17 Free Utah Accident & Health Exam Practice Questions (2026)
How to Use This Health Question Set
Utah tests accident and health insurance either inside the combined Life, Accident and Health Producer exam (Series 17-03) alongside life material, or on its own in the single-line Accident and Health Producer exam (Series 17-02). The Accident and Health Producer exam on its own carries 100 items in 2 hours, for $32 per attempt; the combined exam runs 150 items in 2.5 hours for $44. Either way, there's no pre-licensing course required, both versions are delivered by Prometric, at a Prometric test center or through its ProProctor remote-proctoring option, and Prometric's current Utah bulletin does not publish a flat passing-score percentage at all.
Prometric's Series 17-03 content outline gives accident and health material eight sections of its own, printed as percentages of the combined exam's 150 items: Accident and Health Insurance Basics (12%), Disability Income and Related Insurance (2%), Medical Plans (10%), Group Accident and Health Insurance (10%), Dental Insurance (1%), Medicare (4%), Long-Term Care Insurance (4%), and Federal Tax Considerations for Accident and Health Insurance (2%) — 45% of the combined exam between them, a larger share than the life side carries. Utah's own single-line Accident and Health Producer outline (Series 17-02) sums these sections, plus Utah law and general insurance concepts, to its own 100-item total across 10 sections, with no rounding ambiguity (7+5+30+2+18+21+2+6+7+2=100).
These 17 questions come from Chapters 5 through 8 of LanePrep's Utah Life and Accident & Health quiz bank, none of them repeated from the free 25-question sample across the whole exam: 5 on accident and health basics and disability income (Chapter 5), 4 on medical plans (Chapter 6), 4 on group accident and health and dental insurance (Chapter 7), and 4 on Medicare, long-term care and federal tax (Chapter 8). Each question shows its chapter, so a miss tells you exactly which audio lesson to replay.
Work them before you read the answer. Every question has the explanation folded underneath it. Guessing and then reading is worth more than reading and then agreeing.
Practice Questions 1-5: Accident and Health Basics and Disability Income
Chapter 5 opens the accident and health section with the line between an accident-only policy and one that also covers sickness, how private disability benefits get offset against Social Security Disability Insurance to avoid overinsurance, why an employer-paid group long-term disability benefit is taxable to the employee who receives it, the five-month wait built into SSDI itself, and how a residual disability benefit is triggered once income loss clears its threshold. These five cover the basics-and-disability-income section almost whole.
Question 1 (Chapter 5)
A Utah resident purchases an accident-only policy that provides a $200 daily benefit for hospitalization. After being hospitalized for three days due to pneumonia, the insured submits a claim. The insurer denies the claim. What is the most likely basis for the denial?
- A) The insured did not meet the policy's elimination period.
- B) Hospital indemnity benefits are only payable for accidental injuries, not sickness.
- C) The insured failed to provide proof of loss within the required time frame.
- D) The policy excludes coverage for illnesses such as pneumonia.
Show answer & explanation
Answer: D
Accident-only policies, as defined under Utah Administrative Rule R590-126, provide coverage solely for losses resulting from accidental bodily injury and explicitly exclude sickness. Pneumonia is an illness, not an accidental injury, so the denial is correct. Option A is incorrect because accident-only hospital indemnity policies typically do not have an elimination period; benefits are payable from the first day of hospitalization. Option B misstates the coverage: while accident-only policies do not cover sickness, the denial is based on the peril (sickness) not being covered, not because hospital indemnity benefits are inherently limited to accidents (though in this case they are). Option C is irrelevant to the denial reason given the scenario.
Question 2 (Chapter 5)
A Utah resident becomes disabled and begins receiving Social Security Disability Insurance (SSDI) benefits. They also have a private disability income policy that provides a monthly benefit. How are these benefits typically coordinated?
- A) The private disability benefit is reduced by the amount of SSDI received, so the insured receives the greater of the two amounts.
- B) The private disability benefit is often offset by SSDI benefits, meaning the private insurer subtracts the SSDI amount from its payment to avoid overinsurance.
- C) The private disability benefit is paid in full, and SSDI benefits are reduced dollar-for-dollar by the private benefit amount.
- D) SSDI and private disability benefits are always additive, with no offset between the two programs.
