17 Free Virginia Life, Annuities & Health Practice Questions: Health Insurance Basics and Individual Policy Provisions (2026)
How to Use This Set
This set covers two sections of Prometric's Series 11-01 outline: Health Insurance Basics (section 9.0, 6%, 8 of the 140 scored items) and Individual Health Insurance Policy General Provisions (section 10.0, 11%, 16 items), tied for the largest section on the exam. Together they cover the limited policy types, field underwriting and the uniform provisions every individual policy carries.
Many of these questions cite Virginia's individual health policy rules. Answer first, then open the explanation. These 17 questions come from LanePrep's Virginia L&H quiz bank.
Practice Questions 1-6: Limited Policies, Defenses, Replacement and Underwriting Inputs
Specified disease notices, the time limit on certain defenses, replacing a health policy, agent reports, the free look and genetic information.
Question 1 (Chapter 6)
An insurance agent in Virginia is preparing to sell a specified disease policy that covers only stroke and heart attack. According to Virginia regulations, what must the agent ensure is provided to the applicant at the time of application?
- A) A copy of the insurer's annual financial statement
- B) Proof of the applicant's prior hospitalization for cardiac issues
- C) A waiver of the free-look period
- D) Clear notice that the policy is limited in scope and does not provide comprehensive health coverage
Show answer & explanation
Answer: D
Virginia law and regulations require that limited policies, including specified (dread) disease policies, must include clear notice to the insured about their limited scope. This is a key agent responsibility under field underwriting and marketing requirements. The other options are incorrect: financial statements are not required at application, prior hospitalization proof is not a standard requirement for specified disease policies, and the free-look period cannot be waived by the applicant—it is a statutory right under § 38.2-3502.
Question 2 (Chapter 6)
A Virginia insurance agent is explaining the 'time limit on certain defenses' provision to a client. Which statement correctly describes how this uniform required provision functions in an individual health insurance policy?
- A) The insurer may deny a claim for any reason if submitted more than 60 days after the loss.
- B) After the policy has been in force for two years, the insurer cannot deny a claim based on a pre-existing condition unless it was fraudulently concealed.
- C) Claims must be paid within 30 days of receipt of proof of loss, or the insurer owes interest.
- D) The insurer has three years from the date of a loss to contest the validity of the policy or deny a claim based on a misrepresentation in the application.
Show answer & explanation
Answer: B
The time limit on certain defenses is the health-policy version of incontestability. After the policy has been in force for two years, the insurer may no longer void the policy or deny a claim because of misstatements in the application (except fraudulent ones), and may no longer deny a claim as a pre-existing condition unless the condition was excluded by name, so B is correct. A describes nothing in the provision, C is the time-of-payment provision, and D misstates both the period and the date it runs from.
Question 3 (Chapter 6)
Under Virginia's individual health insurance replacement regulations (14VAC5-141-150), what must an agent do when proposing to replace an existing health insurance policy with a new one?
- A) Ensure the new policy provides at least the same benefits as the old policy and disclose any differences in benefits, limitations, or exclusions.
- B) Advise the client to cancel the existing policy immediately to avoid paying two premiums.
- C) Guarantee that the new policy will have lower premiums than the existing policy.
- D) Avoid discussing the existing policy's pre-existing condition exclusion to prevent confusion.
Show answer & explanation
Answer: A
Virginia's replacement requirements (14VAC5-141-150) mandate that agents must compare the old and new policies, ensure the new policy is suitable, and disclose all material differences in benefits, limitations, and exclusions. Agents must not advise immediate cancellation (B), as this could create a gap in coverage. They cannot guarantee lower premiums (C), as this is not always true and may be misleading. Discussing pre-existing condition exclusions is required (D is wrong)—avoiding it would violate disclosure rules and increase E&O risk.
Question 4 (Chapter 6)
A Virginia insurance agent is completing field underwriting for an individual health insurance applicant. Which of the following pieces of information is typically obtained from the applicant's agent report?
