17 Free South Carolina Life & Health Practice Questions: Accident and Sickness Policy Provisions and Social Insurance (2026)
How to Use This Set
This set covers two sections of the South Carolina Life, Accident and Health exam: Accident & Sickness: Policy Provisions, Clauses, and Riders (15 items, 11.5% of the 130 scored questions) and Social Insurance (6 items, 4.6%).
The provisions section is about naming the right clause for a described situation and applying it: claims timing, cost sharing, renewability, and the exclusions and offsets. Social insurance covers Medicare and Social Security. Open each explanation once you have chosen.
Practice Questions 1-6: Claims, Cost Sharing, Riders and Medicare Parts
Proof of loss, deductible and coinsurance arithmetic, the future increase option, change of occupation, and which Medicare part covers what.
Question 1 (Chapter 5)
A South Carolina insured files a claim for disability benefits under an individual accident and sickness policy. The insurer requests proof of loss. How many days does the insured have to submit the proof of loss after receiving the claim forms from the insurer?
- A) 10 days
- B) 15 days
- C) 20 days
- D) 90 days
Show answer & explanation
Answer: D
Under the mandatory provisions of the Uniform Individual Accident and Sickness Policy Provisions Law, which South Carolina follows, the insured must submit proof of loss within 90 days after the time it is required, unless it is not reasonably possible to do so. The insurer must first provide claim forms within 15 days of receiving notice of claim. Once the insured receives the claim forms, they have 90 days to submit proof of loss. Options A, B, and C are incorrect as they do not match the 90-day requirement for proof of loss submission.
Question 2 (Chapter 5)
A South Carolina resident has an individual accident and sickness policy with a $1,000 annual deductible and 80% coinsurance. After meeting the deductible, the insured incurs $5,000 in eligible medical expenses. How much will the insurer pay toward these expenses?
- A) $4,000
- B) $4,800
- C) $5,000
- D) $3,200
Show answer & explanation
Answer: A
A is correct. The deductible has already been met, so the full $5,000 of eligible expenses is subject to the 80/20 coinsurance: the insurer pays 80% of $5,000, which is $4,000, and the insured pays the remaining $1,000. D ($3,200) wrongly subtracts the deductible a second time before applying coinsurance. B ($4,800) applies 96% rather than 80%. C ($5,000) ignores the insured's 20% share.
Question 3 (Chapter 5)
A South Carolina resident has an individual accident and sickness policy that includes a future increase option rider. The insured wishes to exercise this rider to increase their benefit amount. Which of the following is true?
- A) The insured must provide evidence of insurability to increase the benefit.
- B) The insurer can deny the increase if the insured's occupation has become more hazardous.
- C) The increase in benefit is automatic and occurs annually on the policy anniversary.
- D) The insured can increase the benefit without providing evidence of insurability, but only during specific open enrollment periods.
Show answer & explanation
Answer: D
A future increase option (FIO) rider allows the insured to increase the policy benefit amount at specified times without providing evidence of insurability. These increases are typically allowed during predefined intervals (e.g., every 3 years) or at certain ages, not annually or automatically. The insurer cannot deny the increase based on changes in occupation (that would relate to a change of occupation provision, not the FIO rider). Option A is incorrect because evidence of insurability is not required. Option C is incorrect because the increase is not automatic or annual; it occurs at specified intervals chosen by the insured.
Question 4 (Chapter 5)
A South Carolina resident is reviewing their accident and sickness policy and sees a provision that states the insurer will not pay benefits for a loss that occurs while the insured is working in a job that is significantly more hazardous than the one disclosed in the application. What is this provision called?
- A) Change of occupation provision
- B) Illegal occupation exclusion
- C) Elimination period
- D) Probationary period
Show answer & explanation
Answer: A
This provision is the change of occupation provision, which allows the insurer to adjust or deny benefits if the insured enters an occupation that is more hazardous than the one disclosed in the application, based on the relationship between the premium charged and the risk of the new occupation. An illegal occupation exclusion applies only if the occupation itself is illegal (e.g., committing a felony). An elimination period is the waiting period before benefits begin. A probationary period is an initial period where certain coverages are not effective. Options B, C, and D do not describe a provision tied to a change in job hazard level.
