Aflac

✅✅
How would a contingent beneficiary receive the policy proceeds in an Accidental
Death and Dismemberment (AD&D) policy? - -If the primary beneficiary dies
before the insured

S is employed by a large corporation that provides group health coverage for its
employees and their dependents. If S dies, the company must allow his surviving

✅✅
spouse and dependents to continue their group health coverage for a maximum of
how many months under COBRA regulations? - -36

✅✅
The difference between group insurance and blanket health policies is: -
-Blanket health policies do not issue certificates

P is a new employee and will be obtaining non-contributory group Major Medical

✅✅
insurance from her employer. Which of the following actions must she take during
the open enrollment period? - -Sign an enrollment card

G is an accountant who has ten employees and is concerned about how the

✅✅
business would survive financially if G became disabled. The type of policy which
BEST addresses this concern is: - -Business Overhead Expense.

Which of the following statements BEST describes how a policy that uses the

✅✅
"accidental bodily injury" definition of an accident differs from one that uses the
"accidental means" definition? - -Less restrictive

How does group insurance differ from individual insurance? - ✅✅-Premiums are
lower

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's contingent beneficiary

B has a $100,000 Accidental Death and Dismemberment policy that pays triple

✅✅
indemnity for common carrier death. If B is killed from an accident on a commercial
flight, what will the policy pay B's beneficiary? - -$300,000

Which statement is true regarding a minor beneficiary? - ✅✅ -Normally, a guardian

is required to be appointed in the Beneficiary clause of the contract

P and Q are married and have three children. P is the primary beneficiary on Q's
Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the

✅✅
contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are
killed instantly. The Accidental Death benefits will be paid to: - -P only
 ✅✅
Under which of the following circumstances will the benefits under COBRA
continuation coverage end? - -All group health plans are terminated by the
employer

A Business Overhead Expense policy: - ✅✅-covers business expenses such as

rent and utilities

An insured covered by Accidental Death and Dismemberment (AD&D) insurance has

✅✅
just died. What will happen if the primary beneficiary had already died before the
insured and contingent beneficiary? - -Proceeds will go to the contingent
beneficiary

✅✅
The federal income tax treatment of employer-provided group Medical Expense
insurance can be accurately described as: - -Employee's premiums paid by the
employer is tax-deductible to the employer as a business expenditure

✅✅
What is the maximum Social Security Disability benefit amount an insured can
receive? - -100% of the insured's Primary Insurance Amount (PIA)

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

✅✅
Which of these statements is INCORRECT regarding a Preferred Provider
Organization (PPO)? - -PPO's are NOT a type of managed care systems

✅✅
A medical care provider which typically delivers health services at its own local
medical facility is known as a: - -Health Maintenance Organization

✅✅
Which of the following statements is true about most Blue Cross/Blue Shield
organizations? - -They are nonprofit organizations

✅✅
The percentage of an individual's Primary Insurance Amount (PIA) determines the
benefits paid in which of the following programs? - -Social Security Disability
Income

Which of these is considered a true statement regarding Medicaid? - ✅✅-Funded

by both state and federal governments

✅✅
The health insurance program which is administered by each state and funded by
both the federal and state governments is called: - -Medicaid
Medicare is intended for all of the following groups, EXCEPT: - ✅✅-Those enrolled
as a full-time student

What is Medicare? - ✅✅-is a hospital and medical expense insurance program

✅✅
S wants to open a tax-exempt Health Savings Account. To qualify for this type of
account, Federal law dictates that S must be enrolled in a: - -High-deductible
health plan

A comprehensive major medical health insurance policy contains an Eligible

Expenses provision which identifies the types of health care services that are

✅✅
covered. All of the following health care services are typically covered, EXCEPT for:
- -experimental and investigative services

A prospective insured completes and signs an application for health insurance but
intentionally conceals information about a pre-existing heart condition. The company
issues the policy. Two months later, the insured suffers a heart attack and submits a

✅✅
claim. While processing the claim, the company discovers the pre-existing condition.
In this situation, the company will: - -continue coverage but exclude the heart
condition

✅✅
Which of the following BEST describes a Hospital Indemnity policy? -
-Coverage that pays a stated amount per day of a covered hospitalization

T was treated for an ailment 2 months prior to applying for a health insurance policy.

