Maine Health Insurance Practice Exam Free - 2026

• A. Elect within 60 days, pay up to 100% of the group rate, continue for 18 months
• B. Elect within 30 days, pay up to 110% of the group rate, continue for 6 months
• C. Elect within 45 days, pay up to 102% of the group rate, continue for 36 months
• D. Elect and make the initial payment within 31 days, pay not more than 102% of the group rate, and continue until one year from the last day of work

Correct answer: D. Elect and make the initial payment within 31 days, pay not more than 102% of the group rate, and continue until one year from the last day of work

Explanation: 24-A M.R.S. § 2809-A(11) lets a member or employee of at least 6 months whose coverage ends because of temporary layoff, qualifying permanent layoff or a compensable work injury elect continued group coverage within 31 days of termination, at a payment not exceeding 102% of the group rate including the employer's contribution, with coverage continuing until one year from the last day of work. The 30, 45 and 60 day windows, 100% and 110% caps, and 6, 18 or 36 month periods are not the Maine figures. See 24-A M.R.S. § 2809-A.

• A. At least 10 days' prior notification by first class mail, stating the cancellation date and any conversion rights and grace period
• B. At least 30 days' prior notification by certified mail
• C. At least 60 days' prior notification to each certificate holder
• D. No notice is required when the cancellation is for nonpayment

Correct answer: A. At least 10 days' prior notification by first class mail, stating the cancellation date and any conversion rights and grace period

Explanation: 24-A M.R.S. § 2809-A(1-A) provides that an insurer may not cancel or refuse to renew a group hospital, surgical, dental or major medical policy until it has given at least 10 days' prior notification by first class mail, including the cancellation date, the period for exercising conversion rights and an explanation of any grace period; notice is excused only when the policyholder reports replacement coverage. Thirty and 60 days and certified mail are not the statutory requirements, and nonpayment does not eliminate the notice duty. See 24-A M.R.S. § 2809-A.

• A. No; prior coverage must have ended within 30 days of enrollment
• B. Yes; any prior coverage within the past 24 months counts
• C. Yes; because the termination was due to unemployment, prior coverage ending within 180 days before enrollment counts, instead of the usual 90 days
• D. No; continuity applies only to replacements of one group policy by another

Correct answer: C. Yes; because the termination was due to unemployment, prior coverage ending within 180 days before enrollment counts, instead of the usual 90 days

Explanation: 24-A M.R.S. § 2849-B(2) provides continuity of coverage when prior coverage terminated within 90 days before enrollment in the succeeding contract, extended to 180 days when the coverage ended due to unemployment (and the person is employed when replacement coverage is sought). Thirty days is the late-enrollee request window, not the continuity period; 24 months is not a Maine figure; D describes the separate § 2849 replacement rule. See 24-A M.R.S. § 2849-B.

• A. 45 days after proof of loss is received
• B. 30 days after proof of loss is received and the loss is ascertained
• C. 60 days after proof of loss is received
• D. 15 days after proof of loss is received

Correct answer: B. 30 days after proof of loss is received and the loss is ascertained

Explanation: 24-A M.R.S. § 2436(1) makes a claim payable within 30 days after proof of loss is received and the loss is ascertained by written agreement or arbitration award; a claim neither disputed nor paid within 30 days is overdue, and the 30 days restarts only if the insurer requests reasonable additional information in writing. Sixty days is the standard fire policy period under § 3002; 15 days is the claim-form deadline under § 2164-D; 45 days is not a Maine period. See 24-A M.R.S. § 2436.

• A. A disclosure to a health care provider for treatment purposes
• B. A routine internal report shared among the insurer's departments
• C. A disclosure to a business associate performing claims analysis
• D. A response to another insurer's request for underwriting records

Correct answer: A. A disclosure to a health care provider for treatment purposes

Explanation: The minimum necessary rule applies to most uses, disclosures, and requests of PHI, but it does not apply to disclosures to or requests by a health care provider for treatment, to disclosures made to the individual, or to uses and disclosures made under a valid authorization. Treatment communications need full information to be safe. See 45 CFR 164.502(b).

