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Free WV Accident and Health or Sickness Producer Practice Questions

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Sample Practice Questions

Try these 10 sample questions from the WV Accident and Health or Sickness Producer practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

  1. 1An employee wants benefits that replace part of her own pay if illness prevents her from working. Which policy serves that purpose?

    1. A. An individual disability income policy
    2. B. A business overhead expense policy
    3. C. A key employee disability policy
    4. D. An accidental death and dismemberment policy

    Answer: A

    Explanation: "a portion of the income they lose because of a disabling injury or illness" The benefit replaces the insured person's lost earnings. Overhead and key employee policies protect business interests, while AD&D requires an accident.

    Reference: NAIC Glossary of Insurance Terms — Disability Income

  2. 2An insured asks whether an accident and sickness agent's oral promise changes a policy when it conflicts with the attached endorsement. What constitutes the contract?

    1. A. The signed application and the agent's later oral promise
    2. B. The policy and the insurer's unpublished claim guidelines
    3. C. The policy, its endorsements, and attached papers
    4. D. The policy and any verbal assurances from the agent

    Answer: C

    Explanation: "This policy, including the endorsements and the attached papers," The written policy package is the entire contract; an agent's oral assurance does not replace its terms.

    Reference: West Virginia Code Article 33-15 — §33-15-4(a), Entire Contract

  3. 3Under Original Medicare, a beneficiary sees a physician for covered outpatient care. Which part generally helps pay for that service?

    1. A. Medicare Part A hospital insurance
    2. B. Medicare Part D drug coverage
    3. C. Medicare Part B medical insurance
    4. D. Medigap supplemental insurance

    Answer: C

    Explanation: "Part B helps cover: Services from doctors and other health care providers Outpatient care" Part B covers doctors and outpatient care. Part A addresses inpatient care, Part D drugs, and Medigap the beneficiary's remaining costs.

    Reference: Medicare.gov Parts of Medicare — Parts of Medicare — Part B

  4. 4An insured has two health plans and both cover a submitted claim. How should their payments be coordinated?

    1. A. The secondary plan pays first and the primary plan pays any balance.
    2. B. Both plans independently pay the entire claim to the insured.
    3. C. The primary plan pays first; the secondary may pay the remaining covered balance.
    4. D. The plans alternate which one pays first for successive claims.

    Answer: C

    Explanation: "The primary health plan processes your insurance claim first. If there’s still a balance, then the secondary plan processes the claim for the balance." The primary insurer processes first; the secondary considers a remaining balance, and total benefits cannot exceed the claim.

    Reference: NAIC Consumer Guide to Using Your Health Plan — p. 16, If You Have More Than One Health Plan

  5. 5To earn a commission, a producer knowingly supplies a false answer on an applicant's accident and sickness application. Which unfair practice does that conduct match?

    1. A. Rebating through an inducement outside the policy
    2. B. Defamation of another insurer's financial condition
    3. C. Coercion tied to a lender's insurance requirement
    4. D. Misrepresentation on an insurance application

    Answer: D

    Explanation: "No person shall make false or fraudulent statements or representations on or relative to an application for an insurance policy" The producer's false answer for commission falls under application misrepresentation. Rebating, defamation, and coercion are distinct unfair-practice categories.

    Reference: West Virginia Code Article 33-11 — §33-11-4(11), Misrepresentation in insurance applications

  6. 6Who appoints the West Virginia Insurance Commissioner, and what confirmation is required?

    1. A. The Legislature appoints the commissioner by joint resolution
    2. B. Licensed insurers elect the commissioner, subject to gubernatorial approval
    3. C. The Attorney General appoints the commissioner with House approval
    4. D. The Governor appoints the commissioner with the advice and consent of the Senate

    Answer: D

    Explanation: W. Va. Code §33-2-1 requires Senate "advice and consent" for the Governor's appointment of the commissioner.

    Reference: §33-2 — W. Va. Code §33-2-1

  7. 7What type of disclosure standards must the Commissioner establish for sales of individual accident and sickness policies under §33-28-4?

    1. A. Standards limited to insurer advertising expenses
    2. B. Standards set separately by each producer without Commission approval
    3. C. Standards that apply only after a claim is denied
    4. D. Standards of full and fair disclosure governing manner, content, and required disclosures

    Answer: D

    Explanation: Section 33-28-4(a) directs the Commissioner to establish "standards of full and fair disclosure" for the sale of individual accident and sickness policies and specified subscriber contracts.

