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Ohio 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: Ohio rules in the accident and health, HIC, senior and LTC sections on the Ohio Life, Accident and Health agent exam (11-35). Updated 2026-11-05.

Quick study guide

The 11-35 exam mixes Ohio law into its health sections, mostly from Revised Code Chapters 3923 (sickness and accident), 3922 (external review) and 1751 (health insuring corporations), plus Ohio Adm. Code 3901-8-08 (Medicare supplement) and 3901-4-01 (long-term care).

Individual policies and mandates

The standard provisions of § 3923.04 include a grace period of at least 7 days for weekly premiums, 10 days for monthly premiums and 31 days for other modes. Notice of claim is due within 20 days and proof of loss within 90 days; a lawsuit may be filed no sooner than 60 days after proof of loss and no later than 3 years after proof is due. Health insurers may not use genetic test results in underwriting, though disability income is outside that ban (§ 3901.491). Policies must pay for one screening mammogram a year, plus supplemental screening for women with dense breasts or a higher risk.

Coverage	Right to return or cancel
Individual sickness and accident	10 days from receipt (§ 3923.31)
Medicare supplement	30 days from delivery (§ 3923.335)
Long-term care	30 days from delivery (§ 3923.44(H))
HIC enrollment agreement	72 hours after signing (§ 1751.31(F))

Group, small employer and appeals

Ohio continuation (§ 3923.38) lets an employee insured for the 3 months before an involuntary termination keep group hospital, surgical and medical coverage for 12 months. Ohio's small employer law covers employers with 2 to 50 eligible employees working 30 or more hours a week, and caps any service waiting period at 90 days (§§ 3924.01, 3924.03). Prior authorization answers are due within 48 hours for urgent care and 10 calendar days otherwise (§§ 3923.041, 1751.72). After internal appeals, external review goes to an independent review organization if medical judgment is involved, or to the Superintendent if the question is purely contractual (§ 3922.05). Review organizations decide within 30 days, or 72 hours if the review is expedited.

Health insuring corporations

A HIC (Ohio's term for an HMO) offers basic, supplemental or specialty health care services (§ 1751.01). It may not cancel or nonrenew a member because of health status (§ 1751.18), and it must keep medical information confidential (§ 1751.52).

Medicare supplement and long-term care

Medigap open enrollment runs six months from the first day of the month a person is both 65 and enrolled in Part B. A first-year commission may be no more than 200% of the second year's. Unsolicited door-to-door and telephone contacts are unfair practices (3901-8-09). Both products limit preexisting conditions to a 6-month look-back. Long-term care insurers must offer 5% compound inflation protection, which is included unless the buyer signs a rejection. Lapse notices go to the insured and a designee at least 30 days before termination. The agent hands over the shopper's guide and outline of coverage before presenting the application.

