STUDY GUIDE · ACCIDENT & HEALTH INSURANCE

Accident & Health Insurance Agent Exam Study Guide

Verified against the official content outline July 18, 202614 sections

Written by Every Exam Prep Editorial TeamSource and review policyPublished July 7, 2026Updated July 8, 2026

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Questions: 75
Time limit: 1h 45m
Passing score: 60% (CA) / 70% typical
Exam fee: $55
Governing body: State DOI

The California Accident & Health licensing exam contains 75 questions with a 105-minute time limit, and you need a score of 60 percent to pass. The producer exam fee is $55.

Do the math before you walk in: 60 percent of 75 questions means you must answer 45 questions correctly — you can miss up to 30 and still pass. The time limit works out to 1.4 minutes (84 seconds) per question, which is generous for a multiple-choice exam. The practical strategy that follows:

Answer every question — with 30 misses allowed, an educated guess costs you nothing.
Make one full pass answering everything you know cold, then return to flagged questions with the time you banked.
Don't let any single scenario question eat more than three minutes; mark it and move on.

What the exam looks like

The California Accident & Health (Health-Only) Insurance Agent licensing exam is a multiple-choice test that you take at a state-approved testing center. Knowing the exact structure before you walk in removes surprises and lets you build a realistic pacing plan.

Number of questions: 75 questions
Time limit: 105 minutes
Passing score: 60 percent
Exam fee: $55

Because the passing threshold is 60 percent, you can miss a meaningful number of questions and still pass — but do not treat that as permission to skip topics. Broad, even coverage is safer than deep mastery of a few areas, since the questions are drawn across the full syllabus.

Plan-structure questions test whether you can match cost-sharing and access rules to the right plan type. Learn these three as a contrast set.

Major Medical

Major medical plans cover hospital, surgical, and physician expenses subject to three cost-sharing layers: a deductible, coinsurance, and an out-of-pocket maximum. Exam questions often walk you through a claim in exactly that order — the deductible is paid first, coinsurance splits the next layer, and the out-of-pocket maximum caps what the insured can be required to pay.

HMO

An HMO emphasizes prepaid care through a network and typically requires members to use a primary care physician as a gatekeeper for referrals. "Gatekeeper" is the trigger word: if a question mentions needing a referral from a primary care physician to see a specialist, the answer is HMO.

PPO

A PPO offers a network with lower cost-sharing in-network but still allows out-of-network care at a higher cost. That flexibility is the key distinction from an HMO: a PPO member can go outside the network and remain covered, just at greater expense.

Budget your time per question

With 75 questions and a 105-minute limit, you have an average of 1.4 minutes — roughly 84 seconds — per question. That is comfortable for straightforward recall items but tight if you get stuck.

First pass: Answer every question you know quickly. Flag anything that requires calculation or careful reading.
Second pass: Return to flagged questions with the time you banked from the easy ones.
Final check: Never leave a question blank — an unanswered question is scored the same as a wrong one, and there is no penalty for guessing.

To pass at 60 percent of 75 questions, you need at least 45 correct answers. Aim well above that in practice so exam-day nerves still leave you a margin.

These two coverages replace income or fund care when illness or injury — not death — is the loss. The exam tests their benefit triggers.

Disability Income

Disability income insurance replaces a portion of lost earnings after an elimination period — a waiting period that functions like a time deductible before benefits begin. Policies define disability one of two ways: own-occupation (unable to perform your own job) or any-occupation (unable to perform any job). Own-occupation is the easier standard for the insured to meet, so expect questions asking which definition is more favorable to the claimant.

Long-Term Care

Long-term care insurance covers custodial and skilled care and pays benefits when the insured cannot perform a stated number of activities of daily living (ADLs). The ADL count is the benefit trigger — a question describing someone who can no longer bathe or dress independently is pointing you at the LTC trigger, not a disability income definition.

What it costs to sit

The producer exam fee is $55. Budget for this each time you sit — if you do not pass on the first attempt, you will typically pay the fee again to retake, so preparing thoroughly the first time is the most cost-effective strategy.

The $55 is the exam fee itself and is generally separate from other licensing costs such as pre-licensing education, fingerprinting/background-check fees, and the license application fee. Confirm the full current fee schedule with the California Department of Insurance before you register so there are no surprises.

Work backward from the target

Your goal is 60 percent — at least 45 of the 75 questions correct. Build every practice session around beating that bar with room to spare, targeting 75–80 percent on practice tests so that a bad day still clears the real threshold.

