NC LIFE INSURANCE Accident and Health latest Practice Exam 2026 Test Review Questions & Answers | Graded A+ | 100% Pass

NC LIFE INSURANCE Accident and Health latest Practice Exam 2026 Test Review Questions & Answers | Graded A+ | 100% Pass Which of the following policies would be the most expensive? - ANSWER-Non cancellable The deductible that an insured has to pay before benefits begin to bepaid by the insurer in a major medical policy is know as the: - ANSWER-Initial Deductible When a specialist within the insurance company reviews a file to asses whether an alternate treatment is available that might be cheaper, this is known as: - ANSWER Case Management X has an 80/20 major medical policy with a $250 deductible. Since X has not satisfied any of the deductible, if X incurs $1500 in medical expenses, how much of the bill will the INSURER pay? - ANSWER-$1000 What is the feature found in a major medical policy that replaces a certain amount of coverage each year lost as a result of a claim? - ANSWER-Restoration of Benefits In a major medical policy, what limits the amount of total deductible on a per person deductible policy? - ANSWER-Family Deductible Limit When available Dental & Vision coverage generally are issued in what type of Health Insurance policy? - ANSWER-Group Which of the following is not a required uniform provision in individual health insurance policies? - ANSWER-Change of Occupation If the co-insurance feature in a major medical policy is 75%-25% with a $100 deductible, how much of a $2,100 bill would the insured have to pay? - ANSWER-$600 Regardless of you expenses this policy pays a flat amount per day in the hospital. What is this called? - ANSWER-Hospital Indemnity or Hospital Income Plan Under the proof of loss provision: - ANSWER-The insured has 180 days to file proof of loss NC LIFE NC LIFE By adding the major medical to the basic, the insured now has the equivalent of comprehensive major medical coverage. The deductible which is in between the basic and the major medical coverage is known as the: - ANSWER-Corridor Deductible Which of the following is false regarding the NONCANCELABLE form of renewability? - ANSWER-The policy can be canceled but only for reasons stated in the contract Premiums may not be increased on which of the following health policies? - ANSWER Noncancelable The time limit on certain defenses (Incontestable) is: - ANSWER-2 years from the date of issue Which of the follow is not a feature of a Dental Plan? - ANSWER-High Policy Limits The optional provision, OTHER INSURANCE IN THIS INSURER, is specifically designed to: - ANSWER-limit the risk with any one individual insured with the company What is the "consideration" given by an insurance company? - ANSWER-Promises in the Policy Unfortunately, Larry's family was involved in an automobile accident. What is the name of the health insurance provision which explains how the deduction works in their situation? - ANSWER-Common Accident X and Y have twin sons, A and B, who have just turned 18. In the fall A will enter college and B is going into the Army. Who will X and Y be able to continue to cover under their health policy? - ANSWER-A only A Comprehensive Medical Expense policy pays 100% of the first $5,000 of expenses, has a corridor deductible of $100 and 80% / 20% coinsurance. How much of a $6,100 bill will the insurance company pay? - ANSWER-$5,800 What is used in major medical policies to limit coverage for a specific disease? - ANSWER-Inside Limits X incurs $1400 in eligible expenses. The policy is 80/20 with a $200 annual deductible. This is the first claim for the year. What is the maximum amount the insured will be required to pay on this claim? - ANSWER-$440 The Notice of Claim provision requires the insured to notify the insurance company of a claim within: - ANSWER-20 days What does the term First Dollar mean? - ANSWER-The policy has no deductible NC LIFE NC LIFE After the basic benefits are exhausted, the corridor deductible must be paid before the benefits of what coverage becomes payable? - ANSWER-Major Medical The words "reasonable & customary" found in a health policy mean: - ANSWER-The policy will pay what most Dr's & Hospitals charge for similar services in the same geographic area Which statement is FALSE about the insuring clause of a health policy? - ANSWER Pre-existing conditions are never covered Group Medical expense policies do NOT cover: - ANSWER-Work related injuries covered under Workmen's Comp A major medical insurance policy would NOT cover expenses for: - ANSWER-Charges covered under Workmen's Comp If a health policy "covers the cost up to the semi-private room rate" this is: - ANSWER an Inside/Internal Limit Pre-admission certification is a cost control method which is one of the ways that an insurer can contain premium costs under what type of provisions? - ANSWER-Case Management An __________ deductible must be paid at the beginning of a major medical policy. A ___________ deductible is paid after first dollar benefits but before a major medical coinsurance feature begins. - ANSWER-Initial-Corridor Which of the following is true about the change of occupation provision? - ANSWER-It is NOT mandatory In Major Medical and Comprehensive policies, a COINSURANCE provision: - ANSWER-provides for a percentage participation by the insured Autopsies are allowed: - ANSWER-Except where prohibited by the law Which of the required uniform provisions in a health insurance policy restricts agents from waiving any provisions in the policy? - ANSWER-Entire Contract X has a guaranteed renewable long-term disability income policy with a monthly benefit of $3,500 and has a Relation of Earnings to Insurance optional provision in the contract. If X becomes disables and is currently making $3,300 but has an average income over a 24 month period prior to his disability of $3,800, how much will X receive a month income during his disability? - ANSWER-$3,500 NC LIFE NC LIFE What is the feature that limits the amount of money that an insured has to pay out of pocket once he has paid a certain amount under the coinsurance clause? - ANSWER Stop Loss In a health policy, what constitutes the entire contract? - ANSWER-The policy & a copy of any rate tables used to calculate premium Common exclusions on Health policies do NOT include: - ANSWER-Injury which occurred while being held hostage during a bank robbery If the insured files notice of claim on June 10th the claim form must be provided by: - ANSWER-June 25th Which of the following is usually covered as a basic hospital miscellaneous expense? - ANSWER-Operating Room Charges Which of the following is a common feature of a Group Major Medical Insurance? - ANSWER-Coinsurance What is the "consideration" given by an insured? - ANSWER-Statements on the application and payment of the first premium How is coinsurance in an individual health policy regulated? - ANSWER-There is no regulations If the insured's age is misstated on a health insurance application, what amount is payable under the policy? - ANSWER-The amount the premium would have purchased at the correct age of the insured Expenses that are not covered under Health Insurance policies are: - ANSWER Exclusions In a reinstated health insurance policy, sickness coverage usually begins: - ANSWER 11 days after reinstatement Which type of renewability assures renewability up to a specific age of the insured, although the insurer reserves the right to chance the premium rate on a CLASS basis? - ANSWER-Guaranteed Renewable The Legal Actions provision in a health policy addresses when an insured can sue a company over a claim. What is the earliest and latest this can be done? - ANSWER-60 days/3 years X has an 80/20 major medical policy with a $250 annual deductible which has already been satisfied for the year. X incurs $2,250 in eligible expenses, how much will the insurer pay on this claim? - ANSWER-$1800 NC LIFE Basic Medical Expense policies provide: - ANSWER-Basic hospital, misc., and surgical coverage The grace period for a semi-annual premium on an individual major medical policy is: - ANSWER-31 days X is the manager of a record store when he buys a disability policy. After the policy is purchased, X becomes a construction worker. If X becomes disables after becoming a construction worker, the company will do which of the following if X's policy contains the -optional provision: Change of Occupation?- - ANSWER-Reduce the Benefits If the company do not let the policy owner know something about whether or not the policy is reinstated within 45 days: - ANSWER-It is automatically assumed that the policy is reinstated What is used in major medical policies to limit coverage for any specific diseases? - ANSWER-Inside Limits NC LIFE