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North Carolina Health Insurance — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

accident and health or sickness

Individual authority for sickness, injury, accidental death and disability income; includes agents and brokers.

Licensing authority: North Carolina Department of Insurance · Application information

Reinstatement within four months of continuing education lapse
No examination is required for this applicant pathway.
Deadline
Complete deficient CE and pay the $75 administrative fee within four months after the prior compliance year ends.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after the four month CE remedy period
Accident and Health or Sickness Agent
Base authority
For Medicare/LTC, maintain or separately re-establish health authority.
Education
The current .0811 temporary amendment effective May 6, 2026 omits the former prelicensing-course requirement.
Prior status
CE lapse not remedied within four months; pass the appropriate line licensing examination.
Restoration following child support enforcement suspension or revocation
No examination is required for this applicant pathway.
Compliance
Obtain designated-representative certification of compliance after satisfying the support order, agreed payment schedule or relevant subpoena.
Fingerprints
Resident producer restoration after support-related suspension or revocation requires electronic fingerprints under .0418(a)(5).
Scope
Restores the prior line; this is the special child-support enforcement process rather than ordinary reissuance after disciplinary revocation.

Official no-examination sources

Effective from 2026-09-22.

Continuation or renewal subject to disciplinary reexamination
Accident and Health or Sickness Agent
Discretion
After a Chapter 58 violation, the Commissioner may require a written competence examination.
Scope
The appropriate line licensing examination is the identifiable examination; the individual order determines the licensed line tested.
Nonresident license continuation
No examination is required for this applicant pathway.
Home license
Maintain good-standing home-state authority and satisfy reciprocal home-state continuing education.
Status
North Carolina nonresident license lapses 30 days after loss of home-state good standing.

Official no-examination sources

Effective from 2026-09-22.

Nonresident issuance by interstate reciprocity
No examination is required for this applicant pathway.
Application
Submit prescribed application or home-state application and pay fees.
Home license
Hold the same home-state resident line in good standing; home state grants reciprocal nonresident licenses.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident authority
No examination is required for this applicant pathway.
Home license
Within 30 days following the NC lapse prove home-state reinstatement/reissuance; alternatively prove relocation and a new home-state license and submit address notice within 60 days of issuance.
New application
Outside these restoration conditions, file a new application under the applicable nonresident route.

Official no-examination sources

Effective from 2026-09-22.

Resident issuance for an applicant previously licensed in the same line
No examination is required for this applicant pathway.
Application
Apply through NIPR, pay fees and provide resident fingerprints.
Board instruction
An individual who applies for an insurance producer license in this State who was  licensed for the same kinds of insurance in his or her previous home state is not required to pass the NC exam per N.C.G.S. 58-33-32(g),. This exemption is only available if the application is received within 90 days after the applicant's previous home state license(s) are cancelled. ASD accepts the information on the Producer Database (PDB) maintained by the NAIC or affiliates or subsidiaries of the NAIC, indicating that the producer was licensed in good standing for the kind of insurance requested.
Prior authority
Meet one of the three same-line home-state licensure and good-standing alternatives in G.S. 58-33-32(g).
Relocation
Moving producers apply within 90 days of establishing North Carolina legal residence.

Official no-examination sources

Effective from 2026-09-22.

Reissuance after individual license revocation
Accident and Health or Sickness Agent
Base authority
For Medicare/LTC, hold or separately re-establish health authority.
Prior status
Comply with every Article 33 issuance requirement; Commissioner must approve fitness.
Relicensure after surrender or termination outside the exam waiver period
Accident and Health or Sickness Agent
Application
Reapply and pay fees; resident lapse of more than one year requires fingerprints.
Base authority
For Medicare/LTC, hold or separately re-establish health authority.
Prior status
No longer eligible for an examination waiver; meet requirements for a previously unlicensed applicant.
Resident license continuation
No examination is required for this applicant pathway.
Continuing education
Maintain 24 biennial credit hours, including three ethics hours for the underlying health authority; documented waivers and extensions are conditions.
Course assessments
A chosen CE course may require its own completion examination; no separately identified licensing exam is prescribed for ordinary continuation.
Grandfathered exemption
A CE exemption granted before October 1, 2010 continues with annual certification of age 65 or older, 25 years of continuous licensure, and a listed professional designation or inactive-agent status. This is a CE exemption, not a separately issued retired license.
Hardship extension
Request an extension in writing during or before the last month of the compliance year under .0807.
Military or disability waiver
Military service or long-term medical disability may support a CE waiver of up to one year with deployment orders or a notarized physician statement; certify medical disability annually.
Status
Maintain an unsuspended, unrevoked license; no annual producer renewal application.

