Tennessee Accident and Health Exam: Full Content Breakdown and Strategy Guide

The Tennessee Accident and Health licensing exam is administered by Pearson VUE, contains 77 questions — 68 scored and 9 unscored pretest — and must be passed at 70% to earn Accident and Health line of authority from the Tennessee Department of Commerce and Insurance. No mandatory prelicensing course is required. The A&H exam covers the broadest product landscape of any Tennessee licensing line — health insurance plan types, Medicare in all its parts, Medicaid through TennCare, disability income insurance, long-term care insurance, the Affordable Care Act framework, and Tennessee's state-specific health insurance regulatory provisions. Candidates who underestimate the breadth of this exam because they are familiar with health insurance as a consumer consistently fail the state law section and the Medicare-specific content that appears in higher volume than most candidates anticipate. This post provides the complete content breakdown for the Tennessee A&H exam: every topic area, what each tests at exam-level specificity, how the content is weighted, and the strategic approach that produces first-time passing scores.

The Two-Section Structure

Every Tennessee insurance licensing exam tests two knowledge domains within a single 77-question, 105-minute session.

Section 1 — General Accident and Health Concepts: Tests foundational knowledge of health insurance products, disability income insurance, long-term care insurance, Medicare, Medicaid, ACA framework, and policy provisions that apply across all jurisdictions.

Section 2 — Tennessee State Laws and Regulations: Tests specific knowledge of Tennessee's insurance regulatory framework — TCA Title 56, TDCI authority, Tennessee-specific health insurance provisions, TennCare structure, and the producer conduct rules that apply specifically in Tennessee.

Both sections contribute to the single pool of 68 scored questions. The state law section is where the largest concentration of preventable failures occurs — candidates who know health insurance thoroughly from professional experience but have not studied Tennessee's specific statutory provisions lose enough state law questions to fall below 70% on the total exam.

General Section: Health Insurance Plan Types

Traditional Indemnity Insurance

Traditional indemnity insurance — also called fee-for-service — is the original health insurance model. The insured receives care from any provider, the provider bills the insurer, and the insurer pays based on the policy's benefit schedule.

Key characteristics:

Complete freedom of provider choice — no network restriction

No referral required for specialist care

Higher out-of-pocket costs than managed care plans — deductibles and coinsurance apply

Insurer typically reimburses a percentage of usual, customary, and reasonable (UCR) charges — commonly 80% after deductible

The insured pays the remaining 20% plus any amount above UCR

The indemnity concept: Indemnity insurance restores the insured to their pre-loss financial position — it pays based on actual medical expenses incurred rather than providing a fixed scheduled benefit. This is distinct from benefit schedule plans that pay a fixed dollar amount per procedure regardless of actual cost.

Health Maintenance Organizations (HMOs)

HMOs provide comprehensive health coverage through a defined network of providers in exchange for a fixed monthly premium and low or no cost-sharing at the point of service.

Key characteristics:

Primary care physician (PCP) gatekeeper — the insured selects a PCP who manages all care

Referral required to see a specialist — without a PCP referral, specialist visits are generally not covered

Network-only coverage — services received outside the HMO network are not covered except for emergency care

Low or no deductibles — copayments apply per visit

Preventive care emphasis — HMOs have financial incentive to keep members healthy and reduce expensive interventions

Staff model HMO: Physicians are employed directly by the HMO and practice at HMO-owned facilities. The most integrated model.

Group model HMO: The HMO contracts with a physician group practice that provides services exclusively to the HMO's members.

Network model HMO: The HMO contracts with multiple physician group practices, each of which may also serve non-HMO patients.

IPA model (Independent Practice Association): The HMO contracts with an IPA — an association of independent physicians in private practice who agree to see HMO members alongside their other patients. The most flexible HMO model and the most common in practice.

Preferred Provider Organizations (PPOs)

PPOs offer a middle path between the cost efficiency of HMOs and the freedom of traditional indemnity insurance.

Key characteristics:

Preferred provider network — in-network providers have contracted with the insurer for reduced fees

Out-of-network coverage available — at a reduced benefit level (higher deductible, higher coinsurance)

No PCP requirement — members can see any specialist directly without a referral

Higher premiums than HMOs — members pay for the freedom to go out-of-network

In-network vs. out-of-network cost comparison: In-network services typically have lower deductibles and lower coinsurance. Out-of-network services have higher deductibles and higher coinsurance — sometimes significantly higher. The cost differential incentivizes in-network use without requiring it.