Question 5 (Chapter 5)
A South Carolina resident is eligible for Medicare. Which part of Medicare covers physician services, outpatient hospital care, and durable medical equipment?
- A) Part B
- B) Part A
- C) Part C
- D) Part D
Show answer & explanation
Answer: A
A is correct because Medicare Part B covers physician services, outpatient care, and durable medical equipment. B is incorrect as Part A covers inpatient hospital stays. C is incorrect as Part C is Medicare Advantage. D is incorrect as Part D covers prescription drugs.
Question 6 (Chapter 5)
A South Carolina resident is eligible for Medicare. Which part of Medicare covers prescription drugs?
- A) Part D
- B) Part A
- C) Part B
- D) Part C
Show answer & explanation
Answer: A
A is correct because Medicare Part D covers prescription drugs. B is incorrect as Part A covers inpatient hospital stays. C is incorrect as Part B covers physician services and outpatient care. D is incorrect as Part C is Medicare Advantage, which may include drug coverage but is not the standalone part for drugs.
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Practice Questions 7-12: Optional and Mandatory Provisions
Naming provisions such as the intoxication exclusion and relation of earnings to insurance, renewability, grace periods, preexisting conditions, and the insurer's right to examine.
Question 7 (Chapter 5)
A South Carolina resident is reviewing their accident and sickness policy and sees a provision that states the insurer will not pay benefits for a loss that occurs while the insured is intoxicated. What is this provision called?
- A) Intoxication and narcotics exclusion
- B) Impairment/exclusion rider
- C) Illegal occupation exclusion
- D) Relation of earnings to insurance
Show answer & explanation
Answer: A
Many accident and sickness policies include an intoxication and narcotics exclusion, which denies benefits for losses occurring while the insured is under the influence of alcohol or drugs. This is a standard optional provision under the Uniform Individual Accident and Sickness Policy Provisions Law. Option B refers to a rider that excludes specific impairments, not a general condition like intoxication. Option C applies to jobs involving illegal acts (e.g., drug trafficking), not personal intoxication. Option D relates to benefit adjustments based on income changes, not exclusions.
Question 8 (Chapter 5)
A South Carolina resident is reviewing their accident and sickness policy and sees a provision that states benefits will be reduced by the amount of any workers' compensation benefits received for the same loss. What is this provision called?
- A) Coordination of benefits
- B) Relation of earnings to insurance
- C) Workers' compensation offset
- D) Illegal occupation exclusion
Show answer & explanation
Answer: B
The 'relation of earnings to insurance' provision is a standard optional provision in accident and sickness policies that reduces disability benefits by the amount of workers' compensation or other earnings replacement benefits received for the same loss, preventing overinsurance. Option A, 'coordination of benefits,' typically refers to how multiple health plans pay for medical expenses, not disability income offsets. Option C is not a standard provision title. Option D applies to losses occurring during illegal occupations, not benefit offsets.
Question 9 (Chapter 5)
A South Carolina resident has an individual accident and sickness policy that is guaranteed renewable. The insurer wishes to nonrenew the policy at the next anniversary date because the insured filed multiple claims. Which statement is true?
- A) The insurer may nonrenew the policy if it provides 60 days' notice.
- B) The insurer may nonrenew the policy only if the insured fails to pay the premium.
- C) The insurer cannot nonrenew the policy for any reason except nonpayment of premium.
- D) The insurer may nonrenew the policy if it offers to renew with a different benefit structure.
Show answer & explanation
Answer: C
A guaranteed renewable policy gives the insured the right to renew the policy at each anniversary date. The insurer may not cancel or refuse to renew the policy except for nonpayment of premium. It cannot nonrenew due to claims experience, age, or changes in health.
Question 10 (Chapter 5)
A South Carolina resident purchases an individual accident and sickness policy with a quarterly premium payment mode. The insured misses the premium due date. Under the mandatory grace period provision required by S.C. Code § 38-71-130, how many days does the insured have to pay the premium before the policy lapses?