✅✅
This condition was noted on the application and the policy was issued shortly
afterwards. How will the insurer likely consider this condition? - -Insurer will
likely treat as a pre-existing condition which may not be covered for one year

✅✅
Which of the following medical expenses does Cancer insurance NOT cover? -
-Arthritis

✅✅-life insurance policies

Which of the following is NOT a limited benefit plan? -

Deductibles are used in health policies to lower: - ✅✅-overuse of medical services

✅✅
Which of the following statements BEST describes dental care indemnity coverage?
- -Services are reimbursed after insurer receives the invoice

✅✅
In order to establish a Health Reimbursement Arrangement (HRA), it MUST: -
-be established by the employer

✅✅
Which of the following phrases refers to the fees charged by a healthcare
professional? - -Usual, customary, and reasonable expenses
 ✅✅
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

An individual has a Major Medical policy with a $5,000 deductible and an 80/20

✅✅
Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in
covered medical expenses are incurred? - -$7,000

✅✅
The first portion of a covered Major Medical insurance expense that the insured is
required to pay is called the: - -initial deductible

✅✅
M is insured under a basic Hospital/Surgical Expense policy. A physician performs
surgery on M. What determines the claim M is eligible for? - -Determined by
the terms of the policy

V is insured under an individual Disability Income policy with a 30-day Elimination

✅✅
period. On July 1, he is involved in an accident and temporarily disabled. He returns
to work on December 1. How many months of benefit are payable? - -4 months

N is covered under an individual Disability policy with a 30-day Elimination period

✅✅
and a monthly benefit of $500. N is totally disabled for 3 1/2 months. N's total benefit
received on this claim is: - -$1,250

R had received full disability income benefits for 6 months. When he returns to work,

✅✅
he is only able to resume half his normal daily workload. Which provision pays
reduced benefits to R while he is not working at full capacity? - -Residual
Disability

A Disability Income policy owner suffers a disability which was due to the same
cause as a previous disability. Both disabilities occurred within a five-month period.

✅✅
The insurer may cover the second disability without a new elimination period under
the: - -Recurrent Disability provision

P received Disability income benefits for 3 months then returns to work. She is able
to work one month before her condition returns, leaving her disabled once again.

✅✅
What would the insurance company most likely regard this second period of disability
as? - -A recurrent disability

Non-occupational disability coverage is designed for: - ✅✅ -employees who suffer

non-work related disabilities, since work-related disabilities are covered by Workers'
Compensation
✅✅
In a Disability Income policy, which of these clauses acts as a deductible? -
-Elimination Period

A CEO's personal assistant suffered injuries at home and as a result, was unable to

✅✅
work for four months. Which type of policy will pay a monthly benefit to the personal
assistant? - -Disability Income

✅✅
T has Disability Income policy that pays a monthly benefit of $5000. If T becomes
partially disabled, what can he likely expect? - -Less than $5,000 per month
benefit regardless of the cause

✅✅
Which of the following is the MOST important factor when deciding how much
Disability Income coverage an applicant should purchase? - -Applicant's
monthly income

✅✅
Which of the following health insurance policy provisions specifies the health care
services a policy will provide? - -Insuring clause

Which of these is considered a mandatory provision? - ✅✅-Payment of Claims

An assignment of benefits of a Health Policy: - ✅✅-transfers payments to someone
other than the policy owner

When an insurance company sends a policy to the insured with an attached

✅✅
application, the element that makes the application part of the contract between the
insured and the insurer is called the: - -Entire Contract provision

✅✅
The Legal Actions provision of an insurance contract is designed to do all of the
following, EXCEPT: - -protect the producer

✅✅
Which health policy clause stipulates that an insurance company must attach a copy
of the application to the policy to ensure that it is part of the contract? - -Entire
Contract

✅✅
The clause in an Accident and Health policy which defines the benefit amounts the
insurer will pay is called the: - -Insuring clause

