Hawaii Health Insurance Practice Exam Free - 2026

• A. No, because eligibility requires 26 weeks of covered employment
• B. Yes, because she was employed at least fourteen weeks with 20 or more paid hours and at least $400 of wages in each
• C. No, because she must have earned at least $1,000 in each week
• D. Yes, but only if she worked 40 hours in each of the 16 weeks

Correct answer: B. Yes, because she was employed at least fourteen weeks with 20 or more paid hours and at least $400 of wages in each

Explanation: HRS § 392-25 makes an individual eligible for temporary disability benefits if the individual has been in employment for at least fourteen weeks, during each of which the individual received remuneration for twenty or more hours and earned wages of at least $400, during the fifty-two weeks immediately preceding the first day of disability; Rita's 16 qualifying weeks satisfy this. Twenty-six weeks (A) is the maximum benefit duration under § 392-23, not the eligibility test; the wage test is $400, not $1,000 (C); and 40 hours is not required (D). See HRS § 392-25.

• A. Yes, because open enrollment lasts only 30 days after Part B enrollment
• B. No, because she applied within the six-month open enrollment period beginning with the first month of Part B enrollment
• C. Yes, unless she has at least twelve months of prior creditable coverage
• D. No, because Hawaii requires guaranteed issue of Medicare supplement policies at any time

Correct answer: B. No, because she applied within the six-month open enrollment period beginning with the first month of Part B enrollment

Explanation: HAR § 16-12-6.2(a) prohibits an issuer from denying or conditioning issuance, or discriminating in pricing, because of health status, claims experience or medical condition for an application submitted prior to or during the six-month period beginning with the first day of the first month in which the individual is enrolled for benefits under Medicare Part B. The window is six months, not 30 days (A); creditable coverage affects only preexisting-condition exclusions, and the rule refers to six months of coverage, not twelve (C); and open enrollment protection is time-limited rather than perpetual (D). See HAR § 16-12-6.2.

• A. A right to return the policy within thirty days of delivery for a refund of premium
• B. A right to return the policy within ten days of delivery for a refund of premium
• C. A right to return the policy within fifteen days for a refund less a processing fee
• D. A right to return the policy within sixty days if no claims were filed

Correct answer: A. A right to return the policy within thirty days of delivery for a refund of premium

Explanation: HAR § 16-12-8(e) requires Medicare supplement policies and certificates to carry a prominently printed notice on the first page stating that the policyholder has the right to return the policy within thirty days of its delivery and to have the premium refunded if not satisfied for any reason. Ten and fifteen days (B, C) are shorter than the required period and no processing fee deduction is permitted; sixty days (D) is not the rule. See HAR § 16-12-8.

• A. No coverage, because autism treatment is excluded as educational
• B. Coverage for children under 18 with no dollar limit on ABA
• C. Coverage only for diagnosis, not treatment
• D. Coverage for diagnosis and treatment of autism for covered individuals under fourteen, with ABA subject to a maximum benefit of $25,000 per year

Correct answer: D. Coverage for diagnosis and treatment of autism for covered individuals under fourteen, with ABA subject to a maximum benefit of $25,000 per year

Explanation: HRS § 431:10A-133(a) requires individual and group accident and health policies issued or renewed after January 1, 2016 to cover the diagnosis and treatment of autism for covered individuals under fourteen years of age, and subsection (d) makes applied behavior analysis subject to a maximum benefit of $25,000 per year for children thirteen and under. The mandate is not an exclusion (A), the age limit is fourteen rather than eighteen and ABA is capped (B), and treatment as well as diagnosis is covered (C). See HRS § 431:10A-133.

• A. To exclude coverage for any illness or injury that first develops during the initial year the policy is in force
• B. To reduce the benefit amount for conditions that were disclosed and accepted during underwriting
• C. To require a higher premium for applicants who reported a chronic condition on the application
• D. To limit coverage for a condition that existed before coverage began, subject to policy terms and law

Correct answer: D. To limit coverage for a condition that existed before coverage began, subject to policy terms and law

Explanation: A preexisting condition limitation addresses conditions that existed before the policy effective date. Modern rules vary by policy type, so candidates should avoid assuming one rule applies everywhere.

• A. Documentation submitted to support that a covered loss occurred
• B. A document proving the insurer is profitable
• C. A replacement for the policy application
• D. The producer's sales script

Correct answer: A. Documentation submitted to support that a covered loss occurred

Explanation: Proof of loss is claim documentation submitted to the insurer so it can evaluate whether benefits are payable under the policy.

• A. Submit complete written proof of the loss within the required time period
• B. Tell the insurer about a covered loss within the required time period
• C. File a lawsuit against the insurer if the claim is not paid within the period
• D. Wait for the insurer to send claim forms before reporting the loss

Correct answer: B. Tell the insurer about a covered loss within the required time period

Explanation: Notice-of-claim provisions require timely notification so the insurer can start the claim process and request needed forms or information.

• A. The insured submitted the claim on time
• B. The deductible had already been met and all conditions were satisfied
• C. The claimed expense is excluded or not covered by the policy
• D. The policy was active and the service was covered

Correct answer: C. The claimed expense is excluded or not covered by the policy

Explanation: Claims can be denied when the expense falls outside policy coverage, is excluded, lacks required proof, or fails another policy condition.

• A. Claims being denied under a preexisting condition limitation
• B. The secondary plan from paying any portion of the claim
• C. Dependents from being covered under more than one plan
• D. Duplicate benefit payments that exceed covered expenses

Correct answer: D. Duplicate benefit payments that exceed covered expenses

Explanation: Coordination of benefits rules determine payment order when more than one health plan covers the same person, helping avoid duplicate recovery beyond covered expenses.

• A. Optionally renewable
• B. Guaranteed renewable
• C. Cancelable
• D. Conditionally renewable

Correct answer: D. Conditionally renewable

Explanation: Conditionally renewable policies let the insurer refuse renewal only on grounds stated in the policy, such as reaching a certain age or leaving a job - never deteriorating health. The classification sits between optionally renewable (the insurer may decline renewal for any reason on a premium due date) and guaranteed renewable (the insured has the right to renew, though premiums may rise by class).

• A. Whether a provider's billed charges fall within usual, customary, and reasonable limits
• B. Whether healthcare services are medically necessary and appropriate under plan rules
• C. Whether an applicant's health history makes the risk acceptable for coverage
• D. Whether a claimant has submitted timely notice and complete proof of loss

Correct answer: B. Whether healthcare services are medically necessary and appropriate under plan rules

Explanation: Utilization review examines the medical necessity, appropriateness, or efficiency of services under the health plan's rules.

• A. Refund premiums already paid if the insured becomes totally disabled
• B. Pay the insured a monthly benefit equal to the premium during a hospital stay
• C. Waive future premiums if the insured meets the policy's disability requirements
• D. Keep the policy in force without premiums once the insured reaches a stated age

Correct answer: C. Waive future premiums if the insured meets the policy's disability requirements

Explanation: A waiver of premium rider can keep coverage in force without premium payments if the insured satisfies the rider's disability definition and waiting-period requirements.