17 Free North Carolina Life & Health Practice Questions: Accident and Health Insurance Policies (2026)

Question 1 (Chapter 4)

An insured has a disability policy with a 90-day elimination period. After 40 days of disability, they return to work for two weeks, then suffer a relapse of the same condition. Under the recurrent disability provision, how is the elimination period handled?

• A) The insured must restart the full 90-day elimination period.
• B) The recurrent disability provision waives the elimination period entirely.
• C) The recurrent disability provision only applies if the insured was out of work for at least 6 months.
• D) The insured must complete an additional 50 days to reach the 90-day requirement.

Question 2 (Chapter 4)

An HMO member requires a referral from their primary care physician (PCP) to see a specialist. What is the role of the PCP in this scenario?

• A) Gatekeeper
• B) Independent contractor
• C) Utilization reviewer
• D) Claims adjuster

Question 3 (Chapter 4)

Which of the following is a common exclusion found in most disability income policies?

• A) Disability caused by sickness.
• B) Disability caused by accidental bodily injury.
• C) Disability resulting from a work-related accident.
• D) Disability resulting from an act of war.

Question 4 (Chapter 4)

In a managed care system, what does an 'open panel' HMO allow?

• A) Members to choose from a larger list of physicians, including those who also see non-HMO patients.
• B) Members to see any doctor in the country.
• C) Physicians to work exclusively for the HMO.
• D) The HMO to charge higher premiums.

Question 5 (Chapter 4)

Which of the following is a characteristic of 'basic medical expense' insurance?

• A) High lifetime maximum limits.
• B) High deductibles and coinsurance.
• C) Comprehensive coverage for all medical services.
• D) Low limits and first-dollar coverage.

Question 6 (Chapter 4)

An insured has a disability policy with an AD&D rider. If the insured loses a hand in a work-related accident, what will the policy pay?

• A) The capital sum for the loss of a limb.
• B) The principal sum only if the insured dies.
• C) Nothing, as AD&D riders only cover loss of life.
• D) The full monthly disability benefit for the rest of their life.

Question 7 (Chapter 4)

Which of the following is a characteristic of a 'Staff Model' HMO?

• A) Physicians are independent contractors who see both HMO and non-HMO patients.
• B) The HMO contracts with a group of doctors who share a practice.
• C) Physicians are employees of the HMO and work in a clinic owned by the HMO.
• D) The HMO only covers emergency care.

Question 8 (Chapter 4)

What is the primary function of a 'Gatekeeper' in an HMO?

• A) To process claims payments.
• B) To manage the hospital's admission department.
• C) To negotiate rates with out-of-network providers.
• D) To control costs by requiring referrals from the Primary Care Physician (PCP) to see specialists.

Question 9 (Chapter 4)

What is the primary goal of 'Pre-admission Certification'?

• A) To verify the medical necessity of a hospital stay before it occurs, thus controlling costs.
• B) To ensure the hospital has enough beds.
• C) To confirm the patient's insurance coverage is active.
• D) To allow the doctor to choose the hospital.

Question 10 (Chapter 4)

Sarah, a licensed architect in North Carolina, has a disability income policy. For the first two years of disability, the policy defines total disability as being unable to perform the material duties of her own occupation. After two years, if she is still disabled, the definition changes to being unable to perform any occupation for which she is reasonably suited by education, training, or experience. What type of total disability definition is included in Sarah's policy?

• A) Any occupation
• B) Presumptive disability
• C) Own occupation, indefinitely
• D) Combination definition

Question 11 (Chapter 4)

Which of the following would most likely be excluded from coverage under a typical Basic Medical Expense policy issued in North Carolina?

• A) Emergency room treatment for an accidental injury.
• B) In-patient hospital room and board for a covered illness.
• C) Surgical procedures performed by a licensed physician.
• D) Routine dental care and cosmetic surgery.

Question 12 (Chapter 4)

A North Carolina insured has a comprehensive major medical policy that combines basic medical expense coverage with major medical coverage into a single plan. There is no 'corridor deductible' between the basic and major medical components. What does this imply about the deductible structure?

• A) The basic plan pays first, and then the major medical deductible applies to remaining expenses.
• B) The basic plan and major medical plan each have separate, independent deductibles.
• C) There is a single, overall deductible that applies to all covered medical expenses.
• D) The policy pays 100% of all expenses from the first dollar.

Question 13 (Chapter 4)

Laura, a self-employed artist in North Carolina, purchases a disability income policy that covers disabilities resulting from both on-the-job and off-the-job injuries or illnesses. What type of coverage does Laura have?

• A) Nonoccupational coverage only.
• B) Occupational coverage only.
• C) Full coverage.
• D) Workers' Compensation.

Question 14 (Chapter 4)

A policyholder has a disability income policy with a 90-day elimination period. They become disabled on January 1st and return to work on April 15th (105 days later). If the policy covers the disability, when do the benefit payments begin?

• A) January 1st.
• B) April 1st.
• C) January 31st.
• D) April 15th.

Question 15 (Chapter 4)

A 'gatekeeper' in an HMO model is responsible for which of the following?

• A) Processing all insurance claims for the network.
• B) Authorizing referrals to specialists and managing overall care.
• C) Setting the premium rates for the HMO members.
• D) Providing emergency surgery for all network patients.

Question 16 (Chapter 4)

What is the primary purpose of a 'probationary period' in a disability income policy?

• A) To allow the insured time to pay the first premium.
• B) To prevent coverage for illnesses that existed before the policy was issued.
• C) To ensure the insured is actively working at the time of the claim.
• D) To provide a grace period for late premium payments.

Question 17 (Chapter 4)

What is the primary purpose of a 'Family Maximum' deductible in a major medical plan?

• A) It limits the number of family members who can be covered.
• B) It limits the total deductible a family must pay in a year.
• C) It reduces the monthly premium for families.
• D) It allows the family to skip the deductible if they are healthy.