Exam (elaborations)
Health Final Questions and Answers
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Exam of 6 pages for the course North Carolina accident and health insurance at North Carolina accident and health insurance (Health Final)
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Health FinalWhich of the following statements regarding the Commissioner of Insurance is FALSE?
A)The Commissioner may administer oaths to witnesses in an investigation.
B)The Commissioner is unable to regulate the activities of alien insurance companies.
C)The Commissioner is an elected official of state government.
D)The Commissioner may suspend an agent's license without hearing if the public is felt
to be at risk. - answerD)The Commissioner may suspend an agent's license without
hearing if the public is felt to be at risk.
All states, including North Carolina, have adopted the uniform provisions developed by
the National Association of Insurance Commissioners. There are twelve of these
provisions that must be included in every accident and health insurance policy. These
provisions are designed to:
A)Protect the insurance companies from unfair claims by consumers.
B)Lay the foundation for federal regulation of the health insurance industry.
C)Establish a consistent base for determining premiums.
D)Protect the insured by establishing a consistent set of policy terms. -
answerC)Establish a consistent base for determining premiums.
"S" became totally disabled two years ago. During the first year of disability, the
insurance company sent "S" $1,000 each month. The next year, it was increased to
$1,050 and this year the payment will be $1,100. "S" had purchased which of the
following riders?
A)A Cost of Living rider.
B)The Guaranteed Purchase Option rider.
C)The Social Security rider.
D)The Waiver of Premium rider. - answerA)A Cost of Living rider.
The least restrictive definition of total disability is the:
A)Inability to perform any of the duties of the disabled person's own occupation.
B)Inability to perform the duties of any occupation.
C)Temporary confinement to home or in a hospital.
D)Inability to perform the duties of an occupation for which the disabled person is
reasonably suited. - answerD)Inability to perform the duties of an occupation for which
the disabled person is reasonably suited.
Which policy provision stipulates the number of days that must pass after the insured
has become disabled before policy benefits will be paid?
A)Preexisting conditions.
B)Probationary period.
C)Corridor deductible.
, D)Elimination period. - answerD)Elimination period.
North Carolina Accident and Health Regulations require:
A)Benefits to be denied if services are provided by chiropractors.
B)10 days prior written notice be provided to the insured before lapsing any accident
and health insurance policy.
C)Issuance of accident and health insurance to be refused because of mental illness to
make the coverage more affordable.
D)Accident and health insurance coverage for a physically impaired child insured under
family coverage to extend beyond age 26. - answerD)Accident and health insurance
coverage for a physically impaired child insured under family coverage to extend
beyond age 26.
The practice of misrepresenting an insurance product in order to induce a client to
cancel an existing contract is commonly called:
A)Rebating.
B)Misrepresentation.
C)Twisting.
D)Coercion. - answerC)Twisting.
The stop-loss provision in a Major Medical Policy allows:
A)The insurer to postpone benefit payments if loss ratios exceed a designated
percentage.
B)The insured to limit the amount of co-insurance "out-of-pocket" expense for major
occurrences.
C)The insured to suspend premium payments if medical expenses exceed the stop-loss
limit.
D)The insurer to limit the amounts payable for procedures according to reasonable
charges. - answerB)The insured to limit the amount of co-insurance "out-of-pocket"
expense for major occurrences.
"S" has a major medical policy with a $1,000,000 aggregate limit. The deductible is
$250.00, participation is set at 80/20 and stop-loss is set at $2,000. "S" has an eligible
medical expense of $8,000. How much will "S" pay on this claim?
A)$1,500.
B)$1,550.
C)$1,600.
D)$1,800. - answerB)$1,550.
A Major Medical Policy will:
A)Exclude from coverage medical treatment received from a Veterans Administration
hospital.
B)Cover maternity care on the same basis as any physical injury or illness after a 10
month probationary period.
C)Provide first dollar coverage on medical expenses.
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