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Free Accident & Health and Sickness Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the Accident & Health and Sickness practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1A self-employed architect wants a policy that replaces part of her own earnings if illness prevents her from working. Which coverage fits that need?

    1. A. Individual disability income insurance
    2. B. Business overhead expense insurance
    3. C. Key employee disability insurance
    4. D. Accidental death and dismemberment insurance

    Answer: A

    Explanation: "Disability insurance is a type of insurance that provides income if a worker is unable to perform their job duties and earn money due to a disability." The architect seeks replacement of her personal earnings, whereas the other policies address business expenses, the employer's loss, or accidental loss.

    Reference: NAIC, Simplifying the Complications of Disability Insurance — Disability Insurance

  2. 2A producer orally promises to expand coverage under a Hawaii individual accident-and-health policy containing the statutory entire-contract clause. What is needed for a valid policy change?

    1. A. The producer's oral agreement recorded in agency notes
    2. B. Approval by an insurer executive officer endorsed on or attached to the policy
    3. C. The beneficiary's written acceptance of the producer's promise
    4. D. A claim form reflecting the broader coverage at the time of loss

    Answer: B

    Explanation: "No change in this policy shall be valid until approved by an executive officer of the insurer and unless the approval is endorsed on or attached to this policy." An agent's oral promise cannot itself amend the policy; executive approval and endorsement or attachment are required.

    Reference: Hawaii Revised Statutes §431:10A-105 — HRS §431:10A-105, Entire Contract; Changes

  3. 3A Medicare enrollee receives a routine outpatient physician service. Which part of Original Medicare generally helps cover that service?

    1. A. Part A hospital insurance
    2. B. Part B medical insurance
    3. C. Part C Medicare Advantage
    4. D. Part D drug coverage

    Answer: B

    Explanation: "Services from doctors and other health care providers" The service is physician outpatient care, assigned to Part B rather than Part A inpatient coverage or drug coverage.

    Reference: CMS Medicare, Parts of Medicare — Part B (Medical Insurance)

  4. 4An insured returns to part-time work after a disability but still has reduced earnings. Which disability benefit is designed to fill part of that income gap?

    1. A. Waiver of premium benefit
    2. B. Cost-of-living increase
    3. C. Residual disability benefit
    4. D. Future increase option

    Answer: C

    Explanation: "This coverage fills the gap in income if you are partially disabled, resulting in reduced income." Residual coverage addresses reduced earnings during partial disability; the other benefits change premiums or future coverage.

    Reference: NAIC, Simplifying the Complications of Disability Insurance — Residual Benefit(s)

  5. 5Which proposed accident-and-health insurance arrangement ordinarily requires the competent proposed insured's own written application or consent under Hawaii law?

    1. A. A spouse obtaining insurance on the other spouse
    2. B. An adult obtaining insurance on a dependent minor
    3. C. An unrelated adult obtaining insurance on another competent adult
    4. D. An employer providing qualifying group disability coverage

    Answer: C

    Explanation: "No life insurance or accident and health or sickness insurance contract upon an individual shall be made or effectuated unless at the time of the making of the contract the individual insured, being of competent legal capacity to contract, applies for or consents to the insurance in writing, except in the following cases:" The statute separately permits a spouse to insure the other spouse, specified insurance on a minor, and group disability contracts. Only the unrelated adult coverage falls under the written-consent rule.

    Reference: Hawaii Revised Statutes §431:10-206 — HRS §431:10-206, Application for insurance: consent of insured required

  6. 6Which statement best describes the Hawaii insurance commissioner's basic enforcement duty under the Insurance Code?

    1. A. The commissioner enforces the Insurance Code
    2. B. The attorney general alone enforces the Insurance Code
    3. C. Each insurer enforces the Code against its producers
    4. D. County prosecutors administer all insurance licensing

    Answer: A

    Explanation: HRS §431:2-201(b) says the commissioner "shall enforce this code." The enforcement duty therefore belongs to the commissioner.

    Reference: PART II — HRS §431:2-201(b)

  7. 7For Hawaii prepaid health care purposes, how many hours per week must a person work for one employer to meet the basic regular-employee definition?

    1. A. At least 15 hours
    2. B. At least 20 hours
    3. C. At least 30 hours
    4. D. At least 35 hours

    Answer: B

    Explanation: HRS §393-3 defines a regular employee as one employed by an employer "for at least twenty hours per week," excluding seasonal employment.