A simple weekly structure

Learn the concepts: Work through accident and health insurance fundamentals — policy provisions, disability income, medical expense coverage, and applicable regulations.
Practice under timed conditions: Simulate the real constraint of 75 questions in 105 minutes so pacing becomes automatic.
Review misses: For every wrong answer, write down why the correct answer is correct — understanding the reasoning beats memorizing.

Because the exam is only 75 questions, a handful of weak topics can disproportionately affect your score. Track your accuracy by subject and spend extra time wherever you dip below your 45-correct safety margin.

Underwriting questions reward precise knowledge of when and for whom requirements apply.

Insurable Interest

In life insurance, insurable interest must exist only at the inception of the policy — not at the time of loss. This timing rule is a classic exam trap.
A person is presumed to have unlimited insurable interest in their own life.

Risk Classification

After evaluating an applicant, the insurer classifies them as preferred, standard, or substandard — or declines the risk. Know all four outcomes; a question may ask what happens to an applicant who doesn't fit any acceptable class.

Information Sources and Applicant Rights

The MIB (Medical Information Bureau) is a nonprofit database of coded medical impressions shared among member insurers. It is not a credit bureau and not a government agency — distractors often mislabel it.
Under the Fair Credit Reporting Act, an insurer that obtains a consumer or investigative report must notify the applicant, who has the right to know the nature of the information collected.

Beneficiary questions are order-of-succession questions. Master the chain:

A primary beneficiary is first in line; a contingent beneficiary receives proceeds only if the primary predeceases the insured.
If no beneficiary survives, proceeds are paid to the insured's estate.

Also distinguish control over the designation itself:

A revocable beneficiary can be changed by the owner at any time.
An irrevocable beneficiary must consent before the owner can make a change.

Scenario questions typically kill off beneficiaries in sequence and ask where the money goes — walk the chain from primary, to contingent, to estate, and check whether any change of beneficiary in the fact pattern required an irrevocable beneficiary's consent.

These provisions appear on nearly every licensing exam, usually as "which provision applies" scenarios. Each one pairs a trigger with a fixed outcome.

Grace period: typically 30 or 31 days after a missed premium, during which coverage stays in force.
Incontestability: after the policy has been in force for two years, the insurer cannot contest it for misstatements or concealment — except for nonpayment of premium.
Suicide clause: excludes suicide during the first two years, limiting the insurer's liability to a refund of premiums paid.
Misstatement of age: the death benefit is adjusted to what the premium paid would have purchased at the correct age — the claim is not denied.
Nonforfeiture options: guarantee the accumulated cash value through cash surrender, reduced paid-up insurance, or extended term.

Note the contrast the exam loves: misstatement of age adjusts the benefit even after the contestable period, while a two-year-old policy otherwise cannot be contested. And the suicide clause refunds premiums rather than paying the face amount — don't confuse the two remedies.

Rider questions are matching exercises — each rider has one trigger and one benefit. Learn them as pairs:

Waiver of premium: waives premiums if the insured becomes totally disabled.
Guaranteed insurability: lets the insured buy additional coverage at set intervals without evidence of insurability.
Accelerated death benefit: advances part of the death benefit if the insured is diagnosed as terminally ill.

Watch the trigger words: "totally disabled" points to waiver of premium, "without evidence of insurability" points to guaranteed insurability, and "terminally ill" points to accelerated death benefit. Distractor answers swap the triggers between riders.

Even on an accident-and-health-focused exam, general product knowledge shows up in cross-cutting questions. Organize the products along two axes: does it build cash value, and who bears the investment risk.

Term

Term insurance covers a specified period, pays a death benefit only if the insured dies within that term, and builds no cash value — making it the least expensive form per dollar of coverage. Decreasing term reduces the death benefit over time and is the classic answer for covering a mortgage, since the debt shrinks alongside the benefit.

Whole Life

Whole life features a level premium, a guaranteed death benefit, and a guaranteed cash value that grows on a fixed schedule. At maturity — typically age 100 or 121 — the cash value equals the face amount.

Universal Life

Universal life is flexible-premium permanent insurance that separates the mortality, expense, and interest components, letting the owner adjust premiums and death benefits within limits. Its cash value earns a current interest rate subject to a contractual guaranteed minimum.

Variable Life

Variable life invests cash value in separate account subaccounts, so values fluctuate with performance and the policyowner bears the investment risk. Because it is a security, its sale requires a FINRA registration in addition to a life license — a heavily tested licensing detail.

