NORTH CAROLINA HEALTH INSURANCE
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
When Linda suffered a broken hip, she notified her agent, in writing, within 12
days of the loss. However, her agent did not notify the insurance company until 60
days after the loss. Which of the following statements correctly explains how this
claim would be handled?
A. The insurer is considered to be notified since the notification to agent equals
notification to the insurer
B. The insurer may delay the payment of this claim for up to 6 months
C. The insurer may settle this claim for less than it otherwise would have had the
notification been provided in a timely manner
D. The insurer may deny the claim since it was not notified within the required 20
day time frame - CORRECT ANSWER ✔✔- A.
While repairing the roof of his house an insured accidentally falls off and breaks
his arm and sustains a head injury that results in total blindness of both eyes. His
policy contains an Accidental Death & Dismemberment Rider. What is the extent
of benefits that he will receive?
A. Reciprocal Amount
B. Principal Sum
C. Capital Sum
D. 50% of the Principal - CORRECT ANSWER ✔✔- B.
Which of the following is true regarding inpatient hospital care for HMO
members?
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,A. Inpatient hospital care is not part of HMO services
B. Care can be provided outside of the service area
C. Can can only be provided in the service area
D. Services for treatment of mental disorders are unlimited - CORRECT
ANSWER ✔✔- B.
As it pertains to group health insurance, the continuation provision stipulates that
A. Terminated employees may convert to an individual policy only upon proof of
insurability
B. Group coverage must be extended for terminated employees up to a certain
period of time at the employers expense
C. Group coverage must be extended for terminated employees up to a certain
period of time at the employees expense
D. Retiring employees must be allowed to convert their group coverage to
individual policies - CORRECT ANSWER ✔✔- C.
All of the following apply to short term disability plans EXCEPT
A. Individual plans can provide benefit periods of up to 2 years
B. A benefit period of 26 weeks is most common for group plans
C. Both group and individual plans are renewable
D. Group plans can provide benefit periods of up to 52 weeks - CORRECT
ANSWER ✔✔- C.
Which describes the features of a comprehensive major medical policy?
A. There is no coinsurance
B. Basic medical expense benefits are provided in single package
C. The deductible is always expressed as a deferred amount
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,D. It is the same as major medical insurance - CORRECT ANSWER ✔✔- B.
If an insurer accepts premium payments by credit card, who is responsible for
paying the fees charged by a credit card company?
A. Credit card company
B. Insurer accepting payment
C. Policy owners, as part of premium
D. Insured - CORRECT ANSWER ✔✔- B.
When a disabled dependent child reaches the age limit for coverage, how long does
the policyowner have to provide proof of dependency in order for the dependent to
remain covered under the policy?
A. 15 days
B. 31 days
C. 60 days
D. 10 days - CORRECT ANSWER ✔✔- B.
If a licensee is convicted of a criminal violation , the licensees insurance license is?
A. Suspended after hearing
B. Automatically suspended
C. Automatically revoked
D. Not affected - CORRECT ANSWER ✔✔- B.
All of the following are differences between Individual and group health insurance
EXCEPT
A. In individual policies, the individual selects coverage options, while in a group
plan all employees are covered for the same coverage which is chosen by employer
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, B. Individual coverage can be written on an occupation or no occupational basis
C. Individual policies are renewable, while group terminates when the individual
leaves
D. Individual insurance does not require medical examinations, while group
insurance does not require medical examinations - CORRECT ANSWER ✔✔- D.
A licensee decides to terminate his residency in the state. Which of the following
would be an appropriate action?
A. Delivering the license to the commissioner within 30 days
B. Allowing the license to expire
C. Notifying the NAIC
D. Notifying the commissioner within 10 days - CORRECT ANSWER ✔✔- A.
Which of the following is not a feature of a noncancelable policy?
A. The insurer may terminate the contract only at renewal for certain conditions
B. The premiums cannot be increased beyond the amount stated in the policy
C. The guarantee to renew coverage usually applies until the insured reaches
certain age
D. The insured has the right to renew the policy for the life of the contract -
CORRECT ANSWER ✔✔- A.
Which of the following must an insurer obtain in order to transact insurance within
a given state?
