Free Idaho Accident & Health Practice Questions

Keep these three straight and you'll bank easy points all day: a peril is the cause of loss (fire, wind, theft), a hazard is something that increases the chance or severity of that loss, and risk is the uncertainty of loss itself. The peril is the thing that actually does the damage.

A hazard doesn't cause the loss itself; it just makes a loss more likely or more severe. Icy steps, frayed wiring, a careless attitude: none of those start the fire or the fall, but they tip the odds. Causes of loss are perils; hazards just stack the deck.

A stock insurer is owned by its stockholders (shareholders), who receive taxable dividends when the company profits. Policyholders are just customers. Contrast that with a mutual insurer, which is owned by its policyholders. Stock equals stockholders; mutual equals members/policyholders.

A mutual insurer is owned by its policyholders, so a 'dividend' is really a return of overpaid premium, which is why it's generally not taxable. And it's never guaranteed; it depends on the company's results. Stock dividends, by contrast, go to stockholders and are taxable.

A reciprocal (an unincorporated group of members who insure each other) is run by an attorney-in-fact. The members are both insureds and insurers to one another. Niche, but the exam likes the 'attorney-in-fact' detail, so tuck it away.

A captive (or exclusive) agent represents a single insurer, and that insurer owns the book of business. An independent agent represents multiple companies and owns their own expirations (the renewal rights). The ownership-of-expirations detail is the classic distinguisher.

Apparent authority is about appearances: what a reasonable customer believes the agent can do based on how the insurer let the agent act (business cards, signage, company applications). Express authority is spelled out in the contract; implied is what's needed to carry out the express. Apparent is the 'looks legit' bucket.

Express authority is the authority written right into the agency agreement, the powers the insurer explicitly hands the agent. Implied authority fills in the gaps needed to use that express authority, and apparent authority is what the public reasonably assumes. Express equals expressly stated.

Concealment is staying silent about a material fact you know the insurer would want, and if it's intentional, it can void the policy. It's the sin-of-omission version of misrepresentation (which is an active false statement). Both turn on the fact being 'material,' meaning it would have affected the insurer's decision.

A waiver is voluntarily surrendering a known right, say, an insurer choosing not to enforce a policy condition. Estoppel is the follow-on: once you've waived something, you can be legally prevented (estopped) from later trying to enforce it. Waiver is the giving up; estoppel is being held to it.

Medical expense insurance pays for the care itself, hospital stays, surgery, doctor visits, and related services, rather than replacing income. It's the bucket most people picture when they hear health insurance. Hook: medical expense pays the providers; disability income pays you.

Disability income is paid as a stream of periodic payments (usually monthly) for as long as the qualifying disability lasts, up to the policy's benefit period. It functions like a substitute paycheck rather than a one-time payout. Hook: think of it as a replacement salary that keeps coming while you can't work.

In group coverage the insurer issues one master contract to the group sponsor (typically the employer), and each covered member receives a certificate of coverage rather than an individual policy. Hook: the employer holds the master contract; employees hold certificates.

For health insurance, insurable interest must exist when the policy is applied for; you naturally have it in your own health, and, for example, an employer has it in a key employee. Unlike property insurance, it isn't re-tested at the time of loss. Hook: insurable interest is checked at the start, when the application is taken.

Group coverage is underwritten on the group as a whole, its size, industry, and demographics, rather than screening each person's health. That's why an employee can usually enroll without a medical exam during the eligibility window. Hook: group underwriting looks at the group, not each individual's medical history.

Noncancelable is the strongest renewal guarantee for the insured: the insurer can't cancel, can't refuse renewal, and can't raise the premium beyond what the policy already states, all the way to the stated age. Hook: noncancelable locks everything, coverage and premium alike, in the insured's favor.

Optionally renewable hands the insurer discretion: at each anniversary or renewal date it can decide whether to renew at all and can raise the premium. It's much weaker protection for the insured than guaranteed renewable. Hook: the insurer holds the option, so renewal is its choice at each renewal date.

The stop-loss, or out-of-pocket maximum, protects the insured from runaway costs: once their deductible and coinsurance add up to the cap, the insurer pays 100% of covered charges for the rest of the period. Hook: stop-loss stops the bleeding, since after the cap the insured's share drops to zero.

