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Pennsylvania accident and health insurance exam flashcards

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The Pennsylvania Accident and Health exam (Series 16-02) has 100 questions, and Pennsylvania law is spread through its ten sections instead of sitting in one state part. [1] These flashcards focus on the numbers and rules from Pennsylvania law that the outline names. Each answer shows where it comes from. "ICL" is Pennsylvania's Insurance Company Law of 1921.

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Required provisions (outline section 4.0)

1. In Pennsylvania's required "Time Limit on Certain Defenses," after how long can the insurer no longer use non-fraudulent misstatements to void the policy?
Three years from the date of issue. (ICL 618(A)(2)) [2]

2. What grace periods must the policy allow?
Not less than 7 days for weekly premium policies, 10 days for monthly, and 31 days for all others. (ICL 618(A)(3)) [2]

3. A reinstatement application gets a conditional receipt and the insurer says nothing. When is the policy reinstated?
On the forty-fifth day after the date of the conditional receipt, unless the insurer told the insured in writing before then that it disapproves the application. (ICL 618(A)(4)) [2]

4. How soon must written notice of claim be given?
Within twenty days after the loss starts, or as soon after as is reasonably possible. (ICL 618(A)(5)) [2]

5. The insurer does not send claim forms. How long before the claimant can file proof without them?
Fifteen days after notice of claim. (ICL 618(A)(6)) [2]

6. When is proof of loss due?
Within ninety days after the loss (or after the end of the period the insurer is liable for, for periodic benefits). Except for lack of legal capacity, no later than one year. (ICL 618(A)(7)) [2]

7. How often must ongoing disability (periodic) benefits be paid?
At an interval the policy sets, but not less often than monthly. (ICL 618(A)(8)) [2]

8. If no beneficiary designation is in effect, who gets the benefit for loss of life?
The insured's estate. (ICL 618(A)(9)) [2]

9. What are the limits on suing the insurer?
No suit until sixty days after written proof of loss. No suit after three years from when proof of loss was required. (ICL 618(A)(11)) [2]

10. Can the beneficiary block the insured from changing beneficiaries?
No, unless the insured made an irrevocable designation. (ICL 618(A)(12)) [2]

11. Who can change the policy?
Only an executive officer of the insurer, with the approval endorsed or attached. No agent can change the policy or waive its provisions. (ICL 618(A)(1)) [2]

Optional provisions (section 4.0)

12. Under the optional cancellation provision, how much notice must the insurer give?
Written notice stating when the cancellation takes effect, not less than five days later. (ICL 618(B)(8)) [2]

13. If the insurer cancels, how is the earned premium figured?
Pro rata. If the insured cancels, by the short-rate table. (ICL 618(B)(8)) [2]

14. What does the "Illegal Occupation" provision exclude?
Any loss where a contributing cause was the insured committing or attempting a felony, or working in an illegal occupation. (ICL 618(B)(10)) [2]

Free look

15. How many days does an individual health policy give to examine the policy?
Ten. The "Notice of Insured's Right to Examine Policy for Ten Days" must be printed on the face of the policy, with a full refund option. (31 Pa. Code 89.73(a)) [3]

16. How long is the free look on a long-term care policy?
Thirty days from delivery, with the premium refunded. (ICL 1110) [4]

Children (section 6.0)

17. A policy requires an added premium for a newborn. When must notice and premium be given to keep coverage past the first stretch?
Within 31 days after the date of birth. (Act 81 of 1975, Section 3) [5]

18. When does a newborn's coverage begin under an expense incurred health policy?
From the moment of birth. (Act 81 of 1975, Section 1) [5]

19. What must newborn coverage include?
Coverage of injury or sickness, including care and treatment of medically diagnosed congenital defects, birth abnormalities, prematurity and routine nursery care. Routine well-baby care does not have to be included unless it is provided for other dependent children under the same class of coverage. (Act 81 of 1975, Section 2) [5]

20. Can the insurer examine the insured while a claim is pending?
Yes. At its own expense, as often as it reasonably requires while the claim is pending, and it can do an autopsy in case of death where the law does not forbid it. (ICL 618(A)(10)) [2]

Medicare supplement (section 9.0)

21. When is the Medicare supplement open enrollment period?
The 6 months starting on the first day of the first month the person is enrolled in Medicare Part B. During it, the issuer cannot deny or condition coverage or price it differently because of health status. (31 Pa. Code 89.778(a)) [6]

22. During open enrollment, an applicant has at least 6 months of creditable coverage. Can the issuer exclude a pre-existing condition?
No. (31 Pa. Code 89.778(b)) [6]

How to use these cards

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Prep Retention is independent and is not affiliated with PSI or the state.

Sources

Laws and exam documents quoted as of October 2026.

  1. PSI, Pennsylvania Accident and Health outline, Series 16-02 (effective 3/1/2026): https://proctor2.psionline.com/media/programs/PAINS/16-02xx.pdf
  2. Insurance Company Law of 1921 (Act of May 17, 1921, P.L. 682, No. 284), Section 618 (policy provisions): https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1921&SessInd=0&ActNum=0284
  3. 31 Pa. Code 89.73: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter89/s89.73.html&d=reduce
  4. Insurance Company Law of 1921, Section 1110 (long-term care right to return): same URL as source 2
  5. Act of Aug. 1, 1975, P.L. 157, No. 81 (newborn children coverage): https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1975&SessInd=0&ActNum=0081
  6. 31 Pa. Code 89.778: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter89/s89.778.html&d=reduce

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