Nc State Law - Health Exam
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To qualify for an insurance agent's license, a person must have all of thefollowing EXCEPT:
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College degree
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Good reputation and character
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Licensing fee
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18 years of age
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The 'NC State Law - Health Exam' assesses knowledge of health insurance policies and ethical sales practices in North Carolina. It covers review periods, plan types, licensing requirements, and continuing education, crucial for agents and brokers in the insurance industry.
Quiz Preview
- 2.
Terry is licensed in North Carolina as a life and health insurance agent. To maintain his license, how many hours of continuing education must he complete every two years?
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12
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24
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30
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40
Correct Answer
A. 24Explanation
In every two-year license renewal period, licensees are required to complete at least 24 hours of continuing education. At least three hours must be in ethics.Rate this question:
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- 3.
Josephson Corporation will be offering a group health insurance policy this year to its employees. Which employee will not be eligible for coverage?
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Frank, who owns 50 percent of the company and works full-time
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Rachel, who works 30 hours per week in the accounting department
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Sebastian, who works part-time for the company during the fall and winter
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Anna, who is a vice president in the company and works 40 hours per week
Correct Answer
A. Sebastian, who works part-time for the company during the fall and winterExplanation
Owners, proprietors, and partners are considered eligible employees along with individuals who work on a full-time, nonseasonal basis, with a normal work week of 30 or more hours. Those who work on a part-time, temporary, or substitute basis are not eligible to participate in an employer-sponsored group health plan.Rate this question:
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- 4.
Delta Vacation Cruises wants to purchase group health coverage for its passengers. Which type of insurance should Delta purchase?
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Blanket policy
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Credit disability
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Illness only
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Accident and illness indemnity
Correct Answer
A. Blanket policyExplanation
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.Rate this question:
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- 5.
The Commissioner of Insurance cannot suspend or revoke an agent’s license for which of the following reasons?
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Failing to meet projected sales goals
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Having an agent's license denied or suspended in another state
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Forging an individual's name on an insurance application
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Accepting insurance from an unlicensed individual
Correct Answer
A. Failing to meet projected sales goalsExplanation
accepting insurance from an unlicensed individualRate this question:
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- 6.
To boost her sales at the end of the year, Agent Trudy started offering potential clients a $250 cash gift card in exchange for purchasing a life insurance policy. Which ethical sales practice has Agent Trudy violated?
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Twisting
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False information
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Rebating
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Churning
Correct Answer
A. RebatingExplanation
Agents cannot offer anything of value to induce someone to buy insurance, including a rebate of the premium, dividends, stocks or bonds, or paid employment. They also cannot pay or offer to pay anything of value that is not specified in the insurance contract. This unfair trade practice is known as rebating.Rate this question:
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- 7.
Best Insurance Company is incorporated in Canada and just applied for a license to transact insurance in North Carolina. Which type of insurer is Best Insurance Company considered in North Carolina?
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Domestic
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Foreign
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Alien
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Limited
Correct Answer
A. AlienExplanation
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.Rate this question:
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- 8.
Newborn children are automatically covered under an insured’s healthinsurance policy for how long?
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From birth to the first birthday
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From birth to 30 days
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From birth to the end of the first calendar year
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From birth to the policy renewal date
Correct Answer
A. From birth to 30 daysExplanation
Dependent children are covered by their parents’ health insurance from the moment of birth. The policyholder must
notify the insurer of a child’s birth within 30 days and must pay the premium to continue health coverage for the child
beyond the 30-day
period.Rate this question:
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- 9.
Which type of limited policy will provide health insurance benefits when the insured or his dependents are hospitalized?
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Credit life and health policy
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Surplus lines policy
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Industrial health policy
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Hospitalization policy
Correct Answer
A. Hospitalization policyExplanation
Hospitalization insurance provides benefits when the insured or his or her dependents are hospitalized.Rate this question:
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- 10.
Bill believes he has a cause of action against his health insurer for itsrefusal to pay benefits on a claim. He filed written proof of loss on April1. Not having received a response by May 1, he decides to take legalaction. What will his attorney probably do?
