PEARSON VUE NATIONAL HEALTH INSURANCE
EXAM SCRIPT 2026 FULL SOLUTION
◉ What are group health insurance plans? Answer: Health insurance
policies offered to groups of people, usually through employers.
◉ What is COBRA? Answer: A federal law allowing continuation of
group health coverage after leaving employment for a limited time.
◉ What does the HIPAA Privacy Rule protect? Answer: The
confidentiality of patients' health information.
◉ What is catastrophic health insurance? Answer: A plan with low
premiums and very high deductibles designed for worst-case
scenarios.
◉ What are mandated benefits in health insurance? Answer:
Services or conditions state law requires insurers to cover.
◉ How is "disability" typically defined differently in health
insurance policies? Answer: Some define disability as inability to
perform your own occupation; others as inability to perform any
occupation for which you are reasonably suited.
,◉ What factors can legally be used by underwriters in North
Carolina to determine health insurance eligibility? Answer: Age,
tobacco use, and geographic location are typically permitted; health
status is limited post-ACA.
◉ What does "subrogation" mean in health insurance claims?
Answer: The insurer's right to pursue a third party who caused the
insured's injury to recover claim costs paid.
◉ What is the free look period for health insurance in NC? Answer:
10 days
◉ What is the grace period for weekly premium policies? Answer: 7
days
◉ What is the grace period for monthly premium policies? Answer:
10 days
◉ What is the grace period for all other premium schedules?
Answer: 31 days
◉ What is the required notice before policy lapse due to
nonpayment? Answer: 15 days
,◉ What is the contestability period (except in cases of fraud)?
Answer: 2 years
◉ What is the time limit for insurers to send claim forms after
receiving notice? Answer: 15 days
◉ What is the deadline for submitting notice of claim? Answer: 20
days
◉ What is the deadline for submitting proof of loss? Answer: 180
days
◉ What is the required payment time for indemnity claims? Answer:
Immediately
◉ What is the required payment frequency for disability claims?
Answer: Monthly
◉ What is the waiting period for sickness coverage after
reinstatement? Answer: 10 days
◉ What is the waiting period for accident coverage after
reinstatement? Answer: None
, ◉ What is the minimum wait before legal action can be taken after
filing a claim? Answer: 60 days
◉ What is the maximum time allowed to file legal action after a
claim? Answer: 3 years
◉ What is the required notice before increasing individual policy
rates? Answer: 30 days
◉ What is the definition of a small employer in NC? Answer: 2-50
employees
◉ What is the minimum workweek to qualify as a full-time
employee? Answer: 30 hours
◉ What is the deadline to add a new employee to group coverage?
Answer: 90 days
◉ What is the minimum guaranteed period for group health
insurance rates? Answer: 12 months
◉ What is the look-back period for preexisting conditions? Answer:
6 months
EXAM SCRIPT 2026 FULL SOLUTION
◉ What are group health insurance plans? Answer: Health insurance
policies offered to groups of people, usually through employers.
◉ What is COBRA? Answer: A federal law allowing continuation of
group health coverage after leaving employment for a limited time.
◉ What does the HIPAA Privacy Rule protect? Answer: The
confidentiality of patients' health information.
◉ What is catastrophic health insurance? Answer: A plan with low
premiums and very high deductibles designed for worst-case
scenarios.
◉ What are mandated benefits in health insurance? Answer:
Services or conditions state law requires insurers to cover.
◉ How is "disability" typically defined differently in health
insurance policies? Answer: Some define disability as inability to
perform your own occupation; others as inability to perform any
occupation for which you are reasonably suited.
,◉ What factors can legally be used by underwriters in North
Carolina to determine health insurance eligibility? Answer: Age,
tobacco use, and geographic location are typically permitted; health
status is limited post-ACA.
◉ What does "subrogation" mean in health insurance claims?
Answer: The insurer's right to pursue a third party who caused the
insured's injury to recover claim costs paid.
◉ What is the free look period for health insurance in NC? Answer:
10 days
◉ What is the grace period for weekly premium policies? Answer: 7
days
◉ What is the grace period for monthly premium policies? Answer:
10 days
◉ What is the grace period for all other premium schedules?
Answer: 31 days
◉ What is the required notice before policy lapse due to
nonpayment? Answer: 15 days
,◉ What is the contestability period (except in cases of fraud)?
Answer: 2 years
◉ What is the time limit for insurers to send claim forms after
receiving notice? Answer: 15 days
◉ What is the deadline for submitting notice of claim? Answer: 20
days
◉ What is the deadline for submitting proof of loss? Answer: 180
days
◉ What is the required payment time for indemnity claims? Answer:
Immediately
◉ What is the required payment frequency for disability claims?
Answer: Monthly
◉ What is the waiting period for sickness coverage after
reinstatement? Answer: 10 days
◉ What is the waiting period for accident coverage after
reinstatement? Answer: None
, ◉ What is the minimum wait before legal action can be taken after
filing a claim? Answer: 60 days
◉ What is the maximum time allowed to file legal action after a
claim? Answer: 3 years
◉ What is the required notice before increasing individual policy
rates? Answer: 30 days
◉ What is the definition of a small employer in NC? Answer: 2-50
employees
◉ What is the minimum workweek to qualify as a full-time
employee? Answer: 30 hours
◉ What is the deadline to add a new employee to group coverage?
Answer: 90 days
◉ What is the minimum guaranteed period for group health
insurance rates? Answer: 12 months
◉ What is the look-back period for preexisting conditions? Answer:
6 months
