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California Health, Senior Health and Long-Term Care Law: Practice Questions

20 free practice questions with explanations. Pick an answer for each, then check your score.

Exam weight: California-specific objectives on the Accident & Health exam on the California Life-Only and Accident & Health agent exams. Updated 2026-11-04.

Quick study guide

On the Accident and Health exam, most California law sits in senior health products (15 of the 45 medical expense questions), with more in the long-term care, group and regulation objectives.

Who regulates what

The Department of Insurance is presumed to have jurisdiction over anyone covering medical expenses (CIC 740) and regulates disability insurers, which issue most PPO and EPO policies. HMOs and other health care service plans answer to the Department of Managed Health Care under the Knox-Keene Act. No one may alter a disability application without the applicant's written consent, apart from the insurer's clearly marked administrative insertions (CIC 10382).

Group coverage

A carrier replacing a group medical plan within 60 days must immediately cover everyone validly covered under the old plan, whatever its actively-at-work, confinement or pregnancy rules (CIC 10128.3). Cal-COBRA serves employers with 2 to 19 eligible employees: up to 36 months at no more than 110% of the group rate. Premium tax credits require buying through Covered California.

Medicare supplement (CIC 10192.1 and following)

Rule	California requirement
Open enrollment	6 months from the first month the person is 65 or older and in Part B; 6 months after Part B for people on Medicare because of disability
Birthday rule	Every year, a window of at least 60 days starting on the birthday to switch to equal or lesser benefits with no health questions
Guaranteed issue	E.g., a Medicare Advantage plan ends; the right usually runs to 63 days after the old coverage ends
Free look	30 days, full refund
Commissions	First year no more than 200% of the second year; the same renewal rate for at least 5 renewal years
Medi-Cal	Policy can be suspended up to 24 months; ask within 90 days

HICAP (Health Insurance Counseling and Advocacy Program) gives free counseling on Medicare and long-term care insurance. Its number, 1-800-434-0222, appears in Medicare supplement outlines of coverage, and long-term care prospects must be told about it at solicitation.

Long-term care (CIC 10230 and following)

The agent delivers the outline of coverage before presenting the application, and the personal worksheet at or before application. Free look: 30 days. Home care triggers: 2 of 7 activities of daily living or cognitive impairment (non-tax-qualified), 2 of 6 (tax-qualified). Insurers must offer inflation protection compounding at 5% or more. A third policy sold within 12 months is presumed an unnecessary replacement. Agents need 8 hours of LTC training in each of their first four license years, then 8 before each renewal.

Seniors

Disability policies sold to people 65 or older carry a 30-day free look (CIC 786). Ads calling a sales event a "seminar" or "class" must add "and insurance sales presentation" (CIC 787).

