17 Free Iowa Life & Health Practice Questions: Iowa Accident & Health Insurance Law (2026)
How to Use This Iowa Accident and Health Law Set
Iowa law pertinent to accident and health insurance only is the second half of the Accident & Health exam's Iowa section: 15 of the exam's 80 scored items. The other 15 Iowa items, law common to all lines, are tested on this exam too. Pearson VUE's outline lists the health-only topics as individual and group health, Medicare supplement, long-term care, the HAWK-I and HIPIOWA special programs, the Affordable Care Act and the No Surprises Act. Iowa tests Accident & Health on its own exam, separate from Life, and this set belongs to it.
These 17 questions come from LanePrep's Iowa L&H quiz bank and cite the rules they test. The outline prints a rule beside each subtopic: for example IAC 191-37 for Medicare supplement, IAC 191-39 for long-term care, Iowa Code chapter 514I for HAWK-I and Iowa Code chapter 514E for HIPIOWA. Federal rules that apply in Iowa, such as the No Surprises Act and the ACA, are in the mix too.
Sort by market first: individual, small group, large group, Medicare supplement or long-term care. A rule that is right for one market is a classic wrong answer for another.
Practice Questions 1-6: Adopted Children, HIPIOWA, Proof of Loss and the No Surprises Act
When coverage for an adopted child starts, what HIPIOWA is, how the No Surprises Act protects against balance billing and what it leaves the patient to pay, the proof-of-loss deadline, and how much of a group a noncontributory plan must cover.
Question 1 (Chapter 8)
A couple in Des Moines finalizes the adoption of a 2-year-old child on October 15th. They wish to add the child to their existing family health policy. According to Iowa Code section 514C.10, when does coverage for this child begin?
- A) On the first day of the month following the finalization of the adoption.
- B) Only after the child passes a physical examination required by the insurer.
- C) After a standard 90-day waiting period for pre-existing conditions.
- D) From the date of placement for the purpose of adoption or from the date of the final decree of adoption.
Show answer & explanation
Answer: D
Iowa Code section 514C.10 stipulates that health policies must provide coverage for an adopted child from the date of placement for adoption or the date of the final decree of adoption, under the same terms as a biological child.
Question 2 (Chapter 8)
An Iowa resident who has been denied health insurance due to a high-risk medical condition may be eligible for coverage through HIPIOWA. What does HIPIOWA stand for under Iowa Code Chapter 514E?
- A) Health Insurance Plan of Iowa
- B) Health Insurance Program for Iowa Working Adults
- C) High-risk Insurance Pool of Iowa
- D) Health Information Portability in Iowa
Show answer & explanation
Answer: A
HIPIOWA stands for the Health Insurance Plan of Iowa, as established in Iowa Code Chapter 514E. It serves as the state's comprehensive health insurance association for 'uninsurable' individuals (though its role has changed significantly since the ACA).
Question 3 (Chapter 8)
Under the 'No Surprises Act' as it applies to Iowa residents, which scenario is protected from 'balance billing'?
- A) An insured individual receives emergency services from an out-of-network provider or facility.
- B) A patient chooses to see an out-of-network primary care doctor for a routine physical.
- C) A patient uses an out-of-network pharmacy for a maintenance medication.
- D) An individual purchases a short-term limited-duration policy that does not cover specialists.
Show answer & explanation
Answer: A
The No Surprises Act protects consumers from surprise balance billing for emergency services from out-of-network providers or facilities, and for certain non-emergency services provided by out-of-network providers at in-network facilities.
Question 4 (Chapter 8)
Under Iowa Code 514A.3, 'Proof of Loss' for a health insurance claim must generally be submitted to the insurer within how many days after the date of such loss?
- A) 30 days
- B) 60 days
- C) 180 days
- D) 90 days
Show answer & explanation
Answer: D
Written proof of loss must be furnished to the insurer within 90 days after the date of the loss for which claim is made (Iowa Code 514A.3).
Question 5 (Chapter 8)
A company in Des Moines with 100 employees applies for a group health insurance policy. According to Iowa Code section 509.1, if the employees are not required to contribute to the premium (noncontributory), what percentage of eligible employees must be covered by the plan?
- A) 100%
- B) 50%
- C) 75%
- D) Only those who pass a medical examination
Show answer & explanation
Answer: A
Under Iowa Code 509.1, for noncontributory group health plans (where the employer pays the entire premium), 100% of eligible employees must be covered to prevent adverse selection.
Question 6 (Chapter 8)
Under the federal No Surprises Act as applied in Iowa, a patient receives emergency care at an out-of-network hospital. What is the maximum the patient can be required to pay?
- A) The full billed amount from the out-of-network hospital.
- B) A flat fee of $5,000 regardless of the service.
- C) The amount they would have paid for in-network cost-sharing (e.g., copay/deductible).
- D) Nothing; the insurer must pay 100% of the bill.
