Virginia Health Insurance Practice Exam Free - 2026

• A. Charge a short-rate cancellation fee and refund the balance
• B. Keep one month's premium as an administrative charge
• C. Promptly refund the premium paid, with the policy void from inception
• D. Convert the policy to a 30-day term contract

Correct answer: C. Promptly refund the premium paid, with the policy void from inception

Explanation: Individual accident and sickness policies must carry the printed 10-day right-to-return notice; if returned within 10 days of receipt, the premium paid is promptly refunded and the policy is void from the beginning. See Va. Code § 38.2-3502.

• A. 7 days
• B. 10 days
• C. 31 days
• D. 45 days

Correct answer: B. 10 days

Explanation: Virginia's required grace period for individual accident and sickness policies is at least 7 days for weekly premium policies, 10 days for monthly premium policies, and 31 days for all other modes. A monthly-premium policy therefore requires at least 10 days. See Va. Code § 38.2-3503.

• A. may do so freely, since he sells no policies
• B. needs only a limited lines license
• C. must register as a third-party administrator
• D. must be licensed as an insurance consultant, unless an exception such as licensed attorney or CPA applies

Correct answer: D. must be licensed as an insurance consultant, unless an exception such as licensed attorney or CPA applies

Explanation: Anyone who charges a fee to advise or purports to advise on life and annuities, accident and sickness, or property and casualty insurance must hold a Virginia insurance consultant license; the only exceptions include licensed attorneys, bank trust officers, actuaries or CPAs in the normal course of business, and employed risk managers. See the Virginia Bureau of Insurance Licensing Information Bulletin (Prometric) and Va. Code § 38.2-1831 licensing framework.

• A. not use the misstatement to void the policy or deny a claim for a loss commencing after the two-year period
• B. void the policy at any time for any misstatement
• C. deny claims but not void the policy
• D. rescind coverage if it acts within 90 days of discovery

Correct answer: A. not use the misstatement to void the policy or deny a claim for a loss commencing after the two-year period

Explanation: After two years from the date of issue, only fraudulent misstatements in the application may be used to void an individual accident and sickness policy or deny a claim for loss commencing after the two-year period. See Va. Code § 38.2-3503.

• A. Retrospective review, then subrogation
• B. Precertification (prospective review), then concurrent review
• C. Concurrent review, then case settlement
• D. Field underwriting, then claims adjudication

Correct answer: B. Precertification (prospective review), then concurrent review

Explanation: Precertification, a form of prospective review, requires the plan's approval before elective services such as scheduled hospital admissions. Concurrent review takes place during the course of treatment, monitoring the ongoing stay so care continues only as long as medically necessary. Retrospective review, by contrast, examines care after it has been delivered.

• 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.