Florida 240 License exam-with 100% verified solutions 2024-2025-tutor verified.docx, Exams of Public Health

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Florida 240 License exam-with 100% verified solutions

2024-2025-tutor verified

The stated amount or percent of liquid assets that an insurer must have on hand that will satisfy future obligations to its policyholders is called: Reserves An insurance applicant MUST be informed of an investigation regarding his/her reputation and character according to the: Fair Credit Reporting Act A nonprofit incorporated society that does not have capital stock and operates for the sole benefit of its members is known as: A fraternal benefit society What I the name of the law that requires insurers to disclose information gathering practices and where the information was obtained? Fair Credit Reporting Act Who elects the governing body of a mutual insurance company? Policyholders A group-owned insurance company that is formed to assume and spread the liability ricks of its members is known as a: Risk retention group What type of reinsurance contract involves two companies automatically sharing their risk exposure? treaty

What year was the McCarran-Ferguson Act enacted? 1945 Which of these describe a participating life insurance policy? Policy owners are entitled to receive dividends At what point must a life insurance applicant be informed of their rights that fall under the Fair Credit Reporting Act? Upon completion of the application Which of the following requires insurers to disclose when an applicant's consumer or credit history is being investigated: 1970 - Fair Credit Reporting Act What type of reinsurance contract involves two companies automatically sharing their risk exposure? Treaty A group-owned insurance company that is formed to assume and spread the liability risks of its members is known as a: risk retention group All of the following are considered to be typical characteristics describing the nature of an insurance contract, EXCEPT: Bilateral The part of a life insurance policy guaranteed to be true is called a(n) warranty

Statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called representations Q purchases a $500,000 life insurance policy and pays $900 in premiums over the first six months. Q dies suddenly and the beneficiary is paid $500,000. This exchange of unequal values reflects which of the following insurance contract features? Aleatory When must insurable interest be present in order for a life insurance policy to be valid? When the application is made A life insurance arrangement which circumvents insurable interest statutes is called: Investor-Originated Life Insurance Stranger Originated Life Insurance (STOLI) has been found to be in violation of which of the following contractual elements? Legal Purpose (Insurable Interest) Who makes the legally enforceable promises in a unilateral contract? Insurance company A policy of adhesion can only be modified by whom? insurance company When third-party ownership is involved, applicants who also happen to be the stated primary beneficiary are required to have:

insurable interest in the proposed insured Which of these is considered a statement that is assured to be true in every aspect? Warranty Which of these require an offer, acceptance, and consideration? contract If a contract of adhesion contains complicated language, to whom would the interpretation be in favor of? insured Insurance contracts are known as _____ because certain future conditions or acts must occur before any claims can be paid. conditional Insurance policies are offered on a "take it or leave it" basis, which make them: Contracts of Adhesion In regards to representations or warranties, which of these statements is TRUE? If material to the risk, false representations will void a policy

Which of these arrangements allows one to bypass insurable interest laws? Investor-Originated Life Insurance In an insurance contract, the insurer is the only party who makes a legally enforceable promise. What kind of contract is this? unilateral Which of these is NOT a type of agent authority? principal E and F are business partners. Each takes out a $500,000 life insurance policy on the other, naming himself as primary beneficiary. E and F eventually terminate their business, and four months later E dies. Although E was married with three children at the time of death, the primary beneficiary is still F. However, an insurable interest no longer exists. Where will the proceeds from E's life insurance policy be directed to? In this situation, the proceeds from E's life insurance policy will go to F. When must insurable interest exist for a life insurance contract to be valid? Inception of the contract Life and health insurance policies are: unilateral contracts

A policy of adhesion can only be modified by whom? insurance company At what point does an informal contract become binding? When one party makes an offer and the other party accepts that offer What is the consideration given by an insurer in the Consideration clause of a life policy? Promise to pay a death benefit What is the consideration given by an insurer in the Consideration clause of life policy? Promise to pay a death benefit to a named beneficiary Insurance policies are considered aleatory contracts because: performance is conditioned upon a future occurrence Taking receipt of premiums and holding them for the insurance company is an example of fiduciary responsibility

The Consideration clause in a life insurance contract contains what pertinent information? The schedule and amount of premium payments Which of the following consists of an offer, acceptance, and consideration? Contract Which of the following consists of an offer, acceptance, and consideration? contract Which of these is NOT considered to be an element of an insurance company? Negotiating What is a warranty? is a statement guaranteed to be true A life insurance policy would be considered a wagering contract WITHOUT: insurable interest G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is Business Overhead Expense

Which of the following claims are typically excluded from Medical expense policies? Intentionally self-inflicted injuries XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is 100% A Business Overhead Expense policy: covers business expenses such as rent and utilities A Business Overhead Expense policy would cover which of the following if a business owner becomes disabled? Utilities and office rent What is issued to each employee of an employer health plan? certificate The benefits under a Disability Buy-Out policy are payable to the company or another shareholder

