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Illinois Health, Medicare Supplement and Long-Term Care Law: Practice Questions

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

Exam weight: 17 health-only questions on the Illinois Accident and Health state exam on the Illinois Life and Accident & Health producer state exams. Updated 2026-11-04.

Quick study guide

Section II of the Illinois Accident and Health state exam draws on the Insurance Code (215 ILCS 5), the Illinois HIPAA, HMO and LHSO Acts (215 ILCS 97, 125 and 130) and Title 50 of the Administrative Code.

Medicare supplement (5/363, 5/363a; Part 2008)

Open enrollment runs six months from the first day of the month a person is both 65 and enrolled in Part B. Illinois adds two rights of its own. People under 65 who have Medicare because of a disability cannot be turned down if they apply within six months of enrolling in Part B, and cannot be charged more than the issuer's highest rate for people 65 and older. Policyholders aged 65 to 75 get a yearly 45-day birthday window to move to equal or lesser benefits with the same issuer (or one of its affiliates). Producers who sell in the home must complete a Policy Check List with the buyer. They must not call themselves a "Medicare advisor" or suggest the government backs the policy.

Long-term care (5/351A; Part 2012)

Long-term care coverage must last at least 12 consecutive months. A policy may not be cancelled because of the insured's age or declining health, may not cover only skilled care, and may not require a prior hospital stay. A required prior institutional stay before non-institutional benefits can be no longer than 30 days. Producers need 8 hours of one-time training plus 4 hours before each renewal. Partnership policies sold before age 61 need at least 3% compound inflation protection (or a CPI-linked rate).

Rule	Medicare supplement	Long-term care	Other individual A&H
Free look	30 days (5/363(4))	30 days (5/351A-7)	10 days (Part 2007.80)
Preexisting conditions	Defined by a 6-month lookback; claims cannot be denied after 6 months of coverage	6-month lookback and 6-month exclusion at most (5/351A-5)	Excepted benefits only; none in ACA-type coverage (97/20)

Individual policies and advertising (Parts 2007 and 2002)

Accident policies may have no waiting period. An excepted benefit policy may wait up to 6 months for a short list of conditions such as hernia and tonsils. Specified disease policies must say "This is a limited policy. Read it carefully." Ads for limited enrollment periods must leave 6 months between periods for the same product, and paid endorsements must be disclosed.

Group replacement, HIPAA, HMOs

When a group medical plan is discontinued, a member who is totally disabled keeps benefits for that disability for up to 12 months. A replacing carrier credits deductible expenses from the prior 90 days. Illinois now bans preexisting condition exclusions except in excepted benefits. Section 5/364 bars charging more solely because of blindness. HMO medical-necessity disputes go to an independent physician, and LHSOs provide only limited services such as dental, vision and ambulance.

