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)
What is the maximum period of time during which an insurer may contest fraudulent misstatements
made in a health insurance application?
a) 90 days after the effective policy date
b) 6 months after the effective policy date
c) 1 year after the effective policy date
d) As long as the policy is in force
- Correct Answer :d) As long as the policy is in force
Why: An insurer can contest a fraudulent misstatement as long as the policy is in force. No other
statement or misstatement made in the application at the time of issue will be used to deny a claim
after the policy has been in force for 2 years.
Which of the following is an eligibility requirement for all Social Security Disability income benefits?
a) Have permanent kidney failure
b) Be at least age 50
c) Have attained fully insured status
A+ TEST BANK 1
, North Carolina Health Insurance License
Test 2025
d) Be disabled for at least 1 year –
Correct Answer :c) Have attained fully insured status
Why: Although Social Security offers many benefits, such as retirement, survivors and Medicare, only
those who have attained fully insured status are eligible for Disability Income benefits. Contributing
to Social Security for 40 quarters (10 years) attains fully insured status.
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
a) They cover the cost of extended nursing home care
b) They cover Medicare deductibles and copayments
c) They supplement Medicare benefits
d) They are issued by private insurers
- Correct Answer :a) They cover the cost of extended nursing home care
Why: Medicare supplement policies (Medigap) do not cover the cost of extended nursing home care.
Medigap plans are designed to fill the gap in coverage attributable to Medicare's deductibles,
copayment requirements, and benefit periods. These plans are issued by private insurance
companies.
Which of the following is an example of a producer's fiduciary duty?
a) A duty to base all transactions upon the principle of Utmost Good Faith
b) The obligation to tell the truth to the best of one's knowledge
c) The trust that a client places in the producer in regard to handling premiums
d) An obligation to state every known fact about the policy the producer is selling
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, North Carolina Health Insurance License
Test 2025
- Correct Answer :c) The trust that a client places in the producer in regard to handling premiums
Why: An agent acts in a fiduciary capacity, based upon trust and confidence, when handling the
financial affairs of their customers, including the handling of premiums.
Which of the following is true about the requirements regarding HIV exams
a) HIV exams may not be used as a basis for underwriting.
b) The applicant must give prior informed written consent.
c) Results may be disclosed to the agent and the underwriter.
d) Prior informed oral consent is required from the applicant
. - Correct Answer :b) The applicant must give prior informed written consent.
Why: A separate written consent form must be obtained prior to an HIV exam. HIV exam results may
be disclosed to underwriters, but not agents.
Which of the following options best depicts how the eligibility of members for group health
insurance is determined?
a) Eligibility is not determined, but simply accepted
b) By the physical conditions of the applicants at the time of employment
c) In such a manner as to establish individual selection as to the amounts of insurance
d) By conditions of employment –
Correct Answer :d) By conditions of employment
A+ TEST BANK 3
, North Carolina Health Insurance License
Test 2025
Why: The individual employer normally must provide insurance coverage to all full-time employees.
The employer can specify within some limitations how many hours are considered full time, and
whether both salaried and hourly employees will be covered. The employer can also legally exclude a
particular group of employees from the eligible class of employees
All of the following are covered by Part A of Medicare EXCEPT
a) Home health services.
b) Physician's and surgeon's services.
c) In-patient hospital services.
d) Post-hospital nursing care.
- Correct Answer :b) Physician's and surgeon's services.
Why: Physician's and surgeon's services are covered under Part B
Which provision states that the insurance company must pay Medical Expense claims immediately?
a) Relation of Earnings to Insurance
b) Time of Payment of Claims
c) Payment of Claims
d) Legal Actions –
Correct Answer :b) Time of Payment of Claims
Why: The Time Payment of Claims provision requires that claims will be paid immediately upon
receipt of proofs of loss except for periodic payments, which are to be paid as specified in the policy.
