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NC Health Insurance - Accident & Health Insurance Provisions - Chapter Quiz Questions and Answers 100% Solved
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NC Health Insurance - Accident & Health Insurance Provisions - Chapter Quiz
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NC Health Insurance - Accident & HealthInsurance Provisions - Chapter Quiz
An insured carries health insurance with two different providers and is covered on an
expense incurred basis. He has an appendectomy and files the claims to both insurers.
Neither company is notified in advance that the insurer has other coverage. What
should each insurer pay?
A. Only one should pay the full amount
B. Nothing. The insured lied about the dual nature of his coverage, so the insurers are
not responsible for covering the claims
C. The full amount
D. A proportionate amount – answer D. A proportionate amount
In the event that an insured is covered on an expense-incurred basis for the same
expenses under multiple insurers and the insurers are not informed about the other
sources of coverage before the loss, proportionate shares of the claims should be paid
A man is injured while robbing a convenience store. How does his major medical policy
handle the payment of his claim?
A. 50% of claim will be paid
B. If the man is not convicted, he will get 75% of his claim paid
C. The claim is paid in full
D. Claim is denied if his policy contains the Illegal Occupation provision - answerD.
Claim is denied if his policy contains the Illegal Occupation provision
This optional provision specifically excludes coverage for injuries incurred while
performing an illegal act. The insurer will not be liable for any loss to which a
contributing cause was the insured's commission of or attempt to commit a felony or to
which a contributing cause was the insured's being engaged in an illegal occupation.
An insured wants to name her husband as the beneficiary of her health policy. She also
wishes to retain all of the rights of ownership. The insured should have her husband
named as what type of beneficiary?
A. Irrevocable
B. Revocable
C. Primary
D. Contingent - answerB. Revocable
, If her husband is named the revocable beneficiary, the insured would be the
policyowner and could make changes to contract. Her husband would receive any death
benefit
When an insured purchased her disability income policy, she misstated her age to the
agent. She told the agent that she was 30 years old, when in fact, she was 37. If the
policy contains the optional misstatement of age provision
A. The elimination will be extended 6 months for each year of age misstatement
B. Because the misstatement occurred more than 2 years ago, it has no effect.
C. Amounts payable under the policy will reflect the insured's correct age
D. The contract will be deemed void because of the misstatement of age. - answerC.
Amounts payable under the policy will reflect the insured's correct age
If an insured misstates his or her age upon policy application, the optional misstatement
of age provision will change the payable benefit to that which would have been
purchased at the insured's actual age.
An insured owes his insurer a premium payment. Since then, he incurs medical
expenses. The insurer deducts the unpaid premium amount from the claim amount and
pays the insured the difference. What is the name of this provision?
A. Proof of loss
B. Payment of claims
C. Unpaid premium
D. Legal action - answerC. Unpaid premium
If a premium is past due and the insurer owes claim payment, the amount of the
premium will be deducted from the amount of the claim. For example, if a claim is worth
$500 and the premium costs $200, the insured would receive the net total of $300 from
his insurer.
Which of the following provisions is mandatory for health insurance policies?
A. Physical examination and autopsy
B. Recurrent disability
C. Unpaid premiums
D. Intoxicants and narcotics - answerA. Physical examination and autopsy
Physical examination and autopsy is a mandatory required by law. The other answer
choices are optional provisions
Which of the following statements is true concerning the alteration of optional policy
provisions?
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