Official no-examination sources

Effective from 2026-09-22.

Resident initial issuance by examination
Accident and Health or Sickness Agent
Age
At least 18 years old.
Application
Submit the Uniform Application through NIPR and pay fees; supply supporting documentation for screening responses.
Appointment
Insurer appointment is required before acting as that insurer's agent.
Education
G.S. 58-33-30(d)(1) prohibits a specified course or amount of instruction for producer licensure. Older 11 NCAC 06A .0304(c) states: (c) Applicants taking the life, accident and health or sickness, Medicare supplement, long term care, personal lines, property, or casualty examination shall bring to the examination site an Examination Admission Ticket/Certificate of Course Completion, validated by an approved prelicensing school or by the Division indicating that the applicant has successfully completed the mandatory prelicensing education requirements as specified in G.S. 58-33-30(d)(2). The Examination Admission Ticket/Certificate of Course Completion is valid for 90 days from the date of course completion or a maximum of five examination sittings, whichever occurs first.
Fingerprints
Initial resident applicants and resident relicensing following a lapse of at least one year submit electronic fingerprints.
Fitness
No disqualifying act under G.S. 58-33-46; supply required criminal-history documents.
Reinstatement of a lapse under one year excluding inactive or expired status
No examination is required for this applicant pathway.
Application
Submit reinstatement application and applicable fees; CE lapse uses its separate remedy period.
Lapse
Less than one year and status other than Inactive or Expired.

Official no-examination sources

Effective from 2026-09-22.

Broker activity by an already licensed producer
No examination is required for this applicant pathway.
Existing authority
Already hold the North Carolina producer license for the health insurance brokered.
Older rule demand
11 NCAC 06A .0404(c) states: Each applicant shall file with his application a surety bond or cash, certificates of deposit, or securities as provided by statute. Any cash, certificate of deposit, or securities deposited in lieu of the surety bond shall be held in accordance with 11 NCAC 11B .0100.
Placement
Place through an insurer-appointed producer; broker authority grants no binding authority.
Statutory change
G.S. 58-33-10(7) includes brokers within the producer identity; the older rule cites G.S. 58-33-30(f), repealed effective July 7, 2022.

Official no-examination sources

Effective from 2026-09-22.

Insurance Producer Business Entity

A business entity selling, soliciting, or negotiating insurance must obtain an insurance producer license and designate a licensed natural person responsible for compliance.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident business entity issuance
No examination is required for this applicant pathway.
Application
Uniform Business Entity Application through NIPR; pay fees and meet Secretary of State conditions.
Home state
Hold a good-standing resident business entity license in the home state with reciprocity.
Individuals
Each person personally selling, soliciting or negotiating needs the applicable individual license.
Responsible producer
Designate a natural person already licensed in North Carolina responsible for insurance-law compliance.

Official no-examination sources

Effective from 2026-09-22.

Business entity reapplication after lapse
No examination is required for this applicant pathway.
Application
Uniform Business Entity Application through NIPR; pay fees and meet Secretary of State conditions.
Individuals
Each person personally selling, soliciting or negotiating needs the applicable individual license.
Prior status
Lapsed entity license; reapply under G.S. 58-33-31(b).
Responsible producer
Designate a natural person already licensed in North Carolina responsible for insurance-law compliance.

Official no-examination sources

Effective from 2026-09-22.

Annual business entity renewal
No examination is required for this applicant pathway.
Deadline
Renew electronically through NIPR and pay fees for April 1 renewal following March 31 expiration.
Responsible producer
Designate a natural person already licensed in North Carolina responsible for insurance-law compliance.

Official no-examination sources

Effective from 2026-09-22.

Resident business entity issuance
No examination is required for this applicant pathway.
Application
Uniform Business Entity Application through NIPR; pay fees and meet Secretary of State conditions.
Individuals
Each person personally selling, soliciting or negotiating needs the applicable individual license.
Responsible producer
Designate a natural person already licensed in North Carolina responsible for insurance-law compliance.

