17 Free Missouri Life & Health Practice Questions: Other Concepts, Field Underwriting and Missouri A&H Law (2026)
How to Use This Set
This set covers other insurance concepts and field underwriting procedures, together with Missouri laws pertinent to Accident and Health insurance only. On the Accident and Health single-line outline, Other Insurance Concepts carries 5 items, Field Underwriting Procedures 8, and the Missouri-specific block for the line 20. On the combined exam the Missouri block for Accident and Health only carries 15.
The Missouri block cites RSMo Chapter 376 for required provisions, Medicare supplement, long-term care, group insurance and minimum maternity benefits, among other topics. The questions below test the practical consequences: newborn coverage, appeals, renewability, continuation and conversion, clinical trials and parity.
These 17 questions have answers and explanations behind each one. Try each question before you open the explanation.
Practice Questions 1-6: Newborns, Formularies, Coordination, COBRA and Renewal
Covered here: newborn coverage, formulary notice, coordination of benefits, COBRA cost, expedited review and renewal provisions. Work each question before you open the explanation.
Question 1 (Chapter 6)
Under Missouri law, which of the following statements is generally true regarding health insurance coverage for newborn children?
- A) Coverage for a newborn child is available only if the insurer received and approved an application before the child was born.
- B) Insurers may treat a newborn's congenital conditions as a pre-existing condition and exclude them from coverage.
- C) A newly born child of the insured is automatically covered under the parent's policy from the moment of birth for an initial period, without requiring an additional application or premium for that period, but the policyholder must enroll the child to continue coverage beyond it.
- D) Coverage for a newborn child is only available if the parents have a family plan; individual policies cannot cover dependents.
Show answer & explanation
Answer: C
Individual and group health policies generally include a newborn-coverage provision under which a child born to the insured is automatically covered from birth for an initial period without added premium or a formal application, but the policyholder must notify the insurer and enroll the child to continue coverage beyond that initial period. Congenital conditions are not treated as pre-existing conditions for purposes of denying newborn coverage. Option A is incorrect because a newborn cannot be applied for before birth. Option B is incorrect because congenital conditions are not excludable as pre-existing. Option D is incorrect because individual policies can include dependent coverage.
Question 2 (Chapter 6)
A Missouri resident with a health insurance policy receives a notice from their insurer stating that a prescribed medication is being moved to a higher cost-sharing tier, effective next month. This notice is required under which Missouri provision?
- A) Grievance procedures
- B) Formulary notification
- C) Expedited review
- D) Utilization review
Show answer & explanation
Answer: B
Missouri law requires health insurers to provide advance notice when a medication is moved to a higher cost-sharing tier or removed from the formulary. This is known as formulary notification. Grievance procedures address complaints about claim denials or coverage disputes. Expedited review is for urgent care situations. Utilization review evaluates the medical necessity of services.
Question 3 (Chapter 6)
In the context of Missouri health insurance law, which of the following is a required offer (not a required benefit) that insurers must make available to policyholders?
- A) Coverage for mammography screenings
- B) Coverage for autism spectrum disorder and applied behavior analysis
- C) Coverage for chiropractic services
- D) Coverage for diabetes management services
Show answer & explanation
Answer: D
Missouri law requires insurers to offer coverage for diabetes management services as a required offer, meaning it must be made available but the policyholder can reject it. Required benefits (like mammography, autism/ABA, and chiropractic services under certain conditions) must be included in the policy unless specifically rejected in writing. Diabetes management, along with speech/hearing services and chemotherapy, is listed as a required offer rather than a required benefit under Missouri statutes.
Question 4 (Chapter 6)
A Missouri resident with a group health insurance policy leaves their job and elects COBRA continuation coverage. Which of the following statements is true regarding the cost of COBRA coverage?
- A) The former employee pays the same premium as active employees, with the employer continuing to subsidize the cost.
- B) The former employee pays only the employee portion of the premium; the employer pays the employer portion.
- C) COBRA coverage is free for the first 6 months, then the employee pays the full premium.
- D) The former employee pays the entire premium plus a 2% administrative fee.
Show answer & explanation
Answer: D
Under COBRA (federal law, applicable in Missouri), the qualified beneficiary must pay the entire premium for coverage, plus a 2% administrative fee. The employer is not required to subsidize any portion of the premium after employment ends. Options A, B, and C are incorrect: the employee pays the full cost (not the same as active employees), pays both employee and employer portions, and there is no free period under standard COBRA rules.
