Minnesota Health Insurance Practice Exam Free - 2026

• A. She must request external review within 30 days, pay a $25 filing fee, and the decision is advisory only.
• B. She must request external review within six months of the adverse determination; the health plan company pays the cost, and a decision is due no later than 45 days (72 hours if expedited).
• C. External review is available only after she files a lawsuit.
• D. She must request external review within one year, and the reviewer has 90 days to decide.

Correct answer: B. She must request external review within six months of the adverse determination; the health plan company pays the cost, and a decision is due no later than 45 days (72 hours if expedited).

Explanation: Minnesota allows an enrollee or someone acting on the enrollee's behalf to submit a written request for external review to the commissioner within six months from the date of the adverse determination; the health plan company bears all costs of the review and must participate; the decision must be made as soon as practical but no later than 45 days, with expedited review within 72 hours for life-threatening or emergency situations. There is no filing fee, no lawsuit prerequisite, and the periods in options A and D are wrong. See Minn. Stat. § 62Q.73, subds. 3 and 6.

• A. Yes; a small employer (1 to 50 employees) with at least 75 percent of eligible employees participating and an employer contribution of at least 50 percent must be issued coverage on a guaranteed-issue basis.
• B. No; guaranteed issue in Minnesota applies only to employers with 2 to 25 employees.
• C. No; 100 percent participation is required for guaranteed issue.
• D. Yes, but only if the carrier is a health maintenance organization.

Correct answer: A. Yes; a small employer (1 to 50 employees) with at least 75 percent of eligible employees participating and an employer contribution of at least 50 percent must be issued coverage on a guaranteed-issue basis.

Explanation: A Minnesota small employer is one that employed an average of at least one (not counting a sole proprietor) but not more than 50 employees, and every carrier in the small employer market must offer and issue its plans on a guaranteed-issue basis. A small employer with at least 75 percent of eligible employees who have not waived coverage participating and contributing at least 50 percent of the cost must be guaranteed coverage; 24 of 30 is 80 percent. The 2-to-25 range, 100 percent participation, and HMO-only limitation are not the Minnesota rules. See Minn. Stat. § 62L.02, subd. 26, and § 62L.03, subds. 1 and 3.

• A. 10 days from delivery
• B. 15 days from delivery
• C. 20 days from the application date
• D. 30 days from delivery

Correct answer: D. 30 days from delivery

Explanation: Minnesota Medicare supplement policies and certificates must give the insured the right to return the policy within 30 days of its delivery and have the premium refunded in full if, after examination, the insured is not satisfied for any reason. The 10-day period is the general right to cancel under § 72A.51, which expressly excludes Medicare-related coverage; 15 and 20 days are not Minnesota periods. See Minn. Stat. § 62A.38.

• A. Acknowledge within 5 calendar days; decide within 15 calendar days
• B. Acknowledge within 10 business days; complete the investigation and inform the claimant of acceptance or denial within 30 business days, or explain the delay
• C. Acknowledge within 15 business days; decide within 45 calendar days
• D. Acknowledge within 30 days; decide within 60 days

Correct answer: B. Acknowledge within 10 business days; complete the investigation and inform the claimant of acceptance or denial within 30 business days, or explain the delay

Explanation: Minnesota's unfair claims practices statute requires an insurer to acknowledge receipt of notification of a claim within ten business days (unless the claim is paid within that time), respond to pertinent communications within ten business days, and complete its investigation and inform the insured or claimant of acceptance or denial within 30 business days after receipt of notification, or explain why more time is needed and when a decision is expected. The other options mix calendar days and periods that do not appear in the statute. See Minn. Stat. § 72A.201, subd. 4.

• A. Medicare pays first because she is over 65
• B. The two coverages split every claim equally
• C. The employer's group health plan pays first, and Medicare pays second
• D. She must choose one payer and drop the other

Correct answer: C. The employer's group health plan pays first, and Medicare pays second

Explanation: When a person 65 or older has group health coverage based on current employment and the employer has 20 or more employees, the group health plan pays first and Medicare is the secondary payer. If the employer had fewer than 20 employees, the order would reverse and Medicare would pay first. See medicare.gov.

• A. To build tax-deferred cash value for retirement
• B. To pay for or reimburse medical expenses
• C. To indemnify the insured for damage to property
• D. To provide a death benefit to named beneficiaries

Correct answer: B. To pay for or reimburse medical expenses

Explanation: The primary purpose of health insurance is to pay for or reimburse medical expenses including hospitalization, doctor visits, medications, and other healthcare services.

• A. The maximum amount the insurer will pay for covered expenses in a policy year
• B. The percentage of covered expenses the insured shares with the insurer after the deductible
• C. The amount the insured must pay before insurance begins covering expenses
• D. The fixed dollar amount the insured pays each time a covered service is received

Correct answer: C. The amount the insured must pay before insurance begins covering expenses

Explanation: A deductible is the amount the insured must pay out-of-pocket for covered healthcare services before the insurance company begins to pay. Higher deductibles generally mean lower premiums.

• A. The fixed dollar amount the insured pays at the time a covered service is received
• B. The amount the insured must pay each year before the plan begins paying benefits
• C. The rule deciding which plan pays first when the insured is covered by two plans
• D. The percentage of costs the insured pays after the deductible is met

Correct answer: D. The percentage of costs the insured pays after the deductible is met

Explanation: Coinsurance is the percentage of covered healthcare costs that the insured pays after the deductible has been met. For example, with 80/20 coinsurance, the insurer pays 80% and the insured pays 20%.

• A. A fixed amount paid for a covered service at the time of service
• B. A percentage of the bill the insured pays after the deductible is met
• C. The amount the insured pays each year before the plan starts to pay
• D. The periodic amount paid to the insurer to keep the policy in force

Correct answer: A. A fixed amount paid for a covered service at the time of service

Explanation: A copayment is a fixed dollar amount that the insured pays for a covered healthcare service at the time of service. For example, a $30 copay for a doctor visit or $10 copay for a generic prescription.

• A. The highest deductible a plan may charge before it must begin sharing your costs
• B. The most you have to pay for covered services in a year before insurance pays 100%
• C. The most the insurance company will pay for your covered services during the year
• D. The total premium you can be charged for coverage during a single policy year

Correct answer: B. The most you have to pay for covered services in a year before insurance pays 100%

Explanation: The out-of-pocket maximum is the most you'll pay during a policy period for covered services through deductibles, copays, and coinsurance. After reaching this limit, the insurance company pays 100% of covered expenses.

• A. A condition that first appears during the probationary period
• B. A chronic condition that is not covered under any health plan
• C. A health condition that existed before coverage began
• D. A medical exam the insurer requires before issuing a policy

Correct answer: C. A health condition that existed before coverage began

Explanation: A pre-existing condition is generally a condition for which the insured received diagnosis, care, or treatment before the coverage began. For ACA-compliant individual and group major medical coverage, insurers may not deny coverage, exclude the condition, or charge more because of it. Excepted benefits such as disability income, long-term care, and hospital indemnity coverage may still underwrite and apply pre-existing condition limits, as may short-term limited-duration insurance, which is not treated as individual health insurance coverage.

• A. The group of insurers that share a large risk under a reinsurance treaty
• B. The list of prescription drugs a health plan agrees to cover
• C. The producers and agencies appointed to sell a health plan's policies
• D. The facilities, providers, and suppliers a health plan contracts with

Correct answer: D. The facilities, providers, and suppliers a health plan contracts with

Explanation: A network is the group of doctors, hospitals, pharmacies, and other healthcare providers that have contracted with a health insurance plan to provide services at negotiated rates.