North Carolina Accident and Health Practice Exam

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• Which organization is most likely to have its premiums adjusted based on risk assessments?
• What type of coverage is generally included in a long-term care insurance policy?
• What is an "insurance premium adjustment"?
• Under COBRA regulations, how many months can dependents continue their group health coverage after an employee's death?
• Which provision allows an insurer to adjust policy benefits and rates if the insured changes to a more hazardous occupation?
• What does a Hospital Indemnity policy pay for?
• Which benefit describes services provided for mental health issues?
• What do usual, customary, and reasonable (UCR) charges refer to in insurance terms?
• What is defined as a "full-time employee" under ACA guidelines?
• What role do premium rates play in health insurance?
• What is the key benefit of having a guaranteed renewable policy?
• What is the minimum age required to be licensed as an agent in North Carolina?
• What is the term "provider" in health insurance?
• In a basic Hospital/Surgical Expense policy, which factor primarily influences the amount of the claim?
• Which clause in a health insurance policy describes the events that will trigger benefits?
• An insured is required to submit proof of loss on a health insurance claim within how many days of the date of loss?
• What governs the contract terms for an insurance policy?
• What type of information would the Medical Information Bureau (MIB) likely disclose?
• What is the name of the provision that specifies to whom the insurer will pay benefits?
• What is a common characteristic of individual health insurance policies?
• What type of health plan typically involves a lower premium due to higher deductibles?
• Which of the following best describes the function of the Life and Health Insurance Guaranty Association?
• How many days is the grace period for a health policy that is paid on a quarterly basis in North Carolina?
• For how long must an employee be insured to be eligible for continuation under a Group Health Insurance Policy after termination?
• Define "premium subsidy."
• What amount will B's beneficiary receive if B is killed in a commercial flight accident under the Accidental Death and Dismemberment policy?
• What does PPO stand for in health insurance?
• What is the role of a primary care physician in an HMO?
• What does "out-of-pocket maximum" refer to in health insurance?
• What is a correct statement regarding a Guaranteed Renewable Health Insurance policy?
• What does "claims processing time" refer to in health insurance?
• How much of the death benefit will the contingent beneficiary receive if both primary beneficiaries die before the insured?
• When must a Group Health policy provide coverage for a newborn child?
• Continuation of coverage of a group Hospital, Surgical, and Major Medical Policy must include what?
• What is a common limitation found in health insurance policies regarding specific actions and occurrences?
• What is a "rider" in an insurance policy?
• What is typically true about the elimination period in an individual Disability Income policy?
• In which situation is a Guaranteed Renewable policy advantageous for the policyholder?
• What are the two main types of health insurance plans?
• What is an "insurance dividend"?
• All of the following actions are considered rebating EXCEPT?
• Which type of claim is typically excluded from Medical Expense policies?
• What are "essential health benefits" as defined by the ACA?
• Which parts of a health insurance policy are guaranteed to be true?
• Which phrase refers to the fees typically charged by a healthcare professional?
• What does the term “guaranteed renewable” refer to in health insurance?
• Why is prevention emphasized in health insurance policies?
• In the event K failed to pay a renewal premium and subsequently made a payment that was accepted, which policy provision governs reinstatement of coverage?
• For how long must every insurance agent/broker maintain their records and documents for insurance transactions?
• What does the term "underwriting" refer to in health insurance?
• Which of these options can an individual use their medical flexible spending account to pay for?
• Define "exclusion" in a health insurance policy.
• Which insurance practice is banned under North Carolina's regulations?
• Which statement about disability benefits is true?
• Which of the following best defines a "non-renewable" insurance policy?
• Which entity typically utilizes a third-party administrator (TPA)?
• What is the significance of "network tiers" in a health insurance plan?
• What is meant by the term "special enrollment period"?
• When choosing a beneficiary for a life insurance policy, who has the authority to do so?
• Which role does a claims adjuster NOT have in the insurance industry?
• Which type of insurer typically reimburses its insureds for covered medical expenses?
• Which of the following describes "outpatient services" in health care?
• How many days must an insured notify their insurer of a medical claim after an accident?
• What is the purpose of the "out-of-pocket maximum"?
• In North Carolina, an insurance broker represents whom?
• To be licensed as an accident and health insurance agent in North Carolina, the applicant MUST:
• How does an HMO primarily manage healthcare costs?
• What typically prompts a health insurance company to send an EOB?
• Which statement is true regarding a group accident and health policy issued to an employer?
• How does the loss ratio impact health insurance providers?
• What is the main intent of a Coinsurance clause in a Major Medical policy?
• What type of insurance provides coverage for long-term care services?
• All of the following statements about Major Medical benefits are true, EXCEPT:
• Which of the following policy provisions prevents an insurance company from adding external documents into an insurance policy?
• Which of the following best explains the term 'exclusions' in insurance contracts?
• Which of the following is a typical exclusion in Health Insurance policies?
• Which of the following entities is NOT considered a managed care organization?
• What is the function of a health insurance marketplace?
• Which type of insurance policy provides coverage that pays a set amount per day during hospitalization?
