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Delaware Health Practice Exam

20 exam-style questions drawn from the same bank as our full Delaware Health course (Delaware 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. What does the Medical Information Bureau supply to a member insurer?
A credit score and payment historyComplete medical records from providersA claim history for the applicantCoded information from prior applications
2. The Part D late-enrollment penalty is calculated as:
A flat $50 per month surcharge for any delay, regardless of lengthTwice the standard Part D premium for two years after late enrollment1% of the national base beneficiary premium for every full month the beneficiary was without creditable drug coverage for more than 63 continuous days, added permanently to the Part D premium10% of the national base beneficiary premium for every full 12 months the beneficiary was without creditable drug coverage, added permanently to the Part D premium
3. Which is NOT one of the acts §2304(20) twisting is aimed at inducing?
Assignment of a claimRetention of a policyConversion of a policySurrender of a policy
4. A managed care plan pays an assigned primary care physician a fixed monthly amount for each enrolled member. One assigned member turns out to be high-utilizing and generates far more care than that monthly amount covers. Under this arrangement:
The member owes coinsurance on every visit beyond the capitated monthly amountThe provider bills the carrier per service once the capitated amount is exhaustedThe carrier reimburses the excess visits at the plan's usual and customary rateThe provider absorbs the loss, because capitation is paid per member per month
5. Under 18 Del. C. §7403 an insurer may require an HIV test only after obtaining:
The producer's certificationDepartmental approvalPrior written informed consentA physician's referral
6. The premium a Mini-COBRA beneficiary pays may not exceed:
150% of the group rate102% of the group rate100% of the group rate110% of the group rate
7. An insured with legal capacity could not reasonably file proof on time. What is the outer limit for filing?
One year after proof was dueTwo years after proof was dueSix months after proof was dueThree years after proof was due
8. How does a comprehensive major medical plan differ from a supplementary one?
It sits on top of a basic planIt carries no out-of-pocket maximumIt replaces the basic plan entirelyIt pays only for surgical expense
9. An HMO member wants to see a dermatologist for a skin condition. To have the visit covered by the HMO, she should:
Call the HMO member-services line and request a direct authorization for the specialist visitSee any board-certified dermatologist and submit a claim form to the HMO for retrospective reviewSelf-refer to any in-network dermatologist listed in the HMO's published provider directory onlineSee her primary care physician (PCP), who will issue a referral to a network dermatologist
10. A hospital indemnity policy pays $200 per day of inpatient admission for up to 30 days. The insured is admitted for six days and the hospital bills $48,000. That policy pays:
$1,200 to the hospital, applied against the insured's deductible and coinsurance$48,000 to the hospital, coordinated as secondary to the major medical carrier$1,200 in cash to the insured, without regard to what the hospital actually billedNothing, because the major medical plan is primary for the entire inpatient stay
11. An insured's coverage terminated on June 30. In August she receives treatment for a chronic condition that first arose in March, while the policy was still in force. The claim is:
Payable, because chronic conditions are treated as continuing covered claimsNot payable, because a chronic condition is a categorical contract exclusionNot payable, because the care was rendered after the policy period endedPayable, because the condition itself arose during the policy period in March
12. An EPO differs from a PPO primarily in that:
Only an EPO must cover ACA preventive services at first dollar; PPO products may apply the in-network deductible to preventive careAn EPO requires a PCP and prior referrals before specialist visits; a PPO permits direct specialist self-referral by the memberAn EPO provides no out-of-network benefit except for emergencies; a PPO covers out-of-network services at a reduced benefit levelAn EPO pays providers under a capitation model; a PPO reimburses providers strictly on a fee-for-service per-claim basis
13. Under a Delaware credit life policy, the creditor is beneficiary:
For the whole death benefitOnly if the debtor consentsTo the extent of the unpaid balanceOnly for unsecured debt
14. An advertisement built by a producer, not the insurer, is:
Outside Regulation 1302Covered as a sales aidGoverned only by §2304(2)Covered only if it names a policy
15. 18 Del. C. §2316 forbids refusing to issue an accident and sickness policy because of:
A prior claim historyResidence outside the StateThe applicant's occupationBlindness or deafness
16. The minimum grace period for a monthly premium individual health policy under §3307 is:
7 days31 days20 days10 days
17. Membership in the Delaware Life and Health Insurance Guaranty Association is:
Limited to insurers over a size testVoluntary for domestic insurersRequired only of health insurersA condition of transacting business
18. Compared with a fully insured group health plan, a self-funded plan administered on an ASO basis is generally NOT subject to:
COBRA continuation requirementsHIPAA portability and nondiscrimination rulesState-mandated benefit laws and state premium taxesERISA fiduciary duties under §404(a)
19. A single applicant with household income at 180% of the federal poverty level is shopping the Marketplace. She is drawn to a bronze plan with a $0 net premium after her advance premium tax credit but is also considering a silver plan that would cost her $45/month after APTC. The most important consideration the producer should raise is that:
Bronze plans do not cover the ten ACA Essential Health Benefits categories so she would have no preventive coverage even with the premium-tax-credit advance applied at enrollmentShe must select the bronze plan because it is the second-lowest-cost benchmark plan available to her under the SLCSP calculation used to set the APTC dollar amountBronze plans are not eligible for any advance premium tax credit and she will owe the full premium when she reconciles the credit on her Form 8962 at tax timeOnly the silver plan qualifies for cost-sharing reductions, which would raise its actuarial value to 87% and substantially lower her deductible and out-of-pocket costs
20. Compared with Original Medicare, a Medicare Advantage plan is most distinctively characterized by:
Coverage of routine custodial nursing-home care that Original Medicare does not pay for, financed through the supplemental long-term-care benefit add-on built into every contractDirect administration by CMS rather than by a private insurer, with the carrier acting only as a claims-processing intermediary under the contracted fiscal-agent arrangementA defined provider network, copay-based cost sharing, and an annual in-network maximum out-of-pocket (MOOP) limit that Original Medicare does not haveMandatory inclusion of prescription drug coverage on every plan with no stand-alone PDP option permitted; the Medicare Advantage drug benefit fully replaces the separate Part D enrollment path

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