Oregon Health Insurance Practice Exam Free - 2026

• A. 10 days
• B. 15 days
• C. 20 days
• D. 30 days

Correct answer: A. 10 days

Explanation: ORS 743.492 requires every health insurance policy (except single premium nonrenewable policies) to carry a notice that the purchaser may return the policy within 10 days of its delivery and have the premium refunded if not satisfied for any reason, after which the policy is void from the beginning. Thirty days (D) is the return period for Medicare supplement policies under ORS 743.686 and long term care policies under ORS 743.655, and 15 (B) and 20 days (C) are not Oregon periods. See ORS 743.492.

• A. 14 days
• B. 21 days
• C. 31 days
• D. 60 days

Correct answer: C. 31 days

Explanation: ORS 743A.090 requires individual and group health benefit plans with family coverage to cover a child from the moment of birth (and an adopted child from placement), and subsection (3) allows a policy that requires an additional premium to require notice of the birth and payment within 31 days after the date of birth to continue coverage beyond that 31-day period. Fourteen (A), 21 (B) and 60 days (D) are not the Oregon statutory period. See ORS 743A.090.

• A. Immediately, because he is employed and not living at home
• B. When he reaches 26 years of age, unless he qualifies as a disabled child
• C. At age 23 unless he is a full-time student
• D. At age 30, matching Oregon's extended dependent rule

Correct answer: B. When he reaches 26 years of age, unless he qualifies as a disabled child

Explanation: ORS 743A.090(5) defines a child, for required family coverage, as an individual under 26 years of age, or a disabled individual 26 or older who meets the conditions in subsection (1)(b), such as a physician's certification of an ongoing disability preventing self-sustaining employment and prior coverage for at least two years. Employment or residence elsewhere (A) does not end eligibility, there is no age-23 student rule (C), and Oregon has no extension to age 30 (D). See ORS 743A.090.

• A. The right to return the policy within 10 days for a refund
• B. The right to return the policy within 20 days less an administrative fee
• C. The right to return the policy within 30 days of delivery and have the premium refunded
• D. The right to cancel at any time with a pro rata refund

Correct answer: C. The right to return the policy within 30 days of delivery and have the premium refunded

Explanation: ORS 743.686 requires Medicare supplement policies and certificates to have a notice prominently printed on the first page stating that the applicant may return the policy within 30 days of its delivery and have the premium refunded if not satisfied for any reason, with the refund paid directly and timely. Ten days (A) is the general health policy free look under ORS 743.492; a 20-day period with a fee (B) and a general any-time pro rata cancellation right (D) are not what the statute provides. See ORS 743.686.

• A. Rescind the policy back to its original issue date, since misstatements remain contestable
• B. Reduce all future benefits proportionally, as it may for a misstatement of age
• C. Void the policy but refund all premiums paid, since the error was not fraudulent
• D. Nothing based on that misstatement, because the contestable window has closed

Correct answer: D. Nothing based on that misstatement, because the contestable window has closed

Explanation: The provision bars an insurer from using an innocent or negligent misstatement to void coverage or deny a claim once the policy has been in force for the stated period, which is two or three years depending on the version of the provision a state has adopted. Rescission and premium refund are contest remedies that are no longer available for a non-fraudulent error after that window closes. Arbitrarily cutting benefits is not a remedy this provision authorizes; the misstatement of age provision, not this one, allows a proportional benefit adjustment. Fraudulent misstatements may remain contestable.

• A. Quarterly premiums, 31 days
• B. Annual premiums, 10 days
• C. Monthly premiums, 31 days
• D. Weekly premiums, 15 days

Correct answer: A. Quarterly premiums, 31 days

Explanation: The provision sets a graduated scale: 7 days for weekly premium policies, 10 days for monthly, and 31 days for any longer mode such as quarterly, semiannual, or annual. Monthly premiums get 10 days rather than 31, weekly get 7 rather than 15, and annual premiums get the full 31 days rather than 10. Coverage stays in force during the grace period, and any unpaid premium may be deducted from a claim paid in that window.