An annuity liquidates a principal sum into a stream of income and is the mathematical opposite of life insurance: it protects against outliving one's assets rather than dying too soon. That "opposite of life insurance" framing is itself a common exam question.

Fixed vs. Variable

A fixed annuity guarantees a minimum interest rate and a fixed payout, with the insurer bearing the investment risk. A variable annuity invests in separate accounts, shifts the investment risk to the owner, and is a security requiring registration. Notice the parallel with fixed-schedule whole life versus variable life — "separate account" is the signal that risk sits with the owner and a securities registration applies.

Payout Options

The life-only payout provides the largest payment but ceases at death. The trade-off logic to remember: the fewer guarantees the insurer makes to survivors, the larger each payment to the annuitant.

Tax questions follow a small set of rules. Anchor on the defaults, then learn the exceptions.

Life Insurance

A death benefit paid to a named beneficiary in a lump sum is generally received income-tax-free.
Under a settlement option, the principal remains tax-free but any interest earned is taxable.
Premiums for personal life insurance are not tax-deductible.
A modified endowment contract (MEC) — a policy that fails the seven-pay test by being overfunded — loses favorable treatment: loans and withdrawals are taxed LIFO (earnings out first) and may incur a 10% penalty before age 59½.

Annuities

Annuity payments are taxed under the exclusion ratio: each payment is part tax-free return of principal and part taxable earnings, taxed as ordinary income.
Withdrawals before age 59½ generally incur a 10% early-withdrawal penalty.
A 1035 exchange lets an owner swap one life or annuity contract for another of like kind without triggering current tax.

Group Life

Employer-paid group life coverage up to $50,000 is tax-free to the employee; the cost of coverage above that is reported as imputed income.

Memory hook: death benefits and principal come back tax-free; earnings and interest are what get taxed — and overfunding (MEC) or early access (pre-59½) is what triggers penalties.

Accident & Health Insurance flashcards

32 cards on the highest-yield terms and rules. Grading uses spaced repetition and saves in this browser.

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How much time are you given to complete the exam?
105 minutes.
What score do you need to pass?
60 percent.
What is the producer exam fee?
$55.
Roughly how much time do you have per question on average?
About 1.4 minutes per question (105 minutes ÷ 75 questions), so keep a steady pace and flag tough items to revisit.
How many questions can you miss and still pass?
With a 60% passing bar on 75 questions, you must answer at least 45 correctly, so you can miss up to 30.
Difference between a deductible and coinsurance?
A deductible is a fixed amount the insured pays before the policy pays; coinsurance is the percentage of covered costs the insured shares after the deductible is met.
Term: Guaranteed renewable policy
The insurer must renew the policy as long as premiums are paid and cannot change an individual insured's coverage, though it may raise premiums for an entire class.
Term: Pre-existing condition
A medical condition for which the insured received care or advice before the policy's effective date; it may be subject to a waiting or exclusion period.
What are the four core exam logistics facts to memorize?
75 questions, 105 minutes, 60% to pass, and a $55 producer exam fee.
How many questions are on the California Accident & Health Insurance Agent exam?
75 questions.
Term: Indemnity (in health insurance)
A benefit that pays a fixed dollar amount for a covered event (e.g., a set amount per hospital day) regardless of the actual expense incurred.
Term: Elimination period
A waiting period after a disability begins before disability income benefits start to be paid; it functions like a time deductible.
Term: HMO vs. PPO
An HMO typically requires using in-network providers and a primary-care referral for specialists; a PPO offers more provider flexibility and out-of-network coverage at higher cost.
Term: Waiver of premium
A provision that keeps a policy in force without further premium payments while the insured is totally disabled.
Term: Stop-loss (out-of-pocket maximum)
A limit on the total the insured must pay in a period; once reached, the insurer pays 100% of remaining covered expenses.
What is a Preferred Provider Organization (PPO)?
A network-based health plan offering lower out-of-pocket costs when using in-network providers while still covering out-of-network providers at higher costs and higher patient responsibility.
What is a waiver of premium rider?
A rider that waives all future insurance premiums if the insured becomes totally disabled, keeping the policy in force at no additional cost during the disability period.
Define a guaranteed renewable clause.
A contract provision guaranteeing the insured's right to renew coverage at the end of each period (typically annually) without the insurer being able to decline renewal, though rates may increase on a class basis.
What is the key difference between guaranteed and non-guaranteed renewable policies?
Guaranteed renewable policies cannot be canceled and must be renewed; non-guaranteed renewable policies allow the insurer to decline renewal or cancel coverage at the end of the term for any reason.
What does the free look period allow?
The free look period (typically 10-14 days) allows applicants to review a newly purchased policy and return it for a full refund if unsatisfied, no questions asked.
Define benefit period in health insurance.
The time period during which benefits are available—often called the waiting or elimination period. It is the timespan from the incurred loss until benefits begin to be paid under the policy.
What is a deductible?
The amount of covered medical expenses the insured must pay out-of-pocket before the insurance coverage begins to pay benefits.
How does coinsurance work?
A cost-sharing arrangement where the insured pays a fixed percentage of covered medical expenses (e.g., 20%) after meeting the deductible, while the insurer pays the remaining percentage (e.g., 80%).
What is a copay?
A fixed dollar amount the insured must pay for specific medical services (e.g., $25 for an office visit) regardless of the actual cost, often due at the time of service.
Define out-of-pocket maximum.
The maximum total amount an insured must pay for covered medical expenses in a given year; once reached, the insurer typically pays 100% of additional covered expenses for the remainder of the year.
What is prior authorization?
A requirement that the insured or healthcare provider obtain approval from the insurance company before receiving certain medical services or procedures to verify medical necessity.
What is coordination of benefits?
A provision in health insurance that determines the order of payment when a person is covered by multiple insurance policies, ensuring benefits do not exceed the actual medical expenses.
What does HIPAA privacy rule protect?
Protected health information (PHI) of individuals—HIPAA protects the privacy, security, and breach notification of PHI by covered entities and business associates.
Define an explanation of benefits (EOB).
A document the insurer sends to the insured detailing what services were provided, what was covered, what was not covered, and the breakdown of charges between insured and insurer.
What is an underwriting guideline?
A set of standards and criteria used by insurance companies to evaluate an applicant's health, medical history, occupation, and other risk factors to determine insurability and premium rates.
What is a health savings account (HSA)?
A tax-advantaged savings account available to individuals enrolled in high-deductible health plans (HDHPs) that allows them to save pre-tax money for qualified medical expenses.
Define a Health Maintenance Organization (HMO).
A managed care plan requiring members to use only network providers and to select a primary care physician (PCP) who coordinates all care; typically has lower premiums but limited provider choice.