Show answer & explanation
Answer: C
The No Surprises Act protects consumers from 'balance billing' for emergency services. The patient's cost-sharing (deductibles, coinsurance) must be calculated based on in-network rates.
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Practice Questions 7-12: Medicare Supplement, Group Certificates, Claim Payment, Small-Group Rating and Long-Term Care
The Medicare supplement free-look, who delivers a group certificate, when claims must be paid, which factor a small-employer carrier may not use to set premiums, the long-term care nonforfeiture benefit, and what a carrier must offer when it discontinues a class of individual coverage.
Question 7 (Chapter 8)
A senior citizen in Sioux City receives their new Medicare Supplement policy. How long is the 'Free Look' period during which they can return the policy for a full refund for any reason (IAC 191-37.28(1)(e))?
- A) 10 days
- B) 20 days
- C) 30 days
- D) 45 days
Show answer & explanation
Answer: C
IAC 191-37.28(1)(e) requires a Medicare supplement policy or certificate to carry a prominent notice on its first page, or attached to it, stating in substance that the covered individual has the right to return it within 30 days of its delivery and have the premium refunded if, after examination, the individual is not satisfied for any reason.
Question 8 (Chapter 8)
A group health insurance policy is issued to an employer in Council Bluffs. According to Iowa Code 509.3, who is responsible for delivering the 'Certificate of Insurance' to the individual employees?
- A) The Iowa Insurance Division
- B) The individual employees must download it from a state website
- C) The Social Security Administration
- D) The insurer (through the policyholder/employer)
Show answer & explanation
Answer: D
Iowa Code 509.3 requires the insurer to provide to the policyholder (employer) for delivery to each employee a certificate setting forth a statement as to the insurance protection to which they are entitled.
Question 9 (Chapter 8)
A policyholder with an individual health policy in Iowa is injured in an accident. According to the 'Time of Payment of Claims' provision in Iowa Code 514A.3, when must the insurer pay indemnities for a loss other than one for which periodic payment is provided?
- A) Within 30 days of the end of the calendar month.
- B) Within 60 days of the date of the accident.
- C) Immediately upon receipt of due written proof of such loss.
- D) Only after the final medical bill has been adjudicated.
Show answer & explanation
Answer: C
Iowa Code 514A.3 requires that 'Time of Payment of Claims' for non-periodic losses (like a one-time medical expense) must be paid immediately upon receipt of due written proof of loss.
Question 10 (Chapter 8)
An Iowa small employer carrier is calculating premiums for a small group. Under Iowa Code 513B.4(2)(b), which of the following factors is PROHIBITED from being used as a case characteristic to vary premium rates?
- A) Age
- B) Geographic area
- C) Gender
- D) Family composition
Show answer & explanation
Answer: C
Iowa Code 513B.4(2)(b) allows a small employer carrier to use only age, geographic area, family composition and group size as case characteristics without the commissioner's prior approval. Gender is not on that list, and the federal ACA rating rules for the small group market also bar rating by gender, so gender is the factor that may not be used to vary premium rates.
Question 11 (Chapter 8)
If an Iowa Long-Term Care policyholder decides to stop paying premiums, they may be entitled to a 'Nonforfeiture Benefit.' According to IAC 191-39.29, which of the following is a common form of this benefit?
- A) A full cash refund of all premiums plus 5% interest.
- B) A shortened benefit period (paid-up) policy.
- C) Automatic enrollment in the HAWK-I program.
- D) A voucher for 30 days of free nursing home care.
Show answer & explanation
Answer: B
IAC 191-39.29 requires that a long-term care policyholder be offered a nonforfeiture benefit (and, if it is declined, a contingent benefit upon lapse), and 39.29(7)(b) describes the nonforfeiture benefit as a shortened benefit period providing paid-up long-term care coverage after lapse. A cash refund of premiums with interest, automatic HAWK-I enrollment, or a voucher for free nursing home care is not a nonforfeiture benefit.
Question 12 (Chapter 8)
An Iowa insurer decides to discontinue a specific 'class' of individual health insurance. Under Iowa Code 513C.6(1)(c)(3), the insurer must offer each covered individual the option to:
- A) Receive a cash payout equal to one year of premiums.
- B) Purchase any other individual health insurance coverage currently being offered by the insurer.
- C) Enroll in the HAWK-I program regardless of income.
- D) Sue the insurer for breach of contract.
Show answer & explanation
Answer: B
Iowa Code 513C.6(1)(c) lets a carrier discontinue a particular type of individual health benefit plan only with the commissioner's approval and only if, among other conditions, it gives the required notices and offers each individual of the discontinued plan the option to purchase any other health plan the carrier currently offers to individuals in Iowa (513C.6(1)(c)(3)).
