NORTH CAROLINA HEALTH INSURANCE STATE EXAM PREP|UPDATED&VERIFIED|GUARANTEED SUCCESS

Insured Contingent Beneficiary If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the uniform Simultaneous Death Act? Reimbursement Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy? $25,000 J has an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will receive from his policy? payable to the company or another shareholder The benefits under a Disability Buy-Out policy are: off-the -job accident An accident policy will most likely pay a benefit for a(n) indemnity a payment for damage or loss continue group health benefits The COBRA gives workers whose employment has been terminated the right to Social Security Disability Income The percentage of as individual's Primary Insurance Amount determines the benefits paid in which of the following programs. 100% of the insured's Primary Insurance Amount (PIA) What is the maximum Social Security Disability benefit amount an insured can receive? PPO's are NOT a type of managed care system Which of these statements is INCORRECT regarding a PPO? Part A covers hospitalization; Part B covers doctor's services What does Medicare Parts A and B cover? PPO Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured? closed panel The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n) Her group health plan (if the employer has more than 20 employees, the group health plan generally pays first) A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary? Commercial Insurers Which of the following reimburses its insureds for covered medical expenses? If the employee paid for qualified medical expenses, the reimbursements may be tax-free Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT? Restoration of used benefit Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefit has been used, or after the policy has been in effect for a particular period of time? Common Accident Deductible If several family members are injured in the same accident, only one deductible is applied. $1,600 M has a Major Medical Insurance policy with a $200 flat deductible and an 80% Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how much will M receive in payment for this claim? Family maximum deductable This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year lower than the actual expenses incurred Basic Hospital and Surgical policy benefits are Coverage that pays a stated amount per day of a covered hospitalization Which of the following BEST describes a Hospital Indemnity policy? Surgically removing a facial birthmark Which of the following costs would a Basic Hospital/Surgical policy likely cover? carryover provision Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible? Residual Disability R had received full disability income benefits for 6 months. When he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?