- A) Results of the applicant's HIV test conducted at a clinic
- B) The applicant's height, weight, blood pressure, and pulse from a paramedical exam
- C) The agent's observations about the applicant's occupation, hobbies, and general health appearance
- D) Confirmation of the applicant's Medicare eligibility status
Show answer & explanation
Answer: C
The agent report (also called the producer's report) contains the agent's observations about the applicant, including occupation, hobbies, lifestyle, and general health appearance, which help assess risk. HIV test results (A) come from medical exams or lab tests with consent, not the agent report. Height, weight, blood pressure, and pulse (B) are obtained from paramedical exams. Medicare eligibility (D) is not part of standard field underwriting for private health insurance and is addressed separately through notification requirements.
Question 5 (Chapter 6)
Under Virginia law, which of the following is a prohibited basis for underwriting or rate classification in individual health insurance due to genetic information privacy protections?
- A) The applicant's current cholesterol levels from a recent blood test
- B) The applicant's family history of hypertension
- C) The applicant's occupation as a construction worker
- D) Results of a genetic test indicating a predisposition to Alzheimer's disease
Show answer & explanation
Answer: D
Virginia law prohibits the use of genetic information in underwriting health insurance under §§ 38.2-508.4 and 613(C), which fall under genetic information privacy protections. Using results from a genetic test indicating a predisposition to Alzheimer's disease would constitute unfair discrimination based on genetic information. Cholesterol levels (A) and family history of hypertension (B) are permissible underwriting factors, as they are not protected genetic information under these statutes. Occupation (C) is also a valid risk classification factor and not prohibited by genetic privacy laws.
Question 6 (Chapter 6)
Under Virginia's genetic information privacy laws, which of the following actions is prohibited for an insurer when underwriting an individual health insurance policy?
- A) Requesting that the applicant undergo a genetic test as part of the underwriting process
- B) Considering family medical history when classifying risk for coverage
- C) Using information obtained from the Medical Information Bureau (MIB) that includes genetic test results
- D) Using the results of a genetic test to determine eligibility for coverage if the applicant has not exhibited symptoms of the condition
Show answer & explanation
Answer: D
Virginia Code §§ 38.2-508.4 and 613(C) prohibit insurers from using genetic information, including the results of genetic tests, to deny coverage, limit benefits, or establish eligibility requirements for individuals who are asymptomatic for the condition. While insurers may request genetic tests (though this is rare and regulated), consider family medical history, or use MIB information, they are expressly prohibited from using genetic test results to make underwriting decisions for asymptomatic individuals. Using MIB data containing genetic test results would also be prohibited if used for underwriting, but the primary prohibition is on the use of the genetic information itself for eligibility or rating.
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Practice Questions 7-12: Reinstatement, Replacement, Reports and Limited Coverages
Reinstatement, what a replacement notice must compare, investigative consumer reports, vision coverage and the insuring clause.
Question 7 (Chapter 6)
A Virginia resident has an individual health insurance policy with a 'reinstatement' uniform required provision. The policy lapsed due to nonpayment of premium on August 1. The insured submits a late premium payment on August 20 along with a statement of good health. What is required for the policy to be reinstated under this provision?
- A) The insurer must accept the late premium and reinstate the policy without any additional requirements
- B) The insurer may require evidence of insurability, such as a statement of good health, before reinstating the policy
- C) The policy can only be reinstated if the lapse was less than 30 days
- D) The insured must submit a new application and undergo full underwriting as if applying for the first time
Show answer & explanation
Answer: B
The 'reinstatement' uniform required provision (§ 38.2-3503(A)) allows an insured to restore a lapsed policy by paying overdue premiums, but the insurer may require evidence of insurability (such as a statement of good health) before agreeing to reinstate coverage. There is no universal 30-day limit for reinstatement under this provision, and the insured does not need to submit a new application or undergo full underwriting. The policy is not automatically reinstated upon premium payment; the insurer retains the right to assess continued insurability.
Question 8 (Chapter 6)
A Virginia insurance agent is replacing a client's existing individual health insurance policy with a new policy from a different insurer. The client has a pre-existing condition that was covered under the current policy after a 12-month waiting period. Under Virginia's replacement regulations (14VAC5-141-150) and pre-existing condition exclusion rules (§ 38.2-3514.1), what must the agent do regarding the pre-existing condition exclusion in the new policy?
