Health Insurance

In order to establish a health reimbursement arrangement it must

Be established by the employer

An agent who illegally discounts insurance premium is said to be engaged in

Rebating

Which of the following characteristics is associated with a large group disability income policy?

No medical underwriting

Which of these statements concerning an individual disability income policy is true

Normally includes an Elimination period

All of the following statements regarding group health insurance are true, EXCEPT

an individual policy is given to each member

Consolidated Omnibus Budget Reconciliation Act (COBRA) Gives workers and their families whose employment has been terminated the right to

continue group health benefits

Basic Medical Expense Insurance

has lower benefit limits than Major Medical insurance

Which of the following is not a limited benefit plan

life insurance policies

Basic hospital and surgical policy benefits are

lower than the actual expenses incurred

ABC insurance company fails to pay death proceeds after satisfactory proof of loss was submitted. ABC must then begin paying interest on the death proceeds after ___ days of receiving proof of loss

30 days

And insurance applicant was recently denied insurance coverage. The applicant is requesting access from the insurer to record personal information regarding this decision. Under the information and privacy protection act, the insurer MUST make the information available within ___ business days

30 days

Every insurance agent/broker must maintain all records books and documents for insurance transactions for a period not less than

5 years

How long most every insurance agent maintain our records books and documents related to each insurance transaction?

5 years

Which Which of these actions is not considered an act of rebating

Sharing commissions with other license and appointed agents

Under what conditions me a lender required the purchase of insurance as a condition of making a loan?

Only if the borrower is not restricted in his/her choice of insurers

P is insured under a basic cancer plan which of the following conditions would be covered under this plan?

Operation for a malignant tumor

Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services to 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

The benefits under a disability buy-out policy are

Payable to the company or another shareholder

On an accidental death and dismemberment insurance policy (AD&D) who is qualified to change the beneficiary designation?

Policyowner

Life insurance replacement regulation is designed to protect the interest of

Policyowners

The coordination of benefits provision

Prevents and insured covered by two health plans from making a profit on a covered loss

The percentage of an individual's primary insurance amount determines the benefits paid and which of the following programs?

Social Security disability income

The insuring clause

States the scope and limits of the coverage

Chemical dependency treatment under a group health policy must include (over the life of the contract) a minimum benefit of

$16,000

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

A resident agent who moves out of the state of North Carolina has ___ Business days to notify the commissioner of insurance of the address change

10 days

Terminated employee must have been covered for at least ___ Months under a group health insurance policy immediately prior to termination in order to be eligible for a continuation of coverage

3 months

And ensure a must maintain grievance records for

3 years

An agent must complete ___ biennial Continuing education credit hours to maintain his/her license

24

A ______ of benefits of a health policy transfers payments to someone other than the policy owner

Assignment

Group health plan typically contain a coordination of benefits provision. This provisions purpose is to

Avoid the duplication of benefit payments

Which type of policy with paying employees salary if the employer was injured in a bicycle accident and out of work for six weeks?

Business Overhead Expense

P loses an arm and a farm accident and has paid $10,000 from his accidental death and dismemberment policy. This benefit is known as the

Captital Sum

How is the Life and Health Insurance Guaranty Associated funded?

From member companies

A physician opens up a new practice and qualifies for a $7000 a month disability income policy. What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow?

Guaranteed insurability option rider

A medical care provider which typically delivers health services edits on local medical facility is known as a

HMO

What type of provider is no for stressing preventative medical care and routine physical examinations?

HMO

Which of the following types of organizations are prepaid group health plans were members pay in advance for the services are participating physicians in hospitals that have agreements?

HMO

Tee was treated for an element two months prior to applying for a health insurance policy. This condition was noted on the application in the policy was issued shortly afterwards. How are the insurer likely consider this condition?

Insurer will likely treat as a pre-existing condition which may not be covered for one year

A policy owners rice are limited under which beneficiary designation

Irrevocable

Which of the following actions may not be taken by an insurance company to ensure a substandard applicant for disability income coverage

Lengthen the contestability period

In order for a domestic, foreign, or alien insurance company to conduct business, it must be authorized by whom?

The state where they are conducting business

A business overhead expense policy

Where is business expenses such as rent and utilities

The minimum age which a person can sign a life insurance application is

15 years

A life insurance contract may not be voided by the insurance company beginning ____ years after the policy's issue date

2 years

And insured must notify an insurer of a medical claim within ___ days after an accident

20

An agent who sells insurance policies for an unauthorized ensure in North Carolina may be personally liable for

All claims from policies sold by the agent

Accidental death coverage is provided to commercial airline passengers and which of the following types of policies?