Show answer & explanation
Answer: B
Most private disability income policies include an offset provision that reduces the private benefit by the amount received from Social Security Disability Insurance (SSDI) or other government disability programs. This prevents the insured from receiving more in disability benefits than their pre-disability earnings, avoiding overinsurance. Option A incorrectly states the private benefit is reduced to the greater of the two; it is reduced by the SSDI amount, not set to the maximum. Option C reverses the offset direction; SSDI is not reduced by private benefits. Option D is incorrect because offsets are common and designed to coordinate benefits, not allow unlimited stacking.
Question 3 (Chapter 5)
Under Utah Administrative Rule R590-126, which of the following is a required uniform provision in individual accident and health policies regarding the time limit on certain defenses?
- A) The insurer may contest the validity of the policy after two years from the date of issue for non-payment of premiums only.
- B) The insurer has up to three years to assert a defense based on misrepresentation in the application.
- C) The incontestability period does not apply if the insured commits fraud during the claim process.
- D) After the policy has been in force for two years during the insured's lifetime, the insurer shall have no right to contest the policy for any cause whatsoever, except non-payment of premiums.
Show answer & explanation
Answer: D
R590-126 adopts the NAIC model provision for incontestability, which states that after two years of the policy being in force during the insured's lifetime, the insurer cannot contest the policy for any reason except non-payment of premiums. Option A is incorrect because the incontestability period applies broadly, not just to non-payment of premiums, and the time frame is two years, not two years only for non-payment. Option B is incorrect as the defense period is limited to two years, not three. Option C misstates the law: fraud in a claim does not revive the incontestability period; the two-year period is based on the policy's duration, not claim conduct.
Question 4 (Chapter 5)
Which statement accurately describes the five-month waiting period for Social Security Disability Insurance (SSDI) benefits?
- A) Benefits begin immediately upon approval, but the first five months are paid at a reduced rate.
- B) The waiting period applies only to Supplemental Security Income (SSI), not to SSDI.
- C) SSDI benefits are payable for the first five months of disability, after which a new application is required.
- D) The five-month waiting period starts on the date the disability begins and must be completed before any SSDI benefits are payable.
Show answer & explanation
Answer: D
For SSDI, there is a five-month full calendar month waiting period that begins with the first full month after the onset of disability. No SSDI benefits are payable for any month during this waiting period. Benefits start with the sixth full month of disability. Option A is incorrect because benefits are not paid at all during the waiting period, not at a reduced rate. Option B is incorrect; the five-month waiting period applies to SSDI, not SSI (which has no such waiting period). Option C reverses the rule; benefits are not paid for the first five months and then stopped—they begin after the waiting period ends.
Question 5 (Chapter 5)
A Utah resident has an individual disability income policy with a benefit amount set at 60% of their pre-disability earnings. They become disabled and can work part-time, earning 40% of their pre-disability income. Assuming the policy includes a residual disability provision with a 20% income loss threshold, what is the most likely outcome?
- A) No benefit is payable because the insured is still working and earning income.
- B) Full disability benefit is payable because the insured cannot perform their regular occupation.
- C) A residual disability benefit is payable, calculated to replace a portion of the lost income.
- D) The benefit is reduced by 50% due to the income earned from part-time work.
Show answer & explanation
Answer: C
The insured's income loss is 60% (100% - 40% = 60%), which exceeds the 20% threshold for residual disability benefits. Therefore, a residual (partial) disability benefit is payable, typically calculated to replace a proportion of the lost income (e.g., 60% of the full benefit, or as defined by the policy's formula). Option A is incorrect because residual benefits are designed for those who are working but with reduced income. Option B is incorrect because the insured is not totally disabled (they are working part-time). Option D incorrectly applies a reduction based on earned income; while some policies may have offsets, the standard residual benefit is not a simple dollar-for-dollar reduction but is based on the income loss percentage and threshold.
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Practice Questions 6-9: Medical Plans and Federal Health Reform
Chapter 6 moves into medical plan structure and the federal rules layered on top of it: the ACA's flat ban on annual dollar limits for essential health benefits, the law that actually requires guaranteed issue in Utah's individual market, how a POS plan handles an out-of-network specialist visit taken without a referral, and why Utah's old HIPUtah high-risk pool stopped being most residents' coverage option once ACA guaranteed issue took effect. These four move through managed care and federal health reform together.
