17 Free Louisiana Health Insurance Exam Practice Questions (2026)
How to Use This Health Insurance Question Set
Louisiana's own statute and PSI's exam names call this line of authority Accident and health or sickness, and the "or sickness" suffix is part of the name. On the combined exam outline, the health sections are individual health and accident policy provisions at 7 percent, disability income at 4 percent, medical plans at 4 percent, group health at 3 percent, health insurance for senior citizens and special needs individuals at 7 percent, and the health share of a federal tax section that the combined outline splits with life at 2 percent.
Candidates who take Health and Accident or Sickness as its own standalone exam face 100 questions in 120 minutes for $36, with the same raw 70 percent passing score written into R.S. 22:1545(A). There is no pre-licensing course in Louisiana, and there hasn't been since Act 273 of 2022 took effect on June 3, 2022.
These 17 questions come from Chapters 7 and 8 of LanePrep's Louisiana Life & Health quiz bank, none of them repeated from the free 25-question sample across the whole exam: 9 on individual health policy provisions, disability income and medical plans (Chapter 7), and 8 on group health, seniors and special needs, and federal tax for health (Chapter 8). Each question shows its chapter, so a miss tells you exactly which audio lesson to replay.
For context, the NAIC's first-time pass rate on the standalone Health and Accident or Sickness exam was 49.5 percent in 2024 and 43.6 percent in 2025. The 2024 figure includes candidates who tested remotely before remote testing ended on July 8, 2024, and the 2025 figure is in-person only, so treat the two as a snapshot, not a trend.
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 1-6: Claim Forms, Elimination Periods, Payment of Claims and Disability Definitions
Chapter 7 opens with the claim process: what the insured may do when the insurer doesn't send claim forms within 15 days, and where death benefits go when no beneficiary is named. Between those sit three questions about timing and cost sharing: an elimination period applied to a 45-day disability, a probationary period that decides a respiratory infection claim, and a major medical plan whose stop-loss caps the insured's total. The block ends on the any-occupation definition of total disability.
Question 1 (Chapter 7)
After receiving a notice of claim from an insured, a Louisiana insurer fails to send the required claim forms within 15 days. What is the insured's right in this situation?
- A) The insured is relieved of the duty to provide proof of loss entirely.
- B) The insured must wait another 15 days before taking action.
- C) The insurer is required to pay the claim automatically without further documentation.
- D) The insured may submit proof of loss in any written form describing the occurrence and nature of the loss.
Show answer & explanation
Answer: D
If the insurer fails to provide claim forms within 15 days of receiving notice, the insured is deemed to have complied with the proof of loss requirement by submitting written proof that describes the nature and extent of the loss.
Question 2 (Chapter 7)
A disability income policy has a 30-day elimination period and a $2,000 monthly benefit. If the insured is disabled for 45 days, how much will the policy pay?
- A) $1,000
- B) $3,000
- C) $2,000
- D) $500
Show answer & explanation
Answer: A
The elimination period is a 'time deductible.' The policy pays for the duration of the disability *minus* the elimination period. 45 days - 30 days = 15 days of benefits. 15 days is half a month, so half of $2,000 is $1,000.
Question 3 (Chapter 7)
A Louisiana policyholder is hospitalized for a major surgery and submits a claim. The policy specifies that for any loss of life, benefits are paid to the named beneficiary. However, the insured has not named a beneficiary. According to the 'Payment of Claims' required provision, how will the insurer distribute the death benefit if the insured dies during surgery?
- A) The benefits will be paid to the insured's estate.
- B) The benefits must be paid to the Louisiana Department of Insurance to be held in escrow.
- C) The benefits are forfeited to the insurer to cover administrative costs.
- D) The benefits are split equally among all surviving immediate family members.
Show answer & explanation
Answer: A
Under the Uniform Required 'Payment of Claims' provision (R.S. 22:975), death benefits are paid to the designated beneficiary. If no beneficiary is designated, the benefits are paid to the insured's estate. Distractors B, C, and D are not standard legal procedures for claim payments.