    Reference: HRS 0393 (0003) — HRS §393-3, definition of regular employee

  8. 8The owner of a two-person practice becomes disabled. The practice needs funds for rent, utilities, and employee payroll while the owner recovers. Which coverage addresses those expenses?

    1. A. Individual disability income insurance
    2. B. Business overhead expense insurance
    3. C. Business disability buyout insurance
    4. D. Key employee disability insurance

    Answer: B

    Explanation: "This type of provision covers standard business expenses such as payroll, utilities, rent, etc., while the business owner recovers from a disability." Rent, payroll, and utilities are business overhead while the owner recovers; wage-replacement and ownership-buyout policies address other losses.

    Reference: NAIC, Small Business Insurance — Disability Insurance for Small Businesses

  9. 9A Hawaii individual health policy was issued four years ago. A nonfraudulent application misstatement is discovered after a new covered loss begins. Under the statutory time-limit provision, what may the insurer do solely because of that misstatement?

    1. A. Void the policy because every application error remains contestable
    2. B. Reduce the claim by the amount of premiums paid in the first year
    3. C. Deny the new claim if the error concerned the insured's health
    4. D. Neither void the policy nor deny this claim on that ground

    Answer: D

    Explanation: "After three years from the date of issue of this policy, no misstatements, except fraudulent misstatements, made by the applicant in the application for this policy shall be used to void this policy or to deny a claim for loss incurred or disability as defined in the policy commencing after the expiration of the three-year period;" The loss began after the three-year period and the misstatement is nonfraudulent, so neither voiding nor denial on that ground is permitted.

    Reference: Hawaii Revised Statutes §431:10A-105 — HRS §431:10A-105, Time Limit on Certain Defenses

  10. 10A beneficiary chooses an approved private Medicare plan that bundles Part A, Part B, and usually Part D instead of receiving benefits through Original Medicare. Which coverage route is this?

    1. A. A standalone Part D drug plan
    2. B. A Medicare supplement policy
    3. C. A Medicare Advantage Part C plan
    4. D. A state Medicaid benefit package

    Answer: C

    Explanation: "These “bundled” plans include Part A, Part B, and usually Part D." The private approved bundled route is Medicare Advantage, also called Part C.

    Reference: CMS Medicare, Parts of Medicare — Medicare Advantage (also known as Part C)

Topics in this practice bank

These topics describe the available practice for Accident & Health and Sickness. Review the examination outline and its sources for scope and allocation details.

