Free Idaho Accident & Health insurance exam practice test

Correct answer: B. Yes; COBRA continuation coverage is a listed exception

• A. Incorrect. The general rule against paying insurance from an HSA has exceptions, and COBRA continuation coverage is one of them.
• B. Correct. Publication 969 says you may not use HSA funds to pay for insurance except for listed types, which include health care continuation coverage (such as coverage under COBRA).
• C. Incorrect. Publication 969 lists four exceptions, including long-term care insurance and COBRA continuation coverage, not just Medicare.
• D. Incorrect. COBRA coverage is a listed exception, so the premiums count as expenses HSA funds may pay; they are not treated as nonmedical spending.

You may not use HSA funds to pay for insurance, except for the following. [...] 1. Long-term care insurance. [...] 2. Health care continuation coverage (such as coverage under COBRA). [...] 3. Health care coverage while receiving unemployment compensation under federal or state law. [...] 4. Medicare and other health care coverage if you were 65 or older (other than premiums for a Medicare supplemental policy, such as Medigap).

Correct answer: A. At least 31 days

• A. Correct. Section 7B requires basic hospital expense coverage for a period of not less than thirty-one (31) days during a continuous hospital confinement for each person insured.
• B. Incorrect. Fourteen days is shorter than the 31-day minimum in Section 7B.
• C. Incorrect. Twenty-one days is shorter than the 31-day minimum in Section 7B.
• D. Incorrect. Section 7B sets the minimum at 31 days, not 60 days.

"Basic hospital expense coverage" is a policy of accident and sickness insurance that provides coverage for a period of not less than thirty-one (31) days during a continuous hospital confinement for each person insured under the policy, for expense incurred for necessary treatment and services rendered as a result of accident or sickness for at least the following:

Correct answer: C. 102 percent of the plan's cost for similarly situated covered individuals

• A. Incorrect. The plan may charge more than 100 percent of its cost; the cap is 102 percent.
• B. Incorrect. The cap is 102 percent, not 110 percent.
• C. Correct. The maximum COBRA charge cannot exceed 102 percent of the cost to the plan for similarly situated individuals who have not incurred a qualifying event.
• D. Incorrect. The cap is 102 percent, not 150 percent.

The maximum amount charged cannot exceed 102 percent of the cost to the plan for similarly situated individuals covered under the plan who have not incurred a qualifying event.

Correct answer: A. Requiring the client to take a genetic test

• A. Correct. Medicare.gov lists asking about family history or requiring a genetic test among illegal Medigap practices.
• B. Incorrect. This is not on Medicare.gov's list of illegal practices.
• C. Incorrect. This is not on Medicare.gov's list of illegal practices.
• D. Incorrect. This is not on Medicare.gov's list of illegal practices.

It's illegal if someone tries to: [...] Ask you questions about your family history or require you to take a genetic test.

Correct answer: A. Limited scope dental benefits

• A. Correct. 45 CFR 146.145(b)(3)(iii)(A) says limited scope dental benefits are benefits substantially all of which are for treatment of the mouth (including any organ or structure within the mouth).
• B. Incorrect. Limited scope vision benefits are for treatment of the eye, not the mouth.
• C. Incorrect. Long-term care benefits are a separate category of limited excepted benefits.
• D. Incorrect. The regulation names benefits for treatment of the mouth limited scope dental benefits.

Limited scope dental benefits are benefits substantially all of which are for treatment of the mouth (including any organ or structure within the mouth).

Correct answer: A. On the first page; that it is guaranteed renewable or noncancellable

• A. Correct. Section 8A(1) says the renewability provision shall be appropriately captioned, appear on the first page, and clearly state that coverage is guaranteed renewable or noncancellable.
• B. Incorrect. Section 8A(1) places the provision on the first page of the policy and calls for guaranteed renewable or noncancellable coverage.
• C. Incorrect. The provision must appear on the first page and state that coverage is guaranteed renewable or noncancellable.
• D. Incorrect. Section 8A(1) puts the provision on the first page and requires guaranteed renewable or noncancellable wording.

Section 8. Required Disclosure Provisions [...] A. Renewability. Individual long-term care insurance policies shall contain a renewability provision. [...] The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancellable.

