits
supplemental major medical - Answer: elimates the insured from having to pay any deductible.
social security waiting period - Answer: 5 months
Impairment Rider - Answer: Excludes coverage for a specific ailment or condition that otherwise would
be covered (e.g., previous back injury)
