Accident & Health FundamentalsQuestion 7 of 716
A 45-year-old applicant with a history of diabetes applies for an individual ACA-compliant health policy through Covered California. The insurer may:
a.Exclude diabetes-related claims during the first 12 months of coverage
b.Deny the application outright as an uninsurable medical risk
c.Charge a 50% premium surcharge for the pre-existing condition
d.Not deny coverage or charge a higher premium based on the diabetes
Explanation
Since 2014, the ACA has prohibited individual and group market insurers from denying coverage, charging higher premiums, or excluding benefits based on any pre-existing condition. Permitted rating factors are limited to age, geography, family size, and tobacco use.
Law Reference: 42 U.S.C. §300gg-3 (ACA pre-existing conditions)This topic, taught in full in the California Life & Health Insurance Producer Exam guide. California Life & Health Insurance Producer Exam — Complete Study Guide (2026) — PDF + EPUB, $19.99 · 14-day refund →
Practice all 716 questions free — no signup required.
Own the complete California Life & Health Insurance Producer Exam guide — PDF + EPUB, $19.99 →
Related questions on this topic
- Cal-COBRA differs from federal COBRA primarily because it:
- To be eligible to contribute to a Health Savings Account (HSA), an individual must be covered by:
- Under the ACA metal-tier framework, a silver plan must cover what approximate percentage of the average enrollee's covered medical costs (its actuarial value)?
- Under the ACA, a group health plan that offers dependent coverage must make that coverage available to an enrolled employee's adult child until the child reaches age:
- Which of the following is NOT one of the ten Essential Health Benefits categories that an ACA-compliant individual or small group plan must cover?
- A health plan has a $2,000 deductible, 20% coinsurance, and a $7,500 out-of-pocket maximum. Once the insured reaches the out-of-pocket maximum, in-network covered services for the rest of the plan year are paid at:
Last reviewed: · editorial process
PrepPass team · Verified against California Life & Health Insurance License Exam · How we review
Reviewed by John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verify)