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Delaware Health Insurance Practice Questions & Answers 2026/2027 | Latest Exam Prep &
Study Guide
100 Questions with Verified Answers
Study Guide Note: This practice exam covers the Accident & Health Producer
(InsDE_Health02) licensing exam for Delaware. The state-specific section consists of 42
scored questions plus 13 pretest questions with a 60-minute time limit . The general
knowledge section contains 50 scored questions plus 10 pretest questions in 75 minutes . A
scaled passing score of 70% is required . Delaware does not require pre-licensing education .
Section 1: Health Insurance Fundamentals (Questions 1–20)
1. What is the primary purpose of health insurance?
A. To eliminate all medical expenses
B. To transfer the financial risk of medical costs from the individual to the insurer
C. To guarantee perfect health
D. To replace lost income
Answer: B. Health insurance transfers the financial risk associated with medical expenses to
an insurer in exchange for a premium. It does not eliminate all expenses but protects against
catastrophic costs.
2. What is a deductible in a health insurance policy?
A. The monthly premium amount
B. The amount the insured must pay before the insurer begins to share costs
C. A fixed fee paid at each doctor visit
D. The maximum the insurer will pay
Answer: B. A deductible is the amount the insured must pay out-of-pocket before the
insurance company begins sharing in covered expenses .
3. What is a copayment?
A. A percentage of the bill the insured pays
B. A fixed dollar amount paid by the insured for a covered service at the time of care
C. The monthly premium
D. The annual deductible
Answer: B. A copayment is a set fee paid by the insured each time a medical service is used,
such as $30 for a doctor visit .
4. What is coinsurance?
A. A fixed fee per service
B. The percentage of covered expenses the insured pays after meeting the deductible
,2
C. The insurer's share of costs
D. The premium amount
Answer: B. Coinsurance is the percentage the insured pays for covered services after the
deductible has been met, such as 20% of the bill .
5. What is an out-of-pocket maximum?
A. The maximum the insurer will pay for a service
B. The most the insured would have to pay for covered services in a plan year
C. The maximum premium increase
D. The deductible limit
Answer: B. The out-of-pocket maximum is the most a member would have to pay for
covered services in a plan year .
6. What is a health insurance network?
A. The total number of members covered by a plan
B. All the providers that have a contract with a health plan
C. An online resource only
D. The insurance company's headquarters
Answer: B. A network consists of all the providers (hospitals, physicians, specialists) that
have a contract with a health plan .
7. Which of the following is a characteristic of a Health Maintenance Organization (HMO)?
A. Full coverage for out-of-network providers
B. Requirement to use network providers for full benefits
C. No referrals required
D. No gatekeeper
Answer: B. HMOs require insureds to use network providers except in emergencies to
receive full coverage benefits .
8. What is a Preferred Provider Organization (PPO)?
A. A plan that only covers network providers
B. A plan that offers provider flexibility with financial incentives to use preferred providers
C. A government health plan
D. A plan with no deductibles
Answer: B. PPOs offer provider flexibility with preferred networks and out-of-network
coverage at higher costs, incentivizing members to use preferred providers.
9. What is a Point of Service (POS) plan?
, 3
A. A pure HMO
B. A pure PPO
C. A hybrid plan combining HMO and PPO features
D. An indemnity plan
Answer: C. POS plans combine HMO and PPO features, offering in-network gatekeeper care
and out-of-network flexibility at higher cost.
10. What is an indemnity plan?
A. A managed care plan
B. A traditional fee-for-service plan allowing any provider
C. An HMO
D. A PPO
Answer: B. Indemnity (fee-for-service) plans are traditional health insurance plans that allow
the insured to choose any provider without network restrictions.
11. What is a coordination of benefits (COB) provision?
A. A provision that increases total benefits
B. A provision that prevents overinsurance by coordinating payment between multiple
insurers
C. A provision that eliminates deductibles
D. A provision that allows duplicate coverage payments
Answer: B. COB ensures that when multiple policies exist, benefits do not exceed the total
allowable medical expenses .
12. What does a renewability provision protect against?
A. Premium increases
B. Cancellation due to increased claims after the policy is issued
C. Coverage for new conditions
D. Changes in benefit levels
Answer: B. Renewability provisions protect insureds from cancellation except under specific
conditions such as nonpayment of premiums or fraud .
13. What is a waiting period in a health insurance policy?
A. The time before the policy is issued
B. The time that must pass before certain benefits become payable
C. The time after a claim is filed
D. The time before premiums are due
Answer: B. A waiting period delays coverage for specific conditions or benefits until a
defined time has passed .
