Free Massachusetts Accident & Health insurance exam practice test

Last updated October 12, 2026

These 25 questions follow the mix of the Massachusetts Accident, Health or Sickness Producer exam that Pearson VUE has given since July 22, 2026: 16 general health insurance questions and 9 on Massachusetts law. Pick your answers, then check them. Every question explains all four choices and quotes the law or official source it comes from.

These are practice questions written by Prep Retention, not questions from the actual exam.

Question 1 Types of health policiesOmar was an HSA-eligible individual for all of 2025 but has not yet made his 2025 HSA contribution. According to IRS Publication 969 (2025), what is the last day he can make contributions to his HSA for 2025?

A. April 15, 2026
B. December 31, 2025
C. March 15, 2026
D. October 15, 2026

Show the answer and explanation

Correct answer: A. April 15, 2026

A. Correct. Publication 969 says you can make contributions to your HSA for 2025 through April 15, 2026.
B. Incorrect. Contributions for 2025 may be made after the year ends, through April 15, 2026.
C. Incorrect. Publication 969 gives April 15, 2026, not March 15, as the last date for 2025 contributions.
D. Incorrect. Publication 969 sets the deadline at April 15, 2026; it does not run to October.

When To Contribute [...] You can make contributions to your HSA for 2025 through April 15, 2026.
Source: IRS Publication 969 (2025), Health Savings Accounts, When To Contribute

Question 2 Types of health policiesDuring the preceding calendar year, a business employed an average of 40 employees on business days, and it employs 38 on the first day of its plan year. Under 42 U.S.C. 300gg-91(e)(4), how is the business classified for its group health plan?

A. As a large employer, because it averaged more than 25 employees
B. As a small employer, because it averaged from 1 to 50 employees
C. As a large employer, because it had more than 2 on the first day
D. As a small employer, because it averaged fewer than 20 employees

Show the answer and explanation

Correct answer: B. As a small employer, because it averaged from 1 to 50 employees

A. Incorrect. Under (e)(4), an employer averaging at least 1 but not more than 50 employees is a small employer; 25 is not the dividing line.
B. Correct. Section 300gg-91(e)(4) defines a small employer as one that averaged at least 1 but not more than 50 employees on business days in the preceding calendar year and employs at least 1 on the first day of the plan year.
C. Incorrect. The count on the first day of the plan year only needs to be at least 1 for a small employer; the 40-employee average makes it small.
D. Incorrect. It averaged 40 employees, not fewer than 20; it is small because 40 is within the 1 to 50 range.

The term "small employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employees on the first day of the plan year.
Source: 42 U.S.C. 300gg-91(e)(4) (Cornell LII), small employer

Question 3 Types of health policiesRaj has a preferred provider organization (PPO) plan. How does his plan generally treat care he receives from doctors and hospitals outside its network?

A. He may use them, and he pays the same as he would in the network
B. He may not use them for any care, even in an emergency situation
C. He may use them, but he pays more than he would in the network
D. He may use them only if he lives outside the plan's service area

Show the answer and explanation

Correct answer: C. He may use them, but he pays more than he would in the network

A. Incorrect. A PPO charges less for network providers, so out-of-network care costs more.
B. Incorrect. A PPO allows the use of providers outside the network for an additional cost.
C. Correct. In a PPO, you pay less if you use network providers, and you can use providers outside the network for an additional cost.
D. Incorrect. A PPO lets members use outside providers for an additional cost; it does not depend on where the member lives.

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. [...] You pay less if you use providers that belong to the plan's network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Source: HealthCare.gov glossary, preferred provider organization (PPO)

Question 4 Types of health policiesDana is an HSA-eligible individual who will be 56 years old at the end of her tax year. According to IRS Publication 969 (2025), by how much is her HSA contribution limit increased because of her age?

