17 Free Tennessee Life & Health Practice Questions: Accident & Health Provisions and Social Insurance (2026)
How to Use This Set
Policy provisions, clauses and riders are Section II of the Tennessee Accident and Health exam, with 15 items, and social insurance is Section III, with 6. Both sit inside the 50 scored general-knowledge questions.
The set mixes contract mechanics, such as the grace period and claims provisions, with the government programs the exam expects you to describe accurately.
Practice Questions 1-6: Grace Period, Age Misstatement and Government Programs
Disability grace periods, how a misstated age is handled, Medicaid, the time benefits are paid, consideration and Medicare Part D.
Question 1 (Chapter 5)
A Tennessee policyholder has a disability income policy with a monthly premium payment mode. If the premium was due on October 1st and the insured suffers a disabling injury on October 8th without having paid the premium, how must the insurer handle the claim?
- A) The claim must be denied because the policy lapsed on October 2nd.
- B) The claim must be paid in full, and the insurer cannot collect the overdue premium.
- C) The insurer must reinstate the policy first before the claim can be processed.
- D) The claim must be paid, but the insurer may deduct the overdue premium from the benefit.
Show answer & explanation
Answer: D
For monthly premium policies, Tennessee law requires a grace period of at least 10 days. Since the injury occurred on the 8th day of the grace period, the policy is still in force. The insurer is entitled to deduct the owed premium from the claim settlement.
Question 2 (Chapter 5)
During the application process for a health insurance policy, an applicant accidentally states their age as 32 when they are actually 37. If a claim is filed five years later, how will the insurer handle the misstatement of age?
- A) The insurer will void the policy for material misrepresentation.
- B) The insurer must pay the full benefit because the incontestable period has passed.
- C) The insurer will pay the claim but deduct the difference in premiums for the last five years.
- D) The insurer will adjust the benefits to what the premium paid would have purchased at the correct age.
Show answer & explanation
Answer: D
The Misstatement of Age or Gender provision is an exception to the incontestable rule. It allows the insurer to adjust the benefits at any time to match what the premium would have purchased at the correct age or gender.
Question 3 (Chapter 5)
Which statement regarding Medicaid (administered as TennCare in Tennessee) is CORRECT?
- A) It is a needs-based program funded by both federal and state governments.
- B) It is a federal program with no state involvement.
- C) It is available to anyone over age 65 regardless of income.
- D) It only covers prescription drugs for the elderly.
Show answer & explanation
Answer: A
Medicaid is a joint federal and state program that provides health coverage to individuals with low income and limited resources. In Tennessee, the Medicaid program is primarily operated through TennCare.
Question 4 (Chapter 5)
A Tennessee resident has a disability income policy that pays monthly benefits. When the insured becomes disabled, the 'Time of Payment of Claims' provision requires the insurer to pay these periodic indemnity benefits at what frequency?
- A) Immediately upon receipt of the final proof of loss.
- B) At the end of the disability period only.
- C) Lump sum every six months.
- D) At least monthly.
Show answer & explanation
Answer: D
For claims involving periodic payment (like disability income), the 'Time of Payment of Claims' provision states that benefits must be paid at least monthly. Non-periodic claims (like medical bills) are paid immediately upon receipt of proof.
Question 5 (Chapter 5)
During a sales presentation in Murfreesboro, a producer explains that the 'Consideration Clause' is a vital part of the insurance contract. What two elements constitute the 'consideration' provided by the applicant?
- A) The application and the initial premium.
- B) The medical exam and the credit report.
- C) The policy delivery and the producer's commission.
- D) The promise to pay and the insuring clause.
Show answer & explanation
Answer: A
Consideration is something of value exchanged by the parties. For the applicant, consideration consists of the statements made in the application and the payment of the initial premium.
Question 6 (Chapter 5)
Which of the following statements regarding Medicare Part D is TRUE for a Tennessee senior?
- A) It is a voluntary program offered through private insurers to provide prescription drug coverage.
- B) It is automatically provided for free to anyone enrolled in Part A.
- C) It covers long-term custodial care in a nursing home.
- D) It only covers drugs administered in a hospital setting.
Show answer & explanation
Answer: A
Medicare Part D is the prescription drug program. It is optional and is provided through private insurance companies that contract with Medicare (PDPs or through Medicare Advantage plans).
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Practice Questions 7-12: Cost Sharing, Renewability and Optional Provisions
Deductible and coinsurance arithmetic, the cancelable policy, coordination of benefits, the illegal occupation provision, stop-loss and Medicare Advantage. Apply the deductible first, then coinsurance on what remains.
