PEARSON VUE HEALTH INSURANCE PRACTICE TEST

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PEARSON VUE HEALTH INSURANCE PRACTICE TEST

Actual Qs and Ans - Expert-Verified Explanation -Guaranteed passing score -100 Questions and Answers

-Format: Multiple-choice / Flashcard

Question 1: What is NC Health Choice?

Answer:

North Carolina's version of the Children's Health Insurance Program (CHIP) for children in families with income too high for Medicaid.Question 2: The Internal Revenue Service (IRS) considers Disability Income benefits paid under

an employer-paid group Disability Income to be:

Answer:

• fully taxable

Question 3: The insurance policy clause that identifies the contracting parties and defines the

scope and limits of coverage is called the:

Answer:

• Insuring clause

Question 4: Which of the following health policies requires a beneficiary designation?

Answer:

• Travel Accident

Question 5: Credit Accident and Health insurance MUST provide coverage for a loss caused by:

Answer:

disability Question 6: A married insured has an Accidental Death and Dismemberment (AD&D) policy that names their sibling as the primary beneficiary and their child as the contingent beneficiary. If the insured and their sibling are both killed instantly in a train accident, the policy proceeds would be paid to which of the following?

Answer:

The insured's child Question 7: What documents are required to apply for a health insurance policy in North Carolina?

Answer:

Proof of identity, income verification, and any required application forms.

Question 8: What is Medicaid?

Answer:

A state and federally funded program that provides health coverage to low-income individuals and families.Question 9: Which of the following types of provisions guarantees renewability to a specified date or age unless certain specified events occur?

Answer:

• Conditionally Renewable

Question 10: Which of the following statements about the Medicare program is CORRECT?

Answer:

It is a federally sponsored program.Question 11: The Social Security program provides all of the following benefits EXCEPT:

Answer:

Workers compensation

Question 12: A claim for a pre-existing condition may NOT be denied after a Major Medical

policy has been in effect for a minimum of:

Answer:

• two years

Question 13: What is the primary purpose of health and accident insurance?

Answer:

To provide coverage for medical expenses and income loss resulting from illness or injury.Question 14: A producer may be guilty of misrepresentation if the Answer: tells an insured the deductible on a policy is less than it actually is Question 15: A group policy issued to a newspaper or other publisher to cover its carriers is referred to as which of the following types of policies?

Answer:

• Blanket Accident and Health

Question 16: What is an accident policy?

Answer:

A health insurance policy that covers losses caused only by accidental bodily injuries.

Question 17: What is a PPO?

Answer:

Preferred Provider Organization - allows more flexibility to see providers both inside and outside the network without referrals.Question 18: Under a Guaranteed Renewable Accident & Health policy, an insurer retains the

right to:

Answer:

Increase the premium rate for an entire class of insureds Question 19: Two people own a small interior design studio that employs six people. The owners are concerned about the financial continuation of the business if either of them should become permanently disabled. In this situation, a producer would MOST likely recommend which of the following types of contracts?

Answer:

• Disability Buy-Out

Question 20: The purpose of the Medical Information Bureau (MIB) is to:

Answer:

Share medical data among member companies Question 21: Under an Accidental Death and Dismemberment (AD&D) policy, insurable interest must exist at which of the following times?

Answer:

At the inception of the policy Question 22: Under the Claims Forms provision of a health policy, if the insurance company

fails to send claim forms within the time period required, the insured should:

Answer:

Submit the claim in any form, which must be accepted by the company as adequate proof of loss Question 23: A precertification review prior to a nonemergency hospitalization is an example of:

Answer:

• managed care

Question 24: What is a network provider?

Answer:

A health care provider who has a contract with an insurer or managed care organization to provide services at negotiated rates.Question 25: The Coordination of Benefits clause found in group health master contracts is

used to:

Answer:

Avoid double payment of benefits to an insured who has duplicate group coverages

Question 26: What is the elimination period in a disability policy?

Answer:

The waiting period after a disability begins before benefits start.