Practice questions

Dolores, 70, lives in Illinois and has had a Medicare supplement policy for five years. Under 215 ILCS 5/363(8), what can she do around her birthday without the issuer considering her health?
1. A.Switch within 30 days before or after her birthday to any Medicare supplement plan from any issuer
2. B.Switch within 45 days of her birthday to equal or lesser benefits from her issuer or one of its affiliates
3. C.Switch within 63 days after her birthday to a plan with richer benefits from her current issuer
4. D.Nothing, because guaranteed purchases ended six months after her Medicare Part B coverage began
Show answer
Answer: B. Illinois gives Medicare supplement policyholders aged 65 through 75 an annual 45-day open enrollment period beginning on their birthday, during which the issuer may not deny, condition or price coverage based on health status, claims experience or medical condition. The new policy must offer benefits equal to or lesser than the old one. Legislation Illinois enacted in 2024 widened the choice from the same issuer to that issuer's affiliates. The window does not allow an upgrade or a move to an unrelated insurer, and it is not tied to the first six months of Part B.
Source: Illinois content outline II.A: Medicare supplements, minimum standards (215 ILCS 5/363); 215 ILCS 5/363; NAIC: State Medigap rules, birthday rule and coverage for under-65s (as of 11 May 2026)
Marcus, 52, has Medicare because of a disability and enrolled in Part B on March 1. Under 215 ILCS 5/363(6), an Illinois Medicare supplement issuer:
1. A.Must accept him if he applies within 63 days of March 1, at a rate based on his health
2. B.Cannot deny him if he applies within 6 months of March 1, or charge more than its top 65-and-over rate
3. C.May turn him down, because the Illinois guarantee covers only people aged 65 or older
4. D.Must accept him for Plan A only, at a premium rate set by the Department of Insurance
Show answer
Answer: B. Section 363(6) bars denying coverage to an applicant under 65 who has Medicare because of a disability and applies within 6 months of first enrolling in Part B (or of being notified of retroactive Part B eligibility). The issuer must offer disabled applicants every type of policy it offers to people eligible by age, and may not charge them more than its highest current filed rate for that plan for people 65 or older. 50 Ill. Adm. Code 2008.74(d) applies these rights regardless of age or any Part B late enrollment penalty. Nothing limits him to Plan A, and the window is 6 months, not 63 days.
Source: Illinois content outline II.A.3: Medicare supplements, under 65 disabled (215 ILCS 5/363; 50 Ill. Adm. Code Part 2008); 215 ILCS 5/363; 50 Ill. Adm. Code 2008.74
A producer who makes home visits to sell Medicare supplement insurance in Illinois is choosing a title for his business cards. Under 215 ILCS 5/363a(4), which title is prohibited?
1. A.Medicare Advisor
2. B.Health Insurance Producer
3. C.Licensed Insurance Agent
4. D.Agent, Prairie Mutual Life Insurance Company
Show answer
Answer: A. In a home solicitation sale to people eligible for Medicare, an agent may not imply he runs an advisory business paid separately from insurance sales by using terms such as Medicare consultant, Medicare advisor, Medicare Bureau or disability insurance consultant. He also may not suggest the policy is approved or recommended by the state or federal government, or that he works for a government agency. Section 363a(3) actually requires him to identify himself as an insurance agent and name the insurers he represents, so the other titles are proper. Violations can bring a civil penalty of $500 to $5,000 per offense.
Source: Illinois content outline II.A.2: Medicare supplements, disclosure requirements (215 ILCS 5/363a); 215 ILCS 5/363a
Under 215 ILCS 5/363a(3)(f), when an Illinois agent sells a Medicare supplement policy in a home solicitation sale, the Policy Check List must be:
1. A.Mailed to the buyer by the insurer within 30 days after the policy is issued, with a refund form
2. B.Completed by the insurer's underwriter after the sale and kept only in the company's own files
3. C.Filled out in duplicate with the buyer at the point of sale, with signed copies to buyer and company
4. D.Filed with the Department of Insurance and approved before the policy can be delivered
Show answer
Answer: C. The Policy Check List shows, for hospital, skilled nursing, home care and prescription drug services, what Medicare, the existing coverage and the new policy pay and what the insured must pay, and states whether the policy meets Illinois's Medicare supplement minimum standards. Applicant and agent sign it in duplicate at the point of sale; the purchaser and the company each get a copy, and the company keeps its copies at a regional or administrative office (363a(5)(c)). The statute does not require it to be filed with the Department. The agent must also deliver an outline of coverage with the policy and forward any premium refund draft within 2 weeks of getting it from the insurer.
