Oklahoma Health Insurance Practice Exam Free - 2026

• A. Yes, misstatements may be used at any time
• B. Yes, because the Oklahoma time limit on certain defenses is five years
• C. No, after 2 years from the date of issue, only fraudulent misstatements can be used to void the policy or deny a claim for loss commencing after that period
• D. No, because the time limit on certain defenses in Oklahoma is one year

Correct answer: C. No, after 2 years from the date of issue, only fraudulent misstatements can be used to void the policy or deny a claim for loss commencing after that period

Explanation: Oklahoma's required TIME LIMIT ON CERTAIN DEFENSES provision states that after two (2) years from the date of issue, no misstatements, except fraudulent misstatements, made in the application may be used to void the policy or deny a claim for loss incurred or disability commencing after that two-year period. One-year and five-year periods are wrong, and non-fraudulent misstatements cannot be used indefinitely. See 36 O.S. § 4405(A)(2).

• A. 10 days for the monthly policy and 31 days for the annual policy
• B. 31 days for both policies
• C. 7 days for the monthly policy and 30 days for the annual policy
• D. 30 days for both policies

Correct answer: A. 10 days for the monthly policy and 31 days for the annual policy

Explanation: Oklahoma's required GRACE PERIOD provision requires a grace period of not less than 7 days for weekly premium policies, 10 days for monthly premium policies, and 31 days for all other policies (such as quarterly, semi-annual, or annual). A flat 30- or 31-day period for both is wrong, and 7 days applies only to weekly premium policies. See 36 O.S. § 4405(A)(3).

• A. Within 10 days
• B. Within 20 days after the occurrence or commencement of the loss, or as soon thereafter as reasonably possible
• C. Within 60 days
• D. Within 90 days

Correct answer: B. Within 20 days after the occurrence or commencement of the loss, or as soon thereafter as reasonably possible

Explanation: The required NOTICE OF CLAIM provision states that written notice of claim must be given to the insurer within twenty (20) days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Ten days is too short; 90 days is the proof-of-loss deadline and 60 days is the minimum wait before a legal action, so both are distractors from other provisions. See 36 O.S. § 4405(A)(5).

• A. 30 days
• B. 45 days
• C. 20 days
• D. 15 days

Correct answer: D. 15 days

Explanation: Under the required CLAIM FORMS provision, if the insurer does not furnish its claim forms within fifteen (15) days after notice of claim, the claimant is deemed to have complied with the proof-of-loss requirement by submitting, within the time fixed for proof of loss, written proof covering the occurrence, character, and extent of the loss. Twenty days is the notice-of-claim period, and 30 and 45 days appear in other provisions (reinstatement conditional receipt is 45 days). See 36 O.S. § 4405(A)(6).

• A. Explain the limitations clearly and avoid suggesting the policy covers everything
• B. Refer the applicant to the insurer's claims department for any questions about limits
• C. Disclose the limitations after the policy is delivered, during the free look period
• D. Rely on the outline of coverage alone, since it replaces any verbal explanation

Correct answer: A. Explain the limitations clearly and avoid suggesting the policy covers everything

Explanation: Clear disclosure helps consumers understand what they are buying. Producers should not imply that limited-benefit or supplemental policies are comprehensive major medical coverage.

• A. The insurer must approve the application once suitability has been documented
• B. The recommended product should reasonably fit the consumer's needs and circumstances
• C. The producer is relieved of any liability once the consumer signs a suitability acknowledgment form
• D. The product with the lowest premium must be recommended regardless of benefits

Correct answer: B. The recommended product should reasonably fit the consumer's needs and circumstances

Explanation: Suitability focuses on whether a recommendation is appropriate for the consumer's needs, objectives, and situation, based on available information.

• A. $1,000
• B. $5,000
• C. $6,000
• D. $7,000

Correct answer: B. $5,000

Explanation: The insured first satisfies the $1,000 deductible. The remaining $5,000 is the amount subject to the 80/20 coinsurance split.

• A. $500
• B. $1,000
• C. $1,200
• D. $5,000

Correct answer: B. $1,000

Explanation: After the $1,000 deductible, $5,000 remains. The insured's 20% coinsurance share of $5,000 is $1,000, before considering any out-of-pocket maximum.

• A. Cap the total benefits the insurer will pay over the insured's lifetime
• B. Set the amount the insured must pay before the plan begins to pay
• C. Limit the insured's covered cost-sharing for a policy period
• D. Limit the premium increases an insurer may impose at each renewal

Correct answer: C. Limit the insured's covered cost-sharing for a policy period

Explanation: An out-of-pocket maximum caps covered cost-sharing, such as deductibles, coinsurance, and copayments, according to the plan's rules.

• A. A written referral from the insured's producer before a specialist visit
• B. Review of a claim after the service is rendered to confirm medical necessity
• C. Payment of the full charge up front, with reimbursement after plan review
• D. Plan approval before certain services are provided or paid as covered

Correct answer: D. Plan approval before certain services are provided or paid as covered

Explanation: Prior authorization requires advance plan approval for certain services, drugs, or procedures. Lack of authorization may affect coverage or payment.

• A. The member may pay more out of pocket than with an in-network provider
• B. The plan pays nothing, because PPOs cover in-network providers exclusively
• C. The member must first obtain a referral from a primary care gatekeeper
• D. The out-of-network provider is bound to accept the plan's negotiated rate

Correct answer: A. The member may pay more out of pocket than with an in-network provider

Explanation: PPOs usually provide stronger benefits for in-network care and may impose higher cost-sharing, balance-billing exposure, or different rules for out-of-network care.

• A. The drug is free after one retail fill
• B. The highest cost-sharing level, and the drug often must come from a designated specialty pharmacy
• C. The drug is not FDA approved
• D. The drug can be prescribed only by a hospital

Correct answer: B. The highest cost-sharing level, and the drug often must come from a designated specialty pharmacy

Explanation: Specialty tiers hold the most expensive drugs - often biologics or injectables needing special handling or monitoring. Cost-sharing is the plan's highest, frequently coinsurance rather than a flat copay, and plans commonly require filling through a contracted specialty pharmacy that manages storage, shipping, and patient support.