Question 6 (Chapter 6)
A Utah individual health insurance policy issued in 2024 includes a $2,000 annual dollar limit on essential health benefits. The insured is diagnosed with a serious illness and reaches this limit in July. Under the Affordable Care Act (ACA) as applied in Utah, what is the insurer's obligation for the remainder of the year?
- A) The insurer may impose the annual limit but must offer a rider to increase it for an additional premium
- B) The insurer must cover essential health benefits up to a higher ACA-defined annual limit ($5,000 for 2024)
- C) The insurer can deny further essential health benefit claims until the next policy year begins
- D) The insurer must continue covering essential health benefits without any annual dollar limit
Show answer & explanation
Answer: D
D is correct: The ACA prohibits annual dollar limits on essential health benefits for plan years beginning on or after January 1, 2014. A $2,000 annual limit on EHBs violates federal law; the insurer must cover EHBs without any annual dollar limit. A is incorrect because the ACA ban cannot be circumvented by offering a rider. B is incorrect because there is no ACA-defined higher annual limit—the ban is absolute. C is incorrect because denying claims based on a prohibited limit is unlawful.
Question 7 (Chapter 6)
A Utah resident with a pre-existing condition applies for individual health insurance coverage. The insurer reviews the application and notes the condition but issues the policy at standard rates without any exclusion rider or waiting period. Which law primarily requires this guaranteed issue protection in Utah's individual market?
- A) The Affordable Care Act (ACA) guaranteed issue provisions
- B) HIPAA portability provisions for individual market coverage
- C) Utah's HIPUtah high-risk pool statute (31A-29-101–123)
- D) Utah Insurance Code § 31A-22-605 (individual policy provisions)
Show answer & explanation
Answer: A
A is correct: The ACA's guaranteed issue requirement (effective 2014) prohibits insurers from denying coverage or charging higher premiums based on health status in the individual market. B is incorrect because HIPAA's portability provisions primarily addressed group-to-group and group-to-individual portability with limited individual market protections; the ACA superseded and expanded these. C is incorrect because HIPUtah was Utah's high-risk pool mechanism for otherwise-uninsurable individuals, largely supplanted by ACA guaranteed issue. D is incorrect because § 31A-22-605 addresses standard policy provisions, not guaranteed issue.
Question 8 (Chapter 6)
A Utah resident is enrolled in a POS (Point-of-Service) plan. They visit an out-of-network specialist without a referral from their primary care physician. How will the plan typically process this claim compared to an in-network referral visit?
- A) The plan will deny the claim entirely because POS plans require referrals for all specialist visits, in-network or out-of-network
- B) The plan will cover the visit at the same cost-sharing level as an in-network referral visit because POS plans treat all specialists equally
- C) The plan will cover the visit only if the specialist agrees to accept the plan's allowed amount as payment in full
- D) The plan will cover the visit but apply higher out-of-network cost-sharing (deductible, coinsurance) and may apply balance billing
Show answer & explanation
Answer: D
D is correct: POS plans blend HMO and PPO features. They require a PCP and referrals for in-network specialist visits (HMO-like), but allow out-of-network access with higher cost-sharing and potential balance billing (PPO-like). A is incorrect because POS plans do permit out-of-network care, unlike strict HMOs. B is incorrect because out-of-network care always carries higher cost-sharing in a POS plan. C is incorrect because out-of-network providers are not contractually bound to accept the allowed amount; balance billing is permitted unless prohibited by state/federal law (e.g., No Surprises Act for emergencies).
Question 9 (Chapter 6)
A Utah resident is covered under a group health plan that is subject to HIPAA's privacy rule. The resident's employer requests a copy of the employee's detailed medical claims history from the health plan to evaluate a workplace accommodation request. Under HIPAA, may the health plan disclose this information to the employer without the employee's authorization?