Practice questions

A company offers a health maintenance organization (HMO) plan in California and is licensed as a health care service plan. Which agency is its primary regulator?
1. A.The Department of Health Care Services, which runs Medi-Cal
2. B.The Department of Managed Health Care, under the Knox-Keene Act
3. C.The Department of Insurance, under the Insurance Code
4. D.Covered California, the state health benefit exchange
Show answer
Answer: B. HMOs are health care service plans governed by the Knox-Keene Health Care Service Plan Act of 1975 (Health and Safety Code 1340 and following), which the Department of Managed Health Care administers (HSC 1341). CIC 740(g) expressly takes health care service plans out of the Department of Insurance's presumed jurisdiction; the Department of Insurance regulates disability insurers, which issue most PPO and EPO policies. The Department of Health Care Services runs Medi-Cal, and Covered California is a marketplace, not the licensing regulator.
Source: CA A&H objectives I.C.4.2; Cal. Ins. Code § 740; Cal. Health & Safety Code § 1340 (Knox-Keene Act); Cal. Health & Safety Code § 1341 (Department of Managed Health Care)
Reviewing a signed application for an individual disability (health) policy, an agent sees that the applicant left out a recent doctor visit. Under CIC 10382, the agent:
1. A.May correct the answer and initial it, as the field underwriter
2. B.May change the answer only with the applicant's written consent
3. C.May correct the answer as long as the policy has not been issued
4. D.May edit the answer if the insurer's underwriter approves the change
Show answer
Answer: B. CIC 10382 says no one other than the applicant may alter a written disability application without the applicant's written consent. The only exception lets the insurer make insertions for administrative purposes, marked so they are clearly not the applicant's. Any other alteration without consent is a misdemeanor, so neither the agent's field-underwriting role, timing before issue nor an underwriter's approval makes an unconsented change lawful.
Source: CA A&H objectives I.C.2.24; Cal. Ins. Code § 10382
An employer's group health insurance is discontinued on March 31, and a new carrier's group policy starts April 1. One employee covered under the old policy is in the hospital on April 1. Under CIC 10128.3, the new carrier must:
1. A.Cover the employee at once, despite any hospital-confinement or actively-at-work rule
2. B.Delay the employee's coverage until he is discharged and back at work
3. C.Cover the employee only after a 90-day probationary period
4. D.Offer the employee an individual policy instead of group coverage
Show answer
Answer: A. A carrier that replaces hospital, medical or surgical coverage within 60 days of the prior policy's discontinuance must immediately cover all employees and dependents validly covered under the old policy who fit its eligibility definitions, regardless of provisions on active full-time employment, hospital confinement or pregnancy (CIC 10128.3(a)). One limit: if the person is totally disabled and entitled to the prior carrier's extension of benefits (at least 12 months for the disabling condition under CIC 10128.2(d)), the new carrier need not pay for that condition. Delaying his coverage or moving him to an individual policy is not allowed, and until he meets the new policy's effective-date requirements, his benefits cannot fall below the old policy's level, less what the old carrier paid (CIC 10128.3(b)).
Source: CA A&H objectives I.C.4.9; Cal. Ins. Code § 10128.3; Cal. Ins. Code § 10128.2
Cal-COBRA (the California Continuation Benefits Replacement Act) gives continuation rights to people covered through employers of what size, and for how long?
1. A.20 or more employees; up to 18 months
2. B.2 to 50 employees; up to 18 months
3. C.1 to 100 employees; up to 29 months
4. D.2 to 19 eligible employees; up to 36 months
Show answer
Answer: D. Cal-COBRA covers employers with 2 to 19 eligible employees that are not subject to federal COBRA (CIC 10128.50(b) and 10128.51(e)), and continuation can last up to 36 months from when coverage would otherwise have ended (CIC 10128.57), at no more than 110% of the group rate (CIC 10128.56). Employers with 20 or more employees fall under federal COBRA, where 18 months is the usual period after a job loss. Someone who exhausts a shorter federal COBRA period through an insured plan can use Cal-COBRA to continue to 36 months in total (CIC 10128.59).
Source: CA A&H objectives III.B.4.i; Cal. Ins. Code § 10128.50; Cal. Ins. Code § 10128.51; Cal. Ins. Code § 10128.56; Cal. Ins. Code § 10128.57; Cal. Ins. Code § 10128.59
A California resident wants an Advance Premium Tax Credit to lower the premium on her individual health plan. Where must she buy the plan?
1. A.From any HMO licensed by the Department of Managed Health Care
2. B.From any insurer licensed by the Department of Insurance
3. C.Through Covered California, the state health benefit exchange
4. D.From any agent who holds an accident and health license
Show answer
