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Free Producer - Accident and Health or Sickness Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the Producer - Accident and Health or 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 consultant wants a policy that replaces part of her personal earnings if an illness keeps her from working. Which policy addresses that loss?

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

    Answer: A

    Explanation: "a policy designed to compensate insured individuals for a portion of the income they lose because of a disabling injury or illness." The insured seeks replacement of her own income; the other policies address business expenses, ownership transfers, or a firm's loss from a key worker.

    Reference: NAIC Glossary of Insurance Terms — Disability Income, glossary

  2. 2A disability policy specifies 90 days between the start of a covered disability and the beginning of benefit payments. What is this waiting interval called?

    1. A. A probationary period
    2. B. An elimination period
    3. C. A grace period
    4. D. A reinstatement period

    Answer: B

    Explanation: "Elimination Period means the number of days during which services are provided to an insured person or during which the insured person is unable to work because of accident or sickness before the insurance policy begins to pay benefits." This 90-day interval runs after disability begins and before benefit payments start; that is the elimination period.

    Reference: 211 CMR 42.00, Form and Contents of Individual Accident and Sickness Insurance — 211 CMR 42.04

  3. 3A Medicare beneficiary asks which numbered part is the Medicare Advantage program. Which part should the producer identify?

    1. A. Part A, hospital insurance
    2. B. Part B, supplementary medical insurance
    3. C. Part C, Medicare Advantage
    4. D. Part D, prescription drug benefit

    Answer: C

    Explanation: "Medicare consists of four programs: Hospital Insurance (Part A), Supplementary Medical Insurance (Part B), Medicare Advantage (Part C), and Medicare Prescription Drug Benefit (Part D)." Medicare's four-part structure assigns Medicare Advantage to Part C.

    Reference: CMS, Overview of Medicare — Overview of Medicare, four programs

  4. 4An accident and sickness policy includes a partial-disability benefit. Which definition matches Massachusetts's standard for that benefit?

    1. A. Inability to perform some major duties of the occupation
    2. B. Inability to perform every task in any occupation
    3. C. Inability to perform only trivial duties of the occupation
    4. D. Inability to work after total-disability benefits end

    Answer: A

    Explanation: "partial disability, if included, shall be defined in relation to the insured person’s inability to perform some part or all of the “major,” “important” or “essential” duties of employment or occupation." Partial disability relates to impaired performance of major, important, or essential duties, and need not follow a paid total-disability period.

    Reference: 211 CMR 42.00, Form and Contents of Individual Accident and Sickness Insurance — 211 CMR 42.05

  5. 5After a Massachusetts applicant signs a written accident and sickness application, a producer discovers an incorrect answer and wants to revise it. What is required for the producer's alteration?

    1. A. The applicant's written consent to the alteration
    2. B. The insurer's administrative insertion notation alone
    3. C. The producer's dated initials beside the alteration
    4. D. The beneficiary's written consent to the alteration

    Answer: A

    Explanation: "No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent" A person other than the applicant needs the applicant's written consent. The insurer's narrow administrative-insertion exception does not authorize a producer to change an answer.

    Reference: Massachusetts General Laws, Chapter 175, Section 108 — M.G.L. c.175 §108(5)(b)

  6. 6A Massachusetts resident applies for an initial accident and health producer license and has no statutory exemption. Which assessment applies?

    1. A. The written producer examination
    2. B. The written adviser examination
    3. C. The public-adjuster examination
    4. D. The continuing-education assessment

    Answer: A

    Explanation: M.G.L. c. 175, § 162K(a) states: "A resident individual applying for an insurance producer license shall pass a written examination unless exempt pursuant to section 162O." The applicant therefore takes the written producer examination.

    Reference: General Law - Part I, Title XXII, Chapter 175, Section 162K — § 162K(a)

  7. 7Which factor may a Massachusetts carrier use to adjust a merged-market group base premium rate under M.G.L. c. 176J, § 3?

    1. A. An applicant's prior claim count
    2. B. The selling producer's experience
    3. C. An approved tobacco-use factor
    4. D. The employer's industry classification

    Answer: C

    Explanation: Section 3(a)(5) permits a carrier to apply "a tobacco use rate factor" in a manner allowed by state and federal law; § 3(a)(7) bars factors not set forth in the section.

    Reference: General Law - Part I, Title XXII, Chapter 176J, Section 3 — § 3(a)(5), (7)

  8. 8A physician who owns a small practice wants disability coverage for office rent, utilities, and staff payroll while she cannot work. Which policy fits those continuing 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," Payroll and utilities are ongoing business overhead, whereas the other choices address personal income, an ownership buyout, or loss of a key worker.

    Reference: NAIC Small Business Insurance — Disability Insurance, business overhead expense

  9. 9After meeting the deductible, an insured must pay 20% of the allowed charge for a covered service. Which cost-sharing feature is this?

    1. A. A fixed copayment amount
    2. B. A deductible amount
    3. C. A coinsurance percentage
    4. D. A premium contribution

    Answer: C

    Explanation: "Co-insurance is the percentage you pay for most health care services even after you meet your deductible." The remaining percentage share after the deductible is coinsurance, distinct from fixed copayment or the initial deductible.

