17 Free Missouri Life & Health Practice Questions: Accident and Health Policy Provisions (2026)
How to Use This Set
This set covers accident and health policy provisions, clauses and riders, with questions on social insurance. On the Accident and Health single-line outline, Policy Provisions, Clauses and Riders carries 15 items and Social Insurance carries 6. The combined exam lists the same sections.
It is the most calculation-heavy of the health sets. Expect coinsurance, deductibles, copayments, out-of-pocket maximums and benefit limits in realistic scenarios, alongside Medicare, Medicaid, mandatory provisions and riders.
These 17 questions have answers and explanations behind each one. Try each question before you open the explanation.
Practice Questions 1-6: Cost Sharing, Medicare and Mandatory Provisions
Covered here: coinsurance after a deductible, Medicare Part A, benefit limits, dual eligibles, time limit on certain defenses and the waiver of premium rider. Work each question before you open the explanation.
Question 1 (Chapter 5)
Under a Missouri accident and health policy with a coinsurance clause requiring the insured to pay 20% of covered expenses after the deductible, the insured incurs $5,000 in covered medical expenses. The policy has a $1,000 deductible. How much will the insurer pay?
- A) $800
- B) $1,000
- C) $3,200
- D) $4,000
Show answer & explanation
Answer: C
First, subtract the deductible: $5,000 - $1,000 = $4,000. Then apply coinsurance: the insurer pays 80% of the remaining $4,000 (since the insured pays 20%), which is $3,200. Option A is 20% of $4,000 (the insured's share). Option B is the deductible amount. Option D incorrectly assumes the insurer pays 80% of the total $5,000 without applying the deductible first.
Question 2 (Chapter 5)
A Missouri resident is eligible for Medicare. Which part of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care?
- A) Medicare Part B
- B) Medicare Part C
- C) Medicare Part D
- D) Medicare Part A
Show answer & explanation
Answer: D
Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers outpatient/medical services like doctor visits and preventive care. Part C (Medicare Advantage) is an alternative way to receive Part A and B benefits. Part D covers prescription drugs. The question specifically describes Part A benefits.
Question 3 (Chapter 5)
A Missouri accident and health policy includes a benefit limit of $50,000 per year for physical therapy services. If the insured incurs $65,000 in covered physical therapy expenses in a policy year, how much will the insurer pay, assuming no deductible or coinsurance applies?
- A) $15,000
- B) $50,000
- C) $65,000
- D) $0
Show answer & explanation
Answer: B
When a policy has a benefit limit (or maximum) for a specific service, the insurer will pay up to that limit for covered expenses in the given period. Here, the limit is $50,000 per year for physical therapy. Even though expenses are $65,000, the insurer pays only $50,000, and the insured is responsible for the excess $15,000. Option A is the excess amount, C ignores the limit, and D is incorrect as expenses up to the limit are covered.
Question 4 (Chapter 5)
In Missouri, which of the following statements accurately describes the coordination between Medicare and Medicaid for individuals who qualify for both programs (dual eligibles)?
- A) Medicare pays first, and Medicaid may help pay Medicare premiums, deductibles, and coinsurance for dual eligibles.
- B) Medicaid pays first, and Medicare pays second for all covered services.
- C) Individuals must choose either Medicare or Medicaid; they cannot receive benefits from both simultaneously.
- D) Medicaid covers only prescription drugs, while Medicare covers all other services for dual eligibles.
Show answer & explanation
Answer: A
For individuals eligible for both Medicare and Medicaid (dual eligibles), Medicare is the primary payer. Medicaid then acts as a secondary payer and may help cover Medicare costs such as premiums, deductibles, and coinsurance. Option B reverses the payer order. Option C is incorrect because dual eligibles can and do receive benefits from both. Option D misstates the coverage; Medicaid covers many services beyond drugs, and Medicare Advantage often includes drug coverage.
Question 5 (Chapter 5)
Which of the following is a mandatory provision in every Missouri accident and health insurance policy that specifies the time frame during which an insurer may contest a claim based on a misstatement in the application, unless fraudulent?