Practice questions

An Ohio individual sickness and accident policy is paid by monthly premium. Under Ohio Rev. Code § 3923.04(C), the grace period written into the policy must be at least:
1. A.5 days
2. B.10 days
3. C.31 days
4. D.7 days
Show answer
Answer: B. Ohio's standard grace period provision leaves the number of days blank and sets the minimum the insurer may insert: 7 days for weekly premium policies, 10 days for monthly premium policies and 31 days for all other policies, such as quarterly or annual. The policy stays in force during the grace period. Five days is a different figure: a policy that lets the insurer refuse renewal must say renewal can be refused by written notice delivered or mailed at least five days before the premium due date.
Source: Ohio 11-35 outline 9.1: Standard provisions, grace period (3923.04(C)); Ohio Rev. Code § 3923.04
Nadia receives her new individual sickness and accident policy in Ohio on March 3. Under Ohio Rev. Code § 3923.31, how long does she have to return it for a refund?
1. A.At least until midnight of March 13, the tenth day after she received it
2. B.Until March 13, but only if she gives the insurer a written reason
3. C.Until April 2, 30 days after she received it
4. D.Only until the policy's effective date, which may be before March 3
Show answer
Answer: A. An Ohio individual sickness and accident policyholder may rescind the policy at least until midnight of the tenth day after receiving it, by returning it to the insurer or an agent; no reason is needed, and mailing it within the period counts as returning it. The policy may keep coverage in force until the return and charge a strictly per-day share of the premium; otherwise it is void from the beginning and the premium is refunded. The right does not apply to single-premium nonrenewable policies. The 30-day window belongs to Medicare supplement (§ 3923.335) and long-term care (§ 3923.44(H)) policies.
Source: Ohio 11-35 outline 9.3: Right to examine (free look) (3923.31); Ohio Rev. Code § 3923.31
Ohio Rev. Code § 3901.491 bars insurers from considering genetic screening or test results when processing an application. As that section defines the coverage it protects, which application falls outside the ban?
1. A.A public employee benefit plan providing medical coverage
2. B.An individual disability income policy
3. C.An individual major medical expense policy
4. D.A group hospital and surgical policy for an employer
Show answer
Answer: B. The section applies to sickness and accident insurance under Chapter 3923 but defines that term to exclude disability income insurance and supplemental sickness and accident policies. For the coverage it does reach, including public employee benefit plans, the insurer may not consider genetic test information when processing an application or judging insurability. It also may not ask about results or use them to cancel, refuse to issue or renew, limit benefits or set premiums. Section 3901.501 applies the same ban to government self-insured plans.
Source: Ohio 11-35 outline 8.7: Individual underwriting, genetic testing (3901.491, .501); Ohio Rev. Code § 3901.491; Ohio Rev. Code § 3901.501
Grace has family coverage under an Ohio expense-incurred health policy that charges a separate premium for each added child. Her son is born on June 1. Under Ohio Rev. Code § 3923.26, what may the policy require her to do to keep him covered after the first weeks?
1. A.Notify the insurer and pay the added premium within 31 days after the birth
2. B.Wait for the next open enrollment, because newborns are covered only from 30 days of age
3. C.Nothing, because a newborn is covered automatically, but only for congenital defects
4. D.Apply within 60 days and give evidence of the baby's insurability
Show answer
Answer: A. A policy that offers family coverage must cover a newborn from the moment of birth, for injury and sickness including medically diagnosed congenital defects and birth abnormalities. If a specific premium is charged for an additional child, the policy may require notice of the birth and payment within 31 days of the birth for coverage to continue beyond that period. Section 1751.61 gives HIC newborns 31 days of coverage from birth and requires the subscriber to notify the HIC within that period to continue it. Adopted children, including children placed for adoption before it is final, must be covered on the same basis as other dependents (§§ 3923.40, 3924.51).
Source: Ohio 11-35 outline 11.4: Newborn child coverage (3923.26; 1751.61); Ohio Rev. Code § 3923.26; Ohio Rev. Code § 1751.61; Ohio Rev. Code § 3924.51
Under the current text of Ohio Rev. Code § 3923.52, how often must an Ohio group sickness and accident policy pay for screening mammography for an adult woman?
1. A.Once between ages 35 and 39, then once every two years
2. B.Once every year, including digital breast tomosynthesis
