Health policy provisions practice questions (Massachusetts A&H exam)
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Section II of the Massachusetts Accident, Health or Sickness Producer exam, "Policy Provisions, Clauses, and Riders," has 15 scored questions. [1] The outline lists the mandatory and optional provisions, other clauses (insuring clause, free look, probationary and elimination periods, waiver of premium, exclusions, pre-existing conditions, coinsurance, deductibles, copayments, prior approval, usual and customary charges, benefit maximums), riders (impairment, guaranteed insurability, future increase option) and renewability (noncancelable, cancelable, guaranteed renewable). [1] Our Massachusetts health flashcards cover the required provisions. This page covers the cost sharing terms, disability policy terms and renewability, with 10 practice questions.
Cost sharing terms, as the Division defines them
- Deductible: "a dollar amount that you must pay before the health plan starts to pay for a covered service." [2]
- Coinsurance: "a percentage of the allowed charge that you will pay for a covered service after any copayments." [2]
- Copayment: "a fixed dollar amount paid by you directly to a doctor, hospital, pharmacy" or other provider. [2]
- Out-of-pocket maximum: "a cap on your cost sharing for a year." [2]
- Exclusions: "listed services for which there is no benefit." [2]
Disability policy terms, from the Division's glossary
- Elimination period: "A type of deductible; the number of days the insured is disabled before insurance policy benefits begin to be paid." [3]
- Waiver of premium: relieves the insured of paying premiums while receiving benefits. [3]
- Noncancelable policy: "guarantees the insured's right to continue the in-force insurance policy by timely payment of the premium." [3]
- Guaranteed renewable policy: the carrier "reserves the right to change the premium rate." [3]
- Cost of living adjustment: increases the monthly benefit each year by a set percentage while the insured is receiving benefits. [3]
- Future purchase option: guarantees the right to buy increased benefits at set intervals. [3]
Practice questions
1. What is a fixed dollar amount you pay a provider for a covered service called?
A. Deductible
B. Copayment
C. Coinsurance
D. Premium
Answer: B. [2]
2. You pay 20 percent of the allowed charge after copays. What is that?
Answer: Coinsurance, a percentage of the allowed charge you pay for a covered service. [2]
3. What is the yearly cap on your cost sharing called?
Answer: The out-of-pocket maximum. [2]
4. In a disability policy, what is the elimination period?
Answer: A type of deductible: the number of days the insured is disabled before benefits begin. [3]
5. Which renewability type lets the insurer change the premium rate?
Answer: Guaranteed renewable. [3]
6. Which renewability type guarantees the right to continue the policy by paying the premium on time?
Answer: Noncancelable. [3]
7. Which rider increases disability benefits each year while the insured is on claim?
Answer: Cost of living adjustment. [3]
8. Which option lets the insured buy higher benefits at set times later?
Answer: Future purchase option (the outline calls it future increase option). [3]
9. What does utilization review do?
Answer: The Division says health plans use it to decide if a service is necessary according to their medical standards. [2]
10. Under Massachusetts law, what can an insurer do at the time of a claim if a premium is overdue (optional provision)?
Answer: Deduct the unpaid premium from the claim payment. (M.G.L. c. 175, s. 108) [4]
Study tips
- Copayment is a fixed dollar amount, coinsurance is a percentage, the deductible comes first, and the out-of-pocket maximum caps it all for the year.
- Noncancelable guarantees the right to continue by paying the premium on time; under guaranteed renewable, the carrier reserves the right to change the premium rate.
Practice more with the free Massachusetts Accident and Health practice test.
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
- Massachusetts Division of Insurance, Consumer Guide to Understanding Health Insurance: https://www.mass.gov/info-details/consumer-guide-to-understanding-health-insurance
- Massachusetts Division of Insurance, Appendix A, Glossary of Common Disability Income Terminology: https://www.mass.gov/doc/appendixa2010pdf/download
- M.G.L. c. 175, s. 108: https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXII/Chapter175/Section108