TEXAS HEALTH INSURANCE EXAM
2023/2024 QUESTIONS AND ANSWERS
Accident - Answer-An unplanned, unforeseen event which occurs suddenly and at an
unspecified place.
Accident Insurance - Answer-A type of insurance that protects the insured against loss
due to accidental bodily injury.
Accidental Bodily Injury - Answer-Unplanned, unforeseen traumatic injury to the body.
Accidental Death and Dismemberment - Answer-An insurance policy which pays a
specified amount or a specified multiple of the insured's benefit if the insured dies, loses
his/her sight, or loses two limbs due to an accident.
Accidental Death Benefits - Answer-A policy rider that states that the cause of death will
be analyzed to determine if it complies with the policy description of accidental death.
Activities of Daily Living - Answer-Activities individuals must do every day such as
moving about, getting dressed, eating, bathing, etc.
Actual Charge - Answer-The amount a physician or supplier actually bills for a particular
service or supply.
Adhesion - Answer-A contract offered on a "take-it-or-leave-it" basis by an insurer, in
which the insured's only option is to accept or reject the contract. Any ambiguities in the
contract will be settled in favor of the insured.
Admitted (Authorized) Insurer - Answer-An insurance company authorized and licensed
to transact business in a particular state.
Adult Day Care - Answer-A program for impaired adults that attempts to meet their
health, social, and functional needs in a setting away from their homes.
Adverse Selection - Answer-The tendency of risks with higher probability of loss to
purchase and maintain insurance more often than the risks who present lower
probability.
Agent - Answer-An individual who is licensed to sell, negotiate, or effect insurance
contracts on behalf of an insurer.
Aleatory - Answer-A contract in which participating parties exchange unequal amounts.
Insurance contracts are aleatory in that the amount the insured will pay in premiums is
unequal to the amount the insurer will pay in the event of a loss.
, Alien Insurer - Answer-An insurance company that is incorporated outside the United
States.
Alzheimer's disease - Answer-A disease that causes the victim to become dysfunctional
due to degeneration of brain cells and severe memory loss.
Apparent Authority - Answer-The appearance or the assumption of authority based on
the actions, words, or deeds of the principal or because of circumstances the principal
created.
Approved Amount - Answer-The amount Medicare determines to be reasonable for a
service that is covered under part B of Medicare.
Assignment - Answer-A claim to a provider or medical supplier to receive payments
directly from Medicare.
Attained Age - Answer-The age of the insured at a determined date.
Which is false about contingent beneficiaries?
A. They are different from primary beneficiaries
B. They may receive benefits if the primary beneficiary is no longer able to
C. They are a backup
D. They can never be changed - Answer-D. They can never be changed
All but which of the following are HDHP benefit areas, according to federal regulations?
A. First dollar coverage
B. Out-of-pocket maximum
C. Non-contributory
D. Deductible - Answer-C. Non-contributory
Justine is in the final stages of a battle with cancer. What type of care does she require?
A. Rehabilitation
B. Hospital
C. Hospice
D. Terminable - Answer-C. Hospice
Which of the following terms means that the disability policy will pay benefits if the
insured cannot work in their usual field of work?
A. Specific occupation
B. General occupation
C. Any occupation
D. Personal occupation
E. Own occupation - Answer-Own Occupation
Which of the following is true about Medicaid?
A. It is a federal program
2023/2024 QUESTIONS AND ANSWERS
Accident - Answer-An unplanned, unforeseen event which occurs suddenly and at an
unspecified place.
Accident Insurance - Answer-A type of insurance that protects the insured against loss
due to accidental bodily injury.
Accidental Bodily Injury - Answer-Unplanned, unforeseen traumatic injury to the body.
Accidental Death and Dismemberment - Answer-An insurance policy which pays a
specified amount or a specified multiple of the insured's benefit if the insured dies, loses
his/her sight, or loses two limbs due to an accident.
Accidental Death Benefits - Answer-A policy rider that states that the cause of death will
be analyzed to determine if it complies with the policy description of accidental death.
Activities of Daily Living - Answer-Activities individuals must do every day such as
moving about, getting dressed, eating, bathing, etc.
Actual Charge - Answer-The amount a physician or supplier actually bills for a particular
service or supply.
Adhesion - Answer-A contract offered on a "take-it-or-leave-it" basis by an insurer, in
which the insured's only option is to accept or reject the contract. Any ambiguities in the
contract will be settled in favor of the insured.
Admitted (Authorized) Insurer - Answer-An insurance company authorized and licensed
to transact business in a particular state.
Adult Day Care - Answer-A program for impaired adults that attempts to meet their
health, social, and functional needs in a setting away from their homes.
Adverse Selection - Answer-The tendency of risks with higher probability of loss to
purchase and maintain insurance more often than the risks who present lower
probability.
Agent - Answer-An individual who is licensed to sell, negotiate, or effect insurance
contracts on behalf of an insurer.
Aleatory - Answer-A contract in which participating parties exchange unequal amounts.
Insurance contracts are aleatory in that the amount the insured will pay in premiums is
unequal to the amount the insurer will pay in the event of a loss.
, Alien Insurer - Answer-An insurance company that is incorporated outside the United
States.
Alzheimer's disease - Answer-A disease that causes the victim to become dysfunctional
due to degeneration of brain cells and severe memory loss.
Apparent Authority - Answer-The appearance or the assumption of authority based on
the actions, words, or deeds of the principal or because of circumstances the principal
created.
Approved Amount - Answer-The amount Medicare determines to be reasonable for a
service that is covered under part B of Medicare.
Assignment - Answer-A claim to a provider or medical supplier to receive payments
directly from Medicare.
Attained Age - Answer-The age of the insured at a determined date.
Which is false about contingent beneficiaries?
A. They are different from primary beneficiaries
B. They may receive benefits if the primary beneficiary is no longer able to
C. They are a backup
D. They can never be changed - Answer-D. They can never be changed
All but which of the following are HDHP benefit areas, according to federal regulations?
A. First dollar coverage
B. Out-of-pocket maximum
C. Non-contributory
D. Deductible - Answer-C. Non-contributory
Justine is in the final stages of a battle with cancer. What type of care does she require?
A. Rehabilitation
B. Hospital
C. Hospice
D. Terminable - Answer-C. Hospice
Which of the following terms means that the disability policy will pay benefits if the
insured cannot work in their usual field of work?
A. Specific occupation
B. General occupation
C. Any occupation
D. Personal occupation
E. Own occupation - Answer-Own Occupation
Which of the following is true about Medicaid?
A. It is a federal program