Official no-examination sources

Effective from 2026-09-22.

Credit Agent

Applicants must be at least 18, apply online and pay the required fees. A company appointment is required to use the license.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident limited authority by reciprocity
No examination is required for this applicant pathway.
Application
Submit prescribed application and pay fees.
Home state
Hold equivalent limited authority in a good-standing resident home-state license; reciprocity required.
Scope
Only the home-state limited scope is granted.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident limited authority
No examination is required for this applicant pathway.
Home state
Within 30 days following NC lapse prove restoration of home-state limited authority; alternatively show relocation and a new home-state license and address notice within 60 days of issuance.
Scope
Only equivalent prior limited authority is restored; otherwise submit a new application.

Official no-examination sources

Effective from 2026-09-22.

Relicensure after limited authority surrender, termination or lapse
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Prior status
Previously held limited authority lapsed, was surrendered, or terminated; meet requirements for a previously unlicensed applicant of this exam-free type.
Scope
Credit health sold by lenders to cover their loans; only authorized credit insurance products.

Official no-examination sources

Effective from 2026-09-22.

Annual limited representative renewal
No examination is required for this applicant pathway.
Appointment
Maintain the appropriate limited authority and appointment.
Deadline
April 1 annual renewal; company submits the electronic payment under .0501.

Official no-examination sources

Effective from 2026-09-22.

Resident limited authority issuance
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Scope
Credit health sold by lenders to cover their loans; only authorized credit insurance products.

Official no-examination sources

Effective from 2026-09-22.

Limited Representative — Dental Services

Limited-representative authority for dental services, including selling dental services for Delta Dental of North Carolina; company appointment is required.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident limited authority by reciprocity
No examination is required for this applicant pathway.
Application
Submit prescribed application and pay fees.
Home state
Hold equivalent limited authority in a good-standing resident home-state license; reciprocity required.
Scope
Only the home-state limited scope is granted.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident limited authority
No examination is required for this applicant pathway.
Home state
Within 30 days following NC lapse prove restoration of home-state limited authority; alternatively show relocation and a new home-state license and address notice within 60 days of issuance.
Scope
Only equivalent prior limited authority is restored; otherwise submit a new application.

Official no-examination sources

Effective from 2026-09-22.

Relicensure after limited authority surrender, termination or lapse
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Prior status
Previously held limited authority lapsed, was surrendered, or terminated; meet requirements for a previously unlicensed applicant of this exam-free type.
Scope
Dental coverage from dental-only carriers, including the Department-specified Delta Dental authority.

Official no-examination sources

Effective from 2026-09-22.

Annual limited representative renewal
No examination is required for this applicant pathway.
Appointment
Maintain the appropriate limited authority and appointment.
Deadline
April 1 annual renewal; company submits the electronic payment under .0501.

Official no-examination sources

Effective from 2026-09-22.

Resident limited authority issuance
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Scope
Dental coverage from dental-only carriers, including the Department-specified Delta Dental authority.

Official no-examination sources

Effective from 2026-09-22.

Nonresident Limited Lines Producer

Nonresident limited lines producer license granting the same scope of authority as granted under the license issued by the producer's home state.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident limited health continuation
No examination is required for this applicant pathway.
Home state
Maintain the same home-state authority in good standing; NC license lapses 30 days after loss of home-state good standing.

Official no-examination sources

Effective from 2026-09-22.

Nonresident reciprocal limited health issuance
No examination is required for this applicant pathway.
Application
Submit prescribed application and pay fees.
Home state
Hold good-standing resident home-state limited health authority with reciprocity.
Scope
Only the scope granted by the home-state license is authorized.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident limited health authority
No examination is required for this applicant pathway.
Restoration
Within 30 days after NC lapse prove home-state restoration; alternatively prove relocation and new home-state license with address notice within 60 days of issuance. Otherwise reapply.

Official no-examination sources

Effective from 2026-09-22.

Auto Rental Limited License

Rental company/franchisee authority for rental-period accident and health coverages.

Licensing authority: North Carolina Department of Insurance · Application information

Rental car company or franchisee initial issuance
No examination is required for this applicant pathway.
Entity
Rental company or franchisee; submit application, fees and insurer competency/appointment certificate.
Materials
Submit brochures and employee training program for approval; selling employees complete the training.
Scope
Accidental death/dismemberment and accident medical expenses during rentals of no more than 30 consecutive days.