3. C.Only when a doctor orders it after finding a lump
4. D.Once every two years, starting at age 50
Show answer
Answer: B. Section 3923.52 requires individual and group policies to cover one screening mammography every year for adult women, including digital breast tomosynthesis. It also requires supplemental screening such as MRI or ultrasound for women with dense breast tissue or a higher risk, and cytologic (cervical cancer) screening. A mammogram ordered to investigate a lump is diagnostic, which the definition of screening excludes. The mandate does not apply to specified disease, accident-only, hospital indemnity or Medicare supplement policies, and § 1751.62 sets the same rule for HICs providing basic health care services.
Source: Ohio 11-35 outline 11.4: Cytologic screening and mammography (3923.52; 1751.62); Ohio Rev. Code § 3923.52; Ohio Rev. Code § 1751.62
Ed is laid off after two years under his Ohio employer's group major medical policy. He is not eligible for Medicare or any other group plan. Under Ohio's continuation law (Ohio Rev. Code § 3923.38), how long may he keep his hospital, surgical and medical coverage?
1. A.Up to 6 months, or until he finds a new job
2. B.Up to 18 months, the same as federal COBRA
3. C.Up to 36 months, if he pays 102% of the group rate
4. D.Up to 12 months after the date his coverage would otherwise end
Show answer
Answer: D. To qualify, an employee must have been insured continuously for the 3 months before employment ended, must not have quit voluntarily and must not have been fired for gross misconduct. He may then continue coverage for himself and his eligible dependents for 12 months. He must elect in writing and pay the first contribution to the employer, generally within 31 days after coverage would end. The deadline can be as short as 10 days after the coverage end date or after the employer's notice. Monthly payments cannot exceed the group rate, and dental and vision coverage need not be continued. The 18- and 36-month periods come from federal COBRA, not this section.
Source: Ohio 11-35 outline 13.4: Continuation of coverage under COBRA and Ohio-specific rules (3923.38); Ohio Rev. Code § 3923.38
An Ohio physician sends a patient's health insurer an electronic prior authorization request for a non-urgent outpatient MRI. Under Ohio Rev. Code § 3923.041(B)(4), the insurer must approve or deny it within:
1. A.30 days of receiving the request
2. B.10 calendar days of receiving the request
3. C.48 hours of receiving the request
4. D.15 business days after the MRI is performed
Show answer
Answer: B. For requests submitted electronically, the insurer must respond within 48 hours for urgent care services and within 10 calendar days for anything else; the deadlines do not apply to emergency services. A denial must give the specific reason, and if the request is incomplete the insurer must say exactly what information it needs. Appeals of a prior authorization denial follow the same 48-hour and 10-day timing, are handled between the requesting practitioner and a clinical peer, and can then go to external review. Section 1751.72 sets the same deadlines for HICs.
Source: Ohio 11-35 outline 11.3: Prior authorization procedures (3923.041, 1751.72); Ohio Rev. Code § 3923.041; Ohio Rev. Code § 1751.72
An Ohio insurer denies a claim because the contract excludes the service, and no medical judgment or medical information was involved. After the internal appeal process is exhausted, who conducts the external review under Ohio Rev. Code §§ 3922.05 and 3922.11?
1. A.The insurer's own medical director
2. B.An arbitration panel chosen jointly by the parties
3. C.An independent review organization chosen by the insurer
4. D.The Superintendent of Insurance
Show answer
Answer: D. A denial based on a contractual issue that involved no medical judgment or medical information is reviewed by the Superintendent, who will not take it until the covered person has exhausted the insurer's internal appeals. Denials involving medical judgment go to an independent review organization, which the Superintendent assigns at random from an approved list and never one with a conflict of interest; the insurer does not choose it. If the Superintendent decides medical judgment is needed after all, the insurer must start an independent review. If the Superintendent finds the service covered, the insurer must cover it.
Source: Ohio 11-35 outline 11.7: Adverse benefit determination (3922.01-.23); Ohio Rev. Code § 3922.05; Ohio Rev. Code § 3922.11
After a final adverse benefit determination, Raj's treating physician certifies that waiting for a standard external review could seriously jeopardize his life. Under Ohio Rev. Code § 3922.09, once his insurer receives a request for an expedited external review, the independent review organization must decide no later than:
1. A.24 hours after the insurer receives the request
2. B.30 days after the insurer receives the request
3. C.10 calendar days after the review organization is assigned
4. D.72 hours after the insurer receives the request
Show answer
Answer: D. In an expedited review, the independent review organization must uphold or reverse the denial as quickly as the person's condition requires, and no more than 72 hours after the insurer receives the request. If its notice is not in writing, it must send written confirmation within 48 hours of deciding. A standard review must be decided within 30 days (§ 3922.05(H)). Expedited review is not available for retrospective denials, and when a denial is reversed the insurer must provide coverage immediately.
Source: Ohio 11-35 outline 11.7: Adverse benefit determination (3922.01-.23); Ohio Rev. Code § 3922.09; Ohio Rev. Code § 3922.05
An Ohio health insuring corporation sells a plan that covers only outpatient vision care, not combined with any other supplemental service. Under Ohio Rev. Code § 1751.01, this plan provides:
1. A.Supplemental services bundled with basic health care services
2. B.Limited benefit services that fall outside Chapter 1751
3. C.Basic health care services
4. D.Specialty health care services
Show answer
Answer: D. Basic health care services include physician, inpatient hospital, outpatient medical, emergency, urgent care, diagnostic and preventive services, and a HIC offering any of them generally must offer all of them. Supplemental services include dental, vision, podiatric, prescription drug, home health, nursing, physical therapy and chiropractic care, and intermediate or long-term care facilities. A specialty health care service is one supplemental service offered on an outpatient-only basis and not combined with other supplemental services, such as a stand-alone vision plan. A HIC providing only specialty services sends subscribers its plan description every two years instead of every year (§ 1751.33).
Source: Ohio 11-35 outline 12.2: HIC services (1751.01(A)-(C)); Ohio Rev. Code § 1751.01; Ohio Rev. Code § 1751.33
Tom signs an enrollment agreement with an Ohio health insuring corporation on Monday at noon and then changes his mind. Under Ohio Rev. Code § 1751.31(F), he may cancel it:
1. A.Only at the HIC's next open enrollment period
2. B.Within 72 hours after signing, by written notice to the HIC or its agent
3. C.Within 10 days after he receives his evidence of coverage
4. D.Within 30 days, but only if he has not used any services
Show answer
Answer: B. Anyone obligated to pay any part of the premium under an enrollment agreement may cancel it within 72 hours after signing, on top of any other right to revoke the offer. Cancellation takes effect when written notice is given to the HIC or its agents, and a mailed notice counts as filed on its postmark date. Every potential applicant must receive an approved solicitation document at or before the time of solicitation. A HIC and its agents may not offer money or other valuable consideration, or use misleading representations, to induce enrollment, although agent commission programs are allowed.
Source: Ohio 11-35 outline 12.3: Solicitation documents (1751.31); Ohio Rev. Code § 1751.31
Under Ohio Rev. Code § 1751.18, on which ground may an Ohio health insuring corporation cancel or refuse to renew an enrollee's coverage?
1. A.A new diagnosis of a chronic medical condition after enrollment
2. B.The enrollee's heavy use of health care services during the past year
3. C.Genetic test results showing the enrollee has a higher risk of cancer
4. D.Fraud or intentional misrepresentation, if not based on health status
Show answer
Answer: D. A HIC may not cancel or nonrenew coverage because of a health status-related factor or the member's need for health care services. Health status-related factors include health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability and disability, so the other three choices are all barred. Fraud or intentional misrepresentation of material fact is a permitted ground, as long as the decision is not based directly or indirectly on health status. An enrollee can complain to the HIC and, within 30 days after its written response, appeal to the Superintendent.
Source: Ohio 11-35 outline 12.3: Member rights and renewal (1751.18); Ohio Rev. Code § 1751.18
Carol turns 65 on April 10, and her Medicare Part B coverage starts on May 1. Under Ohio Adm. Code 3901-8-08(N), her Medicare supplement open enrollment period:
1. A.Runs six months from April 10, her 65th birthday, whether or not Part B has started
2. B.Runs from three months before to three months after the month she turns 65
3. C.Runs six months from May 1, with no denial or higher price for health reasons
4. D.Runs for 30 days before and 30 days after her birthday each year
Show answer