A. $500
B. $1,000
C. $1,500
D. $2,000

Show the answer and explanation

Correct answer: B. $1,000

A. Incorrect. The age-based increase in Publication 969 is $1,000, not $500.
B. Correct. Publication 969 says an eligible individual who is 55 or older at the end of the tax year has a contribution limit increased by $1,000.
C. Incorrect. The increase for an eligible individual age 55 or older is $1,000.
D. Incorrect. Publication 969 states a $1,000 increase, not $2,000.

If you are an eligible individual who is age 55 or older at the end of your tax year, your contribution limit is increased by $1,000.
Source: IRS Publication 969 (2025), Health Savings Accounts, Additional contribution

Question 5 Types of health policiesRay is confined in a hospital operated by the federal government. He owns a hospital confinement indemnity policy subject to NAIC Model 171, Section 6E. How does Section 6E affect his claim?

A. The policy may exclude his stay because federal hospitals bill no charges
B. The policy cannot exclude his stay just because the hospital is federal
C. The policy pays half its daily benefit for stays in federal hospitals
D. The policy may exclude his stay unless he served in the armed forces

Show the answer and explanation

Correct answer: B. The policy cannot exclude his stay just because the hospital is federal

A. Incorrect. Section 6E does not allow this exclusion; it bars excluding coverage because of confinement in a federal hospital.
B. Correct. Section 6E says policies providing hospital confinement indemnity coverage shall not contain provisions excluding coverage because of confinement in a hospital operated by the federal government.
C. Incorrect. Section 6E does not permit a reduced benefit for federal hospital stays.
D. Incorrect. Section 6E bars the federal hospital exclusion for all insureds, with no military service condition.

Policies providing hospital confinement indemnity coverage shall not contain provisions excluding coverage because of confinement in a hospital operated by the federal government.
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 6E

Question 6 Health policy provisions and ridersA health insurer decides to stop offering all health insurance coverage in the individual market in a state. Under federal law (42 U.S.C. 300gg-2(c)(2)(A)), what notice must it give before discontinuing that coverage?

A. 60 days' notice to covered individuals, with no notice to the state
B. 90 days' notice to the state insurance department, with no notice to insureds
C. 30 days' notice to covered individuals and to the state insurance department
D. 180 days' notice to the state authority and to each covered individual

Show the answer and explanation

Correct answer: D. 180 days' notice to the state authority and to each covered individual

A. Incorrect. The statute requires notice to the applicable State authority as well, and at least 180 days in advance.
B. Incorrect. Notice must go to each covered individual as well as the State authority, at least 180 days in advance.
C. Incorrect. Thirty days is far shorter than the 180 days of notice required for leaving a market.
D. Correct. Section 300gg-2(c)(2)(A)(i) requires notice to the applicable State authority and to each plan sponsor or individual at least 180 days before discontinuation.

Discontinuance of all coverage [...] In any case in which a health insurance issuer elects to discontinue offering all health insurance coverage in the individual or group market, or all markets, in a State, health insurance coverage may be discontinued by the issuer only in accordance with applicable State law and if [...] the issuer provides notice to the applicable State authority and to each plan sponsor or individual, as applicable, (and participants and beneficiaries covered under such coverage) of such discontinuation at least 180 days prior to the date of the discontinuation of such coverage; and
Source: 42 U.S.C. 300gg-2(c)(2)(A)(i) (Cornell LII)

Question 7 Health policy provisions and ridersAn insurer wants to describe its individual disability policy as "noncancellable and guaranteed renewable." Under NAIC Model 171, Section 7A(2)(a), what does the regulation require when such a term is used?

A. It must be shown in capital letters on the policy's first page
B. It must be paired with added wording that explains it
C. It must be approved in writing by an insurer's officer
D. It must be repeated in a notice sent at each annual renewal

Show the answer and explanation

Correct answer: B. It must be paired with added wording that explains it

A. Incorrect. Section 7A(2)(a) calls for further explanatory language, not a type style.
B. Correct. Section 7A(2)(a) says these terms shall not be used without further explanatory language, under the disclosure rules of Section 8A(1).
C. Incorrect. Section 7A(2)(a) does not call for executive officer approval of the term.
D. Incorrect. Section 7A(2)(a) does not call for a notice at each renewal.

