Free New Jersey Health Insurance Practice Exam Online

Correct answer: D. N.J.S.A. 17B:27A-7.16

N.J.S.A. 17B:27A-7.16 requires individual health benefits plans to provide coverage for expenses incurred in screening and diagnosing autism or another developmental disability, so this is correct.

• A: N.J.S.A. 17:22A-32 relates to producer licensing qualifications, not mandated individual-market health benefits, so this option is incorrect.
• B: N.J.S.A. 26:2S-11 establishes the right to an IHCAP external appeal, not a coverage mandate for autism screening, so this option is incorrect.
• C: N.J.S.A. 17B:26A-13 addresses Medicare supplement plan offerings, an unrelated line of business, so this option is incorrect.

Correct answer: D. N.J.A.C. 11:20

N.J.A.C. 11:20 is the chapter housing the IHC Program's rules, including the standard individual health benefit plan designs (Plans A/50, B, C, D, and HMO), so this is correct.

• A: N.J.A.C. 11:1 is a general opening chapter of Title 11 and is not where the IHC Program's substantive rules sit, so this option is incorrect.
• B: N.J.A.C. 11:17 is the producer licensing chapter, not the individual-market coverage chapter, so this option is incorrect.
• C: N.J.A.C. 11:21 houses the SEH (small-group) Program rules, the sibling program to IHC but a distinct chapter, so this option is incorrect.

Correct answer: A. The Individual Health Coverage (IHC) Program and the Small Employer Health (SEH) Program

The IHC Program (individual market) and the SEH Program (small-group market) are the two state-law creations, under N.J.S.A. 17B:27A-2 et seq. and 17B:27A-17 et seq. respectively, that require carriers to offer standardized health benefit plans, so this is correct.

• B: GetCoveredNJ is the state's ACA exchange and IHCAP is the external appeals program; neither is the source of the guaranteed-availability mandate for off-exchange coverage, so this option is incorrect.
• C: The SEH Board administers the small-group program but is not itself a coverage-availability program, and there is no such thing as a 'DOBI Producer Registry' program, so this option is incorrect.
• D: NJ FamilyCare is New Jersey's Medicaid/CHIP program and has no role in guaranteeing individual or small-group commercial coverage availability, so this option is incorrect.

Correct answer: B. The Individual Health Insurance Reform Act

The Individual Health Insurance Reform Act, codified at N.J.S.A. 17B:27A-2 et seq., created the IHC Program and its standard plan requirements, so this is correct.

• A: The Health Care Quality Act is the statutory basis for the IHCAP external appeal program, not for individual-market rate and plan rules, so this option is incorrect.
• C: The Insurance Producer Licensing Act of 2001 governs producer licensing, not the individual health insurance market's substantive coverage rules, so this option is incorrect.
• D: The Small Employer Health Benefits Program Act governs the small-group market, a separate statutory scheme from the individual market, so this option is incorrect.

Correct answer: C. Offer every small employer a choice among a defined set of standard health benefit plans

N.J.S.A. 17B:27A-19a requires every small employer carrier to offer every small employer its choice among the standard SEH health benefit plans, so this is correct.

• A: The SEH Act governs employers within the small-employer size band, not employers above 50 eligible employees, which fall outside the small-group program entirely, so this option is incorrect.
• B: The SEH Act does not require a per-quote Commissioner sign-off; rate filings are made informationally to DOBI rather than case-by-case for each small employer, so this option is incorrect.
• D: Carriers are not limited to HMO products under the SEH Act; multiple standard plan designs, not a single delivery-system type, are mandated, so this option is incorrect.