CDI Site Accident and Health Agentination Exam
Independent Revision Guide and Practice
CDI Accident and Health Agent Examination - Complete Practice Guide
Below is a comprehensive, independent review guide for the California
Department of Insurance (CDI) Accident and Health Agent Licensing
Examination. This guide covers key concepts, core vocabulary, and practice
questions to help you prepare .
Part 1: Health Insurance Fundamentals
Policy Types & Core Concepts
1. What is the primary purpose of a "deductible" in a health insurance plan?
A) To determine the monthly premium cost
B) To cover the full cost of all medical services
C) To require the insured to pay a specific amount out-of-pocket before the insurer
begins to cover costs
D) To eliminate the need for a copayment
Answer: C
1
,Rationale: A deductible is the amount the insured must pay for covered health care
services before the insurance company starts to pay . It acts as a cost-sharing
mechanism between the insured and the insurer.
2. Which type of health plan typically requires members to select a Primary Care
Physician (PCP) and obtain referrals to see specialists?
A) Preferred Provider Organization (PPO)
B) Health Maintenance Organization (HMO)
C) Exclusive Provider Organization (EPO)
D) Point-of-Service (POS) Plan
Answer: B
Rationale: An HMO operates on a "gatekeeper" model. The PCP coordinates all
care and provides referrals for specialist services, a key feature that distinguishes
HMOs from other managed care plans like PPOs .
3. How does a PPO differ from an HMO?
2
,A) PPOs require referrals for specialists
B) PPOs allow members to see out-of-network providers, usually at a higher cost
C) PPOs do not have provider networks
D) PPOs cover 100% of all medical costs
Answer: B
Rationale: While PPOs have a network of preferred providers, members have the
flexibility to see out-of-network providers, though they will pay more for those
services. HMOs generally do not cover out-of-network care .
4. The "individual mandate" penalty under the Patient Protection and Affordable
Care Act (PPACA) was:
A) Increased in 2020
B) Completely eliminated at the federal level in 2019
C) Expanded to include dental coverage only
D) Applied only to high-income earners
Answer: B
3
, Rationale: The federal tax penalty for not having health insurance (the individual
mandate) was effectively reduced to $0 starting in 2019 .
5. What is the function of "coinsurance"?
A) A fixed dollar amount paid for each service
B) The percentage of allowed charges that the insured pays after meeting the
deductible
C) The total amount paid annually in premiums
D) A deductible applied to prescription drugs only
Answer: B
Rationale: Coinsurance is the percentage of costs the insured pays after the
deductible is met. For example, an 80/20 plan means the insurer pays 80% and the
insured pays 20% .
6. A Medigap policy is designed to:
4
Independent Revision Guide and Practice
CDI Accident and Health Agent Examination - Complete Practice Guide
Below is a comprehensive, independent review guide for the California
Department of Insurance (CDI) Accident and Health Agent Licensing
Examination. This guide covers key concepts, core vocabulary, and practice
questions to help you prepare .
Part 1: Health Insurance Fundamentals
Policy Types & Core Concepts
1. What is the primary purpose of a "deductible" in a health insurance plan?
A) To determine the monthly premium cost
B) To cover the full cost of all medical services
C) To require the insured to pay a specific amount out-of-pocket before the insurer
begins to cover costs
D) To eliminate the need for a copayment
Answer: C
1
,Rationale: A deductible is the amount the insured must pay for covered health care
services before the insurance company starts to pay . It acts as a cost-sharing
mechanism between the insured and the insurer.
2. Which type of health plan typically requires members to select a Primary Care
Physician (PCP) and obtain referrals to see specialists?
A) Preferred Provider Organization (PPO)
B) Health Maintenance Organization (HMO)
C) Exclusive Provider Organization (EPO)
D) Point-of-Service (POS) Plan
Answer: B
Rationale: An HMO operates on a "gatekeeper" model. The PCP coordinates all
care and provides referrals for specialist services, a key feature that distinguishes
HMOs from other managed care plans like PPOs .
3. How does a PPO differ from an HMO?
2
,A) PPOs require referrals for specialists
B) PPOs allow members to see out-of-network providers, usually at a higher cost
C) PPOs do not have provider networks
D) PPOs cover 100% of all medical costs
Answer: B
Rationale: While PPOs have a network of preferred providers, members have the
flexibility to see out-of-network providers, though they will pay more for those
services. HMOs generally do not cover out-of-network care .
4. The "individual mandate" penalty under the Patient Protection and Affordable
Care Act (PPACA) was:
A) Increased in 2020
B) Completely eliminated at the federal level in 2019
C) Expanded to include dental coverage only
D) Applied only to high-income earners
Answer: B
3
, Rationale: The federal tax penalty for not having health insurance (the individual
mandate) was effectively reduced to $0 starting in 2019 .
5. What is the function of "coinsurance"?
A) A fixed dollar amount paid for each service
B) The percentage of allowed charges that the insured pays after meeting the
deductible
C) The total amount paid annually in premiums
D) A deductible applied to prescription drugs only
Answer: B
Rationale: Coinsurance is the percentage of costs the insured pays after the
deductible is met. For example, an 80/20 plan means the insurer pays 80% and the
insured pays 20% .
6. A Medigap policy is designed to:
4