The terms 'noncancellable,' 'guaranteed renewable,' or 'noncancellable and guaranteed renewable' shall not be used without further explanatory language in accordance with the disclosure requirements of Section 8A(1).
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 7A(2)(a)

Question 8 Health policy provisions and ridersUnder the minimum standards in NAIC Model 171, a policy may specify a probationary or waiting period for specified diseases or conditions that does not exceed how long?

A. 30 days
B. 90 days
C. 12 months
D. 6 months

Show the answer and explanation

Correct answer: D. 6 months

A. Incorrect. Model 171 allows up to six months, not just 30 days.
B. Incorrect. Model 171 allows up to six months, not just 90 days.
C. Incorrect. Model 171 caps the period at six months, not 12 months.
D. Correct. Model 171 permits a probationary or waiting period not to exceed six months for specified diseases or conditions.

a policy may specify a probationary or waiting period not to exceed six (6) months for specified diseases or conditions
Source: NAIC Model 171, probationary period for specified diseases or conditions

Question 9 Health policy provisions and ridersGus's individual accident policy includes the optional illegal occupation provision of the NAIC Uniform Individual Accident and Sickness Policy Provision Law (Model 180). He is hurt while engaged in an illegal occupation, and that work was a contributing cause of the injury. How does the provision apply?

A. The insurer pays only the medical expense part
B. The insurer pays half of the loss
C. The insurer is not liable for the loss
D. The insurer pays once he is convicted

Show the answer and explanation

Correct answer: C. The insurer is not liable for the loss

A. Incorrect. The provision removes liability for the loss; it does not split it into covered and uncovered parts.
B. Incorrect. The provision removes liability for the loss rather than reducing it by half.
C. Correct. The provision says the insurer shall not be liable for any loss to which a contributing cause was the insured's being engaged in an illegal occupation.
D. Incorrect. The provision does not depend on a conviction; a contributing cause is enough.

The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony [...] or to which a contributing cause was the insured's being engaged in an illegal occupation
Source: NAIC Uniform Individual Accident and Sickness Policy Provision Law (Model 180), Section 3B, Illegal occupation

Question 10 Health policy provisions and ridersUnder NAIC Model 171, Section 6F(4), a disability income protection policy may exclude illness, treatment, or medical condition arising out of which of these?

A. A heart attack or stroke
B. Complications of pregnancy
C. Incarceration
D. Any cancer diagnosis

Show the answer and explanation

Correct answer: C. Incarceration

A. Incorrect. Section 6F(4) does not list heart attack or stroke as a permitted exclusion.
B. Incorrect. Model 171 permits a pregnancy exclusion only with an exception for complications of pregnancy, and this item is not in Section 6F(4).
C. Correct. Section 6F(4) permits excluding illness, treatment or medical condition arising out of incarceration with respect to disability income protection policies.
D. Incorrect. Section 6F(4) does not permit a general cancer exclusion.

A policy shall not limit or exclude coverage by type of illness, accident, treatment or medical condition, except as follows: [...] Illness, treatment or medical condition arising out of: [...] With respect to disability income protection policies, incarceration.
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 6F (lead-in), 6F(4) and 6F(4)(e)

Question 11 Social insuranceGail joins a Medicare Medical Savings Account (MSA) Plan. According to Medicare.gov, how does this type of plan pay for her care?

A. It pairs a low-deductible plan with an account she must fund herself
B. It pairs a high-deductible plan with an account the plan funds each year
C. It pays her doctors directly with no deductible and no separate account
D. It reimburses her monthly from Medicare Part A funds for costs she submits

Show the answer and explanation

Correct answer: B. It pairs a high-deductible plan with an account the plan funds each year

A. Incorrect. Medicare.gov says MSAs combine a high-deductible plan with a savings account that the plan deposits money into.
B. Correct. Medicare.gov says MSAs combine a high-deductible insurance plan with a medical savings account, and the plan deposits money into the account once at the beginning of each calendar year.
C. Incorrect. An MSA Plan uses a high-deductible plan together with a medical savings account.
D. Incorrect. Medicare.gov describes a yearly deposit by the plan into her MSA account at the start of the calendar year.