    Reference: NAIC, Understand Your Health Plan's Deductible — Understand Your Health Plan's Deductible, Co-insurance

  10. 10A producer explains a federal-state health coverage program with mandatory eligibility groups that include qualified low-income pregnant women and people receiving SSI. Which program is being described?

    1. A. Medicare hospital insurance
    2. B. Medicaid medical assistance
    3. C. Social Security disability insurance
    4. D. Federal COBRA continuation coverage

    Answer: B

    Explanation: "Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups." Medicaid includes the listed mandatory eligibility groups; the other programs have different qualification structures.

    Reference: Medicaid.gov, Eligibility Policy — Eligibility Policy, mandatory eligibility groups

Topics in this practice bank

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

  • General Knowledge — I. Types of Policies
    • A. Disability income
    • A.1. Individual disability income policy
    • A.2. Business overhead expense policy
    • A.3. Business disability buyout policy
    • A.4. Group disability income policy
    • A.5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C.1. Basic hospital, medical, and surgical policies
    • C.2. Major medical policies
    • C.3. Health Maintenance Organizations (HMOs)
    • C.4. Preferred Provider Organizations (PPOs)
    • C.5. Point of Service (POS) plans
    • C.6. Flexible Spending Accounts (FSAs)
    • C.7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C.8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E.1. Differences between individual and group contracts
    • E.2. General characteristics
    • E.3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F.1. Eligibility
    • F.2. Levels of care
    • G. Other policies
    • G.1. Dental
    • G.2. Vision
    • G.3. Cancer
    • G.4. Critical illness or specified disease
    • G.5. Worksite (employer-sponsored)
    • G.6. Hospital indemnity
    • G.7. Short-term medical
    • G.8. Accident
  • General Knowledge — II. Policy Provisions, Clauses, and Riders
    • A. Mandatory and optional provisions
    • A.1. Entire contract
    • A.2. Time limit on certain defenses (incontestable)
    • A.3. Grace period
    • A.4. Reinstatement
    • A.5. Notice of claim
    • A.6. Claim forms
    • A.7. Proof of loss
    • A.8. Time of payment of claims
    • A.9. Payment of claims
    • A.10. Physical examination and autopsy
    • A.11. Legal actions
    • A.12. Change of beneficiary
    • A.13. Misstatement of age or gender
    • A.14. Change of occupation
    • A.15. Illegal occupation
    • A.16. Relation of earnings to insurance
    • B. Other provisions and clauses
    • B.1. Insuring clause
    • B.2. Free look
    • B.3. Consideration clause
    • B.4. Probationary period
    • B.5. Elimination period
    • B.6. Waiver of premium
    • B.7. Exclusions and limitations
    • B.8. Preexisting conditions
    • B.9. Coinsurance
    • B.10. Deductibles
    • B.11. Eligible expenses
    • B.12. Copayments
    • B.13. Pre-authorizations and prior approval requirements
    • B.14. Usual, reasonable, and customary (URC) charges
    • B.15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C.1. Impairment/exclusions
    • C.2. Guaranteed insurability
    • C.3. Future increase option
    • D. Rights of renewability
    • D.1. Noncancelable
    • D.2. Cancelable
    • D.3. Guaranteed renewable
  • General Knowledge — III. Social Insurance
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • General Knowledge — 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
  • General Knowledge — 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.1. Elements of a contract
    • H.2. Insurable interest
    • H.3. Warranties and representations
    • H.4. Unique aspects of the insurance contract
    • H.4.a. Conditional
    • H.4.b. Unilateral
    • H.4.c. Adhesion
    • H.4.d. Aleatory
  • Massachusetts Specific — I. Massachusetts Laws and Rules Pertinent to All Lines of Insurance
    • A. Licensing
    • A.1. Process
    • A.2. Types of licenses
    • A.2.a. Producers
    • A.2.b. Business entity producers
    • A.2.c. Nonresident producers
    • A.2.d. Temporary
    • A.2.e. Advisers
    • A.2.f. Reinsurance intermediaries
    • A.2.g. Exemptions
    • A.3. Maintenance and duration
    • A.3.a. Reinstatement and renewal
    • A.3.b. Address change
    • A.3.c. Reporting of actions
    • A.3.d. Assumed names
    • A.3.e. Continuing education requirements, exemptions and penalties
    • A.4. Disciplinary actions
    • A.4.a. Cease and desist order
    • A.4.b. Hearings
    • A.4.c. Probation, suspension, revocation, refusal to issue or renew
    • A.4.d. Penalties and fines
    • B. State Regulation
    • B.1. Commissioner’s general duties and powers
    • B.2. Company regulation
    • B.2.a. Certificate of authority
    • B.2.b. Solvency
    • B.2.c. Rates
    • B.2.d. Policy forms