Exclusive Provider Organizations (EPOs)

EPOs combine features of HMOs and PPOs in a specific way that is frequently tested because candidates confuse them with both.

Key characteristics:

Network-only coverage like an HMO — no out-of-network coverage except emergencies

No PCP or referral requirement like a PPO — members can see specialists directly

The critical combination: restrictive on coverage (network only) but flexible on access (no gatekeeper)

The testable distinction: EPO vs. HMO — EPO does not require a PCP or referral. EPO vs. PPO — EPO provides no out-of-network coverage. EPO combines the worst of both (no out-of-network flexibility, no referral freedom from HMO) and the best of both (direct specialist access from PPO, lower premium from restricted network) depending on how you frame it.

Point of Service Plans (POS)

POS plans are hybrids that allow members to choose at the point of service whether to use the HMO-style network or the PPO-style out-of-network option.

Key characteristics:

PCP gatekeeper for in-network use — like an HMO

Out-of-network coverage available — like a PPO, but at significantly higher cost

Members decide at each service event whether to stay in-network (lower cost, PCP referral required) or go out-of-network (higher cost, no referral required)

The testable distinction: POS vs. HMO — POS allows out-of-network use. POS vs. PPO — POS requires PCP referral for in-network care. POS is the most flexible managed care option but typically the most administratively complex.

High-Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs)

HDHPs pair high deductibles with lower premiums and eligibility to contribute to a Health Savings Account.

2026 HSA-qualifying HDHP minimum deductibles:

Individual: $1,650

Family: $3,300

2026 HSA contribution limits:

Individual: $4,400

Family: $8,750

HSA triple tax advantage: Contributions are tax-deductible (or pre-tax through payroll), growth is tax-free, and withdrawals for qualified medical expenses are tax-free. This triple benefit is specifically testable — the exam asks what makes HSAs attractive from a tax perspective.

HSA eligibility rules:

Must be enrolled in a qualifying HDHP

Cannot have other first-dollar health coverage (including Medicare Part A or B)

Cannot be claimed as a dependent on another person's tax return

HSA funds roll over year to year — they do not expire like Flexible Spending Account (FSA) funds

FSA comparison: Flexible Spending Accounts allow pre-tax contributions for medical expenses but are use-it-or-lose-it — unused funds are forfeited at year end (subject to a small rollover allowance under IRS rules). FSAs do not require HDHP enrollment.

General Section: Policy Provisions

The Consideration Clause

Establishes what each party gives in exchange for the insurance contract. The insurer provides the promise of benefit payment. The insured provides the application (including truthful representations) and the first premium payment. Both elements — the application and the premium — constitute the insured's consideration.

The Entire Contract Clause

The policy and the attached application constitute the entire contract between the insurer and the insured. Any statements made by the insurer's agents that are not incorporated into the written policy are not binding. The insured is protected from having policy terms changed orally — any modification must be in writing and attached to the policy.

The Grace Period

Health insurance: 7-day grace period for weekly premium policies; 10-day grace period for monthly premium policies; 31-day grace period for all other policies (including annual premium policies).

The grace period distinction between health insurance and life insurance is specifically testable. Life insurance has a standard 30-day grace period. Health insurance has a 31-day grace period for non-weekly, non-monthly policies — a one-day difference that appears on exam questions.

The Reinstatement Provision

If a health insurance policy lapses due to non-payment, the policyholder may apply for reinstatement. If the insurer does not deny reinstatement within 45 days of receiving the reinstatement application and premium, the policy is automatically reinstated. The reinstated policy does not cover sickness that manifests within 10 days of reinstatement — the waiting period prevents reinstatement solely to obtain benefits for a known condition.

The Incontestability Provision

After a health insurance policy has been in force for a specified period — typically two to three years — the insurer cannot contest coverage based on misrepresentation in the application except for fraudulent misstatement. The health insurance incontestability provision parallels the life insurance provision in structure but differs in the applicable period depending on the policy type.