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Advise him to file suit
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Advise him to wait
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Advise him to file proof of loss again
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Advise him to cancel the policy
Correct Answer
A. Advise him to waitExplanation
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.Rate this question:
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- 11.
Larry, Brian, Susan, and Jennifer just started working for AllPro Insurance Company in North Carolina. Based on their job descriptions below, which of them is NOT acting as a producer?
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Larry, who receives insurance applications from the public
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Brian, who is a vice president in AllPro's human resources department and does not receive commissions
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Susan, who collects insurance premiums for AllPro
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Jennifer, who solicits insurance policies for AllPro and receives commissions
Correct Answer
A. Brian, who is a vice president in AllPro's human resources department and does not receive commissionsExplanation
An employee of an insurer who devotes substantially all of his or her time to activities other than soliciting insurance applications and who does not receive a commission based upon the amount of insurance business transacted is not acting as an agent.Rate this question:
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- 12.
Eric fails to pay the annual premium on his major medical insurance policy. The grace period provision allows him to pay the premium within how many days after the due date?
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7
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14
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21
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31
Correct Answer
A. 31Explanation
A policyholder is entitled to a 31-day grace period in which to pay the premium due on an annually renewable health insurance policy.Rate this question:
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- 13.
Which of the following groups would typically NOT be eligible for groupaccident and health insurance?
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Association group
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Neighborhood group
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Labor union
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Employer group
Correct Answer
A. Neighborhood groupExplanation
Employer groups, association groups, and labor unions are eligible for group accident and health insurance.
Neighborhood groups are not an approved group.Rate this question:
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- 14.
Abby lives in Maryland, where she is licensed as an insurance agent. She wants to apply for a nonresident license in North Carolina. Which of the following conditions must she satisfy?
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She must move to North Carolina.
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She must surrender her Maryland license.
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She must be sponsored by an agent licensed in North Carolina.
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She must show her license to be in good standing in Maryland.
Correct Answer
A. She must show her license to be in good standing in Maryland.Explanation
A person who is not a North Carolina resident may be licensed as an insurance agent in North Carolina if the person is a licensed agent in good standing in his or her home state.Rate this question:
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- 15.
When meeting with a prospect to discuss life insurance, Agent Tyler makes disparaging comments about the financial stability and reputation of a competitor to dissuade the prospect from purchasing its policies. Which unfair trade practice has Agent Tyler committed?
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Defamation
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Rebating
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Unfair discrimination
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Coercion
Correct Answer
A. DefamationExplanation
It is considered defamation to publish or circulate a false, deceptive, or misleading statement about—or a statement that is maliciously critical of or derogatory to—the financial condition of an insurer, when such a statement is designed to injure anyone in the insurance business.Rate this question:
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- 16.
Emil, an agent licensed in North Carolina, moves to a new home on April 30. He is required to notify the North Carolina Department of Insurance by what date?
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May 7
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May 10
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May 30
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October 31
Correct Answer
A. May 10Explanation
An agent who changes his or her residential or e-mail address must notify the Insurance Department within ten days of the change.Rate this question:
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- 17.
Jim owes $10,000 to Acme Corporation, and he pays $500 each month on the loan. If he decides to take out a credit accident and health insurance policy to cover the payments if he dies or becomes disabled, the policy may not exceed what amount?
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One-half of Jim's debt
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The total amount of Jim's debt
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The total amount of Jim's debt plus a premium for extra costs
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One-third of Jim's debt
Correct Answer
A. The total amount of Jim's debtExplanation
A credit accident and health insurance policy cannot exceed the total amount of indebtedness at any given time, nor may the monthly disability benefit exceed the amount of the loan's monthly payment.Rate this question:
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- 18.
Emily solicits policies and accepts premiums from the public but is notlicensed as an agent. She then turns over the applications andpremiums to her husband, who is licensed. Which statement is correct?
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Emily has committed a felony.
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Emily is not required to be licensed to solicit policies and accept premiums.
