New Jersey Health Insurance Practice Exam Free - 2026

• A. 10 days
• B. 7 days
• C. 31 days
• D. 45 days

Correct answer: A. 10 days

Explanation: New Jersey individual health policies must grant a grace period of not less than 7 days for weekly premium policies, 10 days for monthly premium policies, and 31 days for all other policies. A monthly-premium policy therefore requires at least 10 days. See N.J.S.A. 17B:26-6.

• A. 10 days
• B. 31 days
• C. 15 days
• D. 7 days

Correct answer: D. 7 days

Explanation: The mandatory grace period provision requires not less than 7 days for weekly premium policies (10 for monthly, 31 for all other modes), so a 5-day grace period is not compliant. See N.J.S.A. 17B:26-6.

• A. Yes, within five years of issue
• B. No; after 2 years, only fraudulent misstatements can be used to void the policy or deny a claim
• C. Yes, if it refunds all premiums
• D. No; the policy became incontestable after 1 year

Correct answer: B. No; after 2 years, only fraudulent misstatements can be used to void the policy or deny a claim

Explanation: After 2 years from the date of issue, no misstatements except fraudulent misstatements made by the applicant may be used to void an individual health policy or deny a claim for loss incurred after that period. See N.J.S.A. 17B:26-5.

• A. Yes, preexisting conditions are always excludable
• B. Yes, if the insured knew of the condition
• C. No; after 2 years, a claim may not be denied on the ground the condition existed before coverage unless it was specifically excluded
• D. No; preexisting condition denials are prohibited from day one on all policies

Correct answer: C. No; after 2 years, a claim may not be denied on the ground the condition existed before coverage unless it was specifically excluded

Explanation: The time-limit-on-certain-defenses provision also bars denying or reducing a claim after 2 years on the ground a disease or condition existed before the effective date, unless it was specifically excluded from coverage. See N.J.S.A. 17B:26-5.

• A. The fixed amount the insured pays at each office visit or prescription fill
• B. The percentage of covered expenses the insured shares with the plan after the deductible
• C. The amount the insured pays before the plan begins paying covered expenses
• D. The most the insured will pay for covered expenses during the plan year

Correct answer: C. The amount the insured pays before the plan begins paying covered expenses

Explanation: A deductible is the amount the insured must pay for covered services before the plan starts paying according to the policy terms.

• A. The insured pays a fixed dollar amount for each covered service at the time of care
• B. Two insurers covering the same person coordinate so that benefits are not duplicated
• C. The insured pays the full cost of covered services until the deductible is satisfied
• D. The insured and insurer share covered costs by percentage after the deductible

Correct answer: D. The insured and insurer share covered costs by percentage after the deductible

Explanation: Coinsurance is a cost-sharing percentage. For example, after the deductible, the plan may pay a percentage and the insured pays the remaining percentage.

• A. It requires each family member to pay $2,000 before benefits begin
• B. It doubles every deductible when a new dependent is added
• C. It applies only to hospital stays
• D. Once covered expenses from family members reach $2,000 combined, the deductible is satisfied for the whole family

Correct answer: D. Once covered expenses from family members reach $2,000 combined, the deductible is satisfied for the whole family

Explanation: A family deductible caps the household's total deductible exposure. Combined covered expenses - commonly with no single member counting more than their individual deductible - satisfy it, after which the plan pays benefits for every family member as though each individual deductible had been met.

• A. To cap the total benefits the plan will pay over the insured's lifetime
• B. To limit the insured's covered cost sharing during a plan period
• C. To limit the premium the insurer may charge the insured in a plan year
• D. To set the amount the insured pays before the plan's coinsurance begins

Correct answer: B. To limit the insured's covered cost sharing during a plan period

Explanation: An out-of-pocket maximum caps the insured's covered cost sharing for a plan period. Premiums and noncovered services may not count, depending on plan terms.

• A. A fixed daily cash benefit paid to the insured for each day of hospital confinement
• B. Routine doctor visits and preventive care paid in full with no deductible or coinsurance
• C. Large or broad medical expenses subject to deductibles, coinsurance, limits, and exclusions
• D. Lost income when sickness or injury keeps the insured from working for an extended period

Correct answer: C. Large or broad medical expenses subject to deductibles, coinsurance, limits, and exclusions

Explanation: Major medical coverage is designed for a broad range of medical expenses, often including hospital, physician, surgical, and related services under the policy.

• A. Surgeon's fees paid according to a schedule of covered procedures
• B. Physician office visits and outpatient diagnostic tests covered by the policy
• C. Income lost while the insured is confined to a hospital and unable to work
• D. Room, board, and hospital-related charges covered by the policy

Correct answer: D. Room, board, and hospital-related charges covered by the policy

Explanation: Hospital expense benefits are associated with covered hospital charges such as room, board, and related inpatient services, depending on policy terms.

• A. Covered surgical procedures and related charges
• B. Physician office visits and routine preventive care
• C. Hospital room and board during a covered stay
• D. Diagnostic lab work and X-rays ordered before admission

Correct answer: A. Covered surgical procedures and related charges

Explanation: Surgical expense benefits are designed to help pay for covered surgical services, subject to the policy's limits and exclusions.

• A. They are required by law to be sold only alongside a major medical policy
• B. They may pay only specified amounts or cover only specified conditions or services
• C. They are issued on a guaranteed renewable basis and cannot exclude any preexisting condition
• D. They count as minimum essential coverage that satisfies major medical requirements

Correct answer: B. They may pay only specified amounts or cover only specified conditions or services

Explanation: Limited-benefit policies may provide narrower coverage than major medical policies. Applicants should understand what is and is not covered.