- A) 31 days
- B) 7 days
- C) 10 days
- D) 45 days
Show answer & explanation
Answer: A
Under the Uniform Individual Accident and Sickness Policy Provisions Law adopted in South Carolina (S.C. Code § 38-71-130), the mandatory grace period is 7 days for weekly premiums, 10 days for monthly premiums, and 31 days for all other payment modes (quarterly, semi-annual, annual). Since this policy is paid quarterly, the grace period is 31 days. Option B (7 days) applies only to weekly premiums. Option C (10 days) applies only to monthly premiums. Option D (45 days) is the time an insurer has to reject a reinstatement application, not the grace period.
Question 11 (Chapter 5)
A South Carolina resident is covered under an individual accident and sickness policy with a preexisting condition limitation. The policy defines a preexisting condition as one for which medical advice or treatment was received within 12 months prior to the effective date. The insured received treatment for a knee injury 10 months before the policy's effective date. The policy has a 12-month preexisting condition exclusion period. When will coverage for the knee injury become available?
- A) Immediately, because the treatment was more than 6 months before the effective date
- B) After 12 months from the policy effective date
- C) After 6 months from the policy effective date
- D) Never, because the condition was treated within the look-back period
Show answer & explanation
Answer: B
The condition falls within the 12-month look-back period (treatment 10 months prior), so it is a preexisting condition. The policy has a 12-month exclusion period for preexisting conditions. Coverage for that condition becomes available after the 12-month exclusion period expires from the policy effective date. Option A is incorrect; the look-back period is 12 months, not 6. Option C confuses the exclusion period length. Option D is incorrect because preexisting condition exclusions are time-limited, not permanent.
Question 12 (Chapter 5)
A South Carolina resident is reviewing their individual accident and sickness policy and sees a provision stating that the insurer has the right to examine the insured as often as reasonably necessary during the pendency of a claim. Which mandatory provision is this?
- A) Proof of Loss
- B) Time of Payment of Claims
- C) Physical Examination and Autopsy
- D) Legal Actions
Show answer & explanation
Answer: C
The Physical Examination and Autopsy provision (mandatory under S.C. Code § 38-71-130) gives the insurer the right to examine the insured as often as reasonably necessary while a claim is pending, and to require an autopsy in case of death (where not forbidden by law). Option A (Proof of Loss) relates to documentation of the claim. Option B (Time of Payment) sets deadlines for claim payment. Option D (Legal Actions) limits when lawsuits can be filed.
Practice Questions 13-17: Claim Timing, Defenses, Free Look and Social Insurance
When the first benefit is due, time limits on defenses and the fraud exception, the free look provision, and the scope of Social Security and Medicare Advantage.
Question 13 (Chapter 5)
A South Carolina insured has an individual accident and sickness policy with a 90-day elimination period for disability benefits. The insured becomes disabled on January 1 and remains disabled continuously. The policy pays benefits monthly. When is the first benefit payment due, assuming the insurer processes the claim promptly after the elimination period ends?
- A) April 30
- B) January 31
- C) March 31
- D) April 1
Show answer & explanation
Answer: A
A is correct. With disability beginning January 1, a 90-day elimination period runs through the end of March (31 + 28 + 31 days), so benefits begin to accrue on April 1. Because the policy pays monthly, the first monthly benefit covers April and is payable at the end of that month, April 30. B would be a 30-day elimination period. C is the last day of the elimination period, when nothing is yet payable. D is the day benefits start to accrue, not the date the first monthly payment is due.
Question 14 (Chapter 5)
A South Carolina resident purchases an individual accident and sickness policy. Two years after the policy's effective date, the insurer discovers that the insured intentionally misrepresented a material fact on the application regarding a pre-existing condition, which would have led to a denial of coverage. What action can the insurer take regarding this policy?
- A) The insurer must continue the policy in force and cannot deny claims related to the misrepresented condition, as the 'Time Limit on Certain Defenses' provision has passed.
- B) The insurer may void the policy and deny all claims, even after two years, due to the fraudulent misstatement.
- C) The insurer may only increase the premium to reflect the true risk, but cannot void the policy.
- D) The insurer can deny claims related to the pre-existing condition but must keep the policy in force for other covered losses.
Show answer & explanation
Answer: B
The 'Time Limit on Certain Defenses' provision (often called the incontestable clause in health insurance) generally prevents an insurer from voiding a policy or denying claims based on misstatements in the application after a specified period, typically two years. However, this provision explicitly makes an exception for fraudulent misstatements. If the misstatement was fraudulent, the insurer can void the policy and deny claims at any time, even after the two-year period, as per S.C. Code § 38-71-130(2).
