MICHIGAN ACCIDENT & HEALTH
INSURANCE EXAM QUESTIONS AND
ANSWERS 2026 VERIFIED.
The act of _________ insurance does NOT require an individual to hold an insurance producer
license.
-soliciting
-negotiating
-underwriting
-selling - ANS Underwriting
XYZ Company has applied for group health insurance for its employees. What information would
the insurer's underwriters likely use to determine the appropriate coverage and final premium
rate given to the group?
-Arrest reports
-AM Best rating
-Experience rating
-Credit reports - ANS Experience rating
Who is financially liable for the payment of covered claims in a fully insured group health plan?
-Insurer
-Health provider
-Guaranty Association
-Group member - ANS Insurer
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 48
,Which of the following types of employee welfare plans is specifically exempt from regulation
under ERISA?
-Blue Cross-Blue Shield plans
-Accident plans
-Hospital benefit plans
-Church plans - ANS Church plans
Which of the following statements about COBRA is CORRECT?
-The premium for continued group medical coverage may be up to 102% of the premium that
would otherwise be charged.
-The employer must pay the cost of the continued group coverage.
-The schedule of benefits during the continuation period may be different than those provided
under the group plan.
-COBRA permits an employee to convert a group certificate to an individual policy. - ANS The
premium for continued group medical coverage may be up to 102% of the premium that would
otherwise be charged.
Which of the following is the purpose of medical cost management?
-To influence hospital charges and doctors' fees
-To discourage individuals from utilizing health care services
-To control health claim expenses
-To encourage individuals to seek medical help only as a last resort - ANS To control health
claim expenses
Which of the following is considered to be a point of service (POS) plan?
-Managed care plan
-Preferred provider organization
-Protected care provider
-Restricted provider organization - ANS Managed care plan
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 48
,Which of the following best describes the characteristics of Preferred Provider Organizations
(PPOs)?
-PPOs are generally public in nature rather than private
-If service is obtained outside the PPO, benefits are reduced and costs increase
-PPOs operate like an HMO on a prepaid basis
-Health care providers themselves are barred from forming a PPO due to conflict of interest -
ANS If service is obtained outside the PPO, benefits are reduced and costs increase
When comparing an HMO to a PPO, the PPO
-always requires service in a network
-always requires a referral to specialists
-is a prepaid medical service plan
-provides a greater choice of providers - ANS provides a greater choice of providers
When a preferred provider organization (PPO) insured goes out-of-network, which of the
following actions occur?
-The benefits are taxable
-The insured will pay a reduced amount
-The insured has lower out-of-pocket expenses
-The insurer will pay a reduced amount - ANS The insurer will pay a reduced amount
What is the name of a health care delivery system involving private insurers who contract with
doctors and hospitals to provide services at set prices and allows insureds to choose among
designated doctors and hospitals when medical treatment and care is needed?
-Health Insuring Corporation
-Administrative services organization
-Preferred provider organization
-Health care service organization - ANS Preferred provider organization
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 48
, What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an
employee to do?
-In the event of employment termination, group health insurance can be kept if the employee
pays the premiums
-Remain on their current coverage for 30 months
-In the event of employment termination, group health insurance can be kept if the employer
pays the premiums
-Receive a tax credit to help offset the cost of health insurance - ANS In the event of
employment termination, group health insurance can be kept if the employee pays the
premiums
The policyholder for a group health benefit plan is considered to be the
-Insurer
-Employee
-Liaison
-Employer - ANS Employer
The difference between pre-certification and concurrent review is that pre-certification
-costs more to the patient
-is considered a cost containment measure
-occurs before the treatment is provided
-costs less to the patient - ANS occurs before the treatment is provided
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies ONLY to
employers with which number of employees?
-5 or more
-20 or more
-50 or more
-15 or more - ANS 20 or more
@COPYRIGHT ALL RIGHTS RESERVED PAGE 4 OF 48
INSURANCE EXAM QUESTIONS AND
ANSWERS 2026 VERIFIED.
