Free Wisconsin Accident & Health practice questions

Answer: B. At any time, but no more often than once each year after that point

Wisconsin requires a hospital or medical expense policy with a dependent limiting age to keep covering a child who cannot support himself or herself through employment because of intellectual disability or physical handicap and who depends chiefly on the insured for support. The insurer may require the insured to furnish proof of the incapacity and dependency within 31 days after the child reaches the limiting age and at any time after that, except that it may not demand proof more often than annually once the 2-year period following the limiting age has passed. Requests every 90 days or every 6 months after that period are too frequent, and the right to ask for proof continues past the first 2 years.

Answer: D. No more than 5 days

Wisconsin requires the employer to give the terminated insured written notice of the right to continue group coverage or convert to individual coverage, including the payment amounts and how, where and when to pay, within 5 days after the employer receives notice to terminate the coverage. The 30-day figure belongs to a different step: the terminated insured who elects continuation must pay the employer the required amount within 30 days after receiving the employer's notice. The statute sets no 7-day or 60-day period for the employer's notice.

Answer: C. 75 miles

Wisconsin prohibits a disability policy from excluding or limiting coverage for care received outside the state when the care is given within 75 miles of the insured's residence in a facility that the state where it sits has licensed or approved. The statute qualifies this with an exception by reference to Wis. Stat. Sec. 628.36, which this item does not test. None of 25, 50 or 100 miles is the distance the statute uses.

Answer: C. The insurer whose policy the flyer is advertising

Wisconsin's accident and sickness advertising rule places responsibility for every advertisement's content, form and method of distribution on the insurer whose policy is advertised, no matter who designed, wrote, printed or used it. The rule also requires the insurer to make its agents submit proposed advertisements for its approval before use. Who designed or paid for the flyer does not shift that responsibility to the agent or to the printer, and the rule does not make the commissioner responsible for an advertisement's content.

Answer: D. Set timelines for deciding both urgent requests and nonurgent requests for review

Under this Wisconsin statute, a health care plan or governmental self-insured plan that covers only certain specified prescription drugs or devices must give physicians a way to present medical evidence for an individual patient exception for a drug or device the plan does not routinely cover, and that process must include timelines for both urgent and nonurgent review. The statute does not require the insured to exhaust the formulary first, does not route exception requests to an independent review organization, and does not require the commissioner to approve each exception.

Answer: B. At least one person authorized to take corrective action and, if available, an insured other than the grievant

Wisconsin's grievance statute requires the panel that investigates each grievance to include at least one individual with authority to take corrective action, plus at least one insured who is not the person filing the grievance when an insured is available to serve. The statute does not place a physician or a representative of the commissioner's office on the panel. It also does not limit the panel to uninvolved claims staff, because an insured must be added when one is available. An independent review organization is not part of the internal grievance panel that this statute describes.

Answer: B. A term of up to 12 months and an aggregate of up to 18 months

Wisconsin generally requires individual health coverage to be renewed at the insured's option, but it exempts short-term bridge coverage whose term is no more than 12 months and whose total with the insurer's consecutive nonrenewable coverage of the same person does not exceed 18 months. Coverage periods count as consecutive when no more than 63 days separate them, and the coverage must also meet the commissioner's rules on such plans. The 6-month, 24-month and 36-month figures in the other options do not match either limit the statute sets.

Answer: D. It must give at least 180 days' notice before discontinuance and stay out of that market for 5 years.

When an insurer leaves a Wisconsin group market entirely, it must notify the commissioner, each employer or plan sponsor, and the covered participants and beneficiaries at least 180 days before coverage ends, and it may not issue or deliver any group health benefit plan in that market until 5 years after the last plan is discontinued. The 90-day notice period governs an insurer that drops only one particular type of group plan while staying in the market, and that narrower rule carries no 5-year bar, so neither 90-day option fits a full market exit. A 2-year bar does not match the statute.

Answer: B. 10 days

Wisconsin lets the holder of an individual or franchise disability policy send it back within 10 days after receiving it. When that happens the contract is void and every payment made under it is refunded. The 30-day return window is reserved for Medicare supplement, Medicare replacement and long-term care policies, which the stem rules out, so it does not apply to this policy. Neither 7 days nor 20 days is the period the statute sets for this right of return.

Answer: C. 10 eligible employees

Wisconsin's parity rule requires that the limits, deductibles, copayments and similar terms applied to treatment of nervous and mental disorders and alcohol and other drug abuse problems be no more restrictive than the most common limits applied to substantially all other coverage under the plan. An employer with a group health benefit plan may elect to exempt the plan from that parity rule for a plan year if it will have fewer than 10 eligible employees on the first day of the plan year. An exempt plan must promptly notify its enrollees and must still meet the coverage requirements of the 2007 version of the statute. The figures of 2, 20 and 50 are not the threshold this exemption uses.