The Time Limit on Certain Defenses

Limits the period during which the insurer may deny claims based on misrepresentation. After two to three years of continuous coverage, most health policies limit the insurer's right to deny claims based on preexisting condition misrepresentation — not eliminating it for fraud but restricting it for innocent misrepresentation.

Coordination of Benefits (COB)

When a person is covered by two health insurance policies — as a named insured under one and as a dependent under another — coordination of benefits rules prevent overpayment beyond 100% of actual expenses.

Primary vs. secondary determination:

The policy that covers the person as a named insured is primary — it pays first, up to its limits

The policy that covers the person as a dependent is secondary — it pays the remaining balance up to 100% of actual expenses, subject to its own benefit limits

The birthday rule for dependent children: When a child is covered under both parents' health insurance, the parent whose birthday falls earlier in the calendar year (month and day only — not year) has the primary policy. The parent with the later birthday has the secondary policy.

The National Association of Insurance Commissioners (NAIC) COB model: Establishes order of benefit determination when multiple policies cover the same person — named insured first, then dependent coverage, then birthday rule for children.

COBRA Continuation Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires employers with 20 or more employees who offer group health plans to offer continuation coverage to employees and dependents who lose coverage due to qualifying events.

COBRA qualifying events and continuation periods:

Employee termination (voluntary or involuntary, except for gross misconduct) or reduction in hours: 18 months

Employee's death, divorce or legal separation from the employee, or employee's entitlement to Medicare: 36 months for the dependent

Dependent child losing dependent status: 36 months

COBRA cost: The qualified beneficiary pays the full premium — the portion formerly paid by the employer plus the portion paid by the employee — plus a 2% administrative fee. COBRA coverage is expensive precisely because the employer's contribution is no longer subsidizing the premium.

Election period: Qualified beneficiaries have 60 days from the date coverage ends or the date of the COBRA notice (whichever is later) to elect COBRA continuation.

The 20-employee threshold: COBRA applies only to employers with 20 or more employees in the prior calendar year. Smaller employers may be subject to state mini-COBRA laws — Tennessee has provisions for smaller employers that the exam may test.

Conversion Rights

When group health coverage terminates, the insured has the right to convert to an individual health policy without evidence of insurability, regardless of health status. The converted policy is typically a different plan design than the group plan — often with higher premiums and different benefit structure. The conversion right must be exercised within 31 days of group coverage termination.

Subrogation

Subrogation is the insurer's right to recover from a responsible third party the amounts it paid to the insured. If a health insurer pays $50,000 in medical expenses for injuries caused by a negligent third party, and the insured later recovers $50,000 from the third party's liability insurer, the health insurer can claim reimbursement from those recovered proceeds. The insured cannot be unjustly enriched by receiving both insurance benefits and full tort recovery for the same loss.

General Section: Medicare

Medicare is consistently one of the highest question-density topics on the Tennessee A&H exam. Candidates who have not studied Medicare's four parts in detail — particularly the specific services covered by each part, the premium structures, and the Medigap standardized plan framework — lose multiple exam questions to Medicare content.

Medicare Part A — Hospital Insurance

Coverage: Inpatient hospital care, skilled nursing facility (SNF) care following a qualifying hospital stay, hospice care, and limited home health care.

Premium: Most Medicare beneficiaries pay no Part A premium — they have earned premium-free Part A through at least 40 quarters of Medicare-taxed employment. Beneficiaries with fewer qualifying quarters pay a monthly premium.

Benefit periods and cost-sharing: Part A uses benefit periods — not calendar years — to structure cost-sharing. A new benefit period begins each time the beneficiary has been out of the hospital or SNF for 60 consecutive days.

Days 1–60 of each benefit period: Inpatient deductible (2026: $1,676) — paid once per benefit period

Days 61–90: Daily coinsurance ($419/day in 2026)

Days 91–150 (lifetime reserve days): Higher daily coinsurance ($838/day in 2026); each beneficiary has 60 lifetime reserve days total

Beyond 150 days in a benefit period: No Medicare coverage

Skilled nursing facility coverage:

Days 1–20: Fully covered by Medicare

Days 21–100: Daily coinsurance ($209.50/day in 2026)

Beyond 100 days: No Medicare SNF coverage

SNF qualification requirement: Medicare covers SNF care only following a qualifying hospital inpatient stay of at least 3 consecutive days. Observation status (which is classified as outpatient) does not qualify. The 3-day qualifying stay is a specifically testable provision.