    Reference: §33-28 — W. Va. Code §33-28-4(a)

  8. 8A self-employed dentist is disabled and wants insurance to keep the practice's rent, utilities, and staff payroll paid during recovery. Which coverage fits?

    1. A. An individual disability income policy
    2. B. A business overhead expense policy
    3. C. A key employee disability policy
    4. D. A business disability buyout policy

    Answer: B

    Explanation: "covers standard business expenses such as payroll, utilities" The insured need is recurring operating expense during the owner's disability. Personal disability income replaces earnings, key employee coverage protects the employer, and buyout coverage addresses an ownership transfer.

    Reference: NAIC Small Business Insurance — Disability Insurance — business overhead

  9. 9A health policy has been in force for more than two years. The insurer discovers a nonfraudulent application misstatement and seeks to deny a disability beginning after that period. What rule applies?

    1. A. The misstatement may always void coverage regardless of timing.
    2. B. The insurer may deny only if the later disability is severe.
    3. C. The insurer may void coverage whenever premiums were low.
    4. D. The nonfraudulent misstatement cannot support that denial.

    Answer: D

    Explanation: "After two years from the date of issue of this policy no misstatements, except fraudulent misstatements" The two-year provision bars use of nonfraudulent misstatements against a later loss; fraud remains an express exception.

    Reference: West Virginia Code Article 33-15 — §33-15-4(b), Time Limit on Certain Defenses

  10. 10A beneficiary wants Medicare benefits delivered through a Medicare-approved private health plan that bundles Parts A and B and usually drug coverage. Which option is described?

    1. A. Original Medicare without a private plan
    2. B. A stand-alone Part D prescription plan
    3. C. A private Medicare supplement policy
    4. D. A Medicare Advantage plan, also called Part C

    Answer: D

    Explanation: "These “bundled” plans include Part A, Part B, and usually Part D." Medicare Advantage is the approved private-plan alternative that bundles A and B and often D. The other choices do not provide that bundle.

    Reference: Medicare.gov Parts of Medicare — Medicare Advantage (also known as Part C)

Topics in this practice bank

These topics describe the available practice for WV Accident and Health or Sickness Producer. Review the examination outline and its sources for scope and allocation details.