Official no-examination sources

Effective from 2026-09-22.

Reapplication after rental limited license lapse
No examination is required for this applicant pathway.
Entity
Rental company or franchisee; submit application, fees and insurer competency/appointment certificate.
Materials
Submit brochures and employee training program for approval; selling employees complete the training.
Prior status
Lapsed license; meet current company issuance requirements.
Scope
Accidental death/dismemberment and accident medical expenses during rentals of no more than 30 consecutive days.

Official no-examination sources

Effective from 2026-09-22.

Annual rental limited license renewal
No examination is required for this applicant pathway.
Deadline
Renew annually on April 1 electronically through NIPR and pay fees.
Training
Submit brochures and employee training program for approval; selling employees complete the training.

Official no-examination sources

Effective from 2026-09-22.

Temporary Insurance Producer License

Temporary insurance producer license for servicing an insurance business, issued at the commissioner's discretion without an examination for up to 180 days or longer for good cause.

Licensing authority: North Carolina Department of Insurance · Application information

Business entity member or employee
No examination is required for this applicant pathway.
Applicant
Death or disability of the individual designated in a licensed entity application or license.
Discretion
Commissioner approval required; authority may be limited and a licensed-producer or insurer sponsor may be required.
Duration
Up to 180 days, or longer for good cause; terminates upon transfer of the business.
Insurers
For death or disability, only insurers that appointed the original producer at death or commencement of disability may be represented.

Official no-examination sources

Effective from 2026-09-22.

Designee of a producer entering military service
No examination is required for this applicant pathway.
Applicant
Licensed producer enters active service in the United States Armed Forces.
Discretion
Commissioner approval required; authority may be limited and a licensed-producer or insurer sponsor may be required.
Duration
Up to 180 days, or longer for good cause; terminates upon transfer of the business.
Insurers
For death or disability, only insurers that appointed the original producer at death or commencement of disability may be represented.

Official no-examination sources

Effective from 2026-09-22.

Other public interest circumstance
No examination is required for this applicant pathway.
Applicant
Commissioner finds this circumstance best serves the public interest.
Discretion
Commissioner approval required; authority may be limited and a licensed-producer or insurer sponsor may be required.
Duration
Up to 180 days, or longer for good cause; terminates upon transfer of the business.
Insurers
For death or disability, only insurers that appointed the original producer at death or commencement of disability may be represented.

Official no-examination sources

Effective from 2026-09-22.

Spouse, surviving spouse, representative or guardian
No examination is required for this applicant pathway.
Applicant
Death or mental/physical disability of a producer; transfer the business, allow recovery, or train and license personnel.
Discretion
Commissioner approval required; authority may be limited and a licensed-producer or insurer sponsor may be required.
Duration
Up to 180 days, or longer for good cause; terminates upon transfer of the business.
Insurers
For death or disability, only insurers that appointed the original producer at death or commencement of disability may be represented.

Official no-examination sources

Effective from 2026-09-22.

Limited Representative — Travel, Accident and Baggage

Limited-representative authority for travel, accident, and baggage insurance; appointment required with each company for which business is solicited.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident limited authority by reciprocity
No examination is required for this applicant pathway.
Application
Submit prescribed application and pay fees.
Home state
Hold equivalent limited authority in a good-standing resident home-state license; reciprocity required.
Scope
Only the home-state limited scope is granted.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident limited authority
No examination is required for this applicant pathway.
Home state
Within 30 days following NC lapse prove restoration of home-state limited authority; alternatively show relocation and a new home-state license and address notice within 60 days of issuance.
Scope
Only equivalent prior limited authority is restored; otherwise submit a new application.

Official no-examination sources

Effective from 2026-09-22.

Relicensure after limited authority surrender, termination or lapse
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Prior status
Previously held limited authority lapsed, was surrendered, or terminated; meet requirements for a previously unlicensed applicant of this exam-free type.
Scope
Travel coverage including health, accident, life, baggage loss and trip risks; limited to travel products.

Official no-examination sources

Effective from 2026-09-22.

Annual limited representative renewal
No examination is required for this applicant pathway.
Appointment
Maintain the appropriate limited authority and appointment.
Deadline
April 1 annual renewal; company submits the electronic payment under .0501.