- A) Inform the client that the new policy must waive any pre-existing condition exclusion because the client had prior coverage
- B) Advise the client that pre-existing condition exclusions are prohibited in all replacement policies under Virginia law
- C) Provide a written comparison disclosure that includes the pre-existing condition exclusion period of the new policy and how it differs from the current policy
- D) Submit the replacement application without mentioning the pre-existing condition exclusion since the client already satisfied one waiting period
Show answer & explanation
Answer: C
14VAC5-141-150 requires the agent to provide a written comparison disclosure (often called a 'replacement notice') that includes a comparison of benefits, limitations, exclusions, and pre-existing condition provisions between the existing and proposed policies. The new policy may impose its own pre-existing condition exclusion period (subject to § 38.2-3514.1 limits), and credit for prior coverage may apply, but it is not automatic or guaranteed. A is incorrect because the new policy is not required to waive the exclusion; credit may reduce the period but is not mandatory in all cases. B is incorrect because pre-existing condition exclusions are not prohibited in replacement policies. D is incorrect because the agent must disclose the exclusion—failure to do so violates replacement regulations.
Question 9 (Chapter 6)
A Virginia insurance agent is explaining the 'time limit on certain defenses' uniform required provision (§ 38.2-3503(A)) to a client who just purchased an individual health insurance policy. The client asks when the insurer can no longer contest the policy based on misstatements in the application. Which of the following accurately describes this provision?
- A) After the policy has been in force for 30 days during the insured's lifetime, the insurer cannot contest any statements in the application
- B) After the first premium is paid, the insurer has 60 days to investigate the application and must then accept all statements as true
- C) The insurer can never contest the policy after the free look period expires, regardless of fraud
- D) After the policy has been in force for 2 years during the insured's lifetime (except for fraudulent misstatements), the insurer cannot contest the policy or deny a claim based on application misstatements
Show answer & explanation
Answer: D
The 'time limit on certain defenses' (incontestability) provision (§ 38.2-3503(A)) provides that after the policy has been in force for 2 years during the insured's lifetime (excluding any period of disability), the insurer cannot contest the policy or deny a claim based on misstatements in the application, except for fraudulent misstatements. A is incorrect because the period is 2 years, not 30 days. C is incorrect because there is no 60-day investigation window in this provision. B is incorrect because fraudulent misstatements remain contestable even after 2 years.
Question 10 (Chapter 6)
A Virginia resident applies for an individual health insurance policy. The insurer requests an investigative consumer (inspection) report as part of underwriting. Under the Fair Credit Reporting Act and Virginia law, which of the following is a required step before the insurer can obtain this report?
- A) The insurer must notify the applicant in writing that an investigative consumer report may be obtained and disclose the nature and scope of the investigation
- B) The insurer must obtain a court order authorizing the investigation
- C) The agent must personally interview the applicant's neighbors and employers before requesting the report
- D) The applicant must sign a separate authorization form specifically for the investigative consumer report, distinct from the application authorization
Show answer & explanation
Answer: A
Under the Fair Credit Reporting Act (FCRA) § 606 and Virginia law, before obtaining an investigative consumer report, the insurer must provide the applicant with a clear and conspicuous written disclosure that such a report may be obtained, including the nature and scope of the investigation. The applicant must also authorize it. B is incorrect—no court order is needed. C is incorrect—the agent does not conduct the investigation; a consumer reporting agency does. D is incorrect—while authorization is required, it can be included in the application authorization; a separate form is not mandated by statute.
Question 11 (Chapter 6)
A Virginia resident purchases an individual health insurance policy that covers only vision care expenses, such as routine eye exams, glasses, and contact lenses. The policy explicitly states it does not cover any medical expenses, hospitalizations, or prescription drugs. What type of limited health insurance policy does this describe?
