Louisiana Health Insurance Practice Exam Free - 2026

• A. 10 days
• B. 30 days
• C. 7 days
• D. 60 days

Correct answer: B. 30 days

Explanation: Every insurer issuing an individual, group, family group, blanket or association health and accident policy in Louisiana must include a provision giving the policyholder a grace period of thirty days from the date the premium was due; if the premium is paid during the grace period, coverage continues. For individual policies the insurer must also mail a lapse warning if the premium has not arrived fifteen days before the grace period ends. Seven, ten and sixty days are not the statutory grace period. See La. R.S. 22:977(A).

• A. 10 days
• B. 30 days
• C. 90 days
• D. 20 days

Correct answer: D. 20 days

Explanation: Louisiana's required notice-of-claim provision states that written notice of claim for injury or sickness must be given to the insurer within twenty days after the date of the accident or the commencement of the disability from sickness (ten days for industrial policies; immediate notice for accidental death), and late notice does not invalidate the claim if notice was not reasonably possible and is given as soon as reasonably possible. Ten days applies only to industrial policies, and ninety days is the proof-of-loss period. See La. R.S. 22:975(A)(3).

• A. Within 90 days after the loss, and in no event later than one year from the time proof is otherwise required
• B. Within 20 days after the loss, and in no event later than 60 days
• C. Within 30 days after the loss, and in no event later than 6 months
• D. Within 180 days after the loss, with no outside limit

Correct answer: A. Within 90 days after the loss, and in no event later than one year from the time proof is otherwise required

Explanation: Louisiana requires proof of loss within ninety days after the date of the loss (or, for loss-of-time claims, ninety days after the end of the period for which the insurer is liable); failure to comply does not reduce the claim if it was not reasonably possible, provided proof is furnished as soon as reasonably possible and in no event later than one year from the time proof is otherwise required. Twenty days is the notice-of-claim period, and the 30-day and 180-day options are not statutory. See La. R.S. 22:975(A)(5).

• A. Yes; a pre-existing condition may be excluded at any time if it was not disclosed.
• B. Yes, because Louisiana's time limit on defenses is five years.
• C. No; after three years from issue, non-fraudulent misstatements cannot be used to void the policy or deny a claim, and a loss commencing after three years cannot be reduced for an unnamed pre-existing condition.
• D. No, but only because the policy is guaranteed renewable.

Correct answer: C. No; after three years from issue, non-fraudulent misstatements cannot be used to void the policy or deny a claim, and a loss commencing after three years cannot be reduced for an unnamed pre-existing condition.

Explanation: Louisiana's required provision states that after three years from the date of issue no misstatements, except fraudulent ones, may be used to void the policy or deny a claim for loss incurred or disability commencing after that three-year period, and no claim commencing after three years may be reduced or denied because a disease or condition not excluded by name existed before the effective date. The period is three years, not five, the omission here was innocent (not fraudulent), and the protection comes from the statute, not from renewability. See La. R.S. 22:975(A)(13).

• A. The plan of the parent whose birthday falls earlier in the calendar year, regardless of birth year
• B. The plan of the parent who is older, as measured by the full date of birth including the year of birth
• C. The plan of the parent whose coverage has been in effect for the longer period of time
• D. The plan of the parent who is the child's custodial parent under the most recent court order

Correct answer: A. The plan of the parent whose birthday falls earlier in the calendar year, regardless of birth year

Explanation: The birthday rule looks only at month and day, so the parent whose birthday comes first in the calendar year has the primary plan, and the year of birth is irrelevant. The parent's age plays no role, only the position of the birthday within the year. Length of coverage is a tiebreaker used in other coordination situations, such as when both parents share the same birthday, and custodial-parent rules apply only when the parents are divorced or separated.

• A. The policy covers disabilities arising on the job, supplementing the benefits workers compensation pays for work-related injuries
• B. The policy covers disabilities arising off the job, because on-the-job injuries are expected to be handled by workers compensation
• C. The policy covers disabilities arising from any cause, but only while the insured is employed in the occupation shown on the application
• D. The policy covers disabilities arising from sickness only, since occupational injuries are handled under workers compensation

Correct answer: B. The policy covers disabilities arising off the job, because on-the-job injuries are expected to be handled by workers compensation

Explanation: Non-occupational coverage deliberately excludes work-related injury and illness, assuming workers compensation will respond, which lowers the premium; occupational coverage responds 24 hours a day regardless of where the disability arose. The term describes where the disability arose, not whether the insured is currently employed or in a particular occupation. It is not limited to sickness only, and it does not supplement workers compensation for on-the-job claims.

