North Carolina Health Insurance State
Exam Prep
Which type of policy pays benefits to a policyholder covered under a Hospital Expense
policy? - ✔️✔️Reimbursement
J has an Accidental Death and Dismemberment policy with a principal sum of $50,000.
While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will
receive from his policy? - ✔️✔️$25,000
The benefits under a Disability Buy-Out policy are: - ✔️✔️payable to the company or
another shareholder
If the insured and primary beneficiary are both killed in the same accident and it cannot
be determined who died first, where are the death proceeds to be directed under the
uniform Simultaneous Death Act? - ✔️✔️Insured Contingent Beneficiary
An accident policy will most likely pay a benefit for a(n) - ✔️✔️off-the -job accident
a payment for damage or loss - ✔️✔️indemnity
The COBRA gives workers whose employment has been terminated the right to -
✔️✔️continue group health benefits
The percentage of as individual's Primary Insurance Amount determines the benefits
paid in which of the following programs. - ✔️✔️Social Security Disability Income
What is the maximum Social Security Disability benefit amount an insured can receive?
- ✔️✔️100% of the insured's Primary Insurance Amount (PIA)
Which of these statements is INCORRECT regarding a PPO? - ✔️✔️PPO's are NOT a
type of managed care system
What does Medicare Parts A and B cover? - ✔️✔️Part A covers hospitalization; Part B
covers doctor's services
Under what system do a group of doctors and hospitals in a designated area contract
with an insurer to provide services at a prearranged cost to the insured? - ✔️✔️PPO
, The situation in which a group of physicians are salaried employees and conduct
business in an HMO facility is called a(n) - ✔️✔️closed panel
A 66 year-old is covered under a group health plan while employed with a business that
has 40 employees. If she injures herself while walking in the park, what coverage would
be considered primary? - ✔️✔️Her group health plan (if the employer has more than 20
employees, the group health plan generally pays first)
Which of the following reimburses its insureds for covered medical expenses? -
✔️✔️Commercial Insurers
Which of the following statements about Health Reimbursement Arrangements (HRA) is
CORRECT? - ✔️✔️If the employee paid for qualified medical expenses, the
reimbursements may be tax-free
Which provision allows a portion of any used medical benefits to be restored following a
particular amount of benefit has been used, or after the policy has been in effect for a
particular period of time? - ✔️✔️Restoration of used benefit
If several family members are injured in the same accident, only one deductible is
applied. - ✔️✔️Common Accident Deductible
M has a Major Medical Insurance policy with a $200 flat deductible and an 80%
Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how
much will M receive in payment for this claim? - ✔️✔️$1,600
This type of deductible provision waives the deductible for all family members after
some of them have satisfied individual deductibles within the same year - ✔️✔️Family
maximum deductable
Basic Hospital and Surgical policy benefits are - ✔️✔️lower than the actual expenses
incurred
Which of the following BEST describes a Hospital Indemnity policy? - ✔️✔️Coverage
that pays a stated amount per day of a covered hospitalization
Which of the following costs would a Basic Hospital/Surgical policy likely cover? -
✔️✔️Surgically removing a facial birthmark
Which of the following policy features allows an insured to defer current health charges
to the following year's deductible instead of the current year's deductible? -
✔️✔️carryover provision
Exam Prep
Which type of policy pays benefits to a policyholder covered under a Hospital Expense
policy? - ✔️✔️Reimbursement
J has an Accidental Death and Dismemberment policy with a principal sum of $50,000.
While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will
receive from his policy? - ✔️✔️$25,000
The benefits under a Disability Buy-Out policy are: - ✔️✔️payable to the company or
another shareholder
If the insured and primary beneficiary are both killed in the same accident and it cannot
be determined who died first, where are the death proceeds to be directed under the
uniform Simultaneous Death Act? - ✔️✔️Insured Contingent Beneficiary
An accident policy will most likely pay a benefit for a(n) - ✔️✔️off-the -job accident
a payment for damage or loss - ✔️✔️indemnity
The COBRA gives workers whose employment has been terminated the right to -
✔️✔️continue group health benefits
The percentage of as individual's Primary Insurance Amount determines the benefits
paid in which of the following programs. - ✔️✔️Social Security Disability Income
What is the maximum Social Security Disability benefit amount an insured can receive?
- ✔️✔️100% of the insured's Primary Insurance Amount (PIA)
Which of these statements is INCORRECT regarding a PPO? - ✔️✔️PPO's are NOT a
type of managed care system
What does Medicare Parts A and B cover? - ✔️✔️Part A covers hospitalization; Part B
covers doctor's services
Under what system do a group of doctors and hospitals in a designated area contract
with an insurer to provide services at a prearranged cost to the insured? - ✔️✔️PPO
, The situation in which a group of physicians are salaried employees and conduct
business in an HMO facility is called a(n) - ✔️✔️closed panel
A 66 year-old is covered under a group health plan while employed with a business that
has 40 employees. If she injures herself while walking in the park, what coverage would
be considered primary? - ✔️✔️Her group health plan (if the employer has more than 20
employees, the group health plan generally pays first)
Which of the following reimburses its insureds for covered medical expenses? -
✔️✔️Commercial Insurers
Which of the following statements about Health Reimbursement Arrangements (HRA) is
CORRECT? - ✔️✔️If the employee paid for qualified medical expenses, the
reimbursements may be tax-free
Which provision allows a portion of any used medical benefits to be restored following a
particular amount of benefit has been used, or after the policy has been in effect for a
particular period of time? - ✔️✔️Restoration of used benefit
If several family members are injured in the same accident, only one deductible is
applied. - ✔️✔️Common Accident Deductible
M has a Major Medical Insurance policy with a $200 flat deductible and an 80%
Coinsurance clause. If M incurs a $2,200 claim for an eligible medical expense, how
much will M receive in payment for this claim? - ✔️✔️$1,600
This type of deductible provision waives the deductible for all family members after
some of them have satisfied individual deductibles within the same year - ✔️✔️Family
maximum deductable
Basic Hospital and Surgical policy benefits are - ✔️✔️lower than the actual expenses
incurred
Which of the following BEST describes a Hospital Indemnity policy? - ✔️✔️Coverage
that pays a stated amount per day of a covered hospitalization
Which of the following costs would a Basic Hospital/Surgical policy likely cover? -
✔️✔️Surgically removing a facial birthmark
Which of the following policy features allows an insured to defer current health charges
to the following year's deductible instead of the current year's deductible? -
✔️✔️carryover provision
