Free Hawaii Accident & Health insurance exam practice test

Last updated October 14, 2026

These 25 questions follow the mix of the Hawaii Accident and Health Producer exam on the Pearson VUE outline effective January 1, 2026: 15 general health insurance questions and 10 on Hawaii law. Pick your answers, then check them. Every question explains all four choices and quotes the law or official source it comes from.

These are practice questions written by Prep Retention, not questions from the actual exam.

Question 1 Types of health policiesUnder Section 13A of the NAIC Long-Term Care Insurance Model Regulation (Model 641), an insurer must offer each policyholder, at the time of purchase, the option to buy an inflation protection feature no less favorable than one of several listed features. Which feature is described in Section 13A(1)?

A. Benefit levels rise each year by a simple 3% of the starting level
B. Benefit levels rise each year, compounded annually at 2% or more
C. Benefit levels rise each year, compounded annually at 5% or more
D. Benefit levels rise every 5 years by a flat 10% of the start level

Show the answer and explanation

Correct answer: C. Benefit levels rise each year, compounded annually at 5% or more

A. Incorrect. Section 13A(1) calls for annual increases compounded at not less than 5%, not simple 3% increases.
B. Incorrect. The rate in Section 13A(1) is not less than five percent, compounded annually.
C. Correct. Section 13A(1) describes increasing benefit levels annually so that the increases are compounded annually at a rate not less than five percent (5%).
D. Incorrect. Section 13A(1) requires increases every year, compounded annually at not less than 5%.

Requirement to Offer Inflation Protection [...] Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following: [...] (1) Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than five percent (5%);
Source: NAIC Long-Term Care Insurance Model Regulation (Model 641), Section 13A and 13A(1) (Requirement to Offer Inflation Protection)

Question 2 Types of health policiesSam is fired for gross misconduct, and as a result his group health coverage would end. Under federal COBRA law (29 U.S.C. 1163), is his termination a qualifying event?

A. Yes, since every termination of employment counts as one
B. Yes, since any loss of coverage counts as one
C. No, since termination for gross misconduct is excluded
D. No, since a qualifying event requires fewer hours

Show the answer and explanation

Correct answer: C. No, since termination for gross misconduct is excluded

A. Incorrect. Section 1163(2) carves out termination by reason of gross misconduct.
B. Incorrect. A qualifying event must be one of the events listed in section 1163; a loss of coverage alone is not enough.
C. Correct. Section 1163(2) lists termination of employment as a qualifying event other than by reason of the employee's gross misconduct.
D. Incorrect. Termination of employment (other than for gross misconduct) is also a qualifying event, not only a reduction of hours.

For purposes of this part, the term "qualifying event" means, with respect to any covered employee, any of the following events which, but for the continuation coverage required under this part, would result in the loss of coverage of a qualified beneficiary: [...] The termination (other than by reason of such employee's gross misconduct), or reduction of hours, of the covered employee's employment.
Source: 29 U.S.C. 1163 (lead-in) and 1163(2) (Cornell LII)

Question 3 Types of health policiesLou, age 40, buys a separate stand-alone dental plan in addition to his Marketplace health plan. According to HealthCare.gov, which statement is accurate?

A. Its cost is built into his health premium, and coverage starts at once
B. Adult dental is an essential health benefit, so no waiting period applies
C. He pays no premium, because dental is included for all Marketplace adults
D. He pays a separate premium, and adult services may have a waiting period

Show the answer and explanation

Correct answer: D. He pays a separate premium, and adult services may have a waiting period

A. Incorrect. HealthCare.gov says a separate dental plan has its own premium and may have waiting periods for adults.
B. Incorrect. HealthCare.gov says dental coverage isn't an essential health benefit for adults.
C. Incorrect. HealthCare.gov says you pay a separate premium for a separate dental plan.
D. Correct. HealthCare.gov says a separate dental plan has a separate premium and that separate dental plans can have waiting periods before covering services for adults.

