California Health Insurance Practice Exam Free - 2026

• A. 15 days, with a prorated refund
• B. No return right for Medicare supplement products
• C. 30 days from receipt to return it for a full premium refund for any reason, voiding the contract from inception
• D. 90 days, but only for duplicate coverage

Correct answer: C. 30 days from receipt to return it for a full premium refund for any reason, voiding the contract from inception

Explanation: A Medicare supplement policy or certificate must give the insured the right to return it within 30 days of receipt and have the full premium refunded if not satisfied for any reason; the return voids the policy from the beginning, and late refunds accrue interest. See Cal. Ins. Code 10192.17.

• A. 6 months
• B. Until the date 36 months after the coverage would otherwise have terminated
• C. 18 months, with no extensions ever available
• D. Indefinitely, as long as premiums are paid

Correct answer: B. Until the date 36 months after the coverage would otherwise have terminated

Explanation: Cal-COBRA continuation coverage under an insured group plan runs until the date 36 months after the qualified beneficiary's benefits would otherwise have terminated because of the qualifying event, subject to earlier termination events specified in the statute. See Cal. Ins. Code 10128.57.

• A. 7 days
• B. 31 days
• C. 10 days
• D. 60 days

Correct answer: C. 10 days

Explanation: The required grace-period provision for disability policies is at least 7 days for weekly-premium policies, 10 days for monthly-premium policies, and 31 days for all other premium modes, with the policy continuing in force during the grace period. The 60-day figure is the grace period California requires for individual life policies, not disability policies. See Cal. Ins. Code 10350.3.

• A. 10 days
• B. 20 days, or as soon thereafter as is reasonably possible
• C. 30 days
• D. 90 days

Correct answer: B. 20 days, or as soon thereafter as is reasonably possible

Explanation: The mandatory notice-of-claim provision requires written notice within 20 days after the occurrence or commencement of any covered loss, or as soon thereafter as is reasonably possible. Where disability benefits may be payable for at least two years, the insured must also give notice of continuance at least once every six months. Ninety days is the deadline for written proof of loss, not notice of claim. See Cal. Ins. Code 10350.5.

• A. A schedule of usual and customary charges for covered services
• B. A list of network providers a member may use for care
• C. A list of prescription drugs covered by a health plan
• D. A list of pre-existing conditions excluded from a health plan

Correct answer: C. A list of prescription drugs covered by a health plan

Explanation: A formulary is a list of prescription drugs covered by a health insurance plan. Drugs are often organized into tiers, with different cost-sharing amounts for each tier.

• A. Requiring plan approval before a specialty drug is dispensed
• B. Limiting the quantity of a drug a member may fill in a given period
• C. Charging progressively higher copayments as drugs move up formulary tiers
• D. Requiring trial of lower-cost drugs before more expensive options

Correct answer: D. Requiring trial of lower-cost drugs before more expensive options

Explanation: Step therapy requires patients to try one or more lower-cost medications (typically generics) before the plan will cover a more expensive brand-name drug for a condition.

• A. Coverage for assistance with daily living activities when unable to care for oneself
• B. Coverage that replaces lost income when a disability keeps the insured from working
• C. Coverage for extended inpatient hospital stays beyond major medical benefit limits
• D. Coverage that pays the gaps left by Medicare for physician and hospital deductibles

Correct answer: A. Coverage for assistance with daily living activities when unable to care for oneself

Explanation: Long-term care insurance covers services needed when a person cannot perform activities of daily living (like bathing, dressing, eating) due to chronic illness, disability, or cognitive impairment.

• A. Household tasks such as shopping and managing money and medications
• B. Basic self-care tasks used to measure need for long-term care
• C. Skilled nursing services ordered by a physician for a chronic condition
• D. Cognitive tests used to diagnose dementia before benefits are paid

Correct answer: B. Basic self-care tasks used to measure need for long-term care

Explanation: Activities of daily living (ADLs) are basic self-care tasks including bathing, dressing, eating, toileting, transferring (moving), and continence. Inability to perform ADLs often triggers long-term care benefits.

• A. The waiting period that must pass before benefits begin
• B. The event that causes premiums to be waived during a claim
• C. The criteria that must be met before benefits are paid
• D. The maximum number of days for which benefits will be paid

Correct answer: C. The criteria that must be met before benefits are paid

Explanation: A benefit trigger is the condition that must be met before long-term care insurance benefits begin. Common triggers include inability to perform a certain number of ADLs or cognitive impairment.

• A. Requiring every health plan to offer mental health benefits as a covered service
• B. Requiring equal premium rates for members with and without a mental health diagnosis
• C. Requiring mental health screening before a policy is issued to an applicant
• D. Requiring equal coverage for mental health as for medical/surgical conditions

Correct answer: D. Requiring equal coverage for mental health as for medical/surgical conditions

Explanation: Mental health parity means that when a plan does cover mental health and substance use disorder benefits, the financial requirements and treatment limitations applied to them may be no more restrictive than those applied to medical and surgical benefits. Parity does not by itself require a plan to offer mental health coverage; that obligation comes from the essential health benefits rules for individual and small group plans.

• A. Setting premiums based on the entire community rather than individual health status
• B. Setting premiums based on each applicant's individual medical history
• C. Insurance for community organizations
• D. Setting premiums based on a group's actual claims history

Correct answer: A. Setting premiums based on the entire community rather than individual health status

Explanation: Community rating is a method of setting premiums where everyone in a geographic area pays the same base rate, regardless of individual health status. The ACA requires modified community rating.

• A. Setting premiums based on the average risk of a whole geographic area
• B. Setting premiums based on a group's actual claims history
• C. Setting premiums based on each member's individual medical exam
• D. Setting premiums based on how long the group has been insured

Correct answer: B. Setting premiums based on a group's actual claims history

Explanation: Experience rating bases premium rates on the actual claims history and experience of a specific group. Groups with fewer claims may receive lower rates, while those with more claims pay higher rates.