Source: Illinois content outline II.A.2: Medicare supplements, disclosure requirements (215 ILCS 5/363a); 215 ILCS 5/363a
Ruth, 68, has Medicare plus a retiree plan from her former employer that supplements it. The employer ends the plan. Under 50 Ill. Adm. Code 2008.75, she is guaranteed issue of the listed Medicare supplement plans, with no preexisting-condition exclusion, if she applies:
1. A.At any time, because losing a retiree plan gives a permanent guaranteed right
2. B.Only during the 6-month open enrollment that began when she first enrolled in Part B
3. C.Within 30 days after her employer coverage ends, with proof of her prior coverage
4. D.Within 63 days, counted from the later of the termination notice or the date coverage ends
Show answer
Answer: D. A person whose employer plan supplementing Medicare terminates or stops providing all supplemental benefits is an 'eligible person' under 2008.75(b)(1). The guaranteed issue period begins on the later of the termination notice (or a claim denial if no notice came) or the date coverage ends and runs 63 days, and she must send evidence of the termination with her application. During it the issuer may not deny or condition issue, charge more because of her health, or impose a preexisting-condition exclusion. The right is separate from her original open enrollment period and does not last indefinitely.
Source: Illinois content outline II.A.1: Medicare supplements, minimum standards (50 Ill. Adm. Code Part 2008); 50 Ill. Adm. Code 2008.75
An Illinois long-term care policy pays non-institutional benefits only after the insured has received institutional care. Under 215 ILCS 5/351A-6, the policy:
1. A.May require a 60-day nursing home stay before non-institutional benefits begin
2. B.May require a hospital stay of at least 3 days before any benefits are paid
3. C.Cannot require more than a 30-day prior institutional stay, or any prior hospital stay
4. D.May require prior hospitalization for nursing home benefits, but not for home care
Show answer
Answer: C. No Illinois long-term care policy may make any benefit depend on a prior hospital stay, or make institutional benefits depend on first receiving a higher level of institutional care. If non-institutional benefits depend on prior institutional care, the required stay cannot exceed 30 days for which benefits are paid. A benefit marketed as home health care or home care may not require prior institutionalization at all. Any other eligibility limits must appear in a separate paragraph titled 'Limitations or Conditions on Eligibility for Benefits'.
Source: Illinois content outline II.B.1: Traditional long term care (215 ILCS 5/351A-6); 215 ILCS 5/351A-6
Under 215 ILCS 5/351A-4, an Illinois long-term care insurance policy may:
1. A.Cover care in a skilled nursing facility only, with no lower levels of care
2. B.Apply a new waiting period to a benefit increase the insured chooses voluntarily
3. C.Be cancelled once the insured reaches age 85, with a refund of unearned premium
4. D.Be nonrenewed because the insured's mental health has deteriorated
Show answer
Answer: B. Section 351A-4 bars cancelling, nonrenewing or otherwise ending a long-term care policy because of the insured's age or declining mental or physical health. It also bars covering only skilled nursing care, or much more skilled care in a facility than lower levels of care. When coverage is converted or replaced, the new form may not start a new waiting period. The one exception is a benefit increase the insured or group policyholder chooses voluntarily, which may carry its own waiting period.
Source: Illinois content outline II.B.1: Traditional long term care (215 ILCS 5/351A-4); 215 ILCS 5/351A-4
Before issuing an individual long-term care policy, an Illinois insurer must get the applicant's written designation of at least one other person to receive lapse notices, or a signed waiver. Under 50 Ill. Adm. Code 2012.55, how often must the insurer remind the insured of the right to change that designation?
1. A.At least once every 5 years
2. B.At least once a year
3. C.At least once every 2 years
4. D.Only when the premium increases
Show answer
Answer: C. Section 2012.55(a)(1) requires the insurer to tell the insured, no less often than once every 2 years, that the designation can be changed. A policy cannot lapse for nonpayment unless the insurer mails notice first class to the insured and the designee at least 30 days before the lapse date. That notice cannot be sent until a premium has been unpaid for 30 days, and it counts as given 5 days after mailing. The policy must also allow reinstatement if, within 5 months after termination, the insurer gets proof that the insured was cognitively impaired or had lost functional capacity before the grace period ended.
Source: Illinois content outline II.B.1: Traditional long term care (50 Ill. Adm. Code Part 2012); 50 Ill. Adm. Code 2012.55
An Illinois producer licensed for accident and health wants to start selling long-term care insurance, including Partnership policies. Under 50 Ill. Adm. Code 2012.121, she must first complete:
