North Carolina Health Insurance Licensing Exam – Complete Question and Answer Guide with Verified A+ Solutions

NC HEALTH INSURANCE LICENSING
EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ ALREADY
GRADED A+
Judy has a Major Medical policy with a $2,000 deductible and an 80/20
coninsurance. If Judy's medical bills totaled $6,000, how much would the insurer
pay?
1) $2,000
2) $3,200
3) $4,000
4) $6,000 - CORRECT ANSWER ✔✔- 2) $3,200
$6,000 - $2,000 (deductible) x 80% (coninsurance)


When a stock insurer issues both participating and nonparticipating policies, it is
referred to as a company doing business on a ________ plan.
1) two-for-one
2) par and nonpar
3) mixed
4) double - CORRECT ANSWER ✔✔- 3) mixed


T or F: No company doing the business of insurance may make any discrimination
in favor of any person. - CORRECT ANSWER ✔✔- True


The miscellaneous expense benefit in a basic hospital expense policy will normally
cover:


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,1) physicians' bedside visits
2) the administering of anesthesia
3) drugs and medicine administered in the hospital
4) hospital room and board - CORRECT ANSWER ✔✔- 4) hospital room and
board


T or F: COBRA stipulates that if an employee's employment is terminated, group
coverage must be extended for up to 18 months at the employer's expense. -
CORRECT ANSWER ✔✔- False
COBRA requires employers with 20 or more employees to permit employees or
family members to continue their group health coverage at their own expense, but
at group rates.


A disability that is presumed to result from the same or a related cause of prior
disability is called what type of disability?
1) recurrent disability
2) residual disability
3) presumptive disability
4) delayed disability - CORRECT ANSWER ✔✔- 1) recurrent disability


Medicare Part ___ provides medical coverage.
1) C
2) D
3) A
4) B - CORRECT ANSWER ✔✔- 4) B




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,T or F: Mutual insurers are owned by stockholders and stock insurers are owned by
policyholders. - CORRECT ANSWER ✔✔- False


Replacing existing life insurance with a new life insurance policy based upon
incomplete or incorrect representation is referred to as:
1) twisting
2) rebating
3) embezzlement
4) concealment - CORRECT ANSWER ✔✔- 1) twisting


An insured must wait at least ______ after the submission of proof of loss under a
health insurance policy before initiating a lawsuit.
1) 12 hours
2) 30 days
3) 60 days
4) 90 days - CORRECT ANSWER ✔✔- 3) 60 days


T or F: PPOs use the reimbursement method for covered medical expenses. -
CORRECT ANSWER ✔✔- True


Which of the following would most likely NOT be covered under miscellaneous
expenses on Hospital insurance?
1) anesthesia
2) physician services
3) x-rays
4) dressings - CORRECT ANSWER ✔✔- 2) physician services


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, Covered miscellaneous expenses include drugs, x-rays, anesthesia, lab fees,
dressings, and the use of the operating room and supplies


"Capitation" as used by HMOs means:
1) the amount paid to an HMO by a physician or provider for administrative costs
2) the amount paid by an HMO to the state in order to do business
3) the amount an HMO pays to a physician or provider in exchange for rendered
medical services
4) the amount paid to an HMOs medical management service - CORRECT
ANSWER ✔✔- 3) The amount an HMO pays to a physician or provider in
exchange for rendered medical services.


As it pertains to group health insurance, COBRA stipulates that:
1) retiring employees must be allowed to convert their group coverage to
individual policies
2) group coverage must be extended for terminated employees up to a certain
period of time at the employee's expense
3) group coverage must be extended for terminated employees up to a certain
period of time at the employer's expense
4) terminated employees must be allowed to convert their group coverage to
individual policies - CORRECT ANSWER ✔✔- 2) Group coverage must be
extended for terminated employees up to a certain period of time at the employee's
expense
Furthermore, the terminated employee can be required to pay the premium, which
may be up to 102% of the premium that would otherwise be charged


When it comes to hospital expenses, a Medical Indemnity plan pays:
1) a fixed amount per day of hospitilization
2) the beneficiary a certain percentage of total hospital expenses
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