- A) Grace Period
- B) Reinstatement
- C) Time Limit on Certain Defenses
- D) Entire Contract
Show answer & explanation
Answer: C
The Time Limit on Certain Defenses provision (typically two years) prevents the insurer from denying a claim or voiding the policy due to misstatements in the application after that period, unless the misstatement was fraudulent. Grace Period relates to premium payment timing. Reinstatement addresses lapsed policies. Entire Contract states that the policy, application, and riders form the complete agreement.
Question 6 (Chapter 5)
A Missouri resident purchases a disability income policy that includes a waiver of premium rider. Which statement best describes the function of this rider?
- A) It waives the elimination period if the insured is hospitalized.
- B) It increases the monthly benefit amount by 50% during the first year of disability.
- C) It allows the insured to convert the policy to a life insurance policy without evidence of insurability.
- D) It waives the premium payments if the insured becomes totally disabled and meets the policy's definition of disability.
Show answer & explanation
Answer: D
A waiver of premium rider in a disability income policy waives the premium payments while the insured is receiving disability benefits (i.e., is totally disabled as defined by the policy). This prevents the policy from lapsing due to non-payment during disability. Option A confuses the waiver of premium with the elimination period (which is the waiting period before benefits begin). Option B describes a benefit enhancement, not a waiver of premium. Option C describes a conversion privilege, which is unrelated to waiver of premium.
Get the 25-question sample set by email
Want a full-exam practice set to study offline? Drop your email — we'll send 25 questions across every content area, each with the answer and explanation.
No spam. Just the questions and one optional follow-up.
Practice Questions 7-12: Copayments, Medicaid, Defenses and Out-of-Pocket Limits
Covered here: copayment arithmetic, Medicaid for pregnancy, emergency room cost sharing, the two-year defenses period, residual disability and the out-of-pocket maximum. Work each question before you open the explanation.
Question 7 (Chapter 5)
A Missouri resident has a health insurance policy with a $15 copayment for primary care visits and a $30 copayment for specialist visits. If the resident visits their primary care physician 2 times and a specialist 3 times in a month, what is the total copayment amount due?
- A) $120
- B) $75
- C) $90
- D) $105
Show answer & explanation
Answer: A
Calculate the copayments: (2 primary care visits × $15) = $30. (3 specialist visits × $30) = $90. Total copayment = $30 + $90 = $120. Option B ($75) would be correct if all visits were primary care (5 × $15) or if specialist visits were miscalculated. Option C ($90) would be correct if only specialist visits were counted (3 × $30) or if primary care visits were free. Option D ($105) would result from incorrect math, such as (2 × $15) + (3 × $25) = $30 + $75 = $105.
Question 8 (Chapter 5)
Which of the following is a mandatory provision in every Missouri accident and health insurance policy that allows the policyholder to put a lapsed policy back into force after non-payment of premium, subject to certain conditions?
- A) Grace Period
- B) Entire Contract
- C) Incontestability Clause
- D) Reinstatement
Show answer & explanation
Answer: D
The Reinstatement provision is a mandatory provision that allows a policyholder to apply to put a lapsed policy back into force. The insurer may require an application and proof of insurability, and if not rejected within 45 days, the policy is automatically reinstated. The Grace Period (A) allows temporary coverage after non-payment but does not restore a lapsed policy. Entire Contract (B) states the policy and application form the full agreement. Incontestability Clause (C) is not a standard term; the correct term is Time Limit on Certain Defenses.
Question 9 (Chapter 5)
A Missouri resident has a health insurance policy with a $25 copayment for urgent care visits and a 20% coinsurance for emergency room (ER) visits after a $100 deductible. If the resident visits urgent care once and has an ER visit with $900 in covered expenses, what is the total out-of-pocket cost for the resident (copayment + deductible + coinsurance)?
- A) $375
- B) $325
- C) $250
- D) $285
Show answer & explanation
Answer: D
The urgent care visit requires a $25 copayment. For the ER visit, the $100 deductible applies first, leaving $800. A 20% coinsurance on $800 is $160. Total out-of-pocket = $25 + $100 + $160 = $285. Options A, B, and C reflect different miscalculations of the deductible or coinsurance amount.