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Emily has not committed any type of unlawful act.
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Emily has committed a Class 1 misdemeanor.
Correct Answer
A. Emily has committed a Class 1 misdemeanor.Explanation
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.Rate this question:
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- 19.
Blanket disability policies can be issued to all of the following EXCEPT:
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A common carrier, covering all passengers
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A school, covering students
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An employer, covering employees
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A family, covering family members
Correct Answer
A. A family, covering family membersExplanation
Blanket sickness and accident insurance may be issued to common carriers, employers, colleges, volunteer fire departments, and other similar groups.Rate this question:
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- 20.
Ed, Myrna, Jane, and Ravi were each covered by different group health insurance policies that just terminated. Which person will be eligible to convert to an individual health insurance policy?
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Ed, who had been working at RJ Industries for one month before his coverage terminated
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Myrna, whose coverage terminated due to nonpayment of premium
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Jane, whose former policy was replaced by another group policy two weeks after it terminated
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Ravi, who had been working at ABC Corporation for six years when the plan terminated because the insurer stopped offering plans in the state
Correct Answer
A. Ravi, who had been working at ABC Corporation for six years when the plan terminated because the insurer stopped offering plans in the stateExplanation
Group health insurance policies must give each insured the option to convert to an individual policy without providing evidence of insurability if group coverage terminates. The option is available to anyone who has been insured under the group plan for at least three months.Rate this question:
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- 21.
Before delivering a health insurance policy to a client, the agent alters the insuring clause in a way that he believes will benefit the insurance company. Which of the following statements is correct regarding this alteration?
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It is required of a diligent agent.
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It is prohibited by the entire contract provision.
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It is permitted only when it is in the insurer’s best interests.
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It is prohibited unless the insured agrees to it in writing.
Correct Answer
A. It is prohibited by the entire contract provision.Explanation
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.Rate this question:
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- 22.
Bob had been working at Sunset Airlines for ten years when he was laid off on June 1. How long can Bob continue his health insurance coverage under Sunset's group plan?
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6 months
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9 months
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12 months
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18 months
Correct Answer
A. 18 monthsExplanation
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.Rate this question:
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- 23.
Acme Insurance and Apogee Insurance agree to offer different premium rates for persons of equal risk within a particular class. They also agree to limit benefits paid to insureds within this class if the insureds live in certain counties of North Carolina. What are Acme and Apogee engaging in?
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Acceptable marketing and underwriting practices
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Unfair and prohibited business practices
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Insurance fraud
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False advertising
Correct Answer
A. Unfair and prohibited business practicesExplanation
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.Rate this question:
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- 24.
Zelda, a producer selling health insurance, assures a prospectiveapplicant that the insurance company she represents is backed by theprotections of the North Carolina Life and Health Insurance GuarantyAssociation. Which of the following statements is correct regarding thiskind of assurance?
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It is recommended when selling health insurance.
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It is prohibited at all times.
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It is required when selling to Medicare-eligible individuals.
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It is highly regulated by the Insurance Department.
Correct Answer
A. It is prohibited at all times.Explanation
It is an unfair trade practice to use the existence of the North Carolina Life and Health Insurance Guaranty
Association, or the protections the association offers, for the purpose of selling insurance.Rate this question:
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- 25.
An insurer must notify its current customers of its privacy policies or practices at least once every how often?
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6 months
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12 months
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18 months
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24 months
Correct Answer
A. 12 monthsExplanation
An insurer or agent must notify its current customers of its privacy policies or practices at least once every year.Rate this question:
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- 26.
Which of the following is not required to be covered under a group health insurance policy issued in North Carolina?
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Mammograms every year beginning at age 30
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Medicine and treatment for diabetes
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Prostate cancer screening tests
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Cervical cancer screening
Correct Answer
A. Mammograms every year beginning at age 30Explanation
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.Rate this question:
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- 27.
Creative Computers Inc. replaced its group health plan ten days afterterminating its prior coverage. Which of the following statements aboutcovering employees under the new plan is correct?
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The new policy must cover individuals who were insured under the prior plan.