Accident & Health Insurance glossary

The Accident & Health Insurance Agent Exam is California's licensing examination administered by the California Department of Insurance, consisting of 75 questions with a 105-minute time limit and a $55 producer exam fee. It measures a candidate's knowledge and requires a 60 percent score to qualify for a license to sell health insurance.

29 terms the Accident & Health Insurance tests, defined in plain English.

Accident and Health Insurance: A category of coverage that pays benefits for losses resulting from accidental injury, sickness, or disability. It includes products like medical expense, disability income, and long-term care insurance.
Beneficiary: The person or entity designated to receive the policy benefits when a covered event occurs or upon the insured's death. The policyowner controls who is named and can change this designation.
Coinsurance: A cost-sharing arrangement in which the insured and insurer split covered expenses by a set percentage (for example, 80/20) after the deductible is met. The insured's share typically continues until an out-of-pocket maximum is reached.
Contestability Period: A limited time after policy issuance during which the insurer can review the application and deny claims if material misstatements or omissions are discovered. After this period expires, the policy is considered incontestable.
Coordination of Benefits: A provision that prevents an insured from recovering more than 100 percent of actual medical expenses when multiple policies cover the same claim. The insurers work together to ensure appropriate apportionment of benefits.
Copayment: A flat, predetermined fee the insured pays for a specific covered service, such as a doctor visit or prescription. It is paid at the time the service is received.
Deductible: The fixed dollar amount the insured must pay out of pocket for covered services before the insurer begins to pay. It typically resets on a defined period, usually annually.
Disability Income Insurance: Coverage that replaces a portion of the insured's income when they cannot work due to sickness or injury. Benefits are typically paid monthly after the elimination period.
Elimination Period: A waiting period at the start of a disability or long-term care claim during which no benefits are paid. It functions like a time-based deductible before benefits begin.
Exclusion: A specific condition, treatment, or circumstance that is not covered by the insurance policy. Examples include cosmetic procedures or self-inflicted injuries that are explicitly excluded from coverage.
Grace Period: A designated time period after the premium due date during which the policyowner can pay a late premium without losing coverage. The policy remains active during this period.
Health Insurance Portability and Accountability Act (HIPAA): Federal legislation that protects patient privacy, restricts pre-existing condition exclusions, and ensures continuation of coverage when employees lose jobs. It establishes standards for health information security and insured rights.
Incontestability Clause: A policy provision that prevents the insurer from denying claims based on misstatements in the application after a set time period (usually 2 years). It protects the insured from challenges after the contestability period ends.
Indemnity Insurance: Insurance that reimburses the insured for actual losses incurred due to a covered event, up to the policy limit. The insured is 'made whole' but cannot profit from the loss.
Insurable Interest: A legitimate financial or personal stake in the continued health or life of the insured that must exist for a policy to be valid. It prevents insurance from being used as a wager.
Lapse: The termination of an insurance policy due to nonpayment of the premium after the grace period expires. Once lapsed, the policy is no longer in force and coverage ends.
Limit of Liability: The maximum dollar amount an insurance policy will pay for covered losses. Once this limit is reached, the insurer has no further obligation to pay benefits under that policy.
Medical Underwriting: The detailed evaluation of an applicant's health status through questionnaires, medical exams, and records review to assess insurability and set appropriate rates. It differs from non-medical or guaranteed-issue coverage.
