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NC Accident and Health or Sickness Final Exam Questions and Answers Rated A+
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NC Accident and Health or SicknessFinal Exam
Cindy has a new medical plan that provides both health care services and health care
insurance. She is covered by: - answerc. An HMO (Health Maintenance Organization)
If Dan pays his health insurance premium quarterly and fails to make payment on April
1, his grace period will expire: - answera. May 1
Newborn children are covered: - answera. From the moment of birth
Barbara allows her comprehensive major medical plan to lapse. If her policy is
reinstated on March 20th and she contracts mononucleosis on March 29th, what
benefits will she receive? - answerd. None
An insured has returned to work after a disability, but is unable to perform all of his
previous duties. Which of the following definitions would cover his permanent partial
disability? - answera. Residual disability
What type of policy allows an insurer to cancel a policy if certain circumstances stated in
the contract happen? - answerc. Conditionally renewable
When an insured completed his health policy application, his producer did not take a
premium when he submitted it to the insurer. When the producer delivers the policy to
the applicant, he needs to do all of the following EXCEPT: - answerc. Issue the
applicant a conditional receipt.
The Commissioner may suspend, revoke or refuse to issue or renew an agent license
for which of the following reasons? - answerb. Failure to pay child support
What should the insured do if the insurer fails to send the correct forms, under the
Claims Forms provision of a health policy? - answerd. Create their own form on which to
submit the claim.
If an individual has a chronic medical condition, how is the insurer likely to handle this
situation when issuing an individual health policy? - answerb. The insurer will exclude
the condition with an Impairment rider.
James' Carpet Cleaning is considering a noncontributary health plan. Noncontributory
plans require: - answer100% of eligible employees enroll.
,Paul has a basic medical policy. It will pay for: - answera. Doctor visits
Samson has a policy that allows the insurer to cancel the policy at any date specified in
the contract, and to raise his premiums. Which type of policy is it? - answerd. Optionally
renewable
In most Disability Income policies, the Elimination Period applies: - answerTo each
disability separately.
How many days does an insured have to file a notice of claim? - answerb. 20 days
In North Carolina, group long-term care policies will provide covered individuals with a
basis for continuation or conversion of coverage. How many days after the termination
date must an applicant submit a written application and the first premium payment, in
order to be eligible for an individual policy? - answerd. 31 days
What part of the policy directs the insurer on the recipients of benefits? - answerb.
Payment of Claims provision
Which of the following offers the broadest service area and broadest selection of
providers? - answera. PPO
Long-term care plans are written as: - answerb. Guaranteed renewable
The most common plan used with an HSA is: - answerd. HDHP
Capitation is used in: - answera. HMOs
If an applicant misstates their age on an insurance application, what does the insurer do
when it is discovered at claim time? - answerc. Adjust the claim benefits to reflect what
he would have been entitled to if his real age had been given.
A person who is licensed as an agent represents: - answera. The insurer
What right of renewability guarantees insurability, but does not guarantee premiums? -
answerc. Guaranteed renewable
Boycott, coercion and intimidation are all types of: - answerc. Unfair trade practices
An individual has a disability income policy with a Change of Occupation clause when
he changes to a new more hazardous job. He neglects to inform the insurer. What
happens if one year later he files a claim when he becomes disabled? - answerc. The
insurer will pay the claim based on what the premiums would have purchased had the
hazardous occupation been known.
, Which of the following statements is correct when pertaining to coordination of benefits
by a group long-term disability plan with Social Security? - answerb. Group and Social
Security benefits pay a combined maximum limit.
Sam works for large corporation and is eligible for both his company's health plan and
Medicare. Which plan would be primary? - answera. Work
What type of insurance contract is prepared by the insurer and not negotiated? -
answerd. Adhesion
According to the Physical Examination and Autopsy provision, who is responsible for
paying the cost of examining the insured? - answerc. The insurer
A POS (Point od Service) plan is a combination of: - answera. HMO and PPO
The cheapest premium payment mode would be on a policy that is paid: - answerd.
Annually
How many days does an insurer have to provide claims forms after a notice of claim? -
answerc. 15 days
With a Guaranteed Insurability rider on a Disability Income policy, the: - answerb. The
insured can buy additional disability income coverage without proving evidence of
insurability.
The Commissioner performs all of the following duties, EXCEPT: - answerd. Amends
insurance statutes
A Waiver of Premium provision in a Disability Income policy allows: - answera. The
insured to maintain a policy in force while unable to pay premiums when disabled.
Which of the following is not a type of utilization review? - answerc. Introspective review
The insurer has a maximum of how many days after receiving notice of a claim to
provide claims forms? - answerb. 15 days
Greg, a teacher, has a disability income policy with the change of occupation provision.
Greg quits his and becomes an oilfield worker. What would happen to Greg's policy if he
becomes disabled after the job change? - answera. The insurance company would pay
the amount of disability income benefits that the premium purchased would have
covered for Greg's more hazardous occupation.
A health policy will usually exclude losses related to all of the following, EXCEPT: -
answerd. Losses from an auto accident when the insured was at fault
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