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The new policy may exclude individuals who were insured under the prior plan if they have preexisting conditions.
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The new policy may exclude individuals who were insured under the prior plan if they previously submitted claims for hospital confinement or pregnancy.
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The new policy may only exclude employees with claims exceeding specified levels from the new plan.
Correct Answer
A. The new policy must cover individuals who were insured under the prior plan.Explanation
If a group accident and health insurance policy is replaced by another group contract within 15 days after the plan
terminates, each person who is eligible for coverage under the new plan must be insured, regardless of any
provisions relating to active employment, hospital confinement, or pregnancy.Rate this question:
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- 28.
Which type of insurance helps an insured pay off a loan if he or shebecomes disabled?
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Credit accident and health insurance
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Debtor accident and health insurance
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Double indemnity insurance
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Family maintenance insurance
Correct Answer
A. Credit accident and health insuranceExplanation
Credit accident and health insurance helps an insured pay off a loan if he or she dies or becomes disabled. In this
case, the policy pays monthly benefits equal to the amount of the monthly loan payment due.Rate this question:
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- 29.
Abby, age 66, just purchased an individual health insurance policy. On what basis can the insurer exclude coverage for diabetes, a condition that Abby was diagnosed with one year ago?
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The insurer can exclude coverage for up to six months.
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The insurer can exclude coverage for up to one year.
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The insurer may not exclude coverage for Abby's pre-existing condition.
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The insurer may limit coverage only if Abby's pre-existing condition was specifically defined in the policy.
Correct Answer
A. The insurer may limit coverage only if Abby's pre-existing condition was specifically defined in the policy.Explanation
Individual or family health insurance policies issued to individuals over age 65 may limit coverage only for pre-existing conditions that are defined in the policy.Rate this question:
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- 30.
Beatrice is a member of the Supreme Lodge fraternal benefit society.What must Beatrice do before she can sell insurance on its behalf?
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Obtain a restricted agent's license
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Obtain a surplus lines license
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Become a licensed agent with a specialty in fraternal lines insurance
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Comply with the same general licensing requirements that apply to resident agents
Correct Answer
A. Comply with the same general licensing requirements that apply to resident agentsExplanation
Agents of fraternal benefit societies must comply with the same general laws governing licensing that apply to
resident and nonresident agents.Rate this question:
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- 31.
If a group health insurance policy terminates, an employee can elect to continue coverage provided he or she has been insured under the plan for how long before it terminates?
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3 months
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6 months
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9 months
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12 months
Correct Answer
A. 3 monthsExplanation
To be eligible to continue coverage, an employee or member must have been continuously insured for at least three months before the date of termination.Rate this question:
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- 32.
Which statement about the coverage of chemical dependency under a group health insurance policy is CORRECT?
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A group health insurance policy is required to cover treatment for chemical dependency.
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A group health insurance policy can provide different benefits for chemical dependency than for other illnesses.
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A group health insurance policy cannot set limits on the amount of benefits payable for chemical dependency.
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A group policyholder must have the option to purchase coverage for chemical dependency treatment.
Correct Answer
A. A group policyholder must have the option to purchase coverage for chemical dependency treatment.Explanation
Group accident and health insurance policies must contain an optional rider allowing certificate holders to obtain coverage for chemical dependency. Benefits for chemical dependency must be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors that apply to benefits for physical illness generally.Rate this question:
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- 33.
A health insurance policy must pay benefits for services provided by all of the following EXCEPT:
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Optometrists
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Registered nurses
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Physician assistants
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Homeopathic practitioners
Correct Answer
A. Homeopathic practitionersExplanation
Health insurance policies are required to pay benefits for services provided by optometrists, registered nurses, and physician assistants. They are not required to pay for care provided by homeopathic practitioners.Rate this question:
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- 34.
A claimant on a health insurance policy must give written notice of the claim to the insurer within how many days following a loss?
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7
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10
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14
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20
Correct Answer
A. 20Explanation
A claimant on a health insurance policy must give written notice of the claim to the insurer within 20 days after a loss or as soon thereafter as reasonably possible.Rate this question:
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- 35.