Question 5 (Chapter 6)
A Missouri resident with a health insurance policy receives a denial of coverage for a proposed surgical procedure. The insurer states the procedure is not medically necessary. The insured requests an expedited review due to the urgency of their condition. Which of the following best describes the timeframe for an expedited review under the standard expedited review process used for urgent health insurance appeals?
- A) The insurer must make a decision within 24 hours of receiving the request for expedited review.
- B) The insurer must make a decision within 7 days of receiving the request for expedited review.
- C) The insurer must make a decision within 30 days of receiving the request for expedited review.
- D) The insurer must make a decision within 72 hours of receiving the request for expedited review.
Show answer & explanation
Answer: D
An expedited review of a denial based on medical necessity is designed to be completed on a much faster timetable than a standard appeal — typically within 72 hours of the request when the situation is urgent — reflecting the widely used structure for expedited health insurance appeals. Standard internal appeals have longer timeframes. Options A, B, and C do not match the standard timeframe for an expedited review.
Question 6 (Chapter 6)
Under Missouri law, which of the following statements is correct regarding mental health coverage in individual health insurance policies?
- A) Insurers may impose annual visit limits on outpatient mental health services that are lower than those for physical health services.
- B) Missouri law allows insurers to exclude coverage for substance use disorders if they also exclude certain mental health conditions.
- C) Mental health coverage is only required in group health policies, not individual policies.
- D) Coverage for mental health conditions must be provided with no greater financial requirements or treatment limitations than those applied to medical/surgical benefits.
Show answer & explanation
Answer: D
Missouri law requires parity in mental health coverage, meaning financial requirements (like deductibles and copays) and treatment limitations (like visit limits) for mental health and substance use disorder benefits cannot be more restrictive than those for medical/surgical benefits. This applies to both individual and group policies. Option A is incorrect because such limits would violate parity. Option B is incorrect as substance use disorder exclusions are also subject to parity rules. Option C is incorrect because the requirement applies to individual policies as well.
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Practice Questions 7-12: Premium Modes, Trials, Continuation and Conversion
Covered here: premium modes, clinical trials, continuation qualifying events, disabled dependents, group conversion and total disability. Work each question before you open the explanation.
Question 7 (Chapter 6)
Under Missouri law, which of the following is generally true regarding modes of premium payment on an individual accident and health policy?
- A) Paying premiums on an annual basis typically costs the insured less in total over the year than paying the same coverage in monthly installments, because of the added administrative loading built into more frequent payment modes.
- B) Insurers are required to offer premiums on a weekly basis only.
- C) The mode of premium payment has no effect on the total annual premium charged.
- D) Monthly premium payment modes are illegal in Missouri.
Show answer & explanation
Answer: A
Insurers commonly add a modal (installment) loading to premiums paid more frequently than annually, so paying annually is typically less expensive in total than paying the same coverage monthly, quarterly, or semi-annually. Option B is incorrect; insurers are not required to offer weekly premiums. Option C is incorrect because the payment mode does affect the total annual cost due to modal loading. Option D is incorrect; monthly premium payment is a common and permitted mode.
Question 8 (Chapter 6)
Under Missouri law, which of the following statements is correct regarding health insurance coverage for clinical trials?
- A) Insurers must cover routine patient costs associated with approved clinical trials for cancer or other life-threatening diseases.
- B) Insurers must cover all costs associated with participation in any clinical trial for cancer or other life-threatening diseases.
- C) Coverage for clinical trials is optional and may be excluded by insurers at their discretion.
- D) Insurers may deny coverage for clinical trials if the investigational drug or device is not yet approved by the FDA.
Show answer & explanation
Answer: A
Missouri law requires health insurers to cover routine patient costs (such as office visits, lab tests, and hospitalizations) associated with participation in approved clinical trials for cancer or other life-threatening diseases. The law does not require coverage of the investigational drug or device itself, nor does it cover all trial-related costs. Coverage is not optional; it is a required benefit for approved trials. Insurers cannot deny coverage solely because the investigational agent lacks FDA approval if the trial is otherwise approved and meets the statutory criteria.
Question 9 (Chapter 6)
A Missouri resident with a group health insurance policy experiences a qualifying event that allows them to elect continuation coverage. Which of the following events would NOT trigger eligibility for state continuation coverage under Missouri law?
- A) Termination of employment (other than for gross misconduct)
- B) Reduction in the number of hours of employment
- C) Divorce or legal separation from the covered employee
- D) A change in the policyholder's preferred primary care physician
Show answer & explanation
Answer: D
Qualifying events that trigger eligibility for state continuation coverage generally include: termination of employment (for reasons other than gross misconduct), reduction in hours of employment, death of the covered employee, divorce or legal separation, and a dependent child ceasing to meet dependent status requirements. A change in the policyholder's preferred primary care physician is not a qualifying event under state or federal continuation coverage laws (like COBRA). Such a change does not result in a loss of group health coverage and therefore does not trigger continuation rights.
