Accident & Health study guide
Accident & Health · Work through your exam, one topic at a time.
The Accident & Health license qualifies an individual to sell health-related insurance products such as individual and group medical expense coverage, disability income policies, and accident coverage. It is typically pursued by people entering or advancing in insurance sales, agency support, or benefits consulting, and it is often paired with a life insurance license. The Accident & Health study guide has 10 sections and about 3,233 words.
01Insurance Regulation and Licensing
Insurance is regulated chiefly at the state level through a department of insurance headed by a commissioner or superintendent. The McCarran-Ferguson Act (1945) confirms that states regulate the business of insurance unless Congress specifically says otherwise, so federal law does not preempt state insurance rules merely because the activity involves interstate commerce.
350 words, about 2 min02General Insurance Concepts and Principles
Insurance transfers pure risk (loss or no loss) rather than speculative risk. Insurable risk requires a large number of similar exposure units, accidental loss, measurable loss, and losses that are not catastrophic to the insurer.
330 words, about 2 min03Accident and Health Insurance Basics
Accident and health insurance pays benefits for accidental injury , sickness , or both. Distinguish accident-only policies (pay only for accidental bodily injury) from sickness coverage and from comprehensive policies that cover both.
352 words, about 2 min04Health Insurance Policy Provisions, Riders, and Exclusions
Know the uniform policy provisions commonly tested: entire contract , time limit on certain defenses (incontestability) , grace period , reinstatement , claim forms , proof of loss , time of payment of claims , payment of claims , physical examination and autopsy , legal actions , change of occupation , misstatement of age , overinsurance , unpaid premium , cancellation , and conformity with state statutes . Understand that the incontestability clause generally bars the insurer from contesting the policy after it has been in force for a stated period (commonly two years) for misstatements, except fraudulent misstatements, and that the grace period keeps coverage in force during late premium payment.
327 words, about 2 min05Disability Income Insurance
Disability income (DI) insurance replaces a portion of earned income lost to disability-typically 60–70% of income. Candidates must know the definition of disability : own occupation (cannot perform the duties of one's own occupation, generally more favorable to the insured) versus any occupation (cannot perform any occupation for which one is reasonably suited, generally stricter).
335 words, about 2 min06Medical Expense Insurance and Managed Care
Medical expense insurance pays for the cost of care. Know basic medical expense coverage (hospital, surgical, physician) versus major medical coverage with higher limits and broader benefits.
306 words, about 2 min07Group Health Insurance
Group health insurance covers a group under a master policy issued to the group sponsor (typically an employer), with certificates of coverage issued to members. Key concepts: eligibility (who may enroll), open enrollment , actively at work requirements, waiting periods , and late enrollees .
301 words, about 2 min08Government Health Programs (Medicare, Medicaid, and Related)
Medicare is federal health insurance for people 65 and older , certain younger people with disabilities, and people with end-stage renal disease. Know the parts : Part A (hospital insurance, generally premium-free with sufficient work history), Part B (medical insurance, premium-based, covers physician and outpatient services), Part C (Medicare Advantage, private plans delivering A and B benefits, often with extra benefits), and Part D (prescription drug coverage).
309 words, about 2 min09Annuities and Retirement Planning
An annuity is a contract that pays a stream of income, typically for retirement. Know the accumulation phase (premiums grow) and annuitization phase (payments begin).
341 words, about 2 min10Ethical Practices and Consumer Protection
Producers owe duties of honesty, integrity, and fair dealing to applicants, insureds, and insurers. Know the prohibited practices tested on exams: misrepresentation (false statements about policy terms or insurer), false advertising , twisting (misrepresentation to induce replacement), rebating (offering value not in the policy to induce a sale), coercion , intimidation , unfair discrimination (distinguishing among similar risks without actuarial basis), commingling , and fraudulent claims .
282 words, about 1 min