An MSA is a type of consumer-directed Medicare Advantage Plan (Part C). [...] MSAs combine a high-deductible insurance plan with a medical savings account to pay for your health care costs. [...] The plan deposits money into your MSA account once at the beginning of each calendar year.
Source: Medicare.gov, Medicare Medical Savings Account (MSA) Plans

Question 12 Social insuranceMedicare is generally for people 65 or older. According to Medicare.gov, which of these clients under 65 may be eligible for Medicare earlier?

A. A 50-year-old with End-Stage Renal Disease (ESRD)
B. A 60-year-old who retired early after 40 work credits
C. A 55-year-old with low income and limited savings
D. A 62-year-old whose spouse is already on Medicare

Show the answer and explanation

Correct answer: A. A 50-year-old with End-Stage Renal Disease (ESRD)

A. Correct. Medicare.gov says a person may be eligible earlier with a disability, End-Stage Renal Disease (ESRD), or ALS.
B. Incorrect. Early retirement and work credits are not among the listed reasons for getting Medicare before 65.
C. Incorrect. Low income is not among the listed reasons for getting Medicare before 65.
D. Incorrect. A spouse's Medicare enrollment is not one of the listed reasons for getting Medicare before 65.

Medicare is health insurance for people 65 or older who meet citizenship or residency requirements. [...] You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).
Source: Medicare.gov, Get started with Medicare

Question 13 Other health topicsKim's group health plan requires each enrollee to designate a participating primary care provider. Kim wants Dr. Lee, who participates in the network and is available to accept her. Under federal law (42 U.S.C. 300gg-19a(a)), what must the plan do?

A. Assign her the primary care provider nearest to her home
B. Permit her to designate Dr. Lee as her primary care provider
C. Permit Dr. Lee after she stays one year with an assigned doctor
D. Permit Dr. Lee once the employer approves her written request

Show the answer and explanation

Correct answer: B. Permit her to designate Dr. Lee as her primary care provider

A. Incorrect. The statute requires the plan to let her designate any available participating primary care provider, not assign one.
B. Correct. Section 300gg-19a(a) requires the plan to permit each enrollee to designate any participating primary care provider who is available to accept the individual.
C. Incorrect. The statute contains no waiting period before an enrollee may choose an available participating provider.
D. Incorrect. The right to designate an available participating primary care provider does not depend on employer approval.

Choice of health care professional [...] If a group health plan, or a health insurance issuer offering group or individual health insurance coverage, requires or provides for designation by a participant, beneficiary, or enrollee of a participating primary care provider, then the plan or issuer shall permit each participant, beneficiary, and enrollee to designate any participating primary care provider who is available to accept such individual.
Source: 42 U.S.C. 300gg-19a(a) (Cornell LII)

Question 14 Other health topicsNora is covered as an employee under her own employer's group health plan and as a dependent under her husband's group health plan. Under the NAIC Coordination of Benefits Model Regulation (Model 120), which plan is primary for Nora's claims?

A. Her husband's plan, because it covers her as his dependent
B. The plan of the spouse whose birthday falls earlier in the year
C. Her own employer's plan, because it covers her as an employee
D. The plan with the lower deductible for the current plan year

Show the answer and explanation

Correct answer: C. Her own employer's plan, because it covers her as an employee

A. Incorrect. The plan covering Nora as a dependent is the secondary plan.
B. Incorrect. The birthday rule is used for dependent children of parents; it does not decide Nora's own coverage.
C. Correct. The plan that covers the person other than as a dependent is the primary plan, and the plan that covers the person as a dependent is the secondary plan.
D. Incorrect. Model 120 does not set the order of benefits by deductible amount.

the plan that covers the person other than as a dependent [...] is the primary plan and the plan that covers the person as a dependent is the secondary plan.
Source: NAIC Coordination of Benefits Model Regulation (Model 120), order of benefit determination (non-dependent/dependent)

Question 15 Health field underwritingAn insurer that is a HIPAA covered entity asks an applicant to sign an authorization so it can use her protected health information. Under 45 CFR 164.508(c)(4), what must the insurer give her?

