North Dakota Health Insurance Practice Exam Free - 2026

• A. 30 days
• B. 20 days
• C. 15 days
• D. 10 days

Correct answer: D. 10 days

Explanation: Accident and health policies and certificates must carry a notice on the first page that the applicant may return the policy within ten days of its delivery and have the premium refunded if not satisfied for any reason. Twenty days is the life and annuity free look (§§ 26.1-33-02.1, 26.1-34-01.1); thirty days applies to Medicare supplement and long-term care policies; fifteen days is not a North Dakota free-look period. See N.D.C.C. § 26.1-36-02.1.

• A. From the moment of birth, but congenital defects are excluded for 12 months
• B. From the moment of birth, including congenital defects, and coverage continues beyond 31 days only if notice and premium are furnished within 31 days of birth
• C. Only after the insurer receives the application and approves the child's health
• D. From the moment of birth for 90 days, after which underwriting applies

Correct answer: B. From the moment of birth, including congenital defects, and coverage continues beyond 31 days only if notice and premium are furnished within 31 days of birth

Explanation: Policies covering family members must pay benefits for a newborn from the moment of birth, and the coverage includes necessary care and treatment of medically diagnosed congenital defects and birth abnormalities; where a specific premium is required, the policy may require notice of the birth and payment within thirty-one days after birth for coverage to continue beyond the 31-day period. A wrongly excludes congenital defects; C imposes underwriting the statute forbids; D uses a 90-day period that is not in the statute. See N.D.C.C. § 26.1-36-07.

• A. Within 15 business days after receipt of the proof of loss
• B. Within 30 calendar days after receipt
• C. Within 45 days, with 10% interest thereafter
• D. Within 10 business days after receipt

Correct answer: A. Within 15 business days after receipt of the proof of loss

Explanation: After receipt of a health insurance proof of loss form the insurer must, within fifteen business days, pay the claim or the uncontested portion, deny it, or make an initial request for additional information, and must pay or deny within fifteen business days of receiving the requested information. Thirty and forty-five days are other states' prompt-pay figures, and North Dakota's statute contains no 10% interest penalty; ten business days is shorter than the statute requires. See N.D.C.C. § 26.1-36-37.1.

• A. 18 months after termination
• B. 12 months after termination
• C. 39 weeks after the date his coverage would otherwise have ended
• D. 36 months after termination

Correct answer: C. 39 weeks after the date his coverage would otherwise have ended

Explanation: Continuation of group hospital, surgical, and major medical coverage ends at the earliest of nonpayment, termination of the group policy, or the date thirty-nine weeks after the employee's coverage would otherwise have terminated. Eighteen months is the federal COBRA period, not the state rule; twelve months is not in the statute; thirty-six months is the maximum continuation for a former spouse and dependent children after divorce under § 26.1-36-23.1. See N.D.C.C. § 26.1-36-23.

• A. To add coverage for a specified condition in exchange for an extra premium
• B. To charge a higher premium for a substandard risk instead of restricting any benefits
• C. To exclude or limit coverage for a specified condition or hazard, where allowed
• D. To waive the preexisting condition limitation for a specified health condition

Correct answer: C. To exclude or limit coverage for a specified condition or hazard, where allowed

Explanation: An exclusion rider may limit coverage for a named condition or risk. Candidates should remember that legality and use vary by product and jurisdiction.

• A. To exclude coverage for any illness or injury that first develops during the initial year the policy is in force
• B. To reduce the benefit amount for conditions that were disclosed and accepted during underwriting
• C. To require a higher premium for applicants who reported a chronic condition on the application
• D. To limit coverage for a condition that existed before coverage began, subject to policy terms and law

Correct answer: D. To limit coverage for a condition that existed before coverage began, subject to policy terms and law

Explanation: A preexisting condition limitation addresses conditions that existed before the policy effective date. Modern rules vary by policy type, so candidates should avoid assuming one rule applies everywhere.

• A. Documentation submitted to support that a covered loss occurred
• B. A document proving the insurer is profitable
• C. A replacement for the policy application
• D. The producer's sales script

Correct answer: A. Documentation submitted to support that a covered loss occurred

Explanation: Proof of loss is claim documentation submitted to the insurer so it can evaluate whether benefits are payable under the policy.

• A. Submit complete written proof of the loss within the required time period
• B. Tell the insurer about a covered loss within the required time period
• C. File a lawsuit against the insurer if the claim is not paid within the period
• D. Wait for the insurer to send claim forms before reporting the loss

Correct answer: B. Tell the insurer about a covered loss within the required time period

Explanation: Notice-of-claim provisions require timely notification so the insurer can start the claim process and request needed forms or information.

• A. The insured submitted the claim on time
• B. The deductible had already been met and all conditions were satisfied
• C. The claimed expense is excluded or not covered by the policy
• D. The policy was active and the service was covered

Correct answer: C. The claimed expense is excluded or not covered by the policy

Explanation: Claims can be denied when the expense falls outside policy coverage, is excluded, lacks required proof, or fails another policy condition.

• A. Claims being denied under a preexisting condition limitation
• B. The secondary plan from paying any portion of the claim
• C. Dependents from being covered under more than one plan
• D. Duplicate benefit payments that exceed covered expenses

Correct answer: D. Duplicate benefit payments that exceed covered expenses

Explanation: Coordination of benefits rules determine payment order when more than one health plan covers the same person, helping avoid duplicate recovery beyond covered expenses.

• A. Optionally renewable
• B. Guaranteed renewable
• C. Cancelable
• D. Conditionally renewable

Correct answer: D. Conditionally renewable

Explanation: Conditionally renewable policies let the insurer refuse renewal only on grounds stated in the policy, such as reaching a certain age or leaving a job - never deteriorating health. The classification sits between optionally renewable (the insurer may decline renewal for any reason on a premium due date) and guaranteed renewable (the insured has the right to renew, though premiums may rise by class).

• A. Whether a provider's billed charges fall within usual, customary, and reasonable limits
• B. Whether healthcare services are medically necessary and appropriate under plan rules
• C. Whether an applicant's health history makes the risk acceptable for coverage
• D. Whether a claimant has submitted timely notice and complete proof of loss

Correct answer: B. Whether healthcare services are medically necessary and appropriate under plan rules

Explanation: Utilization review examines the medical necessity, appropriateness, or efficiency of services under the health plan's rules.