- A) No, the health plan may not disclose protected health information to the employer without the individual's written authorization, except for limited summary data
- B) Yes, because the employer is the plan sponsor and has a right to access all plan data
- C) Yes, but only if the employer certifies the information is needed for plan administration functions
- D) No, but the employer may obtain the information directly from the employee's treating physician with a signed release
Show answer & explanation
Answer: A
A is correct: HIPAA's privacy rule strictly limits a group health plan's disclosure of protected health information (PHI) to the plan sponsor (employer). The plan may only disclose summary information (e.g., enrollment counts, aggregate claims data) without authorization. Detailed claims history is PHI and requires the individual's written authorization. B is incorrect because plan sponsorship does not grant unlimited PHI access. C is incorrect because even plan administration functions do not permit disclosure of individual-level PHI without authorization or a qualified firewall certification. D is incorrect because it describes a separate disclosure from the physician, not the health plan's obligations.
Practice Questions 10-17: Group Insurance, Dental, Medicare and Long-Term Care
Chapter 7 covers group insurance structure: the certificate of insurance a group member holds as proof of coverage under the sponsor's master contract, the one rating practice Utah's small-group rules flatly prohibit, the labor union group that sponsors coverage across multiple employers, and the difference between a scheduled dental reimbursement and a usual-customary-and-reasonable one. Chapter 8 then closes the outline with four federal-program and tax questions: the six-month window that guarantees Medigap issue, the ADL-and-cognitive-impairment trigger a tax-qualified long-term care policy must use, the above-the-line deduction a self-employed producer's own client can claim for health premiums, and why an employer-paid disability benefit is taxable while an individually-paid one is not. These eight close out the course.
Question 10 (Chapter 7)
Under Utah law, what document is issued to each member of a group health plan as individual proof of coverage under the master contract held by the group sponsor?
- A) Master policy
- B) Certificate of insurance
- C) Group application
- D) Summary of benefits and coverage
Show answer & explanation
Answer: B
Under Utah Code Section 31A-22-501, a master contract is issued to the group sponsor (e.g., employer), and each member receives an individual certificate of insurance as proof of coverage. The master policy (A) is held by the sponsor, not issued to individuals. The group application (C) is used to obtain coverage but is not proof of insurance. The summary of benefits and coverage (D) is a disclosure document required under federal law but does not serve as the legal certificate of insurance under Utah statute.
Question 11 (Chapter 7)
Under Utah's small employer group health insurance regulations, which of the following rating practices is prohibited for groups of 2–50 employees?
- A) Adjusting premiums based on the group's claims experience
- B) Using age as a factor in premium calculation
- C) Setting premiums based on the group's industry classification
- D) Varying premiums based on the health status or medical conditions of group members
Show answer & explanation
Answer: D
For small employer groups (2–50 employees) in Utah, health status-based rating is prohibited under state and federal law (including HIPAA and the ACA). Premiums cannot vary based on the medical conditions or health status of group members. Experience rating (A) is permitted within federal limits, age rating (B) is allowed with restrictions, industry classification (C) may be used in some rating models, and uniform rates (E) are permissible but not required. Only health status-based variation is explicitly prohibited.
Question 12 (Chapter 7)
A Utah labor union sponsors a group health plan for its members who work for multiple employers in the construction industry. What type of eligible group does this represent under Utah insurance law?
- A) Employer-employee group
- B) Trust group
- C) Association group
- D) Labor union group
Show answer & explanation
Answer: D
A group sponsored by a labor union to provide benefits to its members, regardless of which employer they work for, is classified as a labor union group under Utah insurance regulations. This is distinct from employer-employee groups (tied to a single employer), trust groups (formed by employers), and association groups (typically professional or trade associations). The scenario specifically describes a union as the sponsor, making D the correct choice.
Question 13 (Chapter 7)
Which of the following statements about dental insurance reimbursement methods is accurate under typical Utah group dental plans?
- A) Scheduled reimbursement lists a maximum allowable fee for each dental procedure
- B) Scheduled reimbursement plans pay based on the actual charge submitted by the dentist
- C) UCR (usual, customary, and reasonable) reimbursement uses a fixed dollar amount for each procedure regardless of geographic location
- D) UCR reimbursement is always lower than the scheduled amount for the same procedure
Show answer & explanation
Answer: A
In scheduled reimbursement dental plans, the plan establishes a fixed schedule of maximum allowable fees for each procedure, and reimbursement is based on that schedule, not the actual charge. UCR (C) varies by geographic location and dentist's charge, not a fixed amount. Option B describes actual charge reimbursement, which is not used in scheduled plans. Option D is incorrect because UCR can be higher, lower, or equal to scheduled amounts depending on the plan's schedule and local costs; it is not inherently lower.