1. A.Her insurer's product training on its own long-term care policy, which satisfies the whole requirement
2. B.A separate long-term care licensing exam, after which no further training is required
3. C.One-time training of at least 4 hours, then at least 8 hours of training every year
4. D.One-time training of at least 8 hours, then at least 4 hours before each license renewal
Show answer
Answer: D. No one may sell, solicit or negotiate long-term care insurance in Illinois without an accident and health producer license and a one-time training course of at least 8 hours, followed by at least 4 hours of ongoing training before each license renewal. A producer who misses the 4 hours has 12 months from the renewal date to finish them without repeating the 8-hour course. The training covers long-term care services, the Partnership program and Medicaid, inflation protection and suitability, and may not be specific to one insurer or product. Insurers must verify the training before the producer sells their policies.
Source: Illinois content outline II.B.2: Long Term Care Partnership (50 Ill. Adm. Code Part 2012); 50 Ill. Adm. Code 2012.121; 50 Ill. Adm. Code 2012.145(f)
Under 50 Ill. Adm. Code 2012.145, what inflation protection must an Illinois Long-Term Care Partnership policy include when it is sold to a 55-year-old?
1. A.Simple or compound inflation protection at any rate the insurer chooses
2. B.At least 3% compound annual inflation protection, or a CPI-based rate
3. C.None, because inflation protection is optional for Partnership buyers
4. D.Compound annual inflation protection of at least 5%, with no CPI alternative
Show answer
Answer: B. Partnership buyers under age 61 must get compound annual inflation protection of at least 3%, or a rate based on the Consumer Price Index for All Urban Consumers. From age 61 up to 76 it may be simple or compound, still at least 3% or CPI-based, and at 76 or older it is optional. Every Partnership policy must include a Partnership Disclosure Notice stating that buying it does not automatically qualify the insured for Medicaid. The 5% compound figure is the option every long-term care insurer must offer under 2012.80, not the Partnership minimum.
Source: Illinois content outline II.B.2: Long Term Care Partnership (50 Ill. Adm. Code Part 2012); 50 Ill. Adm. Code 2012.145; 50 Ill. Adm. Code 2012.80
Under 50 Ill. Adm. Code 2007.60, which waiting period may an Illinois individual excepted benefit policy include?
1. A.Up to 30 days for accidental injuries before any accident benefits begin
2. B.Up to 12 months for any sickness first diagnosed after the policy's effective date
3. C.Up to 2 years for heart disease or cancer, if named in the policy schedule
4. D.Up to 6 months for hernia, varicose veins, adenoids, appendix or tonsils, except emergencies
Show answer
Answer: D. Section 2007.60(a) generally bars probationary or waiting periods during which no coverage is provided. An excepted benefit policy may set a waiting period of up to 6 months for hernia, varicose veins, adenoids, appendix and tonsils, but not when those conditions are treated as an emergency. Accident policies may have no probationary or waiting period at all. The only other allowance is in the definition of sickness (2007.50), which may include a probationary period of no more than 30 days from the effective date.
Source: Illinois content outline II.D.3: Minimum standards for individual policies, prohibited provisions (50 Ill. Adm. Code Part 2007); 50 Ill. Adm. Code 2007.60; 50 Ill. Adm. Code 2007.50
Under 50 Ill. Adm. Code 2007.80, which statement must appear prominently on the first page of an Illinois specified disease policy?
1. A."This is a limited policy. Read it carefully."
2. B."This policy has been reviewed and approved by the Illinois Department of Insurance."
3. C."This policy replaces all other health coverage you now have."
4. D."This is an accident only policy and it does not pay benefits for loss from sickness."
Show answer
Answer: A. Specified disease policies must carry 'This is a limited policy. Read it carefully.' in contrasting color and bold type at least as large as the policy captions. The accident-only statement is required on accident only policies, not specified disease policies. A statement implying state approval is the kind of representation 215 ILCS 5/149(4) prohibits. Every individual policy except single premium nonrenewable policies must also give the policyholder 10 days after delivery to return it for a premium refund (2007.80(a)(7)).
Source: Illinois content outline II.D.5: Minimum standards for individual policies, disclosure and replacement requirements (50 Ill. Adm. Code Part 2007); 50 Ill. Adm. Code 2007.80; 215 ILCS 5/149
An insurer advertises an individual accident and sickness policy in Illinois with a limited enrollment period. Under 50 Ill. Adm. Code 2002.160, how long after the previous enrollment period for the same product closed may the next one open?