• P is a Major Medical policyowner who is hospitalized due to injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim?
• Describe the function of "preventive services" in a health policy.
• What does "guaranteed issue" mean in health insurance?
• J purchased a Disability Income Policy that can only be terminated by J and has rates that will never exceed the illustrated amounts. What type of policy is this?
• What defines "short-term health insurance"?
• What documentation is essential for maintaining compliance in insurance transactions?
• In the context of health insurance, what does the term “benefit period” refer to?
• Define "health maintenance organization" (HMO).
• What is the status of K's eligibility for insurance coverage as a seasonal employee under North Carolina law?
• What does "basic health insurance" generally cover?
• What is considered a "chronic illness" in health insurance?
• Which of the following medical expenses does Cancer insurance NOT cover?
• Which of the following is an example of preventive service?
• What determines the claim M is eligible for under a basic Hospital/Surgical Expense policy?
• What kind of insurance typically covers extended hospital stays and high medical costs?
• What is a "pre-existing condition" in health insurance?
• What could trigger the Waiver of Premium provision in a policy?
• How long is the standard waiting period for benefits to become available under a Probationary Period?
• What is the primary purpose of the Commissioner of Insurance examining an insurance company's records?
• What is the role of a claims adjuster in health insurance?
• Who may transact solicitations for insurance in North Carolina?
• What does "policy cancellation" in health insurance mean?
• What does "premium" refer to in health insurance?
• Which coverage would be considered primary for a 66-year-old injured while walking in the park?
• What is typically the maximum duration for short-term disability benefits?
• What type of services does "home healthcare services" typically cover?
• What is the primary purpose of health insurance?
• The rules of the Life and Health Insurance Guaranty Association pertain to which policies?
• Define "benefit period" in health insurance policies.
• Which of the following best describes an indemnity health insurance plan?
• What are "allowable charges" in health insurance?
• What is the term used for the annual fee paid for health insurance coverage?
• A disability elimination period is best described as what?
• What fund ensures policyholders receive death benefits on Life Policies if the company is insolvent at the time of claim?
• What is the significance of "network providers" in an HMO?
• Which of the following is true regarding the role of navigators in the health insurance system?
• What is the provision that suspends premium payments while the insured is disabled called?
• M completes an application for health insurance but does not pay the initial premium. Which action is NOT required before the policy goes into effect?
• Which of the following typically characterizes individual health insurance policies?
• Who must fill a vacancy during the North Carolina Commissioner of Insurance's term of office?
• What do "aggregate limits" refer to in a health insurance policy?
• All of the following statements regarding group health insurance are true, EXCEPT:
• What is a key difference between group insurance and individual insurance?
• What is NOT covered by Medicare Parts A and B?
• Who is authorized to change the beneficiary designation on an Accidental Death and Dismemberment policy?
• What is the primary purpose of underwriting in health insurance?
• Under the Common Disaster provision, if both the insured and beneficiary die in an accident, who receives the proceeds?
• What is a key feature of managed care plans?
• What type of contract allows remaining partners to buy out the interest of a disabled business partner?
• What does "explanation of benefits" (EOB) entail?
• Which of the following BEST describes a Hospital Indemnity policy?
• What factor strongly influences premiums in health insurance?
• What benefit is provided under social security for disabilities?
• In North Carolina, what role does an insurance broker perform?
• How many months must approved premium rates for group health insurance be guaranteed by the insurer?
• What action can the Commissioner of insurance take if a licensed person is found to have engaged in fraudulent or dishonest practices?
• Which of the following describes the purpose of a pre-existing condition clause in health insurance?
• Which entity is responsible for underwriting health insurance policies?
• What does the North Carolina insurance laws prohibit that affects trade?
• What role do navigators play in aiding consumers?
• Eligible employees must be added to group health coverage NO LATER than how many days after their first day of employment?
• What is the "claim process" in health insurance?
• Which aspect of managed care plans helps control medical costs?
• What could be a consequence of having a larger sick pool in an insurance company?
• What action is considered rebating by an insurance agent?
• An example of rebating would be what?
• Which of the following might lead to denial of a claim under a Major Medical policy?
• What typically occurs if an insured is injured while engaging in illegal activities?
• What do the sections of an insurance contract which limit coverage refer to?
• What term describes the reimbursement of benefits for injuries caused by a third party?
• Which of the following classifications prohibits insurers from refusing coverage based on certain criteria?
• How must an applicant demonstrate knowledge to be licensed in accident and health insurance in North Carolina?
• What is the effect of having a "sick pool" on insurance premiums?
• What is "preventive care" and why is it important?
• What is a "health audit" in a health insurance context?
• Which type of healthcare service is typically provided by a "provider" as defined in insurance terms?
• What is the primary purpose of a health insurance policy?
• How many days does a policyholder have to return an Accident/Health Insurance Policy for a full refund?
• Essential Benefits without annual and lifetime limits are required on health policies purchased through which channel?
• What is the minimum number of days for the Grace Period provision in an individual health insurance policy?
