Connecticut Health Insurance Practice Exam Free - 2026

• A. Within 31 days after birth
• B. Within 60 days after birth
• C. Within 91 days after birth
• D. Within 30 days after birth

Correct answer: C. Within 91 days after birth

Explanation: Connecticut individual (and group, under section 38a-516) health policies must cover a newborn from the moment of birth, including congenital defects, and where a specific premium is required may demand notification of birth and payment not later than ninety-one days after the date of birth to continue coverage, without prejudicing claims arising in that period. Thirty-one, 60 and 30 days are shorter than the statutory 91-day window. See Conn. Gen. Stat. § 38a-490.

• A. The end of the month she turns 19
• B. Age 23, because she is not a full-time student
• C. The date she becomes employed full time
• D. The policy anniversary date after she attains age 26

Correct answer: D. The policy anniversary date after she attains age 26

Explanation: Each individual health policy in Connecticut must provide that coverage of a child, stepchild or other dependent child terminates not earlier than the policy anniversary date after the child attains age twenty-six, and must cover a stepchild on the same basis as a biological child; the same rule applies to group policies under section 38a-512b. Age 19 and a student-based age 23 are outdated tests, and employment status is not a permitted termination trigger. See Conn. Gen. Stat. § 38a-497.

• A. Within 31 days of his attaining the limiting age
• B. Within 60 days of his attaining the limiting age
• C. Within 90 days of his attaining the limiting age
• D. Within 120 days of his attaining the limiting age

Correct answer: A. Within 31 days of his attaining the limiting age

Explanation: Connecticut group (section 38a-515) and individual (section 38a-489) policies must continue coverage of a child who is incapable of self-sustaining employment by reason of mental or physical handicap and chiefly dependent on the employee, provided proof is furnished within thirty-one days of the child's attaining the limiting age; after two years the insurer may require proof no more than once a year. Sixty, 90 and 120 days exceed the statutory window. See Conn. Gen. Stat. § 38a-515.

• A. 7 days
• B. 10 days
• C. 31 days
• D. 30 days

Correct answer: B. 10 days

Explanation: Connecticut's standard provisions for individual health policies require a grace period of not less than seven days for weekly-premium policies, ten days for monthly-premium policies, and thirty-one days for all other premium modes, during which the policy stays in force. Seven days applies only to weekly premiums, 31 days to quarterly, semiannual or annual premiums, and 30 days is not one of the statutory figures. See Conn. Gen. Stat. § 38a-483.

• A. Subsidies that lower the monthly premium for eligible people buying Marketplace coverage
• B. Provisions that let family members combine their deductibles under a single family limit
• C. Subsidies that lower deductibles, copays, and out-of-pocket limits for eligible individuals
• D. Negotiated discounts that reduce what a plan pays hospitals for covered inpatient services

Correct answer: C. Subsidies that lower deductibles, copays, and out-of-pocket limits for eligible individuals

Explanation: Cost-sharing reductions are subsidies that lower out-of-pocket costs (deductibles, copays, coinsurance) for eligible individuals who choose Silver tier Marketplace plans and meet income requirements.

• A. Anyone willing to pay a higher premium
• B. People under age 30, or those with a hardship or affordability exemption
• C. Only people over age 55
• D. Small business owners only

Correct answer: B. People under age 30, or those with a hardship or affordability exemption

Explanation: Catastrophic plans pair low premiums with a very high deductible. They are limited to people under 30 or those granted a hardship or affordability exemption. They cover the essential health benefits after the deductible, plus at least three primary care visits and free in-network preventive care before it - but premium tax credits cannot be applied to them.

• A. To act as the member's main doctor and coordinate care within the network
• B. To provide specialty treatment after the member obtains a referral from the plan
• C. To review submitted claims and decide which charges are medically necessary
• D. To treat the member for any condition outside the network at no added cost

Correct answer: A. To act as the member's main doctor and coordinate care within the network

Explanation: In many HMO arrangements, the primary care physician coordinates routine care and may provide referrals to specialists within the network.

• A. It requires members to select a primary care gatekeeper for referrals
• B. It usually gives members more provider flexibility than an HMO
• C. It generally pays nothing for care from an out-of-network provider
• D. It pays providers a fixed monthly capitation fee per enrolled member

Correct answer: B. It usually gives members more provider flexibility than an HMO

Explanation: A preferred provider organization usually lets members use network providers at better cost sharing while still offering some coverage for out-of-network care.

• A. Preauthorization from the state insurance department
• B. Payment of the annual deductible in full
• C. A referral from the primary care physician
• D. A second opinion from an out-of-network doctor

Correct answer: C. A referral from the primary care physician

Explanation: Gatekeeper HMO models commonly require the primary care physician to coordinate specialist referrals so care stays within the plan's managed network.

• A. The state requires in-network care to be free of any deductible
• B. The provider is paid a capitation fee rather than billing for each visit
• C. The member's premium is reduced each time an in-network provider is used
• D. The provider has agreed to network terms or negotiated rates

Correct answer: D. The provider has agreed to network terms or negotiated rates

Explanation: PPO networks are built around participating providers that agree to plan terms, which can reduce the member's cost sharing compared with out-of-network care.

• A. Managed-care features with some choice to use out-of-network providers
• B. A high-deductible health plan with a tax-advantaged health savings account
• C. Basic hospital coverage with a separate supplemental major medical policy
• D. Group medical coverage with a disability income rider for the employee

Correct answer: A. Managed-care features with some choice to use out-of-network providers

Explanation: A point-of-service plan often blends HMO-style coordination with the option to use providers outside the network, usually at a higher cost.

• A. Doctors and hospitals the member has used in the past plan year
• B. Doctors, hospitals, and providers that contract with the plan
• C. Employers and associations that sponsor the plan's group contracts
• D. Licensed producers and agencies appointed to sell the plan's policies

Correct answer: B. Doctors, hospitals, and providers that contract with the plan

Explanation: A provider network is the group of medical providers and facilities that have a contractual relationship with the health plan.