If you pick a separate dental plan, you'll pay a separate premium. [...] Separate dental plans can have waiting periods before they start to cover services for adults. [...] Dental coverage isn't an essential health benefit for adults.
Source: HealthCare.gov, Dental coverage in the Marketplace

Question 4 Types of health policiesUnder NAIC Model 171, Section 7A(12), when may an individual accident policy pay a specific dismemberment benefit in lieu of (instead of) the other benefits the insured would otherwise receive?

A. When it equals or is more than the other benefits
B. When the loss occurs within 90 days after the date of the accident
C. When the insured also qualifies for total disability benefits
D. When the insured chose a lump sum on the application

Show the answer and explanation

Correct answer: A. When it equals or is more than the other benefits

A. Correct. Section 7A(12) says specific dismemberment benefits shall not be in lieu of other benefits unless the specific benefit equals or exceeds the other benefits.
B. Incorrect. The 90-day timing rule is a separate standard (Section 7A(11)) for when AD&D benefits are payable, not the test for paying a specific benefit in lieu of others.
C. Incorrect. Section 7A(12) does not tie the in-lieu-of rule to total disability.
D. Incorrect. Section 7A(12) does not depend on any election on the application; the test is whether the specific benefit equals or exceeds the other benefits.

Specific dismemberment benefits shall not be in lieu of other benefits unless the specific benefit equals or exceeds the other benefits.
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 7A(12)

Question 5 Health policy provisions and ridersDev's disability income policy pays both total disability benefits and partial disability benefits. Under NAIC Model 171, Section 7G(4), how many elimination periods may the policy require?

A. Separate periods for total and partial
B. A single elimination period
C. A new period for each separate claim
D. Two, if the partial period is shorter

Show the answer and explanation

Correct answer: B. A single elimination period

A. Incorrect. Section 7G(4) permits only one elimination period when both benefits are provided.
B. Correct. Section 7G(4) says that where a policy provides total and partial disability benefits, only one elimination period may be required.
C. Incorrect. Section 7G(4) addresses policies with both benefit types and allows one elimination period.
D. Incorrect. Section 7G(4) does not allow a second elimination period, whatever its length.

Where a policy provides total disability benefits and partial disability benefits, only one elimination period may be required.
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 7G(4)

Question 6 Health policy provisions and ridersLia is a private pilot. Her insurer wants her individual accident and sickness policy, subject to NAIC Model 171, to exclude illness, treatment or medical conditions arising out of aviation. Under Section 6F of Model 171, how is this exclusion treated?

A. It is not permitted, since a policy may not exclude by type of accident
B. It is permitted if Lia signs a waiver acknowledging it
C. It is not permitted unless the policy is an accident-only policy
D. It is permitted, since aviation is on the list of allowed exclusions

Show the answer and explanation

Correct answer: D. It is permitted, since aviation is on the list of allowed exclusions

A. Incorrect. The general bar on excluding by type of accident has listed exceptions, and aviation is one of them.
B. Incorrect. No signed waiver is needed; Section 6F(4)(c) itself permits the aviation exclusion.
C. Incorrect. The aviation exclusion is permitted without limiting it to accident-only policies.
D. Correct. Section 6F(4)(c) allows a policy to exclude illness, treatment or medical conditions arising out of aviation.

A policy shall not limit or exclude coverage by type of illness, accident, treatment or medical condition, except as follows: [...] Illness, treatment or medical condition arising out of: [...] Aviation;
Source: NAIC Accident and Sickness Insurance Minimum Standards Model Regulation (Model 171), Section 6F (lead-in), 6F(4) (lead-in) and 6F(4)(c)

Question 7 Health policy provisions and ridersAn individual health policy includes the optional conformity with state statutes provision from the NAIC Uniform Individual Accident and Sickness Policy Provision Law (Model 180). One of its provisions, on the policy's effective date, conflicts with the statutes of the state where the insured lives. What happens to that provision?