The Notice of Claims provision requires a policyowner to: - ✅✅-notify an insurer of

a claim within a specified time

J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries
sustained in an accident. J's age as stated on the application five years ago was
found to be understated by ten years. Which of the following actions will the
insurance company take? - ✅✅-The insurer will adjust the benefit to what the
premiums paid would have purchased at the insured's actual age

✅✅
What should an insured do if the insurer does not send claims forms within the time
period set forth in a health policy's Claims Forms provision? - -Submit the claim
in any form

Periodic health claim payments MUST be made at least: - ✅✅-Monthly

✅✅
When does a Probationary Period provision become effective in a health insurance
contract? - -At the policy's inception

An insurer receives proof of loss for an acceptable medical expense claim under an

✅✅
Individual Health Insurance Policy. Under the Time of Payment of Claims provision,
the insurer MUST pay the benefits: - -Immediately

T files a claim on his Accident and Health policy after being treated for an illness.
The insurance company believes that T misrepresented his actual health on the
initial insurance application and is, therefore, disputing the claim's validity. The

✅✅
provision that limits the time period during which the company may dispute a claim's
validity is called: - -Time Limit on Certain Defenses

✅✅
Which of the following policy provisions prohibits an insurance company from
incorporating external documents into an insurance policy? - -Entire Contract

What type of rider would be added to an Accident and Health policy if the policy

✅✅
owner wants to ensure the policy will continue if he/she ever becomes totally
disabled? - -Waiver of Premium rider

An insurance company receives E's application for an individual health policy. E did
not complete all of the medical history questions because she could not remember
the exact dates. E signed the policy and submitted it to the insurance company
anyway. A few weeks later, E suffers a heart attack and is hospitalized without
completing the medical history questions and paying the initial premium. E is not

✅✅
insured. Which of the following clauses details the conditions that E did not meet? -
-Consideration clause

✅✅
In health insurance policies, a waiver of premium provision keeps the coverage in
force without premium payments: - -After an insured has become totally
disabled as defined in the policy

✅✅
Which of the following statements describes what an Accident and Health
policyowner may NOT do? - -Adjust the premium payments
T owns an Accident & Health policy and notifies her insurance company that she has

✅✅
chosen a less hazardous occupation. Under the Change of Occupation provision,
which of the following actions may her insurance company take? - -Increase
her policy's coverage amount

✅✅
An incomplete health insurance application submitted to an insurer will result in
which of these actions? - -Application will be returned to the writing producer

Which of the following are NOT managed care organizations? - ✅✅-Medical

Information Bureau (MIB)

✅✅
Which of the following actions will an insurance company most likely NOT take if an
applicant, who has diabetes, applies for a Disability Income policy? - -Issue the
policy with an altered Time of Payment of Claims provision

Pre-hospitalization authorization is considered an example of: - ✅✅-managed care

✅✅
All of these are considered sources of underwriting information about an applicant,
EXCEPT: - -Rating Services

✅✅
What action should a producer take if the initial premium is NOT submitted with the
application? - -Forward the application to the insurer without the initial premium

An agent takes an individual Disability Income application, collects the appropriate

✅✅
premium, and issues the prospective insured a conditional receipt. The next step the
insurance company will take is to: - -determine if the applicant is an acceptable
risk by completing standard underwriting procedures

✅✅
Which of the following correctly explains the actions an agent should take if a
customer wants to apply for an insurance policy? - -Complete the application
and review the information with the customer prior to obtaining the customer's
signature, then send the application off to the insurance company

✅✅
Information obtained from a phone conversation to the proposed insured can be
found in which of these reports? - -Inspection report

Which parts of a health insurance policy are guaranteed to be true? - ✅✅-Warranty

✅✅
Which of these actions should a producer take when submitting an insurance
application to an insurer? - -Inform insurer of relevant information not included
on the application

✅✅
When an insurance application is taken by a producer, which of these statements is
true? - -Any changes made on the application require the applicant's initials
 ✅✅
An insurance company may NOT reject a prospective insured's insurance application
on the basis of which of the following factors? - -Gender

