Free North Dakota Accident & Health practice questions

Answer: D. Within 30 days, refund premium paid past April, less any claims this term

The required provision obligates the insurer, within 30 days after it is notified of the insured's death, to refund whatever premium was paid for the period beyond the month of death, after subtracting any claim for losses during the current policy term. Here that is the premium for May through the end of the annual term, less any such claim. The refund does not include April, the month of death, so returning the entire annual premium overstates it, and the provision does not let the insurer keep the unused premium. The 30 days run from notice of death, not from a 60-day period after proof of loss. The refund duty does not apply when the insurer has a valid defense to paying benefits, which the facts here rule out.

Answer: B. Within fifteen business days after receiving the form

North Dakota requires an insurer that has received a health insurance proof of loss form to act within fifteen business days. In that time it must pay the claim or the part of it that is not in dispute, deny the claim, or make an initial request for additional information. Thirty calendar days, ten business days and forty-five calendar days are not the period this statute sets: it counts in business days and fixes the number at fifteen.

Answer: A. When the commissioner has authorized it

For these prestandardized policies, an issuer may cancel or nonrenew only for nonpayment of premium or material misrepresentation, unless the commissioner authorizes otherwise. The same standards separately bar cancellation or nonrenewal of a guaranteed renewable policy solely because the insured's health has deteriorated, so declining health is not a permitted ground. Heavy claims and advance notice are not among the stated grounds either, so neither one opens a route to cancellation.

Answer: A. Pay the benefits that the premium actually paid would buy at her true age

North Dakota permits an individual accident and health policy to include a misstatement-of-age provision. Under it, every amount payable is whatever the premium paid would have purchased at the insured's correct age. The claim is therefore paid, but in the adjusted amount. The remedy the provision states is an adjustment of the amounts payable. Rescinding the policy from issue, collecting back premium while paying the full benefit, and denying the claim with a premium refund each describe a remedy the provision does not contain.

Answer: B. Within ten days after the advertisement is first used in the state

North Dakota requires any insurer, health care service plan, or other entity providing Medicare supplement insurance to send the commissioner a copy of each Medicare supplement advertisement within ten days after its first use in the state, whether written, radio, or television, for review or approval to the extent state law requires or authorizes. The deadline runs from first use, so there is no thirty-day advance filing. The duty arises from use of the advertisement, not from a complaint, and it is not deferred to an annual report.

Answer: C. At the time the policy or contract is delivered to the owner

The guaranty association prepares a summary document describing the general purposes and current limitations of the guaranty association law, and the commissioner approves it. A member insurer may not deliver a policy or contract unless the summary document is delivered to the owner at the time the policy is delivered. The document must also be available on request, but that is in addition to delivery with the policy, so a request is not the only point at which the owner receives it. The statute ties the obligation to delivery of the policy, not to the insurer's impairment or insolvency or to a deadline measured from the first premium.

Answer: D. A refund of the premium, since she is within thirty days of delivery and needs no reason

North Dakota requires every Medicare supplement policy to carry a notice, printed on or attached to its first page, that the applicant may return the policy within thirty days of delivery and have the premium refunded if dissatisfied for any reason. May 28 is 25 days after May 3 delivery, so she is inside the window. The period is thirty days, not ten. She does not have to show any defect, because dissatisfaction for any reason is enough. The statute provides for the premium to be refunded, not a refund prorated by days unused.

Answer: B. It is left out entirely when her period of continuous coverage is measured

North Dakota's portability statute requires an insurer to credit qualifying previous coverage against a pre-existing condition period when that coverage was continuous until at least sixty-three days before the new coverage begins. The same section directs that a waiting period under a health benefit plan is not to be considered when the period of continuous coverage is determined. Dana's 45-day waiting period is therefore left out of the measurement. Treating it as days of qualifying coverage, or as a lapse that ends continuity, would both take it into account, which the statute forbids. The statute sets no length threshold for when a waiting period counts.

Answer: A. It is still in force, because the loss falls inside the 31-day grace period

The required grace period provision gives the policyholder 31 days to pay any premium due after the first, and the policy continues in force during that time unless the policyholder gave advance written notice of discontinuance. A loss on day 20 falls within the grace period, so the policy is in force without the premium having been paid first, although the policy may charge the policyholder a pro rata premium covering the days of coverage in the grace period. The grace period applies to every premium except the first, not only to the first. Because the policy continues in force throughout the grace period, there is no lapse that would call for reinstatement.

Answer: C. Within forty business days

When an insurer receives a national medical support notice from the employer, North Dakota requires it to comply with the notice and to take appropriate action within forty business days of the notice's date. Ten business days, thirty calendar days and sixty calendar days are not the period the statute sets.