• A. Disclosing records to another provider for the patient's treatment
• B. Using records internally to process a claim for payment
• C. Routine health care operations such as quality review
• D. Using the individual's information for marketing communications

Correct answer: D. Using the individual's information for marketing communications

Explanation: Treatment, payment, and health care operations generally do not require authorization. Marketing, most uses of psychotherapy notes, and any sale of PHI do require a valid written authorization from the individual. See 45 CFR 164.508.

• A. All business records of any kind
• B. Electronic protected health information they create, receive, maintain, or transmit
• C. Only paper medical charts kept on site
• D. Only information posted on the entity's public website

Correct answer: B. Electronic protected health information they create, receive, maintain, or transmit

Explanation: The Security Rule applies specifically to electronic PHI: covered entities must ensure its confidentiality, integrity, and availability and protect against reasonably anticipated threats. Paper and oral PHI are protected by the Privacy Rule rather than the Security Rule. See 45 CFR 164.306.

• A. 60 days, measured from the later of the date coverage ends or the date the election notice is provided
• B. 31 days from the date of the qualifying event
• C. 90 days from the date the plan administrator is notified
• D. 45 days from the date coverage ends

Correct answer: A. 60 days, measured from the later of the date coverage ends or the date the election notice is provided

Explanation: COBRA gives qualified beneficiaries at least 60 days to elect continuation coverage, running from the later of the date coverage would end or the date the election notice is provided. The 45-day figure is a distractor: that is the deadline for making the first premium payment after electing. See 29 U.S.C. 1161-1168 (COBRA).

• A. Coverage may extend from 18 to a maximum of 29 months, and the plan may charge up to 150% of the premium during the 11-month extension
• B. Coverage may extend to 36 months at the standard 102% premium
• C. Coverage becomes free of charge for the duration of the disability
• D. Coverage may extend indefinitely as long as the disability continues

Correct answer: A. Coverage may extend from 18 to a maximum of 29 months, and the plan may charge up to 150% of the premium during the 11-month extension

Explanation: When a qualified beneficiary is disabled under Social Security rules during the first 60 days of COBRA coverage, the standard 18-month period can be extended by 11 months, to 29 months total. During the 11-month extension the plan may charge the disabled beneficiary up to 150% of the plan's cost, versus the usual 102%. See 29 U.S.C. 1161-1168 (COBRA).

• A. The employee's voluntary resignation
• B. The employee's reduction in work hours
• C. Divorce or legal separation from the covered employee
• D. The employer switching insurance carriers

Correct answer: C. Divorce or legal separation from the covered employee

Explanation: Divorce or legal separation, the covered employee's death, the employee's entitlement to Medicare, and a child's loss of dependent status each give the spouse or dependent up to 36 months of COBRA coverage. Termination of employment and reduction in hours are 18-month events, and a carrier change is not a qualifying event at all. See 29 U.S.C. 1161-1168 (COBRA).

• A. He may elect COBRA but only for 12 months
• B. Termination for gross misconduct is not a qualifying event, so no COBRA continuation coverage is required
• C. He may elect COBRA at 150% of the premium
• D. He automatically receives 18 months of employer-paid coverage

Correct answer: B. Termination for gross misconduct is not a qualifying event, so no COBRA continuation coverage is required

Explanation: COBRA's qualifying event for employees is termination of employment for reasons other than gross misconduct, or a reduction in hours. When the termination is for gross misconduct, the employer is not required to offer continuation coverage to the employee or the family. See 29 U.S.C. 1161-1168 (COBRA).

• A. The 7-month window from March through September, spanning 3 months before, the month of, and 3 months after her 65th birthday month
• B. The 3-month window of May, June, and July only
• C. The calendar year in which she turns 65
• D. The 30 days immediately following her birthday

Correct answer: A. The 7-month window from March through September, spanning 3 months before, the month of, and 3 months after her 65th birthday month

Explanation: The Initial Enrollment Period lasts 7 months: it starts 3 months before the month a person turns 65 and ends 3 months after that month. Enrolling early in the window ensures coverage begins the month of eligibility. See medicare.gov.