Network Provider: A healthcare provider (doctor, hospital, clinic) that has contracted with an insurance company to provide services at negotiated rates. Using in-network providers typically results in lower out-of-pocket costs for the insured.
Out-of-Pocket Maximum: The total dollar amount the insured must pay in deductibles, copayments, and coinsurance before the insurer pays for covered services at 100 percent. Once reached, the insurance company pays all remaining eligible expenses for that plan year.
Passing Score: The minimum percentage of correct answers needed to pass the licensing exam. In California a candidate must score 60 percent to pass, answering the 75-question exam within a 105-minute time limit.
Pre-Existing Condition: A medical condition that existed before the insured enrolled in a health insurance policy. Insurers may exclude or limit coverage for such conditions during a waiting period, though federal law restricts how they can be treated.
Premium: The amount of money the policyowner pays the insurer, on a set schedule, to keep coverage in force. Missing a premium payment can cause the policy to lapse.
Producer Exam Fee: The fee California charges to sit for the producer licensing exam. The producer exam fee is $55.
Renewability: The insurance company's right or obligation to renew a policy at the end of its term. A 'conditionally renewable' policy can be renewed at the insurer's discretion, while 'guaranteed renewable' policies must be renewed unless specific conditions occur.
Rider: An optional provision added to a policy that expands, limits, or modifies its coverage. Common examples include a waiver of premium rider or a guaranteed insurability rider.
Subrogation: The insurer's legal right to recover benefits it has paid by pursuing a third party responsible for the insured's loss. This prevents the insured from recovering twice for the same injury.
Underwriting: The process by which an insurer evaluates an applicant's risk to decide whether to issue coverage and at what premium. It relies on health history, applications, and sometimes medical exams.
Waiting Period: A specified time period during which certain benefits are not paid, commonly used in disability or long-term care coverage. It protects insurers from short-term claims and is similar to but broader than an elimination period.

Frequently asked questions

How many questions are on the Accident & Health Insurance Agent Exam and how long do I have?

The exam contains 75 questions, and you are given a 105-minute time limit to complete them. That works out to roughly 1.4 minutes per question, so you should keep a steady pace and flag harder items to revisit rather than getting stuck early.

What score do I need to pass?

You need a score of 60 percent to pass. On a 75-question exam, that means you must answer at least 45 questions correctly, so you can miss up to 30 and still pass. Aim comfortably above that threshold to leave a safety margin for tricky questions.

How much does the exam cost?

The producer exam fee is $55. Budget for this fee each time you sit for the exam — if you don't pass on your first attempt, you'll typically need to pay the fee again to retake it, so preparing thoroughly the first time saves money.

How should I pace myself during the exam?

With 75 questions and a 105-minute limit, you have about 1.4 minutes per question on average. A good strategy is to move quickly through questions you know, mark uncertain ones, and reserve the final 10–15 minutes to review flagged items and confirm you've answered every question, since you only need 60 percent correct to pass.

Official sources

Primary documents used to verify the exam details shown on this page.

California Accident & Health ExamCalifornia DOI / PSIinsurance.ca.gov
NAIC — Producer Licensing and Health Insurance RegulationNational Association of Insurance Commissionerscontent.naic.org
NIPR — Producer Licensing and RenewalsNational Insurance Producer Registrynipr.com
PSI Exams — Insurance Licensure Test DeliveryPSI Servicespsiexams.com
Consumer Information Guides — Health InsuranceCalifornia Department of Insuranceinsurance.ca.gov

Last verified against the official exam content outline: July 18, 2026