17 Free Oklahoma Health Insurance Exam Practice Questions (2026)
How to Use This Health Insurance Question Set
Oklahoma'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 sections this set covers are Health Providers and Products at 15 items, Medicare at 5 items and Long-Term Care at 5 items.
Candidates who take Accident and Health or Sickness as its own standalone exam face 100 scored questions plus 5 unscored in 120 minutes for $38, with the same 70 percent correct passing score, a raw percent, not a scaled score. Oklahoma requires no pre-licensing course and no fingerprinting for it.
These 17 questions come from Chapters 6 and 7 of LanePrep's Oklahoma Life & Health quiz bank, none of them repeated from the free 25-question sample across the whole exam: 9 on health providers and products (Chapter 6) and 8 on Medicare and long-term care (Chapter 7). 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 Accident and Health or Sickness exam was 48.6 percent in 2024 and 52.0 percent in 2025, with in-person and remote candidates combined in both years.
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: Group Policyholders, MEWAs, HMO Models, Capitation and Credit Disability
Chapter 6 opens with group health: who holds the master contract when an employer sets up a plan, and why the Oklahoma Insurance Department (OID) regulates MEWAs (multiple employer welfare arrangements) so closely. It then moves into managed care: the HMO model in which a physician also keeps a private practice, and the capitation method of paying providers, which comes up twice in this block. In between sits a question on what happens to a credit disability policy when the loan it protects is paid off early.
Question 1 (Chapter 6)
When an Oklahoma employer establishes a group health insurance plan, who is the policyholder that receives the 'Master Contract'?
- A) Each individual employee.
- B) The Oklahoma Insurance Department.
- C) The primary care physician.
- D) The employer.
Show answer & explanation
Answer: D
In group insurance, the employer (or association) is the applicant and policyholder who receives the Master Contract. Employees are 'certificate holders' and receive a Certificate of Insurance.
Question 2 (Chapter 6)
What is the primary reason the Oklahoma Insurance Department (OID) closely regulates MEWAs?
- A) To prevent them from being used to avoid state insurance regulations and to ensure they remain solvent to pay claims.
- B) To ensure they are not competing too heavily with Blue Cross Blue Shield.
- C) To make sure they only hire producers with Life licenses.
- D) To ensure they provide coverage for pets and livestock.
Show answer & explanation
Answer: A
MEWAs have historically faced solvency issues. Regulators monitor them to ensure they have enough reserves to pay claims and are not fraudulent schemes designed to bypass state mandates.
Question 3 (Chapter 6)
A physician in Oklahoma City provides services to HMO members but also maintains a private practice where she sees patients from various other insurance plans. This arrangement is characteristic of which HMO model?
- A) Open Panel (Independent Practice Association)
- B) Staff Model
- C) Closed Panel
- D) Captive Group Model
Show answer & explanation
Answer: A
In an Open Panel or IPA model, the HMO contracts with physicians who operate out of their own offices and may see non-HMO patients. A Staff Model (B) or Closed Panel (C) typically involves physicians who are employees of the HMO or are restricted to seeing only HMO members.
Question 4 (Chapter 6)
In an Oklahoma HMO, the system of paying a provider a fixed, monthly fee for each member regardless of whether the member seeks medical care is called:
- A) Fee-for-service
- B) Indemnity
- C) Capitation
- D) Co-payment
Show answer & explanation
Answer: C
Capitation is the primary method of compensating HMO providers. It shifts the financial risk to the provider, as they receive the same 'per head' (capitated) payment regardless of the volume of services provided.
Question 5 (Chapter 6)
What happens to a Credit Disability insurance policy if the underlying loan is paid off early or refinanced?
- A) The coverage continues until the original 5-year term expires.
- B) The coverage is automatically converted to a standalone Disability Income policy.
- C) The coverage terminates, and the insured may be entitled to a premium refund.
- D) The insured must continue to pay premiums to the lender.
Show answer & explanation
Answer: C
Because Credit Disability is tied to a specific debt, if the debt is cancelled or paid off, the insurance coverage ends. A pro-rata refund of unearned premium is usually required.
Question 6 (Chapter 6)
In an Oklahoma HMO, the 'Capitation' method of provider reimbursement means the doctor is paid:
- A) A fee for every individual service or procedure performed.
