17 Free Pennsylvania Life & Health Practice Questions: Individual A&H, Disability, Medical Plans, Group and Dental (2026)

Question 1 (Chapter 6)

Mark holds an individual disability income policy in Pennsylvania that defines total disability during the first two years as the insured's inability to perform the substantial and material duties of their own regular occupation. After two years, the definition shifts to the inability to perform the duties of any occupation for which they are reasonably suited by education, training, or experience. What type of total disability definition does Mark's policy utilize after the initial two-year period?

• A) Own occupation definition
• B) Presumptive disability definition
• C) Residual disability definition
• D) Any occupation definition

Question 2 (Chapter 6)

An insured allows their individual health policy to lapse for nonpayment of premium. The insurer subsequently sends an application for reinstatement. According to the Reinstatement provision (40 P.S. § 753(A)(4)), if the insurer takes no action and fails to approve or reject the reinstatement application within how many days from the date of application, is the policy automatically reinstated?

• A) 15 days
• B) 30 days
• C) 60 days
• D) 45 days

Question 3 (Chapter 6)

An individual disability income policy in Pennsylvania contains an optional provision regarding a 'Change of Occupation' (40 P.S. § 753(B)(1)). If an insured changes to a more hazardous occupation and is injured, how does the insurer typically adjust the policy benefits?

• A) Adjust the indemnity to the amount that the premium paid would have purchased at the more hazardous classification
• B) Cancel the policy immediately and refund all past premiums
• C) Double the monthly benefit to match the increased occupational risk
• D) Deny the claim entirely without any return of premium

Question 4 (Chapter 6)

A Pennsylvania small business owner purchases a Disability Buy-Sell insurance policy funded by a business entity. What is the primary purpose of this type of business disability insurance?

• A) To reimburse the business for ongoing operating expenses like rent and utilities if the owner becomes disabled
• B) To replace the personal salary of the disabled owner for household expenses
• C) To pay for temporary clerical staff while an employee is out on maternity leave
• D) To provide funds to buy out a disabled owner's interest in the business so the healthy partners can maintain control

Question 5 (Chapter 6)

A comprehensive major medical health insurance policy features a $1,000 deductible, an 80/20 coinsurance clause, and a $5,000 out-of-pocket stop-loss limit. The insured incurs $11,000 in covered medical expenses. How much in total will the insurer pay for these expenses?

• A) $8,000
• B) $7,200
• C) $10,000
• D) $8,800

Question 6 (Chapter 6)

An employer in Pennsylvania is setting up a group dental plan and wants to minimize administrative complexity and adverse selection by combining medical and dental deductibles into a single pool. What type of dental plan structure features a shared deductible across medical and dental expenses?

• A) Integrated deductible plan
• B) Stand-alone dental plan
• C) Nonscheduled dental indemnity plan
• D) Prepaid capitation plan

Question 7 (Chapter 6)

Under the Health Insurance Portability and Accountability Act (HIPAA) (40 P.S. § 981-1), group health plans are restricted in how they can apply pre-existing condition exclusions. Which of the following best describes HIPAA's protection regarding pre-existing conditions when individuals transition between group health plans?

• A) Pre-existing conditions can be permanently excluded by any new employer plan forever
• B) HIPAA prohibits all group health plans from ever asking about medical history
• C) Certificates of prior creditable coverage can be used to reduce or eliminate pre-existing condition waiting periods under a new group plan
• D) HIPAA requires the state government to pay all medical bills for pre-existing conditions

Question 8 (Chapter 6)

Under the 'Illegal Occupation' provision (40 P.S. § 753(B)(10)), what is the insurer's liability if the insured is injured while committing a felony?

• A) The insurer is not liable for any loss sustained as a result of the insured's commission of a felony.
• B) The insurer must pay the claim but can sue the insured for damages.
• C) The insurer must pay 50% of the claim as a penalty.
• D) The insurer must pay the claim if the insured was not convicted of the crime.

