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Hong KongA worked health insurance question
Three worked items on accident and health, all written by us. Between them they cover the three confusions that cost most marks in this half of the paper: which waiting period is running, which renewability promise was made, and which piece of cost sharing a number represents.
Accident and health is the heavier half of the general portion. Types of policies carries 16 questions and provisions, clauses and riders carries 15, which between them are close to a third of the 100 general items.
It is also where the vocabulary is worst. Three of these terms sound like each other and two of those three are near-identical promises with one difference. All three questions below were written by us against the published outline. None is a real exam item.
Question one: which clock is running
A disability income policy is issued on 1 March with a 30-day elimination period. The insured is injured in a fall on 1 June and is totally disabled from that date. When do benefits begin to accrue?
- On the date of the disability
- 30 days after the date of the disability
- 30 days after the policy was issued
- 30 days after the insurer receives proof of loss
The two dates in that stem are doing all the work. March is the policy. June is the loss. Once you know which clock the elimination period hangs on, the question takes four seconds, and if you do not, no amount of thinking will produce it.
Learn the pair as a sentence rather than as two definitions. The elimination period starts when you get hurt. The probationary period starts when you buy the policy.
Question two: the promise with one difference
An individual disability income policy requires the insurer to renew the coverage until the insured reaches a stated age, and permits the insurer to raise the premium only if it does so for an entire class of insureds. How is this policy best described?
- Noncancelable
- Guaranteed renewable
- Conditionally renewable
- Optionally renewable
The class-rating clause is the entire item. Take it out and options A and B are indistinguishable, which is why an item writer would never take it out.
So when a renewability question appears, hunt for the premium. If the stem says nothing about it, read again, because it is in there.
Question three: three numbers, three different jobs
A major medical plan has a $500 annual deductible and pays 70% of covered charges once the deductible has been met. Separately, the member pays a flat $50 for each office visit regardless of the deductible. What is the $50 called?
- A deductible
- Coinsurance
- A copayment
- A stop-loss limit
This is the cleanest example on the site of a distractor built from the stem itself. The item writer did not have to invent anything: the stem contains a deductible and a percentage, so two options are pre-supplied.
The discriminator is the form of the number. A percentage of the bill is coinsurance. A flat amount attached to a service is a copayment. An amount you pay before anything is covered is the deductible. Nothing else about the sentence matters.
The pattern across all three
None of these questions requires arithmetic and none requires an obscure fact. Each one turns on a single feature of the stem: a date, a clause about premiums, the shape of a number. Miss that feature and every option looks reasonable. Find it and three of them disappear.
| Item | The deciding feature | The wrong answer it produces |
|---|---|---|
| Elimination period | Which event the days run from | The probationary period |
| Renewability | Whether the premium can move | Noncancelable |
| Cost sharing | Percentage, flat fee or up front | Whichever other number is in the stem |
Our opinion about this half of the paper: the accident and health sections are where a candidate from outside the industry loses most, and it is a vocabulary problem rather than a difficulty problem. The concepts are simple. The names for them were chosen by a hundred years of drafting committees and several of them are almost the same words.
The honest limit is the same as everywhere on this site. We wrote these against the published content outline; we have not seen a Pearson item and we are not going to pretend the real wording matches ours. What transfers is the structure, because the pairs live in the outline and anyone building four options from it will reach for the same neighbors.
Common questions
Are these real Texas insurance exam questions?
No. All three were written for this site against the published content outline. Nobody here has sat the exam or seen a live form, and reproducing a real item would be a copyright problem as well as a dishonest one.
When does an elimination period start?
At the start of the disability, not at policy issue. It is a deductible measured in days rather than dollars. The provision that runs from policy issue is the probationary period, which excludes sickness claims arising in the first weeks of coverage.
What makes a policy noncancelable rather than guaranteed renewable?
The premium. Both oblige the insurer to renew to a stated age, but a guaranteed renewable policy allows rate increases applied to an entire class of insureds, while a noncancelable policy fixes the premium for the life of the contract.
How do I tell a copayment from coinsurance?
By the shape of the number. Coinsurance is a percentage of covered charges shared after the deductible. A copayment is a flat amount attached to a specific service and does not vary with the size of the bill. The deductible is what you pay before coverage starts.
How many accident and health questions are on the exam?
Types of policies carries 16 and provisions, clauses and riders carries 15, so close to a third of the 100 general questions come from those two sections alone. Further health content sits in social insurance and in the Texas accident and health section.