NC
PEARSON VUE
NORTH CAROLINA • PEARSON VUE
All Lines Adjuster
Final Exam Questions
& Answers
With Multiple Choice Options & Answer Key
Medicare • Disability Income • NC State Law • Producer Licensing
Group Coverage • Policy Provisions • Regulatory Compliance • Timeframes
Health & Accident Insurance • North Carolina Department of Insurance
,NC Pearson Vue • All Lines Adjuster • Final Exam Page 1
Final Exam — Questions, Choices & Answers
SECTION 1: Medicare, Claims & Policy Fundamentals
Charges for which of the following items is NOT considered a covered expense under a
1
Medicare Supplement policy (Part B)?
A. Hospital room and board B. Physician visits
C. Dental services D. Outpatient surgery
Answer: C. Dental services
Health insurance policies are offered on a 'take it or leave it' basis and referred to as which of
2
the following types of contracts?
A. Bilateral contracts B. Contracts of Adhesion
C. Unilateral contracts D. Aleatory contracts
Answer: B. Contracts of Adhesion
Under the Claims Forms provision of a health policy, if the insurance company fails to send
3
claim forms within the required time period, the insured should:
A. Wait for the forms to arrive B. Cancel the policy
C. Submit the claim in any form, which must be accepted by the company as adequate proof of loss D. File a
complaint with the Commissioner
Answer: C. Submit the claim in any form, which must be accepted by the company as adequate proof
of loss
4 In an Accidental Death and Dismemberment (AD&D;) policy, capital sum refers to:
A. The total policy benefit amount B. A lump sum payment made for an accidental dismemberment
C. The principal sum paid at death D. The maximum lifetime benefit
Answer: B. A lump sum payment made for an accidental dismemberment
5 The Coordination of Benefits clause found in group health master contracts is used to:
A. Determine primary vs. secondary coverage B. Avoid double payment of benefits to an insured who has
duplicate group coverages
C. Calculate the maximum benefit payable D. Identify eligible dependents
Answer: B. Avoid double payment of benefits to an insured who has duplicate group coverages
North Carolina • Health & Accident Insurance • Study Guide
, NC Pearson Vue • All Lines Adjuster • Final Exam Page 2
6 Which of the following definitions MOST accurately describes the Probationary Period?
A. The period during which claims are under review B. The time before a new policy becomes active
C. The waiting period a new hire must satisfy prior to becoming eligible for group health coverage D. The
contestability period of the policy
Answer: C. The waiting period a new hire must satisfy prior to becoming eligible for group health
coverage
7 A Health Maintenance Organization (HMO) differs from a traditional insurer in that an HMO:
A. Charges higher premiums B. Emphasizes preventive medicine
C. Allows any provider to be seen D. Does not require referrals
Answer: B. Emphasizes preventive medicine
A married insured has an AD&D; policy naming their sibling as primary beneficiary and their
8 child as contingent. If both the insured and sibling are killed in an accident, the policy proceeds
would be paid to:
A. The insured's estate B. The sibling's estate
C. The insured's spouse D. The insured's child
Answer: D. The insured's child
9 The Social Security program provides all of the following benefits EXCEPT:
A. Retirement benefits B. Disability benefits
C. Workers compensation D. Survivor benefits
Answer: C. Workers compensation
10 Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to:
A. Cancel individual policies B. Increase the premium rate for an entire class of insureds
C. Reduce coverage without notice D. Deny renewal for any reason
Answer: B. Increase the premium rate for an entire class of insureds
SECTION 2: Disability Income & Group Coverage
North Carolina • Health & Accident Insurance • Study Guide
PEARSON VUE
NORTH CAROLINA • PEARSON VUE
All Lines Adjuster
Final Exam Questions
& Answers
With Multiple Choice Options & Answer Key
Medicare • Disability Income • NC State Law • Producer Licensing
Group Coverage • Policy Provisions • Regulatory Compliance • Timeframes
Health & Accident Insurance • North Carolina Department of Insurance
,NC Pearson Vue • All Lines Adjuster • Final Exam Page 1
Final Exam — Questions, Choices & Answers
SECTION 1: Medicare, Claims & Policy Fundamentals
Charges for which of the following items is NOT considered a covered expense under a
1
Medicare Supplement policy (Part B)?
A. Hospital room and board B. Physician visits
C. Dental services D. Outpatient surgery
Answer: C. Dental services
Health insurance policies are offered on a 'take it or leave it' basis and referred to as which of
2
the following types of contracts?
A. Bilateral contracts B. Contracts of Adhesion
C. Unilateral contracts D. Aleatory contracts
Answer: B. Contracts of Adhesion
Under the Claims Forms provision of a health policy, if the insurance company fails to send
3
claim forms within the required time period, the insured should:
A. Wait for the forms to arrive B. Cancel the policy
C. Submit the claim in any form, which must be accepted by the company as adequate proof of loss D. File a
complaint with the Commissioner
Answer: C. Submit the claim in any form, which must be accepted by the company as adequate proof
of loss
4 In an Accidental Death and Dismemberment (AD&D;) policy, capital sum refers to:
A. The total policy benefit amount B. A lump sum payment made for an accidental dismemberment
C. The principal sum paid at death D. The maximum lifetime benefit
Answer: B. A lump sum payment made for an accidental dismemberment
5 The Coordination of Benefits clause found in group health master contracts is used to:
A. Determine primary vs. secondary coverage B. Avoid double payment of benefits to an insured who has
duplicate group coverages
C. Calculate the maximum benefit payable D. Identify eligible dependents
Answer: B. Avoid double payment of benefits to an insured who has duplicate group coverages
North Carolina • Health & Accident Insurance • Study Guide
, NC Pearson Vue • All Lines Adjuster • Final Exam Page 2
6 Which of the following definitions MOST accurately describes the Probationary Period?
A. The period during which claims are under review B. The time before a new policy becomes active
C. The waiting period a new hire must satisfy prior to becoming eligible for group health coverage D. The
contestability period of the policy
Answer: C. The waiting period a new hire must satisfy prior to becoming eligible for group health
coverage
7 A Health Maintenance Organization (HMO) differs from a traditional insurer in that an HMO:
A. Charges higher premiums B. Emphasizes preventive medicine
C. Allows any provider to be seen D. Does not require referrals
Answer: B. Emphasizes preventive medicine
A married insured has an AD&D; policy naming their sibling as primary beneficiary and their
8 child as contingent. If both the insured and sibling are killed in an accident, the policy proceeds
would be paid to:
A. The insured's estate B. The sibling's estate
C. The insured's spouse D. The insured's child
Answer: D. The insured's child
9 The Social Security program provides all of the following benefits EXCEPT:
A. Retirement benefits B. Disability benefits
C. Workers compensation D. Survivor benefits
Answer: C. Workers compensation
10 Under a Guaranteed Renewable Accident & Health policy, an insurer retains the right to:
A. Cancel individual policies B. Increase the premium rate for an entire class of insureds
C. Reduce coverage without notice D. Deny renewal for any reason
Answer: B. Increase the premium rate for an entire class of insureds
SECTION 2: Disability Income & Group Coverage
North Carolina • Health & Accident Insurance • Study Guide