  • General Knowledge — I. TYPES OF POLICIES (16 scoreable questions)
    • A. Disability income
    • A. Disability income — 1. Individual disability income policy
    • A. Disability income — 2. Business overhead expense policy
    • A. Disability income — 3. Business disability buyout policy
    • A. Disability income — 4. Group disability income policy
    • A. Disability income — 5. Key employee policy
    • B. Accidental death and dismemberment
    • C. Medical expense insurance
    • C. Medical expense insurance — 1. Basic hospital, medical, and surgical policies
    • C. Medical expense insurance — 2. Major medical policies
    • C. Medical expense insurance — 3. Health Maintenance Organizations (HMOs)
    • C. Medical expense insurance — 4. Preferred Provider Organizations (PPOs)
    • C. Medical expense insurance — 5. Point of Service (POS) plans
    • C. Medical expense insurance — 6. Flexible Spending Accounts (FSAs)
    • C. Medical expense insurance — 7. High Deductible Health Plans (HDHPs) and related Health Savings Accounts (HSAs)
    • C. Medical expense insurance — 8. Health Reimbursement Accounts (HRAs)
    • D. Medicare supplement policies
    • E. Group insurance
    • E. Group insurance — 1. Differences between individual and group contracts
    • E. Group insurance — 2. General characteristics
    • E. Group insurance — 3. COBRA
    • F. Individual/Group Long Term Care (LTC)
    • F. Individual/Group Long Term Care (LTC) — 1. Eligibility
    • F. Individual/Group Long Term Care (LTC) — 2. Levels of care
    • G. Other policies
    • G. Other policies — 1. Dental
    • G. Other policies — 2. Vision
    • G. Other policies — 3. Cancer
    • G. Other policies — 4. Critical illness or specified disease
    • G. Other policies — 5. Worksite (employer-sponsored)
    • G. Other policies — 6. Hospital indemnity
    • G. Other policies — 7. Short-term medical
    • G. Other policies — 8. Accident
  • General Knowledge — II. POLICY PROVISIONS, CLAUSES, AND RIDERS (15 scoreable questions)
    • A. Mandatory and optional provisions
    • A. Mandatory and optional provisions — 1. Entire contract
    • A. Mandatory and optional provisions — 2. Time limit on certain defenses (incontestable)
    • A. Mandatory and optional provisions — 3. Grace period
    • A. Mandatory and optional provisions — 4. Reinstatement
    • A. Mandatory and optional provisions — 5. Notice of claim
    • A. Mandatory and optional provisions — 6. Claim forms
    • A. Mandatory and optional provisions — 7. Proof of loss
    • A. Mandatory and optional provisions — 8. Time of payment of claims
    • A. Mandatory and optional provisions — 9. Payment of claims
    • A. Mandatory and optional provisions — 10. Physical examination and autopsy
    • A. Mandatory and optional provisions — 11. Legal actions
    • A. Mandatory and optional provisions — 12. Change of beneficiary
    • A. Mandatory and optional provisions — 13. Misstatement of age or gender
    • A. Mandatory and optional provisions — 14. Change of occupation
    • A. Mandatory and optional provisions — 15. Illegal occupation
    • A. Mandatory and optional provisions — 16. Relation of earnings to insurance
    • B. Other provisions and clauses
    • B. Other provisions and clauses — 1. Insuring clause
    • B. Other provisions and clauses — 2. Free look
    • B. Other provisions and clauses — 3. Consideration clause
    • B. Other provisions and clauses — 4. Probationary period
    • B. Other provisions and clauses — 5. Elimination period
    • B. Other provisions and clauses — 6. Waiver of premium
    • B. Other provisions and clauses — 7. Exclusions and limitations
    • B. Other provisions and clauses — 8. Preexisting conditions
    • B. Other provisions and clauses — 9. Coinsurance
    • B. Other provisions and clauses — 10. Deductibles
    • B. Other provisions and clauses — 11. Eligible expenses
    • B. Other provisions and clauses — 12. Copayments
    • B. Other provisions and clauses — 13. Pre-authorizations and prior approval requirements
    • B. Other provisions and clauses — 14. Usual, reasonable, and customary (URC) charges
    • B. Other provisions and clauses — 15. Lifetime, annual, or per cause maximum benefit limits
    • C. Riders
    • C. Riders — 1. Impairment/exclusions
    • C. Riders — 2. Guaranteed insurability
    • C. Riders — 3. Future increase option
    • D. Rights of renewability
    • D. Rights of renewability — 1. Noncancelable
    • D. Rights of renewability — 2. Cancelable
    • D. Rights of renewability — 3. Guaranteed renewable
  • General Knowledge — III. SOCIAL INSURANCE (6 scoreable questions)
    • A. Medicare (Parts A, B, C, D)
    • B. Medicaid
    • C. Social Security benefits
  • General Knowledge — IV. OTHER INSURANCE CONCEPTS (5 scoreable questions)
    • A. Total, partial, recurrent and residual disability
    • B. Owner’s rights
    • C. Dependent children benefits
    • D. Primary and contingent beneficiaries
    • E. Modes of premium payments
    • F. Nonduplication and coordination of benefits (e.g., primary vs. excess)
    • G. Occupational vs. non-occupational
    • H. Tax treatment of premiums and proceeds of insurance contracts (e.g., disability income and medical expenses, etc.)
    • I. Managed care
    • J. Workers Compensation
    • J. Workers Compensation — 1. Impact on health insurance benefits