Correct answer: B. No, accident policies may not contain waiting periods

• A. Incorrect. The 6-month allowance in Section 6A is for specified diseases or conditions, and accident policies may not have waiting periods.
• B. Correct. Section 6A states that accident policies shall not contain probationary or waiting periods.
• C. Incorrect. Section 6A allows no waiting period at all in accident policies.
• D. Incorrect. Section 6A sets no minimum waiting period; it bars them in accident policies.

a policy may specify a probationary or waiting period not to exceed six (6) months for specified diseases or conditions and losses resulting from disease or condition related to hernia, disorder of reproduction organs, varicose veins, adenoids, appendix and tonsils. However, the permissible six-month exception shall not be applicable where the specified diseases or conditions are treated on an emergency basis. Accident policies shall not contain probationary or waiting periods.

Correct answer: A. Pre-authorization

• A. Correct. HealthCare.gov defines preauthorization as a decision by your health insurer or plan that a service is medically necessary, which a plan may require for certain services before you receive them, except in an emergency.
• B. Incorrect. Subrogation is an insurer's right to recover a payment from the party at fault.
• C. Incorrect. Coordination of benefits decides which of two plans pays first.
• D. Incorrect. An elimination period is a waiting period before disability benefits begin.

A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. [...] Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency.

Correct answer: A. Her monthly premiums for the plan

• A. Correct. HealthCare.gov says the out-of-pocket limit doesn't include monthly premiums; after the limit is reached, the plan pays 100% of covered in-network benefits.
• B. Incorrect. After the limit, the plan pays 100% of covered benefits, so in-network coinsurance stops.
• C. Incorrect. After the limit, the plan pays 100% of covered benefits, so in-network copayments stop.
• D. Incorrect. Deductibles count toward the limit; after it is reached, the plan pays 100% of covered benefits.

After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. [...] The out-of-pocket limit doesn't include: [...] Your monthly premiums

Correct answer: C. 60 days

• A. Incorrect. Section 6L allows sixty (60) days, not 15.
• B. Incorrect. Section 6L allows sixty (60) days, not 30.
• C. Correct. Section 6L says that if a claim is denied, the issuer shall, within sixty (60) days of the date of a written request by the policyholder or certificateholder, or a representative, provide a written explanation of the reasons for the denial.
• D. Incorrect. Section 6L allows sixty (60) days, not 45.

If a claim under a long-term care insurance contract is denied, the issuer shall, within sixty (60) days of the date of a written request by the policyholder or certificateholder, or a representative thereof: [...] Provide a written explanation of the reasons for the denial; and

Correct answer: C. Nothing for covered home health services

• A. Incorrect. Medicare.gov says covered home health services cost nothing.
• B. Incorrect. Medicare.gov does not describe a daily copayment for covered home health services; you pay nothing.
• C. Correct. Medicare.gov says you pay nothing for covered home health services.
• D. Incorrect. Medicare.gov says you pay nothing for covered home health services.

You must need part-time or intermittent skilled services and you're "homebound," which means you must meet both of these conditions: [...] You pay nothing for covered home health services.

Correct answer: A. $217.00

• A. Correct. For 2026, the daily coinsurance for days 21 through 100 of extended care services in a benefit period is $217.00.
• B. Incorrect. Day 30 falls within days 21 through 100, for which a daily coinsurance of $217.00 applies in 2026.
• C. Incorrect. $434 per day is the 2026 amount for the 61st through 90th day, not for day 30 of extended care services.
• D. Incorrect. $868 per day is the 2026 amount for lifetime reserve days.

the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $217.00 in 2026 [...] $434 per day for the 61st through 90th day [...] $868 per day for lifetime reserve days

Correct answer: A. So that all plans together pay no more than 100% of allowable expense

• A. Correct. Section 7 lets the secondary plan reduce its payment so that, combined with the primary plan's payment, total benefits for the claim do not exceed 100 percent of the total allowable expense.
• B. Incorrect. The secondary plan calculates what it would have paid and applies it to unpaid allowable expense; the limit is 100 percent of total allowable expense.
• C. Incorrect. The combined limit in Section 7 is 100 percent of the total allowable expense, not 80 percent.
• D. Incorrect. Section 7 does not set a 50 percent share; it caps total benefits at 100 percent of allowable expense.

In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any allowable expense under its plan that is unpaid by the primary plan. [...] The secondary plan may reduce its payment by the amount so that, when combined with the amount paid by the primary plan, the total benefits paid or provided by all plans for the claim do not exceed 100 percent of the total allowable expense for that claim.

Correct answer: D. Benefits for the dependents of the worker who was killed

• A. Incorrect. Wex says these laws provide benefits for the dependents of workers who are killed, not just wages already owed.
• B. Incorrect. Wex says these laws provide benefits for the dependents of workers who are killed.
• C. Incorrect. Wex describes benefits for the dependents of workers who are killed, not a set ten-year wage lump sum.
• D. Correct. Wex says workers' compensation laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses.