Question 7 (Chapter 5)
A Clarksville resident has a major medical policy with a $1,000 deductible and an 80/20 coinsurance clause. If the insured incurs $6,000 in covered medical expenses, how much will the insured be responsible for paying in total?
- A) $1,000
- B) $1,200
- C) $2,200
- D) $2,000
Show answer & explanation
Answer: D
The insured first pays the $1,000 deductible. This leaves $5,000 ($6,000 - $1,000). Under 80/20 coinsurance, the insured pays 20% of the remainder ($5,000 x 0.20 = $1,000). Total responsibility is $1,000 (deductible) + $1,000 (coinsurance) = $2,000.
Question 8 (Chapter 5)
An insurance company issues a 'Cancelable' health insurance policy to a resident of Franklin. If the insurer decides to cancel the policy mid-term, what must it do under the Uniform Provisions?
- A) It can cancel at any time without notice or refund.
- B) It can only cancel if the insured files too many claims.
- C) It must wait until the policy anniversary and provide 31 days' notice.
- D) It must provide at least 5 days' written notice and refund any unearned premium on a pro-rata basis.
Show answer & explanation
Answer: D
A cancelable policy allows the insurer to cancel the policy at any time by providing written notice (typically 5 days). The insurer must refund any unearned premium. This is the least favorable renewability provision for the insured.
Question 9 (Chapter 5)
A married couple in Knoxville both have group health insurance through their respective employers, and they cover their children under both plans. According to the 'Birthday Rule' for Coordination of Benefits, which plan is primary for the children?
- A) The plan of the parent whose birthday falls earlier in the calendar year.
- B) The plan of the parent who is older in age.
- C) The plan that has been in force the longest.
- D) The father's plan is always primary in Tennessee.
Show answer & explanation
Answer: A
The Birthday Rule states that the primary policy for children is the one belonging to the parent whose birthday (month and day) occurs earliest in the calendar year. If both parents have the same birthday, the policy that has been in effect longer is primary.
Question 10 (Chapter 5)
An insured individual is injured while participating in a felony robbery. If the policy includes the 'Illegal Occupation' optional provision, what action is the insurer permitted to take regarding the claim?
- A) Pay the claim in full but cancel the policy immediately
- B) Pay only 50% of the claim as a penalty
- C) Deny the claim entirely
- D) Pay the claim but increase the future premiums
Show answer & explanation
Answer: C
The 'Illegal Occupation' optional provision states that the insurer is not liable for any loss to which a contributing cause was the insured's commission of, or attempt to commit, a felony or being engaged in an illegal occupation.
Question 11 (Chapter 5)
An individual in Chattanooga has a major medical policy with a $5,000 'Stop-Loss' (Out-of-Pocket Maximum) limit. If the insured incurs $50,000 in covered medical expenses, and the policy has an 80/20 coinsurance after a $1,000 deductible, what is the maximum the insured will pay?
- A) $1,000
- B) $5,000
- C) $6,000
- D) $10,800
Show answer & explanation
Answer: B
The 'Stop-Loss' or 'Out-of-Pocket Maximum' is the maximum amount the insured must pay in a year for covered services. Once the insured's deductible and coinsurance reach this limit (in this case $5,000), the insurer pays 100% of remaining covered expenses.
Question 12 (Chapter 5)
A Tennessee resident is turning 65 and decides to enroll in a Medicare Advantage plan (Medicare Part C). Which of the following is TRUE regarding this choice?
- A) The individual no longer needs to pay the Medicare Part B premium.
- B) The plan is provided directly by the federal government.
- C) The plan must provide at least the same benefits as Original Medicare (Parts A and B).
- D) Medicare Advantage plans never include prescription drug coverage.
Show answer & explanation
Answer: C
Medicare Part C (Medicare Advantage) plans are offered by private companies and must provide all the services covered under Original Medicare (Parts A and B). Most also include Part D (prescription drug) coverage.
Practice Questions 13-17: Claims Procedure, Noncancelable Policies and the ACA
What happens when claim forms do not arrive, what a noncancelable policy guarantees, waiver of premium timing, who pays for an exam and how preexisting conditions are treated.
Question 13 (Chapter 5)
A Knoxville resident submits a notice of claim to their insurer. The insurer fails to send the required claim forms within the 15-day statutory period. What is the insured's next step under the Mandatory Uniform Provisions?
- A) The insured must wait another 15 days before taking action.
- B) The insured is deemed to have complied with the proof of loss requirement by submitting written proof covering the occurrence and character of the loss.