Agent Smith knows that his best friend, Agent Thomas, is embezzling money from clients. However, Agent Smith does not notify the Commissioner in order to protect his friend. What is the result?
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Agent Smith's license will be revoked.
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Agent Smith's license may be suspended for up to two years.
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Agent Smith can be sanctioned but not disciplined.
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Agent Smith will not be punished because he does not have a fiduciary duty to report the crime.
Correct Answer
A. Agent Smith's license will be revoked.Explanation
Anyone who believes that insurance fraud, embezzlement, or a violation of the insurance laws is being or has been committed is required to notify the Commissioner. A person's license will be revoked or not renewed if he or she willfully fails to comply with this requirement.Rate this question:
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- 36.
Policyowners who buy a health insurance policy issued in North Carolina are entitled to review the policy without obligation for at least how many days after it is delivered?
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7
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10
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21
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31
Correct Answer
A. 10Explanation
The right to examine provision of health insurance policies issued in North Carolina entitles a policyowner to review the policy for at least ten days after it is delivered. If unsatisfied with it for any reason, the policyowner can return it to the insurer for a full refund of the premium paid.Rate this question:
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- 37.
A franchise accident and health insurance policy may be issued to at least how many employees of a corporation?
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Two
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Three
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Five
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Ten
Correct Answer
A. FiveExplanation
Franchise accident and health coverage is an individual health insurance policy that may be issued to five or more employees of a corporation, copartnership, individual employer, or governmental entity.Rate this question:
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- 38.
Statewide Insurers wants to obtain an investigative consumer report about an applicant because of questions it has regarding the individual's credit history. What must Statewide do before it can obtain a report?
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Notify the applicant that he has the right to be interviewed in connection with the report
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Obtain the applicant's signed consent before obtaining the report
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Notify the applicant that he has the right to prepare his own report
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Require the applicant to sign an affidavit attesting to the truth of the statements in the report
Correct Answer
A. Notify the applicant that he has the right to be interviewed in connection with the reportExplanation
Insurers and agents may not prepare or request an investigative consumer report about an individual in connection with an insurance application unless the person is informed that he or she may request to be interviewed in connection with the report and is entitled to receive a copy.Rate this question:
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- 39.
Which of the following entities would not be considered a health insurer in North Carolina?
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A hospital service corporation
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A health maintenance organization
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A group health plan
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A reciprocal insurer
Correct Answer
A. A reciprocal insurerExplanation
HMOs, hospital service corporations, and group health plans are all considered health insurers in North Carolina. A reciprocal insurer is not a health insurer.Rate this question:
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- 40.
Which of the following persons would not qualify for a temporaryproducer’s license in North Carolina?
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Wife of a disabled producer
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Surviving spouse of a deceased producer
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Person designated by a producer on active military duty
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Parttime producer of a licensed agency
Correct Answer
A. Parttime producer of a licensed agencyExplanation
Anyone who transacts insurance in North Carolina, even on a parttime
basis, must obtain an insurance producer’s
license.Rate this question:
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- 41.
Becky works as an agent for Delta Insurance Company, which is located in North Carolina. What must Becky do in order to sell life insurance on behalf of Delta to U.S. military personnel who are stationed in Germany?
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She must obtain a nonresident license.
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She must obtain a surplus lines agent's license.
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She must obtain a restricted license.
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Nothing, because she is already licensed as an agent.
Correct Answer
A. She must obtain a restricted license.Explanation
The Commissioner may issue a restricted military sales agent license to a person who represents a domestic life insurance company in a foreign country on a U.S. military installation or with U.S. military personnel.Rate this question:
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- 42.
During the application process, ABC Insurers receives personal and confidential information about Tom, who is applying for a life insurance policy. In which of the following circumstances must ABC Insurers obtain Tom's written authorization before disclosing this information?