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)
What is the maximum period of time during which an insurer may contest fraudulent misstatements
made in a health insurance application?
a) 90 days after the effective policy date
b) 6 months after the effective policy date
c) 1 year after the effective policy date
d) As long as the policy is in force
- Correct Answer :d) As long as the policy is in force
Why: An insurer can contest a fraudulent misstatement as long as the policy is in force. No other
statement or misstatement made in the application at the time of issue will be used to deny a claim
after the policy has been in force for 2 years.
Which of the following is an eligibility requirement for all Social Security Disability income benefits?
a) Have permanent kidney failure
b) Be at least age 50
c) Have attained fully insured status
A+ TEST BANK 1
, North Carolina Health Insurance License
Test 2025
d) Be disabled for at least 1 year –
Correct Answer :c) Have attained fully insured status
Why: Although Social Security offers many benefits, such as retirement, survivors and Medicare, only
those who have attained fully insured status are eligible for Disability Income benefits. Contributing
to Social Security for 40 quarters (10 years) attains fully insured status.
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
a) They cover the cost of extended nursing home care
b) They cover Medicare deductibles and copayments
c) They supplement Medicare benefits
d) They are issued by private insurers
- Correct Answer :a) They cover the cost of extended nursing home care
Why: Medicare supplement policies (Medigap) do not cover the cost of extended nursing home care.
Medigap plans are designed to fill the gap in coverage attributable to Medicare's deductibles,
copayment requirements, and benefit periods. These plans are issued by private insurance
companies.
Which of the following is an example of a producer's fiduciary duty?
a) A duty to base all transactions upon the principle of Utmost Good Faith
b) The obligation to tell the truth to the best of one's knowledge
c) The trust that a client places in the producer in regard to handling premiums
d) An obligation to state every known fact about the policy the producer is selling
A+ TEST BANK 2
, North Carolina Health Insurance License
Test 2025
- Correct Answer :c) The trust that a client places in the producer in regard to handling premiums
Why: An agent acts in a fiduciary capacity, based upon trust and confidence, when handling the
financial affairs of their customers, including the handling of premiums.
Which of the following is true about the requirements regarding HIV exams
a) HIV exams may not be used as a basis for underwriting.
b) The applicant must give prior informed written consent.
c) Results may be disclosed to the agent and the underwriter.
d) Prior informed oral consent is required from the applicant
. - Correct Answer :b) The applicant must give prior informed written consent.
Why: A separate written consent form must be obtained prior to an HIV exam. HIV exam results may
be disclosed to underwriters, but not agents.
Which of the following options best depicts how the eligibility of members for group health
insurance is determined?
a) Eligibility is not determined, but simply accepted
b) By the physical conditions of the applicants at the time of employment
c) In such a manner as to establish individual selection as to the amounts of insurance
d) By conditions of employment –
Correct Answer :d) By conditions of employment
A+ TEST BANK 3
, North Carolina Health Insurance License
Test 2025
Why: The individual employer normally must provide insurance coverage to all full-time employees.
The employer can specify within some limitations how many hours are considered full time, and
whether both salaried and hourly employees will be covered. The employer can also legally exclude a
particular group of employees from the eligible class of employees
All of the following are covered by Part A of Medicare EXCEPT
a) Home health services.
b) Physician's and surgeon's services.
c) In-patient hospital services.
d) Post-hospital nursing care.
- Correct Answer :b) Physician's and surgeon's services.
Why: Physician's and surgeon's services are covered under Part B
Which provision states that the insurance company must pay Medical Expense claims immediately?
a) Relation of Earnings to Insurance
b) Time of Payment of Claims
c) Payment of Claims
d) Legal Actions –
Correct Answer :b) Time of Payment of Claims
Why: The Time Payment of Claims provision requires that claims will be paid immediately upon
receipt of proofs of loss except for periodic payments, which are to be paid as specified in the policy.
A+ TEST BANK 4