Question 14 (Chapter 8)
A 68-year-old Utah resident is enrolled in Original Medicare Part A and Part B. She is considering purchasing a Medicare Supplement (Medigap) policy to help cover out-of-pocket costs. During which period does she have a guaranteed-issue right to buy any Medigap policy sold in Utah without medical underwriting?
- A) During the annual Medicare Open Enrollment Period (October 15–December 7)
- B) During the General Enrollment Period for Medicare Part B (January 1–March 31)
- C) During the Special Enrollment Period for losing employer group health coverage
- D) During the six-month period that begins the month she is both 65 or older and enrolled in Medicare Part B
Show answer & explanation
Answer: D
D is correct because the Medigap Open Enrollment Period is a six-month window that starts the month a person is both 65 or older and enrolled in Medicare Part B. During this period, insurers must use guaranteed-issue rights, meaning they cannot deny coverage or charge more based on health status. A is incorrect because the annual Medicare Open Enrollment Period is for changing Medicare Advantage or Part D plans, not for Medigap guaranteed-issue rights. B is incorrect because the General Enrollment Period is for signing up for Part B if missed initially, not for Medigap protections. C is incorrect because losing employer coverage triggers a different Special Enrollment Period for Medicare, not the Medigap Open Enrollment Period; while it may provide a guaranteed-issue right for Medigap under certain circumstances, it is not the initial guaranteed-issue period tied to Part B enrollment.
Question 15 (Chapter 8)
A Utah resident purchases a tax-qualified long-term care (LTC) insurance policy. Which of the following is a requirement for benefits to be payable under this type of policy under federal tax law?
- A) The policyholder must be unable to perform at least two activities of daily living (ADLs) for a period of 90 days or more.
- B) The policyholder must be confined to a nursing home for at least 60 days to trigger benefits.
- C) The policyholder must have paid premiums for at least 5 years before becoming eligible for benefits.
- D) The policyholder must be certified by a licensed healthcare practitioner as unable to perform at least two ADLs for at least 90 days, or require substantial supervision due to severe cognitive impairment.
Show answer & explanation
Answer: D
D is correct because, under federal law for tax-qualified LTC contracts, benefits are triggerable only when the policyholder is certified by a licensed healthcare practitioner as (1) unable to perform at least two activities of daily living (ADLs) for at least 90 days, or (2) requiring substantial supervision due to severe cognitive impairment (such as Alzheimer's disease). A is incorrect because it omits the requirement for certification by a healthcare practitioner and the cognitive impairment alternative. B is incorrect because confinement to a nursing home is not required; benefits can be paid for care in various settings, including home health or assisted living. C is incorrect because there is no federal requirement for a minimum premium payment period before benefits become eligible under tax-qualified LTC policies.
Question 16 (Chapter 8)
A Utah resident who is self-employed as a sole proprietor pays $4,800 annually for her own health insurance premiums. How does she typically treat these premiums for federal income tax purposes?
- A) She can deduct the premiums as an adjustment to income on Form 1040, regardless of whether she itemizes deductions.
- B) She can deduct the premiums as an itemized medical expense on Schedule A, subject to the 7.5% of adjusted gross income floor.
- C) She cannot deduct the premiums at all because she is not incorporated.
- D) She must treat the premiums as a business expense on Schedule C, which reduces her self-employment tax liability.
Show answer & explanation
Answer: A
A is correct because self-employed individuals, including sole proprietors and partners, may deduct 100% of their health insurance premiums as an adjustment to income on Form 1040 (line 16 of Schedule 1), which reduces adjusted gross income and is available whether or not they itemize deductions. B is incorrect because while medical expenses can be itemized, the self-employed health insurance deduction is specifically an above-the-line adjustment, not subject to the 7.5% AGI floor for itemized medical expenses. C is incorrect because self-employed individuals are eligible for this deduction. D is incorrect because, although the premiums are related to the business, they are deducted as an adjustment to income on Form 1040, not as a business expense on Schedule C; deducting them on Schedule C would not reduce self-employment tax liability, as the adjustment to income approach does.