A. A list of each person who will see her data
B. A copy of the medical records it receives
C. A copy of the authorization she signed
D. A written summary of its underwriting decision

Show the answer and explanation

Correct answer: C. A copy of the authorization she signed

A. Incorrect. 164.508(c)(4) requires a copy of the signed authorization, not a list of each person who will see her information.
B. Incorrect. The rule requires a copy of the signed authorization, not the records.
C. Correct. A covered entity that seeks an authorization from an individual must provide the individual with a copy of the signed authorization.
D. Incorrect. 164.508(c)(4) requires a copy of the signed authorization, not a summary of the underwriting decision.

If a covered entity seeks an authorization from an individual for a use or disclosure of protected health information, the covered entity must provide the individual with a copy of the signed authorization.
Source: 45 CFR 164.508(c)(4)

Question 16 Health field underwritingAn insurer declines an applicant based in part on information in a consumer report. Under 15 U.S.C. 1681m(a)(1), in what form may the insurer give the applicant notice of the adverse action?

A. Written notice sent by certified mail
B. Oral, written, or electronic notice
C. Written notice through the agent alone
D. A notice posted on the insurer's website

Show the answer and explanation

Correct answer: B. Oral, written, or electronic notice

A. Incorrect. The statute does not require certified mail; oral or electronic notice is also allowed.
B. Correct. 1681m(a)(1) requires the person taking adverse action to provide oral, written, or electronic notice of the adverse action to the consumer.
C. Incorrect. The statute permits oral, written, or electronic notice and does not require it to go through the agent.
D. Incorrect. A general website posting is not notice provided to the consumer.

provide oral, written, or electronic notice of the adverse action to the consumer
Source: 15 U.S.C. 1681m(a)(1)

Question 17 Massachusetts laws for all linesA licensed Massachusetts producer moves to a new address. Under M.G.L. c. 175, s. 162M, how soon must she inform the commissioner of the change?

A. No later than 10 days after moving
B. No later than 60 days after moving
C. No later than 15 days after moving
D. No later than 30 days after moving

Show the answer and explanation

Correct answer: D. No later than 30 days after moving

A. Incorrect. 162M(f) allows 30 days, not 10.
B. Incorrect. 162M(f) allows 30 days, not 60.
C. Incorrect. 162M(f) allows 30 days, not 15.
D. Correct. 162M(f) requires licensees to inform the commissioner of a change of address within 30 days of the change.

(f) Licensees shall inform the commissioner by any means acceptable to the commissioner of a change of address within 30 days of the change.
Source: M.G.L. c. 175, s. 162M(f)

Question 18 Massachusetts laws for all linesAn insurer's application form asks whether the applicant has experienced any previous adverse underwriting decision. Under M.G.L. c. 175I, s. 11, what must that inquiry also do?

A. Request the reasons for any such prior decision
B. Limit itself to decisions made in the last 5 years
C. Tell the applicant a yes answer cannot affect the rate
D. Be approved in advance by the commissioner

Show the answer and explanation

Correct answer: A. Request the reasons for any such prior decision

A. Correct. 175I:11 allows an inquiry about any previous adverse underwriting decision only if the inquiry also requests the reasons for that decision.
B. Incorrect. 175I:11 sets no five-year look-back; it requires that the reasons also be requested.
C. Incorrect. 175I:11 does not require that statement; it requires that the reasons also be requested.
D. Incorrect. 175I:11 does not require the commissioner's advance approval of the question.

No insurance institution, insurance representative or insurance-support organization may seek information in connection with an insurance transaction concerning any previous adverse underwriting decision experienced by an individual unless such inquiry also requests the reasons for any previous adverse underwriting decision.
Source: M.G.L. c. 175I, s. 11

Question 19 Massachusetts laws for all linesUnder M.G.L. c. 175, s. 2B, unless the commissioner approves it in writing sooner, how long must a copy of a policy form be on file with the commissioner before the form may be delivered to more than fifty policyholders in Massachusetts?