    • K. Subrogation
    • L. Cost containment
  • General Knowledge — V. FIELD UNDERWRITING PROCEDURES (8 scoreable questions)
    • A. Completing the application
    • B. Explaining sources of insurability and HIPAA privacy information (e.g., MIB Report, Fair Credit Reporting Act, etc.)
    • C. Initial premium payment and receipt and consequences of the receipt (e.g., medical examination, etc.)
    • D. Submitting application (and initial premium if collected) to company for underwriting
    • E. Policy delivery
    • F. Explaining policy and its provisions, riders, exclusions, and ratings to clients
    • G. Replacement
    • H. Contract law
    • H. Contract law — 1. Elements of a contract
    • H. Contract law — 2. Insurable interest
    • H. Contract law — 3. Warranties and representations
    • H. Contract law — 4. Unique aspects of the insurance contract
    • H. Contract law — 4. Unique aspects of the insurance contract — a. Conditional
    • H. Contract law — 4. Unique aspects of the insurance contract — b. Unilateral
    • H. Contract law — 4. Unique aspects of the insurance contract — c. Adhesion
    • H. Contract law — 4. Unique aspects of the insurance contract — d. Aleatory
  • West Virginia Specific — I. WEST VIRGINIA LAWS AND RULES COMMON TO LIFE AND ACCIDENT AND SICKNESS INSURANCE (21 scoreable questions)
    • A. Insurance Commissioner (2 questions)
    • A. Insurance Commissioner (2 questions) — 1. Broad powers
    • A. Insurance Commissioner (2 questions) — 2. Examination of records
    • A. Insurance Commissioner (2 questions) — 3. Notice and conduct of hearing
    • A. Insurance Commissioner (2 questions) — 4. Penalties
    • A. Insurance Commissioner (2 questions) — 5. Filing and approval of forms
    • B. Definitions (4 questions)
    • B. Definitions (4 questions) — 1. Domestic, foreign, and alien companies
    • B. Definitions (4 questions) — 2. Stock and mutual
    • B. Definitions (4 questions) — 3. Transacting insurance
    • B. Definitions (4 questions) — 4. Producer
    • C. Licensing (7 questions)
    • C. Licensing (7 questions) — 1. Purpose/Requirements
    • C. Licensing (7 questions) — 2. Qualifications
    • C. Licensing (7 questions) — 2. Qualifications — a. Producer
    • C. Licensing (7 questions) — 2. Qualifications — b. Direct response
    • C. Licensing (7 questions) — 2. Qualifications — c. Nonresident Life/A&H producer
    • C. Licensing (7 questions) — 2. Qualifications — d. Fingerprinting
    • C. Licensing (7 questions) — 3. Termination of license
    • C. Licensing (7 questions) — 3. Termination of license — a. Expiration and cancellation
    • C. Licensing (7 questions) — 3. Termination of license — b. Revocation and suspension
    • C. Licensing (7 questions) — 3. Termination of license — c. Nonrenewal
    • C. Licensing (7 questions) — 4. Limitation of license
    • C. Licensing (7 questions) — 5. Appointment
    • C. Licensing (7 questions) — 6. Education requirements
    • C. Licensing (7 questions) — 6. Education requirements — a. Continuing education
    • C. Licensing (7 questions) — 7. Mandatory reporting requirements
    • C. Licensing (7 questions) — 7. Mandatory reporting requirements — a. Criminal prosecution and administrative action
    • C. Licensing (7 questions) — 7. Mandatory reporting requirements — b. Fraud
    • D. Unfair Trade Practices (6 questions)
    • D. Unfair Trade Practices (6 questions) — 1. Unfair claims methods and practices
    • D. Unfair Trade Practices (6 questions) — 2. Excessive charges
    • D. Unfair Trade Practices (6 questions) — 3. Rebating
    • D. Unfair Trade Practices (6 questions) — 4. Coercion
    • D. Unfair Trade Practices (6 questions) — 5. Misrepresentation
    • D. Unfair Trade Practices (6 questions) — 6. Defamation
    • D. Unfair Trade Practices (6 questions) — 7. Advertising
    • D. Unfair Trade Practices (6 questions) — 8. Penalties
    • E. Mass Marketed Life & Sickness Insurance (1 question)
    • F. West Virginia Life and Health Guaranty Association (1 question)
    • G. Unauthorized Insurers
  • West Virginia Specific — II. WEST VIRGINIA LAWS AND RULES PERTINENT TO ACCIDENT AND HEALTH OR SICKNESS INSURANCE ONLY (9 scoreable questions)
    • A. Required Disclosure Provisions; Individual Minimum A&S Standards (1 question)
    • B. Requirements for Replacement; Individual Minimum A&S Standards (1 question)
    • C. Medicare Supplement Insurance (2 questions)
    • D. Health Maintenance Organization Act (1 question)
    • D. Health Maintenance Organization Act (1 question) — 1. Definitions
    • D. Health Maintenance Organization Act (1 question) — 2. Deceptive practice
    • E. Corporations (1 question)
    • E. Corporations (1 question) — 1. Hospital service corporations
    • E. Corporations (1 question) — 2. Medical service corporations
    • E. Corporations (1 question) — 3. Dental service corporations
    • E. Corporations (1 question) — 4. Health service corporations
    • F. Coverage for Newborn Children (1 question)
    • G. Long-Term Care (1–2 questions)
    • H. Small Employer Group (0–1 question)

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These are independent study questions, not actual examination items. For examination requirements and official information, view WV Accident and Health or Sickness Producer details.