NORTH CAROLINA HEALTH
INSURANCE STATE EXAM PREP
CORRECT 100%
Insured Contingent Beneficiary - ANSWER 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 - ANSWER Which type of policy pays benefits to a policyholder
covered under a Hospital Expense policy?
$25,000 - ANSWER 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 - ANSWER The benefits under a
Disability Buy-Out policy are:
off-the -job accident - ANSWER An accident policy will most likely pay a benefit for a(n)
indemnity - ANSWER a payment for damage or loss
continue group health benefits - ANSWER The COBRA gives workers whose
employment has been terminated the right to
Social Security Disability Income - ANSWER 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) - ANSWER What is the
maximum Social Security Disability benefit amount an insured can receive?
PPO's are NOT a type of managed care system - ANSWER Which of these statements
is INCORRECT regarding a PPO?
Part A covers hospitalization; Part B covers doctor's services - ANSWER What does
Medicare Parts A and B cover?
PPO - ANSWER 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 - ANSWER 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) - ANSWER 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?
Residual Disability - ANSWER 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?
time deductible - ANSWER A disability elimination period is best described as
Time period a disabled person must wait before benefits are paid - ANSWER What is
the elimination period of an individual disability policy?
Premiums may increase at time of renewal - ANSWER What is considered to be a
characteristic of a conditionally Renewable Health Insurance policy?
Time limit on certain defenses - ANSWER The policy provision that entitles the insurer
to establish conditions the insured must meet while a claim is pending is
20 days - ANSWER insurers may request a hearing within how many days if their policy
is rejected
45 days - ANSWER M's insurance company denied a reinstatement application for her
lapsed health insurance policy. The company did not notify M of this denial. How many
days from the reinstatement application date does the insurance company have to notify
M of the denial before the policy will be automatically placed back in force?
time limit on certain defenses - ANSWER which accident and health policy provision
addresses pre-existing conditions?
31 - ANSWER an insured pays premiums on an annual basis for an individual health
insurance policy. What is the minimum number of days for the grace. Provision?
waiver of premium Rider - ANSWER what type of Rider would be added to an accident
and health policy if the policy owner wants to ensure the policy will continue if he or she
ever becomes totally disabled?
prevents delayed claim payments made by the insurer - ANSWER what is the purpose
of the time of payment of claims provision?
non-cancelable - ANSWER what type of renewability guarantees premium rates and
renewability?
INSURANCE STATE EXAM PREP
CORRECT 100%
Insured Contingent Beneficiary - ANSWER 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 - ANSWER Which type of policy pays benefits to a policyholder
covered under a Hospital Expense policy?
$25,000 - ANSWER 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 - ANSWER The benefits under a
Disability Buy-Out policy are:
off-the -job accident - ANSWER An accident policy will most likely pay a benefit for a(n)
indemnity - ANSWER a payment for damage or loss
continue group health benefits - ANSWER The COBRA gives workers whose
employment has been terminated the right to
Social Security Disability Income - ANSWER 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) - ANSWER What is the
maximum Social Security Disability benefit amount an insured can receive?
PPO's are NOT a type of managed care system - ANSWER Which of these statements
is INCORRECT regarding a PPO?
Part A covers hospitalization; Part B covers doctor's services - ANSWER What does
Medicare Parts A and B cover?
PPO - ANSWER 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 - ANSWER 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) - ANSWER 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?
Residual Disability - ANSWER 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?
time deductible - ANSWER A disability elimination period is best described as
Time period a disabled person must wait before benefits are paid - ANSWER What is
the elimination period of an individual disability policy?
Premiums may increase at time of renewal - ANSWER What is considered to be a
characteristic of a conditionally Renewable Health Insurance policy?
Time limit on certain defenses - ANSWER The policy provision that entitles the insurer
to establish conditions the insured must meet while a claim is pending is
20 days - ANSWER insurers may request a hearing within how many days if their policy
is rejected
45 days - ANSWER M's insurance company denied a reinstatement application for her
lapsed health insurance policy. The company did not notify M of this denial. How many
days from the reinstatement application date does the insurance company have to notify
M of the denial before the policy will be automatically placed back in force?
time limit on certain defenses - ANSWER which accident and health policy provision
addresses pre-existing conditions?
31 - ANSWER an insured pays premiums on an annual basis for an individual health
insurance policy. What is the minimum number of days for the grace. Provision?
waiver of premium Rider - ANSWER what type of Rider would be added to an accident
and health policy if the policy owner wants to ensure the policy will continue if he or she
ever becomes totally disabled?
prevents delayed claim payments made by the insurer - ANSWER what is the purpose
of the time of payment of claims provision?
non-cancelable - ANSWER what type of renewability guarantees premium rates and
renewability?