Official no-examination sources

Effective from 2026-09-22.

Resident limited authority issuance
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Scope
Travel coverage including health, accident, life, baggage loss and trip risks; limited to travel products.

Official no-examination sources

Effective from 2026-09-22.

limited lines travel insurance producer business entity license

Travel producer business entity allowing registered travel retailers to disseminate travel coverage including health risks.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident travel business by reciprocity
No examination is required for this applicant pathway.
Application
Apply in the prescribed form and pay producer fees.
Home state
Equivalent good-standing resident home-state business authority and reciprocity.
Responsible producer
Designate an employee holding an individual producer license for compliance.
Retailers
Maintain and update retailer register annually; submit it on request and certify federal-law compliance.
Scope
Travel risks; exclude major medical plans for trips over six months and products requiring another specific producer license.
Training
Train retailer staff in the products, ethical sales practices and required disclosures.

Official no-examination sources

Effective from 2026-09-22.

Reapplication after travel business lapse
No examination is required for this applicant pathway.
Application
Apply in the prescribed form and pay producer fees.
Prior status
Lapsed license; meet current issuance requirements.
Responsible producer
Designate an employee holding an individual producer license for compliance.
Retailers
Maintain and update retailer register annually; submit it on request and certify federal-law compliance.
Scope
Travel risks; exclude major medical plans for trips over six months and products requiring another specific producer license.
Training
Train retailer staff in the products, ethical sales practices and required disclosures.

Official no-examination sources

Effective from 2026-09-22.

Annual travel business entity renewal
No examination is required for this applicant pathway.
Application
Apply in the prescribed form and pay producer fees.
Renewal
Entity license expires March 31 unless the renewal fee is paid; update the travel retailer register annually.
Responsible producer
Designate an employee holding an individual producer license for compliance.
Retailers
Maintain and update retailer register annually; submit it on request and certify federal-law compliance.
Scope
Travel risks; exclude major medical plans for trips over six months and products requiring another specific producer license.
Training
Train retailer staff in the products, ethical sales practices and required disclosures.

Official no-examination sources

Effective from 2026-09-22.

Resident limited lines travel business issuance
No examination is required for this applicant pathway.
Application
Apply in the prescribed form and pay producer fees.
Responsible producer
Designate an employee holding an individual producer license for compliance.
Retailers
Maintain and update retailer register annually; submit it on request and certify federal-law compliance.
Scope
Travel risks; exclude major medical plans for trips over six months and products requiring another specific producer license.
Training
Train retailer staff in the products, ethical sales practices and required disclosures.

Official no-examination sources

Effective from 2026-09-22.

vision services

Vision coverage from vision-only carriers, including the Department-specified Delta Dental authority.

Licensing authority: North Carolina Department of Insurance · Application information

Nonresident limited authority by reciprocity
No examination is required for this applicant pathway.
Application
Submit prescribed application and pay fees.
Home state
Hold equivalent limited authority in a good-standing resident home-state license; reciprocity required.
Scope
Only the home-state limited scope is granted.

Official no-examination sources

Effective from 2026-09-22.

Restoration of lapsed nonresident limited authority
No examination is required for this applicant pathway.
Home state
Within 30 days following NC lapse prove restoration of home-state limited authority; alternatively show relocation and a new home-state license and address notice within 60 days of issuance.
Scope
Only equivalent prior limited authority is restored; otherwise submit a new application.

Official no-examination sources

Effective from 2026-09-22.

Relicensure after limited authority surrender, termination or lapse
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Prior status
Previously held limited authority lapsed, was surrendered, or terminated; meet requirements for a previously unlicensed applicant of this exam-free type.
Scope
Vision coverage from vision-only carriers, including the Department-specified Delta Dental authority.

Official no-examination sources

Effective from 2026-09-22.

Annual limited representative renewal
No examination is required for this applicant pathway.
Appointment
Maintain the appropriate limited authority and appointment.
Deadline
April 1 annual renewal; company submits the electronic payment under .0501.

Official no-examination sources

Effective from 2026-09-22.

Resident limited authority issuance
No examination is required for this applicant pathway.
Age
At least 18 years old.
Application
Apply through NIPR and pay required fees.
Appointment
Insurer appointment required to use the license.
Fingerprints
Electronic fingerprints for initial resident issuance and re-license after a one-year lapse, except Credit Agent applicants, exempt under G.S. 58-33-48(c)(2).
Scope
Vision coverage from vision-only carriers, including the Department-specified Delta Dental authority.