Workers' compensation laws protect people who become injured or disabled while working at their jobs. The laws provide the injured workers with fixed monetary awards in an attempt to eliminate the need for litigation. These laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses. Some laws also protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of co-workers in most accidents.

Correct answer: B. 90 days after receipt, using its single 30-day extension

• A. Incorrect. The base deadline is 60 days after receipt, not 30, so one extension of up to 30 days makes the latest date 90 days.
• B. Correct. The insurer must act within 60 days of receipt and may take one extension of no more than 30 days, for a latest date of 90 days.
• C. Incorrect. Section 164.526(b)(2)(ii)(B) allows only one extension for an amendment request.
• D. Incorrect. Section 164.526(b)(2)(ii) limits the extension to no more than 30 days, not 60.

The covered entity must act on the individual's request for an amendment no later than 60 days after receipt of such a request, as follows. [...] If the covered entity is unable to act on the amendment within the time required by paragraph (b)(2)(i) of this section, the covered entity may extend the time for such action by no more than 30 days, provided that: [...] The covered entity may have only one such extension of time for action on a request for an amendment.

Correct answer: B. A binder; to protect her from loss during the delay

• A. Incorrect. A rider amends a policy; it is not temporary coverage before issue.
• B. Correct. Wex defines a binder as a temporary insurance contract delivered before a permanent policy is issued, so that the insured is not subject to the risk of loss during the delay of obtaining the permanent policy.
• C. Incorrect. An endorsement changes an issued policy; it is not temporary coverage before issue.
• D. Incorrect. A waiver gives up a right; it is not temporary coverage before issue.

A binder is a temporary insurance contract delivered by the insurer to the insured before a permanent insurance policy is issued. The purpose of a binder is to provide insurance coverage and stand in the place of the permanent policy until the permanent policy is finalized or approved or disapproved by the insurer. This way, the insured is not subject to the risk of loss during the delay of obtaining a permanent insurance policy.

Correct answer: A. The promise made by the other party

• A. Correct. Wex states that one party's promise serves as consideration for the promise of the other.
• B. Incorrect. Wex does not say a court order supplies consideration; each party's promise is consideration for the other's.
• C. Incorrect. Wex does not require a cash deposit; the other party's promise serves as consideration.
• D. Incorrect. A witness's signature is not consideration under the Wex entry; the other party's promise is.

One party's promise serves as consideration for the promise of the other. As a result, each party is an obligor on their own promise and an obligee on the other party's promise.

Correct answer: B. The state

• A. Incorrect. The statute places the cost of these additional examinations on the state, not the person examined.
• B. Correct. Idaho Code 41-210(3) says the cost of such additional examinations and investigations shall be borne by the state.
• C. Incorrect. No insurer is charged under 41-210(3); the state bears the cost.
• D. Incorrect. The statute does not split the cost; the state bears it.

(3) The director may conduct such examinations and investigations of insurance matters, in addition to examinations and investigations expressly authorized, as he may deem proper to determine whether any person has violated any provision of this code or to secure information useful in the lawful administration of any such provision. The cost of such additional examinations and investigations shall be borne by the state.

Correct answer: B. A producer explains a specific policy's terms to a prospective buyer

• A. Incorrect. Negotiating requires that the person either sells insurance or obtains insurance from insurers for purchasers; a neighbor with no insurance role does neither.
• B. Correct. Idaho Code 41-1003(6) defines negotiate as conferring directly with or advising a purchaser or prospective purchaser of a particular contract about its substantive benefits, terms or conditions, by a person who sells insurance or obtains it for purchasers.
• C. Incorrect. A general talk is not conferring with a purchaser about a particular contract of insurance.
• D. Incorrect. A coworker is not a purchaser or prospective purchaser, and commissions are not the contract's benefits, terms or conditions.

(6) "Negotiate" means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms or conditions of the contract, provided that the person engaged in the act either sells insurance or obtains insurance from insurers for purchasers.

Correct answer: A. Ask the director to waive the renewal procedures

• A. Correct. Idaho Code 41-1008(4) lets a producer unable to comply because of military service or another extenuating circumstance request that the director waive renewal procedures.
• B. Incorrect. The statute does not allow transferring a license.
• C. Incorrect. No insurer renewal option appears in 41-1008(4).
• D. Incorrect. The statute provides for a waiver request, not surrender and reapplication.