Question 10 (Chapter 6)
Under Missouri law, which of the following is a required provision in individual health insurance policies regarding the continuation of coverage for dependent children who are incapable of self-sustaining employment due to intellectual or physical disability?
- A) Coverage must be offered until age 26 regardless of disability status.
- B) Coverage for disabled dependent children is optional and requires an additional rider.
- C) Coverage terminates at age 19 for all dependent children, disabled or not.
- D) Coverage may be extended beyond the limiting age if the child is unmarried and chiefly dependent on the insured for support and maintenance due to disability.
Show answer & explanation
Answer: D
Missouri law requires that individual health insurance policies provide for the extension of coverage beyond the limiting age for unmarried dependent children who are incapable of self-sustaining employment due to intellectual or physical disability and who are chiefly dependent on the insured for support. Option A is incorrect because coverage is not automatic until age 26; it depends on disability and dependency. Option B is incorrect because the extension is required, not optional. Option C is incorrect as it contradicts the rule allowing extension for disabled children.
Question 11 (Chapter 6)
A Missouri resident's group health coverage ends due to termination of employment. The group policy includes a conversion privilege. Which of the following is generally true regarding this conversion right?
- A) The employee may convert to an individual policy without evidence of insurability, though the individual policy's benefits and premium may differ from those of the group plan.
- B) Conversion is only available if the employee was covered under the group plan for less than 90 days.
- C) The individual conversion policy must provide identical benefits and premiums to the group policy.
- D) Conversion rights do not exist under Missouri law; only continuation coverage is available.
Show answer & explanation
Answer: A
A conversion privilege allows an employee losing eligibility under a group policy to convert to an individual policy without having to prove insurability, though the converted policy's benefits and premium are typically not identical to the group plan's. Option B is incorrect; conversion rights generally require a minimum period of prior coverage, not a maximum. Option C is incorrect because the individual policy need not mirror the group policy's terms. Option D is incorrect because conversion privileges and continuation coverage are both generally available, addressing different needs.
Question 12 (Chapter 6)
A Missouri resident with an individual health insurance policy is diagnosed with a chronic condition that prevents them from performing any work for which they are reasonably suited by education, training, or experience. The policy defines disability as the inability to perform any occupation. Which type of disability is this?
- A) Partial disability
- B) Recurrent disability
- C) Total disability
- D) Residual disability
Show answer & explanation
Answer: C
Total disability under the 'any occupation' definition means the insured cannot perform any work for which they are reasonably suited by education, training, or experience. Partial disability involves performing some duties of one's own occupation, recurrent disability refers to a repeat of the same condition within a specified period, and residual disability involves a loss of income despite being able to work. Therefore, the scenario describes total disability.
Practice Questions 13-17: Renewability, Residual Disability, Telehealth and Parity
Covered here: renewal and cancellation, residual disability income loss, telehealth, clinical trial coverage and mental health parity. Work each question before you open the explanation.
Question 13 (Chapter 6)
A Missouri resident with a long-term care insurance policy triggers benefits due to cognitive impairment. Which of the following activities is most likely used to determine eligibility for benefits under a typical long-term care policy?
- A) Ability to perform instrumental activities of daily living (IADLs) like managing finances
- B) Need for assistance with two or more activities of daily living (ADLs) such as bathing or dressing
- C) Failure to pass a standardized test measuring memory and orientation
- D) Diagnosis of a specific cognitive impairment like Alzheimer's disease by a physician
Show answer & explanation
Answer: C
Long-term care insurance policies typically use cognitive impairment assessments, such as standardized tests measuring memory and orientation (e.g., the Mini-Mental State Exam), to determine eligibility for benefits when cognitive impairment is the trigger. While need for assistance with ADLs is a common trigger for physical impairment, cognitive impairment triggers rely on evidence of severe cognitive loss. Diagnosis alone is usually insufficient; functional assessment via testing is required. IADLs are not the primary basis for benefit triggers in standard LTC policies.
Question 14 (Chapter 6)
A Missouri resident purchases an individual disability income policy with a residual disability rider. The policy defines residual disability as a loss of income of at least 20% due to sickness or injury. After a car accident, the insured returns to work but can only work 30 hours per week instead of 40, resulting in a 25% income loss. Which statement is correct regarding benefit eligibility?
