Pennsylvania accident and health insurance exam outline
Last updated
The Pennsylvania Accident and Health exam is Series 16-02, given by PSI. Its current outline took effect on March 1, 2026. [1][2] Here is every section, what it is worth, and the Pennsylvania rules it points to.
Exam at a glance
- 100 questions in 120 minutes. [2]
- A few unscored questions: the bulletin says a small number (5 to 10) of experimental questions may be added. They are not scored, and their time is included. [1]
- Pass mark: "a minimum score of 70%." [1]
- Fee: $45. [1]
- One change from the old outline: the line "Insurance with other insurers" was dropped, and a typo was fixed. Section weights stayed the same. [3]
Section weights
The exam has 100 questions, so each percentage equals the number of questions. [2]
| Section | Share | Questions |
|---|---|---|
| 1.0 Insurance Regulation | 13% | 13 |
| 2.0 General Insurance Concepts | 10% | 10 |
| 3.0 Accident and Health Insurance Basics | 10% | 10 |
| 4.0 Individual A&H Policy Provisions | 13% | 13 |
| 5.0 Disability Income and Related Insurance | 10% | 10 |
| 6.0 Medical Plans | 14% | 14 |
| 7.0 Group Health Insurance | 9% | 9 |
| 8.0 Dental Insurance | 2% | 2 |
| 9.0 Health Insurance for Senior Citizens and Special Needs Individuals | 14% | 14 |
| 10.0 Federal Tax Considerations for Health Insurance | 5% | 5 |
Medical plans and senior coverage tie for the biggest share at 14 each. Dental is only 2.
1.0 and 2.0: regulation and general concepts (23 questions)
Section 1.0 is the same licensing and unfair practices list as the Life exam (40 P.S. 310.x, 1171.5, 473, 625, Ch. 81 and the federal rules), plus one item the Life exam does not have: the Affordable Care Act. [2] Section 2.0 covers risk, types of insurers, contract elements, producer authority and legal ideas like indemnity and concealment. [2]
3.0 Accident and Health Basics (10 questions)
- Advertising (31 Pa. Code Ch. 51) and the outline of coverage (40 P.S. 991.1111; 31 Pa. Code 88.181). [2]
- Field and company underwriting, including the delivery receipt requirement (40 P.S. 625.4).
- Types of losses and limited policies: accidental death and dismemberment, hospital indemnity, critical illness, vision, hearing and dental.
- Common exclusions (31 Pa. Code 88.84) and pre-existing conditions (88.51; 89.402).
- Replacing health coverage, including Pennsylvania's replacement rules (31 Pa. Code 88.101 to 88.103).
4.0 Individual Policy Provisions (13 questions)
The required provisions under 40 P.S. 753(A) and the optional ones under 753(B), plus free look, insuring and consideration clauses, renewability, coinsurance, and probationary and elimination periods. [2] Some Pennsylvania wording worth knowing:
- Time limit on certain defenses: Pennsylvania's required wording uses three years from the date of issue. [4]
- Grace period: not less than 7 days for weekly premium policies, 10 for monthly, and 31 for all others. [4]
- Notice of claim: within twenty days of the loss, or as soon after as reasonably possible. [4]
- Claim forms: if the insurer does not send them within fifteen days, the claimant can file written proof without them. [4]
- Proof of loss: within ninety days, and except for lack of legal capacity, no later than one year. [4]
- Legal actions: no suit until sixty days after proof of loss, and none after three years. [4]
- Free look: the "Notice of Insured's Right to Examine Policy for Ten Days" goes on the face of the policy. [5]
5.0 Disability Income (10 questions)
Definitions of total (own occupation and any occupation), partial (31 Pa. Code 88.138), residual (88.139), presumptive and recurrent disability; riders; the relation of earnings to insurance (753(B)(6)); Pennsylvania minimum benefit standards (88.167); group short and long term disability; business coverage like key employee, disability buy-sell and overhead expense; and Social Security disability. [2]
6.0 Medical Plans (14 questions)
Plan types (basic, major medical, HMO, PPO, POS), cost containment, HIPAA, and a long list of Pennsylvania mandated benefits: [2]
- Postpartum coverage, routine pap smears and annual gynecological exams
- Alcohol abuse and dependency treatment, serious mental illness, and mental health parity
- Cancer therapy, mammography, and orally given chemotherapy (Act 73 of 2016)
- Childhood immunizations and medical foods
- Dependent child age limit, adopted children, newborns, and children with disabilities
Newborn coverage in the law's own terms: it applies from the moment of birth, and if a specific premium is required, the policy may require notice of the birth and the premium within 31 days for coverage to continue past that point. [6]
7.0 and 8.0: group and dental (11 questions)
Group contracts and certificates, eligible groups, contributory versus noncontributory plans, pre-existing conditions under group plans (31 Pa. Code 89.402 to 89.406), conversion, coordination of benefits and COBRA. Dental covers treatment categories, scheduled versus nonscheduled plans, and predetermination of benefits. [2]
9.0 Senior Citizens and Special Needs (14 questions)
- Medicare Parts A, B, C and D, and Medicare Select. [2]
- Medicare supplement: open enrollment (31 Pa. Code 89.778), standardized plans, marketing, advertising, suitability, replacement, minimum benefits, disclosure, compensation and guaranteed issue. Under 89.778, the open enrollment window is the 6 months starting with the first day of the first month a person is enrolled in Medicare Part B. [7]
- Long-term care: levels and types of care, partnership coverage, and Pennsylvania's LTC rules on outline of coverage, free look, pre-existing conditions, lapse, inflation protection, nonforfeiture, benefit triggers, suitability and the shopper's guide. LTC buyers get 30 days to return the policy for a premium refund. [2][8]
- Medicaid and employer group plans.
10.0 Federal Tax (5 questions)
How premiums and benefits are taxed for individual, group, disability, medical and long-term care coverage, and health savings accounts, HRAs and FSAs. [2]
FAQ
How many questions is the PA accident and health exam?
100 scored questions in 120 minutes, plus 5 to 10 unscored experimental ones. [1][2]
What is the passing score?
70%. [1]
Is Medicare a big part of it?
Section 9.0, which covers Medicare, Medicare supplement, long-term care and Medicaid, is 14% of the exam. [2]
Work through the free Pennsylvania Accident and Health practice test.
Prep Retention is independent and is not affiliated with PSI or the state.
Sources
- PSI, Pennsylvania Insurance Candidate Information Bulletin (effective 1/22/2026): https://test-takers.psiexams.com/api/content/bulletin/7282
- PSI, Pennsylvania Accident and Health outline, Series 16-02 (effective 3/1/2026): https://proctor2.psionline.com/media/programs/PAINS/16-02xx.pdf
- PSI bulletin, links to the outline in effect through 2/29/2026 and the current outline: same URL as source 1
- Insurance Company Law of 1921 (Act of May 17, 1921, P.L. 682, No. 284), Section 618 (policy provisions; codified at 40 P.S. 753), PA General Assembly: https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1921&SessInd=0&ActNum=0284
- 31 Pa. Code 89.73: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter89/s89.73.html&d=reduce
- Act of Aug. 1, 1975, P.L. 157, No. 81 (newborn children coverage), Sections 1 and 3, PA General Assembly: https://www.palegis.us/statutes/unconsolidated/law-information/view-statute?iFrame=true&txtType=HTM&SessYr=1975&SessInd=0&ActNum=0081
- 31 Pa. Code 89.778: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/031/chapter89/s89.778.html&d=reduce
- Insurance Company Law of 1921, Section 1110 (long-term care right to return): same URL as source 4