- B) A percentage of the HMO's annual profits.
- C) Only when the patient is successfully cured of their ailment.
- D) A fixed monthly fee for every HMO member assigned to them, regardless of whether the member is treated.
Show answer & explanation
Answer: D
Capitation is a 'per head' payment system. The HMO pays the provider a set amount each month for each member in their care. This shifts some of the financial risk to the provider to encourage efficient care.
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Practice Questions 7-12: Non-Occupational Disability, Business Overhead Expense, the Birthday Rule and Long-Term Care Basics
Chapter 6 finishes with disability income and coordination of benefits: what a non-occupational policy pays for, how a Business Overhead Expense policy is taxed, and which parent's group plan is primary for a child under the birthday rule. Chapter 7 then opens long-term care with the Oklahoma income tax treatment of premiums, the kind of care a long-term care policy does not cover, and which authority penalizes a producer who skips the required disclosures.
Question 7 (Chapter 6)
A 'Non-occupational' Disability Income policy will pay benefits in which of the following scenarios?
- A) The insured is injured while working on the job.
- B) The insured is injured at home while mowing the lawn.
- C) The insured develops a disease caused by workplace chemicals.
- D) The insured is injured while performing duties for a second employer.
Show answer & explanation
Answer: B
Non-occupational policies only cover disabilities that occur off the job. Injuries occurring on the job are typically expected to be covered by Workers' Compensation.
Question 8 (Chapter 6)
A small business owner in Broken Arrow purchases a Business Overhead Expense (BOE) Disability policy. If the owner becomes disabled, how are the premiums and benefits treated for tax purposes?
- A) Premiums are not deductible, and benefits are tax-free.
- B) Premiums are tax-deductible, and benefits are tax-free.
- C) Premiums are tax-deductible as a business expense, and benefits are taxable as income.
- D) Neither premiums nor benefits have any tax implications.
Show answer & explanation
Answer: C
For BOE policies, the IRS (and Oklahoma state tax law) allows the premiums to be deducted as a legitimate business expense. However, because the premiums were deducted, any benefits received to pay for business expenses are considered taxable income.
Question 9 (Chapter 6)
A child is covered under both parents' group health plans in Oklahoma. The father's birthday is January 15 and the mother's birthday is March 22. According to the 'Birthday Rule,' which plan is primary?
- A) The mother's plan, because March is later than January.
- B) The plan of the parent who has been employed longer.
- C) The father's plan, because his birthday occurs earlier in the calendar year.
- D) The plans share the cost 50/50 regardless of birthdays.
Show answer & explanation
Answer: C
The 'Birthday Rule' states that the primary plan for a dependent child is the plan of the parent whose birthday (month and day) falls earlier in the calendar year. January 15 comes before March 22.
Question 10 (Chapter 7)
Which of the following is TRUE regarding the tax treatment of Long-Term Care insurance premiums for an Oklahoma resident filing a state income tax return?
- A) LTC premiums are never deductible at the state level.
- B) LTC premiums are only deductible if the insured is under age 50.
- C) Only Medicare Advantage premiums are deductible in Oklahoma.
- D) LTC premiums may be deductible from Oklahoma taxable income, subject to certain limits.
Show answer & explanation
Answer: D
Oklahoma provides tax incentives for Long-Term Care insurance. Premiums paid for a qualified LTC policy may be deductible from Oklahoma state income tax, encouraging residents to plan for their own care needs.
Question 11 (Chapter 7)
Which of the following services is typically NOT covered by a standard Long-Term Care insurance policy?
- A) Acute care in a hospital for a heart attack.
- B) Assistance with Activities of Daily Living (ADLs) like bathing and dressing.
- C) Custodial care in a nursing home.
- D) Adult day care services.
Show answer & explanation
Answer: A
LTC insurance is designed for chronic, long-term custodial or skilled care. Acute care (short-term, intensive medical treatment in a hospital) is covered by major medical insurance or Medicare, not LTC.
Question 12 (Chapter 7)
An Oklahoma producer is assisting a client with a Long-Term Care (LTC) application. The producer fails to provide the 'Long-Term Care Personal Worksheet' and the 'Things You Should Know Before You Buy' disclosure. Which Oklahoma authority is responsible for penalizing this violation?