- C) The insured must file a complaint with the Tennessee Department of Commerce and Insurance before the claim can proceed.
- D) The policy is automatically voided, and all premiums must be refunded.
Show answer & explanation
Answer: B
If the insurer fails to furnish claim forms within 15 days, the claimant shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting written proof of the nature and extent of the loss.
Question 14 (Chapter 5)
An individual has a 'Noncancelable' disability policy. The insurer experiences significant financial losses across its entire Tennessee block of business. Which of the following is TRUE regarding the insurer's ability to raise the insured's premium?
- A) The insurer can raise premiums if it does so for the entire class of policyholders.
- B) The insurer can raise premiums only with the Commissioner's approval.
- C) The insurer cannot raise premiums on a noncancelable policy for any reason during the term of the contract.
- D) The insurer can raise premiums only if the insured files a claim.
Show answer & explanation
Answer: C
A 'Noncancelable' policy guarantees that the insurer cannot cancel the policy, change any provisions, or increase the premium as long as premiums are paid on time, usually until age 65.
Question 15 (Chapter 5)
Under the 'Waiver of Premium' rider in a disability income policy, if the insured becomes totally disabled and the rider has a 60-day waiting period, when does the waiver of premium benefit begin?
- A) After the insured has been continuously disabled for 60 days.
- B) Immediately upon the onset of disability.
- C) On the date the proof of loss is submitted and approved.
- D) After the elimination period for disability income benefits is satisfied.
Show answer & explanation
Answer: A
The Waiver of Premium rider typically includes its own waiting period, which must be satisfied before the premium waiver benefit becomes payable. This waiting period is separate from the policy's elimination period for disability income benefits. The rider specifies that premiums are waived after the insured has been continuously disabled for the stated period (e.g., 60 days). Option B is incorrect because the waiting period must be met. Option C is incorrect because submission of proof of loss does not trigger the waiver; the waiting period does. Option D is incorrect because the Waiver of Premium rider's waiting period is independent of the disability income elimination period.
Question 16 (Chapter 5)
Under the 'Physical Examination and Autopsy' provision in a Tennessee health insurance policy, who bears the cost of a physical examination requested by the insurer while a claim is pending?
- A) The insured
- B) The insurer
- C) The policyholder's employer
- D) The Medicare program
Show answer & explanation
Answer: B
The Physical Examination and Autopsy provision states that the insurer has the right to request a physical examination (or autopsy) as often as reasonably required while a claim is pending, but the insurer must bear the cost of such examination. This protects the insured from being charged for the insurer's due diligence. Option A is incorrect because the insured does not pay. Options C and D are incorrect as neither the employer nor Medicare is responsible for this cost under the provision.
Question 17 (Chapter 5)
Under the Affordable Care Act (ACA), how are preexisting conditions handled for a new applicant enrolling in an individual major medical plan in Tennessee?
- A) The insurer can impose a 12-month exclusion period for the preexisting condition.
- B) The insurer can deny coverage based on the preexisting condition.
- C) The insurer must provide coverage for the preexisting condition without exclusion or extra charge.
- D) The insurer can charge an additional premium for the preexisting condition.
Show answer & explanation
Answer: C
The Affordable Care Act prohibits health insurance companies from denying coverage, charging higher premiums, or imposing waiting periods or exclusions based on preexisting conditions for individual and small group major medical plans. Coverage must be provided on a guaranteed-issue basis, and the preexisting condition must be covered from the effective date of coverage. Options A, B, and D describe practices that are prohibited under the ACA.
The Mistakes That Cost Marks
Applying coinsurance before the deductible. The insured pays the deductible, then the coinsurance percentage of the remaining covered expense, until the stop-loss limit is reached.
Treating age misstatement as grounds to void. The usual remedy is to adjust benefits to what the premium would have bought at the correct age.
Mixing up Medicare parts. Part D is optional prescription coverage through private insurers; Part C plans must cover everything Original Medicare does.
Overstating cancelable policies. A cancelable policy is the least favorable renewability class for the insured.
Forgetting that noncancelable means fixed premium. The insurer cannot cancel, change provisions or raise the premium while premiums are paid.
Missing the proof-of-loss fallback. If the insurer does not furnish claim forms in time, the claimant is deemed to comply by submitting written proof of the loss.
Assuming preexisting-condition exclusions survive the ACA. In individual major medical plans they may not be used to deny coverage, charge more or impose exclusions.
Your Next Step
Run the full set once without looking at the answers, then reread the explanations for every miss. When the pattern is clear, try the free course preview and the rest of the free Tennessee Life & Health practice questions.
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