A policy owner would like to change the beneficiary on a Life insurance policy and make the change permanent. Which type of designation would fulfill this need? irrevocable Which contract permits the remaining partners to buy-out the interest of a disabled business partner? Disability Buy-Sell T and S are named co-primary beneficiaries on a $500,000 Accidental Death and Dismemberment policy insuring their father. Their mother was named contingent beneficiary. Five years later, S dies of natural causes and the father is killed in a scuba accident shortly afterwards. How much of the death benefit will the mother receive? $ Which of the following medical expenses does Cancer insurance NOT cover? arthritis The difference between group insurance and blanket health policies is: Blanket health policies do not issue certificates Which type of policy would pay an employee's salary if the employer was injured in a bicycle accident and out of work for six weeks? Business Overhead Expense

On an Accidental Death and Dismemberment (AD&D) insurance policy, who is qualified to change the beneficiary designation? Policyowner The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers (and their families) whose employment has been terminated the right to: continue group health benefits K is the insured and P is the sole beneficiary on an Accidental Death and Dismemberment (AD&D) insurance policy. Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision, which of these statements is true? Proceeds will be paid to P's estate How would a contingent beneficiary receive the policy proceeds in an Accidental Death and Dismemberment (AD&D) policy? If the primary beneficiary dies before the insured Which mode of payment is NOT used by health insurance policies? Single Premium G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled. The type of policy which BEST addresses this concern is

Business Overhead Expense Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party? Subrogation S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? 36 When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans? contributory Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business? Business owner becoming disabled An accident policy will most likely pay a benefit for a(n) off-the-job accident

An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses? Loss of eyesight due to an accidental injury Health Insurance Portability and Accountability Act (HIPAA) gives privacy protection for: health information Under which of the following circumstances will the benefits under COBRA continuation coverage end? All group health plans are terminated by the employer The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the waiting period Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that uses the "accidental means" definition? Less restrictive Which type of policy pays benefits to a policyholder covered under a Hospital Expense policy? reimbursement

The federal income tax treatment of employer-provided group Medical Expense insurance can be accurately described as: Employee's premiums paid by the employer is tax-deductible to the employer as a business expenditure P and Q are married and have three children. P is the primary beneficiary on Q's Accidental Death and Dismemberment (AD&D) policy and Q's sister R is the contingent beneficiary. P, Q, and R are involved in a car accident and Q and R are killed instantly. The Accidental Death benefits will be paid to P only J has an Accidental Death and Dismemberment policy with a principal sum of $50,000. While trimming the hedges, J cuts off one of his fingers. What is the MAXIMUM J will receive from his policy? $25, Which of the following characteristics is associated with a large group disability income policy? No medical underwriting K has an Accidental Death and Dismemberment (AD&D) insurance policy where her husband is beneficiary and her daughter is contingent beneficiary. Under the Common Disaster clause, if K and her husband are both killed in an automobile accident, where would the death proceeds be directed? daughter

Which of the following statements does NOT accurately describe the tax treatment of premiums and benefits of individual Accident and Health insurance? Disability income policy premiums are tax-deductible coordination of benefits provision prevents an insured covered by two health plans from making a profit on a covered loss Accidental Death coverage is provided to commercial airline passengers in which of he following types of policies? Blanket Accident policy If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act? Insured's contingent beneficiary Which of the following statements is correct regarding an employer/employee group health plan? the employer receives a master policy and the employees receive certificates Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party? Subrogation

All students attending a large university could be covered by a blanket policy Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is Business Overhead Expense How does group insurance differ from individual insurance? Premiums are lower P is an employee who quits her job and wants to convert her group health coverage to an individual policy. After the expiration of COBRA laws, which of the following statements is TRUE? She does NOT need to provide evidence of insurability An insured covered by AD&D insurance has just died. What will happen if the primary beneficiary had already died before the insured and contingent beneficiary? Proceeds will go to the contingent beneficiary All of the following statements regarding group health insurance is true, EXCEPT: An individual policy is given to each member

What kind of Accidental Death and Dismemberment (AD&D) insurance beneficiary requires his/her consent when a change of beneficiary is made? Irrevocable beneficiary Which statement is TRUE regarding a group accident & health policy issued to an employer? The employer receives the policy and each employee is issued a certificate P is a new employee and will be obtaining non-contributory group Major Medical insurance from her employer. Which of the following actions must she take during the open enrollment period? Sign an enrollment card M purchased an Accidental Death and Dismemberment (AD&D) policy and named his son as beneficiary. M has the right to change the beneficiary designation at anytime. What type of beneficiary is his son? Revocable T is covered by an Accidental Death and Dismemberment (AD&D) policy that has an irrevocable beneficiary. What action will the insurance company take if T requests a change of beneficiary? Request of the change will be refused