A. It voids the entire policy, and all of the premium is refunded
B. It stays in force until the insurer files a revised form
C. It is amended so that it conforms to that state's statutes
D. It may be kept or deleted at the option of the insured

Show the answer and explanation

Correct answer: C. It is amended so that it conforms to that state's statutes

A. Incorrect. Only the conflicting provision is affected, and it is amended to conform rather than voiding the policy.
B. Incorrect. The provision is amended to conform by operation of the policy language itself.
C. Correct. A provision that conflicts with the statutes of the insured's state of residence on the effective date is amended to conform.
D. Incorrect. The insured does not choose; the provision is amended to conform to the state's statutes.

Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform
Source: NAIC Uniform Individual Accident and Sickness Policy Provision Law (Model 180), Section 3B, Conformity with state statutes

Question 8 Health policy provisions and ridersA client asks whether her new health plan can set a lifetime dollar maximum. According to HealthCare.gov, which statement is accurate?

A. It may cap all of her benefits once she reaches age 65
B. It may cap only services that aren't essential health benefits
C. It may cap essential health benefits at a high dollar amount
D. It may not cap any benefit of any kind at any dollar amount

Show the answer and explanation

Correct answer: B. It may cap only services that aren't essential health benefits

A. Incorrect. HealthCare.gov describes no age-based lifetime cap.
B. Correct. HealthCare.gov says insurers can't set a dollar limit on essential health benefits but can still put yearly or lifetime dollar limits on services that aren't essential health benefits.
C. Incorrect. Lifetime dollar limits on essential health benefits are not allowed at any amount.
D. Incorrect. Insurers may still set yearly or lifetime dollar limits on services that aren't essential health benefits.

Insurance companies can't set a dollar limit on what they spend on essential health benefits for your care during the entire time you're enrolled in that plan. [...] Insurance companies can still put yearly or lifetime dollar limits on spending for health care services that aren't considered essential health benefits.
Source: HealthCare.gov, Ending lifetime and yearly limits

Question 9 Social insuranceGina has a Medicare drug plan and expects high drug costs early in the year. She asks about the Medicare Prescription Payment Plan. According to Medicare.gov, which statement about this option is accurate?

A. It spreads her drug costs over the year but does not lower them
B. It lowers her drug costs but charges a small monthly fee to join
C. It replaces her Part D plan with a monthly payment arrangement
D. It caps her yearly drug costs at a lower amount for a flat fee

Show the answer and explanation

Correct answer: A. It spreads her drug costs over the year but does not lower them

A. Correct. Medicare.gov says the plan spreads out-of-pocket drug costs across the calendar year, costs nothing to join, and doesn't save money or lower drug costs.
B. Incorrect. Medicare.gov says there's no cost to participate and that the option doesn't lower drug costs.
C. Incorrect. It is a payment option that works with her current drug coverage, not a replacement for it.
D. Incorrect. Participation is free, and the option doesn't save money or lower drug costs.

The Medicare Prescription Payment Plan is a payment option that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year [...] There's no cost to participate in the Medicare Prescription Payment Plan. [...] This payment option might help you manage your monthly expenses, but it doesn't save you money or lower your drug costs.
Source: Medicare.gov, Medicare Prescription Payment Plan

Question 10 Social insuranceJoan is not eligible for premium-free Part A, so she must buy Medicare Part A. She did not buy it when she was first eligible for Medicare. According to Medicare.gov, what may happen to her monthly Part A premium?

A. It may go up by 1% for each month
B. It may go up 20% for each year
C. It may go up by 10%
D. It may double for as long as she has it

Show the answer and explanation

Correct answer: C. It may go up by 10%

A. Incorrect. A 1% per month penalty is the Part D rule, not the Part A rule.
B. Incorrect. Medicare.gov states a 10% increase for Part A.
C. Correct. Medicare.gov says that if you have to buy Part A and don't buy it when first eligible, your monthly premium may go up 10%.
D. Incorrect. Medicare.gov states a 10% increase for Part A, not doubling.

If you have to buy Part A, and you don't buy it when you're first eligible for Medicare, your monthly premium may go up 10%.
Source: Medicare.gov, Avoid late enrollment penalties (Part A)

Question 11 Other health topicsRay is a federal employee covered by the Federal Employees' Compensation Act. He is injured while performing his duties, and the injury is proximately caused by his own intoxication. Under 5 U.S.C. 8102(a), is compensation payable for this injury?

