NC HEALTH INSURANCE EXAM
QUESTIONS OBJECTIVE ASSESSMENT
WITH CORRECT SOLUTIONS||A+
GRADED||100% GUARANTEED
PASS||<<NEWEST VERSION>>
The most important key factors evaluated in the health insurance underwriting
process are: - ANSWER ✓ medical history and occupation
In health insurance underwriting when classifying risk, the three most important
factors are: - ANSWER ✓ physical condition, moral hazards, occupation
T/F: Moral hazards are personal habits such as alcohol or drug use. - ANSWER ✓
True
T/F: If a change of occupation occurs without the company's knowledge and a
claim is filed, the company cannot adjust the benefit amount. That is why it is
important for agents to monitor client employment. - ANSWER ✓ False
T/F: Genetic information or testing always includes routine physical examinations.
- ANSWER ✓ False
the condition of being diseased; the rate of disease in a population - ANSWER ✓
morbidity
Substandard risk factors result in? - ANSWER ✓ higher premiums (higher than
average risk)
Which of the following is NOT a factor in determining health insurance
premiums? a) Morbidity b) Mortality c) Interest d) Expenses - ANSWER ✓
mortality
,T/F: In individual plans, premiums paid for personal disability income insurance
by an individual are nontaxable. - ANSWER ✓ False
T/F: If an insurance company reimburses the insured for medical expenses, the
insured can deduct that amount from their federal income tax. - ANSWER ✓ False
T/F: All medical care including premiums is fully tax deductible if a person is
self-employed. - ANSWER ✓ True
Medical cost management is a means of controlling claims expenses. What are the
four of the general approaches plans utilize? - ANSWER ✓ Mandatory second
opinions, precertification review, ambulatory surgery, and case management
T/F: Case Management provides insureds with the choice of outpatient or
inpatient surgery. - ANSWER ✓ False
T/F: Mandatory second opinions are not necessary before an insured undergoes
any nonlife-threatening surgery. - ANSWER ✓ False
A "person" can include which of the following: a) An individual b) A partnership
c) A firm d) All of the above - ANSWER ✓ ALL
A "Department" refers to which of the following: - ANSWER ✓ the department
of insurance of north carolina
T/F: A "domestic company" is a company incorporated or organized under the
laws of North Carolina. - ANSWER ✓ true
T/F: An insurance agent may use a pretext interview to obtain information in
connection with an insurance transaction. - ANSWER ✓ true
T/F: The Federal Privacy Disclosure Notice must be provided at least every five
years during the continuation of the policy. - ANSWER ✓ False
T/F: An insurance agent who is licensed in North Carolina may advertise in
another state where they are not licensed. - ANSWER ✓ false
, Insurers offering a preferred provider benefit plan must provide to the
Commissioner summary data about the financial reimbursements offered to health
care providers _________. - ANSWER ✓ annually
T/F: A person enrolled in a preferred provider benefit plan may obtain covered
health care services from a provider who does not participate in the plan. -
ANSWER ✓ true
A Utilization Review is: - ANSWER ✓ A set of formal techniques designed to
monitor the clinical necessity of health care services
T/F: Every insurer must maintain records of each grievance received and the
insurer's review of each grievance. - ANSWER ✓ true
T/F: The required accident and health policy provisions must be in the designated
language unless alternative language is submitted and approved by the
Commissioner. - ANSWER ✓ true
Michelle's Law requires that coverage continue for a dependent child during a
medically necessary leave of absence from college. - ANSWER ✓ true
"________" refers to the most frequently used level of charge made for a specific
service in the geographic area in which services are received. - ANSWER ✓
reasonable and customary
An employee electing continuation must pay to the group policyholder, in
advance, the amount of contribution required by the policyholder, but not more
than ___ of the full group rate for the insurance on the due date of each payment. -
ANSWER ✓ 102%
T/F: A notification of the continuation privilege does not need to be included in
each individual certification of coverage. - ANSWER ✓ false
In order to be eligible for conversion, written application and the first premium
payment for the converted policy must be made to the insurer not later than ____
days after the date of termination of insurance. - ANSWER ✓ 31
QUESTIONS OBJECTIVE ASSESSMENT
WITH CORRECT SOLUTIONS||A+
GRADED||100% GUARANTEED
PASS||<<NEWEST VERSION>>
The most important key factors evaluated in the health insurance underwriting
process are: - ANSWER ✓ medical history and occupation
In health insurance underwriting when classifying risk, the three most important
factors are: - ANSWER ✓ physical condition, moral hazards, occupation
T/F: Moral hazards are personal habits such as alcohol or drug use. - ANSWER ✓
True
T/F: If a change of occupation occurs without the company's knowledge and a
claim is filed, the company cannot adjust the benefit amount. That is why it is
important for agents to monitor client employment. - ANSWER ✓ False
T/F: Genetic information or testing always includes routine physical examinations.