Medicare Part B — Medical Insurance

Coverage: Physician services, outpatient hospital care, preventive services, durable medical equipment (DME), mental health services, and outpatient physical, occupational, and speech therapy.

Premium: Part B requires a monthly premium ($185/month in 2026 for most beneficiaries). Higher-income beneficiaries pay Income-Related Monthly Adjustment Amounts (IRMAA) — premium surcharges based on modified adjusted gross income.

Cost-sharing: Annual deductible ($257 in 2026), then 80% Medicare / 20% beneficiary coinsurance for most covered services. There is no out-of-pocket maximum under original Medicare — the 20% coinsurance applies without limit, which creates the coverage gap that Medigap insurance addresses.

Preventive services: Part B covers a wide range of preventive services at no cost-sharing — annual wellness visits, screenings for cancer, cardiovascular disease, and diabetes, immunizations.

Enrollment: Part B enrollment is voluntary but carries penalties for late enrollment. The Initial Enrollment Period (IEP) is the 7-month window centered on the month of Medicare eligibility (3 months before, the month of, and 3 months after). Beneficiaries who delay enrollment beyond the IEP without creditable coverage pay a permanent 10% premium penalty for each 12-month period they delayed.

Medicare Part C — Medicare Advantage

Medicare Advantage plans are private insurance plans approved by CMS that provide all Medicare Part A and Part B benefits — and typically additional benefits — through a managed care structure.

Key characteristics:

Operated by private insurers — not the federal government directly

Must cover all original Medicare services except hospice (hospice remains under original Medicare)

Most plans include Part D prescription drug coverage

Often include dental, vision, and hearing benefits not covered by original Medicare

Plan types: HMO, PPO, PFFS (Private Fee-for-Service), SNP (Special Needs Plan)

Annual out-of-pocket maximum — unlike original Medicare, Advantage plans must cap out-of-pocket costs

Enrollment: Beneficiaries enrolled in Medicare Advantage plans continue to pay their Part B premium plus any plan-specific premium. Some plans have $0 additional premium. CMS pays the Advantage plan a capitated monthly amount to provide Medicare benefits.

The producer certification requirement: Producers who sell Medicare Advantage and Part D plans must complete annual certification through the carrier's training portal (typically including AHIP certification) before they can represent those plans in any plan year. This annual certification is separate from the Tennessee A&H license and must be renewed every year.

Medicare Part D — Prescription Drug Coverage

Part D provides prescription drug benefits through private insurance plans approved by CMS.

Enrollment: Voluntary but with permanent late enrollment penalties — 1% premium increase per month for each month of delayed enrollment without creditable prescription drug coverage.

Plan structure: Formulary-based — each plan has a list of covered drugs organized into tiers with different cost-sharing levels. Beneficiaries should review formulary coverage for their specific medications before selecting a plan.

2025–2026 changes — the $2,000 out-of-pocket cap: The Inflation Reduction Act capped Medicare Part D out-of-pocket costs at $2,000 per year effective 2025 — eliminating the previous coverage gap (donut hole) that had required beneficiaries to pay 25% of costs after initial coverage limits were reached. This is a significant recent change that may appear on current Tennessee exams.

Medicare Supplement Insurance (Medigap)

Medigap policies are standardized private insurance products designed to fill the gaps in original Medicare (Parts A and B) — covering deductibles, coinsurance, and copayments that original Medicare leaves to the beneficiary.

Standardization: Medigap plans are federally standardized — each plan letter (A through N) offers identical benefits regardless of which insurer sells it. Plan G from one insurer covers exactly the same benefits as Plan G from another insurer. The only difference between insurers selling the same plan letter is the premium.

The most common Medigap plans:

Plan G: Covers all Medicare cost-sharing except the Part B deductible. The most comprehensive plan available to new Medicare beneficiaries after January 1, 2020. (Plan F, which also covered the Part B deductible, is no longer available to new Medicare beneficiaries.)

Plan N: Covers most cost-sharing with some copayments for office visits and emergency room visits. Lower premium than Plan G.

Plan A: Covers only the basic core benefits — Part A hospital coinsurance and the 365 additional hospital days.