- A) The insured qualifies for total disability benefits because they cannot work full-time
- B) The insured qualifies for residual disability benefits because the income loss exceeds the policy's 20% threshold
- C) The insured qualifies for partial disability benefits because they are working reduced hours
- D) The insured does not qualify for any disability benefits because they are still working
Show answer & explanation
Answer: B
Residual disability benefits are triggered when the insured suffers a loss of income (typically 20% or more) due to disability but can still work. The 25% income loss exceeds the 20% threshold, making the insured eligible for residual disability benefits. Total disability (A) requires inability to perform material duties. Partial disability (C) is a separate definition often tied to specific duties or time loss, not income percentage. The insured does qualify for benefits (D is incorrect) under the residual disability provision.
Question 15 (Chapter 6)
Under Missouri law, which of the following is generally true regarding telehealth services under an individual health insurance policy?
- A) Insurers may not deny coverage for an otherwise-covered service solely because it was delivered via telehealth rather than in person.
- B) Telehealth services are never covered under individual health insurance policies.
- C) Telehealth coverage is limited to mental health services only.
- D) Insurers may charge a higher deductible specifically for the same service delivered by telehealth rather than in person.
Show answer & explanation
Answer: A
Telehealth-parity requirements generally provide that a service covered when delivered in person remains covered when delivered via telehealth, so an insurer may not deny coverage based solely on the method of delivery. Option B is incorrect; telehealth is a covered delivery method, not an excluded one. Option C is incorrect; telehealth parity is not limited to mental health services. Option D is incorrect because telehealth-parity rules generally prohibit charging higher cost-sharing for the same covered service based on the mode of delivery.
Question 16 (Chapter 6)
A Missouri resident with an individual health insurance policy receives a denial for a clinical trial-related service. The insurer states clinical trials are not covered. Under Missouri law, which of the following statements is correct?
- A) Clinical trial coverage is optional and must be offered as a separate rider
- B) Individual health policies must cover routine patient costs associated with approved clinical trials for cancer or other life-threatening conditions
- C) Clinical trial coverage is only required for Medicare supplement policies
- D) Insurers may deny all clinical trial costs, including routine care, if the trial is out-of-network
Show answer & explanation
Answer: B
Missouri law requires individual health insurance policies to cover routine patient costs for enrollees participating in approved clinical trials for cancer or other life-threatening conditions. This is a mandatory benefit, not optional (A). It applies to individual health policies generally, not just Medicare supplements (C). Insurers cannot deny routine care costs (like doctor visits and lab tests) that would be covered outside a trial, even if the trial is out-of-network (D), though they may not be required to cover the investigational item or service itself.
Question 17 (Chapter 6)
Under Missouri law, which of the following statements is correct regarding health insurance coverage for mental health conditions in individual policies?
- A) Insurers may impose higher deductibles for mental health claims than for physical health claims.
- B) Coverage for mental health conditions must be provided at parity with coverage for physical health conditions.
- C) Insurers are not required to cover any mental health conditions unless they are biologically based.
- D) Mental health coverage is limited to inpatient hospitalization only.
Show answer & explanation
Answer: B
Missouri law requires that coverage for mental health conditions be provided at parity with coverage for physical health conditions in individual health insurance policies. This means similar deductibles, copays, visit limits, and management requirements. Options A, C, and D are incorrect: insurers cannot impose higher financial burdens, must cover a broad range of conditions (not just biologically based), and coverage is not limited to inpatient care.
The Mistakes That Cost Marks
Mixing up continuation and conversion. Continuation keeps the group coverage going for a time, while conversion moves you to an individual policy without evidence of insurability. They address different needs (questions 9 and 11).
Misreading COBRA cost. A qualified beneficiary pays the whole premium plus an administrative fee, and the employer does not subsidise it (question 4).
Blurring renewability labels. Learn what guaranteed renewable and noncancelable each promise before you read the options (questions 6 and 13).
Looking for lost work rather than lost income. Residual disability is triggered by loss of income while still working, not by inability to work at all (question 14).
Mixing up disability definitions. Total disability under an any-occupation definition means unable to do any work the person is reasonably suited for (question 12).
Assuming coordination can pay more than the bill. Coordination of benefits exists to stop total payments exceeding the allowable expense (question 3).
Your Next Step
Score yourself on the three groups and note which ones went worst, then return to that part of the outline. The course preview lets you try the audio lessons and quiz format, and our free practice question hub has the full list of topic sets for the Missouri Life & Health exam.
For the format and difficulty, read how many questions are on the exam and whether the exam is hard.
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