Blanket Accident policy

The difference between group insurance and blanket health policies is

Blanket health policies do not issue certificates

G is an accountant who has 10 employees and is concerned about how the business with survive financially if he became disabled. The type of policy which best address this concern is

Business Overhead Expense

Which of the following best describes a hospital indemnity policy?

Coverage that pays a stated amount per day of a covered hospitalization

__________ could have claim to viatixal settlement proceeds

Creditors

Which of the following statements does not accurately describe the tax treatment of premiums and benefits of individual accident and health insurance?

Disability income policy premiums are tax deductible

Which of the following statements best describes the intent of a coinsurance clause in a major medical policy?

Discourages overutilization of the insurance coverage

In a disability income policy which of these closets acts as a deductible

Elimination period

An example of unfair discrimination would be

Offering different terms of coverage for a different policy owners having the same risk classification

A major medical policy typically

provides benefits for reasonable and necessary medical expenses, subject to policy limits

Which type of policy pays benefits to a policyholder covered under a hospital expense policy?

reimbursement

An accident/health policyholder has ___ days to return the policy and receive a full refund on premiums

10 days

How long is the free look period for accident and health policies sold in North Carolina?

10 days

Which of the following organizations will make reimbursement payments directly to the insured individual for covering medical expenditures?

Commercial Insurer

If a dispute arises over an insurance contract the agent who sold the policy is considered to represent the

Company

Which of the following would be a likely candidate for disability income insurance on a key employee?

Company executive

When an insurance company sends a policy to the insured with an attached application be element that makes the application part of the contract between the insured and the insurer is called the

Entire contract provision

North Carolina insurance law permits which of the following practices

Higher rates of mail insurance for life insurance based exclusively on gender

Which of the following statements about health reimbursement arrangements is correct?

If the employee paid for qualifying medical expenses the reimbursements may be tax-free

The first portion of a covered major medical insurance expense that the insurance is required to pay is called the

Initial deductible

If an insurance application is being investigated into his/her personal character and mode of living the applicant must be notified of this investigation. Which of the following makes this a requirement?

Insurance information and privacy protection act

Which of the following actions as required by an insured who leave the primary area of medical coverage and seeks medical care?

Obtain prior approval from the insurer for the medical service

When an insured has the same disability within a specified time. And the insurance company provides the same benefits without a new waiting. The second disability is covered under which of the following benefits

Recurrent disability

T is covered by an accidental death and dismemberment policy that has an irrevocable beneficiary. What action will the insurance company take if T request a change of beneficiary?

Request of the change will be refused

When a person return to work after a period of total disability but cannot earn as much as he or she did before the disability the situation is called which of the following

Residual disability

Which of the following services is not included under hospitalization expense coverage?

Surgical fees

If an agent is found to be incompetent and trustworthy or financially irresponsible the commissioner of insurance may

Suspend, revoke, or refuse to renew the agents license

Essential benefits without annual in life time limits are required on any health policy purchased

Through the federal marketplace

An agent complete an application with a client for a $50,000 life insurance policy. At what point is the latest a policy summary and buyers guy must be given to the applicant?

Upon policy delivery

Which of the following phrases refers to the fees charged by a healthcare professional?

Usual, customary, and reasonable expenses

The provision in a group health policy that allows the insurer to post phone coverage for a covert illness 30 days after the policies a better day is referred to as the

Waiting Period

The provision in a health insurance policy that suspense premiums being paid to the Insurer why the insured is disabled is called the

Waiver of premium

North Carolina insurance law specifically allows the commissioner of insurance issue a temporary license which of the following individuals

A surviving spouse of a deceased agent

Many small business owners worry how their business will survive financially if the owner becomes disabled. The policy which best addresses this concern is

Business overhead expense

The federal income tax treatment of employer provided group medical expense insurance can be accurately described as

Employee premiums paid by the employer is tax deductible to the employer as a business expendinture

One roll of the life and health guaranty association is to

Maintain public confidence in the promises of insurers

Which of the following does Social Security NOT provide benefits for?

dismemberment

A disability elimination period is best described as a

time deductible

An agent inducing an insured to lapse, forfeit, or surrender insurance through misrepresentation is committing the illegal act of

twisting