ACCIDENT AND HEALTH INSURANCE EXAMS SCRIPT
2025/2026 QUESTIONS AND SOLUTION RATED A+
✔✔Military Suspension Provision - ✔✔This provision is designed to protect active duty
and reserve members of the armed forces. Individual plans may suspend coverage (and
premium) during active military service. When no longer serving, these individuals will
be permitted to resume coverage and premiums without any waiting periods.
✔✔Free Look Provision - ✔✔refund after 10 days (seniors maybe 30)
✔✔Exclusions - ✔✔losses not covered by a policy
✔✔pre-existing condition clause - ✔✔a clause permitting permanent or temporary
exclusion of coverage for any physical or mental problems the insured had at the time
the policy was purchased.
✔✔Exclusion rider - ✔✔unique exclusion that applies to one person
✔✔probationary period - ✔✔period of no coveraged before it begins.
✔✔Workers Compensation - ✔✔plan providing treatment for workers injured on the job
✔✔Medical Expense Policies - ✔✔- Basic
- Major Medical
- Comprehensive major medical
✔✔Base Plan Policies (Medical Expense) - ✔✔provides first dollar coverage, no co-pay
and low policy limits.
-Basic Medical, Basic Hospital, Basic Surgical
✔✔Major Medical Policies (Medical Expense) - ✔✔offer broad coverage and high limits
- const containment = a deductible, coinsurance, inside limits, and exclusions
✔✔Comprehensive Major Medical Policies - ✔✔marry the base plan to the major
medical to give you a little first dollar coverage
✔✔assignment - ✔✔redirection of the flow of benefits from policy owner to health care
provider
✔✔newborns are covered: - ✔✔from birth
✔✔adopted children are covered: - ✔✔from date of placement
, ✔✔Stop Loss Feature - ✔✔Places a dollar limit on the insured's yearly out-of-pocket
expenses
✔✔first dollar coverage - ✔✔insurance plans that cover all medical spending, with little
or no patient payment
✔✔Coinsurance - ✔✔controls policy over-utilization
✔✔disability income insurance - ✔✔substitute paycheck
✔✔occupation - ✔✔critical component in underwriting health insurance
✔✔your occupation - ✔✔if you can not do your job, you are disabled
✔✔any occupation - ✔✔if you can not do your job or any job you are reasonably suited,
then you are disabled
✔✔totally disabled - ✔✔must stem from an accident or illness
✔✔Presumptive Total Disability - ✔✔- Loss of sight, speech, hearing, limbs
✔✔short term disability income - ✔✔benefit less than 2 years (less expensive)
✔✔long term disability income - ✔✔benefit more than 5 years
✔✔social security rider (SIS) - ✔✔promises to pay the $1,000 each month if social
security does not
✔✔Additional Monthly Benefit (AMB) Rider - ✔✔will pay the $1,000 while social security
is deciding on disability
✔✔residual benefit limit rider - ✔✔will pay a % of lost income until end of coverage
✔✔Partial Disability Rider - ✔✔pay up to 50% of total benefit for 6 months
✔✔Recurrent Disability Provision - ✔✔A disabling condition which returns within a
specified period of time to be considered an extension of prior disability. The insured is
not required to undergo another elimination period.
✔✔waiver of premium provision - ✔✔If the insured is totally disabled for 90 days, future
premiums will be waived as long as the insured remains disabled
✔✔rehabilitation benefit provision - ✔✔pays for retraining to find a job in another line of
work
2025/2026 QUESTIONS AND SOLUTION RATED A+
✔✔Military Suspension Provision - ✔✔This provision is designed to protect active duty
and reserve members of the armed forces. Individual plans may suspend coverage (and
premium) during active military service. When no longer serving, these individuals will
be permitted to resume coverage and premiums without any waiting periods.
✔✔Free Look Provision - ✔✔refund after 10 days (seniors maybe 30)
✔✔Exclusions - ✔✔losses not covered by a policy
✔✔pre-existing condition clause - ✔✔a clause permitting permanent or temporary
exclusion of coverage for any physical or mental problems the insured had at the time
the policy was purchased.
✔✔Exclusion rider - ✔✔unique exclusion that applies to one person
✔✔probationary period - ✔✔period of no coveraged before it begins.
✔✔Workers Compensation - ✔✔plan providing treatment for workers injured on the job
✔✔Medical Expense Policies - ✔✔- Basic
- Major Medical
- Comprehensive major medical
✔✔Base Plan Policies (Medical Expense) - ✔✔provides first dollar coverage, no co-pay
and low policy limits.
-Basic Medical, Basic Hospital, Basic Surgical
✔✔Major Medical Policies (Medical Expense) - ✔✔offer broad coverage and high limits
- const containment = a deductible, coinsurance, inside limits, and exclusions
✔✔Comprehensive Major Medical Policies - ✔✔marry the base plan to the major
medical to give you a little first dollar coverage
✔✔assignment - ✔✔redirection of the flow of benefits from policy owner to health care
provider
✔✔newborns are covered: - ✔✔from birth
✔✔adopted children are covered: - ✔✔from date of placement
, ✔✔Stop Loss Feature - ✔✔Places a dollar limit on the insured's yearly out-of-pocket
expenses
✔✔first dollar coverage - ✔✔insurance plans that cover all medical spending, with little
or no patient payment
✔✔Coinsurance - ✔✔controls policy over-utilization
✔✔disability income insurance - ✔✔substitute paycheck
✔✔occupation - ✔✔critical component in underwriting health insurance
✔✔your occupation - ✔✔if you can not do your job, you are disabled
✔✔any occupation - ✔✔if you can not do your job or any job you are reasonably suited,
then you are disabled
✔✔totally disabled - ✔✔must stem from an accident or illness
✔✔Presumptive Total Disability - ✔✔- Loss of sight, speech, hearing, limbs
✔✔short term disability income - ✔✔benefit less than 2 years (less expensive)
✔✔long term disability income - ✔✔benefit more than 5 years
✔✔social security rider (SIS) - ✔✔promises to pay the $1,000 each month if social
security does not
✔✔Additional Monthly Benefit (AMB) Rider - ✔✔will pay the $1,000 while social security
is deciding on disability
✔✔residual benefit limit rider - ✔✔will pay a % of lost income until end of coverage
✔✔Partial Disability Rider - ✔✔pay up to 50% of total benefit for 6 months
✔✔Recurrent Disability Provision - ✔✔A disabling condition which returns within a
specified period of time to be considered an extension of prior disability. The insured is
not required to undergo another elimination period.
✔✔waiver of premium provision - ✔✔If the insured is totally disabled for 90 days, future
premiums will be waived as long as the insured remains disabled
✔✔rehabilitation benefit provision - ✔✔pays for retraining to find a job in another line of
work