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Before disclosing information to law enforcement agencies who are investigating insurance fraud
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Before disclosing information in response to an administrative order
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Before disclosing information to third parties for telemarketing and sales purposes
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Before disclosing information to a consumer reporting agency
Correct Answer
A. Before disclosing information to third parties for telemarketing and sales purposesExplanation
ABC Insurers must obtain Tom's written authorization before disclosing personal and confidential information obtained during the application process if it discloses information to third parties for telemarketing and sales purposes.Rate this question:
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- 43.
Anthony is eligible for Medicaid and also eligible for coverage under his new employer's group health benefit plan. Which statement is correct?
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The employee benefit plan may limit his benefits because he is eligible for Medicaid.
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The employee benefit plan may deny him a policy.
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The employee benefit plan may not take into account the fact that Anthony is receiving Medicaid benefits when paying benefits.
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The employee benefit plan may require Anthony to pay a higher premium than other employees.
Correct Answer
A. The employee benefit plan may not take into account the fact that Anthony is receiving Medicaid benefits when paying benefits.Explanation
An employee benefit plan may not limit or exclude benefits because an employee is eligible for Medicaid. A health insurer may not take into account the fact that a person is eligible for or receiving Medicaid benefits when issuing policies or paying benefits.Rate this question:
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- 44.
Which of the following statements about the conversion provision ingroup health insurance policies is correct?
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An employee must provide evidence of insurability to convert to an individual policy.
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An employee must complete an application and pay the first premium within six months after coverage terminates.
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A person will not have the right to convert a policy if it was terminated due to nonpayment of premium.
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A person must prove that he or she is uninsurable to convert to an individual policy.
Correct Answer
A. A person will not have the right to convert a policy if it was terminated due to nonpayment of premium.Explanation
A person does not have a conversion right if a group policy was terminated due to nonpayment of premium or is
replaced by similar coverage under another group policy within 31 days. A person also cannot convert to an individual
policy if he or she did not continue coverage for the entire 18-month
continuation period after the group policy
terminated.Rate this question:
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- 45.
Which of the following is not a power granted to the North Carolina Commissioner of Insurance?
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Examining insurers' financial statements
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Enforcing insurance laws
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Issuing regulations to administer insurance laws
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Prosecuting individuals for violating insurance laws
Correct Answer
A. Prosecuting individuals for violating insurance lawsExplanation
The Commissioner reports violations concerning the insurance business to the state attorney general or other law enforcement officials, who are responsible for prosecuting criminal acts.Rate this question:
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- 46.
Liam's group health insurance policy terminated on February 1. Withinhow many days must he apply for a conversion policy and pay the firstpremium?
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15
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31
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60
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90
Correct Answer
A. 31Explanation
A person must apply for an individual policy and pay the initial premium within 31 days of leaving the group plan.Rate this question:
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- 47.
Which of the following is NOT an unfair claims settlement practice if committed by an insurance company in North Carolina?
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Failing to promptly acknowledge communications about claims
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Failing to promptly settle a claim for which liability is uncertain
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Offering to settle claims for less than due to encourage litigation
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Raising policy defenses to reduce a claim
Correct Answer
A. Failing to promptly settle a claim for which liability is uncertainExplanation
An insurer is not obligated to settle a claim for which it is not clearly liableRate this question:
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- 48.
Which of the following techniques is not used during the utilization review process?
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Second opinions
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Preventive care review
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Discharge planning
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Concurrent review
Correct Answer
A. Preventive care reviewExplanation
Second opinions, discharge planning, and concurrent review are all part of the utilization review process. Preventive care review is not a utilization review technique.Rate this question:
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- 49.
Which of the following is not considered a health benefit plan?
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HMO contract
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Accident and health insurance certificate
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Multiple employer welfare arrangement plan
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Medicare supplement policy
Correct Answer
A. Medicare supplement policyExplanation
HMO contracts, accident and health insurance policies or certificates, and multiple employer welfare arrangement plans are considered health benefit plans. A Medicare supplement policy is not a health benefit plan.Rate this question:
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Mar 22, 2023Quiz Edited by
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Aug 17, 2016Quiz Created by
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