Massachusetts health insurance law practice questions
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The Massachusetts Accident, Health or Sickness Producer exam has 15 questions on "Massachusetts Laws and Regulations Pertinent to Accident, Health or Sickness Insurance Only." The outline lists, among others, required and optional policy provisions, health insurance provisions, Medicare supplement policies, MassHealth and long-term care. [1] Our Massachusetts health flashcards cover the required provisions, dependents, group continuation and the Medicare supplement open enrollment rules. This page covers the optional provisions, the individual mandate, small groups, mental health benefits and Medicare supplement eligibility, with 12 practice questions.
Optional provisions (175:108)
Massachusetts allows optional provisions in individual accident and sickness policies, including: [2]
- Change of occupation: if the insured is hurt or sick after moving to a more hazardous occupation, benefits are limited to what the premium would buy at the more hazardous rate.
- Misstatement of age: amounts payable are what the premium would have bought at the correct age.
- Other insurance in this insurer: coverage above a stated limit from the same insurer is void, and premiums for the excess are returned.
- Unpaid premium: any premium due and unpaid can be deducted from a claim payment.
- Conformity with state statutes: a provision that conflicts with the law of the insured's state is amended to meet that law's minimum requirements.
- Illegal occupation: no liability for a loss where a contributing cause was the insured committing a felony or working in an illegal occupation.
Practice questions
1. An insured switches from office work to a more hazardous job and is hurt. Under the optional change of occupation provision, what does the insurer pay?
A. Nothing
B. The full benefit
C. What the premium paid would have bought at the rate for the more hazardous occupation
D. Double the benefit
Answer: C. (175:108, optional provisions) [2]
2. A claim is paid while a premium is overdue. What can the insurer do under the unpaid premium provision?
Answer: Deduct the unpaid premium from the claim payment. (175:108) [2]
3. A policy provision conflicts with the law of the state where the insured lives. What happens?
Answer: It is amended to conform to the minimum requirements of that state's statutes. (175:108) [2]
4. Under Massachusetts's individual mandate, who must have health coverage?
Answer: Residents age 18 and over, so long as coverage is deemed affordable under the schedule set by the board of the Connector. (111M:2(a)) [3]
5. A resident's coverage ends. How long do they have to get new creditable coverage?
Answer: 63 days from the termination. (111M:2(a)) [3]
6. For small group health plans, what is an "eligible employee"?
Answer: One who works full time with a normal work week of thirty or more hours. (176J:1) [4]
7. What size business is an "eligible small business or group"?
Answer: One that, on at least fifty percent of its working days in the past year, employed from one to not more than fifty eligible employees. (176J:1) [4]
8. How must accident and sickness policies with hospital and surgical expense coverage handle certain mental disorders?
Answer: They must provide mental health benefits on a nondiscriminatory basis for the diagnosis and treatment of biologically-based mental disorders listed in the law, such as schizophrenia, major depressive disorder, bipolar disorder, panic disorder, eating disorders, post-traumatic stress disorder, substance abuse disorders and autism. (175:47B) [5]
9. Can an insurer deny or cancel an accident and sickness policy primarily because the insured was exposed to DES (diethylstilbestrol)?
Answer: No. That is prohibited discrimination. (175:108C) [6]
10. For Medicare supplement purposes, who is an "eligible person"?
Answer: Someone who lives in Massachusetts at least six consecutive months each calendar year, is eligible for or enrolled in Medicare for both hospital and physician services due to age or disability, and is not eligible for employer-sponsored coverage. People eligible for Medicare only because of end-stage renal disease are excluded. (176K:1) [7]
11. A group plan member divorces and later remarries. Can the former spouse keep benefits?
Answer: Yes, if the divorce judgment provides for it, through a rider to the family plan or an individual plan, either of which may cost more as set by the commissioner. (175:110I(b)) [8]
12. Under the illegal occupation provision, when is the insurer not liable?
Answer: For a loss where a contributing cause was the insured committing or attempting a felony, or working in an illegal occupation. (175:108) [2]
Study tips
- Learn the optional provisions by name and what each one does. The exam often describes the situation and asks which provision applies.
- The mandate numbers are age 18 and 63 days to replace lost coverage. The small group numbers are thirty hours, one to fifty employees, and fifty percent of working days.
More Massachusetts law questions are in the free Massachusetts 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, Massachusetts content outlines 122301 (effective July 22, 2026): https://www.pearsonvue.com/content/dam/VUE/vue/en/documents/publications/122301.pdf
- M.G.L. c. 175, s. 108: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section108
- M.G.L. c. 111M, s. 2: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111M/Section2
- M.G.L. c. 176J, s. 1: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176J/Section1
- M.G.L. c. 175, s. 47B: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section47B
- M.G.L. c. 175, s. 108C: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section108C
- M.G.L. c. 176K, s. 1: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter176K/Section1
- M.G.L. c. 175, s. 110I: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section110I