• A. Paid in full, because reinstatement restores coverage retroactively to the lapse date
• B. Denied, because sickness is covered only if it begins more than 10 days after the reinstatement date
• C. Paid at 50 percent, because benefits under a reinstated policy phase in gradually over the first 30 days
• D. Denied, because a reinstated policy excludes sickness for one year after the reinstatement date

Correct answer: B. Denied, because sickness is covered only if it begins more than 10 days after the reinstatement date

Explanation: The standard reinstatement provision covers accidental injury immediately upon reinstatement but imposes a short waiting period, typically 10 days, before sickness is covered, which discourages someone from reinstating only after symptoms appear. Reinstatement is prospective, so it never fills the gap during the lapse. There is no 50 percent phase-in and no one-year sickness bar in the uniform provision.

• A. Within 60 days after the insurer furnishes claim forms, and not before
• B. Within 3 years after the loss, the same outer limit for legal actions
• C. Within 20 days after the loss begins, or as soon as reasonably possible
• D. Within 90 days after the loss, with no allowance for late notice

Correct answer: C. Within 20 days after the loss begins, or as soon as reasonably possible

Explanation: Notice of claim is the first and quickest step, due within 20 days of the occurrence or start of the loss, with a reasonableness allowance for insureds who genuinely cannot comply. Proof of loss comes later, is more detailed, and carries a longer deadline that some states lengthen beyond the model's 90 days. The three-year period is the outer limit for bringing legal action, and 60 days is the waiting period before suit may be filed.

• A. The insurer must pay a statutory penalty directly to the claimant in addition to the claim benefit
• B. The claim is deemed approved and must be paid in full without any further proof from the claimant
• C. The claimant must wait until the forms actually arrive, and the proof of loss deadline is extended accordingly
• D. The claimant may submit written proof of the nature and extent of the loss in any reasonable form

Correct answer: D. The claimant may submit written proof of the nature and extent of the loss in any reasonable form

Explanation: If claim forms are not furnished within the stated period, commonly 15 days after notice, the claimant is deemed to have met the proof requirement by submitting written proof describing the occurrence, character, and extent of the loss. The insurer still gets to evaluate that proof, so the claim is not automatically payable. Forcing the claimant to wait would defeat the provision's purpose, and a direct fine to the claimant is not part of this provision.

• A. 20 days
• B. 45 days
• C. 90 days
• D. 180 days

Correct answer: C. 90 days

Explanation: The uniform provision sets proof of loss at 90 days, measured from the date of loss or, for periodic benefits such as disability income, from the end of each benefit period. Twenty days is the notice of claim deadline, not proof of loss. The provision also excuses late proof where it was not reasonably possible to comply, generally if furnished within about a year absent legal incapacity. Some states adopted a longer period than the model, so always confirm your own state's version.

• A. Suit may not be filed until 60 days after proof of loss is furnished, and not more than 3 years after proof of loss was required
• B. Suit may be filed as soon as proof of loss is furnished, but must be filed within 1 year after the date of the loss
• C. Suit may be filed only after the insurer issues a written denial of the claim, and must be filed within 90 days after the date of that denial
• D. Suit may not be filed until the policy is surrendered to the insurer, and not more than 5 years after the date of loss

Correct answer: A. Suit may not be filed until 60 days after proof of loss is furnished, and not more than 3 years after proof of loss was required

Explanation: The provision sets both a floor and a ceiling: a 60-day cooling-off window that gives the insurer time to investigate and pay, and an outer limit of about three years after proof of loss was due. Allowing immediate suit would remove the insurer's chance to settle voluntarily. The deadlines key off proof of loss rather than a written denial, and no surrender of the policy is required. States may adopt slightly different periods, so confirm your own state's version.

• A. Require the insured to undergo an annual wellness screening at the insured's expense as a condition of keeping the policy in force, and deny claims if it is skipped
• B. Examine the insured at the insurer's own expense as often as reasonably necessary while a claim is pending, and order an autopsy where not forbidden by law
• C. Examine the insured no more than once per policy year during a pending claim, with the insured paying the examiner's fee and any travel costs
• D. Order an autopsy in any death claim regardless of state law, and examine the insured at the insured's expense as often as the insurer chooses

Correct answer: B. Examine the insured at the insurer's own expense as often as reasonably necessary while a claim is pending, and order an autopsy where not forbidden by law

Explanation: The provision gives the insurer a reasonable investigative right during a pending claim, but expressly places the cost on the insurer and conditions autopsy on state law permitting it. Limiting exams to once a year or shifting cost to the insured contradicts the wording. Some states restrict or prohibit autopsies, so an unconditional autopsy right does not exist, and routine wellness screenings are unrelated to claim investigation.