  • I. TYPES OF POLICIES
    • A. Disability income
    • A. Disability income / 1. Individual disability income policy
    • A. Disability income / 2. Business overhead expense policy
    • A. Disability income / 3. Business disability buyout policy
    • A. Disability income / 4. Group disability income policy
    • A. Disability income / 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance / 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance / 2. Major medical policies
    • C. Medical expense insurance / 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance / 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance / 5. Point of Service (POS) plans
    • C. Medical expense insurance / 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance / 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance / 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance / 1. Differences between individual and group contracts
    • E. Group insurance / 2. General characteristics
    • E. Group insurance / 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) / 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) / 2. Levels of care
    • G. Other policies
    • G. Other policies / 1. Dental
    • G. Other policies / 2. Vision
    • G. Other policies / 3. Cancer
    • G. Other policies / 4. Critical illness or specified disease
    • G. Other policies / 5. Worksite (employer-sponsored)
    • G. Other policies / 6. Hospital indemnity
    • G. Other policies / 7. Short-term medical
    • G. Other policies / 8. Accident
  • II. POLICY PROVISIONS, CLAUSES, AND RIDERS
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions / 1. Entire contract
    • A. Mandatory and optional provisions / 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions / 3. Grace period
    • A. Mandatory and optional provisions / 4. Reinstatement
    • A. Mandatory and optional provisions / 5. Notice of claim
    • A. Mandatory and optional provisions / 6. Claim forms
    • A. Mandatory and optional provisions / 7. Proof of loss
    • A. Mandatory and optional provisions / 8. Time of payment of claims
    • A. Mandatory and optional provisions / 9. Payment of claims
    • A. Mandatory and optional provisions / 10. Physical examination and autopsy
    • A. Mandatory and optional provisions / 11. Legal actions
    • A. Mandatory and optional provisions / 12. Change of beneficiary
    • A. Mandatory and optional provisions / 13. Misstatement of age or gender
    • A. Mandatory and optional provisions / 14. Change of occupation
    • A. Mandatory and optional provisions / 15. Illegal occupation
    • A. Mandatory and optional provisions / 16. Relation of earning to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses / 1. Insuring clause
    • B. Other provisions and clauses / 2. Free look
    • B. Other provisions and clauses / 3. Consideration clause
    • B. Other provisions and clauses / 4. Probationary period
    • B. Other provisions and clauses / 5. Elimination period
    • B. Other provisions and clauses / 6. Waiver of premium
    • B. Other provisions and clauses / 7. Exclusions and limitations
    • B. Other provisions and clauses / 8. Preexisting conditions
    • B. Other provisions and clauses / 9. Coinsurance
    • B. Other provisions and clauses / 10. Deductibles
    • B. Other provisions and clauses / 11. Eligible expenses
    • B. Other provisions and clauses / 12. Copayments
    • B. Other provisions and clauses / 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses / 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses / 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders / 1. Impairment/exclusions
    • C. Riders / 2. Guaranteed insurability
    • C. Riders / 3. Future increase option
    • D. Rights of renewability
    • D. Rights of renewability / 1. Noncancelable
    • D. Rights of renewability / 2. Cancelable
    • D. Rights of renewability / 3. Guaranteed renewable
  • III. SOCIAL INSURANCE
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • IV. OTHER INSURANCE CONCEPTS
    • A. Total, partial, recurrent and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • K. Subrogation
  • V. FIELD UNDERWRITING PROCEDURES
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law / 1. Elements of a contract
    • H. Contract law / 2. Insurable interest
    • H. Contract law / 3. Warranties and representations
    • H. Contract law / 4. Unique aspects of the insurance contract
    • H. Contract law / 4. Unique aspects of the insurance contract / a. Conditional
    • H. Contract law / 4. Unique aspects of the insurance contract / b. Unilateral
    • H. Contract law / 4. Unique aspects of the insurance contract / c. Adhesion
    • H. Contract law / 4. Unique aspects of the insurance contract / d. Aleatory
  • I. HAWAII LAWS AND RULES COMMON TO LIFE, ACCIDENT AND HEALTH, PROPERTY, CASUALTY AND PERSONAL LINES INSURANCE
    • A. Insurance Commissioner
    • A. Insurance Commissioner / 1. General powers and duties
    • A. Insurance Commissioner / 2. Examination of records
    • A. Insurance Commissioner / 3. Notice of hearings
    • A. Insurance Commissioner / 4. Penalties
    • B. Definitions
    • B. Definitions / 1. Authorized and unauthorized
    • B. Definitions / 2. Domestic, foreign, and alien
    • B. Definitions / 3. Stock, reciprocal and mutual
    • B. Definitions / 4. Certificate of authority
    • B. Definitions / 5. Insurance
    • C. Licensing
    • C. Licensing / 1. General qualifications for licensing
    • C. Licensing / 2. Persons required to be licensed
    • C. Licensing / 2. Persons required to be licensed / a. Producer
    • C. Licensing / 2. Persons required to be licensed / b. Temporary license
    • C. Licensing / 2. Persons required to be licensed / c. Nonresident
    • C. Licensing / 2. Persons required to be licensed / d. Exemptions
    • C. Licensing / 3. Denial, suspension, revocation of licenses
    • C. Licensing / 4. Renewal of license and continuing education
    • D. Marketing practices
    • D. Marketing practices / 1. Unfair and deceptive practices
    • D. Marketing practices / 2. Reporting and accounting for premiums
    • D. Marketing practices / 3. Sharing commissions
    • D. Marketing practices / 4. Required records and record retention
    • D. Marketing practices / 5. Controlled business
    • D. Marketing practices / 6. Premiums
    • E. Guaranty Associations
  • II. HAWAII LAWS AND RULES PERTINENT TO ACCIDENT AND HEALTH INSURANCE ONLY
    • A. Marketing methods and practices
    • A. Marketing methods and practices / 1. Prepaid health care
    • A. Marketing methods and practices / 2. Temporary Disability Insurance (TDI)
    • B. Policy clauses and provisions
    • B. Policy clauses and provisions / 1. Mandated benefits
    • B. Policy clauses and provisions / 2. Cancellation
    • C. Long Term Care
    • C. Long Term Care / 1. Basic standards
    • C. Long Term Care / 2. Outline of coverage
    • C. Long Term Care / 3. Policy definitions
    • C. Long Term Care / 4. Suitability

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