Question 15 (Chapter 5)
A South Carolina resident purchases a new individual accident and sickness policy. The policy includes a 'Free Look' provision. What is the primary purpose of this provision?
- A) To allow the insured to receive free medical examinations during the first year of the policy.
- B) To permit the insured to review the policy for a specified period after delivery and return it for a full refund if not satisfied.
- C) To enable the insurer to re-underwrite the policy and adjust premiums within the first 30 days.
- D) To offer a temporary period of coverage while the full underwriting process is completed.
Show answer & explanation
Answer: B
The 'Free Look' provision (also known as the Right to Examine Policy) grants the policyholder a specific period (typically 10 days for most health policies, but 30 days for Medicare supplements in South Carolina) after receiving the policy to review its terms. If dissatisfied for any reason, the policyholder can return the policy for a full refund of premiums paid. This provision is designed to protect consumers and ensure they understand what they are purchasing.
Question 16 (Chapter 5)
A South Carolina resident is planning for retirement and wants to understand their potential Social Security benefits. Which of the following benefits is NOT typically provided by the Social Security program?
- A) Retirement benefits for eligible workers
- B) Long-term care benefits for extended nursing home stays
- C) Survivors' benefits for eligible family members of a deceased worker
- D) Disability benefits for workers who become totally disabled
Show answer & explanation
Answer: B
The Social Security program provides a safety net primarily through retirement benefits, survivors' benefits, and disability benefits (SSDI) to eligible workers and their families. It does NOT typically provide long-term care benefits for extended nursing home stays. Long-term care is generally covered by private long-term care insurance or Medicaid for those who qualify based on income and asset limits.
Question 17 (Chapter 5)
A South Carolina resident, aged 70, is covered by Medicare Part A and Part B. They decide to enroll in a Medicare Advantage Plan (Part C). Which of the following statements is true regarding their Medicare coverage after enrolling in Part C?
- A) Their Medicare Advantage Plan will provide all Part A and Part B benefits, and potentially additional benefits, through a private insurer.
- B) They will lose their original Medicare Part A and Part B benefits entirely.
- C) They will continue to receive benefits from both original Medicare and the Medicare Advantage Plan simultaneously.
- D) They must also purchase a separate Medicare Supplement (Medigap) policy to cover deductibles and coinsurance.
Show answer & explanation
Answer: A
When an individual enrolls in a Medicare Advantage Plan (Part C), they are essentially choosing to receive their Medicare Part A and Part B benefits through a private insurance company approved by Medicare, rather than directly through Original Medicare. The Part C plan must cover all services that Original Medicare covers, and often includes additional benefits like vision, dental, hearing, and prescription drug coverage (MAPD plans). They do not lose their Medicare eligibility, but their benefits are administered by the Part C plan. One cannot have a Medicare Advantage Plan and a Medigap policy at the same time.
The Mistakes That Cost Marks
Subtracting the deductible twice. Once the deductible is met, coinsurance applies to the full eligible amount.
Naming provisions by their effect, not their title. The change of occupation provision, the intoxication and narcotics exclusion, the relation of earnings to insurance provision, and physical examination are four different clauses. Match the described effect to the title.
Treating guaranteed renewable as loose. Under a guaranteed renewable policy the insurer cannot refuse to renew because of claims, age or health. The exceptions are narrow, mainly nonpayment.
Counting the elimination period carelessly. If disability starts January 1 and the policy has a 90-day elimination period, benefits accrue after that period ends. Work out the calendar before choosing a date.
Forgetting the fraud exception. The time limit on certain defenses stops an insurer contesting a policy after the stated period, but a fraudulent misstatement is the exception.
Confusing Medicare parts. Part A is inpatient, Part B is physician and outpatient, Part C is Medicare Advantage delivered by a private insurer, and Part D is prescription drugs. A Medicare Advantage plan replaces the delivery of Parts A and B, it does not stack on top, and Medigap is not paired with it.
Assuming Social Security pays for long-term care. It provides retirement, survivors and disability benefits, not nursing home care.
Your Next Step
Review every question you missed against the outline section it belongs to, then run the set again a few days later. When the misses stop clustering, move on to the next section.
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