✅✅
Before a health insurance policy is issued, which of these components of the
contract is required? - -Applicant's signature on application

✅✅
Which of these factors do NOT play a role in the underwriting of a health insurance
policy? - -Marital status

✅✅
Every insurance agent/broker MUST maintain all records, books, and documents for
insurance transactions for a period of not less than - -5 years

Which of the following requires that an applicant for an individual Health Policy be

✅✅
notified of an investigation into his personal character, general reputation, and mode
of living? - -Insurance Information and Privacy Protection Act

When L applies for a Health Insurance Policy, L unintentionally fails to list a previous
visit to a cardiologist. If the insurance company contests the policy, it MUST do so

✅✅
within 2 years
after it discovers the misstatement - -from the date of issue

✅✅
A vacancy that occurs during the North Carolina Commissioner of Insurance's term
of office MUST be filled by the - -Governor

Insurers organized under the laws of North Carolina are called - ✅✅-domestic
companies

✅✅
In North Carolina, a health policy that is paid on a quarterly basis requires a grace
period of - -31 Days

✅✅
For an individual health policy that is paid for on a monthly basis, the Grace Period
provision is a MINIMUM of how many days? - -10 Days

An example of unfair discrimination would be - ✅✅-offering different terms of

coverage for different policy owners having the same risk classification

An example of an unfair claims practice would be - ✅✅-failing to effectuate prompt,

fair, and equitable settlements of a claim

AT LEAST how many days before the effective date of a rate increase must an

✅✅
insurer provide written notice to individual accident and health policy owners? -
-30
 ✅✅
The policyholder has how many days to return an Accident/Health Insurance Policy
and receive a full refund on premiums? - -10

A temporary license is issued by the Commissioner of Insurance to allow - ✅✅-the

personal representative of a deceased agent to provide service to existing
policyowners

✅✅
Continuation of coverage of a group Hospital, Surgical, and Major Medical Policy
MUST include - -hospital expenses

✅✅
If an insurer has been notified by the Commissioner of Insurance that an individual
Health Policy form does not comply with the state's laws, the insurer may - -not
issue the form in connection with any new application

✅✅
Every Group Health Policy providing benefits for chemical dependency treatments
must include, for the life of the contract, a - -$16,000

✅✅
According to the Affordable Care Act (ACA), a dependent child's eligibility status is
determined by - -age

Under a Group Health Insurance Policy, continuation shall be available only to an

✅✅
employee who has been insured immediately prior to the date of termination for a
period of AT LEAST - -3 months

Circulation of any oral or written statement or any pamphlet, circular, article, or

✅✅
literature that is false or maliciously critical of or derogatory to the financial condition
of an insurer is known as - -defamation

An agent that has been or is engaged in conduct that violates the Insurance
Information and Privacy Protection Act shall be issued and served a statement of

✅✅
charges and notice of hearing by the Commissioner of Insurance. The date of such
hearing shall be AT LEAST how many days after service of charges? - -10

✅✅
Approved premium rates for group health insurance shall be guaranteed by the
insurer for an initial period of not LESS than how many months? - -12

✅✅
The funds used by the Life and Health Insurance Guaranty Association to carry out
its purpose are obtained from the - -member companies

✅✅
The Insurance Information and Privacy Protection Act is designed to limit or direct
the information collection activities of all of the following EXCEPT - -insurance
regulators
 ✅✅
An insurance company MUST clearly specify questions designed to obtain
information solely for marketing research - -in any insurance transaction

✅✅
The fund that assures policyholders payment of death benefits on Life Policies, if the
company is insolvent at the time of the claim, is called the - -Life and Health
Insurance Guaranty Association

✅✅
After notice and a hearing, the Insurance Commissioner may revoke an agent's
license for all of the following reasons EXCEPT the - -agent is found to be
insolvent

✅✅
Before a Health Policy is issued or delivered, the form, classification or risks, and
premium rates MUST be filed with the - -Commissioner of Insurance