Official no-examination sources

Effective from 2026-09-22.

Accident and Health or Sickness Agent

Provider
Pearson VUE
Format
Four-option multiple-choice examination
Exam questions
55 scored questions plus up to 5 unscored pretest questions
Time limit
1 hour, 15 minutes
Passing score
70 on a scaled 0–100 scale
Exam fee
$45 per examination attempt
Examination outline
  • I. ACCIDENT & HEALTH INSURANCE POLICIES
    • A. Disability income insurance
    • 1. Nature and purpose
    • 2. Insuring agreement / clause and perils covered
    • 3. Definition of total disability
    • a. Own occupation
    • b. Any occupation for which the insured is reasonably suited
    • c. Any occupation
    • d. Combination definitions (own occupation/any occupation)
    • e. Presumptive disability
    • 4. Partial disability
    • 5. Residual disability
    • 6. Recurrent disability
    • 7. Elimination (waiting) period
    • 8. Probationary period
    • 9. Length of coverage (benefit period)
    • a. Short term vs. long term
    • b. Accident vs. sickness
    • 10. Nonoccupational vs. full coverage
    • 11. Common exclusions
    • 12. Other benefit features or options
    • a. Cost of living adjustment
    • b. Guaranteed insurability option
    • c. Accidental death and dismemberment
    • d. Accidental bodily injury vs. accidental means
    • 13. Disability benefits in life insurance contracts
    • B. Basic Medical Expense insurance
    • 1. Nature and purpose
    • 2. Insuring agreement and perils covered
    • 3. Hospitalization expense
    • 4. Surgical expense
    • 5. Other physicians’ charges (regular medical expense)
    • 6. Common exclusions
    • C. Major Medical insurance
    • 1. Nature and purpose
    • 2. Covered charges (expenses)
    • 3. Inside (internal) limits
    • 4. Common exclusions
    • 5. Deductible
    • a. Per injury or sickness vs. cumulative (e.g., annual)
    • b. Common accident/common sickness
    • c. Family maximum
    • 6. Percentage participation (coinsurance)
    • a. Nature and purpose
    • b. Stop loss feature
    • 7. Benefit period
    • 8. Maximum limits
    • a. Per injury or illness vs. lifetime
    • b. Unlimited
    • 9. Pre-admission certification
    • 10. Carryover provisions
    • 11. Other benefit features, options, or expenses covered
    • a. Maternity
    • b. Dental
    • c. Prescription drug
    • d. Vision
    • e. Dread disease and limited coverage
    • f. Outpatient treatment
    • 12. Key features of the Affordable Care Act (ACA)
    • a. Preventive care
    • b. Unlimited lifetime benefit
    • c. Preexisting conditions
    • d. Dependents to age 26
    • D. Comprehensive coverage
    • 1. Basic plan plus major medical (Corridor deductible)
    • 2. Comprehensive major medical
    • E. Hospital indemnity
    • F. Managed Care
    • 1. Health Maintenance Organization (HMO)
    • a. Closed and Open Panel
    • (1) Staff
    • (2) Independent Practice Association (IPA)
    • b. Gatekeeper/Primary Care Physician
    • c. Concept of managing healthcare expenses
    • 2. Preferred Provider Organization (PPO)
    • a. In-network healthcare
    • b. Out-of-network healthcare
    • c. Concept of managing healthcare expenses
  • II. ACCIDENT & HEALTH INSURANCE PROVISIONS
    • A. Individual policy mandatory provisions
    • 1. Entire contract
    • 2. Time limit on certain defenses / Incontestable
    • 3. Grace period
    • 4. Reinstatement
    • 5. Notice of claim
    • 6. Claim forms
    • 7. Proof of loss
    • 8. Time of payment of claims
    • 9. Payment of claims
    • 10. Physical examination and autopsy
    • 11. Legal actions
    • 12. Change of beneficiary
    • B. Individual policy optional provisions