1. A.No sooner than 6 months
2. B.No sooner than 12 months
3. C.Immediately; periods may run back to back
4. D.No sooner than 30 days
Show answer
Answer: A. An individual enrollment period for a product may not open until at least 6 months after the previous period for the same product closed, and the ad must give a mail-by date 10 to 40 days after the period is first advertised. Changing renewability, benefit amounts or waiting periods does not make a policy a different product, and affiliated insurers under common control count as one insurer. Calling a routine enrollment period 'special' or 'limited' is prohibited. A reduced first premium may not be shown more often or more prominently than the renewal premium, and the two must appear side by side.
Source: Illinois content outline II.C: Advertising (215 ILCS 5/149; 50 Ill. Adm. Code Part 2002); 50 Ill. Adm. Code 2002.160
A celebrity is paid to appear in an Illinois TV advertisement praising an insurer's accident and sickness policy. Under 50 Ill. Adm. Code 2002.90, the advertisement must:
1. A.Disclose the payment only if the celebrity is also a stockholder of the insurer
2. B.Include the celebrity's sworn affidavit, filed with the Department of Insurance
3. C.Avoid any mention of benefits the celebrity has received under the policy
4. D.Disclose the payment with language substantially like "Paid Endorsement"
Show answer
Answer: D. Testimonials must be genuine, current, applicable to the policy advertised and accurately reproduced, and the insurer adopts every statement in them as its own. Payment for a testimonial or endorsement must be disclosed with words substantially like 'Paid Endorsement', and any financial interest in the insurer, such as being a stockholder, director, officer or employee, must be disclosed too. Union scale wages for TV or radio performances need not be disclosed. If a testimonial mentions benefits received, the insurer keeps the claim data for four years or until its next examination report, whichever is longer.
Source: Illinois content outline II.C: Advertising (50 Ill. Adm. Code Part 2002); 50 Ill. Adm. Code 2002.90
An Illinois employer's group major medical policy is discontinued while one employee is totally disabled. Under 215 ILCS 5/367i and 50 Ill. Adm. Code 2013.60, a 'reasonable' extension of benefits for that disability lasts until the earliest of:
1. A.6 months, or the date the employee returns to work
2. B.31 days, the period allowed to apply for a conversion policy
3. C.90 days, the date the maximum benefit is reached, or the end of total disability
4. D.12 months, the date the maximum benefit is reached, or the end of total disability
Show answer
Answer: D. Section 367i requires group health policies to provide a reasonable extension of benefits for anyone totally disabled when the policy is discontinued. For hospital and medical expense coverage and HMO plans (other than dental, pharmaceutical or other limited expense coverage), Section 2013.60 sets this at the earliest of 12 months, exhaustion of the maximum benefit or the end of total disability; plans covering only hospital, only medical or only surgical expenses use 90 days. Under disability income contracts, discontinuance has no effect on benefits for a disability already under way. The prior carrier may not stop the extension because the person becomes covered by a new carrier (2013.70).
Source: Illinois content outline II.E.1: Group insurance, discontinuance and replacement (215 ILCS 5/367i; 50 Ill. Adm. Code Part 2013); 215 ILCS 5/367i; 50 Ill. Adm. Code 2013.60
An Illinois employer replaces its group health insurer mid-year. Under 50 Ill. Adm. Code 2013.70, when the succeeding carrier applies its deductible, it must credit expenses applied to the prior plan's deductible during:
1. A.The 12 months before the new plan's effective date
2. B.No period; each employee starts a new deductible on the first day
3. C.The 90 days before the new plan's effective date
4. D.The prior plan's entire final policy year
Show answer
Answer: C. The succeeding carrier must credit deductibles, coinsurance, copayments and waiting periods already met under a prior plan with similar benefits. For deductibles, the credit covers expenses incurred and applied to the prior deductible in the 90 days before the new plan takes effect, for the same or overlapping benefit periods. The new carrier must cover everyone eligible under its plan without individual underwriting, and also people validly insured under the prior plan who fail its actively-at-work or non-confinement rules. The prior carrier remains liable only for its accrued liabilities and extensions of benefits.
Source: Illinois content outline II.E.1: Group insurance, discontinuance and replacement (50 Ill. Adm. Code Part 2013); 50 Ill. Adm. Code 2013.70
Under the current text of the Illinois Health Insurance Portability and Accountability Act (215 ILCS 97/20), health insurance coverage issued or renewed in Illinois:
1. A.May exclude preexisting conditions only after a 63-day break in coverage