The open enrollment period: For the six months beginning with the month a person turns 65 and enrolls in Part B, Medigap insurers must sell any plan without medical underwriting — guaranteed issue regardless of health status. After the open enrollment period, Medigap is subject to medical underwriting in most states — applicants can be charged higher premiums or denied based on health status.

Medigap and Medicare Advantage: A beneficiary enrolled in Medicare Advantage cannot use a Medigap policy — Medigap supplements original Medicare only. The two programs cannot be used simultaneously.

What Medigap does NOT cover:

Prescription drugs (requires a separate Part D plan)

Dental, vision, and hearing (requires separate coverage or Medicare Advantage)

Long-term custodial care

General Section: Disability Income Insurance

Disability income insurance is consistently underrepresented in candidates' preparation — most candidates who have health insurance familiarity have less personal experience with disability products, creating knowledge gaps that the exam exploits.

Definition of Disability

The definition of disability in a policy is the most important feature determining when benefits are paid.

Own-occupation definition: The insured is considered disabled if they cannot perform the material duties of their own specific occupation — even if they could work in a different capacity. A surgeon who loses fine motor control in their hands is disabled under an own-occupation policy even if they could teach medicine. The most protective definition. The most expensive. The gold standard for specialists.

Any-occupation definition: The insured is considered disabled only if they cannot perform the duties of any occupation for which they are reasonably suited by education, training, and experience. A surgeon who loses fine motor control is not disabled under an any-occupation policy if they could become a medical consultant or hospital administrator. The least protective definition. The least expensive.

Modified own-occupation (transitional): Own-occupation for the first two to five years of disability; any-occupation thereafter. The most common compromise definition in group long-term disability plans.

The exam tests the definitions by their practical outcomes. Scenario questions ask: under which definition is this person disabled? Know how each definition applies to specific factual scenarios.

Elimination Period (Waiting Period)

The elimination period is the waiting period between the onset of disability and when benefits begin. No benefits are paid during the elimination period — it functions like a deductible in time rather than dollars.

Common elimination periods: 30, 60, 90, 180 days. Individual disability policies commonly offer 90-day elimination periods as the most cost-effective balance between premium and self-insurance capacity.

The premium relationship: Longer elimination period = lower premium. The insured assumes responsibility for the income loss during the elimination period, reducing the insurer's risk exposure and therefore the premium.

Short-term disability (STD) vs. long-term disability (LTD):

STD: Shorter elimination period (0–14 days), shorter benefit period (typically 13–26 weeks)

LTD: Longer elimination period (typically 90 days), longer benefit period (2 years, 5 years, to age 65, or lifetime)

Benefit Amount

Individual disability income policies typically replace 60–70% of pre-disability gross income. The replacement is partial — not 100% — to preserve the financial incentive to return to work. Benefits paid from individually owned policies purchased with after-tax premiums are income-tax-free. Benefits from employer-paid group policies are typically taxable income.

Benefit Period

Short-term: Weeks to months — typically 13 or 26 weeks.

Long-term: Years or age-based — common benefit periods include 2 years, 5 years, to age 65, or to age 67. Lifetime disability benefit periods are rare in individual policies but may appear on the exam as a concept.

Residual Disability

Residual (partial) disability occurs when the insured can work but at reduced capacity — fewer hours or reduced duties — resulting in a proportional income loss. A residual disability benefit pays a proportional benefit based on the percentage of income lost, rather than requiring the insured to be totally unable to work.

The proportional formula: If the insured's pre-disability income was $10,000/month and post-disability income is $6,000/month, the income loss is 40%. The residual benefit pays 40% of the disability income benefit amount.

Waiver of Premium

If the insured becomes disabled, premiums are waived for the duration of the disability after the elimination period. The policy remains in force without premium payment while the insured is disabled. If the insured recovers and returns to work, premium payments resume.

Social Insurance Supplement (SIS) Rider

Pays an additional benefit if the insured is denied Social Security Disability Insurance (SSDI) benefits. The rider provides a bridge between the insured's own disability policy coverage and the anticipated SSDI benefit that was applied for but not yet approved.

Non-Cancelable vs. Guaranteed Renewable Policies

Non-cancelable: The insurer cannot cancel the policy, raise the premium, or change the policy terms as long as premiums are paid. The policy terms — including the disability definition, benefit amount, and elimination period — are locked for the life of the policy. The most protective policy type. The most expensive.