Cost-sharing features like deductibles and coinsurance keep the insured financially involved, which both spreads the cost and discourages overusing services for minor issues. That helps hold premiums down for everyone. Hook: cost-sharing gives the insured skin in the game, curbing overuse and helping control premiums.

The Fair Credit Reporting Act requires that an applicant be told, in advance, that an investigative consumer report, which gathers information on character, lifestyle, and reputation through interviews, may be obtained. The applicant also has the right to learn the nature and scope of the report. Hook: the FCRA guarantees you advance notice that a lifestyle or reputation report may be pulled.

The grace period varies with how often premiums are paid: 7 days for weekly premiums, 10 days for monthly premiums, and 31 days for any other mode. The less often you pay, the longer the grace period. Hook: weekly 7, monthly 10, everything else 31, so the rarer the payment, the longer the grace.

On reinstatement, accidental injury losses are covered immediately, but sickness is covered only if it begins more than 10 days after the reinstatement date. The 10-day gap on sickness exists to discourage someone from reinstating only because they've just become ill. Hook: accidents covered at once, sickness has to wait 10 days after reinstatement.

If the insurer doesn't deliver claim forms on time, the claimant is allowed to submit proof of loss in their own words; any written statement of the nature and extent of the loss will satisfy the requirement. Hook: no forms from the insurer means you can describe the loss in any written form.

Benefits are generally paid to the insured, while any death benefit (such as under AD&D) goes to the named beneficiary, or to the insured's estate if none is named. Hook: living benefits to the insured, death benefits to the beneficiary.

The facility of payment clause lets the insurer pay up to a stated amount to a relative or whoever appears equitably entitled, which is useful when there's no living beneficiary or the insured is deceased or incapacitated. It gives the insurer a practical way to settle small amounts without a court. Hook: facility of payment is the insurer's shortcut to pay someone fairly entitled when no beneficiary fits.

The insured generally has up to 3 years (5 in some states) from the time proof of loss is required to file a lawsuit, after which the right to sue expires. Hook: at least 60 days before you can sue, no more than 3 years after, that's the legal-action window.

The owner keeps the right to change the beneficiary unless they've named an irrevocable beneficiary, in which case the beneficiary's written consent is required. Hook: revocable means change freely, irrevocable means you need the beneficiary's okay.

If the insured moves to riskier work and is later hurt, the insurer can pay reduced benefits, specifically the amount the premium already paid would have purchased at the rate for the more hazardous job. The policy isn't void; the benefit is simply scaled to the risk. Hook: a more hazardous job means benefits shrink to match what your premium buys at the higher-risk rate.

Because age affects the premium, a misstatement is corrected by adjusting the benefit rather than canceling coverage: the insurer pays what the premium actually paid would have bought at the true age. Hook: a wrong age just resizes the benefit to match what you really paid for.

This provision lets the insurer avoid paying for losses the insured suffers while committing or attempting a felony or from being engaged in an illegal occupation. Hook: get hurt while breaking the law in a serious way and the policy won't pay.

The any-occupation definition is stricter and more insurer-friendly: you're considered totally disabled only if you can't work in any job that fits your background. It's harder to qualify for benefits than under own occ. Hook: any occ asks whether you can do any suitable job, not just your old one.

The recurrent disability provision says that a relapse from the same cause within a set time (often six months) counts as a continuation of the prior claim, so the insured doesn't have to satisfy a brand-new elimination period. A later, unrelated disability would start fresh. Hook: same cause, soon after, means it picks up where it left off, no new waiting period.

No benefits are paid during the elimination period, so with a 60-day elimination period, benefits start accruing only after those 60 days of continuous disability have passed. The insured covers that initial gap themselves. Hook: nothing is paid until the elimination period clock runs out.

The probationary period is a short stretch at the start of the policy during which sickness-related disabilities aren't covered, which discourages someone from buying coverage once symptoms appear. Disabilities from accidents are usually covered from day one. Hook: a probationary period delays sickness coverage at the very start, while accidents are covered right away.

Insurers cap benefits below full income (and below what you'd net after taxes, since the benefits are often tax-free) so the insured always has a financial reason to recover and return to work. Paying 100% could encourage staying disabled, known as malingering. Hook: benefits stop short of full pay so working still beats collecting.