- A) Accident-only insurance
- B) Specified (dread) disease insurance
- C) Vision care insurance
- D) Critical illness insurance
Show answer & explanation
Answer: C
Vision care insurance is a type of limited health insurance policy that covers only vision-related expenses, such as eye exams, glasses, and contact lenses, and explicitly excludes medical, hospitalization, and prescription drug coverage. Accident-only insurance covers injuries from accidents, specified disease covers specific illnesses like cancer or heart attack, and critical illness provides a lump-sum for conditions like kidney failure or major organ transplant. The scenario matches the definition of vision care insurance as outlined in the Virginia Life, Annuities, and Health Insurance Examination content outline under limited policies.
Question 12 (Chapter 6)
Which of the following is a required element of the insuring clause in an individual health insurance policy issued in Virginia?
- A) A statement that the insurer will pay a lump-sum benefit upon diagnosis of a critical illness.
- B) A promise by the insurer to provide coverage in exchange for the payment of premiums.
- C) A detailed list of all exclusions that apply to the policy.
- D) The policyholder's signature acknowledging receipt of the policy.
Show answer & explanation
Answer: B
The insuring clause in an individual health insurance policy contains the insurer's fundamental promise to provide coverage or pay benefits in exchange for the payment of premiums. It defines the scope of the insurer's obligation. Options A, C, D describe other policy components: a lump-sum critical illness benefit is part of the policy's benefits (not the insuring clause), exclusions are covered elsewhere, the signature is part of delivery, and the free look period is a separate provision (§ 38.2-3502).
Practice Questions 13-17: Critical Illness, Other Insurance, Guaranty Disclosure and Renewability
Lump-sum critical illness benefits, pregnancy and underwriting, the coordination provision, guaranty association disclosure and what guaranteed renewable lets an insurer change.
Question 13 (Chapter 6)
A Virginia resident is considering a critical illness insurance policy that pays a lump-sum benefit upon diagnosis of covered conditions such as heart attack, stroke, or kidney failure. Which of the following best describes a key characteristic of this type of limited health insurance policy?
- A) It reimburses the insured for actual medical expenses incurred up to a policy limit.
- B) It provides a fixed cash payment upon diagnosis of a specified condition, regardless of actual expenses.
- C) It only covers injuries resulting from accidents, such as fractures or lacerations.
- D) It pays a daily benefit for each day of hospitalization due to any cause.
Show answer & explanation
Answer: B
Critical illness insurance is a limited health insurance policy that provides a lump-sum benefit upon the diagnosis of a specified condition (e.g., heart attack, stroke, kidney failure). The benefit is paid regardless of the actual medical expenses incurred and is not tied to reimbursement of costs. It does not reimburse actual expenses (A), cover only accident injuries (C), pay daily hospitalization benefits (D), or pay off loans. The lump-sum, diagnosis-triggered payment is the defining feature of critical illness policies as outlined in the Virginia exam content outline.
Question 14 (Chapter 6)
A Virginia insurance agent is completing an application for an individual health insurance policy. The applicant discloses they are currently pregnant. Which of the following statements is true regarding the insurer's underwriting decision under Virginia law?
- A) The insurer may decline coverage or impose an exclusion rider for pregnancy-related conditions as a pre-existing condition.
- B) The insurer must accept the application but may charge a higher premium due to the increased risk.
- C) The insurer may postpone the application until after the pregnancy is completed.
- D) The insurer cannot consider pregnancy in underwriting and must treat it as any other condition for coverage purposes.
Show answer & explanation
Answer: D
Under the federal Pregnancy Discrimination Act and Virginia's incorporation of non-discrimination principles (§ 38.2-508 et seq.), pregnancy cannot be used as a basis to deny coverage, charge higher premiums, impose exclusion riders, or postpone applications in individual health insurance underwriting. Pregnancy must be treated like any other medical condition. Options A, B, and C describe prohibited discriminatory practices under federal law that Virginia insurers must follow.
Question 15 (Chapter 6)
Which of the following scenarios best illustrates a situation where the 'insurance with other companies' uniform optional provision (§ 38.2-3504) would apply to coordinate benefits in an individual health insurance policy?
- A) The policyholder has two separate health insurance policies with the same insurer and incurs a medical expense covered under both policies.