Answer: C. An issuer may not deny, condition or price a Medicare supplement policy based on health status (including tobacco use), claims experience, receipt of care or medical condition if the application is made before or during the six months starting on the first day of the first month the person is both 65 or older and enrolled in Part B. For Carol, that month is May. If she has at least six months of creditable coverage, no preexisting-condition exclusion may apply. Otherwise § 3923.332 bars excluding a preexisting condition after six months of coverage or looking back more than six months. The seven months around the 65th birthday month describe Medicare's own initial enrollment period, not Medigap open enrollment.
Source: Ohio 11-35 outline 15.4: Medicare supplements, open enrollment (3923.33, .331-.336; OAC 3901-8-08); Ohio Adm. Code 3901-8-08; Ohio Rev. Code § 3923.332
An Ohio insurer pays agents a $100 commission in the second year of a Medicare supplement policy. Under Ohio Adm. Code 3901-8-08(S), the most it may pay as a first-year commission is:
1. A.$100
2. B.$300
3. C.$150
4. D.$200
Show answer
Answer: D. First-year commission or other compensation may be no more than 200% of what is paid for selling or servicing the policy in the second year. Renewal compensation must equal the second-year amount and be paid for at least five renewal years. When an existing policy is replaced, the agent may receive no more than the replacing issuer's renewal compensation. Compensation includes bonuses, gifts, prizes, awards and finder's fees, not only cash commissions.
Source: Ohio 11-35 outline 15.4: Medicare supplements, permitted compensation arrangements (OAC 3901-8-08); Ohio Adm. Code 3901-8-08
Which of these is an unfair or deceptive practice under Ohio Adm. Code 3901-8-09 when marketing Medicare supplement insurance?
1. A.Telling the buyer she may pay her premiums directly to the insurance company
2. B.Calling an existing client to review her current coverage
3. C.Leaving a flyer on a Medicare-eligible stranger's windshield in a parking lot
4. D.Sending a direct-mail advertisement that carries the required government disclaimer
Show answer
Answer: C. The rule bans unsolicited contacts with Medicare-eligible people. These include door-to-door solicitation and leaving leaflets at a residence or on a car, approaching people in common areas such as parking lots and lobbies, and unsolicited telephone calls and voicemails. The ban does not reach mass advertising such as direct mail, or contacts with people the agent already has a business relationship with. Agents must state, verbally and in writing, that the buyer may pay premiums directly to the insurer. Marketing material must carry the disclaimer 'Not connected with or endorsed by the U.S. government or the federal medicare program.'
Source: Ohio 11-35 outline 15.4: Solicitation of Medicare supplements (OAC 3901-8-09); Ohio Adm. Code 3901-8-09
Joan has had a Medicare supplement policy for two years and replaces it with another issuer's Medicare supplement policy. Under Ohio Adm. Code 3901-8-08(Z), the new policy:
1. A.May apply a new 90-day waiting period for sickness, but not for accidents
2. B.May exclude preexisting conditions for six months, the usual Medigap limit
3. C.May not apply any preexisting-condition, waiting, elimination or probationary period
4. D.Must credit only the last six months of her old coverage against a 12-month exclusion
Show answer
Answer: C. When a Medicare supplement policy replaces one that has been in effect for at least six months, the replacing policy may not impose any preexisting-condition, waiting, elimination or probationary period. If the old policy was in force for less time, the new issuer must credit the time already served. Before the policy is issued or delivered, the agent must give the applicant a replacement notice signed by both of them, and the issuer keeps a signed copy. Selling a policy that would leave someone with more than one Medicare supplement policy is prohibited (3901-8-08(X)).
Source: Ohio 11-35 outline 15.4: Medicare supplements, replacement (OAC 3901-8-08); Ohio Adm. Code 3901-8-08
Under Ohio Rev. Code § 3923.44(B) and (D), how may an Ohio long-term care policy treat preexisting conditions?
1. A.Look back 12 months, and exclude them for the first 12 months of coverage
2. B.Look back 6 months at most, and exclude them only for losses beginning in the first 6 months
3. C.Exclude a named condition permanently by rider if the applicant disclosed it
4. D.Look back 5 years, but exclude only conditions the applicant failed to disclose
Show answer
