Nc Health Insurance Practice Exam

Medicaid covers necessary medical services, including transportation, as well as necessary prescription drugs.
Cosmetic surgery is not covered.

A group health plan that offers dependent coverage must continue such coverage for an employee's adult child until
the child turns 26 years old, whether or not the child is married. Plans are not required to cover the spouse or child of
eligible children.

Concealment is deliberately withholding material facts when applying for insurance. If the concealed facts would have
changed the insurer's decision to offer the insurance policy, then the insurer can void the insurance contract.

Generally, the person who is covered by a medical expense insurance plan is called an insured or a subscriber.

Comprehensive major medical plans do not cover cosmetic surgery, experimental procedures or treatment, or alcohol
and drug abuse treatment.

To qualify for a license, an applicant must be at least 18 years old, complete a prelicensing education program, pay
the licensing fees, and pass the required state examination. An applicant also must not have been convicted of a
felony or crime involving dishonesty or fraud.

A co-payment is a fixed fee that insureds pay for their use of specific medical services covered by the plan.

Concealment is deliberately withholding material facts when applying for insurance. If the concealed facts would have
changed the insurer's decision to offer the insurance policy, then the insurer can void the insurance contract.
Contributions

Business overhead expense insurance reimburses the company for certain business expenses if the business owner
is disabled. Covered expenses may include utilities, leased equipment, office supplies, nonowner salaries, and rent.

Blanket insurance provides health insurance benefits to a changing group of people who are exposed to the same
risks, such as passengers on a cruise ship.

Employer groups, association groups, and labor unions are eligible for group accident and health insurance.
Neighborhood groups are not an approved group.

Risk management by avoidance means avoiding situations that could result in loss.

A policyholder is entitled to a 31-day grace period in which to pay the premium due on an annually renewable health
insurance policy.

If Greg supplements his basic hospital plan with a supplementary major medical policy, the supplementary plan would
cover hospital room and board beginning on the 31st day and costs above $3,000.

A PPO subscriber is free to select, from an extensive list of providers, the physician he or she prefers to see. A
person can also choose a non-PPO provider but must pay more if he or she obtains nonemergency treatment from
outside the network of PPO providers.

The shorter the policy's elimination period, the higher the premium. Therefore, if Alicia chooses a 30-day elimination
period instead of a 90-day period, her annual premium will be higher.

Providers who become part of a PPO are required to accept the PPO's previously negotiated fee as full payment for
services.

Acme and Apogee are agreeing to an unreasonable restraint of trade in the insurance business of North Carolina.
Furthermore, they are engaging in unfair discrimination by charging persons of the same class and substantially
equal risk different premium rates and by paying different benefits to persons in this class.

Preferred risk applicants are issued policies with lower premium rates than standards risks or substandard risks.
Jessica will therefore receive the lowest premium rate of all the applicants.

A hazard is a condition that increases the number of losses or the severity of losses. Taking medications to control a
life-threatening disease is a hazard-reduction technique.

A hospital indemnity policy provides cash benefits that the insured may use as he or she sees fit. The benefit amount
per day is predetermined and paid regardless of any other coverage the insured may have.

Jim's application has been classified as substandard, which means that he falls below the insurer's standard
guidelines. The insurer may attach a waiver to the policy that excludes from coverage any loss associated with a
specified condition, or the insurer may charge an added premium.

A key provision of group insurance is that it does not discriminate on the basis of an individual's health history.

A key provision of group insurance is that it does not discriminate on the basis of an individual's health history.

The plan in which a person directly participates because he or she is employed by or associated with the plan
sponsor is the primary plan. This plan pays the benefits for that person. Coverage provided by any other plan or
insurer is secondary. It pays benefits only to the extent the primary plan did not cover the loss.

North Carolina classifies insurance companies according to where they were incorporated. An alien company is one
that has been incorporated or organized under the laws of any jurisdiction outside the United States.

At the end of the underwriting process, the insurer sends the issued policy to the agent, who then delivers the policy
to the client.

For short-term job-related injuries, an employer must provide workers' compensation insurance. Most short-term group disability plans do not provide coverage for on-the-job injuries.

Waiver is voluntarily giving up a known right. If an insurer voluntarily gives up a legal right that it has under an
insurance contract, it cannot deny a claim based on a violation of that right. Estoppel is similar to the idea of waiver
but involves giving up a right without intending to do so. The difference is the lack of intent to give up the right.

A business overhead expense policy covers certain overhead costs of a small business owner upon his or her
disability. Workers' compensation does not cover these costs.

In risk transfer, an individual or business transfers the risk of loss to an insurance company in return for the payment
of a premium.

An individual disability income policy that is issued with a benefit that is a stated amount uses a flatrate
approach.

These provisions ensure that the insured does not profit from any one policy. Health insurance policies are designed to return the insured to the position he or she was in before a covered loss. They are not intended to provide benefits that exceed the insured's loss.

The time during which an insurer can void an insurance company on the basis of fraud is typically limited to two years
from the date the contract was signed and issued.

The way in which covered care services are delivered depends on the plan or policy.

An insurer or agent must notify its current customers of its privacy policies or practices at least once every year.

Under the entire contract provision, changes to an insurance policy are invalid unless they are approved and
endorsed by an officer of the insurance company. An agent cannot unilaterally change the terms of the policy.

The out-of-pocket maximum represents the amount the insured must pay before the insurer pays 100 percent of the
policy's benefits. Co-pays do not apply to the out-of-pocket maximum.

The legal actions provision of a health insurance policy prohibits the insured from suing the insurer on a claim before
60 days have passed since filing written proof of loss. However, an insured cannot bring suit after six years have
passed since filing proof of loss.

The effective coverage date depends on when the applicant pays the first premium.

It is unlawful for a person to solicit insurance, accept premiums, or otherwise act as an agent, broker, limited
representative, adjuster, or appraiser without a license. A violation of this requirement is considered a Class 1
misdemeanor.

Medicare Advantage plans are obtained through private health insurance companies and offer expanded benefits.
They provide all of the Part A Hospital Insurance and Part B Medical Expense coverage. Some may also provide the
Part D Prescription Drug coverage.

Health insurance policies must cover one baseline mammogram for women ages 35 through 39. Thereafter, insurers
must cover mammograms on a schedule that depends on a woman's age and breast cancer risk.

The list of EHBs includes about a dozen medical care services that range from pediatric and wellness programs to
lab and rehabilitative services, as well as emergency care services, that are not subject to annual or lifetime limits on
the dollar value of policy benefits.

A benefit of business health insurance is the plan owner's ability to receive favorable tax treatment.

A hazard is a characteristic that increases the chance of a peril occurring. A physical hazard is a physical
characteristic, such as blindness, that increases the chance of loss. A physical hazard exists due to a person's
physical condition as opposed to arising from his or her character.

A group sickness and accident insurance policy must provide that an employee who has been insured continuously
for at least three months and whose coverage is terminated for any reason other than nonpayment of the premium is
entitled to continue coverage under the group plan for up to 18 more months.

A Medicare Advantage policy or certificate must provide payment for full coverage under the policy for covered
emergency services that are not available through network providers.

The IRS, the state insurance office, and the insurer all have a say in the qualifying size of a group plan. The state's
attorney general is not involved.

The IRS, the state insurance office, and the insurer all have a say in the qualifying size of a group plan. The state's
attorney general is not involved.