2. B.May not impose any preexisting condition exclusion, except in excepted benefits
3. C.May exclude a preexisting condition for 12 months, less prior creditable coverage
4. D.May exclude a preexisting condition for up to 18 months, but only for late enrollees
Show answer
Answer: B. As amended by the 102nd General Assembly, Section 20(A) bars any preexisting condition exclusion in health insurance coverage issued, amended, delivered or renewed after the amendment took effect. The ban does not reach the excepted benefits in Section 20(C)(2), such as accident-only, disability income, limited dental or vision, long-term care, specified disease, hospital indemnity and Medicare supplement coverage. The Act still defines creditable coverage and the 63-day significant break, but neither now permits an exclusion. Section 25 separately bars group plans from basing eligibility or premiums on health status, medical history, genetic information or disability.
Source: Illinois content outline II.E.2: Illinois Health Insurance Portability and Accountability Act (215 ILCS 97); 215 ILCS 97/20; 215 ILCS 97/25
Jill is legally blind and otherwise in good health. Under 215 ILCS 5/364, which of these may an Illinois accident and health insurer NOT do?
1. A.Judge her other medical conditions by the same actuarial standards it uses for sighted applicants
2. B.Pay a licensed dentist for covered dental services under a policy that refers to 'physicians'
3. C.Offer her incentives to use a particular hospital
4. D.Charge her a higher rate for the same coverage solely because she is blind
Show answer
Answer: D. Section 364 bars refusing to insure, refusing to continue coverage, limiting coverage or charging a different rate solely because of blindness or partial blindness, and treats a disability policy that presumes disability on loss of eyesight as a refusal to insure. Her other conditions, including the cause of the blindness, may be judged by the same actuarial standards used for sighted people. The section expressly allows incentives to use a particular hospital or person. It also makes 'physician' or 'doctor' in a health policy include a licensed dentist for covered services within that license.
Source: Illinois content outline II.F: Unfair practices (215 ILCS 5/364); 215 ILCS 5/364
An Illinois HMO and an enrollee's primary care physician disagree about whether a covered service the physician proposes is medically necessary. Under 215 ILCS 125/4-10, the dispute is reviewed by:
1. A.The HMO's medical director, whose decision on necessity is final and binding
2. B.The Director of Insurance, who must issue a decision within 90 days
3. C.An unaffiliated physician with the same class of license, chosen jointly by patient, doctor and HMO
4. D.A panel of three physicians employed by the HMO and chosen by the HMO
Show answer
Answer: C. Every HMO must provide timely review by a physician unaffiliated with the HMO who holds the same class of license as the primary care physician, chosen jointly by the patient (or next of kin or legal representative), the primary care physician and the HMO. If the reviewer finds the service medically necessary, the HMO must provide it, and it may not base future contract or employment action against the physician solely on the review. HMOs must also run an enrollee complaint system (4-6). They must deliver the evidence of coverage within 30 days after the later of the coverage effective date or receipt of completed enrollment notice (4-1).
Source: Illinois content outline II.H: Health Maintenance Organizations (215 ILCS 125/4-1 through 4-16); 215 ILCS 125/4-10; 215 ILCS 125/4-1
Under the Illinois Limited Health Service Organization Act (215 ILCS 130/1002), which of these is a 'limited health service' that an LHSO may provide on a prepaid basis?
1. A.Vision care
2. B.Emergency room care offered as a stand-alone benefit
3. C.Physician office visits for general illness
4. D.Inpatient hospital care
Show answer
Answer: A. Limited health services are ambulance, dental, vision, pharmaceutical, clinical laboratory and podiatric care. They exclude hospital, medical, surgical and emergency services, except where these are essential to delivering the limited service; essential services of that kind are covered unless specifically excluded. An HMO, by contrast, must provide basic health care services: emergency care, inpatient hospital and physician care, outpatient medical services, mental health services and care for alcohol and drug abuse (215 ILCS 125/1-2).
Source: Illinois content outline II.I: Limited Health Service Organizations (215 ILCS 130); 215 ILCS 130/1002; 215 ILCS 125/1-2

Where these questions come from: Illinois content outline (Pearson VUE #121402, Accident and Health state exam), section II: Illinois statutes and regulations pertinent to accident and health insurance only (A: Medicare supplements, B: Long term care, C: Advertising, D: Minimum standards for individual policies, E: Group insurance, F: Unfair practices, H: HMOs, I: LHSOs) — 17 scored questions. See how we write questions.