North Carolina Health Insurance State Exam 2025

North Carolina Health Insurance State Exam 2025 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 Insurance Insurance 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? Time deductible - -A disability elimination period is best described as Time a disabled person must wait before benefits are paid - -What is the elimination period of an individual disability policy? Insurance Insurance Premiums may increase at time of renewal - -What is considered to be a characteristic of a conditionally Renewable Health Insurance policy? Time limit on certain defenses - -The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is 20 days - -insurers may request a hearing within how many days if their policy is rejected 45 days - -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 - -which accident and health policy provision addresses pre-existing conditions? 31 - -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 - -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 - -what is the purpose of the time of payment of claims provision? Non-cancelable - -what type of renewability guarantees premium rates and renewability? Guaranteed renewable - -K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds. This type of policy is considered 15 - -how many days must an insurer provide an insured with claim forms after receiving notice of a loss? Review the policy annually and determine whether or not to renew it - -with optionally renewable Health policies, the insurer may Notify an insurer of a claim within a specified time - -the notice of claims provision requires a policyowner to Prospective review - -which of the following involves analyzing a case before admission to determine what type of treatment is necessary? Insurance Insurance Application will be returned to the writing producer - -an incomplete health insurance application submitted to an insurer will result in which of these actions? Inform the insurer of relevant information not included on the application - -which of these actions should a producer take when submitting an insurance application to an insurer? Applicants physician - -an applicant's medical information received by the medical information Bureau may be furnished to the Insurance contract to the proposed insured - -what is being delivered during a policy delivery? Send a notice to the MIB that the applicant was declined - -a prepaid application for individual disability income insurance was recently submitted to an insurer. When the insurer received the MIB report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company not take