Question 4 (Chapter 7)
An insured buys a health policy on January 1st that includes a 30-day 'Probationary Period' for sickness. On January 15th, the insured is hospitalized with a severe respiratory infection. How will the insurer handle the claim?
- A) The claim will be paid because the insured had the policy for 15 days.
- B) The claim will be paid, but the insured must pay a double deductible.
- C) The claim will be denied because respiratory infections are always excluded.
- D) The claim will be denied because the sickness occurred during the probationary period.
Show answer & explanation
Answer: D
The Probationary Period is a period of time at the start of a policy during which sickness is not covered. This is designed to protect the insurer against adverse selection (people buying insurance only when they feel a sickness coming on). Accidents are typically covered immediately.
Question 5 (Chapter 7)
An insured has a Major Medical plan with a $1,000 deductible, 80/20 coinsurance, and a $5,000 'Stop-Loss' limit (out-of-pocket maximum, including the deductible). If the insured incurs $30,000 in covered medical expenses, how much will the insured pay in total?
- A) $1,000
- B) $6,800
- C) $5,000
- D) $7,000
Show answer & explanation
Answer: C
The Stop-Loss (or Out-of-Pocket Maximum) limits the insured's liability. Without the stop-loss, the insured would pay $1,000 + 20% of $29,000 ($5,800) = $6,800. However, since the stop-loss limit is $5,000, the insured's total payment is capped at $5,000.
Question 6 (Chapter 7)
A 45-year-old accountant has a disability income policy with a 'Any-Occupation' definition of total disability. He suffers a severe hand injury that prevents him from accounting but allows him to work as a greeter at a retail store. Will he receive benefits?
- A) Yes, because he cannot perform his own occupation.
- B) Yes, because he is partially disabled.
- C) No, because he is capable of performing some gainful occupation.
- D) No, because the injury is not presumptive.
Show answer & explanation
Answer: C
The 'Any-Occupation' definition is the most restrictive. It requires the insured to be unable to perform the duties of ANY occupation for which they are reasonably suited by education, training, or experience. Since he can work as a greeter, he is not 'totally disabled' under this definition.
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Practice Questions 7-12: Disability Provisions, Social Security, Medigap and Group Premiums
Chapter 7 continues with the waiver of premium rider, how often disability benefits must be paid, and the Social Security definition of disability. Chapter 8 then turns to seniors and group health: the policy that fills the gaps in original Medicare, what makes a group plan contributory, and how premiums and benefits are taxed when an employer pays for a group medical expense plan.
Question 7 (Chapter 7)
An insured has a disability income policy with a 'Waiver of Premium' rider. They become totally disabled and have satisfied the elimination period. What is the effect of this rider?
- A) The insurer will pay the premiums for the insured for the remainder of their life.
- B) The insurer will refund all premiums paid prior to the disability.
- C) The insured does not have to pay premiums while they remain totally disabled.
- D) The premium is reduced by 50% during the disability period.
Show answer & explanation
Answer: C
The Waiver of Premium rider allows the insured to stop paying premiums while they are totally disabled (usually after a waiting period), ensuring the policy stays in force.
Question 8 (Chapter 7)
An insured in Lafayette has an individual disability income policy. They become totally disabled, and the insurer begins paying monthly benefits after the elimination period. According to the 'Time of Payment of Claims' Uniform Required Provision, how frequently must the insurer pay these benefits?
- A) Annually, as a lump sum.
- B) At least monthly, if the policy specifies periodic payments.
- C) Within 30 days of the initial proof of loss, then no further payments are guaranteed.
- D) Weekly, regardless of the policy's payment schedule.
Show answer & explanation
Answer: B
The 'Time of Payment of Claims' provision, as outlined in the Uniform Required Provisions, states that benefits for loss of time (like disability income) will be paid at least monthly, if the policy specifies periodic payments. This ensures a steady income stream for the disabled insured. Options A, C, and D do not align with this standard provision.
Question 9 (Chapter 7)
A 40-year-old worker in Louisiana suffers a severe injury and applies for Social Security Disability benefits. What is the definition of 'disability' that the Social Security Administration (SSA) uses to qualify individuals for benefits?
