North Carolina Health Insurance License
Test 2025
North Carolina Health Insurance License Test
2025 Prep Test Bank With Verified Questions
and Correct Detailed Answers ( Rationales )
Actual Exam Practice| NC Health Insurance
Exam Prep Test Bank (Latest)
Accident and health insurance policy exclusions typically include all of the following, except:
A
Nonoccupational injuries
B
Injuries covered under a government plan
C
Intentionally self-inflicted injuries
D
Elective cosmetic surgery
- Correct Answer :Nonoccupational injuries
Nonoccupational injuries are covered. Job related or occupational injuries are typically
excluded as they are covered by Workers' Compensation.
If an insured has a policy with 80/20 coinsurance, how is payment split?
A+ TEST BANK 1
, North Carolina Health Insurance License
Test 2025
A
The insurer pays 80% and the insured pays 20%
B
The insured pays $20 and the rest is covered by the insurer
C
The insured pays 80% and the insurer pays 20%
D
The insurer pays $80 and the rest is covered by the insured –
Correct Answer :The insurer pays 80% and the insured pays 20%
Coinsurance is a cost sharing feature and is stated as a percentage, such as 80/20, of sharing
between the insurer and the insured; The insurer pays the larger percentage.
If a policy requires the payment of an additional premium for the continuation of coverage
for a newborn, the insurer must be notified within 31 days of the ______.
A
First day of the month of birth
B
Date of birth
C
Policy date
D
Hospitalization date –
Correct Answer :Date of birth
A+ TEST BANK 2
, North Carolina Health Insurance License
Test 2025
Although coverage begins immediately, notification of birth or adoption and payment of any
required premium must occur within 31 days after the date of birth or adoption in order to
continue coverage beyond 31 days.
When payment under a Medical Expense policy is based on the average fee charged by all
doctors in a given geographical area, and the balance of any overcharges or costs of any
disallowed services are the insured's responsibility, the payment is known as:
A
Usual, customary, reasonable (UCR) payment
B
Cash payment
C
Blanket payment
D
Scheduled payment –
Correct Answer :Usual, customary, reasonable (UCR) payment
The question defines the (UCR) method of payment.
Joe suffers a broken leg while on vacation. With Joe's HMO, he may seek medical care at
which of the following?
A
An approved HMO facility
B
A military hospital
A+ TEST BANK 3
, North Carolina Health Insurance License
Test 2025
C
A facility near his home, where he must return for treatment
D
The nearest emergency room –
Correct Answer :The nearest emergency room
Since Joe's broken leg would qualify as an emergency, his HMO would pay for necessary
services at the nearest emergency room.
If an insured suffers a dismemberment under the AD&D policy, which of the following will
provide benefit payouts to the beneficiary?
A
Capital sum
B
Principal investments
C
Capital funds
D
Principal sum –
Correct Answer :Capital sum
Dismemberment benefits payable under an AD&D policy are referred to as the capital sum.
A+ TEST BANK 4
Test 2025
North Carolina Health Insurance License Test
2025 Prep Test Bank With Verified Questions
and Correct Detailed Answers ( Rationales )
Actual Exam Practice| NC Health Insurance
Exam Prep Test Bank (Latest)
Accident and health insurance policy exclusions typically include all of the following, except:
A
Nonoccupational injuries
B
Injuries covered under a government plan
C
Intentionally self-inflicted injuries
D
Elective cosmetic surgery
- Correct Answer :Nonoccupational injuries
Nonoccupational injuries are covered. Job related or occupational injuries are typically
excluded as they are covered by Workers' Compensation.
If an insured has a policy with 80/20 coinsurance, how is payment split?
A+ TEST BANK 1
, North Carolina Health Insurance License
Test 2025
A
The insurer pays 80% and the insured pays 20%
B
The insured pays $20 and the rest is covered by the insurer
C
The insured pays 80% and the insurer pays 20%
D
The insurer pays $80 and the rest is covered by the insured –
Correct Answer :The insurer pays 80% and the insured pays 20%
Coinsurance is a cost sharing feature and is stated as a percentage, such as 80/20, of sharing
between the insurer and the insured; The insurer pays the larger percentage.
If a policy requires the payment of an additional premium for the continuation of coverage
for a newborn, the insurer must be notified within 31 days of the ______.
A
First day of the month of birth
B
Date of birth
C
Policy date
D
Hospitalization date –
Correct Answer :Date of birth
A+ TEST BANK 2
, North Carolina Health Insurance License
Test 2025
Although coverage begins immediately, notification of birth or adoption and payment of any
required premium must occur within 31 days after the date of birth or adoption in order to
continue coverage beyond 31 days.
When payment under a Medical Expense policy is based on the average fee charged by all
doctors in a given geographical area, and the balance of any overcharges or costs of any
disallowed services are the insured's responsibility, the payment is known as:
A
Usual, customary, reasonable (UCR) payment
B
Cash payment
C
Blanket payment
D
Scheduled payment –
Correct Answer :Usual, customary, reasonable (UCR) payment
The question defines the (UCR) method of payment.
Joe suffers a broken leg while on vacation. With Joe's HMO, he may seek medical care at
which of the following?
A
An approved HMO facility
B
A military hospital
A+ TEST BANK 3
, North Carolina Health Insurance License
Test 2025
C
A facility near his home, where he must return for treatment
D
The nearest emergency room –
Correct Answer :The nearest emergency room
Since Joe's broken leg would qualify as an emergency, his HMO would pay for necessary
services at the nearest emergency room.
If an insured suffers a dismemberment under the AD&D policy, which of the following will
provide benefit payouts to the beneficiary?
A
Capital sum
B
Principal investments
C
Capital funds
D
Principal sum –
Correct Answer :Capital sum
Dismemberment benefits payable under an AD&D policy are referred to as the capital sum.
A+ TEST BANK 4
