Idaho health policy provisions, clauses and riders practice questions
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Section II of the Idaho Accident and Health exam's general part, Policy Provisions, Clauses, and Riders, has 15 of the 50 general questions. [1] It lists mandatory and optional provisions; other provisions and clauses (insuring clause, free look, consideration clause, probationary period, elimination period, 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]
Our Idaho health law questions page covers the required claim provisions. This page covers Idaho's optional provisions, renewability and the cost sharing terms, with 10 practice questions.
Optional provisions (Idaho Code 41-2117 to 41-2127)
If a policy includes these subjects, it must use the statute's words or approved wording no less favorable to the insured. [2]
- Change of occupation: if the insured is hurt or gets sick after changing to a more hazardous occupation, the insurer pays only what the premium paid would have bought at the rates for that occupation. If the new occupation is less hazardous, the insurer lowers the premium rate on proof of the change and returns the excess unearned premium. [3]
- Misstatement of age: "all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age." [4]
- Illegal occupation: no liability for a loss to which committing or attempting a felony, or working in an illegal occupation, contributed. [5]
- Intoxicants and narcotics: no liability for a loss caused by being intoxicated or under the influence of a narcotic, unless the narcotic was given on a physician's advice. [6]
- Relation of earnings to insurance: if total loss of time benefits from all coverage exceed the insured's monthly earnings when disability began, or average monthly earnings for the two years before, whichever is greater, the insurer pays only a proportionate amount. [7]
Renewability (Idaho Code 41-2128)
When an insurer keeps the right to refuse renewal on an individual basis (other than accident only policies), the refusal may not take effect before the renewal date on or after and nearest each policy anniversary, and it does not affect any claim that began while the policy was in force. [8]
Policy form and dependents (Idaho Code 41-2103)
An individual policy may cover two or more family members on the application of an adult family member, who is the policyholder. For new and renewing policies, "dependent" includes an unmarried child under twenty five who gets more than half of their support from the parent, or an unmarried child of any age medically certified as disabled and dependent on the parent. [9] Printed text must be at least ten point type, and a policy paying medical or surgical expenses must let the insured freely choose the doctor. [9]
Cost sharing terms (Idaho Department of Insurance glossary)
- Coinsurance: your share of the cost of a covered service, figured as a percent of the allowed amount, paid on top of any deductible. [10]
- Copayment: a fixed amount you pay for a covered service, usually when you get the service. [10]
- Preauthorization: a decision that a service, treatment, drug or equipment is medically necessary; it is not a guarantee of coverage and is also called prior authorization. [10]
- UCR: the amount usually charged in an area for a medical service, sometimes used to set the allowed amount. [10]
- Balance billing: a provider billing you for the difference between its charge and the allowed amount; a preferred provider may not do this for covered services. [10]
Practice questions
1. An insured changes to a less hazardous occupation and proves it. What must the insurer do?
A. Nothing until renewal
B. Cancel the policy
C. Lower the premium rate and return the excess unearned premium
D. Raise the benefits
Answer: C. (Idaho Code 41-2118) [3]
2. A claim shows the insured's age was understated. How are benefits figured?
Answer: At the amount the premium paid would have bought at the correct age. (Idaho Code 41-2119) [4]
3. A loss happened while the insured was committing a felony. What does the optional provision allow?
Answer: The insurer is not liable for that loss. (Idaho Code 41-2126) [5]
4. The relation of earnings provision compares benefits with what earnings?
Answer: Monthly earnings when disability began, or average monthly earnings over the two years before, whichever is greater. (Idaho Code 41-2123) [7]
5. An insurer that may refuse renewal individually wants to drop a policy mid-term. When can the refusal take effect?
Answer: Not before the renewal date on or after and nearest the policy anniversary. (Idaho Code 41-2128) [8]
6. Under Idaho's individual policy rule, up to what age may an unmarried child who gets most of their support from a parent stay a dependent?
Answer: Under twenty five. (Idaho Code 41-2103(3)) [9]
7. A policy pays surgical expenses. Who chooses the surgeon?
Answer: The insured, who is entitled to a free choice of medical doctor. (Idaho Code 41-2103(8)) [9]
8. A plan pays 80% of the allowed amount after the deductible. What is the insured's 20% share called?
Answer: Coinsurance. [10]
9. Does preauthorization guarantee the plan will pay?
Answer: No. It is a decision that the care is medically necessary, not a guarantee of coverage. [10]
10. A preferred provider bills the patient for the gap between its charge and the allowed amount for a covered service. Is that allowed?
Answer: No. The glossary says preferred providers may not balance bill for covered services. [10]
Study tips for section II
- Split provisions into required (claims and contract rules) and optional (occupation, age, felony, intoxicants, earnings).
- Coinsurance is a percent; a copayment is a fixed amount.
- Rights of renewability (noncancelable, cancelable, guaranteed renewable) and the three riders listed are also on this section. [1]
Practice more with the free Idaho 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, Idaho content outlines 121301 (effective July 31, 2025): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/121301.pdf
- Idaho Code 41-2117: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2117/
- Idaho Code 41-2118: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2118/
- Idaho Code 41-2119: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2119/
- Idaho Code 41-2126: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2126/
- Idaho Code 41-2127: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2127/
- Idaho Code 41-2123: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2123/
- Idaho Code 41-2128: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2128/
- Idaho Code 41-2103: https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH21/SECT41-2103/
- Idaho Department of Insurance, Glossary of Health Coverage and Medical Terms: https://doi.idaho.gov/wp-content/uploads/2021/04/Health-Coverage-and-Medical-Terms-Glossary-2.pdf