A. Yes; any injury on duty is paid, regardless of fault
B. Yes, but the benefit is cut by 50 percent for fault
C. No, unless he finishes a substance treatment program
D. No; an injury caused by his intoxication is excluded

Show the answer and explanation

Correct answer: D. No; an injury caused by his intoxication is excluded

A. Incorrect. Section 8102(a) excludes injuries caused by willful misconduct, intent to injure, or proximately caused by intoxication.
B. Incorrect. The statute does not reduce benefits for intoxication; it bars compensation when intoxication proximately caused the injury.
C. Incorrect. Section 8102(a) contains no treatment-program exception to the intoxication exclusion.
D. Correct. Section 8102(a) provides compensation for injury sustained in the performance of duty unless the injury is proximately caused by the intoxication of the injured employee.

The United States shall pay compensation as specified by this subchapter for the disability or death of an employee resulting from personal injury sustained while in the performance of his duty, unless the injury or death is [...] (1) caused by willful misconduct of the employee; [...] (2) caused by the employee's intention to bring about the injury or death of himself or of another; or [...] (3) proximately caused by the intoxication of the injured employee.
Source: 5 U.S.C. 8102(a) (Federal Employees' Compensation Act, Compensation for disability or death of employee) (Cornell LII)

Question 12 Other health topicsAccording to the NAIC Glossary of Health Insurance Terms, health maintenance organizations (HMOs) and preferred provider organizations (PPOs) are each a type of what?

A. Fraternal benefit society
B. Managed care organization
C. Health savings account plan
D. Fixed indemnity plan

Show the answer and explanation

Correct answer: B. Managed care organization

A. Incorrect. The NAIC glossary describes HMOs and PPOs as managed care organizations, not fraternal societies.
B. Correct. The NAIC glossary defines both an HMO and a PPO as a type of managed care organization that provides coverage through a network.
C. Incorrect. An HSA is a tax-favored account, not a network-based managed care organization.
D. Incorrect. Fixed indemnity plans pay set amounts; the NAIC glossary calls HMOs and PPOs managed care organizations.

A type of managed care organization (health plan) that provides health care coverage through a network of hospitals, doctors and other health care providers. [...] A type of managed care organization (health plan) that provides health care coverage through a network of providers.
Source: NAIC Glossary of Health Insurance Terms (Health Maintenance Organization; Preferred Provider Organization)

Question 13 Health field underwritingUnder 45 CFR 164.528(a), how far back may an individual's accounting of disclosures of protected health information reach, and may the individual ask for a shorter period?

A. Three years; a shorter period cannot be requested
B. Six years; a shorter period cannot be requested
C. Six years; a shorter period can be requested
D. Ten years; a shorter period can be requested

Show the answer and explanation

Correct answer: C. Six years; a shorter period can be requested

A. Incorrect. The look-back is six years, not three, and a shorter period may be requested.
B. Incorrect. The period is six years, but the individual may request a shorter period.
C. Correct. The accounting covers disclosures in the six years before the request, and the individual may request a period of less than six years.
D. Incorrect. The rule reaches back six years, not ten.

An individual has a right to receive an accounting of disclosures of protected health information made by a covered entity in the six years prior to the date on which the accounting is requested, except for disclosures: [...] An individual may request an accounting of disclosures for a period of time less than six years from the date of the request.
Source: 45 CFR 164.528(a)(1) (lead-in) and (a)(3)

Question 14 Health field underwritingAn agent wants a medical provider that is a HIPAA covered entity to release an applicant's protected health information to the insurer. Under 45 CFR 164.508(a)(1), unless the rules otherwise permit or require it, what does the provider need before it may disclose that information?

