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Pennsylvania medical plans and group health practice questions

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On the Pennsylvania Accident and Health exam (Series 16-02), section 6.0 Medical Plans is 14%, section 7.0 Group Health Insurance is 9%, and section 8.0 Dental Insurance is 2%, so together they make up a quarter of the test. [1] The outline covers plan types (basic, major medical, HMO, PPO, point of service), cost containment, HIPAA, Pennsylvania mandated benefits, group contracts and eligibility, conversion, COBRA, and dental plans. [1] This page explains the main terms and the Pennsylvania rules, then gives 10 practice questions.

Plan types and cost terms

Pennsylvania rules for dependents

A policy may cover the insured's children under a specified age that may not exceed 19, unless a dependency test is used, and newborns must be covered under Act 81 of 1975. [7] An insurer issuing group health coverage must, at the policyholder's option, let a child of an insured employee stay covered through age 29, at the employee's expense, if the child is unmarried, has no dependents, lives in Pennsylvania or is a full time student, and has no other coverage. [8]

Conversion and COBRA

A group hospital, surgical or major medical expense policy must let an employee or member whose coverage ends, and who was insured for at least three months, buy a converted individual policy. Application and the first premium are due within 31 days after termination, and the policy is issued without evidence of insurability. The converted policy takes effect the day after the group insurance ends. There is no right to convert if coverage ended for failure to pay a required contribution, or if the group coverage was replaced by similar coverage within 31 days. [9] Group policies must also treat statements by applicants, in the absence of fraud, as representations and not warranties. [9]

Federal COBRA generally applies to group health plans of employers with 20 or more employees in the prior year, and a qualified person may have to pay up to 102% of the plan's cost. [10]

Practice questions

1. Which plan type usually limits coverage to providers who work for or contract with the plan, except in emergencies?

A. PPO
B. HMO
C. Indemnity plan
D. Major medical with no network

Answer: B. [2]

2. A PPO member sees a doctor outside the network. What usually happens?

Answer: The care can be covered, but at an additional cost compared with using network providers. [3]

3. What is another name for preauthorization?

Answer: Prior authorization, prior approval or precertification. [5]

4. Without a dependency test, what is the highest age limit a Pennsylvania policy may set for covered children?

Answer: 19. (31 Pa. Code 88.32) [7]

5. Under Pennsylvania group health law, through what age may an eligible unmarried adult child stay covered at the policyholder's option?

Answer: Through age 29, at the employee's expense, if the conditions are met. (Insurance Company Law, section 617.1) [8]

6. An employee's group medical coverage ends on June 30 and she converts on time. When does the converted policy take effect?

Answer: July 1, the day following the end of the group insurance. (Insurance Company Law, section 621.2(d)(4)) [9]

7. An employee with a health savings account changes employers. What happens to the account?

Answer: It stays with the employee. IRS Publication 969 says it "stays with you if you change employers or leave the work force." [6]

8. An employee insured for two years leaves employment. How long do they have to apply and pay for a converted policy?

Answer: Within 31 days after termination, with no evidence of insurability required. (Insurance Company Law, section 621.2(d)) [9]

9. Which employee is not entitled to a converted policy?

A. One whose employment ended in a layoff
B. One whose coverage ended because they did not pay a required contribution
C. One insured for four months
D. One whose employer dropped coverage entirely with no replacement

Answer: B. (section 621.2(d)) [9]

10. Under federal COBRA, what is the most a qualified person may be charged?

Answer: Up to 102% of the cost to the plan. [10]

Study tips for sections 6.0 to 8.0

Practice the full A&H exam with our Pennsylvania accident and health practice test.

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. HealthCare.gov, Health Maintenance Organization (HMO): https://www.healthcare.gov/glossary/health-maintenance-organization-hmo/
  3. HealthCare.gov, Preferred Provider Organization (PPO): https://www.healthcare.gov/glossary/preferred-provider-organization-ppo/
  4. HealthCare.gov, Deductible: https://www.healthcare.gov/glossary/deductible
  5. HealthCare.gov, Preauthorization: https://www.healthcare.gov/glossary/preauthorization/
  6. IRS Publication 969: https://www.irs.gov/publications/p969
  7. 31 Pa. Code 88.32: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter88/s88.32.html&d=reduce
  8. Insurance Company Law of 1921 (Act of May 17, 1921, P.L. 682, No. 284), Section 617.1: https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1921&SessInd=0&ActNum=0284
  9. Insurance Company Law of 1921 (Act of May 17, 1921, P.L. 682, No. 284), Section 621.2: https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1921&SessInd=0&ActNum=0284
  10. U.S. Department of Labor, COBRA continuation coverage: https://www.dol.gov/general/topic/health-plans/cobra

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