Wisconsin Health Insurance Exam Practice
Questions with Definitive Solutions
Accident - Answer An unplanned, unforeseen event which occurs suddenly and at an unspecified place.
Accident Insurance - Answer A type of insurance that protects the insured against loss due to accidental
bodily injury.
Accidental Bodily Injury - Answer Unplanned, unforeseen traumatic injury to the body.
Accidental Death and Dismemberment - Answer An insurance policy which pays a specified amount or a
specified multiple of the insured's benefit if the insured dies, loses his/her sight, or loses two limbs due
to an accident.
Accidental Death Benefits - Answer A policy rider that states that the cause of death will be analyzed to
determine if it complies with the policy description of accidental death.
Acquired Immunodeficiency Syndrome (AIDS) - Answer An infectious and incurable disease caused by
the human immunodeficiency virus (HIV).
Activities of Daily Living - Answer Activities individuals must do every day such as moving about, getting
dressed, eating, bathing, etc.
Actual Charge - Answer The amount a physician or supplier actually bills for a particular service or
supply.
Adhesion - Answer A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of
the insured.
Admitted (Authorized) Insurer - Answer An insurance company authorized and licensed to transact
insurance in a particular state.
,Adult Day Care - Answer A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
Adverse Selection - Answer The tendency of risks with higher probability of loss to purchase and
maintain insurance more often than the risks who present lower probability.
Agent - Answer An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of
an insurer.
Aleatory - Answer A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the
insurer will pay in the event of a loss.
Alien Insurer - Answer An insurance company that is incorporated outside the United States.
Alzheimer's Disease - Answer A disease that causes the victim to become dysfunctional due to
degeneration of brain cells and severe memory loss.
Ancillary - Answer Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia,
and lab work, but not hospital room and board.
Apparent Authority - Answer The appearance or the assumption of authority based on the actions,
words, or deeds of the principal or because of circumstances the principal created.
Approved Amount - Answer The amount Medicare determines to be reasonable for a service that is
covered under Part B of Medicare.
Assignment - Answer A claim to a provider or medical supplier to receive payments directly from
Medicare.
Attained Age - Answer The age of the insured at a determined date.
, Attending Physician's Statement (APS) - Answer A statement usually obtained from the applicant's
doctor.
Avoidance - Answer A method of dealing with risk (e.g. if a person wanted to avoid the risk of being
killed in an airplane crash, he/she might choose never to fly in a plane).
Basic Hospital Expense Insurance - Answer Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay.
Basic Medical Expense Insurance - Answer Coverage for doctor visits, x-rays, lab tests, and emergency
room visits; benefits, however, are limited to specified dollar amounts.
Beneficiary - Answer The person who receives the proceeds from the policy when the insured dies.
Benefit Period - Answer The length of time over which the insurance benefits will be paid for each
illness, disability or hospital stay.
Birthday Rule - Answer The method of determining primary coverage for a dependent child, under which
the plan of the parent whose birthday occurs first in the calendar year, is designated as primary.
Blanket Medical Insurance - Answer A policy that provides benefits for all medical costs, including doctor
visits, hospitalization, and drugs.
Boycott - Answer An unfair trade practice in which one person refuses to do business with another until
he or she agrees to certain conditions.
Buyer's Guide - Answer A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
Cafeteria Plan - Answer A selection of health care benefits from which an employee may choose the
ones that he/she needs.
Questions with Definitive Solutions
Accident - Answer An unplanned, unforeseen event which occurs suddenly and at an unspecified place.
Accident Insurance - Answer A type of insurance that protects the insured against loss due to accidental
bodily injury.
Accidental Bodily Injury - Answer Unplanned, unforeseen traumatic injury to the body.
Accidental Death and Dismemberment - Answer An insurance policy which pays a specified amount or a
specified multiple of the insured's benefit if the insured dies, loses his/her sight, or loses two limbs due
to an accident.
Accidental Death Benefits - Answer A policy rider that states that the cause of death will be analyzed to
determine if it complies with the policy description of accidental death.
Acquired Immunodeficiency Syndrome (AIDS) - Answer An infectious and incurable disease caused by
the human immunodeficiency virus (HIV).
Activities of Daily Living - Answer Activities individuals must do every day such as moving about, getting
dressed, eating, bathing, etc.
Actual Charge - Answer The amount a physician or supplier actually bills for a particular service or
supply.
Adhesion - Answer A contract offered on a "take-it-or-leave-it" basis by an insurer, in which the insured's
only option is to accept or reject the contract. Any ambiguities in the contract will be settled in favor of
the insured.
Admitted (Authorized) Insurer - Answer An insurance company authorized and licensed to transact
insurance in a particular state.
,Adult Day Care - Answer A program for impaired adults that attempts to meet their health, social, and
functional needs in a setting away from their homes.
Adverse Selection - Answer The tendency of risks with higher probability of loss to purchase and
maintain insurance more often than the risks who present lower probability.
Agent - Answer An individual who is licensed to sell, negotiate, or effect insurance contracts on behalf of
an insurer.
Aleatory - Answer A contract in which participating parties exchange unequal amounts. Insurance
contracts are aleatory in that the amount the insured will pay in premiums is unequal to the amount the
insurer will pay in the event of a loss.
Alien Insurer - Answer An insurance company that is incorporated outside the United States.
Alzheimer's Disease - Answer A disease that causes the victim to become dysfunctional due to
degeneration of brain cells and severe memory loss.
Ancillary - Answer Additional, miscellaneous services provided by a hospital, such as x-rays, anesthesia,
and lab work, but not hospital room and board.
Apparent Authority - Answer The appearance or the assumption of authority based on the actions,
words, or deeds of the principal or because of circumstances the principal created.
Approved Amount - Answer The amount Medicare determines to be reasonable for a service that is
covered under Part B of Medicare.
Assignment - Answer A claim to a provider or medical supplier to receive payments directly from
Medicare.
Attained Age - Answer The age of the insured at a determined date.
, Attending Physician's Statement (APS) - Answer A statement usually obtained from the applicant's
doctor.
Avoidance - Answer A method of dealing with risk (e.g. if a person wanted to avoid the risk of being
killed in an airplane crash, he/she might choose never to fly in a plane).
Basic Hospital Expense Insurance - Answer Coverage that provides benefits for room, board and
miscellaneous hospital expenses for a certain number of days during a hospital stay.
Basic Medical Expense Insurance - Answer Coverage for doctor visits, x-rays, lab tests, and emergency
room visits; benefits, however, are limited to specified dollar amounts.
Beneficiary - Answer The person who receives the proceeds from the policy when the insured dies.
Benefit Period - Answer The length of time over which the insurance benefits will be paid for each
illness, disability or hospital stay.
Birthday Rule - Answer The method of determining primary coverage for a dependent child, under which
the plan of the parent whose birthday occurs first in the calendar year, is designated as primary.
Blanket Medical Insurance - Answer A policy that provides benefits for all medical costs, including doctor
visits, hospitalization, and drugs.
Boycott - Answer An unfair trade practice in which one person refuses to do business with another until
he or she agrees to certain conditions.
Buyer's Guide - Answer A booklet that describes insurance policies and concepts, and provides general
information to help an applicant make an informed decision.
Cafeteria Plan - Answer A selection of health care benefits from which an employee may choose the
ones that he/she needs.