✅✅
The following acts are examples of unfair methods of competition and deceptive
practices in the business of insurance EXCEPT the use of - -comparisons
showing that a policy has higher benefits

✅✅
North Carolina insurance law specifically allows the Commissioner to issue a
temporary license to which of the following individuals? - -A surviving spouse of
a deceased agent

✅✅
To be licensed as an accident and health insurance agent in North Carolina, the
applicant MUST - -have successfully completed at least 20 hours of instruction
approved by the Commissioner of Insurance

✅✅
If a company accepts a renewal premium payment that would extend coverage
beyond the policy's MAXIMUM age limit, the company - -must continue the
coverage to the end of the period of time for which the premium was accepted

✅✅
One of the stated purposes of the Life and Health Insurance Guaranty Association is
to - -assist in the prevention of insurer insolvencies

✅✅
Eligible employees must be added to group health coverage NO LATER than how
many days after their first day of employment? - -90 days

All of the following actions are considered rebating EXCEPT - ✅✅-sharing

commissions with other licensed and appointed agents

No insurer shall refuse to insure an individual because of - ✅✅-race

✅✅
Which of the following statements is true about most Blue Cross/Blue Shield
organizations? - -They are nonprofit organizations
 ✅✅
The provision in a health insurance policy that suspends premiums being paid to the
insurer while the insured is disabled is called the: - -Waiver of Premium

✅✅
An insured MUST submit a proof of loss on a health insurance claim within how
many days after the date of loss? - -180

✅✅
Which of the following BEST describes a short-term medical expense policy? -
-Nonrenewable

What is the elimination period of an individual disability policy? - ✅✅-Time period a

disabled person must wait before benefits are paid

✅✅
Which of the following BEST describes how pre-admission certifications are used? -
-Used to prevent nonessential medical costs

An insurance broker in North Carolina is a representative of the - ✅✅-insured

A comprehensive major medical health insurance policy contains an Eligible
Expenses provision which identifies the types of health care services that are

✅✅
covered. All of the following health care services are typically covered, EXCEPT for:
- -experimental and investigative services

✅✅
With a Basic Medical Expense policy, what does the hospitalization expense cover? -
-hospital room and board

According to the Information and Privacy Protection Act, when access to recorded
personal information is requested following an adverse underwriting decision, the

✅✅
insurer must make the information available within how many business days? -
-30

✅✅
An insurance company MUST clearly specify questions designed to obtain
information solely for marketing research - -in any insurance transaction

✅✅
Which of these statements accurately describes the Waiver of Premium provision in
an Accident and Health policy? - -Premiums are waived after the insured has
been totally disabled for a specified time period

What type of rider would be added to an Accident and Health policy if the

✅✅
policyowner wants to ensure the policy will continue if he/she ever becomes totally
disabled? - -Waiver of Premium rider

✅✅
What must the policyowner provide to the insurer for validation that a loss has
occurred? - -Proof of Loss
 ✅✅
The rules and regulations of the Life and Health Insurance Guaranty Association in
North Carolina apply to - -Life and Health Policies issued by companies
authorized in North Carolina

✅✅
Boycott, coercion, and intimidation that result in the unreasonable restraint of trade
are prohibited under the North Carolina insurance laws covering - -unfair trade
practices

✅✅
Which contract permits the remaining partners to buy-out the interest of a disabled
business partner? - -Disability Buy-Sell

✅✅
Which of the following statements about a Guaranteed Renewable Health Insurance
policy is CORRECT? - -Premiums normally increase at time of renewal

✅✅
Under the Affordable Care Act (ACA), health coverage is provided for dependents up
to the age of - -26

✅✅
Which of the following policy provisions prohibits an insurance company from
incorporating external documents into an insurance policy? - -Entire Contract

✅✅
Which of the following reimburses its insureds for covered medical expenses? -
-Commercial insurers

✅✅
What is the primary factor that determines the benefits paid under a disability income
policy? - -Wage

✅✅
A Fraternal Benefit Society has each of the following characteristics EXCEPT -
-Exists For profit