Question 10 (Chapter 5)
A Missouri resident purchases an individual major medical policy that includes a mandatory Time Limit on Certain Defenses provision. Two years and three months after the policy's issue date, the insurer discovers the insured failed to disclose a prior diagnosis of hypertension on the application. The insurer attempts to deny a claim for a heart attack, citing the misrepresentation. The insured argues the misstatement was not fraudulent. Under Missouri law, which statement is correct?
- A) The insurer may deny the claim because the misrepresentation was material to the risk.
- B) The insurer may not deny the claim because the two-year incontestability period has expired and the misstatement was not fraudulent.
- C) The insurer may deny the claim only if it can prove the insured knew of the condition at the time of application.
- D) The insurer may deny the claim because the Time Limit on Certain Defenses provision applies only to life insurance policies, not accident and health policies.
Show answer & explanation
Answer: B
B is correct: Missouri's mandatory Time Limit on Certain Defenses provision requires accident and health policies to state that after two years from the policy's issue date, no misstatement in the application (unless fraudulent) can be used to void the policy or deny a claim. The two-year period has passed and the misstatement was not fraudulent, so the insurer cannot deny the claim. A is wrong because materiality does not override the statutory incontestability period. C is wrong because knowledge is irrelevant once the two-year period expires for non-fraudulent misstatements. D is wrong because the provision is mandatory for accident and health policies in Missouri, not just life insurance.
Question 11 (Chapter 5)
A Missouri resident has an individual disability income policy with a 90-day elimination period and a 'residual disability' rider. The resident suffers a partial disability that reduces their income by 40%. The policy defines residual disability as a loss of at least 20% of pre-disability income. The resident returns to work part-time after 45 days but continues to have a 40% income loss. How does the elimination period apply to the residual disability benefit?
- A) The elimination period does not apply to residual disability benefits; they are payable immediately upon proof of income loss.
- B) The elimination period must be satisfied in full (90 consecutive days of total disability) before any residual disability benefits are payable.
- C) The elimination period is satisfied by the 45 days of total disability, and residual benefits begin on day 46 for the continuing income loss.
- D) The elimination period for residual disability is typically separate and may be satisfied by a period of partial disability; the 45 days of total disability may count toward it, depending on policy language.
Show answer & explanation
Answer: D
D is correct: In Missouri disability income policies, residual disability riders often have their own elimination period provisions. The elimination period for residual disability may be satisfied by a period of total disability, partial disability, or a combination, depending on the specific policy language. The 45 days of total disability may count toward satisfying the elimination period for residual benefits, but this is not automatic — it depends on the policy's terms. A is wrong because residual disability benefits typically are subject to an elimination period. B is wrong because residual disability does not usually require 90 consecutive days of total disability first. C is wrong because it assumes the 45 days automatically satisfies the elimination period and benefits begin on day 46, which oversimplifies the policy's specific terms.
Question 12 (Chapter 5)
A Missouri resident purchases an individual accident and health policy with a $2,000 annual deductible and 20% coinsurance. The policy has an out-of-pocket maximum of $5,000 (including deductible and coinsurance). In January, the insured incurs $10,000 in covered expenses. In June, the insured incurs another $15,000 in covered expenses. How much will the insured pay in total for the year, and how much will the insurer pay?
- A) Insured pays $5,000; insurer pays $25,000
- B) Insured pays $5,000; insurer pays $20,000
- C) Insured pays $7,000; insurer pays $18,000
- D) Insured pays $2,000; insurer pays $23,000
Show answer & explanation
Answer: B
B is correct: The insured first pays the $2,000 deductible. Total covered expenses for the year = $25,000. After the deductible, $23,000 is subject to 20% coinsurance, which is $4,600. Uncapped out-of-pocket would be $2,000 + $4,600 = $6,600, but the policy's $5,000 out-of-pocket maximum caps the insured's total cost at $5,000. The insurer pays the remainder: $25,000 - $5,000 = $20,000. Option A is wrong because it has the insurer paying the full $25,000 on top of the insured's $5,000, which would exceed the total expenses incurred. Option C is wrong because it does not apply the out-of-pocket maximum correctly. Option D is wrong because it ignores coinsurance and the out-of-pocket maximum.