An integrated, or offset, plan coordinates with Social Security disability so the combined payment doesn't exceed the target percentage of income; the policy reduces its benefit (dollar-for-dollar or partially) by what Social Security pays. It controls overinsurance and lowers the premium. Hook: the policy's benefit shrinks by whatever Social Security kicks in.

Business overhead expense coverage reimburses fixed business costs, rent, utilities, employee salaries, and the like, while the owner is disabled, so the business can keep its doors open. It pays actual covered expenses on a reimbursement basis over a relatively short benefit period and does not replace the owner's own income. Hook: BOE keeps the lights on at the business, not money in the owner's pocket.

A disability buy-sell arrangement supplies the money for the remaining owners (or the business) to purchase the share of an owner who becomes permanently disabled, mirroring how a life-insurance buy-sell works at death. Hook: it funds the buyout of a disabled owner's stake in the business.

Social Security disability imposes a five-month waiting period, so benefits start in the sixth full month of disability. Combined with the strict definition, it makes private disability income coverage important for bridging that gap. Hook: Social Security disability makes you wait five months before the first payment.

Group plans are commonly nonoccupational because employees are already protected on the job by workers' compensation, so the group plan avoids duplicating that coverage and instead handles off-the-job disabilities. Hook: group DI skips on-the-job claims because workers' comp already has them.

Basic medical expense plans (hospital, surgical, and physician expense) typically pay from the first dollar with little or no deductible, but they cap benefits at modest limits. They cover routine costs well but can run out fast for a catastrophic claim. Hook: basic plans pay early but shallow, low deductible and low ceiling.

UCR ties the allowable benefit to what providers in the same area normally charge for that procedure, rather than to a flat schedule. A charge far above the local norm may not be fully covered. Hook: UCR pays the going local rate, not just any billed amount.

Major medical is built for big claims: it features high (or no) maximum benefits, a deductible, and coinsurance, in exchange for covering a broad range of expenses. The cost sharing is the trade-off for that wide, deep protection. Hook: major medical goes big and broad, with a deductible and coinsurance along the way.

Supplementary (or superimposed) major medical layers on top of a basic plan, picking up large or extended expenses once the basic plan's limited benefits run out. Hook: supplementary major medical is the backup layer that kicks in after basic runs dry.

The corridor deductible is the gap the insured must cover between the exhaustion of the basic plan's benefits and the start of the supplementary major medical benefits. It links the two layers together. Hook: the corridor is the deductible bridge between basic running out and major medical starting.

An HMO operates on a prepaid basis: members pay a fixed periodic amount and receive comprehensive services from the HMO's providers, who are often paid by capitation (a set fee per member). It shifts the focus from billing per service to managing care within a fixed budget. Hook: an HMO is prepaid care, a flat fee buys a defined set of services.

HSAs are tied to HDHPs by law: you must be covered by a qualified high deductible health plan (and have no disqualifying coverage) to contribute. The high deductible is what the HSA is meant to help fund. Hook: no HDHP, no HSA, they're a required pair.

An HSA belongs to the individual, so it follows them from job to job, the balance rolls over year to year, and it offers strong tax treatment: deductible (or pre-tax) contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. Hook: an HSA is yours to keep, rolls over, and is tax-favored coming and going.

Consumer-directed plans put more decision-making, and more of the early cost, in the consumer's hands, pairing a high deductible with a tax-favored account so people shop more carefully for care. Hook: consumer-directed means you steer the spending, with skin in the game.

Precertification is a utilization-management tool: the plan reviews and approves certain planned services or admissions in advance to confirm they're medically necessary before agreeing to pay. Emergencies are generally exempt. Hook: precert means getting the plan's green light before non-emergency care.

The insurer issues one master contract to the group sponsor, and each covered member gets a certificate of coverage summarizing their benefits and rights. The members don't hold individual policies. Hook: the sponsor gets the master contract, the members get certificates.

A valid insurable group must exist for some primary reason other than getting insurance, such as an employer, a union, or a trade association, so the coverage is incidental and the group isn't just assembled to game the system. Hook: the group has to exist first for another reason, with insurance as a perk, not the point.

The probationary period is the initial stretch of employment, often 30 to 90 days, that a new hire must complete before becoming eligible to enroll. It's followed by the enrollment (eligibility) period when they can actually sign up. Hook: the probationary period is the wait before a new hire can even enroll.