A. 30 days
B. 60 days
C. 45 days
D. 15 days

Show the answer and explanation

Correct answer: A. 30 days

A. Correct. 2B bars delivery to more than fifty policyholders until the form has been on file for thirty days, unless the commissioner approves it in writing before then.
B. Incorrect. 2B requires thirty days on file, not 60.
C. Incorrect. 2B requires thirty days on file, not 45.
D. Incorrect. 2B requires thirty days on file, not 15.

No policy form of insurance shall be delivered or issued for delivery to more than fifty policyholders in the commonwealth until a copy of the policy form has been on file for thirty days with the commissioner, unless before the expiration of said thirty days the commissioner shall have approved the form of the policy in writing as complying with this section;
Source: M.G.L. c. 175, s. 2B (first paragraph)

Question 20 Massachusetts laws for all linesAn agent who collected premiums for a company pays them over after the company's written demand. Under M.G.L. c. 175, s. 176, what may the agent hold back from the amount paid over?

A. His commission and any office expenses he thinks are reasonable
B. Nothing at all, not even his commission on the policy
C. Any deductions the insured agreed to orally at the sale
D. His commission and deductions the company agreed to in writing

Show the answer and explanation

Correct answer: D. His commission and deductions the company agreed to in writing

A. Incorrect. Deductions beyond his commission must have the company's written consent.
B. Incorrect. Section 176 allows the agent to keep his commission.
C. Incorrect. Deductions require the written consent of the company, not the insured's oral agreement.
D. Correct. Section 176 refers to paying over the premium less his commission and any deductions allowed by the written consent of the company.

If he fails to pay the same over to the company after written demand made upon him therefor, less his commission and any deductions to which, by the written consent of the company, he may be entitled, such failure shall be prima facie evidence that he has used or applied the said premium for a purpose other than paying the same over to the company, and upon conviction thereof he shall be guilty of larceny.
Source: M.G.L. c. 175, s. 176

Question 21 Massachusetts accident and health lawsAn individual accident and sickness policy issued in Massachusetts has monthly premiums. Under the Grace Period provision in M.G.L. c. 175, s. 108(3)(a), the grace period must be at least how many days?

A. 7 days
B. 10 days
C. 15 days
D. 31 days

Show the answer and explanation

Correct answer: B. 10 days

A. Incorrect. 7 days is the minimum for weekly premium policies.
B. Correct. The provision calls for a number not less than 10 for monthly premium policies.
C. Incorrect. 15 days is not one of the minimums in the provision.
D. Incorrect. 31 days is the minimum for policies other than weekly and monthly premium policies.

A grace period of [insert a number not less than ''7'' for weekly premium policies, ''10'' for monthly premium policies and ''31'' for all other policies] days will be granted for the payment of each premium falling due after the first premium during which grace period the policy shall continue in force.
Source: M.G.L. c. 175, s. 108, subdivision 3(a), required provision (3) Grace Period

Question 22 Massachusetts accident and health lawsAn individual disability income policy includes the optional Overinsurance provision under M.G.L. c. 175, s. 108(3)(b). After the loss-of-time benefit has been payable for how many days does the provision allow the benefit to be adjusted?

A. 30 days
B. 90 days
C. 60 days
D. 180 days

Show the answer and explanation

Correct answer: B. 90 days

A. Incorrect. The provision uses 90 days, not 30.
B. Correct. The Overinsurance provision adjusts the benefit after the loss-of-time benefit has been payable for 90 days, if total coverage exceeds the stated share of earned income.
C. Incorrect. The provision uses 90 days, not 60.
D. Incorrect. The provision uses 90 days, not 180.