- ANSWER ✓ False
the condition of being diseased; the rate of disease in a population - ANSWER ✓
morbidity
Substandard risk factors result in? - ANSWER ✓ higher premiums (higher than
average risk)
Which of the following is NOT a factor in determining health insurance
premiums? a) Morbidity b) Mortality c) Interest d) Expenses - ANSWER ✓
mortality
,T/F: In individual plans, premiums paid for personal disability income insurance
by an individual are nontaxable. - ANSWER ✓ False
T/F: If an insurance company reimburses the insured for medical expenses, the
insured can deduct that amount from their federal income tax. - ANSWER ✓ False
T/F: All medical care including premiums is fully tax deductible if a person is
self-employed. - ANSWER ✓ True
Medical cost management is a means of controlling claims expenses. What are the
four of the general approaches plans utilize? - ANSWER ✓ Mandatory second
opinions, precertification review, ambulatory surgery, and case management
T/F: Case Management provides insureds with the choice of outpatient or
inpatient surgery. - ANSWER ✓ False
T/F: Mandatory second opinions are not necessary before an insured undergoes
any nonlife-threatening surgery. - ANSWER ✓ False
A "person" can include which of the following: a) An individual b) A partnership
c) A firm d) All of the above - ANSWER ✓ ALL
A "Department" refers to which of the following: - ANSWER ✓ the department
of insurance of north carolina
T/F: A "domestic company" is a company incorporated or organized under the
laws of North Carolina. - ANSWER ✓ true
T/F: An insurance agent may use a pretext interview to obtain information in
connection with an insurance transaction. - ANSWER ✓ true
T/F: The Federal Privacy Disclosure Notice must be provided at least every five
years during the continuation of the policy. - ANSWER ✓ False
T/F: An insurance agent who is licensed in North Carolina may advertise in
another state where they are not licensed. - ANSWER ✓ false
, Insurers offering a preferred provider benefit plan must provide to the
Commissioner summary data about the financial reimbursements offered to health
care providers _________. - ANSWER ✓ annually
T/F: A person enrolled in a preferred provider benefit plan may obtain covered
health care services from a provider who does not participate in the plan. -
ANSWER ✓ true
A Utilization Review is: - ANSWER ✓ A set of formal techniques designed to
monitor the clinical necessity of health care services
T/F: Every insurer must maintain records of each grievance received and the
insurer's review of each grievance. - ANSWER ✓ true
T/F: The required accident and health policy provisions must be in the designated
language unless alternative language is submitted and approved by the
Commissioner. - ANSWER ✓ true
Michelle's Law requires that coverage continue for a dependent child during a
medically necessary leave of absence from college. - ANSWER ✓ true
"________" refers to the most frequently used level of charge made for a specific
service in the geographic area in which services are received. - ANSWER ✓
reasonable and customary
An employee electing continuation must pay to the group policyholder, in
advance, the amount of contribution required by the policyholder, but not more
than ___ of the full group rate for the insurance on the due date of each payment. -
ANSWER ✓ 102%
T/F: A notification of the continuation privilege does not need to be included in
each individual certification of coverage. - ANSWER ✓ false
In order to be eligible for conversion, written application and the first premium
payment for the converted policy must be made to the insurer not later than ____
days after the date of termination of insurance. - ANSWER ✓ 31
