North Carolina Health Insurance Exam || A+ Graded Already.

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 correct answers 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 correct answers B. Which of the following is true regarding inpatient hospital care for HMO members? 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 correct answers 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 correct answers 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 correct answers C. Which describes the features of a comprehensive major medical policy? A. There is no coinsurance 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 correct answers B.