- A) The inability to perform the duties of their 'own occupation' for at least 3 months.
- B) The inability to engage in 'any substantial gainful activity' due to a medical condition expected to last at least 12 months or result in death.
- C) A partial disability that reduces earning capacity by at least 25%.
- D) A disability that prevents them from working in their current job, but allows them to work in a different field.
Show answer & explanation
Answer: B
The Social Security Administration (SSA) has a very strict definition of disability. An individual is considered disabled if they are unable to engage in 'any substantial gainful activity' due to a medical condition that is expected to last at least 12 months or result in death. This is a much narrower definition than 'own occupation' and does not consider partial disability. Option A is too lenient, and options C and D do not meet the SSA's strict criteria.
Question 10 (Chapter 8)
A 66-year-old retiree is looking for coverage to pay for the 'gaps' in their Medicare coverage, such as copayments and deductibles for Part A and Part B. Which type of insurance should the producer recommend?
- A) A Medicare Supplement (Medigap) policy
- B) Medicare Part D
- C) Medicare Part A
- D) A Long-Term Care policy
Show answer & explanation
Answer: A
Medicare Supplement policies (Medigap) are specifically designed to fill the gaps in original Medicare (Parts A and B). Part D covers prescriptions, Part A is hospital, and LTC policies cover custodial care which Medigap does not.
Question 11 (Chapter 8)
A group health plan is described as 'contributory.' What does this mean regarding the premium payments?
- A) The insurance company contributes a portion of the claims.
- B) The employer pays 100% of the cost.
- C) The government provides a subsidy for the premiums.
- D) Both the employer and the employee share the premium costs.
Show answer & explanation
Answer: D
In a contributory plan, the cost of the premium is shared between the employer and the employee.
Question 12 (Chapter 8)
A business owner pays the premiums for a group medical expense plan for their employees. How are the premiums and the benefits treated for federal tax purposes?
- A) Premiums are tax-deductible for the employer; benefits are generally tax-free to the employee.
- B) Premiums are taxable to the employee; benefits are tax-free.
- C) Both premiums and benefits are taxable as ordinary income.
- D) Premiums are tax-free; benefits are taxable as capital gains.
Show answer & explanation
Answer: A
For employer-sponsored group medical expense insurance, the employer can generally deduct the premiums, and the medical benefits received by the employee are typically tax-free.
Practice Questions 13-17: Medigap Core Benefits, Respite Care, Medicare Select and Guaranteed Issue
Chapter 8 closes the Health set on seniors and special needs: the core benefit that every standardized Medicare Supplement plan carries, the long-term care benefit that gives a family caregiver a week away, the network rule behind Medicare Select, which Medicare part pays for a hospital stay followed by skilled nursing care, and the 63-day guaranteed issue window after employer group coverage ends.
Question 13 (Chapter 8)
A producer is comparing Medicare Supplement Plan A and Plan G for a client in Shreveport. Which of the following is a 'core' benefit found in Plan A that must also be present in all other standardized Medigap plans?
- A) Medicare Part A deductible
- B) Medicare Part B deductible
- C) Part B excess charges
- D) Part A copayments for hospital stay days 61-90
Show answer & explanation
Answer: D
Standardized Medicare Supplement plans must all include the 'core' benefits, which include the Part A copayments for hospital days 61-90 and the 365 additional lifetime reserve days. The Part A deductible (A) is not a core benefit (though included in Plan G), and the Part B deductible (B) is no longer covered for new enrollees.
Question 14 (Chapter 8)
A daughter provides full-time care for her elderly father in Ruston. She needs to travel out of state for a week and arranges for her father to stay in a long-term care facility during her absence. This type of LTC coverage is called:
- A) Respite Care
- B) Home Health Care
- C) Adult Day Care
- D) Skilled Nursing Care
Show answer & explanation
Answer: A
Respite care is designed to provide temporary relief for the primary (usually family) caregiver by placing the patient in a facility or bringing in a professional caregiver for a short period.
