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North Carolina Health Insurance Exam
Questions and Correct Answers
When Linda suffered a broken hip, she notified her agent, in
writing, within 12 days of the loss. However, her agent did not
notify the insurance company until 60 days after the loss. Which
of the following statements correctly explains how this claim
would be handled?
A. The insurer is considered to be notified since the notification to
agent equals notification to the insurer
B. The insurer may delay the payment of this claim for up to 6
months
C. The insurer may settle this claim for less than it otherwise
would have had the notification been provided in a timely manner
D. The insurer may deny the claim since it was not notified within
the required 20 day time frame Ans: — A.
While repairing the roof of his house an insured accidentally falls
off and breaks his arm and sustains a head injury that results in
total blindness of both eyes. His policy contains an Accidental
Death & Dismemberment Rider. What is the extent of benefits that
he will receive?
A. Reciprocal Amount
B. Principal Sum
C. Capital Sum
D. 50% of the Principal Ans: — B.
Which of the following is true regarding inpatient hospital care for
HMO members?
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A. Inpatient hospital care is not part of HMO services
B. Care can be provided outside of the service area
C. Can can only be provided in the service area
D. Services for treatment of mental disorders are unlimited Ans: —
B.
As it pertains to group health insurance, the continuation
provision stipulates that
A. Terminated employees may convert to an individual policy only
upon proof of insurability
B. Group coverage must be extended for terminated employees up
to a certain period of time at the employers expense
C. Group coverage must be extended for terminated employees up
to a certain period of time at the employees expense
D. Retiring employees must be allowed to convert their group
coverage to individual policies Ans: — C.
All of the following apply to short term disability plans EXCEPT
A. Individual plans can provide benefit periods of up to 2 years
B. A benefit period of 26 weeks is most common for group plans
C. Both group and individual plans are renewable
D. Group plans can provide benefit periods of up to 52 weeks Ans:
— C.
Which describes the features of a comprehensive major medical
policy?
A. There is no coinsurance
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B. Basic medical expense benefits are provided in single package
C. The deductible is always expressed as a deferred amount
D. It is the same as major medical insurance Ans: — B.
If an insurer accepts premium payments by credit card, who is
responsible for paying the fees charged by a credit card company?
A. Credit card company
B. Insurer accepting payment
C. Policy owners, as part of premium
D. Insured Ans: — B.
When a disabled dependent child reaches the age limit for
coverage, how long does the policyowner have to provide proof of
dependency in order for the dependent to remain covered under
the policy?
A. 15 days
B. 31 days
C. 60 days
D. 10 days Ans: — B.
If a licensee is convicted of a criminal violation , the licensees
insurance license is?
A. Suspended after hearing
B. Automatically suspended
C. Automatically revoked
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D. Not affected Ans: — B.
All of the following are differences between Individual and group
health insurance EXCEPT
A. In individual policies, the individual selects coverage options,
while in a group plan all employees are covered for the same
coverage which is chosen by employer
B. Individual coverage can be written on an occupation or no
occupational basis
C. Individual policies are renewable, while group terminates when
the individual leaves
D. Individual insurance does not require medical examinations,
while group insurance does not require medical examinations Ans:
— D.
A licensee decides to terminate his residency in the state. Which of
the following would be an appropriate action?
A. Delivering the license to the commissioner within 30 days
B. Allowing the license to expire
C. Notifying the NAIC
D. Notifying the commissioner within 10 days Ans: — A.
Which of the following is not a feature of a noncancelable policy?
A. The insurer may terminate the contract only at renewal for
certain conditions
B. The premiums cannot be increased beyond the amount stated in
the policy
© 2025 All rights reserved
North Carolina Health Insurance Exam
Questions and Correct Answers
When Linda suffered a broken hip, she notified her agent, in
writing, within 12 days of the loss. However, her agent did not
notify the insurance company until 60 days after the loss. Which
of the following statements correctly explains how this claim
would be handled?
A. The insurer is considered to be notified since the notification to
agent equals notification to the insurer
B. The insurer may delay the payment of this claim for up to 6
months
C. The insurer may settle this claim for less than it otherwise
would have had the notification been provided in a timely manner
D. The insurer may deny the claim since it was not notified within
the required 20 day time frame Ans: — A.
While repairing the roof of his house an insured accidentally falls
off and breaks his arm and sustains a head injury that results in
total blindness of both eyes. His policy contains an Accidental
Death & Dismemberment Rider. What is the extent of benefits that
he will receive?
A. Reciprocal Amount
B. Principal Sum
C. Capital Sum
D. 50% of the Principal Ans: — B.
Which of the following is true regarding inpatient hospital care for
HMO members?
© 2025 All rights reserved
, 2 | Page
A. Inpatient hospital care is not part of HMO services
B. Care can be provided outside of the service area
C. Can can only be provided in the service area
D. Services for treatment of mental disorders are unlimited Ans: —
B.
As it pertains to group health insurance, the continuation
provision stipulates that
A. Terminated employees may convert to an individual policy only
upon proof of insurability
B. Group coverage must be extended for terminated employees up
to a certain period of time at the employers expense
C. Group coverage must be extended for terminated employees up
to a certain period of time at the employees expense
D. Retiring employees must be allowed to convert their group
coverage to individual policies Ans: — C.
All of the following apply to short term disability plans EXCEPT
A. Individual plans can provide benefit periods of up to 2 years
B. A benefit period of 26 weeks is most common for group plans
C. Both group and individual plans are renewable
D. Group plans can provide benefit periods of up to 52 weeks Ans:
— C.
Which describes the features of a comprehensive major medical
policy?
A. There is no coinsurance
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, 3 | Page
B. Basic medical expense benefits are provided in single package
C. The deductible is always expressed as a deferred amount
D. It is the same as major medical insurance Ans: — B.
If an insurer accepts premium payments by credit card, who is
responsible for paying the fees charged by a credit card company?
A. Credit card company
B. Insurer accepting payment
C. Policy owners, as part of premium
D. Insured Ans: — B.
When a disabled dependent child reaches the age limit for
coverage, how long does the policyowner have to provide proof of
dependency in order for the dependent to remain covered under
the policy?
A. 15 days
B. 31 days
C. 60 days
D. 10 days Ans: — B.
If a licensee is convicted of a criminal violation , the licensees
insurance license is?
A. Suspended after hearing
B. Automatically suspended
C. Automatically revoked
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, 4 | Page
D. Not affected Ans: — B.
All of the following are differences between Individual and group
health insurance EXCEPT
A. In individual policies, the individual selects coverage options,
while in a group plan all employees are covered for the same
coverage which is chosen by employer
B. Individual coverage can be written on an occupation or no
occupational basis
C. Individual policies are renewable, while group terminates when
the individual leaves
D. Individual insurance does not require medical examinations,
while group insurance does not require medical examinations Ans:
— D.
A licensee decides to terminate his residency in the state. Which of
the following would be an appropriate action?
A. Delivering the license to the commissioner within 30 days
B. Allowing the license to expire
C. Notifying the NAIC
D. Notifying the commissioner within 10 days Ans: — A.
Which of the following is not a feature of a noncancelable policy?
A. The insurer may terminate the contract only at renewal for
certain conditions
B. The premiums cannot be increased beyond the amount stated in
the policy
© 2025 All rights reserved
