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Alaska Health Practice Exam

20 exam-style questions drawn from the same bank as our full Alaska Health course (Alaska Accident and Health Producer Exam Prep). Answer all 20, then grade yourself — most state exams require 70% to pass. Explanations for every question are part of the full course.

1. A client between jobs asks whether short-term limited-duration insurance is a reasonable long-term replacement for major medical. The producer should explain that short-term coverage:
Is guaranteed issue during open enrollment but excludes prescription drugsMay underwrite pre-existing conditions, cap benefits, and omit an OOP maxMatches major medical benefit for benefit but renews on a shorter cycleMust cover Essential Health Benefits but may impose a higher deductible
2. A client travels constantly for work, keeps established relationships with two out-of-area specialists, and manages a chronic condition largely on her own initiative. For this client an HMO is:
A strong fit, because the gatekeeper will coordinate her chronic condition remotelyA poor fit, because HMOs carry the highest premium of any major managed care designA poor fit, because out-of-area care and self-directed specialist use are restrictedA strong fit, because HMOs pay out-of-area specialists at the in-network benefit
3. How many compliance officers may an Alaska licensed firm designate for each line of authority?
At least twoOne for every ten producersNo limit is setNot more than one
4. An application reaches the insurer with one medical question left blank and is issued. The usual result is that the insurer:
May deny every claim for two yearsMust reissue the policy from scratchMay rescind the policy at any timeHas waived its right to that answer
5. The principal difference between a copay and coinsurance is that:
A copay is paid by the carrier under the in-network agreement; coinsurance is paid by the insured directly to the provider after claim adjudicationA copay counts toward satisfaction of the in-network deductible; coinsurance is excluded from deductible accumulation under the ACA cost-sharing frameworkA copay applies only to in-network covered services; coinsurance applies only when the member uses out-of-network providers on a non-emergency basisA copay is a flat dollar amount fixed regardless of the cost of the service; coinsurance is a percentage that scales with the allowed amount
6. A child is covered by both married parents' plans. Under the birthday rule, the primary plan belongs to:
The parent with the earlier birthdayThe parent who enrolled the child firstThe parent earning moreThe older parent
7. A Section 1332 waiver requires the state to demonstrate that its alternative will, among other things:
Provide coverage that is at least as comprehensive and affordable, cover at least as many residents, and not increase the federal deficitRepeal all federal ACA market reforms in the state including guaranteed-issue, community rating, and the individual mandate as a precondition to the waiverLimit total individual-market enrollment to fewer than 50,000 residents statewide to qualify for the federal pass-through funding mechanism under §1332Replace HealthCare.gov with a fully state-run exchange platform within 12 months of waiver approval as a baseline operational requirement under §1332
8. An Alaska insured moves to a more hazardous occupation and is later injured. Under AS 21.51.170 the insurer:
Voids the policy back to inceptionDenies the claim for non-disclosurePays the reduced amount the premium boughtPays in full and cancels at renewal
9. How does a probationary period differ from an elimination period?
It runs once, at the start of the policyIt is measured in dollars, not in daysIt applies only to accidental injuryIt runs at the start of every new claim
10. Under IRC §7702B(c)(2), to qualify as a 'chronically ill individual' eligible for LTC benefits based on ADL deficits, the insured must be unable to perform:
At least one of the six ADLs without substantial assistance, expected to last 30 daysAt least two of the six ADLs without substantial assistance, expected to last at least 90 daysAll six of the ADLs without substantial assistance, with no duration requirementAt least three of the six ADLs without substantial assistance, expected to last 180 days
11. A plan charges a $300 emergency-room copay. A member goes to the emergency department with chest pain and is admitted as an inpatient from the ER. On many plans the $300 copay is then:
Refunded only after the member files an appeal within the plan year endWaived, because the emergency-room copay is often dropped upon admissionConverted into coinsurance calculated on the full inpatient allowed amountDoubled, because an admission converts the visit into an inpatient episode
12. Under the ACA, every non-grandfathered individual and small-group health plan must cover the ten Essential Health Benefits. Which of the following is NOT one of the ten EHB categories?
Maternity and newborn careLong-term custodial nursing-home carePediatric services including oral and vision careMental health and substance-use-disorder services
13. Alaska's general statutes governing accident and health insurance are codified primarily in:
AS 21.66AS 21.54AS 21.45AS 21.96
14. Under AS 21.53.050, when must an agent deliver the outline of coverage on a long-term care sale?
At the same time as the policyOnly if the applicant asks for itWithin 30 days after issueBefore any application is presented
15. A stand-alone vision policy typically covers a routine eye examination and a frame allowance on what periodic schedule?
An exam every 24 months and a frame allowance every 12 months, on a scheduleAn exam every 12 months and a frame allowance every 24 months, on a scheduleAn exam every 12 months and a frame allowance every 12 months, on a scheduleAn exam every 6 months and a frame allowance every 12 months, on a schedule
16. An insured with a $2,000 deductible, 80/20 coinsurance, and a $7,500 out-of-pocket maximum has paid nothing toward the deductible this year. She has outpatient surgery with a $10,000 allowed amount. How much does the CARRIER pay on this claim?
$6,400, being 80% of the $8,000 that remains after the deductible is met$5,900, being 80% of the allowed amount reduced by the deductible twice$8,000, being the full allowed amount left after the deductible is applied$7,500, because the out-of-pocket maximum caps the carrier's obligation
17. The 'medically necessary' standard in a major-medical insuring clause generally requires that a service be:
Clinically appropriate to diagnose or treat the condition, consistent with generally accepted standards of medical practice, and not primarily for the convenience of the patient or providerThe least expensive treatment option available within the plan's contracted network, even when not the most clinically appropriate, under the carrier's cost-effective-alternative substitution clausePre-approved by a federal review board appointed by HHS under ACA §2719A before the carrier may pay the claim on any non-emergency inpatient or outpatient service ordered by the treating physicianRecommended by any state-licensed physician, regardless of clinical justification, so long as the recommendation appears in the contemporaneously documented medical record submitted with the claim
18. Under AS 21.54, the conversion privilege does NOT apply when group coverage is terminated because:
The employee voluntarily quit a covered position with the group sponsorThe group policy itself terminates entirely (and is not replaced)The employee retired and elected COBRA before the 60-day federal election windowThe employee was discharged for cause under the AS 21.54 misconduct exception
19. A health FSA and an HSA differ in that:
The FSA is owned by the employee individually and fully portable across employer changes; the HSA is owned by the employer plan sponsor and forfeited at the employee's separation from serviceThe FSA is owned by the employer and subject to use-it-or-lose-it; the HSA is owned by the employee, fully portable, and accumulates indefinitelyBoth account types require concurrent enrollment in an HSA-qualified high-deductible health plan under the IRC §223 other-coverage rule for any contributionOnly the HSA permits tax-free reimbursement of IRC §213(d) qualified medical expenses; the FSA may reimburse only dental and vision expenses under the limited-purpose restriction
20. Under AS 21.56, in the Alaska small-group market, premiums may be varied by which of the following rating factors only?
Age, gender, health status, occupation, and prior claimsHealth status, prior claims history, gender, and industry codeAge, geographic area, family composition, and tobacco useAny rating factor the insurer chooses and supports actuarially

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