Because employees share the cost in a contributory plan, not everyone signs up, so insurers usually require around 75% participation to guard against adverse selection. Hook: contributory plans need roughly three-quarters in to keep the risk pool healthy.

The person continuing coverage pays the full premium, up to 102% of the group rate, with the extra 2% covering administrative cost. COBRA preserves access to the group plan, but not the employer's subsidy. Hook: you keep the group coverage but pay it all yourself, plus a 2% admin add-on.

Termination for gross misconduct is the key exception; it does not trigger COBRA rights. Ordinary terminations, layoffs, and resignations do qualify. Hook: gross misconduct is the one firing that forfeits COBRA.

The conversion privilege lets an employee leaving the group switch to an individual policy without proving insurability, though usually at individual (higher) rates and within a limited application window. It protects coverage for someone who has become uninsurable. Hook: conversion turns group coverage into an individual policy with no health questions, but at individual prices.

For active employees age 65 and older at larger employers, the group health plan is primary and Medicare is secondary, under the Medicare Secondary Payer rules. The retiree situation can differ. Hook: still working at a big employer means the group plan leads and Medicare follows.

Coordination of benefits caps the combined payment at 100% of the actual covered expense, here $1,000, no matter how generous each plan is on its own. The primary pays first and the secondary covers the remainder up to that ceiling. Hook: two plans still pay only the real cost, never more than 100%.

Association (or alumni and trade) groups can offer coverage when the association is a bona fide organization formed for reasons other than insurance, with a real purpose, defined membership, and adequate size. Hook: an association group works only if the association is real, not a shell built just to sell coverage.

A nonscheduled, or comprehensive, dental plan pays a percentage of the UCR charge for each service rather than a fixed dollar amount, so benefits track local prevailing fees. It's the dental version of UCR-based medical coverage. Hook: nonscheduled dental pays a percentage of the going UCR rate, not a fixed table.

Basic restorative procedures typically sit in the middle tier, often paid at around 80%, with the patient covering the remaining 20% after any deductible. Hook: basic care lands in the middle, often about 80% covered.

Preventive and diagnostic care covers the routine maintenance items, cleanings, exams, and x-rays, that keep small problems from becoming big ones. Crowns and bridges are major services, and braces are orthodontia. Hook: cleanings and x-rays are textbook preventive care.

The annual (calendar-year) maximum is the ceiling on what the plan pays per covered person each year; once reached, the patient pays the rest until the maximum resets the following year. Dental annual maximums are often modest. Hook: the annual max is the plan's yearly payout ceiling per person.

To encourage preventive care, plans commonly waive the deductible on cleanings and exams while applying it to basic and major services. That keeps the barrier off the care the plan most wants people to use. Hook: the deductible usually skips preventive care and lands on basic and major work.

With predetermination, the dentist submits the proposed treatment plan and the insurer estimates what it will cover before the work is done, so there are no payment surprises. It's recommended for expensive procedures. Hook: predetermination is a no-surprises preview of what the plan will pay.

The alternate benefit (LEAT) provision lets the plan calculate its payment based on the cheapest treatment that would adequately do the job. If the patient chooses a pricier option, they pay the difference. Hook: the plan pays for the cheapest adequate fix; upgrades are on the patient.

Dental is usually written as its own standalone plan rather than folded into major medical, with its own premium, deductible, maximums, and benefit tiers. Employers often offer it as a separate elective benefit. Hook: dental typically stands on its own, separate from the medical plan.

Vision plans typically grant a fixed allowance toward frames or contacts (for example, an allowance applied at purchase), and the member pays anything above that allowance. Exams may carry a small copay. Hook: vision gives you an allowance to spend, and you cover the overage.

Vision coverage usually separates the exam (the professional service) from the materials (lenses, frames, contacts), each with its own copay, allowance, or frequency rule. Hook: vision splits into the exam and the eyewear materials.

People under 65 can get Medicare if they've received Social Security disability benefits for 24 months, and certain conditions (end-stage renal disease, ALS) qualify sooner. Hook: long-term disability, not just age 65, can open the Medicare door.