Practice Questions 13-17: Change of Occupation, Eligible Employees, Long-Term Care Free-Look, MLR and Coordination of Benefits
The change-of-occupation provision in an individual policy, the weekly hours that make an employee eligible for a small-group plan, the long-term care free-look, the ACA's medical loss ratio, and the birthday rule again, this time in a group health setting.
Question 13 (Chapter 8)
An insured under an individual health policy in Iowa changes their occupation from a bank teller to a professional high-rise window washer. If the policy includes the 'Change of Occupation' optional provision under Iowa Code 514A.3, what action will the insurer take if a claim occurs?
- A) The insurer must pay the full claim but may cancel the policy immediately after.
- B) The insurer will pay only the portion of the indemnity that the premium paid would have purchased at the rates for the more hazardous occupation.
- C) The insurer will deny the claim because the new occupation was not disclosed within 10 days.
- D) The insurer will pay the claim in full but increase the next month's premium retroactively.
Show answer & explanation
Answer: B
Under the optional 'Change of Occupation' provision in Iowa Code 514A.3, if an insured moves to a more hazardous occupation, the insurer reduces the benefits to what the premium would have purchased for that risk level. Conversely, if they move to a less hazardous job, the insurer reduces the premium.
Question 14 (Chapter 8)
For the purposes of small group health insurance under Iowa Code 513B.2, an 'eligible employee' is generally defined as an employee who works on a full-time basis with a normal work week of at least how many hours?
- A) 30 hours
- B) 20 hours
- C) 35 hours
- D) 40 hours
Show answer & explanation
Answer: A
Iowa Code 513B.2(10) defines an 'eligible employee' as an employee who works on a full-time basis and has a normal workweek of thirty or more hours; the term does not include an employee who works on a part-time, temporary, or substitute basis.
Question 15 (Chapter 8)
An Iowa resident receives a Long-Term Care insurance policy and decides ten days later that they no longer want it. According to Iowa Code 514G.105(4), what is the 'Free Look' period for this policy?
- A) 10 days
- B) 15 days
- C) 20 days
- D) 30 days
Show answer & explanation
Answer: D
Iowa Code 514G.105(4) gives a long-term care insurance applicant the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination, the applicant is not satisfied for any reason; the refund must be made within thirty days of the return.
Question 16 (Chapter 8)
Under the Affordable Care Act (ACA) as applied in Iowa, what is the Medical Loss Ratio (MLR) requirement for health insurers in the small group market?
- A) 75%
- B) 80%
- C) 85%
- D) 90%
Show answer & explanation
Answer: B
The ACA requires an MLR of 80% for individual and small group markets (and 85% for large groups). This means at least 80% of premium dollars must be spent on medical claims and quality improvement activities.
Question 17 (Chapter 8)
In a group health insurance Coordination of Benefits (COB) situation in Iowa, if a child is covered under both parents' plans, which plan is usually primary according to the 'Birthday Rule'?
- A) The plan of the parent who is older.
- B) The plan of the parent whose birthday falls earlier in the calendar year.
- C) The plan that has been in effect the longest.
- D) The plan of the parent who has custody of the child.
Show answer & explanation
Answer: B
Under standard COB rules used in Iowa, the 'Birthday Rule' states that the primary plan is the one belonging to the parent whose birthday (month and day) occurs earlier in the calendar year.
The Mistakes That Cost Marks
Carrying one free-look number across products. Medicare supplement and long-term care each have their own return right, and neither borrows the ten-day rule from ordinary life insurance. Learn the free-look for each product separately.
Confusing the claim-timing rules. Notice of claim, proof of loss and time of payment are three provisions with three different clocks. Two of them are tested here; do not substitute the notice-of-claim period you learned in the Chapter 6 products set.
Assuming "no surprises" means no cost. The No Surprises Act protects against balance billing for emergency services from out-of-network providers, and the patient owes only the in-network cost sharing. It does not make the care free, and it does not cover a patient who simply chooses an out-of-network provider for routine care.
Mixing the markets. Individual, small group and large group each have their own rules: who counts as an eligible employee, what share of eligible employees a plan must cover, which factors may set premiums, and what the ACA's medical loss ratio requires. Check which market the question describes before you check the rule.
Missing what a carrier must offer. When a carrier discontinues a class of individual coverage, it must offer the people covered other individual coverage it currently sells. When a long-term care policyholder stops paying, a nonforfeiture benefit may apply. Know the form it takes, and that the other forms listed as answers are not nonforfeiture benefits.
Forgetting the special programs. HAWK-I and HIPIOWA are named in the outline. Know what each is and what each is not.
Your Next Step
Try the free preview of LanePrep's Iowa Life & Health course and hear the material on the road, or work through all the free Iowa Life & Health practice questions. If you are sitting both exams, the companion set is Iowa life insurance law.
Question counts and content weighting come from Pearson VUE's Iowa Insurance Content Outlines, effective January 1, 2026. Checked October 2026.
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