Texas Statutes and Rules — Accident and Health Only — practice questions

5.4% of the exam ≈7 real questions 7 free questions here

Newborn and chemical dependency coverage, dependents, Medicare supplements, HIV testing, long-term care, small group plans and the Affordable Care Act: 7 of the 130 scored questions.

Where people lose points

• Newborn coverage cannot exclude congenital defects or wait a period of time.
• Medicare supplement buyers get a 30-day free look.
• An HIV-based decision needs two positive ELISAs confirmed by a Western Blot.
• Long-term care must be at least guaranteed renewable.

Questions and answers, explained

All 3 questions above, with the correct answer and why it is correct. Everything here is on texas statutes and rules — accident and health only.

1. Under TIC 1501.002, who is an eligible employee for a Texas employer health benefit plan?

   • AOnly employees who have worked there at least two years
   • BAny employee, including seasonal and temporary workers
   • CA full-time employee who usually works at least 30 hours a weekCorrect
   • DAny employee who works at least 20 hours a week, including part-time staff

   Why: TIC 1501.002 defines an eligible employee as one who works full time and usually works at least 30 hours a week; it can include a sole proprietor, partner or independent contractor if the plan includes them. Part-time, temporary, seasonal and substitute workers are excluded, as are those covered under another plan.

   Reference TIC 1501.002 — Texas outline III.E.1

2. Under the ACA, how must a non-grandfathered plan cover recommended preventive services, such as certain screenings and immunizations, from in-network providers?

   • AOnly if the insured buys a preventive care rider
   • BWith no cost sharing: no copay, coinsurance or deductibleCorrect
   • COnly after the insured has met the plan's annual deductible
   • DAt 50 percent coinsurance

   Why: The ACA requires non-grandfathered plans to cover recommended preventive services (such as those rated A or B by the U.S. Preventive Services Task Force and recommended immunizations) from in-network providers without any cost sharing. Preventive and wellness services are also one of the ten essential health benefit categories.

   Reference ACA sections 1001, 1302 — Texas outline III.F.3.c

3. Under the ACA, can a non-grandfathered individual health plan deny coverage or charge more because of a preexisting condition?

   • AYes, if the applicant applies outside open enrollment
   • BYes, by adding a two-year exclusion rider
   • CNo; it must accept applicants regardless of health and cover preexisting conditionsCorrect
   • DYes, but only for conditions that a doctor diagnosed or treated in the past 12 months

   Why: The ACA requires guaranteed issue and bans preexisting condition exclusions in non-grandfathered plans. Premiums may vary only by age, tobacco use, family size and geographic area, not by health status. Enrollment may be limited to open enrollment and special enrollment periods, but that is a timing rule, not a health screen.

   Reference ACA sections 1201, 2701-2704 PHSA — Texas outline III.F

Topics inside this domain

• Texas health insurance mandates, Medicare supplements and the ACA

Drill other domains

• Types of Life Policies and Annuities (11.5%)
• Life Policy Riders, Provisions, Options and Exclusions (11.5%)
• Life Application, Underwriting and Policy Delivery (9.2%)
• Retirement and Other Life Insurance Concepts (6.2%)
• Types of Health Policies (12.3%)
• Health Policy Provisions, Clauses and Riders (11.5%)

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