The act of _________ insurance does NOT require an individual to hold an insurance producer
license.
-soliciting
-negotiating
-underwriting
-selling - ANS Underwriting
XYZ Company has applied for group health insurance for its employees. What information would
the insurer's underwriters likely use to determine the appropriate coverage and final premium
rate given to the group?
-Arrest reports
-AM Best rating
-Experience rating
-Credit reports - ANS Experience rating
Who is financially liable for the payment of covered claims in a fully insured group health plan?
-Insurer
-Health provider
-Guaranty Association
-Group member - ANS Insurer
@COPYRIGHT ALL RIGHTS RESERVED PAGE 1 OF 48
,Which of the following types of employee welfare plans is specifically exempt from regulation
under ERISA?
-Blue Cross-Blue Shield plans
-Accident plans
-Hospital benefit plans
-Church plans - ANS Church plans
Which of the following statements about COBRA is CORRECT?
-The premium for continued group medical coverage may be up to 102% of the premium that
would otherwise be charged.
-The employer must pay the cost of the continued group coverage.
-The schedule of benefits during the continuation period may be different than those provided
under the group plan.
-COBRA permits an employee to convert a group certificate to an individual policy. - ANS The
premium for continued group medical coverage may be up to 102% of the premium that would
otherwise be charged.
Which of the following is the purpose of medical cost management?
-To influence hospital charges and doctors' fees
-To discourage individuals from utilizing health care services
-To control health claim expenses
-To encourage individuals to seek medical help only as a last resort - ANS To control health
claim expenses
Which of the following is considered to be a point of service (POS) plan?
-Managed care plan
-Preferred provider organization
-Protected care provider
-Restricted provider organization - ANS Managed care plan
@COPYRIGHT ALL RIGHTS RESERVED PAGE 2 OF 48
,Which of the following best describes the characteristics of Preferred Provider Organizations
(PPOs)?
-PPOs are generally public in nature rather than private
-If service is obtained outside the PPO, benefits are reduced and costs increase
-PPOs operate like an HMO on a prepaid basis
-Health care providers themselves are barred from forming a PPO due to conflict of interest -
ANS If service is obtained outside the PPO, benefits are reduced and costs increase
When comparing an HMO to a PPO, the PPO
-always requires service in a network
-always requires a referral to specialists
-is a prepaid medical service plan
-provides a greater choice of providers - ANS provides a greater choice of providers
When a preferred provider organization (PPO) insured goes out-of-network, which of the
following actions occur?
-The benefits are taxable
-The insured will pay a reduced amount
-The insured has lower out-of-pocket expenses
-The insurer will pay a reduced amount - ANS The insurer will pay a reduced amount
What is the name of a health care delivery system involving private insurers who contract with
doctors and hospitals to provide services at set prices and allows insureds to choose among
designated doctors and hospitals when medical treatment and care is needed?
-Health Insuring Corporation
-Administrative services organization
-Preferred provider organization
-Health care service organization - ANS Preferred provider organization
@COPYRIGHT ALL RIGHTS RESERVED PAGE 3 OF 48
, What does the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 allow an
employee to do?
-In the event of employment termination, group health insurance can be kept if the employee
pays the premiums
-Remain on their current coverage for 30 months
-In the event of employment termination, group health insurance can be kept if the employer
pays the premiums
-Receive a tax credit to help offset the cost of health insurance - ANS In the event of
employment termination, group health insurance can be kept if the employee pays the
premiums
The policyholder for a group health benefit plan is considered to be the
-Insurer
-Employee
-Liaison
-Employer - ANS Employer
The difference between pre-certification and concurrent review is that pre-certification
-costs more to the patient
-is considered a cost containment measure
-occurs before the treatment is provided
-costs less to the patient - ANS occurs before the treatment is provided
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies ONLY to
employers with which number of employees?
-5 or more
-20 or more
-50 or more
-15 or more - ANS 20 or more
@COPYRIGHT ALL RIGHTS RESERVED PAGE 4 OF 48
