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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. The ACA's prohibition on annual and lifetime dollar limits applies to:
Only the preventive-care category of Essential Health Benefits because the USPSTF A/B list expressly prohibits dollar caps; other EHB categories remain subject to the pre-ACA actuarial-equivalence safe harborOnly group health plans sponsored by employers with 50 or more employees on the ALE threshold; the prohibition does not extend to individual or small-group plans under the §4980H triggerEssential Health Benefits on non-grandfathered individual and group plans; it does not extend to limited-benefit supplemental products such as hospital indemnity, critical illness, or accident-only policiesAll health insurance products sold in any market regardless of whether the plan qualifies as major medical or as an excepted-benefit supplemental product under HIPAA Title II
2. Which ACA section defines the essential health benefits package and the metal tiers?
Section 1401Section 1321Section 1512Section 1302
3. How must an insurer deliver a for-cause termination notice to the producer?
By ordinary first class mail, postage prepaidBy electronic mail to the address on fileBy certified mail or by overnight deliveryBy personal service of a licensed process server
4. 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
5. Under Tenn. Code Ann. 56-6-121, the fee to file an application for an insurance producer licence is:
$15.00$50.00$60.00$30.00
6. A carrier applies the deductible, the coinsurance percentage, and the out-of-pocket maximum against which figure when it adjudicates a medical-expense claim?
The provider's billed charge, before any network repricing is performedThe member's remaining annual benefit maximum for the service categoryThe national median charge published for that procedure code each yearThe plan's allowed amount, not the charge the provider originally billed
7. Which of the following most accurately distinguishes a contributory group disability plan from a noncontributory group disability plan?
Noncontributory plans require each enrolling employee to submit full evidence of insurability through the carrier's underwriting process; contributory plans waive medical evidence under the guarantee-issue safe harbor for eligible employeesContributory plans are sold only into unionized employer groups through collective-bargaining trust arrangements; noncontributory plans are sold only into the executive-carve-out market under the §415 limitsContributory plans require some level of employee premium contribution and typically demand at least 75% participation; noncontributory plans are 100% employer-paid and demand 100% participationContributory plans cover only non-occupational sicknesses excluded from workers' compensation; noncontributory plans cover only accidental injuries under the federal split-trigger group-disability framework
8. What minimum number of persons does Tenn. Code Ann. 56-26-201 require for group accident and health insurance?
Twenty five in the eligible classTen, matching the association ruleThree, matching the franchise ruleThe section states no minimum number
9. A plan lets the insured use any licensed provider, imposes no primary care gatekeeper, and reimburses each service subject to usual-customary-and-reasonable limits. That plan is best classified as:
A point-of-service plan being used in its out-of-network mode by the insuredA fee-for-service indemnity plan, the model managed care is defined againstAn exclusive provider organization plan with no primary care referral ruleA preferred provider organization plan with an unusually broad provider panel
10. How does a comprehensive major medical plan differ from a supplementary one?
It sits on top of a basic planIt replaces the basic plan entirelyIt carries no out-of-pocket maximumIt pays only for surgical expense
11. Under 56-6-115 an insurer must file a notice of appointment within 15 days from:
The date the producer's licence was issuedThe end of the calendar quarter of the contractThe date the producer is first paid a commissionThe contract or first application, whichever is first
12. The ordinary monetary penalty for a violation of the Tennessee producer licensing part is not more than:
$1,000 per violation, $100,000 aggregate$5,000 per violation, $100,000 aggregate$500 per violation, $50,000 aggregate$25,000 per violation, $250,000 aggregate
13. Medicare supplement open enrollment under Dept. Rule 0780-01-58-.14 lasts:
7 months12 months3 months6 months
14. A cancer-only policyholder is diagnosed with carcinoma in situ, a non-invasive cancer. Across the market, how do cancer-only policies treat that diagnosis?
Uniformly at the full face amount, because in situ disease is still cancerTreatment varies widely: full benefit, a fraction such as 25%, or excludedUniformly at half the face amount under a standardized industry scheduleUniformly excluded, because in situ disease is never an invasive diagnosis
15. A child is covered as a dependent under both married parents' employer plans. The mother was born on March 2, 1988 and the father on January 19, 1985. Under standard coordination-of-benefits rules, the primary plan for the child is:
The father's plan, because his birthday falls earlier in the calendar yearThe mother's plan, because she is the younger of the two covered parentsThe mother's plan, because her birthday falls later in the calendar yearThe father's plan, because he is the older of the two covered parents
16. A client turned 65 three years ago but delayed enrolling in Medicare Part B because she was covered by her former employer's retiree health plan. The retiree plan is ending and she now wants to enroll in Part B. The correct outcome is:
She may enroll immediately under a guaranteed-issue right with no late-enrollment penalty because the retiree health coverage qualifies as creditable Part B-equivalent coverageShe must wait until the next Annual Election Period (October 15 – December 7) and her Part B coverage will then begin effective January 1 of the following calendar yearShe may enroll under the active-employee Special Enrollment Period with no late penalty because the retiree group plan qualifies as current employer coverage under §1837(i)She may enroll only during the General Enrollment Period (January 1 – March 31) and will owe a Part B late-enrollment penalty of 30% added to her premium for life
17. A client asks whether the Tennessee telehealth mandate applies to her Medicare supplement policy. Under 56-7-1002(i) the answer is:
Yes, it applies to all health coverageNo, unless the policy was issued after 2020No, Medicare supplement is excludedYes, if the carrier is admitted here
18. 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:
Not 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 MarchPayable, because chronic conditions are treated as continuing covered claims
19. After the time limit on certain defenses has run, an insurer may still deny a claim on which basis?
A non-fraudulent application misstatementAn unnamed pre-existing conditionAn innocent omission on the applicationA condition excluded by name in the policy
20. 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

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