Life & Health Insurance Practice Test

Insurance Health Policy Provisions Practice Questions

Health Policy Provisions makes up 5 of every 50 questions on a Tigertest Insurance practice test. Here are 10 of the 20 questions on it, each with the answer and the reason.

Updated 2026-11-10 by the Tigertest team. General portion only, on the NAIC model and standard prelicensing texts. Your state portion is separate.

1. 1. Mary pays her individual health premium monthly, due June 1. She is hospitalized June 8 and has not yet paid. Her policy is:

   • A.In force only for accidents until the premium is paid
   • B.In force, because the grace period is 10 days
   • C.Lapsed, because the grace period for monthly premiums is 7 days
   • D.Lapsed, because no grace period applies to health policies

   Answer: B. Policies with monthly premiums have a 10-day grace period, so coverage continues through June 11 and any unpaid premium can be deducted from a claim. The 7-day grace period applies only to weekly premiums, and 31 days applies to other modes.

2. 2. Jan's lapsed health policy is reinstated on the 45th day after her conditional receipt because the insurer never responded. Coverage for a new sickness begins:

   • A.Immediately on the reinstatement date
   • B.45 days after the reinstatement date
   • C.31 days after the reinstatement date
   • D.10 days after the reinstatement date

   Answer: D. If the insurer issues a conditional receipt and does not disapprove the application, the policy is reinstated on the 45th day. After reinstatement, accidents are covered immediately but sickness only if it begins more than 10 days later, which discourages reinstating after falling ill.

3. 3. Under the uniform provisions, the normal deadlines for notice of claim, the insurer sending claim forms, and the insured filing proof of loss are:

   • A.20 days, 15 days and 90 days
   • B.20 days, 15 days and 60 days
   • C.30 days, 10 days and 180 days
   • D.15 days, 20 days and 90 days

   Answer: A. The insured gives notice within 20 days of the loss, the insurer must furnish claim forms within 15 days of notice, and proof of loss is due within 90 days. If forms are not sent in time, the claimant may submit proof of loss in any written form.

4. 4. A claimant's long-term disability claim is approved for an ongoing disability. Under the time of payment of claims provision, the insurer must pay benefits:

   • A.Quarterly, once the elimination period has ended
   • B.Only after the disability has ended
   • C.At least monthly while the disability continues
   • D.In one lump sum when proof of loss is received

   Answer: C. Benefits are paid immediately on receipt of proof of loss, except that periodic benefits such as disability income are paid at least monthly. A lump sum would defeat the purpose of replacing ongoing income.

5. 5. Dave's medical claim is denied and he wants to sue his insurer. Under the legal actions provision, he may file suit:

   • A.Only after 90 days and within 2 years
   • B.Only after arbitration, with no time limit
   • C.From 60 days to 3 years after proof of loss
   • D.Immediately, but within 1 year of the loss

   Answer: C. The insured must wait 60 days after filing proof of loss, giving the insurer time to investigate, and must sue within 3 years after proof of loss was required. Suing immediately is not allowed under this provision.

6. 6. Three years after issue, an insurer learns that an applicant made an innocent misstatement on her health application. Under the time limit on certain defenses provision, the insurer:

   • A.Cannot void it or deny claims for it
   • B.May cancel the policy with 30 days' notice
   • C.May rescind the policy and refund premiums
   • D.May reduce benefits to match the true facts

   Answer: A. After the policy has been in force 2 years, misstatements in the application, other than fraudulent ones, cannot be used to void the policy or deny a claim. This provision works like the incontestable clause in life insurance.

7. 7. An agent agrees in a letter to waive an exclusion on a client's individual health policy. Under the entire contract provision, the waiver is:

   • A.Valid if the client signs the agent's letter
   • B.Invalid unless the state insurance department approves
   • C.Valid, because the agent represents the insurer
   • D.Invalid unless an executive officer endorses it

   Answer: D. The policy, endorsements and attached application form the entire contract, and only an executive officer of the insurer can approve a change, endorsed on the policy. Agents have no authority to change or waive policy provisions.

8. 8. Which of the following is a mandatory provision under the NAIC Uniform Individual Accident and Sickness Policy Provisions Law?

   • A.Relation of earnings to insurance
   • B.Physical examination and autopsy
   • C.Illegal occupation
   • D.Intoxicants and narcotics

   Answer: B. The insurer may examine a claimant at its own expense while a claim is pending and request an autopsy where law allows, one of 12 mandatory provisions that also include change of beneficiary and payment of claims. Illegal occupation, intoxicants and relation of earnings are optional provisions.

9. 9. A clerk insured under an individual disability policy becomes a commercial roofer without telling the insurer, then is injured on a roof. The insurer will:

   • A.Rescind the policy and refund all premiums
   • B.Pay what the premium buys at the roofer's rate
   • C.Deny the claim for failure to notify it
   • D.Pay the full benefit, then raise future premiums

   Answer: B. Under the change of occupation provision, a move to a more hazardous class reduces benefits to what the premium paid would buy at the new class. A move to a less hazardous occupation instead brings a lower rate and a refund of excess premium.

10. 10. Paul stated his age as 40, but he was 45. He pays $300 a year; the correct premium at 45 is $400. His $2,000 monthly benefit becomes:

    • A.$2,667
    • B.$2,000
    • C.$1,600
    • D.$1,500

    Answer: D. Benefits are adjusted to what the premium paid would have bought at the correct age: $300 / $400 = 75%, and 75% x $2,000 = $1,500. The insurer neither voids the policy nor keeps paying the full benefit.