Delaware Health Insurance Practice Questions & Answers 2026/2027 | Latest Exam Prep &
Study Guide
100 Questions with Verified Answers
Study Guide Note: This practice exam covers the Accident & Health Producer
(InsDE_Health02) licensing exam for Delaware. The state-specific section consists of 42
scored questions plus 13 pretest questions with a 60-minute time limit . The general
knowledge section contains 50 scored questions plus 10 pretest questions in 75 minutes . A
scaled passing score of 70% is required . Delaware does not require pre-licensing education .
Section 1: Health Insurance Fundamentals (Questions 1–20)
1. What is the primary purpose of health insurance?
A. To eliminate all medical expenses
B. To transfer the financial risk of medical costs from the individual to the insurer
C. To guarantee perfect health
D. To replace lost income
Answer: B. Health insurance transfers the financial risk associated with medical expenses to
an insurer in exchange for a premium. It does not eliminate all expenses but protects against
catastrophic costs.
2. What is a deductible in a health insurance policy?
A. The monthly premium amount
B. The amount the insured must pay before the insurer begins to share costs
C. A fixed fee paid at each doctor visit
D. The maximum the insurer will pay
Answer: B. A deductible is the amount the insured must pay out-of-pocket before the
insurance company begins sharing in covered expenses .
3. What is a copayment?
A. A percentage of the bill the insured pays
B. A fixed dollar amount paid by the insured for a covered service at the time of care
C. The monthly premium
D. The annual deductible
Answer: B. A copayment is a set fee paid by the insured each time a medical service is used,
such as $30 for a doctor visit .
4. What is coinsurance?
A. A fixed fee per service
B. The percentage of covered expenses the insured pays after meeting the deductible
,2
C. The insurer's share of costs
D. The premium amount
Answer: B. Coinsurance is the percentage the insured pays for covered services after the
deductible has been met, such as 20% of the bill .
5. What is an out-of-pocket maximum?
A. The maximum the insurer will pay for a service
B. The most the insured would have to pay for covered services in a plan year
C. The maximum premium increase
D. The deductible limit
Answer: B. The out-of-pocket maximum is the most a member would have to pay for
covered services in a plan year .
6. What is a health insurance network?
A. The total number of members covered by a plan
B. All the providers that have a contract with a health plan
C. An online resource only
D. The insurance company's headquarters
Answer: B. A network consists of all the providers (hospitals, physicians, specialists) that
have a contract with a health plan .
7. Which of the following is a characteristic of a Health Maintenance Organization (HMO)?
A. Full coverage for out-of-network providers
B. Requirement to use network providers for full benefits
C. No referrals required
D. No gatekeeper
Answer: B. HMOs require insureds to use network providers except in emergencies to
receive full coverage benefits .
8. What is a Preferred Provider Organization (PPO)?
A. A plan that only covers network providers
B. A plan that offers provider flexibility with financial incentives to use preferred providers
C. A government health plan
D. A plan with no deductibles
Answer: B. PPOs offer provider flexibility with preferred networks and out-of-network
coverage at higher costs, incentivizing members to use preferred providers.
9. What is a Point of Service (POS) plan?
, 3
A. A pure HMO
B. A pure PPO
C. A hybrid plan combining HMO and PPO features
D. An indemnity plan
Answer: C. POS plans combine HMO and PPO features, offering in-network gatekeeper care
and out-of-network flexibility at higher cost.
10. What is an indemnity plan?
A. A managed care plan
B. A traditional fee-for-service plan allowing any provider
C. An HMO
D. A PPO
Answer: B. Indemnity (fee-for-service) plans are traditional health insurance plans that allow
the insured to choose any provider without network restrictions.
11. What is a coordination of benefits (COB) provision?
A. A provision that increases total benefits
B. A provision that prevents overinsurance by coordinating payment between multiple
insurers
C. A provision that eliminates deductibles
D. A provision that allows duplicate coverage payments
Answer: B. COB ensures that when multiple policies exist, benefits do not exceed the total
allowable medical expenses .
12. What does a renewability provision protect against?
A. Premium increases
B. Cancellation due to increased claims after the policy is issued
C. Coverage for new conditions
D. Changes in benefit levels
Answer: B. Renewability provisions protect insureds from cancellation except under specific
conditions such as nonpayment of premiums or fraud .
13. What is a waiting period in a health insurance policy?
A. The time before the policy is issued
B. The time that must pass before certain benefits become payable
C. The time after a claim is filed
D. The time before premiums are due
Answer: B. A waiting period delays coverage for specific conditions or benefits until a
defined time has passed .
