Nc State Law - Health Exam

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.

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.

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.

accepting insurance from an unlicensed individual

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.

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.

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.

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.

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.

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.

Hospitalization insurance provides benefits when the insured or his or her dependents are hospitalized.

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

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.

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

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.

An agent who changes his or her residential or e-mail address must notify the Insurance Department within ten days of the change.

Blanket sickness and accident insurance may be issued to common carriers, employers, colleges, volunteer fire departments, and other similar groups.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

Agents of fraternal benefit societies must comply with the same general laws governing licensing that apply to
resident and nonresident agents.

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.

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.

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.

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.

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.

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.

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.

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.

HMOs, hospital service corporations, and group health plans are all considered health insurers in North Carolina. A reciprocal insurer is not a health insurer.

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.

Anyone who transacts insurance in North Carolina, even on a parttime
basis, must obtain an insurance producer’s
license.

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.

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.

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.

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.

A person must apply for an individual policy and pay the initial premium within 31 days of leaving the group plan.

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.

An insurer is not obligated to settle a claim for which it is not clearly liable

Second opinions, discharge planning, and concurrent review are all part of the utilization review process. Preventive care review is not a utilization review technique.

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.

A person enrolled in a PPO may obtain health-care services from a provider who does not participate in the plan. However, a PPO may limit coverage for health-care services obtained from a nonparticipating provider.