Massachusetts health insurance exam: what the outline covers
Last updated
In Massachusetts, the health insurance license exam is called the Accident, Health or Sickness Producer exam. Pearson VUE gives it under a content outline effective July 22, 2026. Here is what that outline covers, section by section. [1]
The exam in numbers
- 50 scored general knowledge questions plus 5 pretest. [1]
- 30 scored Massachusetts law questions plus 5 pretest. [1]
- 80 scored, 90 in total. Pretest questions do not count. [1]
- Passing score: 70 on a converted scale. [2]
- Fee: $37, paid when you book. [2]
This is its own exam. It is not combined with the Life exam. [2]
| Section | Scored questions | Share of the 80 |
|---|---|---|
| I. Types of Policies | 16 | 20% |
| II. Policy Provisions, Clauses, and Riders | 15 | 18.75% |
| III. Social Insurance | 6 | 7.5% |
| IV. Other Insurance Concepts | 5 | 6.25% |
| V. Field Underwriting Procedures | 8 | 10% |
| Massachusetts Laws and Rules Pertinent to All Lines of Insurance | 15 | 18.75% |
| Massachusetts Laws and Regulations Pertinent to Accident, Health or Sickness Insurance Only | 15 | 18.75% |
Share = section questions divided by 80. [1]
General knowledge (50 questions)
I. Types of Policies (16). Disability income (individual, business overhead expense, business disability buyout, group, key employee); accidental death and dismemberment; medical expense coverage (basic hospital, medical and surgical, major medical, HMOs, PPOs, POS plans, FSAs, HDHPs with HSAs, HRAs); Medicare supplement; group insurance and COBRA; long term care eligibility and levels of care; and dental, vision, cancer, critical illness, worksite, hospital indemnity, short-term medical and accident policies. [1]
II. Policy Provisions, Clauses, and Riders (15). The mandatory and optional provisions (entire contract, time limit on certain defenses, grace period, reinstatement, notice of claim, claim forms, proof of loss, payment of claims, legal actions, change of occupation, relation of earnings to insurance and others); other clauses such as probationary and elimination periods, preexisting conditions, coinsurance, deductibles, copayments and URC charges; riders; and renewability (noncancelable, cancelable, guaranteed renewable). [1]
III. Social Insurance (6). Medicare Parts A, B, C and D, Medicaid, and Social Security benefits. [1]
IV. Other Insurance Concepts (5). Total, partial, recurrent and residual disability; owner's rights; dependent children; beneficiaries; premium modes; coordination of benefits; occupational vs. non-occupational coverage; tax treatment; managed care; workers' compensation; subrogation. [1]
V. Field Underwriting Procedures (8). The application, HIPAA privacy information, the initial premium and receipt, submitting the application, delivery, explaining the policy, replacement, and contract law. [1]
Massachusetts law, all lines (15 questions)
This section is the same one that appears on the Life exam, minus the life settlement broker license. It covers licensing and license upkeep, discipline, the Commissioner's powers, company and producer regulation, unfair practices under chapter 176D section 3 (including rebating), fraud, privacy under chapter 175I, and types of insurers. The full topic list is on our Massachusetts life exam outline page. [1]
Massachusetts law, health only (15 questions)
This is where the Massachusetts health exam gets specific. The outline lists: [1]
- A. Guaranty Association (175:146B).
- B. Producer responsibilities: advertising (175:110E), sales presentations, the outline of coverage (211 CMR 42.09), disclosure of information about individuals (175:108E), notice of information practices (175I:4) and backdating (175:130).
- C. Insurer underwriting: investigative consumer reports (175I:7), medical exams and HIV tests (211 CMR 36.03), unfair discrimination (175:120, 120A to E).
- D. Replacement (175:110(N)(3)(a); 211 CMR 42.08, 42.11) and the individual mandate for minimum creditable coverage (chapter 111M; 956 CMR 5.00).
- E. Required policy provisions (175:108(3)(a)): entire contract, time limit on certain defenses, grace period, reinstatement, claim procedures, physical exams, legal actions, change of beneficiary, free look.
- F. Optional policy provisions (175:108(3)(b)): change of occupation, misstatement of age, other insurance in this insurer, expense-incurred basis, other benefits, unpaid premium, conformity with state statutes, illegal occupation.
- G. Health insurance provisions: open enrollment (chapter 176J), dependent age limits, disabled adult children, newborn and adopted children, the Affordable Care Act and the Massachusetts Health Connector, mental health parity (175:47B), employer group rules including coordination of benefits (211 CMR 38) and continuation of coverage (175:110D, 110G, 110I), and small employer plans (176J; 211 CMR 66).
- H. Medicare supplement: open enrollment (176K:3; 211 CMR 71.10), standardized plans (211 CMR 71.08), and marketing, compensation, suitability, disclosure, right to return, replacement and renewability rules under 211 CMR 71.
- I. MassHealth (chapter 118E, section 9A): eligibility and benefits.
- J. Long-term care (211 CMR 65.00): home health care, exclusions, marketing, suitability, the outline of coverage, nonforfeiture offer, right to return, illustrations, inflation protection, benefit triggers and unintentional lapse.
Study notes from the outline
- Ten lettered topics share 15 questions. The outline gives counts only at the section level, so no single topic is weighted in print. [1]
- State coverage shows up by name. MassHealth, the Health Connector and the individual mandate are listed as test topics, separate from the general Medicaid and Medicare items in Section III. [1]
- Section I is shared. If you are taking both exams, you study it once. [1]
Check yourself with the free Massachusetts Accident & Health practice test and the free Massachusetts insurance law questions.
FAQ
Is the "mass health insurance exam" the same as MassHealth?
No. MassHealth is one topic on the exam (letter I of the health-only section). The exam is the Accident, Health or Sickness Producer exam. [1]
How many Massachusetts law questions are on the health exam?
30 of the 80 scored questions, 15 all-lines and 15 health only. [1]
Can I take it online?
No. Pearson says all Massachusetts candidates test in person at a Pearson test center. [3]
Prep Retention is independent and is not affiliated with Pearson VUE or the state.
Sources
- Pearson VUE, Massachusetts content outlines 122301 (effective July 22, 2026): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/122301.pdf
- Pearson VUE, Massachusetts candidate handbook 122300 (June 2026): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/122300.pdf
- Pearson VUE, Massachusetts insurance page (last updated 2026-08-06): https://www.pearsonvue.com/us/en/ma/insurance.html