Guaranteed renewable: The insurer cannot cancel the policy and must renew it each year as long as premiums are paid — but the insurer can raise premiums for an entire class of insureds (not for an individual). Less protective than non-cancelable because of the class-wide premium increase right.

Conditionally renewable: The insurer can refuse to renew under specified conditions stated in the policy — such as the insured changing occupations to a more hazardous classification.

Optionally renewable: The insurer may choose not to renew the policy at any renewal date. Least protective. Rarely sold in the modern individual disability market.

General Section: Long-Term Care Insurance

The Benefit Trigger

Long-term care benefits are paid when the insured meets the benefit trigger — the clinical standard that establishes the need for long-term care.

The two-of-six ADL trigger: The insured cannot perform at least two of six Activities of Daily Living (ADLs) without substantial assistance:

Bathing

Dressing

Eating

Toileting

Transferring (moving from bed to chair)

Continence

The cognitive impairment trigger: The insured has a severe cognitive impairment — such as Alzheimer's disease — that requires substantial supervision to protect the insured from threats to health or safety. Cognitive impairment qualifies independently of ADL limitations — a person can be cognitively impaired and qualify for LTC benefits even if they can perform all six ADLs.

Both triggers must be defined in the policy and both represent the NAIC LTC Model Act standard that Tennessee follows.

Elimination Period

LTC policies have elimination periods — typically 30, 60, or 90 days — during which the insured pays out of pocket before LTC benefits begin. Longer elimination period = lower premium.

Calendar day vs. service day elimination periods: A calendar day elimination period counts every day regardless of whether care was received. A service day elimination period counts only days on which covered care was actually received. Calendar day elimination periods are satisfied more quickly and are more favorable to the insured.

Benefit Period

How long the policy pays — commonly 2 years, 3 years, 5 years, or unlimited. Benefit amount × benefit period = total lifetime maximum benefit.

Inflation Protection

LTC costs inflate significantly over time — home health aide and nursing facility costs have historically risen faster than general inflation. Inflation protection options:

Simple inflation protection: The daily benefit amount increases by a fixed percentage of the original benefit each year. The increase is always calculated on the original benefit, not the current benefit.

Compound inflation protection: The daily benefit increases by a fixed percentage of the current (already-increased) benefit each year. Compound inflation produces significantly larger total increases over time than simple inflation — and costs more.

Guaranteed purchase option: The insured is offered the opportunity to purchase additional coverage at specified intervals without evidence of insurability. The insured can accept or decline; declining the option eventually eliminates future offers.

Tennessee LTC Training Requirements

Initial training: 8-hour LTC certification training must be completed before selling LTC products in Tennessee. This is a one-time prerequisite — not a recurring CE requirement.

Ongoing training: 4-hour LTC training required every 24 months (anchored to the initial completion date, not the CE renewal cycle). The ongoing training ensures producers remain current with evolving LTC products and regulations.

Training credit toward CE: LTC training hours count toward Tennessee's 24-hour biennial CE requirement — they do not add to it.

Tennessee State Law Section: A&H Focus

TennCare — Tennessee's Medicaid Program

TennCare is Tennessee's name for its Medicaid program. Several Tennessee-specific TennCare provisions are consistently tested on the A&H exam state law section.

TennCare is not expanded Medicaid: Tennessee did not expand Medicaid under the Affordable Care Act. TennCare eligibility is more restricted than states that accepted the ACA's Medicaid expansion to 138% FPL.

Administration: TennCare is administered by the Tennessee Department of Finance and Administration — not the TDCI. This distinction matters for exam questions about regulatory authority.

Federal exchange: Tennessee uses Healthcare.gov — the federal exchange — not a state-based exchange. Producers who help Tennessee clients enroll in marketplace plans do so through Healthcare.gov.

The TennCare direction prohibition (TCA §56-6-112): It is a ground for producer license discipline to knowingly direct a person to submit an application for health care benefits through TennCare when the person is covered by a group policy or when the group policy is being renewed, and then quote a rate for a group health insurance policy if the producer knows the person would have been eligible to participate in the group policy.

This provision is uniquely Tennessee and directly addresses a specific prohibited conduct around TennCare enrollment timing. It appears consistently on A&H exam state law questions. Know it by the statutory reference (§56-6-112) and its specific application — directing a group-covered person to TennCare to deplete public benefits before replacing with private group coverage is a license discipline ground.