- A) The Oklahoma Life and Health Insurance Guaranty Association.
- B) The Centers for Medicare and Medicaid Services (CMS).
- C) The Oklahoma Insurance Commissioner (OID).
- D) The Oklahoma Attorney General's Consumer Protection Division.
Show answer & explanation
Answer: C
The Oklahoma Insurance Commissioner (OID) has the authority to enforce state insurance laws and regulations, including suitability and disclosure requirements for Long-Term Care insurance (36 O.S. §1435.13).
Practice Questions 13-17: Medicare Supplement Plan N, Part D Penalties, the Partnership Program and Enrollment Periods
Chapter 7 closes the Health set on Medicare and long-term care: what a Medicare Supplement Plan N insured pays at a non-preventive office visit, how a Part D late enrollment penalty is calculated, what asset disregard does for the buyer of a Partnership-qualified long-term care policy, when a Medicare Advantage member can switch to another Medicare Advantage plan, and when the initial enrollment period for Part D begins and ends.
Question 13 (Chapter 7)
A client in Norman has Medicare Supplement Plan N. She visits her primary care physician for a non-preventive office visit. Under Plan N rules, what is her typical cost-sharing responsibility for this visit?
- A) She pays a copayment of up to $20.
- B) She pays nothing; Plan N covers 100% of Part B coinsurance.
- C) She pays a copayment of up to $50 for all office visits.
- D) She must pay the full Medicare-approved amount until she meets a $500 deductible.
Show answer & explanation
Answer: A
Medicare Supplement Plan N requires the insured to pay a copayment of up to $20 for some office visits and up to $50 for emergency room visits that do not result in inpatient admission.
Question 14 (Chapter 7)
An Oklahoma resident, Mr. Thompson, delayed enrolling in Medicare Part D for 24 months after his Initial Enrollment Period ended because he felt he didn't need it. He did not have any other 'creditable coverage' during this time. When he finally joins a plan, how will his late enrollment penalty be calculated?
- A) He will pay an additional 1% of the 'national base beneficiary premium' for every full month he was eligible but not enrolled.
- B) He will pay a flat $50 fine for each year he delayed enrollment.
- C) He will be barred from enrolling in Part D for a period equal to the time he delayed enrollment.
- D) He will pay a 10% surcharge on his Part B premiums for the rest of his life.
Show answer & explanation
Answer: A
Medicare Part D late enrollment penalties are calculated as 1% of the national base beneficiary premium for every full month the individual was eligible but lacked creditable coverage. Option D describes the Part B penalty, not Part D.
Question 15 (Chapter 7)
Under the Oklahoma Long-Term Care Partnership Program, what is the primary incentive for a consumer to purchase a 'Partnership-Qualified' policy?
- A) It provides 'Asset Disregard' during Medicaid eligibility determination, protecting one dollar of assets for every dollar of benefits paid by the policy.
- B) The premiums are 100% tax-deductible on federal returns regardless of income.
- C) It guarantees that the insured will never be moved to a different nursing home.
- D) It eliminates the elimination period entirely.
Show answer & explanation
Answer: A
The Partnership Program allows Oklahomans to protect (disregard) assets from Medicaid spend-down requirements. For every dollar the LTC policy pays out in benefits, the individual can keep a dollar of assets and still qualify for Medicaid.
Question 16 (Chapter 7)
An Oklahoma resident, Mr. Miller, is currently enrolled in a Medicare Advantage (Part C) plan. On February 15th, he decides he is unhappy with the plan's network and wants to switch to a different Medicare Advantage plan. Which of the following is TRUE regarding his ability to make this change?
- A) He must wait until the Annual Election Period (AEP) in October to make any changes.
- B) He can switch to another Medicare Advantage plan during the Medicare Advantage Open Enrollment Period (MA OEP).
- C) He can only switch if he qualifies for a Special Enrollment Period (SEP) due to a move.
- D) He can switch plans at any time of the year as long as he pays a late enrollment penalty.
