6 - Statues and Regulations Specific to Health Insurance

Question 1

Insurer must deliver or mail a copy of the application…

Answer 1

-within 15 days after the receipt of the request

Question 2

Insurers must notify Group certificate holders how many days before the cancellation of a Group Health policy if the employer has failed to pay the premium?

Answer 2

-15 days before

Question 3

“free look” period

Answer 3

-10 days

Question 4

Punishment if a group health fiduciary willfully fails to pay the premiums on a group health plan and does not inform certificate holders?

Answer 4

-Class H felony

Question 5

Employer sponsored Franchise health plans require how many employees for Accident and Health?

Answer 5

-5 or more employees

Question 6

If an applicant has the Hemoglobin C Trait, what will the underwriters do on the application?

Answer 6

-ignore the condition

Question 7

under state continuation, the premium is paid by…

Answer 7

-premiums will be paid fully by the certificate holder

Question 8

Whenever replacement of existing Group insurance occurs, liability for coverage must begin….

Answer 8

-within 15 days by the new insurer

Question 9

Health policies, applications, or riders cannot be used until the expiration of a ________ period after they have been filed unless the Commissioner gives a written approval

Answer 9

-90 days

Question 10

An insured covered by an employer group health policy resigns from the company. The former employee has two (2) options to continue his group health insurance program. The individual elects to continue his benefits under the state continuation program. How will the premium be paid for the coverage?

Answer 10

-The former employee will pay the full group rate for the coverage with a 2% administrative charge.

Question 11

Any company or Producer who issues or delivers a health policy in willful violation of insurance regulations is guilty of a….

Answer 11

-Class 3 Misdemeanor

Question 12

A group health policy fiduciary must provide notice of intent to cancel the group plan with how much notice to certificate holders?

Answer 12

-45 days notice

Question 13

Members of an association may obtain a Blanket Accident and Health insurance policy if the association has at least ______ members.

Answer 13

-25

Question 14

When is State Continuation not available?

Answer 14

• if have access to another group health plan

- if there is no active group plan with the employer

Question 15

Fraternal Benefit Society

Answer 15

• Non-profit
• Lodge System
• It’s members only

Question 16

Limiting Age on health policies for mentally retarded individuals current on a parent’s policy?

Answer 16

-no limiting age

Question 17

If an employer has failed to pay premiums on a group health policy, the insurer must notify each certificate holder (employee) of intent to cancel the group health policy at least _______ before cancellation.

Answer 17

-15 days

Question 18

The Life and Health Insurance Guaranty Association will provide payment in the case of the insolvency of a member company up to ___________.

Answer 18

-$300,000 total lifetime aggregate on any single person

Question 19

North Carolina law requires parent’s health insurance coverage to begin on newborn children:

Answer 19

-from the moment of birth

Question 20

Under North Carolina State Continuation, the insured MUST make premium payments by:

Answer 20

-the beginning of each month

Question 21

In an employer sponsored Franchise Group health plan, the employer is required to pay what percent of the premiums for the group?

Answer 21

-none

Question 22

an insurance fiduciary cannot be…

Answer 22

-insured

Question 23

Continuation of group health insurance benefits requires the employee to have been covered under the group plan for how long to be eligible?

Answer 23

-previous 3 months