Tennessee Bad Faith Penalty — TCA §56-7-105

If an insurer wrongfully refuses to pay a valid A&H claim — medical expense claim, disability income claim, or LTC benefit — the insured may recover the claim amount plus up to 25% additional damages. The 25% figure is specifically tested. The A&H exam tests this provision in scenarios where an insurer delays or denies a legitimate claim.

TDCI Structure and Producer Licensing

TDCI authority:

Civil penalties up to $1,000 per violation under TCA §56-2-305

Higher penalties for willful misconduct

License suspension/revocation grounds under TCA §56-6-112

CE requirements:

24 hours biennial; 3 hours ethics; no classroom minimum

LTC training: 8-hour initial (one-time); 4-hour ongoing every 24 months

Annuity suitability: 4-hour one-time training before selling annuities

Renewal:

Fee: $60; 30-day grace period; $120 late fee; up to 1 year late renewal; full relicensing after 1 year

Appointments:

Carrier must file within 15 days of contract date (TCA §56-6-115)

Carrier must notify Commissioner of termination within 30 days (TCA §56-6-117)

Tennessee Unfair Trade Practices Act (TCA Title 56, Chapter 8)

The unfair claims practices provisions under TCA §56-8-105 apply directly to A&H insurance claim handling. Prohibited acts include:

Misrepresenting policy provisions relating to coverage

Failing to acknowledge claims communications with reasonable promptness

Failing to adopt reasonable standards for prompt claims investigation and settlement

Not attempting in good faith to effectuate prompt, fair settlement when liability is clear

Compelling insureds to institute suits by offering substantially less than amounts ultimately recovered

For A&H producers, these prohibitions apply both to their own conduct in facilitating claims and to the conduct of insurers they represent.

Tennessee-Specific A&H Provisions

Small employer health insurance: Tennessee has specific regulations governing health insurance coverage for small employers — typically defined as employers with 2 to 50 employees. Small employer health insurance rules address guaranteed availability, premium rating limitations, and portability provisions.

Individual health insurance continuation: Tennessee law provides continuation rights for individual health insurance beyond COBRA's group coverage provisions — addressing situations where individual market coverage is terminated.

Mental health parity: Tennessee follows federal mental health parity requirements under the Mental Health Parity and Addiction Equity Act (MHPAEA) — group health plans may not impose more restrictive benefit limitations on mental health and substance use disorder (MH/SUD) services than on medical and surgical benefits.

Strategy: How to Study for the Tennessee A&H Exam

Topic Prioritization

Highest priority — deepest study:

Health plan types: HMO (gatekeeper, network only), PPO (freedom of provider, out-of-network covered), EPO (network only, no gatekeeper), POS (hybrid)

Medicare: all four parts — what each covers, premiums, cost-sharing, enrollment rules

Medigap: standardized plans, open enrollment period, guaranteed issue

Disability income: own-occupation vs. any-occupation definition, elimination period, benefit period, non-cancelable vs. guaranteed renewable

LTC: benefit triggers (two of six ADLs; cognitive impairment), elimination period, inflation protection (simple vs. compound)

Tennessee state law: bad faith (25%), TennCare direction prohibition (§56-6-112), TDCI enforcement, CE requirements (24/3, LTC 8+4), appointment rules, renewal fees and grace periods

Medium priority — solid understanding:

COBRA: qualifying events and continuation periods (18 vs. 36 months), 60-day election period, 20-employee threshold

HSA/HDHP: contribution limits, eligibility rules, triple tax advantage

COB: primary/secondary determination, birthday rule

Policy provisions: grace period (31-day for annual premium health policies), reinstatement (45-day automatic rule), subrogation

ACA: essential health benefits, metal tiers, guaranteed issue

Lower priority — basic familiarity:

Specific Medigap plan letters beyond G and N

Medicare Advantage plan types (HMO, PPO, PFFS, SNP)

Social Insurance Supplement rider

Tennessee small employer health insurance regulations

Specific 2026 Medicare cost-sharing amounts (know the structure, not necessarily every dollar figure)

The Medicare Deep Dive

Medicare is the topic area where the most preventable A&H exam failures occur. Most candidates have some familiarity with Medicare as a concept — but the exam tests specific operational details:

