Hawaii health policy provisions, clauses and riders practice questions
Last updated
Section II of the Hawaii Accident and Health exam's general part, Policy Provisions, Clauses, and Riders, has 15 of the 50 scoreable general questions. [1] The outline lists the mandatory and optional provisions (entire contract through relation of earning to insurance), other provisions and clauses (insuring clause, free look, consideration clause, probationary and elimination periods, waiver of premium, exclusions and limitations, preexisting conditions, coinsurance, deductibles, eligible expenses, copayments, pre-authorizations and prior approval requirements, usual, reasonable and customary charges, and lifetime, annual or per cause maximum benefit limits), riders (impairment/exclusions, guaranteed insurability, future increase option) and rights of renewability (noncancelable, cancelable, guaranteed renewable). [1]
The optional cancellation provision is on our Hawaii health law questions page. This page covers Hawaii's required provisions, policy form and cost sharing terms, with 10 practice questions.
Required provisions (HRS 431:10A-105)
- Time limit on certain defenses: after three years from the date of issue, misstatements in the application, except fraudulent ones, cannot be used to void the policy or deny a claim for loss or disability starting after those three years. [2]
- Grace period: at least seven days for weekly premium policies, ten for monthly premium policies and thirty one for all others, for each premium after the first. [2]
- Reinstatement: if the insurer requires a reinstatement application and gives a conditional receipt, the policy is reinstated on approval or, lacking approval, on the forty fifth day after the receipt unless the insurer disapproves in writing first. The reinstated policy covers only accidental injury after reinstatement and sickness that begins more than ten days after it. [2]
- Notice of claim: written notice within twenty days after a covered loss begins, or as soon as reasonably possible. [2]
- Claim forms: if the insurer does not send forms within fifteen days after notice, the claimant may submit written proof without them. [2]
- Proofs of loss: generally within ninety days. Late proof is still accepted if it was not reasonably possible to file on time and it comes as soon as reasonably possible, but, except for lack of legal capacity, no later than fifteen months from the time proof was otherwise required. [2]
- Legal actions: no suit until sixty days after written proof of loss, and none after three years from the time proof is required. [2]
Policy form (HRS 431:10A-104, 10A-109, 10-214)
A policy must express the entire money and other considerations, show when coverage starts and ends, insure only one person except for family coverage, and use type of at least ten point. [3] Someone other than the insured with a proper insurable interest may apply for and own a policy on the insured. [4] Every individual accident and health policy must carry a ten point bold notice giving ten days from receipt to return it for a premium refund. [5]
Cost sharing (Hawaii Insurance Division glossary)
- Coinsurance: your percentage share of a covered service's allowed amount, on top of any deductible; for example, 20% of a $100 allowed amount is $20. [6]
- Deductible: what you pay before the insurer starts paying; the glossary notes it does not apply to HMOs. [6]
- Out of pocket limit: the most you pay in a policy period, usually a year, before the plan pays 100% of the allowed amount. [6]
- Preauthorization: a decision that care is medically necessary, often required except in emergencies and not a guarantee of payment; also called prior authorization, prior approval or precertification. [6]
- UCR: the amount usually charged in an area for a service, sometimes used to set the allowed amount. [6]
Practice questions
1. After how long can an insurer no longer use non-fraudulent application misstatements to deny a Hawaii health claim?
A. One year
B. Two years
C. Three years
D. Five years
Answer: C. (HRS 431:10A-105) [2]
2. What is the minimum grace period on a monthly premium policy?
Answer: Ten days. (431:10A-105) [2]
3. After reinstatement, when does coverage for sickness begin?
Answer: For sickness that begins more than ten days after reinstatement. Accidental injuries after reinstatement are covered. (431:10A-105) [2]
4. A claimant could not file proof of loss on time for good reason. What is the outside limit, absent legal incapacity?
Answer: Fifteen months from the time proof was otherwise required. (431:10A-105) [2]
5. How long must an insured wait after filing proof of loss before suing?
Answer: Sixty days. (431:10A-105) [2]
6. Can a business that has an insurable interest own a health policy on an employee?
Answer: Yes. A person other than the insured with a proper insurable interest may apply for and own the policy. (HRS 431:10A-109) [4]
7. What is the smallest type size allowed for the printed text of a Hawaii accident and health policy?
Answer: Ten point. (HRS 431:10A-104(a)(4)) [3]
8. A covered service has a $100 allowed amount and 20% coinsurance, with the deductible already met. What does the insured pay?
Answer: $20. [6]
9. According to the Hawaii glossary, what plan type does the deductible not apply to?
Answer: HMOs. [6]
10. Is preauthorization a guarantee that the plan will pay?
Answer: No. [6]
Study tips for section II
- Hawaii claim numbers: 20 days notice, 15 days for forms, 90 days proof, 15 months outside limit, 60 days before suit, 3 years to sue.
- Reinstatement: 45 days after a conditional receipt; sickness covered only if it begins more than 10 days later.
- Riders and renewability types are on this section too; learn noncancelable, cancelable and guaranteed renewable by name. [1]
Practice more with the free Hawaii accident and health practice test.
Prep Retention is independent and is not affiliated with Pearson VUE or the state.
Sources
Laws and exam documents quoted as of October 2026.
- Pearson VUE, Hawaii content outlines 121201 (effective January 1, 2026): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/121201.pdf
- HRS 431:10A-105: https://data.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0105.htm
- HRS 431:10A-104: https://data.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0104.htm
- HRS 431:10A-109: https://data.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0109.htm
- HRS 431:10-214: https://data.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010-0214.htm
- Hawaii Insurance Division, Health Insurance Glossary and Terms: https://cca.hawaii.gov/wp-content/uploads/2026/02/Health-Insurance-Glossary-and-Terms.pdf