PA LIFE ACCIDENT HEALTH CORE EXAMS SET 2025/2026
QUESTIONS WITH SOLUTIONS RATED A+
✔✔Claim - ✔✔A request for payment of the benefits provided by an insurance contract.
✔✔Coercion - ✔✔An unfair trade practice in which an insurer uses physical or mental
force to persuade an applicant to buy insurance.
✔✔Coinsurance - ✔✔An agreement between an insurer and insured in which both
parties are expected to pay a certain portion of the potential loss and other expenses.
✔✔Coinsurance Clause - ✔✔A provision that states that the insurer will share the
losses covered by the policy in a proportion agreed upon in advance.
✔✔Commissioner - ✔✔The chief executive and administrative officer of the Insurance
Department.
✔✔Comprehensive Policy - ✔✔A plan that provides a package of health care services,
including preventive care, routine physicals, immunizations, outpatient services, and
hospitalization.
✔✔Comprehensive Major Medical - ✔✔A combination of basic coverage and major
medical coverage the features low deductibles, high maximum benefits, and
coinsurance.
✔✔Concealment - ✔✔The withholding of known facts which, if material, can void a
contract.
✔✔Conditional Contract - ✔✔A type of an agreement in which both parties must
perform certain duties and follow rules of conduct to make the contact enforceable.
✔✔Consideration - ✔✔The binding force in a contract that requires something of value
to be exchanged for the transfer of risk. The consideration on the part of the insurer is
the promise to pay in the event of loss.
✔✔Consideration Clause - ✔✔A part of the insurance contract that states that both
parties must give something of value for the transfer or risk, and specifies the conditions
of the exchange
✔✔Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 - ✔✔The law
that provides for the continuation of group health care benefits for the insured for up to
18 months if he/she terminates employment or is no longer eligible, and for the insured's
dependents for up to 36 months in cases of loss of eligibility due to death of insured,
divorce, or attainment of the limiting age.
,✔✔Consumer Report - ✔✔A written and/or oral statement regarding a consumer's
credit, character, reputation, or habits collected by a reporting agency from employment
records, credit reports, and other public sources.
✔✔Contract - ✔✔An agreement between to or more parties enforceable by law.
✔✔Contributory - ✔✔A group insurance plan that requires the employees to pay part of
the premium.
✔✔Coordination of Benefits - ✔✔A provision that helps determine the primary provider
in situations where an insured is covered by more than one policy, thus avoiding claims
over payments.
✔✔Copayment - ✔✔An arrangement in which an insured must pay a specified amount
of services"up front" and the provider pays the remainder of the cost.
✔✔Custodial Care - ✔✔Care that is rendered to help an insured complete his/her
activities of daily living.
✔✔Death Benefit - ✔✔The amount payable upon the death of the person whose life is
insured.
✔✔Deductible - ✔✔The portion of the loss that is to be paid by the insured before any
claim may be paid by the insurer.
✔✔Defamation - ✔✔An unfair trade practice in which one agent or insurer makes an
injurious statement about another with the intent of harming the person's or company's
reputation .
✔✔Director - ✔✔The chief executive and administrative officer of the insurance
department.
✔✔Disability - ✔✔A physical or mental impairment, either congenital or resulting from
an injury or sickness.
✔✔Disability Income Insurance - ✔✔Health insurance that provides periodic payments
to replace an insured's income when he/she is injured/ill.
✔✔Disclosure - ✔✔An act of identifying the name of the producer, representative or
firm, limited insurance representative, or temporary insurance producer on any policy
situation.
✔✔Domestic Insurer - ✔✔An insurance company that is incorporated in the state.
, ✔✔Domicile of Insurer - ✔✔Insurer's location of incorporation and the legal ability to
write business in a state.
✔✔Dread (Specified) Disease Policy - ✔✔A policy with a high maximum limit that
covers certain diseases named in the contract (such as polio and meningitis)
✔✔Dual Choice - ✔✔A federal requirement that employers who have 25 or more
employees, who are within the service area of a qualified HMO, who pay minimum
wage, and offer a health plan,must offer HMO coverage as well as an indemnity plan.
✔✔Eligibility Period - ✔✔The period of time in which an employee may enroll within a
group health care plan without having to provide evidence of insurability.
✔✔Elimination Period - ✔✔A waiting period that is imposed on the insured from onset of
disability until benefit payments begin.
✔✔Emergency - ✔✔An injury or disease which occurs suddenly and requires treatment
within 24 hours.
✔✔Endodontics - ✔✔An area of dentistry that deals with diagnosis, prevention and
treatment of the dental pulp within natural teeth at the root canal.
✔✔Enrollment Period - ✔✔The amount of time an employee has to sign up for a
contributory group health plan.
✔✔Estoppel - ✔✔A legal impediment to denying a fact or restoring a right that has been
previously waived.
✔✔Excess Charge - ✔✔The difference between the Medicare approved amount for
service or supply and the actual charge.
✔✔Expiration - ✔✔The date specified in the policy as the date of termination
✔✔Explanation of Benefits (EOB) - ✔✔A statement that outlines what services were
rendered, how much the insurer paid, and how much the insured was billed
✔✔Explanation of Medicare Benefits - ✔✔A statement sent to a Medicare patient
indicating how the Medicare claim will be settled.