A policyowner would like to change the beneficiary on an Accidental Death and

✅✅
Dismemberment (AD&D) insurance policy and make the change permanent. Which
type of designation would fulfill this need? - -Irrevocable

✅✅
In North Carolina, which of the following is required in order to continue a resident
insurance agent license? - -Meeting continuing education requirements

✅✅
In a Disability Income policy, which of these clauses acts as a deductible? -
-Elimination Period

N has a Major Medical policy that only pays a portion of N's medical expenses. N is

✅✅
responsible for paying the remaining balance. This provision is known as: -
-Coinsurance
What does Medicare Parts A and B cover? - ✅✅-Part A covers hospitalization;
Part B covers doctor's services

✅✅
Which of the following characteristics is associated with a large group disability
income policy? - -No medical underwriting

✅✅
The situation in which a group of physicians are salaried employees and conduct
business in an HMO facility is called a(n): - -closed panel

What is the purpose of the Time of Payment of Claims provision? - ✅✅-Prevents

delayed claim payments made by the insurer

✅✅
Which of the following is the MOST important factor when deciding how much
Disability Income coverage an applicant should purchase? - -Applicant's
monthly income

✅✅
The Health Insurance Portability and Accountability Act (HIPAA) gives privacy
protection for: - -health information

J has a Disability Income policy that does NOT provide benefits for losses occurring

✅✅
as the result of his employment. What kind of coverage is this? -
-Nonoccupational coverage

Which statement is true regarding a minor beneficiary? - ✅✅ -Normally, a guardian

is required to be appointed in the Beneficiary clause of the contract

✅✅
In North Carolina, an insurer licensed to conduct business in North Carolina, but
domiciled in New Jersey, is called a(n) - -foreign company

✅✅
Which of the following health policy provisions states that the producer does NOT
have the authority to change the policy or waive any of its provisions? - -Entire
Contract

✅✅
Which of the following statements BEST defines usual, customary, and reasonable
(UCR) charges? - -The maximum amount considered eligible for
reimbursement by an insurance company under a health plan

✅✅
The percentage of an individual's Primary Insurance Amount (PIA) determines the
benefits paid in which of the following programs? - -Social Security Disability
Income

✅✅
A policyowner's rights are limited under which beneficiary designation? -
-Irrevocable
 ✅✅
Which of the following health insurance policy provisions specifies the health care
services a policy will provide? - -Insuring clause

✅✅
Accidental Death coverage is provided to commercial airline passengers in which of
the following types of policies? - -Blanket Accident policy

✅✅
Which of the following is the reimbursement of benefits for the treatment of a
beneficiary's injuries caused by a third party? - -Subrogation

M becomes disabled and is unable to work for six months. M dies soon after from
complications arising from this disability. M has a Disability Income policy that pays

✅✅
$2,000 a month. Which of the following statements BEST describes what is owed to
her estate? - -Earned, but unpaid benefits

K is the insured and P is the sole beneficiary on an Accidental Death and

Dismemberment (AD&D) insurance policy. Both are involved in a fatal accident

✅✅
where K dies before P. Under the Common Disaster provision, which of these
statements is true? - -Proceeds will be paid to P's estate

Comprehensive Major Medical policies usually combine: - ✅✅-Major Medical with

Basic Hospital/Surgical coverage

✅✅
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and
their families) whose employment has been terminated the right to: - -continue
group health benefits

Which of the following statements BEST describes how a policy that uses the

✅✅
"accidental bodily injury" definition of an accident differs from one that uses the
"accidental means" definition? - -Less restrictive

Which type of renewability best describes a Disability Income policy that covers an

✅✅
individual until the age of 65, but the insurer has the right to change the premium
rate for the overall risk class? - -Guaranteed Renewable

✅✅
Information obtained from a phone conversation to the proposed insured can be
found in which of these reports? - -Inspection report

Which mode of payment is NOT used by health insurance policies? - ✅✅-Single

premium

When an insurance company sends a policy to the insured with an attached

✅✅
application, the element that makes the application part of the contract between the
insured and the insurer is called the: - -Entire Contract provision
✅✅
Any changes made on an insurance application requires the initials of whom? -
-Applicant