- B) The policyholder has health insurance through their employer and also purchases an individual supplemental policy.
- C) The policyholder is covered under Medicare and also has an individual private health insurance policy.
- D) The policyholder has an individual health insurance policy and also receives benefits from Virginia's Medicaid program.
Show answer & explanation
Answer: B
The 'insurance with other companies' provision coordinates benefits when the insured has coverage under multiple policies, specifying whether benefits are paid on an expense-incurred basis (to avoid over-insurance) or another basis. This applies when the insured has policies with different insurers, such as an employer group plan and an individual supplemental policy. Options A, C, and D are incorrect: option A describes the 'other insurance in this company' provision (same insurer), while options C and D involve government plans (Medicare/Medicaid), which are typically coordinated by law, not this private policy provision; moreover, Medicaid is generally secondary and the provision's application to government plans is limited by coordination-of-benefits regulations.
Question 16 (Chapter 6)
Under Virginia law, which of the following is a required disclosure that must be made to an applicant for an individual health insurance policy regarding the Life, Accident and Sickness Insurance Guaranty Association?
- A) The applicant must be informed that the Guaranty Association covers 100% of all claims, with no upper limit.
- B) The applicant must be provided with a statement that the Guaranty Association protects policyholders if an insurer becomes insolvent, up to the limits specified in § 38.2-1715.
- C) The applicant must be shown the Guaranty Association's most recent financial statements to assess its solvency.
- D) The applicant must be informed that participation in the Guaranty Association is voluntary for insurers.
Show answer & explanation
Answer: B
Virginia law (§ 38.2-1715) requires that applicants for individual health insurance be informed about the Life, Accident and Sickness Insurance Guaranty Association, including that it provides protection to policyholders if an insurer becomes insolvent, subject to the monetary limits and other conditions specified in the statute. This is a standard disclosure to educate applicants about the backup protection available. Options A, C, and D are incorrect: coverage is not 100% unlimited (it has limits like $300,000 for major medical), financial statements are not required disclosures, and participation is mandatory for insurers writing these lines, not voluntary.
Question 17 (Chapter 6)
A Virginia resident has an individual health insurance policy with a 'guaranteed renewable' renewability clause under § 38.2-3514.2. After three years, the insurer wants to increase premiums for all policies of this form in Virginia due to adverse claims experience. Which of the following statements accurately describes the insurer's authority to change premiums?
- A) The insurer may increase premiums on a class basis for all policies of this form in Virginia, but not based on the individual's claims history
- B) The insurer may increase premiums only with the policyholder's written consent
- C) The insurer may increase premiums only at the policy's anniversary date and only by a maximum of 10% per year
- D) The insurer may not increase premiums at any time under a guaranteed renewable policy
Show answer & explanation
Answer: A
Correct: Under § 38.2-3514.2, a guaranteed renewable policy allows the insurer to change premiums on a class basis (e.g., all policies of that form in Virginia) but not based on an individual's claims experience or health status. B is incorrect because individual consent is not required for class-based increases. C is incorrect because Virginia law does not cap the percentage increase at 10%. D is incorrect because guaranteed renewable does not mean premiums are frozen; only noncancelable policies guarantee level premiums.
The Mistakes That Cost Marks
Reading limited policies as comprehensive. Specified disease, vision, accident-only and critical illness policies cover narrow risks, and the applicant must be told so.
Mixing up the benefit styles. Critical illness pays a fixed lump sum on diagnosis regardless of actual expenses. Expense-incurred policies reimburse costs.
Forgetting what the agent report contains. It holds the agent's own observations about occupation, hobbies and general appearance. Test results and paramedical measurements come from other sources.
Confusing the two coordination provisions. "Insurance with other companies" concerns coverage from different insurers. "Other insurance in this company" concerns coverage from the same insurer.
Treating guaranteed renewable as frozen premiums. The insurer cannot cancel the policy, but it can change premiums for a whole class of policies, not for one insured based on that person's claims.
Skipping the replacement disclosure. A replacement needs a comparison of benefits, limitations and exclusions, including the pre-existing condition provisions.
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