    • B.2.e. Examination of books and records
    • B.2.f. Producer appointments
    • B.2.g. Termination of producer appointment
    • B.3. Producer regulation
    • B.3.a. Impersonation
    • B.3.b. Larceny
    • B.3.c. Unlicensed persons compensation
    • B.3.d. Commissions
    • B.3.e. Records Retention
    • B.3.f. Insurance transactions
    • B.4. Unfair or deceptive practices
    • B.4.a. Misrepresentation
    • B.4.b. False advertising
    • B.4.c. Defamation of insurer
    • B.4.d. Boycott, coercion, intimidation
    • B.4.e. False financial statements
    • B.4.f. Failure to maintain a complaint record
    • B.4.g. Unfair discrimination
    • B.4.h. Unfair claims settlement practices
    • B.4.i. Rebating
    • B.5. Insurance fraud regulation
    • B.6. Insurance Information and Privacy Protection
    • B.7. Types of Insurers
    • B.7.a. Foreign, Alien, Domestic
    • B.7.b. Authorized and unauthorized insurers
    • B.7.c. Stock and mutual insurers
  • Massachusetts Specific — II. Massachusetts Laws and Regulations Pertinent to Accident, Health or Sickness Insurance Only
    • A. Life and Health Insurance Guaranty Association Law
    • B. Producer responsibilities in individual accident, health or sickness insurance
    • B.1. Advertising
    • B.1.a. Sales presentations
    • B.1.b. Outline of coverage
    • B.1.c. Disclosure of information about individuals
    • C. Individual underwriting by the insurer
    • C.1. Medical examinations and lab tests (including HIV consent)
    • C.2. Genetic information
    • D. Replacement of Accident, Health, or Sickness Insurance
    • D.1. Massachusetts replacement requirements
    • D.2. Massachusetts individual mandate for minimum creditable coverage requires individual to have health insurance even if the person has accident/sickness
    • E. Required Policy Provisions
    • E.1. Entire contract; changes
    • E.2. Time limit on certain defenses
    • E.3. Grace period
    • E.4. Reinstatement
    • E.5. Claim procedures
    • E.6. Physical examinations and autopsy
    • E.7. Legal actions
    • E.8. Change of beneficiary
    • E.9. Right to examine (free look)
    • F. Optional Policy Provisions
    • F.1. Change of occupation
    • F.2. Misstatement of age
    • F.3. Other insurance in this insurer
    • F.4. Expense-incurred basis
    • F.5. Other benefits
    • F.6. Unpaid premium
    • F.7. Conformity with state statutes
    • F.8. Illegal occupation
    • G. Health Insurance Provisions
    • G.1. Massachusetts eligibility requirements (Open enrollment)
    • G.1.a. Dependent child age limit
    • G.1.b. Disabled adult children
    • G.1.c. Newborn child coverage
    • G.1.d. Coverage of adopted children
    • G.2. Affordable Care Act (ACA) and Massachusetts Health Connector
    • G.2.a. Guaranteed issue
    • G.2.b. Guaranteed renewability
    • G.2.c. Preventive care
    • G.2.d. Emergency services
    • G.2.e. Health status (no discrimination)
    • G.2.f. EHB coverage
    • G.3. Massachusetts Mental Health Parity
    • G.4. Employer group health insurance
    • G.4.a. Nondiscrimination
    • G.4.b. Eligibility for coverage
    • G.4.c. Employee eligibility
    • G.4.d. Coordination of benefits provision (COB)
    • G.4.e. Continuation of coverage under COBRA and Massachusetts specific rules
    • G.5. Small employer and individual medical plans
    • G.5.a. Definition of small employer
    • G.5.b. Availability and eligibility rating rules
    • G.5.c. Restrictions relating to premiums
    • G.5.d. Small group continuation
    • G.5.e. Renewability
    • H. Medicare supplement policies
    • H.1. Open enrollment
    • H.2. Standardized Medicare supplement plans
    • H.2.a. Core benefits, Supplement 1
    • H.3. Massachusetts regulations and required provisions — Advertising
    • H.4. Standards for marketing
    • H.5. Permitted compensation
    • H.6. Appropriateness of recommended purchase and excessive insurance
    • H.7. Required disclosure provisions
    • H.8. Reporting of multiple policies
    • H.9. Buyer's guide
    • H.10. Right to return
    • H.11. Replacement
    • H.12. Benefit standards
    • H.13. Pre-existing conditions
    • H.14. Renewability
    • H.15. Outline of coverage
    • I. MassHealth
    • I.1. Eligibility
    • I.2. Benefits
    • J. Long-Term Care (LTC) Insurance
    • J.1. Home health care
    • J.2. Exclusions
    • J.3. Massachusetts regulations and required provisions
    • J.3.a. Standards for marketing
    • J.3.b. Suitability of recommended purchase
    • J.3.c. Your Options for Financing Long-Term Care
    • J.3.d. Outline of coverage
    • J.3.e. Non-forfeiture benefit offer
    • J.3.f. Required disclosure provisions
    • J.3.g. Right to return
    • J.3.h. Policy illustration
    • J.3.i. Inflation adjustment benefit
    • J.3.j. MassHealth exemption
    • J.3.k. Benefit triggers
    • J.3.l. Unintentional lapse

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