Practice Questions 13-17: Medicare Part B, Beneficiaries, Misrepresentation and Inflation Protection
Covered here: delaying Part B, change of beneficiary, rescission for misrepresentation, long-term care inflation protection and legal actions. Work each question before you open the explanation.
Question 13 (Chapter 5)
A Missouri resident is eligible for Medicare Part B. The resident has not enrolled in Part B because they have employer-sponsored group health coverage through their current employer (with 25 employees). The resident plans to retire in 6 months. Which statement is correct regarding the resident's Medicare Part B enrollment?
- A) The resident must enroll in Part B now to avoid a late enrollment penalty, even with employer coverage.
- B) The resident may delay Part B enrollment without penalty because they have employer coverage based on current employment; they will have a Special Enrollment Period when the employer coverage ends.
- C) The resident may delay Part B enrollment without penalty only if the employer has 100 or more employees.
- D) The resident must enroll in Part B now because the employer has fewer than 20 employees, making Medicare primary.
Show answer & explanation
Answer: B
B is correct: Individuals with employer-sponsored group health coverage based on their own (or a spouse's) current employment may delay Medicare Part B enrollment without incurring a late enrollment penalty, regardless of employer size. They qualify for a Special Enrollment Period (SEP) to enroll in Part B when the employer coverage ends or employment ends. The employer's size (25 employees) does not affect the right to delay; it only affects whether Medicare is primary or secondary payer (for employers with fewer than 20 employees, Medicare is primary). A is wrong because the late enrollment penalty does not apply while the resident is covered under current employer coverage. C is wrong because there is no 100-employee threshold for the penalty-free delay; the SEP is available based on current employment regardless of employer size. D is wrong because, although Medicare is primary for employers with fewer than 20 employees, the individual can still delay Part B enrollment without penalty under the SEP rules.
Question 14 (Chapter 5)
A Missouri resident purchases an individual accident and health policy that includes a mandatory 'Change of Beneficiary' provision. The policyholder initially names their spouse as primary beneficiary. Two years later, the policyholder submits a written request to change the primary beneficiary to their adult child. The insurer receives the request but does not endorse the change on the policy before the policyholder dies. Under Missouri law, which statement is correct regarding the beneficiary designation?
- A) The change is effective as of the date the policyholder signed the written request, regardless of insurer endorsement.
- B) The change is ineffective because the insurer must endorse the change on the policy for it to take effect.
- C) The change is effective only if the insurer approved the change in writing before the policyholder's death.
- D) The change is ineffective because a beneficiary change requires the consent of the original beneficiary.
Show answer & explanation
Answer: A
Under the mandatory Change of Beneficiary provision in Missouri accident and health policies (consistent with standard policy provisions required by RSMo Chapter 376), a change of beneficiary takes effect as of the date the policyholder signs the written request, whether or not the insurer has endorsed it on the policy. The insurer's endorsement is administrative; the policyholder's signed request controls. Option B is incorrect because endorsement is not a condition precedent. Option C is incorrect because insurer approval is not required. Option D is incorrect because the original beneficiary's consent is not required for a revocable beneficiary designation, which is the default unless made irrevocable.
Question 15 (Chapter 5)
A Missouri resident applies for an individual accident and health policy. The application includes a question: 'Within the past 5 years, have you been diagnosed with or treated for any heart or circulatory condition?' The applicant answers 'No.' The applicant had been diagnosed with hypertension 3 years ago and takes medication, but considers it 'controlled' and not a 'condition.' The policy is issued. Nine months later, the insured suffers a stroke and files a claim. The insurer discovers the hypertension diagnosis during claims investigation. The insurer seeks to rescind the policy based on material misrepresentation. Under Missouri law, which statement is correct?
- A) The insurer cannot rescind because the Time Limit on Certain Defenses provision (2 years) bars the defense.