Which services are covered under which Part

The specific cost-sharing structure of Part A (benefit periods, day-by-day coinsurance)

The SNF 3-day qualifying hospital stay requirement

The Part B annual deductible and 80/20 coinsurance split

The Medigap open enrollment guaranteed issue window (6 months starting at age 65 enrollment in Part B)

The distinction between Plan G (no Part B deductible coverage for new enrollees) and Plan F (covers Part B deductible — not available to new enrollees after January 1, 2020)

The COBRA 18-month vs. 36-month periods and the specific qualifying events that trigger each

Allocate more study time to Medicare than your familiarity with the general concept suggests — because the exam tests operational specifics, not the general concept.

The Disability Definition Study Protocol

The own-occupation vs. any-occupation distinction generates more exam questions than its apparent simplicity suggests — because the exam presents scenario-based questions that require applying the definition to specific factual situations. Practice applying each definition to every scenario:

For every disability scenario question: identify the person's prior occupation, identify what they can still do, apply own-occupation (can they do their specific job?) and any-occupation (can they do any reasonable job?) independently, and select the definition under which the person is or is not disabled. Practice this mechanical application until it is automatic.

Frequently Asked Questions

Medicare appears on the A&H exam, but I am primarily interested in selling individual health insurance to working-age adults. Do I really need to study Medicare in depth?

Yes — and the reason is not just professional development. Medicare content constitutes a meaningful portion of the Tennessee A&H exam's general section, and candidates who do not study it thoroughly lose multiple questions that prepared candidates answer correctly. The exam does not distinguish between the Medicare content you plan to use in your career and the content you consider irrelevant. Every question on Medicare Parts A, B, C, and D, Medigap plans, enrollment windows, cost-sharing structures, and the open enrollment guaranteed issue period is a scored question that contributes to your pass or fail result. Candidates who skip Medicare because they are not planning to sell it to seniors frequently discover they needed those points to reach 70%.

The grace period for health insurance is 31 days for annual premium policies but 30 days for life insurance. Will the exam actually test this one-day difference?

Yes — this specific numerical distinction appears on Tennessee insurance exam questions precisely because it is an easy point of confusion. The exam tests whether candidates know the difference between life insurance grace periods (30 days) and health insurance grace periods (31 days for annual premium policies, 10 days for monthly premium policies, 7 days for weekly premium policies). Memorize the health insurance grace period structure as a distinct set of numbers from the life insurance standard. If a question specifies an annual premium health insurance policy and asks about the grace period, the answer is 31 days — not 30. This one-day difference is the kind of specific numerical provision that appears in multiple-choice questions designed to distinguish candidates who studied the specifics from those who relied on general familiarity.

I know from my own experience that EPO and HMO are similar in being network-only plans. How does the exam distinguish them and why does it matter?

The exam distinguishes EPO from HMO by the referral and PCP requirement — not by the network restriction. Both EPOs and HMOs require network-only use. The difference is that HMOs require a primary care physician gatekeeper and a referral to see a specialist, while EPOs do not require a PCP or referral. A question that describes a plan with network-only coverage and no PCP requirement is describing an EPO. A question that describes a plan with network-only coverage and a PCP gatekeeper requirement is describing an HMO. This distinction matters because exam questions frequently present plan characteristics and ask you to identify the plan type — and the distinguishing feature between EPO and HMO is the referral mechanism, not the network restriction. Know both characteristics of each plan type, not just the one that feels most memorable from personal experience.

The Tennessee Accident and Health exam tests a broader landscape of products and regulations than any other Tennessee licensing exam — health plan types, Medicare's complex multi-part structure, Medigap's standardized framework, disability income's definition nuances, long-term care's trigger mechanics, and Tennessee's state law provisions including the TennCare direction prohibition that is uniquely Tennessee. Candidates who prepare for all of these domains systematically — allocating proportionally more time to Medicare and disability than their prior knowledge suggests is necessary — reach the 70% threshold that activates their A&H line of authority and opens access to one of the broadest product markets in Tennessee insurance.

Visit JustInsurance to enroll today and complete your Tennessee A&H exam prep with a state-approved course designed for Pearson VUE — and reach exam day prepared for every domain the exam tests.