Show answer & explanation
Answer: B
The Medicare Advantage Open Enrollment Period (MA OEP) runs from January 1st to March 31st each year. During this time, individuals already enrolled in a Medicare Advantage plan can make a one-time switch to another Medicare Advantage plan or return to Original Medicare and join a Part D plan.
Question 17 (Chapter 7)
An individual is approaching their 65th birthday in July. When does their Initial Enrollment Period (IEP) for Medicare Part D begin and end?
- A) July 1st to July 31st (the month of their birthday).
- B) April 1st to October 31st (3 months before, the month of, and 3 months after their birthday).
- C) January 1st to December 31st of the year they turn 65.
- D) The 63 days following their 65th birthday.
Show answer & explanation
Answer: B
The Initial Enrollment Period (IEP) for Medicare (including Part D) is a 7-month window: 3 months before the month the individual turns 65, the month of the birthday, and 3 months after.
The Mistakes That Cost Marks
Mixing up HMO models and payment methods. In an open panel or independent practice association (IPA) model, the HMO contracts with physicians who work from their own offices and may also see patients from other plans, as the physician in question 3 does. In a staff model or closed panel, the physicians work for or exclusively with the HMO. Capitation pays the provider a fixed monthly amount for each member assigned, whether or not that member is treated. It is not a fee for each service, a share of the HMO's profits or a payment tied to a cure, and it shifts part of the financial risk to the provider. Questions 4 and 6 test it from two directions.
Mixing up group plan roles and rules. When an employer sets up a group health plan, the employer is the policyholder and receives the master contract, while employees are certificate holders. OID regulates MEWAs closely to keep them solvent and to stop them from being used to avoid state insurance rules. Under the birthday rule, the primary plan for a dependent child is the plan of the parent whose birthday, counting month and day only, falls earlier in the calendar year. The year of birth and the length of employment do not matter.
Missing what limits a disability product. A non-occupational disability income policy pays only for disabilities that happen off the job, because injuries at work are expected to fall under workers' compensation. A credit disability policy is tied to one loan, so the coverage ends when the loan is paid off or refinanced, and the insured may be owed a refund of unearned premium. A Business Overhead Expense policy is deductible on the way in and taxable on the way out: the premiums are a business expense and the benefits are taxable.
Expecting long-term care to pay for acute care. Long-term care insurance is built for chronic custodial or skilled care, help with activities of daily living and services like adult day care. Acute hospital care for a heart attack belongs to major medical insurance or Medicare. Two more points from this block: premiums for a qualified long-term care policy may be deductible from Oklahoma taxable income, subject to limits, and a producer who skips the required long-term care disclosures answers to the Insurance Commissioner through OID, not to CMS, the Attorney General or the guaranty association.
Getting the Partnership Program backwards. A Partnership-qualified long-term care policy gives asset disregard when Medicaid eligibility is determined: for every dollar of benefits the policy pays, a dollar of assets is protected from the spend-down requirement. It does not remove the elimination period, guarantee a particular nursing home or make premiums fully deductible on federal returns.
Misjudging Medicare costs. Medicare Supplement Plan N is not a first-dollar plan: the insured pays a copayment on some office visits and on emergency room visits that don't lead to an admission. A Part D late enrollment penalty is a percentage of the national base beneficiary premium for every full month the person was eligible but had no creditable coverage. It is not a flat fine, a lockout or a surcharge on the Part B premium.
Misjudging the enrollment windows. A Medicare Advantage member who wants a different Medicare Advantage plan can switch during the Medicare Advantage Open Enrollment Period early in the year, without waiting for the annual election period and without a special circumstance. The initial enrollment period for Part D is built around the birthday month in which the person becomes eligible, with months on each side of it, so it is not the birthday month alone and not a window that opens only after the birthday.
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 Oklahoma 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 6 of the LanePrep Oklahoma Life & Health course and work forward through Chapter 7 rather than testing yourself again right away. A free preview is available at /ok/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 item counts from PSI Services LLC's Oklahoma Insurance Department Candidate Information Bulletin (dated 7/1/2026) and the PSI content outlines for the Accident and Health or Sickness and combined exams (effective 8/1/2026); pass rates from the NAIC compiled pass-rate workbooks for 2024 and 2025. Read October 2026.
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