    • 1. Change of occupation
    • 2. Misstatement of age
    • 3. Other Insurance in this insurer
    • 4. Insurance with other insurers
    • 5. Relation of earnings to insurance
    • 6. Unpaid premium
    • 7. Conformity with state statute
    • 8. Illegal occupation
    • C. Other provisions
    • 1. Preexisting conditions (Accident / Disability)
    • 2. Right to examine (free look)
    • 3. Consideration
    • 4. Policy continuation
    • a. Optional renewable
    • b. Conditionally renewable
    • c. Guaranteed renewable
    • d. Noncancelable
    • 5. Assignment
    • 6. Premium payment
    • a. Modes (frequency)
    • b. Effect of nonpayment
    • 7. Waiver of premium
    • 8. Insuring clause/agreement
    • 9. Intoxicants and narcotics
  • III. OTHER ACCIDENT & HEALTH TOPICS
    • A. Group insurance
    • 1. Types of benefits
    • 2. Group underwriting
    • 3. Master policy and certificates
    • 4. Nonduplication and coordination of benefits provisions
    • 5. Eighteen month extension of benefits
    • B. Approaches related to group insurance
    • 1. Blanket coverage
    • 2. MEWA coverage
    • C. Social Security disability
    • D. Accidental death and dismemberment coverage
    • 1. Insuring agreements and peril covered
    • 2. Principal sum
    • 3. Capital sum
    • 4. Beneficiary designations
    • E. Business uses
    • 1. Key person
    • 2. Business overhead expense
    • 3. Disability buy-out
    • F. Federal income taxation
    • 1. Accident and health insurance premiums
    • 2. Accident and health insurance benefits
    • G. Misrepresentation and concealment
    • H. Formation of the health insurance contract
    • 1. Application completion
    • 2. Types and uses of initial premium receipts
    • 3. Policy delivery
    • a. Modified/amended vs. issued as applied for
    • b. Nonprepaid vs. prepaid
    • 4. Elements of a valid contract
  • IV. North Carolina Statutes and Regulations Pertinent to Accident & Health
    • A. Contract of Insurance (Ref: Article 1 (G.S. 58-1-10))
    • B. Definitions (Ref: Article 1 (G.S. 58-1-5))
    • C. Commissioner of Insurance (Ref: Article 2 (G.S. 58-2-5, 40, 50, 60, 65, 69, 70, 155, 160, 161, 162, 163, 180, 185, 195, 200); 11 NCAC, Chapter 19, Section .0103)
    • D. General Regulations for Insurance (Ref: Article 3 (G.S. 58-3- 25, 30, 40, 115, 120, 130, 135, 140, 145))
    • E. Licensing of Agents, Brokers, Limited Representatives, and Adjusters (Ref: Article 33 (G.S. 58-33-1, 5, 10, 15, 17, 20, 26, 30, 31, 32, 40, 46, 50, 56, 60, 66, 70, 75, 76, 80, 82, 83, 85, 90, 95, 100, 105, 110, 115, 120, 125, 130, 132, 135); 11 NCAC 4.0423,11 NCAC, Chapter 4, Section .0423)
    • F. Insurance Information & Privacy Protection Act (Ref: Article 39 (G.S. 58-39-5 through 58-39-120))
    • G. Unfair Trade Practices (Ref: Article 63 (G.S. 58-63-15, 20, 50))
    • H. False Pretenses and Cheats (Ref: Article 19 (G.S. 14-100))
    • I. Continuing Education (Ref: 11 NCAC, Chapter 6A, Section .0800)
    • J. General Regulations (Ref: Article 50 (G.S. 58-50-5, 20, 25, 26, 30, 35, 40, 45, 56, 57, 61, 62, 63, 65, 70); 11 NCAC, Chapter 4, Section .0423 (Ethical Standards))
    • K. Nature of Policies (Ref: Article 51 (G.S. 58-51-1, 5, 10, 15, 16, 20, 25, 30, 35, 37, 38, 40, 45, 55, 57, 58, 59, 60, 61, 62, 70, 75, 80, 81, 85, 90, 95, 100, 105, 110, 115, 116, 120, 125))
    • L. Group Health Insurance Continuation and Conversion Privileges (Ref: Article 53; CONTINUATION: (G.S. 58-53-1 through 58-53-40); CONVERSION: (G.S. 58-53-45 through 58-53-115))
    • M. Fraternal Benefit Societies (Ref: Article 24 (G.S. 58-24-1))
    • N. Life and Health Insurance Guaranty Association (Ref: Article 62 (G.S. 58-62-6, 21(d), 86))
Examination sources