Question 9 (Chapter 6)

Under the 'Physical Examinations and Autopsy' provision (40 P.S. § 753(A)(10)), who bears the cost of the exam or autopsy?

• A) The beneficiary.
• B) The state insurance department.
• C) The insurer.
• D) The insured's estate.

Question 10 (Chapter 6)

An insurance policy contains the 'Conformity with State Statutes' provision (40 P.S. § 753(B)(9)). What is the purpose of this provision?

• A) It automatically amends policy provisions that conflict with Pennsylvania law to meet minimum requirements.
• B) It allows the insurer to ignore state laws if they conflict with company policy.
• C) It requires the insured to follow all state laws while traveling.
• D) It mandates that the policyholder must be a resident of Pennsylvania.

Question 11 (Chapter 6)

A group health plan's 'coordination of benefits' (COB) provision is designed to:

• A) Ensure the employer pays the full cost of all claims.
• B) Allow the insured to choose which plan pays first.
• C) Reduce the premium for the employer.
• D) Prevent the insured from making a profit by collecting more than 100% of medical expenses.

Question 12 (Chapter 6)

Under the 'Relation of Earnings to Insurance' provision (40 P.S. § 753(B)(6)), what can an insurer do if the total monthly disability benefits exceed the insured's monthly earnings at the time of disability?

• A) Pro-rate the benefits to match the insured's actual earnings.
• B) Cancel the policy immediately.
• C) Increase the premium to match the benefits.
• D) Deny the claim entirely.

Question 13 (Chapter 6)

Under the 'Time Limit on Certain Defenses' provision (40 P.S. § 753(A)(2)), after how many years is a policy considered 'incontestable' regarding misstatements on the application?

• A) 1 year.
• B) 3 years.
• C) 5 years.
• D) 2 years.

Question 14 (Chapter 6)

An insured has a disability income policy that includes a 'Future Increase Option' rider. If the insured receives a significant promotion and salary increase, how does this rider benefit them?

• A) It automatically increases the benefit amount without requiring any additional premium payment.
• B) It allows the insured to purchase additional disability coverage at specified future dates without providing new evidence of insurability.
• C) It mandates that the insurer increase the coverage amount to match the new salary level regardless of the insured's health status.
• D) It provides a lump-sum payment to the insured to compensate for the lost income during the transition period.

Question 15 (Chapter 6)

An insured with a disability policy suffers a recurrence of a previous disabling condition. If the policy includes a 'Recurrent Disability' provision, what is the typical benefit?

• A) The insured must satisfy a new elimination period for the recurrence.
• B) The recurrence is treated as a new claim, and the maximum benefit period resets.
• C) The recurrence is considered a continuation of the prior disability, and the elimination period is waived.
• D) Benefits are reduced by 50% for any recurring condition.

Question 16 (Chapter 6)

A Pennsylvania resident is covered by an individual disability income policy. The policy includes a 'presumptive disability' clause. The insured suffers a total loss of speech due to a non-work-related accident. How will the insurer typically handle the benefit payment under this specific clause?

• A) The insurer will require the insured to prove they cannot perform any occupation for at least 12 months before paying.
• B) The insurer will waive the elimination period and pay full benefits immediately, assuming total disability.
• C) The insurer will pay only 50% of the benefit amount because the insured can still perform some light tasks.
• D) The insurer will deny the claim because loss of speech does not constitute a physical disability under Pennsylvania law.

Question 17 (Chapter 6)

A dental plan covers 'major services' such as crowns and bridges. If the plan is a 'scheduled' plan, how are benefits determined?

• A) The plan pays a percentage of the dentist's actual charge.
• B) The plan pays a specific dollar amount for each procedure, regardless of the dentist's actual charge.
• C) The plan pays 100% of all costs up to an annual maximum.
• D) The plan pays only if the patient uses an in-network provider.