The Initial Enrollment Period spans 7 months: the 3 months before your 65th-birthday month, that month itself, and the 3 months after. Enrolling on time avoids late penalties. Hook: a 7-month window, three before, the month of, and three after your 65th.

Part A is hospital insurance: it covers inpatient hospital stays, limited skilled nursing facility care, home health care, and hospice. Everyday doctor visits fall under Part B. Hook: Part A is the hospital side, inpatient, skilled nursing, home health, hospice.

Most people pay no premium for Part A because they (and their employers) already funded it through Medicare payroll taxes while working. Those without enough work credits can buy in by paying a premium. Hook: Part A is usually premium-free, paid for by a lifetime of FICA taxes.

Part A uses benefit periods: one begins when you're admitted and ends after you've been out of a hospital or skilled nursing facility for 60 days in a row. A new stay after that starts a new benefit period (and a new deductible). Hook: a Part A benefit period resets only after 60 days fully out of care.

Once the yearly Part B deductible is satisfied, Medicare typically pays 80% of the approved amount and the beneficiary pays the remaining 20% coinsurance. That open-ended 20% is a common reason people add a Medicare Supplement. Hook: Part B pays 80, you pay 20, with no built-in cap on your share.

Medigap policies, sold by private insurers, pay some or all of the out-of-pocket costs Original Medicare leaves behind, like the Part A deductible and the Part B 20% coinsurance. They work alongside Original Medicare, not in place of it. Hook: Medigap fills the holes Original Medicare leaves.

Medigap plans are standardized into lettered plans (Plan A, Plan G, Plan N, and so on); a given lettered plan offers identical core benefits no matter which insurer sells it, so consumers can compare on price and service. Hook: same letter equals same benefits, whoever sells it.

LTC insurance fills the gap left by Medicare, which doesn't pay for ongoing custodial care, by covering help with daily living over an extended period, whether in a facility or at home. Hook: LTC covers the long-term custodial care Medicare leaves out.

Tax-qualified LTC policies generally pay when the insured is unable to perform at least two of the six ADLs (bathing, dressing, eating, transferring, toileting, and continence) for an expected period, or has a severe cognitive impairment. Hook: lose two of the six ADLs and tax-qualified LTC benefits kick in.

Itemizers can deduct unreimbursed medical expenses, but only the portion that exceeds a set percentage of AGI (currently 7.5%). Expenses below that floor aren't deductible. Hook: only medical costs above the AGI floor count, and only if you itemize.

You can't get a tax benefit twice for the same dollar. If you deducted a medical expense and the insurer later reimburses it, that reimbursed amount can become taxable to undo the earlier deduction. Hook: no double-dipping, deduct and then get reimbursed, and the reimbursement is pulled back into income.

Without itemizing, a typical individual gets no federal deduction for personal health premiums; they're paid with after-tax dollars. (Self-employed individuals are a notable exception, covered separately.) Hook: no itemizing usually means no deduction for your health premiums.

Employer-paid group health premiums are a deductible business expense, a major reason employers offer health benefits. Hook: the employer writes off group health premiums as a business cost.

Just like individual medical expense benefits, group medical benefits reimburse care and aren't treated as income, so they're tax-free to the employee. Hook: group medical benefits reimburse bills, so they're tax-free.

The combination is what makes it powerful: the employer deducts the premium as a business expense, and the employee pays no tax on either the coverage or the benefits. Hook: deductible for the employer, tax-free for the employee, the best of both ends.

The employer's premium payments aren't taxed to the employee when paid; the tax is deferred to the benefit stage if a claim arises. Hook: the premium isn't taxed now, the benefit is taxed later instead.

The HSA's triple advantage is contributions that are deductible or pre-tax, earnings that grow tax-free, and withdrawals that are tax-free when used for qualified medical expenses. Few accounts offer all three. Hook: HSA equals a tax break going in, growing, and coming out, all three.

FSA contributions come out of salary on a pre-tax basis, lowering the employee's taxable income, in exchange for the use-it-or-lose-it restriction on unused funds. Hook: FSA money goes in pre-tax, shrinking your taxable pay.

Premiums for a tax-qualified LTC policy count as deductible medical expenses, but only up to age-based dollar limits and only to the extent total medical costs exceed the AGI floor. Hook: qualified LTC premiums can be deducted, within age caps and the usual medical-expense floor.