A. Certificate of authority
B. Producer certificate
C. Business entity license
D. Insurers license - CORRECT ANSWER ✔✔- A.
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EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
When Linda suffered a broken hip, she notified her agent, in writing, within 12
days of the loss. However, her agent did not notify the insurance company until 60
days after the loss. Which of the following statements correctly explains how this
claim would be handled?
A. The insurer is considered to be notified since the notification to agent equals
notification to the insurer
B. The insurer may delay the payment of this claim for up to 6 months
C. The insurer may settle this claim for less than it otherwise would have had the
notification been provided in a timely manner
D. The insurer may deny the claim since it was not notified within the required 20
day time frame - CORRECT ANSWER ✔✔- A.
While repairing the roof of his house an insured accidentally falls off and breaks
his arm and sustains a head injury that results in total blindness of both eyes. His
policy contains an Accidental Death & Dismemberment Rider. What is the extent
of benefits that he will receive?
A. Reciprocal Amount
B. Principal Sum
C. Capital Sum
D. 50% of the Principal - CORRECT ANSWER ✔✔- B.
Which of the following is true regarding inpatient hospital care for HMO
members?
1|Page
,A. Inpatient hospital care is not part of HMO services
B. Care can be provided outside of the service area
C. Can can only be provided in the service area
D. Services for treatment of mental disorders are unlimited - CORRECT
ANSWER ✔✔- B.
As it pertains to group health insurance, the continuation provision stipulates that
A. Terminated employees may convert to an individual policy only upon proof of
insurability
B. Group coverage must be extended for terminated employees up to a certain
period of time at the employers expense
C. Group coverage must be extended for terminated employees up to a certain
period of time at the employees expense
D. Retiring employees must be allowed to convert their group coverage to
individual policies - CORRECT ANSWER ✔✔- C.
All of the following apply to short term disability plans EXCEPT
A. Individual plans can provide benefit periods of up to 2 years
B. A benefit period of 26 weeks is most common for group plans
C. Both group and individual plans are renewable
D. Group plans can provide benefit periods of up to 52 weeks - CORRECT
ANSWER ✔✔- C.
Which describes the features of a comprehensive major medical policy?
A. There is no coinsurance
B. Basic medical expense benefits are provided in single package
C. The deductible is always expressed as a deferred amount
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,D. It is the same as major medical insurance - CORRECT ANSWER ✔✔- B.
If an insurer accepts premium payments by credit card, who is responsible for
paying the fees charged by a credit card company?
A. Credit card company
B. Insurer accepting payment
C. Policy owners, as part of premium
D. Insured - CORRECT ANSWER ✔✔- B.
When a disabled dependent child reaches the age limit for coverage, how long does
the policyowner have to provide proof of dependency in order for the dependent to
remain covered under the policy?
A. 15 days
B. 31 days
C. 60 days
D. 10 days - CORRECT ANSWER ✔✔- B.
If a licensee is convicted of a criminal violation , the licensees insurance license is?
A. Suspended after hearing
B. Automatically suspended
C. Automatically revoked
D. Not affected - CORRECT ANSWER ✔✔- B.
All of the following are differences between Individual and group health insurance
EXCEPT
A. In individual policies, the individual selects coverage options, while in a group
plan all employees are covered for the same coverage which is chosen by employer
3|Page
, B. Individual coverage can be written on an occupation or no occupational basis
C. Individual policies are renewable, while group terminates when the individual
leaves
D. Individual insurance does not require medical examinations, while group
insurance does not require medical examinations - CORRECT ANSWER ✔✔- D.
A licensee decides to terminate his residency in the state. Which of the following
would be an appropriate action?
A. Delivering the license to the commissioner within 30 days
B. Allowing the license to expire
C. Notifying the NAIC
D. Notifying the commissioner within 10 days - CORRECT ANSWER ✔✔- A.
Which of the following is not a feature of a noncancelable policy?
A. The insurer may terminate the contract only at renewal for certain conditions
B. The premiums cannot be increased beyond the amount stated in the policy
C. The guarantee to renew coverage usually applies until the insured reaches
certain age
D. The insured has the right to renew the policy for the life of the contract -
CORRECT ANSWER ✔✔- A.
Which of the following must an insurer obtain in order to transact insurance within
a given state?
A. Certificate of authority
B. Producer certificate
C. Business entity license
D. Insurers license - CORRECT ANSWER ✔✔- A.
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