Wisconsin Health Insurance Practice Exam Free - 2026

• A. Within 31 days after birth
• B. Within 90 days after birth
• C. Within 60 days after birth
• D. Before the birth, by adding the child prospectively

Correct answer: C. Within 60 days after birth

Explanation: Every disability insurance policy must cover a newly born child from the moment of birth, including congenital defects. If a specific premium is required for the child, the policy may require notice of birth and payment within 60 days after the date of birth; the insurer may refuse to continue coverage beyond 60 days without it, unless within one year the insured pays all past-due premiums plus 5.5 percent interest. 31 and 90 days are not the statutory period, and coverage from birth cannot be conditioned on pre-birth enrollment. See Wis. Stat. § 632.895(5).

• A. Give the employee written notice of continuation and conversion rights within 5 days
• B. Give the employee written notice within 30 days
• C. Nothing; the insurer, not the employer, must notify the employee
• D. Nothing, because continuation applies only to employers with 20 or more employees

Correct answer: A. Give the employee written notice of continuation and conversion rights within 5 days

Explanation: When the employer is notified to terminate coverage for a qualifying reason, the employer must give the terminated insured written notice of the right to continue group coverage or convert to individual coverage, including the payment amounts and how, where, and when to pay, not more than 5 days after the employer receives notice to terminate. The duty is on the employer, the period is 5 days rather than 30, and eligibility turns on 3 months of continuous coverage, not on a 20-employee threshold. See Wis. Stat. § 632.897(2)(b) and (2)(d).

• A. It ends because Wisconsin continuation is limited to 18 months from termination
• B. It never terminates as long as premiums are paid
• C. It continues regardless of residence until the group policy ends
• D. It may terminate because he established residence outside Wisconsin, but he then has a right to convert

Correct answer: D. It may terminate because he established residence outside Wisconsin, but he then has a right to convert

Explanation: An insured who tenders the required amount within 30 days after receiving notice has continuation coverage that may not terminate unless one of the listed events occurs: establishing residence outside Wisconsin, failing to make timely premium payments, loss of the group member's eligibility (for a former spouse), or becoming eligible for similar coverage under another group policy. Moving out of state is such an event, and the statute then gives a right to convert to individual coverage. Wisconsin's statute does not impose an 18-month limit, and coverage is not unconditional. See Wis. Stat. § 632.897(3)(a) and (3)(d).

• A. Independent review is unavailable; only an internal grievance is required
• B. The review must be conducted by an independent review organization certified by the commissioner and selected by the insured
• C. The insurer chooses the reviewer from its own network
• D. Independent review is available only for denials over $10,000

Correct answer: B. The review must be conducted by an independent review organization certified by the commissioner and selected by the insured

Explanation: Every insurer issuing a health benefit plan must establish an independent review procedure for coverage denial determinations, and the review may be conducted only by an independent review organization certified under the statute and selected by the insured. An adverse determination qualifies when the amount at stake exceeds $250, so a $4,000 denial is well above the threshold; the insurer cannot pick the reviewer and internal grievance alone is not sufficient. See Wis. Stat. § 632.835(1)(a)4. and (2).

• A. A law requiring group plans to cover pre-existing conditions after a waiting period
• B. A law giving employees the right to convert group coverage to an individual policy
• C. A law allowing continued group health coverage after qualifying events like job loss
• D. A federal program that pays premiums for workers who lose employer coverage

Correct answer: C. A law allowing continued group health coverage after qualifying events like job loss

Explanation: COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that allows employees and their families to continue group health coverage for a limited time after qualifying events like job loss, reduced hours, or divorce.

• A. 36 months for most qualifying events
• B. 12 months for most qualifying events
• C. 29 months for most qualifying events
• D. 18 months for most qualifying events

Correct answer: D. 18 months for most qualifying events

Explanation: COBRA coverage typically lasts 18 months for most qualifying events (job loss, reduced hours). It can extend to 36 months for certain events like divorce or a child losing dependent status.

• A. The former employee pays the full premium plus up to a 2% administrative fee
• B. The plan's insurer absorbs the cost until the employee finds new coverage
• C. The former employer pays the full premium for the first 18 months
• D. The employee pays the same share he or she paid while actively employed

Correct answer: A. The former employee pays the full premium plus up to a 2% administrative fee

Explanation: Under COBRA, the person continuing coverage - typically the former employee - pays the full premium cost (including the portion the employer previously paid) plus up to a 2% administrative fee, which is often far more than the payroll share paid while employed. COBRA rights can also follow a reduction in hours or a dependent qualifying event such as divorce, so the continuing enrollee is not always someone who left the company.

• A. All companies regardless of size
• B. Employers with 20 or more employees
• C. Only government employers
• D. Only Fortune 500 companies

Correct answer: B. Employers with 20 or more employees

Explanation: COBRA applies to employers with 20 or more employees who offer group health plans. Smaller employers may be subject to state continuation laws (often called 'mini-COBRA').

• A. Federal law that lets workers continue group coverage after leaving a job
• B. Federal law that created Medicare and Medicaid for seniors and the poor
• C. Federal law that reformed health insurance and expanded coverage access
• D. Federal law that protects the privacy and portability of health information

Correct answer: C. Federal law that reformed health insurance and expanded coverage access

Explanation: The Affordable Care Act (also known as 'Obamacare') is a comprehensive federal law enacted in 2010 that reformed health insurance markets, expanded Medicaid, created health insurance marketplaces, and established consumer protections.

• A. Services that Medicare Advantage plans must add beyond Parts A and B
• B. Benefits an insurer may offer as optional riders for an extra premium
• C. Emergency and hospital services that every short-term plan must include
• D. Ten categories of services ACA marketplace plans must cover

Correct answer: D. Ten categories of services ACA marketplace plans must cover

Explanation: Essential health benefits are 10 categories of services that ACA marketplace plans must cover, including hospitalization, prescription drugs, maternity care, mental health services, preventive care, and pediatric services.

• A. A platform where individuals can shop for and purchase ACA-compliant health plans
• B. A private exchange where employers buy stop-loss coverage for self-funded plans
• C. A federal agency that sets the premium rates insurers may charge for health plans
• D. A network of hospitals and clinics that agree to accept marketplace plan members

Correct answer: A. A platform where individuals can shop for and purchase ACA-compliant health plans

Explanation: A health insurance marketplace (also called an exchange) is a platform, either state-run or federally-facilitated (HealthCare.gov), where individuals and families can shop for, compare, and purchase ACA-compliant health insurance plans.

• A. Deductions employers claim for the premiums they pay on behalf of workers
• B. Subsidies to help eligible individuals afford marketplace health insurance
• C. Reductions in deductibles and copays for eligible members who choose a silver plan
• D. Refunds insurers must pay when they spend too little of premiums on care

Correct answer: B. Subsidies to help eligible individuals afford marketplace health insurance

Explanation: Premium tax credits are subsidies available to individuals who purchase health insurance through the marketplace and have income within certain limits. They reduce monthly premium costs.