✔✔Exposure - ✔✔A unit of measure used to determine rates charged for insurance
coverage
QUESTIONS WITH SOLUTIONS RATED A+
✔✔Claim - ✔✔A request for payment of the benefits provided by an insurance contract.
✔✔Coercion - ✔✔An unfair trade practice in which an insurer uses physical or mental
force to persuade an applicant to buy insurance.
✔✔Coinsurance - ✔✔An agreement between an insurer and insured in which both
parties are expected to pay a certain portion of the potential loss and other expenses.
✔✔Coinsurance Clause - ✔✔A provision that states that the insurer will share the
losses covered by the policy in a proportion agreed upon in advance.
✔✔Commissioner - ✔✔The chief executive and administrative officer of the Insurance
Department.
✔✔Comprehensive Policy - ✔✔A plan that provides a package of health care services,
including preventive care, routine physicals, immunizations, outpatient services, and
hospitalization.
✔✔Comprehensive Major Medical - ✔✔A combination of basic coverage and major
medical coverage the features low deductibles, high maximum benefits, and
coinsurance.
✔✔Concealment - ✔✔The withholding of known facts which, if material, can void a
contract.
✔✔Conditional Contract - ✔✔A type of an agreement in which both parties must
perform certain duties and follow rules of conduct to make the contact enforceable.
✔✔Consideration - ✔✔The binding force in a contract that requires something of value
to be exchanged for the transfer of risk. The consideration on the part of the insurer is
the promise to pay in the event of loss.
✔✔Consideration Clause - ✔✔A part of the insurance contract that states that both
parties must give something of value for the transfer or risk, and specifies the conditions
of the exchange
✔✔Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 - ✔✔The law
that provides for the continuation of group health care benefits for the insured for up to
18 months if he/she terminates employment or is no longer eligible, and for the insured's
dependents for up to 36 months in cases of loss of eligibility due to death of insured,
divorce, or attainment of the limiting age.
,✔✔Consumer Report - ✔✔A written and/or oral statement regarding a consumer's
credit, character, reputation, or habits collected by a reporting agency from employment
records, credit reports, and other public sources.
✔✔Contract - ✔✔An agreement between to or more parties enforceable by law.
✔✔Contributory - ✔✔A group insurance plan that requires the employees to pay part of
the premium.
✔✔Coordination of Benefits - ✔✔A provision that helps determine the primary provider
in situations where an insured is covered by more than one policy, thus avoiding claims
over payments.
✔✔Copayment - ✔✔An arrangement in which an insured must pay a specified amount
of services"up front" and the provider pays the remainder of the cost.
✔✔Custodial Care - ✔✔Care that is rendered to help an insured complete his/her
activities of daily living.
✔✔Death Benefit - ✔✔The amount payable upon the death of the person whose life is
insured.
✔✔Deductible - ✔✔The portion of the loss that is to be paid by the insured before any
claim may be paid by the insurer.
✔✔Defamation - ✔✔An unfair trade practice in which one agent or insurer makes an
injurious statement about another with the intent of harming the person's or company's
reputation .
✔✔Director - ✔✔The chief executive and administrative officer of the insurance
department.
✔✔Disability - ✔✔A physical or mental impairment, either congenital or resulting from
an injury or sickness.
✔✔Disability Income Insurance - ✔✔Health insurance that provides periodic payments
to replace an insured's income when he/she is injured/ill.
✔✔Disclosure - ✔✔An act of identifying the name of the producer, representative or
firm, limited insurance representative, or temporary insurance producer on any policy
situation.
✔✔Domestic Insurer - ✔✔An insurance company that is incorporated in the state.
, ✔✔Domicile of Insurer - ✔✔Insurer's location of incorporation and the legal ability to
write business in a state.
✔✔Dread (Specified) Disease Policy - ✔✔A policy with a high maximum limit that
covers certain diseases named in the contract (such as polio and meningitis)
✔✔Dual Choice - ✔✔A federal requirement that employers who have 25 or more
employees, who are within the service area of a qualified HMO, who pay minimum
wage, and offer a health plan,must offer HMO coverage as well as an indemnity plan.
✔✔Eligibility Period - ✔✔The period of time in which an employee may enroll within a
group health care plan without having to provide evidence of insurability.
✔✔Elimination Period - ✔✔A waiting period that is imposed on the insured from onset of
disability until benefit payments begin.
✔✔Emergency - ✔✔An injury or disease which occurs suddenly and requires treatment
within 24 hours.
✔✔Endodontics - ✔✔An area of dentistry that deals with diagnosis, prevention and
treatment of the dental pulp within natural teeth at the root canal.
✔✔Enrollment Period - ✔✔The amount of time an employee has to sign up for a
contributory group health plan.
✔✔Estoppel - ✔✔A legal impediment to denying a fact or restoring a right that has been
previously waived.
✔✔Excess Charge - ✔✔The difference between the Medicare approved amount for
service or supply and the actual charge.
✔✔Expiration - ✔✔The date specified in the policy as the date of termination
✔✔Explanation of Benefits (EOB) - ✔✔A statement that outlines what services were
rendered, how much the insurer paid, and how much the insured was billed
✔✔Explanation of Medicare Benefits - ✔✔A statement sent to a Medicare patient
indicating how the Medicare claim will be settled.
✔✔Exposure - ✔✔A unit of measure used to determine rates charged for insurance
coverage
