North Carolina Health Insurance Practice Exam

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Balance billing explained: what it means when providers charge the difference between what your insurer pays and what’s billedWhat does "balance billing" mean?Discovering the Family Maximum Deductible in Health InsuranceWhat deduction method can reduce the deductible owed by family members in a plan?Exploring the Fundamental Principles of InsuranceWhat does the term "fundamental principles of insurance" include?Non-cancelable health insurance guarantees both premium stability and renewalWhat type of renewability guarantees both premium rates and renewability for health insurance?Understanding Allowable Charges in Health InsuranceWhat are "allowable charges" in health insurance?Understanding Deductibles in Health InsuranceIn health insurance, what is a deductible?Understanding high-deductible health plans in North Carolina health insuranceWhat is a characteristic of a high-deductible health plan?Understanding Managed Care and Pre-Hospitalization Authorization in North CarolinaPre-hospitalization authorization is considered an example of?Understanding Medicaid: Discover Essential Health Coverage for Low-Income FamiliesWhich government program provides health coverage for low-income individuals and families?Understanding Minimum Information in the Context of Health InsuranceWhat does "minimum information" refer to in the context of the Information and Privacy Protection Act?Understanding the Carryover Provision in North Carolina Health InsuranceWhat feature allows an insured to defer current health charges to the next year's deductible?Understanding the Children's Health Insurance Program (CHIP)What is the purpose of the Children's Health Insurance Program (CHIP)?Understanding the Function of the Claims Review Process in North Carolina Health InsuranceWhat is the function of the Claims Review process?Understanding the grace period in North Carolina health insurance policiesHow is the term 'grace period' best defined in insurance policies?Understanding the Primary Insurance Amount in Social Security DisabilityIn Social Security Disability, what is the Primary Insurance Amount (PIA) based on?Understanding the Primary Purpose of Health InsuranceWhat is the primary purpose of health insurance?Understanding the Role of Hospital Indemnity PoliciesWhat is the primary function of a Hospital Indemnity policy?Understanding What PPO Means in Health InsuranceWhat does PPO stand for in health insurance terminology?Understanding When You Must Receive Your Health Insurance SummaryWhen must policyholders receive a summary of benefits and coverage?Understanding Your COBRA Rights after Employment TerminationWhat right does COBRA provide to workers whose employment has been terminated?Understanding Your Rights Under the Information and Privacy Protection Act for Health InsuranceIn the context of denying insurance coverage, what is an applicant's right under the Information and Privacy Protection Act?What Is a Copayment and Why Does It Matter?What is a copayment (copay)?What is a Disability Elimination Period and Why Does it Matter?How is a disability elimination period defined?What You Need to Know About Essential Health Benefits under the ACAWhat is an essential health benefit as outlined by the Affordable Care Act?Why Provider Directories Matter for Your Health Insurance ChoicesWhat is the significance of "provider directories"?
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  • In health insurance, what is a "payor"?
  • What is a benefit limit in health insurance?
  • How does a premium tax credit aid individuals?
  • What is the purpose of a "premium" in health insurance?
  • What is the ACA and what is its purpose?
  • Which benefit is not typically included in essential health benefits required by federal marketplace policies?
  • What is an "individual mandate"?
  • How do health insurance premiums typically vary?
  • What is "coordination of benefits"?
  • Which of the following involves analyzing a case before admission to determine what type of treatment is necessary?
  • What is a specialty drug?
  • What is a common exclusion in health insurance policies?
  • What is a key requirement for health policies purchased through the federal marketplace?
  • What does "benefits package" refer to?
  • How does the guaranteed issue provision of the ACA work?
  • If the insured and primary beneficiary die in the same accident and it's unclear who died first, where will the death proceeds go according to the Uniform Simultaneous Death Act?
  • With optionally renewable health policies, the insurer is allowed to do what?
  • What are "high-risk pools"?
  • What does "network" mean in the context of health insurance?
  • What is a health maintenance organization (HMO)?
  • What happens if a person submits incorrect information on a health insurance application?
  • In health insurance, what does the term 'deductible' refer to?
  • What does "service area" refer to in health insurance?
  • What does "level of coverage" refer to in health insurance?
  • How much will M need to pay out-of-pocket before insurance starts covering the claim of $2,200 with a $200 deductible?
  • What criteria determine eligibility for Medicare?
  • What role do health insurance premiums play?
  • What is the impact of the individual mandate under the ACA?
  • Under a Disability Buy-Out policy, who benefits from the payout?
  • What do high deductibles generally indicate in health insurance plans?
  • What criteria typically guides eligibility for health insurance in the federal marketplace?
  • What is a provider network?