Answer: C. Federal premium tax credits and cost-sharing reductions are available only for qualified health plans bought through the exchange, which in California is Covered California. Plans bought directly from a licensed insurer or HMO outside the exchange can be perfectly valid coverage, but they carry no premium tax credit. An agent can help with an exchange application only after completing Covered California's agent agreements and certification, so a license alone is not enough.
Source: CA A&H objectives III.C.5.a and III.C.5.b; Covered California: Financial help; HealthCare.gov glossary: Premium tax credit
Marisol turned 65 in March 2026 but kept her employer's group plan and delayed Medicare Part B, which now starts September 1, 2026. Under CIC 10192.11, her Medicare supplement open enrollment period:
1. A.Ran for six months from March 2026, so it has ended
2. B.Runs for 12 months beginning September 1, 2026
3. C.Lasts 30 days from her Part B effective date
4. D.Runs for six months beginning September 1, 2026
Show answer
Answer: D. Open enrollment is the six-month period beginning with the first day of the first month in which the person is both 65 or older and enrolled in Part B (CIC 10192.11(a)). Marisol meets both conditions only in September 2026, so her window starts then. During it, an issuer cannot deny, condition or price a Medicare supplement policy based on her health, claims or medical condition.
Source: CA A&H objectives III.D.1.e.ii(1)(b); Cal. Ins. Code § 10192.11
A 58-year-old Californian without end-stage renal disease enrolls in Medicare Part B because of a disability. Under CIC 10192.11, she:
1. A.May buy a Medicare supplement policy only with full medical underwriting
2. B.Has open enrollment only if she also qualifies for Medi-Cal
3. C.Cannot buy a Medicare supplement policy until she turns 65
4. D.Has a six-month Medicare supplement open enrollment period after enrolling in Part B
Show answer
Answer: D. CIC 10192.11(d) gives a person enrolled in Medicare by reason of disability an open enrollment period for six months after Part B enrollment (or six months after notice, if eligibility is applied retroactively). Issuers must make certain plans available to these under-65 applicants, such as Plans A, B, D and G for people newly eligible on or after January 1, 2020, though they may rate under-65 applicants as a separate class. She does not have to wait until 65, and Medi-Cal eligibility is not a condition.
Source: CA A&H objectives III.D.1.e.ii(1)(b); Cal. Ins. Code § 10192.11
Ahmed, 72, holds a Medicare supplement Plan G in California. Under the state's "birthday rule" in CIC 10192.11(h), he may:
1. A.Switch plans with no health questions at any time of year, but only within his current insurer
2. B.Switch plans only once, in the 30 days after the first birthday after he enrolled in Medicare
3. C.Buy a plan with equal or lesser benefits without health underwriting, during at least 60 days starting on his birthday
4. D.Buy any plan, including one with more benefits, without health underwriting in the 30 days before his birthday
Show answer
Answer: C. CIC 10192.11(h) gives a person covered by a Medicare supplement policy an annual open enrollment period of 60 days or more beginning on their birthday, during which an issuer may not deny, condition or price coverage based on health, as long as the new policy's benefits are equal to or less than the old one's. Upgrading to richer benefits is not protected, and the right repeats every year. Issuers must tell policyholders about it 30 to 60 days before the window opens.
Source: CA A&H objectives III.D.1.e.ii(1)(b); Cal. Ins. Code § 10192.11
Lena receives notice that her Medicare Advantage plan is leaving her county and her coverage will end on December 31. Under CIC 10192.12, her guaranteed-issue right to buy a Medicare supplement policy ends:
1. A.30 days after she receives the termination notice
2. B.Six months after her 65th birthday
3. C.63 days after her Medicare Advantage coverage ends
4. D.On December 31, the day her plan ends
Show answer
Answer: C. A Medicare Advantage plan leaving the area makes Lena an eligible person (CIC 10192.12(b)(2)(B)). For an involuntary termination like this, the guaranteed-issue period starts when she receives the notice and ends 63 days after the coverage terminates (CIC 10192.12(c)(2)). During it, the issuer may not deny coverage, charge more for health reasons or impose a preexisting-condition exclusion on the plans the section lists.
Source: CA A&H objectives III.D.1.e.ii(1)(c); Cal. Ins. Code § 10192.12
A California Medicare supplement policyholder decides within the free-look period that she does not want the policy. How long does she have from receiving it to return it for a full refund?
1. A.10 days
2. B.20 days
3. C.30 days
4. D.60 days
Show answer
Answer: C. CIC 10192.17 requires a notice on the first page of every Medicare supplement policy that the holder may return it by regular mail within 30 days of receiving it and get the full premium back. The return voids the policy from the beginning. The insurer must refund within 30 days after receiving the returned policy or pay interest. Shorter free-look periods that apply to other products do not apply here.