Question 15 (Chapter 8)
A Louisiana producer is explaining 'Medicare Select' to a client. What is the primary difference between Medicare Select and a standard Medicare Supplement policy?
- A) Medicare Select requires the use of specific network providers to receive full benefits.
- B) Medicare Select is provided by the government, not private insurers.
- C) Medicare Select does not cover Part A deductibles.
- D) Medicare Select is only available to those under age 65.
Show answer & explanation
Answer: A
Medicare Select is a type of Medicare Supplement policy that operates like a PPO or HMO. To receive full benefits, the insured must use providers within the plan's network, except in cases of emergency.
Question 16 (Chapter 8)
A Medicare beneficiary is hospitalized for 10 days and then requires 20 days of skilled nursing facility care. Which part of Medicare covers these expenses?
- A) Part B
- B) Part A
- C) Part C
- D) Part D
Show answer & explanation
Answer: B
Medicare Part A is 'Hospital Insurance.' It covers inpatient hospital stays, skilled nursing facility care (following a hospital stay), hospice care, and some home health care.
Question 17 (Chapter 8)
A 65-year-old Louisiana resident is covered by an employer group health plan. When they retire at 67, the group coverage ends. They apply for a Medicare Supplement policy within 63 days. Which of the following applies?
- A) The insurer can deny them based on pre-existing conditions.
- B) They have 'guaranteed issue' rights and cannot be denied coverage.
- C) They must wait for the next General Enrollment Period.
- D) They are only eligible for Plan A.
Show answer & explanation
Answer: B
When an individual loses employer-sponsored group coverage that is primary to Medicare, they have a 'guaranteed issue' right to purchase certain Medigap policies if they apply within 63 days of the coverage ending.
The Mistakes That Cost Marks
Swapping the elimination period and the probationary period. An elimination period works like a time deductible: the benefit starts counting only after the waiting days of a disability have passed, so a 45-day disability with a 30-day elimination period pays for the remaining 15 days. A probationary period sits at the start of the policy and blocks sickness claims, which is why a respiratory infection on day 15 of a 30-day period is denied.
Reading the stop-loss as an extra cost. The stop-loss, or out-of-pocket maximum, caps what the insured pays in total. When the question says it includes the deductible, the insured's share cannot exceed it no matter how large the covered expenses are.
Mixing up own-occupation and any-occupation definitions. Under an any-occupation definition of total disability, an accountant who can still work as a store greeter is not totally disabled. It is the most restrictive of the definitions, and Social Security uses the same any-gainful-activity idea.
Forgetting what the claim provisions give the insured. If the insurer doesn't provide claim forms within 15 days of notice of claim, the insured is deemed to have complied by submitting written proof of the occurrence and nature of the loss. Death benefits with no beneficiary named go to the insured's estate.
Confusing contributory and noncontributory group plans, and their tax treatment. In a contributory plan the employer and employee share the premium; when the employer pays all of it, 100 percent of eligible employees must enroll. Employer-paid group medical premiums are generally deductible to the employer and the benefits are generally tax-free to the employee.
Blurring the Medicare parts and the Medigap rules. Part A pays for hospital and following skilled nursing facility care. Core Medicare Supplement benefits include the Part A copayments for hospital days 61-90. Medicare Select requires network providers for full benefits, and losing employer group coverage that was primary to Medicare opens a 63-day guaranteed issue window.
Your Next Step
How did you score?
13 or more correct: You're clearing most of the health sections. Move to the Life insurance exam set next, then read how to pass the Louisiana Life & 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 replay that chapter's audio lesson before retesting.
Under 9 correct: Start with Chapter 7 of the LanePrep Louisiana Life & Health course and work forward through Chapter 8 rather than testing yourself again right away. A free preview is available at /la/l-and-h/preview, no signup required.
For a 25-question sample across the whole exam, see the free practice set.
Exam format, fees and content outline weights from PSI Services LLC's Louisiana Department of Insurance Candidate Information Bulletin (updated 1/1/2025) and the Series 102 and 103 content outlines (effective 2/10/2016); pass rates from the NAIC compiled pass-rate workbooks for 2024 and 2025. Read October 2026.
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