1 | Page
HEALTH INSURANCE OHIO EXAM
QUESTIONS AND ANSWERS 2026\2027
Two major perils under a health insurance policy: CORRCT
ANSWER Policies may cover both accident and sickness or
accident only.
Accidental bodily injury: CORRCT ANSWER An unforeseen
and unintended injury that resulted from an accident rather than
a sickness.
Sickness: CORRCT ANSWER Normally defined as an illness,
which first manifests itself while the policy is in force. This is
where a majority of health insurance claims result from.
Loss of income from disability: CORRCT ANSWER Loss of
income caused by accident or sickness causing an insured the
inability to work and earn in come.
Limited Vs Comprehensive: CORRCT ANSWER Limited health
insurance policies only cover specific accidents or diseases.
Comprehensive plan would cover all sickness or accidents that
are not specifically excluded.
,2 | Page
A successful self funded plan will have the following
characteristics: (5) CORRCT ANSWER -A group large enough
to reasonably predict future loss experience.
-Sound statistical data to support the self-funding concept.
-A stop-loss contract to assume losses beyond the insured's
retention.
-A third party administrator who services claims.
-Flexibility in plan design and administrative procedures.
Employee Retirement Income Security Act of 1974 (ERISA):
CORRCT ANSWER A federal law that was enacted to ensure
that employees receive the pension and other benefits
promised by their employers.
Association (alumni or professional) group: CORRCT ANSWER
Can buy group insurance for its members. The group must
have at least 100 members, be organized for a reason other
than buying insurance, have been active for two years, have a
constitution, by-laws, and must hold at least annual meetings.
,3 | Page
Multiple-Employer Trust (MET): CORRCT ANSWER Made up
of two or more employers in similar or related businesses who
do not qualify for group insurance on their own.
Multiple Employer Welfare Associations (MEWAs): CORRCT
ANSWER Can be any entity, other than a duly admitted insurer,
that establishes an employee benefit plan for the purpose of
offering or providing accident and sickness or death benefits to
the employees of at least 2 employers, including self-employed
individuals and their dependents.
They pool their risks in order to self-insure
Accident only policies: CORRCT ANSWER Limited policies that
provide coverage for death, dismemberment, disability or
hospital and medical care resulting from an accident. Only pays
for losses from accidents not sickness.
Principal Sum: CORRCT ANSWER This amount is usually
equal to the amount of coverage under the insurance contract,
or the face amount.
, 4 | Page
Capital Sum: CORRCT ANSWER In case of loss of sight or
accidental dismemberment, a percentage of that principal sum
will be paid by the policy.
Dread Disease (limited risk) policy: CORRCT ANSWER
Provides a variety of benefits for a specific disease such as
cancer policy or heart disease policy. Benefits usually paid as
scheduled, fixed dollar amount.
Hospital indemnity: CORRCT ANSWER Provides a specific
amount on a daily, weekly or monthly basis while the insured is
confined to a hospital.
Critical illness policy: CORRCT ANSWER Pays a lump sum to
the insured upon the diagnoses (and survival) of a critical
illness.
The insured must survive the illness for a certain period of time
(30 days)
Blanket Policy: CORRCT ANSWER Covers members of a
particular group when they are participating in a particular
activity.
HEALTH INSURANCE OHIO EXAM
QUESTIONS AND ANSWERS 2026\2027
Two major perils under a health insurance policy: CORRCT
ANSWER Policies may cover both accident and sickness or
accident only.
Accidental bodily injury: CORRCT ANSWER An unforeseen
and unintended injury that resulted from an accident rather than
a sickness.
Sickness: CORRCT ANSWER Normally defined as an illness,
which first manifests itself while the policy is in force. This is
where a majority of health insurance claims result from.
Loss of income from disability: CORRCT ANSWER Loss of
income caused by accident or sickness causing an insured the
inability to work and earn in come.
Limited Vs Comprehensive: CORRCT ANSWER Limited health
insurance policies only cover specific accidents or diseases.
Comprehensive plan would cover all sickness or accidents that
are not specifically excluded.
,2 | Page
A successful self funded plan will have the following
characteristics: (5) CORRCT ANSWER -A group large enough
to reasonably predict future loss experience.
-Sound statistical data to support the self-funding concept.
-A stop-loss contract to assume losses beyond the insured's
retention.
-A third party administrator who services claims.
-Flexibility in plan design and administrative procedures.
Employee Retirement Income Security Act of 1974 (ERISA):
CORRCT ANSWER A federal law that was enacted to ensure
that employees receive the pension and other benefits
promised by their employers.
Association (alumni or professional) group: CORRCT ANSWER
Can buy group insurance for its members. The group must
have at least 100 members, be organized for a reason other
than buying insurance, have been active for two years, have a
constitution, by-laws, and must hold at least annual meetings.
,3 | Page
Multiple-Employer Trust (MET): CORRCT ANSWER Made up
of two or more employers in similar or related businesses who
do not qualify for group insurance on their own.
Multiple Employer Welfare Associations (MEWAs): CORRCT
ANSWER Can be any entity, other than a duly admitted insurer,
that establishes an employee benefit plan for the purpose of
offering or providing accident and sickness or death benefits to
the employees of at least 2 employers, including self-employed
individuals and their dependents.
They pool their risks in order to self-insure
Accident only policies: CORRCT ANSWER Limited policies that
provide coverage for death, dismemberment, disability or
hospital and medical care resulting from an accident. Only pays
for losses from accidents not sickness.
Principal Sum: CORRCT ANSWER This amount is usually
equal to the amount of coverage under the insurance contract,
or the face amount.
, 4 | Page
Capital Sum: CORRCT ANSWER In case of loss of sight or
accidental dismemberment, a percentage of that principal sum
will be paid by the policy.
Dread Disease (limited risk) policy: CORRCT ANSWER
Provides a variety of benefits for a specific disease such as
cancer policy or heart disease policy. Benefits usually paid as
scheduled, fixed dollar amount.
Hospital indemnity: CORRCT ANSWER Provides a specific
amount on a daily, weekly or monthly basis while the insured is
confined to a hospital.
Critical illness policy: CORRCT ANSWER Pays a lump sum to
the insured upon the diagnoses (and survival) of a critical
illness.
The insured must survive the illness for a certain period of time
(30 days)
Blanket Policy: CORRCT ANSWER Covers members of a
particular group when they are participating in a particular
activity.