Source: CA A&H objectives III.D.1.e.iii(a); Cal. Ins. Code § 10192.17
An insurer pays agents a $200 commission in the second year of a Medicare supplement policy. Under CIC 10192.16, the largest first-year commission it may pay on that policy is:
1. A.$400
2. B.$200
3. C.$300
4. D.$600
Show answer
Answer: A. First-year compensation on a Medicare supplement sale may be no more than 200% of the compensation for the second year, so $400 here (CIC 10192.16(a)). Renewal compensation in later years must equal the second-year amount and continue for at least five renewal years. When an existing policy is replaced, the agent may receive no more than the replacing insurer's renewal compensation.
Source: CA A&H objectives III.D.1.e.ii(1)(d); Cal. Ins. Code § 10192.16
A Medicare supplement policyholder becomes eligible for Medi-Cal. According to the statement required on California Medicare supplement applications (CIC 10192.18), she may:
1. A.Ask to suspend benefits and premiums for up to 24 months, if she asks within 90 days of becoming eligible
2. B.Suspend the policy for as long as she likes, with no deadline to make the request
3. C.Keep both, because Medi-Cal then pays her Medicare supplement premium automatically
4. D.Cancel the policy and receive a refund of every premium paid since it was issued
Show answer
Answer: A. The application statements in CIC 10192.18(a) tell applicants that if they become eligible for Medi-Cal, the policy's benefits and premiums can be suspended on request for up to 24 months, and the request must be made within 90 days of becoming eligible. The policy (or a substantially equivalent one) is reinstated if requested within 90 days of losing Medi-Cal. The same statements warn that applicants may qualify for Medi-Cal and not need a Medicare supplement policy, and the application must ask whether they already have Medi-Cal, Medicare Advantage or another Medicare supplement policy.
Source: CA A&H objectives III.D.1.e.ii(1)(b) and III.D.1.e.iii(b); Cal. Ins. Code § 10192.18
Under CIC 10234.93, when an insurer solicits a prospective long-term care insurance applicant, it must give written notice that the Health Insurance Counseling and Advocacy Program (HICAP):
1. A.Pays claims if the long-term care insurer becomes insolvent
2. B.Provides free health insurance counseling to senior Californians
3. C.Must approve each long-term care policy before it is issued
4. D.Reviews every long-term care claim the insurer denies
Show answer
Answer: B. CIC 10234.93(a)(8) requires written notice at solicitation that HICAP counsels senior California residents on health insurance free of charge, and the agent must give the local HICAP's name, address and phone number plus the statewide number, 1-800-434-0222. HICAP is a counseling program run under the California Department of Aging; it does not approve policies (the Insurance Commissioner does), pay claims of insolvent insurers (that is the guaranty association's role) or decide claims. The same number appears in Medicare supplement outlines of coverage and in the rate-guide statement on Medicare supplement applications.
Source: CA A&H objectives III.D.2 and V.A.1.e; Cal. Ins. Code § 10234.93; California Department of Aging: HICAP
A 70-year-old buys an individual hospital indemnity (disability) policy in California. Under CIC 786, how long does he have after receiving it to return it for a full refund?
1. A.15 days
2. B.30 days
3. C.10 days
4. D.21 days
Show answer
Answer: B. CIC 786 requires individual and group disability policies, and group life policies, offered to people 65 or older in California to allow a 30-day examination period after receipt. Returning the policy within that time voids it from the start, and the insurer must refund all premiums and fees within 30 days or pay interest. The notice must be printed in at least 12-point bold type on the policy and outline of coverage.
Source: CA A&H objectives I.C.2.23 (Ethics: senior citizens); Cal. Ins. Code § 786
Under CIC 10232.7, an individual long-term care insurance policy may be returned for a full premium refund within:
1. A.60 days of the application date
2. B.30 days of the first claim
3. C.10 days of delivery
4. D.30 days of delivery
Show answer
Answer: D. The applicant may return an individual long-term care policy by first-class mail within 30 days of delivery and get the premium refunded if not satisfied for any reason; the return voids the policy from the beginning (CIC 10232.7). The insurer must refund all premiums and policy fees within 30 days after the return. Certificates under the group policies described in CIC 10231.6(a) and (b) are excluded from this section.
Source: CA A&H objectives V.A.1; Cal. Ins. Code § 10232.7
A California long-term care policy that is NOT intended to be federally tax-qualified covers home care. At a minimum, its home care benefit trigger must let an insured qualify with:
1. A.Impairment in 2 of 6 activities of daily living, plus impaired cognitive ability
2. B.Impairment in 2 of 7 activities of daily living, or impaired cognitive ability
