NC (North Carolina) - Health Insurance - Practice
Exam Questions_Well updated
All of the following are true regarding Key Employee Disability Income insurance EXCEPT
A) Premiums are not tax deductible for the employer.
B) Benefits are taxable to the employer.
C) The employer owns the policy.
D) Benefits are paid to the employer to retrain a new person. (Correct Answer) - ✅✅ B) Benefits
are taxable to the employer.
Key person disability income premiums are not deductible to the business, but the benefits are
received income tax free by the business.
How is emergency care covered for a member of an HMO?
A) A member of an HMO can receive care in or out of the HMO service area, but care is preferred
in the service area.
B) A member of an HMO may receive care at any emergency facility, at the same cost as if in his
or her own service area.
C) HMOs have salaried member physicians, but they do not cover emergency care.
D) An HMO emergency specialist will cover the patient. (Correct Answer) - ✅✅ A. A member of
an HMO can receive care in or out of the HMO service area, but care is preferred in the service
area.
Emergency care must be provided for the member in or out of the HMO's service area. If
emergency care is being provided for a member outside the service area, the HMO will be eager to
get the member back into the service area so that care can be provided by salaried member
physicians.
,After appointing an agent, how long does an insurer have to file with the Commissioner the form
detailing the agent's name, address, and other needed information?
A) 15 days
B) 30 days
C) 45 days
D) 60 days (Correct Answer) - ✅✅ B) 30 days
Insurers have 30 days to file, in a form prescribed by the Commissioner, the names, addresses, and
other information required by the Commissioner for its newly appointed agents.
Bethany studies in England for a semester. While she is there, she is involved in a train accident
that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of
benefits that she receives? (Correct Answer) - ✅✅ None
Which of the following are the main factors taken into account when calculating residual
disability benefits?
a)Present earnings and earnings prior to disability
b)Earnings prior to disability and the length of disability
c)Employee's full-time status and length of disability
d)Present earnings and standard cost of living (Correct Answer) - ✅✅ a)Present earnings and
earnings prior to disability
Residual disability will help pay for loss of earnings by making up the difference between the
employee's present earnings and what they were earning prior to disability.
How can a new physician be added to the PPO's approved list?
a)Fill out the appropriate paperwork and wait the 12 month pre-certification period.
b)Pay an annual fee for being on the PPO list.
, c)New physicians are only added once a year, and are selected by the PPO's Board of Directors.
d)Agree to follow the PPO standards and charge the appropriate fees. (Correct Answer) - ✅✅
d)Agree to follow the PPO standards and charge the appropriate fees.
Any physician or hospital that qualifies for and agrees to follow the PPO's standards and charges
the established fees can be added to the PPO's approved list at any time. The providers may
withdraw their name from the list at any time, as well.
Under the uniform required provisions, proof of loss under a health insurance policy normally
should be filed within
a)90 days of a loss.
b)20 days of a loss.
c)30 days of a loss.
d)60 days of a loss. (Correct Answer) - ✅✅ a)90 days of a loss.
Under the Uniform Required Provisions, proof of loss under a health insurance policy normally
should be filed within 90 days of a loss.
Which of the following must an insurer obtain in order to transact insurance within a given state?
a)Business entity license
b)Insurer's license
c)Certificate of authority
d)Producer's certificate (Correct Answer) - ✅✅ c)Certificate of authority
All insurers (domestic, foreign, or alien) must obtain a certificate of authority before transacting
insurance within a given state.
According to the Future Increase Option Rider (FIO), which of the following is NOT a qualifying
event to increase an insured's benefit level?
Exam Questions_Well updated
All of the following are true regarding Key Employee Disability Income insurance EXCEPT
A) Premiums are not tax deductible for the employer.
B) Benefits are taxable to the employer.
C) The employer owns the policy.
D) Benefits are paid to the employer to retrain a new person. (Correct Answer) - ✅✅ B) Benefits
are taxable to the employer.
Key person disability income premiums are not deductible to the business, but the benefits are
received income tax free by the business.
How is emergency care covered for a member of an HMO?
A) A member of an HMO can receive care in or out of the HMO service area, but care is preferred
in the service area.
B) A member of an HMO may receive care at any emergency facility, at the same cost as if in his
or her own service area.
C) HMOs have salaried member physicians, but they do not cover emergency care.
D) An HMO emergency specialist will cover the patient. (Correct Answer) - ✅✅ A. A member of
an HMO can receive care in or out of the HMO service area, but care is preferred in the service
area.
Emergency care must be provided for the member in or out of the HMO's service area. If
emergency care is being provided for a member outside the service area, the HMO will be eager to
get the member back into the service area so that care can be provided by salaried member
physicians.
,After appointing an agent, how long does an insurer have to file with the Commissioner the form
detailing the agent's name, address, and other needed information?
A) 15 days
B) 30 days
C) 45 days
D) 60 days (Correct Answer) - ✅✅ B) 30 days
Insurers have 30 days to file, in a form prescribed by the Commissioner, the names, addresses, and
other information required by the Commissioner for its newly appointed agents.
Bethany studies in England for a semester. While she is there, she is involved in a train accident
that leaves her disabled. If Bethany owns a general disability policy, what will be the extent of
benefits that she receives? (Correct Answer) - ✅✅ None
Which of the following are the main factors taken into account when calculating residual
disability benefits?
a)Present earnings and earnings prior to disability
b)Earnings prior to disability and the length of disability
c)Employee's full-time status and length of disability
d)Present earnings and standard cost of living (Correct Answer) - ✅✅ a)Present earnings and
earnings prior to disability
Residual disability will help pay for loss of earnings by making up the difference between the
employee's present earnings and what they were earning prior to disability.
How can a new physician be added to the PPO's approved list?
a)Fill out the appropriate paperwork and wait the 12 month pre-certification period.
b)Pay an annual fee for being on the PPO list.
, c)New physicians are only added once a year, and are selected by the PPO's Board of Directors.
d)Agree to follow the PPO standards and charge the appropriate fees. (Correct Answer) - ✅✅
d)Agree to follow the PPO standards and charge the appropriate fees.
Any physician or hospital that qualifies for and agrees to follow the PPO's standards and charges
the established fees can be added to the PPO's approved list at any time. The providers may
withdraw their name from the list at any time, as well.
Under the uniform required provisions, proof of loss under a health insurance policy normally
should be filed within
a)90 days of a loss.
b)20 days of a loss.
c)30 days of a loss.
d)60 days of a loss. (Correct Answer) - ✅✅ a)90 days of a loss.
Under the Uniform Required Provisions, proof of loss under a health insurance policy normally
should be filed within 90 days of a loss.
Which of the following must an insurer obtain in order to transact insurance within a given state?
a)Business entity license
b)Insurer's license
c)Certificate of authority
d)Producer's certificate (Correct Answer) - ✅✅ c)Certificate of authority
All insurers (domestic, foreign, or alien) must obtain a certificate of authority before transacting
insurance within a given state.
According to the Future Increase Option Rider (FIO), which of the following is NOT a qualifying
event to increase an insured's benefit level?
