Washington Health Insurance Practice Exam Free - 2026

• A. No sooner than 60 days after written proof of loss and no later than 3 years after proof was required
• B. Immediately after denial, but within 1 year
• C. No sooner than 30 days after notice of claim, within 5 years
• D. Only after arbitration is exhausted

Correct answer: A. No sooner than 60 days after written proof of loss and no later than 3 years after proof was required

Explanation: No legal action may be brought sooner than 60 days after written proof of loss is furnished, nor after the expiration of 3 years from the time written proof of loss is required. See RCW 48.20.142.

• A. Immediately upon payment
• B. On the 30th day after the receipt
• C. Never, without written approval
• D. On the 45th day after the conditional receipt, unless the insurer has disapproved in writing

Correct answer: D. On the 45th day after the conditional receipt, unless the insurer has disapproved in writing

Explanation: When the insurer requires a reinstatement application and issues a conditional receipt, the policy is reinstated upon approval or, lacking approval, on the 45th day after the conditional receipt unless the insurer has previously given written notice of disapproval; sickness is then covered only if it begins more than 10 days after reinstatement. See RCW 48.20.072.

• A. 5 working days
• B. 10 working days
• C. 20 working days
• D. 30 working days

Correct answer: B. 10 working days

Explanation: An insurer must acknowledge receipt of a notice of claim within 10 working days for individual policies (15 working days for group contracts); payment within that period counts as acknowledgment. See WAC 284-30-360.

• A. 10 working days
• B. 30 working days
• C. 15 working days
• D. 45 working days

Correct answer: C. 15 working days

Explanation: Within 15 working days after receipt of fully completed and executed proofs of loss, the insurer must notify the first-party claimant of acceptance or denial; a denial must be in writing and cite the specific policy provision. If more time is needed, the insurer must explain why within the same 15 working days. See WAC 284-30-380.

• A. A plan with higher deductibles and lower premiums, often paired with an HSA
• B. A plan with higher premiums and lower deductibles, usually paired with an FSA
• C. A plan that covers hospital charges after a large per-admission deductible is met
• D. A plan whose deductible is reset each time a new covered illness or injury begins

Correct answer: A. A plan with higher deductibles and lower premiums, often paired with an HSA

Explanation: An HDHP has higher deductibles and lower monthly premiums than traditional plans. HDHPs can be paired with Health Savings Accounts (HSAs) for tax-advantaged savings for medical expenses.

• A. A plan that reimburses any provider the member chooses on a fee-for-service basis
• B. A plan combining HMO and PPO features with a PCP who can refer out of network
• C. A plan that restricts coverage to network providers but does not require referrals
• D. A plan that combines a high deductible with a tax-favored health savings account

Correct answer: B. A plan combining HMO and PPO features with a PCP who can refer out of network

Explanation: A POS plan combines features of HMOs and PPOs. Members choose a primary care physician and need referrals for specialists, but can also go out-of-network for higher costs.

• A. Basic hospital, surgical, and medical coverage with low limits, first-dollar benefits, and no deductible
• B. Coverage that pays a scheduled cash benefit for each day the insured is confined to a hospital
• C. Comprehensive coverage for a wide range of healthcare expenses, subject to an out-of-pocket maximum
• D. Coverage limited to catastrophic illnesses such as cancer, stroke, or heart attack, paid as a lump sum

Correct answer: C. Comprehensive coverage for a wide range of healthcare expenses, subject to an out-of-pocket maximum

Explanation: Major medical provides broad coverage for hospitalization, surgery, physician services, and related care. An ACA-compliant plan may not place annual or lifetime dollar limits on essential health benefits, so the ceiling a student should associate with it is the annual out-of-pocket maximum rather than a benefit maximum. It is not the same as basic medical expense coverage, a hospital indemnity policy, or a limited dread-disease policy.

• A. An employer-owned account funded solely by the employer to reimburse medical costs
• B. An employer account whose unused balance is forfeited at the end of the plan year
• C. A savings account available to people enrolled in a PPO plan rather than an HDHP
• D. A tax-advantaged account for medical expenses, paired with an HDHP

Correct answer: D. A tax-advantaged account for medical expenses, paired with an HDHP

Explanation: An HSA is a tax-advantaged savings account for medical expenses available to individuals enrolled in a High Deductible Health Plan. Contributions are tax-deductible, growth is tax-free, and withdrawals for qualified medical expenses are tax-free.

• A. An employer-sponsored account for pre-tax medical expense savings with use-it-or-lose-it rules
• B. A portable, individually owned account whose unused balance rolls over from year to year
• C. An employer-funded reimbursement arrangement that employees cannot contribute to themselves
• D. An account for medical expenses that can be opened by someone enrolled in a high deductible health plan

Correct answer: A. An employer-sponsored account for pre-tax medical expense savings with use-it-or-lose-it rules

Explanation: An FSA is an employer-sponsored benefit that allows employees to set aside pre-tax dollars for medical expenses. Unlike HSAs, FSAs typically have 'use-it-or-lose-it' rules, though some carry-over is allowed.

• A. The period after issue during which sickness claims are not covered
• B. The waiting period before benefits begin after a covered event
• C. The period after a missed premium during which coverage stays in force
• D. The maximum length of time benefits are paid for a single disability

Correct answer: B. The waiting period before benefits begin after a covered event

Explanation: The elimination period (also called waiting period) is the time between when a covered event occurs (like disability) and when benefits begin. Longer elimination periods result in lower premiums.

• A. Rules requiring the insurer to be reimbursed by a third party who caused the loss
• B. Rules requiring an employer and employees to share the cost of group premiums
• C. Rules determining payment responsibility when the insured has multiple health plans
• D. Rules allowing the insurer to reduce benefits when the insured's earnings have changed

Correct answer: C. Rules determining payment responsibility when the insured has multiple health plans

Explanation: Coordination of benefits determines which insurance plan pays first (primary) and which pays second (secondary) when a person has coverage under more than one health plan, preventing duplicate payments.

• A. The time the insured must wait after a loss before benefits are paid
• B. The time after issue during which sickness is not covered
• C. The time after a premium due date during which coverage continues
• D. The time during which benefits are provided for a covered event

Correct answer: D. The time during which benefits are provided for a covered event

Explanation: The benefit period is the length of time during which benefits are provided for a covered event. For example, a hospital policy might have a 90-day benefit period per hospital stay.