• A. The health plan must reimburse the at-fault driver's insurer for any settlement amounts that duplicate the medical benefits already paid
• B. The at-fault driver's insurer must pay the health plan directly before the insured may file a claim under her own coverage
• C. The health plan may recover from the settlement the amounts it already paid, so the insured is not paid twice for the same expenses
• D. The insured keeps the entire settlement, because subrogation applies only to property insurance and not to health coverage

Correct answer: C. The health plan may recover from the settlement the amounts it already paid, so the insured is not paid twice for the same expenses

Explanation: Subrogation lets the insurer step into the insured's shoes and recover from the responsible party what it already paid, which enforces the indemnity principle by preventing a double recovery for one loss. Letting the insured keep both the benefits and the settlement for the same bills would be exactly that double recovery. The health plan pays first and recovers afterward, and the reimbursement flows to the plan, not from it.

• A. Residual benefits pay a flat reduced percentage of the full benefit for a limited time, while a partial disability benefit is calculated from the percentage of income the insured has actually lost since returning to work
• B. Residual benefits are payable only for disabilities caused by accidental injury, while a partial disability benefit is payable for disabilities caused by either sickness or injury
• C. Residual benefits continue only while the insured remains totally disabled, while a partial disability benefit begins once the insured returns to work in a limited capacity
• D. Residual benefits are calculated from the percentage of income the insured actually lost, while a partial disability benefit typically pays a flat reduced percentage of the full benefit for a limited time

Correct answer: D. Residual benefits are calculated from the percentage of income the insured actually lost, while a partial disability benefit typically pays a flat reduced percentage of the full benefit for a limited time

Explanation: A residual benefit is proportional and income-based, scaling the payment to the measured loss of earnings when the insured returns to work at reduced capacity. A traditional partial disability benefit is simpler, paying a set fraction such as half the total benefit for a stated number of months, often only after a period of total disability. Neither benefit is limited by cause of disability, and residual benefits exist precisely because the insured is no longer totally disabled.

• A. Workers compensation pays for the work-related injury, and the group health plan generally excludes charges covered by workers compensation
• B. The group health plan pays as primary for the work-related injury, and workers compensation reimburses the plan for any remaining balance
• C. Workers compensation pays the medical expenses, while the group health plan pays the employee's lost wages for the duration of disability
• D. The employee may submit the medical bills to either program, and whichever pays first becomes primary for that claim and all future claims

Correct answer: A. Workers compensation pays for the work-related injury, and the group health plan generally excludes charges covered by workers compensation

Explanation: Group health contracts almost always exclude occupational injuries and illnesses, leaving workers compensation as the exclusive source of benefits for a work-related claim. Reversing that order would shift a statutory employer obligation onto the health plan. Group health coverage does not replace lost wages, and the employee cannot elect which program is primary for an occupational claim.

• A. Coverage generally begins at birth for injury and sickness, but congenital defects are excluded as preexisting conditions until the child has been enrolled for the policy's waiting period
• B. Coverage generally begins at birth for injury, sickness, and medically diagnosed congenital defects, with the parent required to notify the insurer and pay any additional premium within the stated enrollment window
• C. Coverage generally begins on the date the insurer receives the parent's written notice of birth, with the newborn treated as a late enrollee subject to underwriting if notice arrives over thirty days after birth
• D. Coverage begins at birth without any premium or notice requirement, because the newborn is treated as an insured under the parent's policy until the next policy anniversary

Correct answer: B. Coverage generally begins at birth for injury, sickness, and medically diagnosed congenital defects, with the parent required to notify the insurer and pay any additional premium within the stated enrollment window

Explanation: Newborn coverage rules provide automatic protection from the moment of birth, including congenital conditions, so long as the policyholder gives notice and pays any additional premium within the required period. Excluding congenital conditions would defeat the purpose of automatic coverage. Making coverage begin on the date of notice would leave the infant unprotected during the highest-risk period, and coverage cannot simply run to the anniversary without the required notice and premium.

• A. Only coverage under an employer's group health plan
• B. Any prior coverage, including plans consisting solely of excepted benefits such as stand-alone dental
• C. Coverage under a group health plan, individual health insurance, Medicare, or Medicaid
• D. Only coverage that was continuously in force for at least five years

Correct answer: C. Coverage under a group health plan, individual health insurance, Medicare, or Medicaid

Explanation: HIPAA defines creditable coverage broadly: it includes group health plans, individual health insurance coverage, Medicare Parts A and B, Medicaid, military health coverage, and several other public programs. Coverage consisting solely of excepted benefits, such as stand-alone dental or vision, does not count. There is no minimum number of years required. See 29 U.S.C. 1181(c).

• A. 30 days after the other coverage ends
• B. 10 days after the other coverage ends
• C. 90 days after the other coverage ends
• D. She must wait for the plan's next annual open enrollment

Correct answer: A. 30 days after the other coverage ends

Explanation: HIPAA gives employees who lose other coverage a special enrollment right in their employer's plan, provided enrollment is requested no later than 30 days after the other coverage is exhausted or employer contributions toward it end. Similar 30-day special enrollment rights apply after marriage, birth, or adoption. Waiting for open enrollment is not required. See 29 U.S.C. 1181(f).