A. An oral request from the agent
B. A copy of the premium receipt
C. A signed replacement notice
D. A valid authorization

Show the answer and explanation

Correct answer: D. A valid authorization

A. Incorrect. An agent's oral request is not the valid authorization the rule requires.
B. Incorrect. A premium receipt does not authorize disclosure of protected health information.
C. Incorrect. A replacement notice concerns replacing existing coverage, not release of health information.
D. Correct. 164.508(a)(1) says a covered entity may not use or disclose protected health information without an authorization that is valid under that section, except as otherwise permitted or required.

Except as otherwise permitted or required by this subchapter, a covered entity may not use or disclose protected health information without an authorization that is valid under this section.
Source: 45 CFR 164.508(a)(1)

Question 15 Health field underwritingWhile delivering an individual health policy, an agent reviews the summary of benefits and coverage (SBC) with the client. The client asks whether the SBC or the policy controls if they ever differ. Under 45 CFR 147.200(a)(2)(i)(H), what must the SBC itself state?

A. That it controls over the policy for every benefit it describes
B. That the agent's oral explanation controls over both documents
C. That any conflict is settled in favor of the issuer's wording
D. That it is just a summary; the policy sets the governing terms

Show the answer and explanation

Correct answer: D. That it is just a summary; the policy sets the governing terms

A. Incorrect. The required statement says the SBC is only a summary, so it does not control over the policy.
B. Incorrect. The required statement points to the plan document or policy, not to an agent's explanation.
C. Incorrect. The required statement points to the policy for the governing provisions; it says nothing about favoring the issuer.
D. Correct. The SBC must include a statement that it is only a summary and that the policy or other coverage document should be consulted for the governing contractual provisions.

Subject to paragraph (a)(2)(iii) of this section, the SBC must include the following: [...] A statement that the SBC is only a summary and that the plan document, policy, certificate, or contract of insurance should be consulted to determine the governing contractual provisions of the coverage
Source: 45 CFR 147.200(a)(2)(i) (lead-in) and (a)(2)(i)(H) (eCFR, current as of 9/25/2026)

Question 16 Hawaii laws for all linesA person with a felony conviction never asks for consent and begins selling insurance in Hawaii without the Commissioner's written consent. Under HRS §431:2-201.3, what is the result?

A. The sales are allowed as long as no client complains
B. The person only has to pay a late request fee
C. The felony is treated as waived once sales begin
D. It is a violation subject to fines and penalties

Show the answer and explanation

Correct answer: D. It is a violation subject to fines and penalties

A. Incorrect. Client complaints play no part; acting without consent is itself a violation.
B. Incorrect. The statute speaks of fines and penalties, not a late request fee.
C. Incorrect. Nothing in the statute waives the conviction automatically.
D. Correct. HRS §431:2-201.3(c) says a person who fails to submit the request and engages in the business without written consent is in violation of the chapter and subject to its fines and penalties.

(c) Any person who fails to submit the request as required by this section and who engages in the business of insurance without the written consent of the commissioner shall be in violation of this chapter and subject to the fines and penalties provided under this chapter.
Source: HRS §431:2-201.3(c)

Question 17 Hawaii laws for all linesUnder HRS §431:2-306, who pays the expense of the Hawaii Commissioner's examination of an insurer?

A. The insurance division
B. The insurer examined
C. The state general fund
D. The guaranty association

Show the answer and explanation

Correct answer: B. The insurer examined

A. Incorrect. The statute puts the cost on the insurer, not the division.
B. Correct. HRS §431:2-306(a) says examinations of any insurer are at the expense of the insurer examined.
C. Incorrect. The general fund does not pay under the quoted text.
D. Incorrect. The guaranty association pays only for its own examination.

§431:2-306 Examination expense. (a) Examinations of: (1) Any insurer; (2) Any person subject to examination under section 431:2-303(2); or (3) Any insurance guaranty fund established pursuant to article 16; shall be at the expense of the insurer, person, or guaranty fund examined.
Source: HRS §431:2-306(a)(1)

Question 18 Hawaii laws for all linesHow does HRS §431:1-201 define insurance in Hawaii?