Answer: B. A long-term care policy may not define a preexisting condition more restrictively than one for which medical advice or treatment was recommended or received within the 6 months before coverage took effect. It may exclude a loss or confinement caused by such a condition only if it begins within 6 months after the effective date. The insurer may still ask for a full health history and underwrite on the answers. It may not use waivers or riders to exclude named conditions beyond that 6-month period. Ohio Adm. Code 3901-4-01(H) requires such limits to appear in a separate paragraph labelled 'Preexisting Condition Limitations.'
Source: Ohio 11-35 outline 15.6: Long-term care, pre-existing conditions (3923.44(B)(4),(5), (D)); Ohio Rev. Code § 3923.44; Ohio Adm. Code 3901-4-01
Before issuing Ruth an individual long-term care policy, an Ohio insurer gets her written designation of her son to receive lapse notices. Under Ohio Adm. Code 3901-4-01(G), if Ruth stops paying premiums, the policy cannot lapse unless the insurer:
1. A.Mails notice to Ruth alone, since the son's designation is only a courtesy
2. B.Phones Ruth's son at least 10 days before the grace period ends
3. C.Notifies the Department of Insurance 60 days before the lapse
4. D.Mails notice to Ruth and her son at least 30 days before the lapse date
Show answer
Answer: D. Notice of lapse for nonpayment must go by first-class mail to the insured and every designee at least 30 days before the lapse date. It may not be sent until a premium has been due and unpaid for 30 days, and it counts as given 5 days after mailing. The insurer must remind the insured at least once every two years of the right to change the designee, and an applicant may instead sign a waiver declining to name anyone. The policy must also allow reinstatement if, within 5 months after termination, the insurer receives proof of cognitive impairment or loss of functional capacity that began before the grace period ended.
Source: Ohio 11-35 outline 15.6: Long-term care, unintentional lapse (3901-4-01(G)); Ohio Adm. Code 3901-4-01
Under Ohio Adm. Code 3901-4-01(M), what inflation protection must an insurer offer with an individual long-term care policy, and when may the policy be issued without it?
1. A.5% simple for 20 years; left out if the buyer declines verbally
2. B.At least 5% compounded yearly; left out only if the policyholder signs a rejection
3. C.CPI-linked every five years; optional, with no paperwork needed
4. D.At least 3% simple yearly; left out if the agent notes the buyer is over 65
Show answer
Answer: B. At the time of purchase, the insurer must offer inflation protection at least as favorable as one of three designs. The first is benefits that rise at least 5% a year, compounded annually. The second is a guaranteed right to buy periodic increases without proof of insurability, of at least the 5%-compound amount, as long as the previous offer was not declined. The third is coverage of a percentage of actual or reasonable charges with no maximum indemnity. The 5% compound design is included in the policy unless the insurer obtains a signed rejection, in the application or on a separate form. Partnership policies have their own minimums under § 3923.44(O): 3% compound for buyers under 61, 3% simple or CPI from 61 to 75, and optional at 76 or older.
Source: Ohio 11-35 outline 15.6: Long-term care, inflation protection (3901-4-01(M)); Ohio Adm. Code 3901-4-01; Ohio Rev. Code § 3923.44
An Ohio agent meets a prospect to sell long-term care insurance. Under Ohio Adm. Code 3901-4-01(EE) and Ohio Rev. Code § 3923.44(I), when must the agent deliver the shopper's guide and the outline of coverage?
1. A.Only if the prospect asks for them
2. B.Before presenting an application or enrollment form
3. C.With the policy when it is delivered
4. D.Within 10 days after the application is signed
Show answer
Answer: B. Every prospective applicant must receive a long-term care shopper's guide in the NAIC format or one approved by the Superintendent. An agent must deliver it before presenting an application or enrollment form, while a direct-response insurer sends it with the application. The outline of coverage, with a notice that consumer information is available from the Department of Insurance, is also due at the initial solicitation, before the application is presented. Life policies with accelerated long-term care benefits give a policy summary instead of the shopper's guide.
Source: Ohio 11-35 outline 15.6: Long-term care, outline of coverage (3901-4-01(DD); 3923.44(I)) and shopper's guide (3901-4-01(EE)); Ohio Adm. Code 3901-4-01; Ohio Rev. Code § 3923.44

Where these questions come from: Ohio Life, Accident and Health agent exam outline (series 11-35, PSI bulletin updated 24 Mar 2026), sections 8.0: Accident and Health Insurance Basics (8%), 9.0: Individual Accident and Health Insurance Policy General Provisions (5%), 11.0: Medical Plans (6%), 12.0: Health Insuring Corporations (5%), 13.0: Group Accident and Health Insurance (5%) and 15.0: Insurance for Senior Citizens and Special Needs Individuals (8%). See how we write questions.