  • What does the acronym ACA stand for?
  • What do pre-existing conditions refer to in health insurance?
  • What role do state regulators play in health insurance?
  • What is a premium tax credit under the ACA?
  • What forms of marketplace health coverage are available in North Carolina?
  • What is the typical benefit of an Accident Policy?
  • What does “pre-authorization” mean in health insurance?
  • What provision allows for the restoration of used medical benefits after a certain amount has been utilized?
  • What type of plans generally allow members to see any healthcare provider without a referral?
  • How do deductibles function in health insurance plans?
  • Describe "long-term care insurance".
  • Which type of service is usually not covered by health insurance?
  • What does the acronym EOB stand for?
  • Describe "health savings accounts" (HSAs).
  • What is the primary purpose of the Affordable Care Act?
  • What typically happens after a health insurance claim is submitted?
  • What does an HMO typically require for specialist visits?
  • A prepaid application for individual disability income insurance was recently submitted to an insurer. What action would the insurance company not take after receiving the MIB report?
  • What is the purpose of the free look period in health insurance policies?
  • Which type of cost is typically covered by a Basic Hospital/Surgical policy?
  • What is the difference between an HMO and a PPO?
  • What is a characteristic of a conditionally Renewable Health Insurance policy?
  • What is "capitation" in the context of health insurance?
  • Which benefit characterizes a Basic Hospital and Surgical policy?
  • What is the primary purpose of a Disability Buy-Out policy?
  • Which statement best describes the free look provision in health insurance?
  • Which accident and health policy provision addresses pre-existing conditions?
  • What is the primary purpose of health insurance?
  • How often must health insurance companies submit their rates for approval in North Carolina?
  • What is the difference between a "premium" and a "deductible"?
  • What is "managed care" in health insurance?
  • What is a fundamental purpose of the standard grace period in insurance policies?
  • What does "pre-existing condition" mean?
  • What does the term "cost-sharing" mean?
  • What may cause a health insurance policy to be considered void?
  • What is being delivered during a policy delivery?
  • What is the purpose of an insurance rider?
  • What is the role of "probationary periods" in health insurance plans?
  • What does the term "co-pay" refer to?
  • What does the notice of claims provision require from a policyholder?
  • What is dual-eligible status in Medicaid?
  • What constitutes a significant change in a health insurance policy?
  • An incomplete health insurance application submitted to an insurer will result in which of these actions?
  • Which of the following is a benefit of Medicaid?
  • What might trigger a special enrollment period?
  • Who benefits from "high-risk pools"?
  • Which provision provides reduced benefits for an insured not working at full capacity?
  • Which of these actions should a producer take when submitting an insurance application to an insurer?
  • What is the Patient Protection and Affordable Care Act commonly referred to as?
  • What type of plan allows members to see any doctor without a referral?
  • Which of the following is a characteristic of a closed panel HMO?
  • What is a "secondary insurance"?
  • What is an indemnity payment?
  • What does "minimum essential coverage" (MEC) mean under the ACA?
  • Which federal law allows an insurer to obtain an inspection report on a potential insured?
  • In health insurance, what is an "integrated health plan"?
  • Which statement about Health Reimbursement Arrangements (HRA) is correct?
  • What does the term "underwriting" refer to in health insurance?
  • An applicant's medical information received by the Medical Information Bureau may be furnished to the?
  • What is a "waiting period" in health insurance?
  • What is typically a feature of Preferred Provider Organizations (PPO)?
  • How many days is the standard grace period for premium payments on individual life insurance policies issued in North Carolina?
  • What does "co-insurance" generally refer to in health insurance plans?
  • What is a "network" in the context of health insurance?
  • Describe the "Health Insurance Portability and Accountability Act" (HIPAA).
  • Which of the following best describes a "provider network"?
  • What is "telemedicine" in the context of health insurance?
  • Which of the following statements is INCORRECT regarding a PPO?
  • What does the term "claim" refer to in health insurance?
  • How many days must an insurer provide an insured with claim forms after receiving notice of a loss?
  • How does the concept of "risk assessment" apply to health insurance underwriting?
  • What is the term for a situation where physicians are salaried employees at an HMO facility?
  • What is the significance of "network" in health insurance?
  • Define "subrogation" in health insurance.
  • What is "open enrollment" in health insurance?
  • What does the elimination period of an individual disability policy refer to?
  • What constitutes a "fundamental health insurance policy"?
  • Which of the following best describes how pre-admission certifications are used?
  • What is the main purpose of a health insurance premium?
  • K has a health policy requiring renewal by the insurer, with premium increases applicable to the entire class of insureds. This is considered which type of policy?
  • What is a catastrophic health insurance plan?
