Idaho health insurance law practice questions
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The Idaho Accident and Health exam has 10 questions on "Idaho statutes, rules, and regulations pertinent to health/disability insurance only." The outline lists policy clauses and provisions, AD&D, disclosure, Medicare supplement, long-term care, the small employer and individual availability acts, disability income protection and the Idaho Health Carrier External Review Act. [1] Our Idaho health outline page covers free look, grace period, newborns and mammograms. This page covers the claim provisions, reinstatement, group rules, long-term care contestability, refunds and external review.
Practice questions
1. Under Idaho's required claim provisions, how soon must written notice of claim be given?
Answer: Within twenty days after the loss starts, or as soon after as reasonably possible. (41-2109) [2]
2. The insurer does not send claim forms. After how many days can the claimant file written proof without them?
Answer: Fifteen days after notice. (41-2110) [3]
3. When is proof of loss due?
Answer: Within ninety days after the loss, or for continuing losses, ninety days after the period the insurer is liable for ends. If that is not reasonably possible, as soon as it is. (41-2111) [4]
4. How often must periodic disability benefits be paid?
Answer: Not less often than monthly. (41-2112) [5]
5. A reinstatement application gets a conditional receipt and no response. When is the policy reinstated?
Answer: On the forty-fifth day after the date of the conditional receipt, if the insurer has not approved it before then. (41-2108(1)) [6]
6. Can the insurer examine the insured or perform an autopsy during a claim?
Answer: Yes, at its own expense, as often as reasonably required while the claim is pending, and an autopsy in case of death where the law does not forbid it. (41-2114) [7]
7. A group medical expense policy ends while an employee is totally disabled. How long must benefits for that disabling condition continue?
Answer: Not less than twelve months after the discontinuance, for covered expenses from the disabling condition. (41-2213(2)) [8]
8. A covered employee is pregnant when the group policy ends and has no replacement group coverage within sixty days. How long do maternity benefits continue?
Answer: Up to twelve months after the discontinuance. (41-2214) [9]
9. A long-term care policy has been in force for eight months. On what grounds may the insurer rescind it?
Answer: A misrepresentation that is both material to the acceptance for coverage and related to the condition for which benefits are sought. (41-4606(2)) [10]
10. After how long is a long-term care policy no longer contestable on misrepresentation alone?
Answer: Two years. After that it can be contested only if the insured knowingly and intentionally misrepresented relevant health facts. (41-4606(3)) [10]
11. A health insurance policyholder cancels mid-month. What refund is due?
Answer: The pro rata portion of the unused premium, to the beginning of the next monthly billing cycle. (41-1333) [11]
12. A health carrier makes a final adverse benefit determination. What must it tell the covered person?
Answer: In writing, that they have the right to request an external review, sent at the same time as the written notice of the decision. Requests, other than expedited ones, go to the director in writing. (41-5905(1), 41-5906) [12]
More rules to know
- Outline of coverage (41-4205(1)): for individual disability policies sold through an agent, the outline of coverage is delivered at the time of application. For direct response sales, it comes with the policy. [13]
- Renewability (41-2128): if an insurer reserves the right to refuse renewal individually, the refusal cannot take effect before the renewal date nearest each policy anniversary. [14]
- Unearned premium at death (41-1332): when a disability policyholder dies, the insurer must return unearned premium on a prorated basis from the month after the month of death. [11]
- External review exclusions (41-5904(2)): the act does not apply to coverages such as specified disease, disability income, long-term care, dental, vision or Medicare supplement policies. [15]
- Large group pre-existing limit (41-2221(1)(a)): a large employer plan cannot exclude covered expenses for a pre-existing condition more than twelve months after coverage starts, with a six-month look-back. [16]
Study tips
- The claim provision numbers repeat across states but are law in Idaho by section: 20 days notice, 15 days for forms, 90 days proof, monthly periodic payment, 45 days reinstatement.
- Long-term care contestability has three stages: under six months, six months to two years, and after two years.
More Idaho law questions are in the free Idaho insurance law 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, Idaho content outlines 121301 (effective July 31, 2025): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/121301.pdf
- Idaho Code 41-2109: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2109/
- Idaho Code 41-2110: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2110/
- Idaho Code 41-2111: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2111/
- Idaho Code 41-2112: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2112/
- Idaho Code 41-2108: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2108/
- Idaho Code 41-2114: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2114/
- Idaho Code 41-2213: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH22/SECT41-2213/
- Idaho Code 41-2214: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH22/SECT41-2214/
- Idaho Code 41-4606: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH46/SECT41-4606/
- Idaho Code 41-1332 and 41-1333: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH13/SECT41-1332/ ; https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH13/SECT41-1333/
- Idaho Code 41-5905 and 41-5906: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH59/SECT41-5905/ ; https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH59/SECT41-5906/
- Idaho Code 41-4205: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH42/SECT41-4205/
- Idaho Code 41-2128: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2128/
- Idaho Code 41-5904: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH59/SECT41-5904/
- Idaho Code 41-2221: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH22/SECT41-2221/