- B) The insurer can rescind because the misrepresentation was material to the risk, regardless of intent.
- C) The insurer can rescind only if it proves the misrepresentation was fraudulent.
- D) The insurer cannot rescind because hypertension is not a 'heart or circulatory condition' under Missouri law.
Show answer & explanation
Answer: B
B is correct: Before the two-year Time Limit on Certain Defenses period has run, an insurer may rescind a policy or deny a claim based on a misrepresentation in the application if the misrepresentation was material to the risk, regardless of the applicant's intent; proof of fraud is required only after the two-year period has elapsed. Here, only 9 months have passed, so the insurer may rely on materiality alone. A is wrong because the two-year period has not run. C is wrong because fraudulent intent is not required to rescind within the two-year period; materiality is enough. D is wrong because hypertension is clearly a circulatory condition within the scope of the application question.
Question 16 (Chapter 5)
A Missouri resident purchases an individual long-term care insurance policy that includes an 'Inflation Protection' rider. The policy provides a daily benefit of $150. The inflation protection option selected is 'simple interest' at 5% per year. After 10 years, what is the daily benefit amount?
- A) $150 (no increase until claim)
- B) $225
- C) $244.33
- D) $200
Show answer & explanation
Answer: B
Simple interest inflation protection increases the daily benefit by a fixed percentage of the original amount each year. 5% of $150 = $7.50 per year. Over 10 years: $7.50 × 10 = $75 increase. $150 + $75 = $225. Option C reflects compound interest (5% compounded annually). Option A is incorrect; inflation protection applies automatically each year. Option D is an arbitrary figure.
Question 17 (Chapter 5)
A Missouri resident with an individual accident and health policy is hospitalized for 10 days. The policy has a $200 per day hospital indemnity benefit and a 30-day elimination period. How much will the insurer pay for this hospitalization?
- A) $200
- B) $0
- C) $2,000
- D) $2,200
Show answer & explanation
Answer: B
The elimination period (also called a waiting period) is the time that must pass after the onset of disability before benefits begin. Since the hospitalization lasted only 10 days and the elimination period is 30 days, no benefits are payable. Therefore, the insurer pays $0. Options A, B, and C incorrectly assume benefits are paid from day one or miscalculate the benefit period.
The Mistakes That Cost Marks
Applying coinsurance to the whole bill. The deductible comes off first, and the coinsurance applies to what remains (questions 1 and 9).
Forgetting the out-of-pocket maximum. Once the cap is reached, the insurer pays the remainder, so the cap limits the insured's total (question 12).
Ignoring the time line on defenses. The time limit on certain defenses changes what an insurer can do about an application misstatement, so check the elapsed time in the question (questions 10 and 15).
Mixing up simple and compound inflation protection. Simple adds a fixed amount of the original benefit each year, while compound builds on the growing benefit (question 16).
Mixing up Medicare parts. Part A is hospital, skilled nursing, hospice and some home health care, Part B is outpatient and medical services, Part C is the Medicare Advantage alternative, and Part D is drugs (question 2).
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.
Free: 25 Missouri L&H practice questions
Liked this article? Get 25 exam-style questions emailed to you — with full answer explanations, no credit card. Closest thing to studying offline.
No spam. Just the questions and one optional follow-up.
Study this topic with LanePrep
Listen to these audio chapters on your commute — no screen required.
Related Articles
How to Pass the Missouri Life & Health Exam on the First Try (2026)
8 min read
$140 With the Combined Exam: Missouri Life & Health License Cost 2026
6 min read
25 Free Missouri Life & Health Exam Practice Questions (2026)
25 min read
Is the Missouri Life & Health Exam Hard? Pass Rates and Difficulty (2026)
4 min read
17 Free Missouri Life & Health Practice Questions: Life Provisions, Riders and Options (2026)
14 min read
17 Free Missouri Life & Health Practice Questions: Application, Underwriting and Delivery (2026)
14 min read
17 Free Missouri Life & Health Practice Questions: Accident and Health Policy Types (2026)
14 min read