KENTUCKY HEALTH INSURANCE
FINAL PAPER 2026 FULL QUESTIONS
AND ACCURATE SOLUTIONS STUDY
GUIDE
◉ What is a Peril? Answer: Perils are the causes of loss insured against
in an insurance policy
◉ What are the elements of risk? Answer: Loss must be (1) due to
chance; (2) definite and measurable; (3) statistical predictable; (4) not
catastrophic; (5) with large loss exposure; and (6) insurance cannot be
mandatory.
◉ What is the difference between a disability income and medical
expense policy? Answer: Medical expense policies cover the hospital
and medical expenses of covered injures or illnesses, whereas disability
income policies actually pay income to a person who must miss work as
the result of an injury or illness.
◉ Define accidental bodily injury Answer: Accidental bodily injury is a
unforeseen and unintended injury that resulted from an accident rather
than a sickness
◉ In what ways can accidental death and dismemberment coverage be
written? Answer: AD&D coverage can be written as a rider or a
separate policy.
,◉ Under accidental death and dismemberment coverage, when would
the capital amount be paid? When would the principal amount be
paid? Answer: The principal sum is paid for accidental death. In the
case of loss of sight or accidental dismemberment, a percentage of that
principal sum will be paid by the policy, often referred to as the capital
sum.
◉ Explain the concept of coverage on first-dollar basis Answer: First-
dollar coverage does not require the insured to pay a deductible
◉ What is the difference between reimbursement and scheduled
benefit payment? Answer: In reimbursement plans, the expenses are
reimbursed directly to the insured for the services provided. In
scheduled benefits plans, the insurer pays up to a certain amount. for
the services, as determined on a schedule for the cost of each
treatment.
◉ What are some common exclusions and limitations in medical
expense policies? Answer: War and active duty military, intentionally
self-inflicted injuries, pre-existing conditions, elective cosmetic surgery,
injuries as a result of participating in criminal activities, and conditions
covered by workers compensation or government plans.
◉ What coverages are provided by a Major Medical Expense policy?
Answer: After basic policy pays, the supplemental major medical will
provide coverage for expenses that were not covered by the basic
, policy, and expenses that exceed the maximum. If the time limitation is
used up by the basic policy, the supplemental coverage will provide
coverage thereafter.
◉ How does restoration of benefits work? Answer: Major medical
policies include a provision that restores a specific dollar amount at
certain intervals after the lifetime limit of coverage has been exhausted
if the insured maintains the policy claim-free for a given period of time.
◉ Once a disability policy is paying a claim, how long will it pay?
Answer: Disability income insurance is designed to provide a
reasonable and predetermined income to a disabled party for a set
period of time subject to a "time deductible" termed an elimination
period.
◉ What is the difference between own occupation and any
occupation? Answer: A policy that has "any occupation" provision will
only provide benefits when the insured is unable to perform any
occupation for which they are suited by reason of education, training,
or experience. "own occupation" is the more liberal definition and
therefore provides a better benefit for the insured.
◉ What is the difference between occupational and nonoccupational
coverage? Answer: Occupational coverage provides benefits for
disabilities resulting from accidents or sickness that occur on or off the
job. Nonoccupational coverage, on the other hand, only covers
disabilities that result from accidents or sickness occurring off the job.
FINAL PAPER 2026 FULL QUESTIONS
AND ACCURATE SOLUTIONS STUDY
GUIDE
◉ What is a Peril? Answer: Perils are the causes of loss insured against
in an insurance policy
◉ What are the elements of risk? Answer: Loss must be (1) due to
chance; (2) definite and measurable; (3) statistical predictable; (4) not
catastrophic; (5) with large loss exposure; and (6) insurance cannot be
mandatory.
◉ What is the difference between a disability income and medical
expense policy? Answer: Medical expense policies cover the hospital
and medical expenses of covered injures or illnesses, whereas disability
income policies actually pay income to a person who must miss work as
the result of an injury or illness.
◉ Define accidental bodily injury Answer: Accidental bodily injury is a
unforeseen and unintended injury that resulted from an accident rather
than a sickness
◉ In what ways can accidental death and dismemberment coverage be
written? Answer: AD&D coverage can be written as a rider or a
separate policy.
,◉ Under accidental death and dismemberment coverage, when would
the capital amount be paid? When would the principal amount be
paid? Answer: The principal sum is paid for accidental death. In the
case of loss of sight or accidental dismemberment, a percentage of that
principal sum will be paid by the policy, often referred to as the capital
sum.
◉ Explain the concept of coverage on first-dollar basis Answer: First-
dollar coverage does not require the insured to pay a deductible
◉ What is the difference between reimbursement and scheduled
benefit payment? Answer: In reimbursement plans, the expenses are
reimbursed directly to the insured for the services provided. In
scheduled benefits plans, the insurer pays up to a certain amount. for
the services, as determined on a schedule for the cost of each
treatment.
◉ What are some common exclusions and limitations in medical
expense policies? Answer: War and active duty military, intentionally
self-inflicted injuries, pre-existing conditions, elective cosmetic surgery,
injuries as a result of participating in criminal activities, and conditions
covered by workers compensation or government plans.
◉ What coverages are provided by a Major Medical Expense policy?
Answer: After basic policy pays, the supplemental major medical will
provide coverage for expenses that were not covered by the basic
, policy, and expenses that exceed the maximum. If the time limitation is
used up by the basic policy, the supplemental coverage will provide
coverage thereafter.
◉ How does restoration of benefits work? Answer: Major medical
policies include a provision that restores a specific dollar amount at
certain intervals after the lifetime limit of coverage has been exhausted
if the insured maintains the policy claim-free for a given period of time.
◉ Once a disability policy is paying a claim, how long will it pay?
Answer: Disability income insurance is designed to provide a
reasonable and predetermined income to a disabled party for a set
period of time subject to a "time deductible" termed an elimination
period.
◉ What is the difference between own occupation and any
occupation? Answer: A policy that has "any occupation" provision will
only provide benefits when the insured is unable to perform any
occupation for which they are suited by reason of education, training,
or experience. "own occupation" is the more liberal definition and
therefore provides a better benefit for the insured.
◉ What is the difference between occupational and nonoccupational
coverage? Answer: Occupational coverage provides benefits for
disabilities resulting from accidents or sickness that occur on or off the
job. Nonoccupational coverage, on the other hand, only covers
disabilities that result from accidents or sickness occurring off the job.