• What is a "waiting period" in health insurance?
• What type of renewability describes a Disability Income policy that cannot be canceled or have its premiums increased?
• What is a "deductible" in health insurance?
• What is the primary function of "navigators" in the health insurance marketplace?
• Which document specifies the amount of benefits to be paid in a health policy?
• Which of the following health insurance policy provisions specifies the health care services a policy will provide?
• What is a medical care provider that typically delivers health services at its own local medical facility?
• What is the purpose of the waiting period in a Disability Income policy?
• What is the term used for an insurance company formed under the laws of Canada in North Carolina?
• How does a “pre-existing condition” affect health insurance coverage?
• Which of the following is NOT typically covered by a Medical Flexible Spending Account?
• What is the term "coinsurance" referring to?
• How can the claims processing time affect policyholders?
• What is an "insurance policy"?
• Which of the following is NOT classified as a limited benefit plan?
• When does a Probationary Period provision take effect in a health insurance contract?
• What characteristic is commonly associated with large group disability income policies?
• Which of the following is typically a characteristic of Health Maintenance Organizations (HMOs)?
• What clause requires an insurance company to attach a copy of the application to the policy?
• What is the minimum benefit required for chemical dependency treatments in a group health policy?
• Which benefit is covered under the minimum benefits for chemical dependency treatments in a group health policy?
• In a Disability Income policy, which of these clauses acts as a deductible?
• What is the key difference between "in-network" and "out-of-network" providers?
• If an insured filed a Proof of Loss for Disability Income and received no response, when can they begin legal action?
• Information obtained from a phone conversation with the proposed insured can be found in which of these reports?
• Which of the following is not typically covered by long-term care insurance?
• After an insured gives notice of loss, what must they do if the insurer does not provide forms?
• What can consumer reports requested by underwriters help determine during the application process?
• Which term best describes an underwriter's assessment of information on a health insurance application?
• What can an insured do if they believe their claim has been unfairly denied?
• Which type of insurance typically covers long-term care expenses?
• What is the initial requirement for an insured to qualify for benefits under the Waiver of Premium provision?
• What do Medicare Parts A and B cover?
• Under which provision may an insurer cover a second disability without a new elimination period?
• If an employee pays part of the premium for a group health plan, what type of plan are they covered under?
• What is the impact of collecting premium payments on an annual basis for an individual health insurance policy?
• Which of these statements concerning an individual Disability Income policy is true?
• What does the term "medical necessity" refer to?
• How does Medicaid differ from Medicare?
• Which type of renewability applies to a Disability Income policy that covers an individual until age 65 with adjustable premium rates?
• What is the role of "chronic care management" in health plans?
• If a company accepts a renewal premium payment that extends coverage beyond the policy's maximum age limit, what must the company do?
• What does the term "sick pool" mean in the context of health insurance?
• The percentage of an individual's Primary Insurance Amount (PIA) is used to determine benefits in which program?
• What differentiates an HMO from a PPO?
• When L applies for a Health Insurance Policy and unintentionally fails to list a previous visit to a cardiologist, how long does the insurer have to contest the policy?
• Which financial principle guides the operation of health insurance policies in terms of risk?
• D is an architect receiving Disability Income benefits who is not able to return to work full time, but can work on a part-time basis. Which of these features would allow D to continue receiving benefits?
• What is a primary characteristic of non-renewable policies?
• What is the Affordable Care Act (ACA)?
• For which of the following expenses does a Basic Hospital policy pay?
• What is the significance of a "network" in health insurance?
• During which phase of insurance does underwriting typically occur?
• What type of health insurance benefits are excluded due to an act of war?
• What aspect of a health insurance policy is often modified by a rider?
• To qualify for a tax-exempt Health Savings Account, what must S be enrolled in?
• Which factor is NOT considered in the underwriting of a health insurance policy?
• What must the policyowner provide to the insurer for validation that a loss has occurred?
• How would an insurance company most likely classify a second period of disability after a brief return to work?
• According to the Information and Privacy Protection Act, how many business days must an insurer provide personal information after an adverse underwriting decision?
• What is "provider credentialing" in health insurance?
• What is one key benefit of having a renewable life insurance policy?
• Non-occupational disability coverage is designed for:
• Under which of the following circumstances will the benefits under COBRA continuation coverage end?
• What type of organization is characterized as a prepaid group health plan where members pay in advance for services?
• When is a claim most likely to be denied in health insurance?
• How much of a self-employed individual's disability income is typically subject to federal income tax if they are totally disabled?
• What is generally required for a valid claim under a health insurance policy?
• What does "copayment" mean in a health insurance context?
• How is "third-party administrator" (TPA) defined in health insurance?
• Which document is crucial for understanding what portion of a medical service an insurance will cover?
• How do behavioral health benefits differ from standard medical benefits?
• Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase?
• What defines a mutual insurance company?
• Which of the following disabilities are typically excluded from coverage in disability policies?
• What is the term for making false statements about an insurer’s financial condition?
• What aspect of underwriting evaluates the insured's lifestyle and occupation?