Which of these types of coverage is best described as a short term medical policy? interim coverage A Business Disability Buyout plan policy is designed: to pay benefits to the Corporation or other shareholders Group/voluntary long-term care policy premiums are typically deducted from the employee's income and are less costly as compared to individual long term care coverage B has a $100,000 Accidental Death and Dismemberment policy that pays triple indemnity for common carrier death. If B is killed from an accident on a commercial flight, what will the policy pay B's beneficiary? $300, A policyowner's rights are limited under which beneficiary designation? irrevocable The reason for a business having a Business Overhead Expense Disability Plan is to cover fixed business expenses Which statement is true regarding a minor beneficiary? Normally, a guardian is required to be appointed in the Beneficiary clause of the contract

T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision? Primary carrier Which of the following BEST describes how a Preferred Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? More physicians to choose from The health insurance program which is administered by each state and funded by both the federal and state governments is called: Medicaid Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured? PPO The individual who provides general medical care for a patient as well as the referral for specialized care is known as a primary care physician

A 66 year-old is covered under a group health plan while employed with a business that has 40 employees. If she injures herself while walking in the park, what coverage would be considered primary? Her group health plan Which of the following does Social Security NOT provide benefits for? dismemberment Medicaid was designed to assist individuals who are below a specific income limit What is the maximum Social Security Disability benefit amount an insured can receive? 100% of the insured's Primary Insurance Amount What is Medicare? is a hospital and medical expense insurance program Medicare is intended for all of the following groups EXCEPT Those enrolled as a full-time student Medicare Part A and Part B do NOT pay for Dental work

Which of the following reimburses its insureds for covered medical expenses? Commercial insurers The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n): closed panel What does Medicare Parts A and B cover? Part A covers hospitalization; Part B covers doctor's services A medical care provider which typically delivers health services at its own local medical facility is known as a Health maintenance organization (HMOs) Which of the following statements is true about most Blue Cross/Blue Shield organizations? They are nonprofit organizations Which of these is considered a true statement regarding Medicaid? Funded by both state and federal governments

Which of the following types of organizations are prepaid group health plans, where members pay in advance for the services of participating physicians and hospitals that have agreements? HMO Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? PPO's are NOT a type of managed care systems J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a preset price. What type of plan does J belong to? health maintenance organization Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenses? Commercial insurer The percentage of an individual's Primary Insurance Amount (PIA) determines the benefits paid in which of the following programs? Social Security Disability Income Which type of provider is known for stressing preventative medical care? Health Maintenance Organizations (HMO's)

Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges? The maximum amount considered eligible for reimbursement by an insurance company under a health plan Which of the following phrases refers to the fees charged by a healthcare professional? Usual, customary, and reasonable expenses Comprehensive Major Medical policies usually combine: Major Medical with Basic Hospital/Surgical coverage Which of these options can an individual use their medical flexible spending account to pay for? prescription drugs Which of the following BEST describes a Hospital Indemnity policy? Coverage that pays a stated amount per day of a covered hospitalization Which of the following is NOT a limited benefit plan? Life insurance policies An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident. Assuming the plan had a $1,000 deductible and an 80/20 Coinsurance clause, how

much will the INSURED be responsible to pay with $11,000 in covered medical expenses? $3,000 Deductibles are used in health policies to lower: overuse of medical services All of the following statements about Major Medical benefits are true, EXCEPT: Benefits have no maximum limit Major Medical policies typically: contain a deductible and coinsurance In Major Medical Expense policies, what is the intent of a Stop Loss provision? Limits an insured's out-of-pocket medical expenses What type of policy would only provide coverage for specific types of illnesses (cancer, stroke, etc)? Dread disease insurance Basic Hospital and Surgical policy benefits are: lower than the actual expenses incurred

Basic Medical Expense insurance: has lower benefit limits than Major Medical insurance T was treated for an ailment 2 months prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards.How will the insurer likely consider this condition? Insurer will likely treat as a pre-existing condition which may not be covered for one year Which of the following costs would a Basic Hospital/Surgical policy likely cover? Surgically removing a facial birthmark cosmetic surgery A characteristic of Preferred Provider Organizations (PPOs) would be: Discounted fees for the patient Which of the following situations does a Critical Illness plan cover? leukemia A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre-existing heart

condition. The company issues the policy. Two months later, the insured suffers a heart attack and submits a claim. While processing the claim, the company discovers the pre-existing condition. In this situation, the company will continue coverage but exclude the heart condition A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered. All of the following health care services are typically covered, EXCEPT for: experimental and investigative services An individual has a Major Medical policy with a $5,000 deductible and an 80/20 Coinsurance clause. How much will the INSURED have to pay if a total of $15,000 in covered medical expenses are incurred? $7,000 A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two claims were paid in September 2013, each incurring medical expenses in excess of the deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as well. What would be this family's out-of-pocket medical expenses for 2013? $1,000 Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy? Discourages overutilization of the insurance coverage