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Tennessee Health Practice Exam

20 exam-style questions drawn from the same bank as our full Tennessee Health course (Tennessee Accident and Health Agent 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 is terminated from his job in May and loses his employer health coverage. Outside of open enrollment, how long is his window to enroll in individual coverage?
90 days from the qualifying event, under a special enrollment period30 days from the qualifying event, under a special enrollment period60 days from the qualifying event, under a special enrollment periodHe must wait for the next annual open enrollment period to enroll
2. Under the ACA's medical loss ratio (MLR) rules, an insurer in the LARGE group market must spend at least what percentage of premium on claims and quality improvement activities to avoid issuing rebates to policyholders?
70%75%80%85%
3. In a traditional fee-for-service indemnity plan, cost containment is delegated almost entirely to the insured. Through which set of mechanisms does that happen?
Narrow provider networks paired with negotiated discount reimbursement schedulesDeductibles, coinsurance, and usual-customary-and-reasonable payment limitsCapitated provider contracts that shift utilization risk onto the treating providerPreauthorization requirements, specialist referrals, and formulary tier controls
4. An insurer issues a policy rated above standard. In contract terms this is:
A binding contract from the issue dateA counter-offer the applicant may acceptAn acceptance of the applicant's offerA conditional receipt in another form
5. An employer pays the whole premium for a group disability income plan. Benefits paid to the employee are:
Received free of income taxTaxable only to the employerFully taxable income to the employeeTaxable only above a stated floor
6. Which of these is a cost containment technique rather than a plan type?
Preferred provider organizationSecond surgical opinion programExclusive provider organizationPoint of service plan
7. How does a nonduplication provision differ from ordinary coordination of benefits?
The secondary plan always pays the balanceThe secondary plan may end up paying nothingIt applies only to dental coverageIt reverses the order of payment
8. Under the legal actions provision, how soon after furnishing proof of loss may an insured sue?
After 60 daysImmediatelyAfter 90 daysAfter 30 days
9. Do the face-of-policy legends in 56-26-125 and 56-26-126 apply to a group health policy?
Only for policies issued after July 1, 1973Only where the employer pays all the premiumNo, 56-26-127 exempts group and franchiseYes, to every policy issued in this state
10. Under Dept. Rule 0780-01-56-.08, how many continuing education hours must a Tennessee producer complete each biennium?
30122024
11. The principal difference between a gold-tier and a silver-tier qualified health plan on the Marketplace is that:
The gold plan is available only through state-based marketplaces under the SBM-only exemption; the silver plan is available on every state and federal exchange platformOnly the silver-tier plan is eligible for advance premium tax credits under the SLCSP-benchmark calculation used in the federal subsidy frameworkOnly the gold-tier plan is statutorily required to cover the ten ACA Essential Health Benefits categories under federal market reformsThe gold plan has an actuarial value of approximately 80% (plan pays 80%, member 20%); the silver plan has an AV of approximately 70%
12. 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 provider bills the carrier per service once the capitated amount is exhaustedThe member owes coinsurance on every visit beyond the capitated monthly amountThe provider absorbs the loss, because capitation is paid per member per monthThe carrier reimburses the excess visits at the plan's usual and customary rate
13. A Tennessee resident holds two hospital indemnity policies from the same insolvent member insurer. The association's exposure is capped at:
$500,000, as a health benefit plan$100,000, because the cap is per life$200,000, one cap per policy$300,000 aggregate for all coverage
14. A legacy individual policy contains a fourth-quarter carryover provision. What does that provision do for the insured?
It refunds a quarter of the deductible if no claim is filed during the yearIt moves the plan-year reset date to the first day of the fourth quarterIt lets expenses from the final three months also count toward next yearIt suspends coinsurance during the last three months of every policy year
15. A Tennessee long-term care policy has been in force for 18 months. To rescind for misrepresentation the insurer must show a misstatement that is:
Fraudulent and proved in a court of lawMaterial and about the condition claimedKnowing and intentional as to healthMaterial, and nothing more is required
16. A client tells his producer that he wants to drop his major-medical coverage and replace it with a hospital indemnity policy that pays $300 per day of admission, because the indemnity premium is much lower. The producer should:
Process the replacement on a signed acknowledgment-of-coverage-gap form because the client has made an informed adult choice and the indemnity premium fits the budgetProcess the replacement only after confirming the client is in good health and obtaining the carrier's underwriting acceptance because indemnity products require a satisfactory medical-history attestationRecommend the client layer an accident-only and a critical-illness policy alongside the hospital indemnity to round out the supplemental coverage to roughly EHB-equivalent scope before terminating major medicalExplain that hospital indemnity is a limited-benefit supplement, not a substitute for major medical, and that dropping major medical would leave the client exposed to catastrophic outpatient and physician costs
17. A Tennessee temporary insurance producer licence may not exceed:
90 days180 days12 months120 days
18. The 'medically necessary' standard in a major-medical insuring clause generally requires that a service be:
The 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 clauseRecommended by any state-licensed physician, regardless of clinical justification, so long as the recommendation appears in the contemporaneously documented medical record submitted with the claimPre-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 physicianClinically 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 provider
19. A family wants HMO-level in-network economics but insists on keeping the option to consult a sub-specialist at an out-of-area academic medical center. The best recommendation is:
A health maintenance organization, which authorizes out-of-area consults on requestA fee-for-service indemnity plan, the lowest-premium option on a carrier's menuAn exclusive provider organization, which pays nothing outside a closed networkA point-of-service plan, which layers an out-of-network option over HMO mechanics
20. Under Tenn. Code Ann. 56-7-2323, a group accident and sickness policy may not reduce benefits because benefits are also payable under:
A blanket group or franchise school policyA workers compensation award for the same injuryA federal Medicare or Medicaid benefit paymentAny other group health plan the insured holds

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