3. C.A hospital stay of at least three days before care begins
4. D.Impairment in 3 of 6 activities of daily living, certified for 90 days
Show answer
Answer: B. For non-tax-qualified policies, CIC 10232.8(a) sets the threshold at either impairment in two of seven activities of daily living (eating, bathing, dressing, ambulating, transferring, toileting and continence) or impaired cognitive ability; either one is enough, and a policy may be more generous. Tax-qualified policies use two of six activities of daily living or cognitive impairment (CIC 10232.8(b)). Requiring both conditions, three activities or a prior hospital stay would be stricter than the section allows.
Source: CA A&H objectives V.A.1.d; Cal. Ins. Code § 10232.8
An agent licensed in 2026 wants to sell long-term care insurance to individuals. Under CIC 10234.93, the agent must complete:
1. A.24 hours of LTC training before each renewal, in place of other continuing education
2. B.8 hours of LTC training in each of the first four license years, starting before any LTC sale
3. C.4 hours of LTC training before each license renewal, starting after the first sale
4. D.A single 8-hour LTC course at any time, with no later LTC training
Show answer
Answer: B. For licensees licensed after January 1, 1992, CIC 10234.93(a)(4) requires 8 hours of long-term care training in each of the first four 12-month periods from original licensing, then 8 hours before each license renewal, and the initial training must be done before soliciting. For resident licensees, the hours count toward continuing education. Agents selling California Partnership for Long-Term Care policies also need 8 hours of live-classroom Partnership training (22 Cal. Code Regs. 58056).
Source: CA A&H objectives V.A.2.a; Cal. Ins. Code § 10234.93; 22 Cal. Code Regs. § 58056 (Partnership agent training)
When must the Long-Term Care Insurance Personal Worksheet be given to an applicant for an individual policy in California?
1. A.Only when the applicant asks for help judging affordability
2. B.Only when the applicant is replacing an existing long-term care policy
3. C.Within 30 days after the policy is delivered, along with the outline of coverage
4. D.At or before application, and it must be returned before the insurer considers the applicant
Show answer
Answer: D. The insurer, and the agent where one is involved, must present the personal worksheet at or before application (CIC 10234.95(c)(1)), and the completed worksheet must be returned before the insurer considers the applicant (CIC 10234.95(d)); only employer group sales are exempt. It helps the insurer apply its suitability standards, which weigh ability to pay, the applicant's goals and existing coverage. Its premium section discloses the insurer's rate increases for the current year and the nine before it, and worksheet information may not be sold.
Source: CA A&H objectives V.A.2.e; Cal. Ins. Code § 10234.95
Under CIC 10234.85, which long-term care insurance sale is presumed to be an unnecessary replacement?
1. A.Any second policy sold to the same policyholder within 24 months
2. B.A replacement made to consolidate policies with a single insurer
3. C.The third or later policy sold to the same policyholder within 12 months
4. D.Any replacement that reduces the policyholder's premium
Show answer
Answer: C. CIC 10234.85 bars anyone from causing a policyholder to replace long-term care coverage unnecessarily and presumes that any third or greater policy sold to a policyholder in a 12-month period is unnecessary. Replacing policies solely to consolidate them with one insurer is exempt. On a replacement, the first-year commission is based only on the premium increase, and if the new premium is not higher, only the renewal rate may be paid (CIC 10234.97).
Source: CA A&H objectives V.A.2.c and V.A.2.f; Cal. Ins. Code § 10234.85; Cal. Ins. Code § 10234.97
At the time of purchase, a California long-term care insurer must offer an inflation protection option at least as favorable as one that:
1. A.Raises benefits with the Consumer Price Index, capped at 2% a year
2. B.Increases benefits each year by 3% simple interest
3. C.Adds a one-time 10% benefit increase after five policy years
4. D.Increases benefits each year, compounded at a rate of at least 5%
Show answer
Answer: D. CIC 10237.1 requires insurers to offer, at purchase, inflation protection no less favorable than benefits compounding annually at 5% or more, a guaranteed right to buy periodic increases of that size without proof of insurability, or coverage of a percentage of actual charges with no dollar cap. Simple 3% growth, a 2% CPI cap or a one-time bump are all less favorable. For group policies, the insurer offers the option to the group policyholder.
Source: CA A&H objectives V.A.1; Cal. Ins. Code § 10237.1

Where these questions come from: California Department of Insurance educational objectives for the Accident & Health agent examination, sections I.C (Insurance Code and ethics), III.B to III.D (group, PPACA and senior health products) and V (long-term care insurance). See how we write questions.