Which type of plan normally includes hospice benefits? - ✅✅-Managed care plans
✅✅
The Commissioner of insurance may suspend, revoke, or refuse to renew the license
of an agent who - -is found guilty of misrepresentation or fraud in obtaining the
license

✅✅
If an individual has an Accidental Death and Dismemberment policy and dies, an
autopsy can be performed in all these situations, EXCEPT: - -When the state
prohibits this by law

✅✅
Which of these types of coverage is best described as a short term medical policy? -
-interim coverage

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

Which of these is considered a true statement regarding Medicaid? - ✅✅-Funded

by both state and federal governments

T files a claim on his Accident and Health policy after being treated for an illness.
The insurance company believes that T misrepresented his actual health on the
initial insurance application and is, therefore, disputing the claim's validity. The

✅✅
provision that limits the time period during which the company may dispute a claim's
validity is called: - -Time Limit on Certain Defenses

✅✅
Which of the following BEST describes a Hospital Indemnity policy? -
-Coverage that pays a stated amount per day of a covered hospitalization

✅✅
An insured must notify an insurer of a medical claim within how many days after an
accident? - -20

✅✅
During the Grace Period, the benefits of an individual health policy will remain in
force if - -the premium is paid

K works for XYZ Clothing Store from September through December each year. K

✅✅
works 45 hours a week for this period of time. The employer's Group Policy would
consider K - -not eligible for the insurance because as a seasonal employee K
does not meet the definition of "employee" under North Carolina law
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries
sustained in an accident. J's age as stated on the application five years ago was

✅✅
found to be understated by ten years. Which of the following actions will the
insurance company take? - -The insurer will adjust the benefit to what the
premiums paid would have purchased at the insured's actual age

✅✅
After an insured gives notice of loss, what must he/she do if the insurer does not
furnish forms? - -File written proof of loss

✅✅
Approved premium rates for group health insurance shall be guaranteed by the
insurer for an initial period of not LESS than how many months? - -12

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

T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an

✅✅
irrevocable beneficiary. What action will the insurance company take if T requests a
change of beneficiary? - -Request of the change will be refused

Health insurance benefits NOT covered due to an act of war are: - ✅✅-excluded
by the insurer in the contract provisions

Which of the following requires that an applicant for an individual Health Policy be

✅✅
notified of an investigation into his personal character, general reputation, and mode
of living? - -Insurance Information and Privacy Protection Act

✅✅
The individual who provides general medical care for a patient as well as the referral
for specialized care is known as a: - -Primary Care Physician

✅✅
Which of the following statements about the classification of applicants is
INCORRECT? - -Substandard applicants are never declined by underwriters

✅✅
If a company accepts a renewal premium payment that would extend coverage
beyond the policy's MAXIMUM age limit, the company - -must continue the
coverage to the end of the period of time for which the premium was accepted

When L applies for a Health Insurance Policy, L unintentionally fails to list a previous

✅✅
visit to a cardiologist. If the insurance company contests the policy, it MUST do so
within 2 years - -From date of issue

Who is NOT required to sign a health insurance application? - ✅✅-Beneficiary

 ✅✅
Defamation is BEST described as publishing or circulating which of the following
types of information? - -Brochures falsely criticizing the financial condition of an
insurance company

Pre-hospitalization authorization is considered an example of: - ✅✅-managed care

P received Disability income benefits for 3 months then returns to work. She is able
to work one month before her condition returns, leaving her disabled once again.

