Health Insurance Exam information
What it is, what's tested, and how it's scored.
Health Insurance exam summary
Most Health Insurance exam content is the same across tests in the U.S. There is typically a small amount that varies by state due to state-specific rules and regulations, all of which are covered in our course. Below are the typical topics that will be covered during the Health Insurance exam:
1. Insurance Regulation
Typically the first and lengthiest part of the exam. This portion does not focus on specific types of insurance, instead delving into fair business practices and various facets of lawful insurance sales including licensing, marketing, and record keeping.
2. General Insurance
Covers foundational concepts that apply to all kinds of insurance, including risk management, legal contracts, and insurer types.
3. Accident and Health Insurance Basics
Covers topics specific to these kinds of insurance, such as the principal types of losses and benefits.
4. Disability Income and Related Insurance
Topics include the types of benefits and coverage and how to qualify for them.
5. Medical Plans
Requires knowledge of HIPAA requirements along with various types of medical plans and providers.
6. Group Accident and Health Insurance
Touches on eligibility, employer plans and expenses, and how group insurance is impacted by regulations like ERISA and Medicare.
7. Dental Insurance
A small portion of the exam but requires specific knowledge of dental treatment categories and terminology, such as the difference between orthodontics and endodontics.
8. Medicare
Various aspects of Medicare are covered in this section, such as standard policies and other options for individuals with Medicare.
9. Long-Term Care Insurance
Covers elements of Long-term care (LTC) policies, such as benefit eligibility, different levels of care, and required provisions.
10. Federal Tax Considerations for Accident and Health Insurance
Has the longest title, but it is often one of the smallest sections in the Health Insurance exam. It covers personally-owned versus employer-group health insurance and Health Savings Accounts (HSAs) versus Health Reimbursement Accounts (HRAs).
The exam is typically between two and three hours and has around 50 to 100 questions. For state-specific exam information, please visit our insurance licensing database.
Achievable Health Insurance content outline
1
General insurance concepts
An overview of foundational concepts essential to understanding the insurance industry. Risk management principles, sources of insurance, different insurance marketing systems, the authority of producers, insurance contracts, and the legal principles governing them.
2
Producer roles and receipt types
An introduction to what an insurance producer is responsible for, including law of agency, fiduciary duty, and types of receipt.
3
Underwriting
The role of the insurance underwriter. Different sources of underwriting information, how premiums are determined, and what it means to "rate" an insurance policy.
4
Health insurance basics
An introduction to commercial insurers, service providers, and government health insurance programs, as well as an overview of the health insurance underwriting process and the concept of a rated policy.
5
Required policy provisions
12 policy provisions are required to be written into a health insurance contract. These required policy provisions are intended to protect the insured.
6
Optional policy provisions
For the purpose of the exam, there are 11 available optional provisions that the insurance company can add to the policy, which, in theory, protect them.
7
Medical expense insurance
This chapter starts with the base plan and moves through comprehensive major medical. It is written chronologically and a history of how health insurance in this country was introduced and evolved into what is available in today's market.
8
Group health insurance
Most people in the United States are covered by group health insurance, usually employer-sponsored. This chapter covers the testable concepts surrounding group health insurance and what you need to know about COBRA and HIPAA.
9
The Affordable Care Act (ACA)
Covers key ACA reforms, including preexisting condition rules, dependent coverage to age 26, essential health benefits, employer mandates, Marketplace plans, and enrollment periods.
10
Disability income insurance
Disability Income insurance is heavily weighted on the pre-licensing exam. This chapter focuses on test-specific concepts, including elimination and benefit period, types of disabilities, and various ways to define "disabled."
11
Accidental death and dismemberment insurance
AD&D is the only (unendorsed) health insurance policy that offers a death benefit. This chapter covers the capital and principal sum and what is required to file a successful claim.
12
Long term care insurance
LTC is a relatively new type of insurance. Here, you will learn about convalescent care, the five Activities of Daily Living, and the laws that apply specifically to LTC insurance.
13
Dental insurance
Every Health Insurance exam will test you on endodontics, prosthodontics, periodontics, orthodontics, and/or oral pathology. Knowing these terms will get you closer to passing the pre-licensing exam.
14
Section 125 plans and limited policies
This chapter covers Health Savings Accounts (HSA), Flexible Spending Accounts (FSA), and Medical Savings Accounts (MSA), as well as Vision, Dread Disease, and Hospital Confinement policies.
15
Federal government programs
The Federal Government is the world's largest insurer. For the exam, you need to be familiar with Social Security disability income insurance, Medicare Parts A, B, C, and D, and health insurance for the military (Tricare and CHAMPUS).
16
Medigap and medicaid
Medigap policies supplement coverage where Medicare is lacking. Medicaid is a state-administered medical expense program for people in financial need.
17
Health insurance taxation
There are only a few ways to test the taxation of health insurance products. Know what is generally true and the exceptions to the rule.
18
State regulations & NAIC insurance law
While insurance concepts are relatively uniform in all 50 states, state regulations vary. The Achievable Health Insurance course is state-specific and covers exactly what you need to know about the state in which you will be testing.
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