After the loss-of-time benefit of this policy has been payable for 90 days, the benefit shall be adjusted, as provided below, if the total amount of unadjusted loss-of-time benefits provided in all valid loss-of-time coverage upon the insured should exceed (insert amount) per cent of the insured's
Source: M.G.L. c. 175, s. 108, subdivision 3(b), optional provision Overinsurance (opening words)

Question 23 Massachusetts accident and health lawsAn issuer must report each Massachusetts resident for whom it has more than one Medicare supplement policy in force. Under 211 CMR 71.19, to whom is the report addressed?

A. The Division's Consumer Services Unit manager
B. The federal Medicare administrative contractor
C. The Division's State Rating Bureau Director
D. The attorney general's insurance fraud unit chief

Show the answer and explanation

Correct answer: C. The Division's State Rating Bureau Director

A. Incorrect. 71.19 names the Director of the State Rating Bureau at the Division of Insurance.
B. Incorrect. The report goes to the Director of the State Rating Bureau at the Division of Insurance.
C. Correct. 71.19 requires the information to be reported on a form prescribed by the Commissioner and addressed to the Director of the State Rating Bureau at the Division of Insurance.
D. Incorrect. 71.19 names the Director of the State Rating Bureau at the Division of Insurance.

On or before March 1st of each year, an Issuer shall report the following information for every individual resident of Massachusetts for which the Issuer has in force more than one Medicare Supplement Insurance Policy: [...] The information required by 211 CMR 71.19 shall be reported on a form prescribed by the Commissioner and addressed to the Director of the State Rating Bureau at the Division of Insurance.
Source: 211 CMR 71.19(1), (3) (Cornell LII), Reporting of Multiple Policies

Question 24 Massachusetts accident and health lawsIvy applies for a family policy under M.G.L. c. 175, s. 108 that is a health benefit plan. She is in the middle of adoption procedures under chapter 210 for a young child. Under s. 108, subdivision 2(a)(3), when may the family policy insure that child?

A. Only after the court enters a final adoption decree
B. While the adoption procedures are still pending
C. Only after the child has lived with her for six months
D. Only once 31 days pass after she files the petition

Show the answer and explanation

Correct answer: B. While the adoption procedures are still pending

A. Incorrect. The family policy may insure the child before the adoption is final.
B. Correct. Subdivision 2(a)(3) lets a family policy insure children during pendency of adoption procedures under chapter 210.
C. Incorrect. No six-month residence condition appears in subdivision 2(a)(3).
D. Incorrect. No 31-day delay applies to children during pendency of adoption procedures.

a policy, excluding contracts that are not health benefit plans, as defined in section 1 of chapter 176J, shall insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be considered the policyholder, 2 or more eligible members of that family, including the policyholder, spouse, dependent children and other dependent persons, children during pendency of adoption procedures under chapter 210
Source: M.G.L. c. 175, s. 108, subdivision 2(a)(3)

Question 25 Massachusetts accident and health lawsTom, 66, has diabetes and applies for a Medicare supplement policy in Massachusetts. The carrier wants to add a rider that excludes diabetes-related claims for his first six months of coverage. How does M.G.L. c. 176K, s. 3(b) treat that rider?

A. It is allowed if the exclusion is shown on the first page
B. It is allowed if Tom applies outside the open enrollment period
C. It is barred, since no pre-existing exclusion is permitted
D. It is allowed if the waiting period is six months or less

Show the answer and explanation

Correct answer: C. It is barred, since no pre-existing exclusion is permitted

A. Incorrect. Disclosure does not cure it; s. 3(b) bars any pre-existing condition limitation or exclusion.
B. Incorrect. Section 3(b) is not limited to open enrollment; no such policy may contain a pre-existing condition exclusion.
C. Correct. Under s. 3(b), no Medicare supplement policy may contain any pre-existing condition limitation or exclusion.
D. Incorrect. Section 3(b) says no Medicare supplement policy may contain any waiting period or pre-existing condition limitation or exclusion, whatever its length.

No policy for medicare supplement insurance or medicare select insurance or a policy issued pursuant to a risk or cost contract may contain any waiting period or pre-existing condition limitation or exclusion.
Source: M.G.L. c. 176K, s. 3(b)

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