A. A promise to indemnify or pay a sum on defined events
B. Any agreement to share business profits among members
C. A savings plan that returns deposits with interest
D. A promise by government to cover public losses

Show the answer and explanation

Correct answer: A. A promise to indemnify or pay a sum on defined events

A. Correct. HRS §431:1-201(a) defines insurance as a contract whereby one undertakes to indemnify another or pay a specified amount upon determinable contingencies.
B. Incorrect. Profit sharing is not the statutory definition.
C. Incorrect. A savings plan is not the statutory definition.
D. Incorrect. The definition is about a contract, not a government promise.

§431:1-201 Insurance defined. (a) Insurance is a contract whereby one undertakes to indemnify another or pay a specified amount upon determinable contingencies.
Source: HRS §431:1-201(a)

Question 19 Hawaii laws for all linesUnder HRS 431:9A-106, a business entity applying for a Hawaii producer license must designate whom to be responsible for its compliance with Hawaii insurance laws and rules?

A. An individual who holds a producer license
B. Any officer of the entity, licensed or not
C. A licensed attorney acting as registered agent
D. Another licensed agency under common ownership

Show the answer and explanation

Correct answer: A. An individual who holds a producer license

A. Correct. HRS 431:9A-106(b)(2) requires the entity to designate a licensed producer who is a natural person responsible for its compliance.
B. Incorrect. The designee must be a licensed producer; an unlicensed officer does not qualify.
C. Incorrect. The designee must be a licensed producer who is a natural person, not an attorney serving as registered agent.
D. Incorrect. The designee must be a natural person, so another business entity cannot be designated.

(b) A business entity acting as an insurance producer is required to obtain an insurance producer license. Application shall be made using the uniform business entity application. Before approving the application, the commissioner shall find that: (1) The business entity has paid all applicable fees; (2) The business entity has designated a licensed producer who is a natural person responsible for the business entity's compliance with the insurance laws and rules of this State; and
Source: HRS 431:9A-106(b)(2)

Question 20 Hawaii laws for all linesAn insurer ends its contract with a Hawaii producer. Under HRS 431:9A-115, within how many days after the effective date of the termination must the insurer notify the Commissioner?

A. 30 days
B. 10 days
C. 15 days
D. 60 days

Show the answer and explanation

Correct answer: A. 30 days

A. Correct. HRS 431:9A-115(a) requires notice to the Commissioner within thirty days following the effective date of the termination.
B. Incorrect. The deadline is thirty days, not ten.
C. Incorrect. Fifteen days is the deadline for mailing the producer a copy after notifying the Commissioner.
D. Incorrect. The deadline is thirty days, not sixty.

§431:9A-115 Notification to commissioner of termination. (a) An insurer or its authorized representative that terminates the appointment, employment, contract, or other insurance business relationship with a producer shall notify the commissioner within thirty days following the effective date of the termination, using the applicable format prescribed by the commissioner.
Source: HRS 431:9A-115(a)

Question 21 Hawaii laws for all linesUnder HRS 431:9A-125, how long must a Hawaii licensee keep his or her own continuing education records after completing an approved course?

A. Two years
B. Three years
C. Four years
D. Five years

Show the answer and explanation

Correct answer: C. Four years

A. Incorrect. The period is four years, not two.
B. Incorrect. The period is four years, not three.
C. Correct. HRS 431:9A-125(a) requires licensees to keep their own CE records for four years after completing an approved course.
D. Incorrect. Five years is the period for approved course providers' attendance records.

[§431:9A-125] Continuing education recordkeeping. (a) Licensees shall maintain their own continuing education records and shall keep these records for four years after completion of an approved continuing education course. (b) Approved course providers shall maintain attendance records for five years to permit the commissioner to verify the attendance and course completion of all licensees enrolled in an approved course.
Source: HRS 431:9A-125(a), (b)

Question 22 Hawaii accident and health lawsUnder HRS §393-7, a prepaid health care plan qualifying under Hawaii's Prepaid Health Care Act must include in-patient hospital care for what period of confinement in each calendar year?