✅✅
What would the insurance company most likely regard this second period of disability
as? - -A recurrent disability

✅✅
The funds used by the Life and Health Insurance Guaranty Association to carry out
its purpose are obtained from the - -member companies

✅✅
K becomes ill after traveling overseas and is unable to work for 3 months. What kind
of policy would cover her loss of income? - -Disability Income

Which of the following is NOT included in the policy face? - ✅✅-Exclusions

✅✅
Group/voluntary long-term care policy premiums are typically deducted from the
employee's income and, - -are less costly as compared to individual long term
care coverage

✅✅
The fund that assures policyholders payment of death benefits on Life Policies, if the
company is insolvent at the time of the claim, is called the - -Life and Health
Insurance Guaranty Association

C was injured while deep sea diving and requires a hospital stay. C has a Major

✅✅
Medical policy with a 80/20 coinsurance clause and a $400 deductible. What is the
MAXIMUM C will pay if the covered medical expenses are $2000? - -$720

✅✅
For which of the following expenses does a Basic Hospital policy pay? -
-Hospital room and board

An agent that has been or is engaged in conduct that violates the Insurance
Information and Privacy Protection Act shall be issued and served a statement of

✅✅
charges and notice of hearing by the Commissioner of Insurance. The date of such
hearing shall be AT LEAST how many days after service of charges? - -10

According to the Time Payment of Claims provision, the insurer must pay Disability

✅✅
Income benefits no less frequently than which of the following options? -
-Monthly
Which of the following provisions specifies how long a policyowner's health coverage

✅✅
will remain in effect if the policyowner does not pay the premium when it is due? -
-Grace Period

✅✅
An individual Disability Income insurance applicant may be required to submit all of
the following information, EXCEPT: - -spouse's occupation

B is a teacher who was injured in a car accident and cannot work. She is now

✅✅
receiving monthly benefits as a result of this accident. Which type of policy does B
have? - -Disability Income

K has a health policy that must be renewed by the insurer and the premiums can

✅✅
only be increased if applied to the entire class of insureds. This type of policy is
considered: - -guaranteed renewable

✅✅
All of the following statements about health coverage for newborns are correct
EXCEPT - -coverage during the first year is limited to congenital defects

✅✅
Eligible employees must be added to group health coverage NO LATER than how
many days after their first day of employment? - -90

A major medical policy typically: - ✅✅-provides benefits for reasonable and

necessary medical expenses, subject to policy limits

Z owns a Disability Income policy with a 30-day Elimination period. Z contracts

pneumonia that leaves him unable to work from January 1 until January 15. Z then

✅✅
becomes disabled from an accident on February 1 and the disability lasts until July 1
the same year. Z will become eligible to receive benefits starting on: - -March 1

✅✅
Which of these statements is INCORRECT regarding a Preferred Provider
Organization (PPO)? - -PPO's are NOT a type of managed care systems

✅✅
The reason for a business having a Business Overhead Expense Disability Plan is to
cover: - -fixed business expenses

✅✅
When is a Group Health policy required to provide coverage for a newborn child? -
-At the moment of birth

A Hospital/Surgical Expense policy was purchased for a family of four in March of

2013. The policy was issued with a $500 deductible and a limit of four deductibles
per calendar year. Two claims were paid in September 2013, each incurring medical
expenses in excess of the deductible. Two additional claims were filed in 2014, each

✅✅
in excess of the deductible amount as well. What would be this family's out-of-pocket
medical expenses for 2013? - -$1000
Which mode of payment is NOT used by health insurance policies? - ✅✅-Single
premium

✅✅
Which of the following statements is correct regarding an employer/employee group
health plan? - -the employer receives a master policy and the employees
receive certificates

✅✅
Which of the following BEST describes how a Preferred Provider Organization (PPO)
is less restrictive than a Health Maintenance Organization (HMO)? - -More
physicians to choose from

T is covered by two health insurance plans: a group plan through his employer and
his spouse's plan as a dependent. Under the Model Group Coordination of Benefits

✅✅
provision, when T files a claim, his employer's plan is considered the: -
-Primary carrier

✅✅
To be licensed as an accident and health insurance agent in North Carolina, the
applicant MUST - -have successfully completed at least 20 hours of instruction
approved by the Commissioner of Insurance

The provision in a Group Health policy that allows the insurer to postpone coverage

✅✅
for a covered illness 30 days after the policy's effective date is referred to as the: -
-Waiting Period

✅✅
Before a Health Policy is issued or delivered, the form, classification or risks, and
premium rates MUST be filed with the - -Commissioner of Insurance