  • What is coinsurance in health insurance?
  • Which type of insurance covers expenses related to a hospital stay?
  • How many days do insurers have to request a hearing if their policy is rejected?
  • Define "out-of-network" benefits in health insurance.
  • The percentage of an individual's Primary Insurance Amount determines benefits paid in which program?
  • If M has a Major Medical Insurance policy with a $200 deductible and incurs a $2,200 claim, how much will M receive for that claim?
  • What does the term "risk pool" refer to?
  • Why is consumer awareness encouraged by health organizations?
  • What do "medical necessity" criteria refer to?
  • What is the purpose of a "rider" in an insurance contract?
  • What is typically included in the Explanation of Benefits (EOB) document?
  • What is the minimum number of days for the grace provision in an individual health insurance policy with annual premium payments?
  • What does Medicare Part A primarily cover?
  • What does COBRA stand for?
  • Which Medicare part covers outpatient care and preventive services?
  • According to the Information and Privacy Protection Act, how many business days must an insurer provide access to recorded personal information after a denial of coverage?
  • What is "coordination of benefits"?
  • What may happen on the 31st day after a missed premium payment?
  • What is an example of a preventive service covered by most health insurance plans?
  • What type of coverage do short-term health insurance plans provide?
  • What role do insurance agents play in health insurance?
  • What is the purpose of "catastrophic insurance"?
  • What is a coverage gap in health insurance?
  • What is the duration of the free look period for accident and health policies sold in North Carolina?
  • Which type of rider is added to an accident and health policy to ensure it continues if the policyholder becomes totally disabled?
  • What is the purpose of a "gag clause" in a provider contract?
  • Which plan requires referrals for specialists?
  • What are "out-of-network" providers in health insurance?
  • What is the primary purpose of the time of payment of claims provision?
  • What is a waiting period in health insurance?
  • In North Carolina, which agency regulates health insurance companies?
  • What is Medicaid expansion?
  • What is a "rider" in an insurance policy?
  • What is the term for the maximum amount a policyholder must pay out-of-pocket for covered services in a plan year?
  • What aspect of insurance does "benefit maximum" directly affect?
  • What is an "Explanation of Benefits" (EOB)?
  • In what type of insurance plan is a network of doctors and hospitals created to provide services at reduced costs?
  • Which type of insurer reimburses its insureds for covered medical expenses?
  • How does a high-deductible health plan (HDHP) differ from a traditional plan?
  • In health insurance, what does the term "deductible" refer to?
  • An accident policy most likely pays benefits for which type of accident?
  • In an Accidental Death and Dismemberment policy with a principal sum of $50,000, what is the maximum amount an individual can receive for losing a finger?
  • For a 66-year-old covered under a group health plan and injured while walking in the park, what is considered primary coverage?
  • How many days does an insurance company have to notify a policyholder of a denial of reinstatement before the policy is automatically placed back in force?
  • Which policy provision allows the insurer to set conditions for a pending claim?
  • M completes an application for health insurance but does not pay the initial premium. All of these actions must occur before M's policy goes into effect, except?
  • What is the role of a "broker" in health insurance?
  • Which type of policy provides benefits to a policyholder covered under a Hospital Expense policy?
  • Which of the following is typically covered by basic health insurance policies?
  • What does the term "subrogation" refer to in health insurance?
  • What does the term "underwriting" mean in health insurance?
  • What is the significance of a formulary in a health insurance plan?
  • Which system involves a group of doctors and hospitals contracting with an insurer to provide services at a prearranged cost?
  • Why is consumer awareness crucial in health insurance?
  • What does a "summary of benefits and coverage" (SBC) provide?
  • Which of the following is often not covered under health insurance plans?
  • What does "benefit maximum" refer to in health insurance?
  • Under the Affordable Care Act, what is the maximum age for dependents to remain on their parent's health insurance?
  • What does “open enrollment” refer to in health insurance?
  • What is a pre-existing condition?
  • What is a "managed indemnity" plan?
  • Which aspect is NOT typically covered by supplemental health insurance?
  • What is the term for a deductible provision that waives the deductible for all family members after some have satisfied individual deductibles?
  • What type of insurance policy pays for medical expenses while the insured is hospitalized?
  • What is the significance of a "maximum out-of-pocket limit"?
  • What is the deductible called when only one deductible is applied if several family members are injured in the same accident?
  • What is typically included in a "benefits package"?
  • Which of the following is a requirement for all individual health insurance plans in North Carolina?
  • What are Essential Health Benefits (EHB)?
  • Which healthcare service is typically excluded from most health insurance plans?
  • What is the maximum Social Security Disability benefit amount an insured can receive?
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