A. 100 days
B. 120 days
C. 90 days
D. 60 days

Show the answer and explanation

Correct answer: B. 120 days

A. Incorrect. The required minimum is one hundred twenty days, not 100.
B. Correct. Section 393-7(c)(1)(A) requires in-patient care for a period of at least one hundred twenty days of confinement in each calendar year.
C. Incorrect. The required minimum is one hundred twenty days, not 90.
D. Incorrect. The required minimum is one hundred twenty days, not 60.

(c) Subject to the provisions of subsections (a) and (b) without limiting the development of medically more desirable combinations and the inclusion of new types of benefits, a prepaid health care plan qualifying under this chapter shall include at least the following benefit types: (1) Hospital benefits: (A) In-patient care for a period of at least one hundred twenty days of confinement in each calendar year covering: (i) Room accommodations; (ii) Regular and special diets; (iii) General nursing services; (iv) Use of operating room, surgical supplies, anesthesia services, and supplies; and (v) Drugs, dressings, oxygen, antibiotics, and blood transfusion services; and
Source: HRS §393-7(c)(1)(A)

Question 23 Hawaii accident and health lawsUnder HRS §392-3, when does a Hawaii worker's temporary disability "benefit year" begin?

A. On January 1 of the year in which the disability occurs
B. Start of the disability week tied to the first valid claim
C. On the date the employer first hired the worker into the job
D. On the date the director approves the worker's benefit claim

Show the answer and explanation

Correct answer: B. Start of the disability week tied to the first valid claim

A. Incorrect. The benefit year runs from the first day of the first week of disability tied to the first valid claim, not the calendar year.
B. Correct. The benefit year is the one-year period beginning with the first day of the first week of disability for which the individual first files a valid claim.
C. Incorrect. The benefit year is tied to the first valid claim, not the hire date.
D. Incorrect. It starts with the first day of the first week of disability, not the approval date.

"Benefit year" with respect to any individual means the one-year period beginning with the first day of the first week of disability with respect to which the individual first files a valid claim for temporary disability benefits.
Source: HRS §392-3

Question 24 Hawaii accident and health lawsA Hawaii accident and health policy reimburses eye exams. An insured gets an eye exam that is within an optometrist's lawful scope of practice from a licensed optometrist. Under HRS §431:10A-116, may the insurer deny payment because a physician did not perform it?

A. Yes, unless a physician first referred the insured
B. No, it is reimbursable from either provider
C. Yes, since only physician services must be paid
D. No, but only half of the usual benefit is payable

Show the answer and explanation

Correct answer: B. No, it is reimbursable from either provider

A. Incorrect. The statute requires reimbursement for either provider; no referral condition is stated.
B. Correct. Reimbursement is due whether the service is performed by a licensed physician or a licensed optometrist.
C. Incorrect. Optometrist services within scope must be reimbursed.
D. Incorrect. The statute gives the same entitlement to reimbursement either way.

Every person insured under a policy of accident and health or sickness insurance delivered or issued for delivery in this State shall be entitled to the reimbursements and coverages specified below: (1) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any visual or optometric service that is within the lawful scope of practice of a duly licensed optometrist, the person entitled to benefits or the person performing the services shall be entitled to reimbursement whether the service is performed by a licensed physician or by a licensed optometrist.
Source: HRS §431:10A-116(1)

Question 25 Hawaii accident and health lawsUnder HRS §431:10A-206, how must a Hawaii group or blanket disability policy providing family coverage on an expense incurred basis treat newborn children?

A. Cover them only after a 30-day waiting period
B. Cover them under the individual newborn rule
C. Leave newborn coverage to the employer's choice
D. Cover them only once the next enrollment opens

Show the answer and explanation

Correct answer: B. Cover them under the individual newborn rule

A. Incorrect. Group policies must comply with section 431:10A-115, which covers newborns from the moment of birth.
B. Correct. Section 431:10A-206 requires such group or blanket policies to cover newborns in compliance with section 431:10A-115.
C. Incorrect. Newborn coverage is required for these group policies.
D. Incorrect. Group policies must comply with section 431:10A-115.

All group or blanket disability policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide coverage for newborn children in compliance with section 431:10A-115.
Source: HRS §431:10A-206

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