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Virginia Health Practice Exam

20 exam-style questions drawn from the same bank as our full Virginia Health course (Virginia Health Insurance 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. When an insurer terminates a producer's appointment for cause in Virginia, the insurer must:
Report the termination only to the local NAIC officeNotify the SCC and provide the reason for terminationObtain the producer's written consent before actingWait until the next license renewal to report it
2. The ACA requires plans offering dependent coverage to make it available to children until they reach age:
30262319
3. Charging two individuals in the same actuarial class different rates for essentially identical health coverage is:
Unfair discriminationStandard field underwritingA lawful loyalty discountA permissible experience adjustment
4. A producer repeatedly convinces clients to replace paid-up coverage with new policies mainly to generate first-year commissions, using misleading illustrations. This pattern is best described as:
Permissible needs-based replacement of coverageChurning through misrepresentation (a form of twisting)Routine coordination-of-benefits practiceA lawful rebate benefiting the policyholder
5. A total disability that leaves an insured permanently unable to work, as defined by the policy, is an example of:
A property lossA liability lossA medical-expense lossAn income (earnings) loss
6. The 'pool of money' on an LTC policy refers to:
The carrier's statutory claim reserve allocated to the individual policyholder under NAIC reserving standards for in-force LTC contractsThe cash surrender value available to the policyowner at any time after the contract's free-look period for hybrid-product nonforfeiture benefitsThe annual aggregate benefit available each calendar year that resets at midnight on December 31 under the standard policy-year accounting conventionThe lifetime maximum benefit, calculated as the daily benefit multiplied by the benefit period, that drains as benefits are paid
7. The principal mechanical difference between an HMO and a PPO is that:
Only a PPO uses negotiated network discounts; an HMO is statutorily required to pay providers at billed charges under the HMO Act of 1973 capitation frameworkAn HMO requires a PCP gatekeeper and referrals and provides no out-of-network benefit; a PPO does not require a PCP and pays a reduced benefit for out-of-network servicesOnly an HMO is subject to the ACA's Essential Health Benefits requirements; PPO products are exempt under the separate large-group experience-rating safe harborOnly an HMO may cover ACA preventive services at first dollar; PPO products must apply the deductible under the modified community-rating exemption for preferred plans
8. The Medical Information Bureau (MIB) primarily helps insurers by:
Setting the premium rates for all insurersSharing coded medical-impairment information among membersLicensing producers in each member statePaying claims directly on behalf of all member insurers
9. In insurance, the applicant's completed application and initial premium generally constitute the:
Offer by the applicantAcceptance by the insurerCounteroffer by the insurerConsideration by the state
10. The 'consideration clause' of a health policy identifies:
The premium amount and the frequency of paymentThe state and county where claims must be filedThe producer's appointment dateThe insurer's home-office address
11. A travel accident policy covering injury while on a specific trip is classified as:
A comprehensive medical planA Medicare supplement policyA limited accident policyA long-term care policy
12. Internal Revenue Code §105 and §125 are most accurately distinguished as:
§105 excludes employer-funded accident-and-health-plan benefits from the employee's gross income; §125 authorizes the cafeteria-plan election mechanism that lets employees choose between cash and qualified non-taxable benefitsIRC §105 is the federal COBRA continuation rule governing post-termination group coverage; §125 by contrast is the HIPAA Title I portability rule governing creditable-coverage transitions between employer plansIRC §105 applies only to individually purchased accident-and-health coverage outside the employer-sponsored market; §125 by contrast applies only to coverage delivered through an employer-sponsored group plan under ERISAIRC §105 governs the tax treatment of HSA contributions and distributions under the federal high-deductible-plan framework; §125 separately governs the rules of operation, election timing, and use-it-or-lose-it forfeiture applicable to health flexible-spending arrangements
13. Concurrent review in a utilization-management program refers to review that occurs:
While the insured is receiving care, such as during a hospital stayOnly long after the claim closes and the insured switches insurersYears after the claim is closedBefore any treatment is scheduled
14. 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?
60 days from the qualifying event, under a special enrollment period90 days from the qualifying event, under a special enrollment period30 days from the qualifying event, under a special enrollment periodHe must wait for the next annual open enrollment period to enroll
15. A client discloses a recent hospitalization the producer fears will lead to a rating. The producer's proper course is to:
Omit the hospitalization to secure a better rateSplit the coverage among several insurers to hide itAdvise the client to reapply in a year and stay silentRecord it accurately and submit the full application
16. Insurers doing business in Virginia must keep their books and records:
Available for examination by the Bureau of InsuranceConfidential and closed to any outside reviewIn a federal repository maintained by the NAICOnly at the insurer's out-of-state headquarters
17. 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 mother's plan, because she is the younger of the two covered parentsThe father's plan, because he is the older of the two covered parentsThe father's plan, because his birthday falls earlier in the calendar yearThe mother's plan, because her birthday falls later in the calendar year
18. The underwriting goal of avoiding adverse selection is best summarized as:
Charging the lowest possible premium to everyoneDeclining all applicants with any health historyClassifying risks fairly so premiums match exposureAccepting every applicant at the same rate
19. Which of the four essential elements of a valid contract requires that the objective be lawful and not against public policy?
ConsiderationOffer and acceptanceCompetent partiesLegal purpose
20. A board-certified orthopedic surgeon suffers a permanent hand injury that ends her surgical career. Six months later she begins a salaried position teaching anatomy at a medical school for $180,000 per year, down from $620,000 as a surgeon. Her individual disability policy contains a true own-occupation definition of disability. How does the policy respond?
It pays the full total disability benefit because she cannot perform the duties of her own occupation, regardless of the teaching incomeIt pays nothing because the return-to-work earnings test under the modified-any-occupation definition terminates benefits when the insured resumes gainful employmentIt pays a reduced benefit only until the teaching salary equals her pre-disability surgical income, then terminates under the recovery-of-income clauseIt pays a proportional residual benefit equal to the percentage of income lost from the pre-disability surgical earnings under the standard residual rider

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