Question 17 (Chapter 8)
A Utah resident who is an employee has disability insurance coverage where her employer pays the entire premium. If she becomes disabled and begins receiving monthly benefit payments, how are these benefits treated for federal income tax purposes?
- A) The benefits are completely tax-free because disability insurance benefits are always tax-free.
- B) The benefits are tax-free because she did not pay the premiums herself.
- C) The benefits are partially taxable based on the ratio of employer-paid to employee-paid premiums.
- D) The benefits are taxable as ordinary income because the employer paid the premiums.
Show answer & explanation
Answer: D
D is correct because when an employer pays the premiums for disability insurance, any disability benefits received by the employee are generally taxable as ordinary income for federal income tax purposes. A and B are incorrect because the taxability of disability benefits depends on who paid the premiums—employer-paid premiums result in taxable benefits. C is incorrect because there is no partial taxation based on a ratio; the benefits are fully taxable when the employer pays 100% of the premiums.
The Accident & Health Mistakes That Cost Marks
Assuming a Life and Accident & Health producer must sit the combined exam. Utah lets a candidate choose either the combined Series 17-03 exam or the single-line Series 17-02 Accident and Health Producer exam — the single-line exam costs less per attempt and tests only the accident-and-health-specific content.
Treating HIPUtah as Utah's current coverage option for hard-to-insure residents. HIPUtah was Utah's high-risk pool before the ACA's guaranteed issue requirement took effect in 2014; most enrollees have since moved to individual market plans that can no longer turn them away or charge more for a pre-existing condition.
Assuming every disability benefit is taxed the same way. Who pays the premium decides who pays the tax — an employer-paid group disability benefit is taxable income to the employee, while an individually-paid policy's benefit is not, because the premium was never deducted or excluded in the first place.
Confusing a scheduled dental plan with a UCR plan. A scheduled plan reimburses a fixed maximum fee per procedure regardless of what the dentist actually charged; a usual-customary-and-reasonable plan reimburses a percentage of what's typical for the procedure in that area, and the two can produce very different payouts for the same bill.
Reading 'no pre-licensing course required' as 'no preparation required.' Utah has never required one, but the Accident and Health exam's first-time pass rate was under two-thirds in 2024. Skipping a course does not mean the material is easy.
Your Next Step
How did you score?
Prometric's current Utah bulletin does not publish a flat passing-score percentage, so there is no honest X-out-of-17 threshold to anchor to here. What these questions can tell you is where you stand across Utah accident and health law, medical plans, group coverage and the federal programs — not whether you'd clear the real cutoff.
13 or more correct: You're clearing most of the accident-and-health-specific outline. Book the Accident and Health Producer exam on its own, or the combined Life, Accident and Health exam if you're also sitting for the Life line, then read how to pass the Utah Life & Accident and Health exam on the first try for the full study plan.
9-12 correct: You're in reasonable shape but not comfortable. Note which chapter your misses fell in and re-listen to that chapter's audio lesson before retesting.
Under 9 correct: The Accident and Health exam's first-time pass rate ran 65.5% in 2024 and 76.8% in 2025 (NAIC compiled) — the highest pass rate of the three exam versions on paper, but still nearly a quarter of first-time candidates did not clear it in 2025. Start with Chapter 5 of the course and work forward rather than testing yourself again right away.
For a 25-question sample across the whole exam, see the free practice set; for the life side, see the Life question set. Chapters 1 and 9 of the LanePrep Utah course are free at /ut/l-and-h/preview — full audio and the chapter quiz, no signup. For the full cost picture, see how much a Utah Life & Accident and Health license costs.
Exam structure and fees from Prometric's Utah Insurance Department Licensing Information Bulletin (effective September 25, 2025). Content outline weights from Prometric's Series 17-03 and Series 17-02 Utah Producer content outlines (effective January 1, 2020), for the accident and health sections. Pass rates from the NAIC 2024 and 2025 compiled pass-rate reports. Utah's passing score is not published in the Bulletin and is not stated here. Read October 2026.
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