17 Free South Carolina Accident & Health Exam Practice Questions (2026)

Answer: B

A Key Employee policy is designed to protect a business from the financial loss incurred when a crucial employee, like a lead engineer, becomes disabled. The benefits are paid to the business to help cover expenses such as finding and training a replacement, or the loss of revenue. An Individual Disability Income policy benefits Alex personally. A Business Overhead Expense policy covers the business's operating costs. A Group Disability Income policy provides income replacement for employees generally, not specifically for the business's loss due to a key person's absence.

Answer: D

A Health Maintenance Organization (HMO) emphasizes preventive care and requires members to choose a Primary Care Physician (PCP) within the network. Referrals from the PCP are necessary to see specialists, and out-of-network care is typically not covered. PPOs offer more flexibility with out-of-network care at a higher cost, and POS plans combine elements of both. A Major Medical policy is a traditional indemnity plan with deductibles and coinsurance, not a managed care model requiring PCPs and referrals.

Answer: A

A Long Term Care (LTC) policy provides coverage for custodial care, skilled nursing care, or intermediate care, typically triggered when an individual cannot perform a certain number of Activities of Daily Living (ADLs) or has a cognitive impairment. Medicare Supplement policies fill gaps in Medicare. Short-Term Medical policies are temporary health insurance. Hospital Indemnity policies pay a fixed benefit during hospitalization, not for long-term care services.

Answer: A

A Short-Term Medical policy is designed to provide temporary health coverage for individuals who are between jobs, waiting for new employer benefits, or other temporary coverage needs. These plans typically have lower premiums but often do not cover pre-existing conditions and have more limited benefits than comprehensive major medical plans. Major Medical policies are long-term, comprehensive plans. Medicare Supplement policies are for those on Medicare. Long Term Care policies cover extended care needs.

Answer: B

B is correct. The any-occupation definition treats the insured as totally disabled only when unable to work in any occupation for which they are reasonably suited by education, training or experience. It is the stricter standard and the one group disability plans commonly use. A (own-occupation) applies when the insured cannot perform the duties of their own job. C describes a hybrid that starts as own-occupation and switches to any-occupation after a set period, which the plan here does not do. D is not the name of a standard definition.

Answer: D

A waiver of premium rider in an accident and sickness policy typically waives the payment of future premiums after the insured has been continuously disabled for a specified waiting period, commonly 6 months. It does not waive deductibles (that is related to medical expense policies), allow benefit increases (that is a guaranteed insurability or future increase option rider), or pay an income benefit (that is the core disability benefit or an income rider). Option A confuses the rider with medical expense cost-sharing. Option B describes a future increase option or guaranteed insurability rider. Option C describes a disability income benefit, not the waiver of premium rider itself.

Answer: B

This clause is an illegal occupation exclusion, which denies benefits if the injury occurs while the insured is engaged in an illegal occupation (such as committing a felony). An elimination period is the time between the onset of disability and when benefits begin. Relation of earnings to insurance limits the benefit amount based on the insured's income to prevent overinsurance. A probationary period is a time at the start of the policy during which certain coverages (like sickness) are not effective. Options A, C, and D do not describe an exclusion for illegal acts.

Answer: D

Individuals receiving Social Security Disability Insurance (SSDI) benefits become eligible for Medicare after a 24-month waiting period. This waiting period begins from the date they are entitled to receive SSDI benefits. Options A, B, and C are incorrect as they do not match the 24-month Medicare eligibility rule for SSDI recipients.

Answer: A

A is correct because Medicare Part D covers prescription drugs. B is incorrect as Part A covers inpatient hospital stays. C is incorrect as Part B covers physician services and outpatient care. D is incorrect as Part C is Medicare Advantage, which may include drug coverage but is not the standalone part for drugs.

Answer: B

The 'Free Look' provision (also known as the Right to Examine Policy) grants the policyholder a specific period (typically 10 days for most health policies, but 30 days for Medicare supplements in South Carolina) after receiving the policy to review its terms. If dissatisfied for any reason, the policyholder can return the policy for a full refund of premiums paid. This provision is designed to protect consumers and ensure they understand what they are purchasing.

Answer: B

The Social Security program provides a safety net primarily through retirement benefits, survivors' benefits, and disability benefits (SSDI) to eligible workers and their families. It does NOT typically provide long-term care benefits for extended nursing home stays. Long-term care is generally covered by private long-term care insurance or Medicaid for those who qualify based on income and asset limits.

Answer: D

Nonduplication of benefits (often part of coordination of benefits) prevents the insured from profiting by ensuring that combined payments from all applicable insurance policies do not exceed 100% of the actual, allowable medical expenses incurred. Option A describes the opposite of nonduplication. Option B describes the determination of primary vs. secondary payer, which is a separate step in coordination. Option C is incorrect; subrogation addresses third-party liability and is unrelated to nonduplication between multiple health policies.

Answer: B

HMOs are characterized by a gatekeeper model where enrollees must select a primary care physician (PCP) who coordinates care and provides referrals for specialist visits. This helps manage utilization and costs. Option A describes a PPO or POS plan feature. Option C is inaccurate; HMOs often have lower premiums but may have higher costs for out-of-network care (which is often not covered). Option D is false; HMOs typically require pre-authorization for many services, especially specialist care and procedures.

Answer: A

Aleatory means the performance of the contract depends on an uncertain event. In accident and sickness insurance, the insurer’s obligation to pay benefits is triggered only if the insured becomes sick or injured—an event that may or may not occur. This uncertainty is fundamental to insurance. Option B describes a unilateral contract (only insurer can promise performance; insured’s only duty is to pay premiums). Option C refers to the statute of frauds requirement, not aleatory. Option D describes the burden of proof, which is procedural, not a defining characteristic of aleatory contracts.

Answer: C

Correct answer is C. South Carolina follows the 'made whole' doctrine for subrogation in health insurance: the insured must be fully compensated (made whole) for their total damages before the insurer can exercise its subrogation right. Since the $120,000 settlement covers medical expenses, lost wages, and pain and suffering, and there is no indication the insured has been made whole, the insurer's subrogation right is subordinate. Option A is incorrect — South Carolina does not allow full recovery regardless of the made whole doctrine. Option B is incorrect — the allocation in the settlement does not override the made whole doctrine. Option D is incorrect — the right depends on the made whole doctrine, not settlement language.

Answer: D

D is correct. South Carolina's long-term care regulation follows the NAIC model: insurers must offer inflation protection to every applicant, who may reject it in writing. A is wrong because a nonforfeiture benefit must be offered but is not a required return-of-premium feature. B is wrong because the regulation does not fix a 30-day waiver-of-premium trigger. C is wrong because long-term care premiums are not guaranteed never to increase; rate increases are regulated, not prohibited.

Answer: A

During the Medicare supplement initial open enrollment period (which begins when a person is both 65 or older and enrolled in Medicare Part B), South Carolina Regulation 69-46 guarantees the right to purchase any Medicare supplement plan (B through N) offered by insurers in the state, without medical underwriting or denial based on pre-existing conditions. This is a key consumer protection. Option B is incorrect because pre-existing condition exclusions do not apply during open enrollment. Option C is false; the open enrollment period starts at Part B enrollment, not after a waiting period. Option D is incorrect; applicants are not limited to Plan A and may choose any standardized plan.