(4) A licensed insurance producer who is unable to comply with license renewal procedures due to military service or some other extenuating circumstance, such as a long-term medical disability, may request that the director waive those procedures. The producer may also request a waiver of any examination requirement or any other fine or sanction imposed for failure to comply with renewal procedures.

Correct answer: C. The payment fully discharges the insurer from claims under the policy

• A. Incorrect. A proper payment without prior written notice discharges the insurer.
• B. Incorrect. No holding period is required by 41-1828.
• C. Correct. 41-1828(1) says payment per the policy terms fully discharges the insurer unless, before payment, it received written notice at its home office of another person's claim.
• D. Incorrect. Court approval is not required for the discharge.

(1) Whenever the proceeds of or payments under a life or disability insurance policy or annuity contract heretofore or hereafter issued become payable in accordance with the terms of such policy or contract, or the exercise of any right or privilege thereunder, and the insurer makes payment thereof in accordance with the terms of the policy or contract or in accordance with any written assignment thereof, the person then designated in the policy or contract or by such assignment as being entitled thereto shall be entitled to receive such proceeds or payments and to give full acquittance therefor, and such payments shall fully discharge the insurer from all claims under the policy or contract unless, before payment is made, the insurer has received at its home office written notice by or on behalf of some other person that such other person claims to be entitled to such payment or some interest in the policy or contract.

Correct answer: C. Term plan

• A. Incorrect. Whole life is not a permitted form under 41-2305.
• B. Incorrect. Endowment is not a permitted form under 41-2305.
• C. Correct. 41-2305(1) permits individual credit life policies issued to debtors only on the term plan.
• D. Incorrect. Universal life is not a permitted form under 41-2305.

41-2305. Forms of credit life insurance and credit disability insurance. Credit life insurance and credit disability insurance shall be issued only in the following forms: (1) Individual policies of life insurance issued to debtors on the term plan.

Correct answer: A. A set daily dollar benefit for each hospital day, whatever the bill

• A. Correct. The rule defines it as daily benefits on an indemnity basis: a fixed dollar amount per day of confinement regardless of expenses incurred.
• B. Incorrect. Indemnity benefits are a fixed amount per day, not a share of charges.
• C. Incorrect. Paying the bill describes expense coverage, not indemnity coverage.
• D. Incorrect. The definition pays daily benefits for confinement, not a lump sum after a waiting stay.

010. DEFINITIONS. [...] 04. Hospital Confinement Indemnity Coverage. “Hospital Confinement Indemnity Coverage” means a policy or certificate of accident and sickness insurance that provides daily benefits for hospital confinement on an indemnity basis, meaning the benefit is a fixed dollar amount per day of confinement, regardless of the expenses incurred. (7-1-24)

Correct answer: C. Disability income protection coverage

• A. Incorrect. Medicare supplement is not on the 41-4204(1) list.
• B. Incorrect. Long-term care is not on the 41-4204(1) list.
• C. Correct. 41-4204(1)(e) lists disability income protection coverage.
• D. Incorrect. Life coverage is not on the 41-4204(1) list.

41-4204. Minimum standards for benefits. (1) The director shall issue rules, subject to chapter 52, title 67, Idaho Code, to establish minimum standards for benefits under each of the following categories of coverage in individual policies, group supplemental policies, nongroup subscriber contracts of nonprofit hospital, medical and dental service associations, and nongroup subscriber contracts of managed care organizations other than conversion policies issued pursuant to a contractual conversion privilege under a group policy of disability insurance: (a) Basic hospital expense coverage; (b) Basic medical-surgical and dental expense coverage; (c) Hospital confinement indemnity coverage; (d) Major medical expense coverage; (e) Disability income protection coverage; (f) Accident only coverage; and (g) Specified disease.

Correct answer: C. Before the issuer considers the applicant for coverage

• A. Incorrect. The worksheet is due before the issuer considers the applicant.
• B. Incorrect. Return is required before consideration, not on request.
• C. Correct. Section 028.03.c requires return before the issuer's consideration of the applicant for coverage.
• D. Incorrect. The rule ties it to the issuer's consideration, not the free look.

028. SUITABILITY. [...] 03. Determination of Standards. To determine whether the applicant meets the standards developed by the issuer; (3-31-22) [...] b. The issuer and producer, if involved, make reasonable efforts to obtain the information set out in Subsection 028.03. The efforts include presentation to the applicant, at or prior to application, the “Long-Term Care Insurance Personal Worksheet.” [...] c. A completed personal worksheet is returned to the issuer prior to the issuer’s consideration of the applicant for coverage, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses. (3-31-22)