NORTH CAROLINA HEALTH INSURANCE
STATE 2026 FULL QUESTIONS WITH
SOLUTIONS GRADED A+
⩥ 2. 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?
A. Restoration of Benefits
B. Stop-Loss
C. Maximum Policy Benefit
D. Percentage Participation.
Answer: B
⩥ 3. The deductible that an insured has to pay before benefits begin to
be paid by the insurer in a major medical policy is known as the
A. Corridor Deductible
B. Initial Deductible
C. Integrated Deductible
D. First Dollar Deductible.
Answer: B
⩥ 4. All of the following are features of a dental plan except
,A. Deductibles
B. Preventive Care
C. Coinsurance
D. High Policy Limits.
Answer: D
⩥ 5. How is coinsurance in an individual health policy regulated?
A. The insured can change the rates as long as they wish
B. There are no regulations
C. The insurer can change the rates as long as they don't exceed 25%
D. The insurer must leave the rate after the first year but not to exceed
25%.
Answer: B
⩥ 6. When a specialist within the insurance company reviews a file to
assess whether an alternate Treatment is available that might be cheaper,
this is known as
A. A Pretreatment Review
B. A Second Surgical Opinion
C. Case Management
D. Stop-Loss.
Answer: C
,⩥ 7. What does the term First Dollar mean?
A. The company begins to pay as soon as the deductible is met
B. The company begins to pay as soon as the stop loss amount is reached
C. The policy does not have a deductible
D. The company will cover the entire amount of expenses incurred as
long as the charges are within the inside limit.
Answer: C
⩥ 8. Group medical expense policies must cover all of the following
except
A. Maternity benefits
B. Chemical Dependency
C. Mental Illness
D. Work related injuries covered under Workers' Compensation.
Answer: D
⩥ 9. 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
A. Initial Deductible
B. Corridor Deductible
C. Flat Deductible
, D. Family Deductible.
Answer: B
⩥ 10. 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?
A. $200
B. $240
C. $440
D. $960.
Answer: C
⩥ 11. 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?
A. $700
B. $1,600
C. $1,800
D. $2,250.
Answer: C
⩥ 12. 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?
STATE 2026 FULL QUESTIONS WITH
SOLUTIONS GRADED A+
⩥ 2. 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?
A. Restoration of Benefits
B. Stop-Loss
C. Maximum Policy Benefit
D. Percentage Participation.
Answer: B
⩥ 3. The deductible that an insured has to pay before benefits begin to
be paid by the insurer in a major medical policy is known as the
A. Corridor Deductible
B. Initial Deductible
C. Integrated Deductible
D. First Dollar Deductible.
Answer: B
⩥ 4. All of the following are features of a dental plan except
,A. Deductibles
B. Preventive Care
C. Coinsurance
D. High Policy Limits.
Answer: D
⩥ 5. How is coinsurance in an individual health policy regulated?
A. The insured can change the rates as long as they wish
B. There are no regulations
C. The insurer can change the rates as long as they don't exceed 25%
D. The insurer must leave the rate after the first year but not to exceed
25%.
Answer: B
⩥ 6. When a specialist within the insurance company reviews a file to
assess whether an alternate Treatment is available that might be cheaper,
this is known as
A. A Pretreatment Review
B. A Second Surgical Opinion
C. Case Management
D. Stop-Loss.
Answer: C
,⩥ 7. What does the term First Dollar mean?
A. The company begins to pay as soon as the deductible is met
B. The company begins to pay as soon as the stop loss amount is reached
C. The policy does not have a deductible
D. The company will cover the entire amount of expenses incurred as
long as the charges are within the inside limit.
Answer: C
⩥ 8. Group medical expense policies must cover all of the following
except
A. Maternity benefits
B. Chemical Dependency
C. Mental Illness
D. Work related injuries covered under Workers' Compensation.
Answer: D
⩥ 9. 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
A. Initial Deductible
B. Corridor Deductible
C. Flat Deductible
, D. Family Deductible.
Answer: B
⩥ 10. 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?
A. $200
B. $240
C. $440
D. $960.
Answer: C
⩥ 11. 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?
A. $700
B. $1,600
C. $1,800
D. $2,250.
Answer: C
⩥ 12. 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?
