Florida 240 Practice Exam/ Questions and Answers/ 2024-2025., Exams of Insurance Economics

Download Florida 240 Practice Exam/ Questions and Answers/ 2024-2025. and more Exams Insurance Economics in PDF only on Docsity! Florida 240 Practice Exam/ Questions and Answers/ 2024-2025. In long-term care insurance, what type of care is provided with intermediate care? - Answer: Occasional nursing or rehabilitative care After a person's employment is terminated, it is possible to obtain individual health insurance after losing the group health coverage provided by the employer. Which of the following is NOT true? a) The employee can convert from group to individual insurance within 31 days of termination. b) The premium of the individual health insurance policy can be higher than the original policy. Page 1 of 15 c) By law, the new, individual policy must provide the same benefits as the group insurance policy. d) Continuation of group coverage need not include dental, vision, or prescription drug benefits. - Answer: c) By law, the new, individual policy must provide the same benefits as the group insurance policy. An insured has endured multiple surgeries and hospitalizations for an illness during the last few months. Her insurer no longer bills her for medical expenses. Which of the following allows for that? a) Waiver of premium b) Maximum loss c) Stop-loss limit d) Grace period - Answer: c) Stop-loss limit L has a major medical policy with a $500 deductible and 80/20 coinsurance. Lis hospitalized and sustains a $2.500 loss. What is the maximum amount that L will have to pay? - Answer: $900 L would first pay the $500 deductible; out of the remaining $2,000, the insurer will pay 80% ($1,600) and the insured will pay 20% ($400). Which of the following entities has the authority to make changes to an insurance policy? a) Department of Insurance Page 2 of 15 When may an insurer require an insured to provide genetic information? - Answer: Never. Insurers are prohibited from requesting a person or relative of a person to supply genetic information. If an insurance company offers Medicare supplement policies, it must offer which of the following plans? a) В-N b) A-D c) A d) A & B - Answer: c) A An insurance company must make available to each applicant a policy form offering the basic core benefits (Plan A) if it will offer any Medicare Supplement policies. An insurance company does not have to issue all or any of the plans B through N. The Florida Health Insurance Coverage Continuation Act requires insurers that sell health plans to small employers to offer in those plans a right to elect to continue coverage, without providing evidence of insurability, to employees who lose their coverage and are unable to replace it. The premium rate for this coverage may NOT exceed: - Answer: 115% of the regular group rate. Page 5 of 15 The coverage may be extended for a period of up to 18 months at a rate not to exceed 115% of the regular group rate. An insurance company has published a brochure that inaccurately portrays the advantages of a particular insurance policy. What is this an example of? - Answer: False advertising False advertising is the illegal practice of advertising or circulating materials that are untrue, deceptive, or misleading. Which of the following does NOT have to be disclosed in a long-term care (LTC) policy? a) Any riders or endorsements b) The aggregate amount of premiums due c) The meaning of the terms "reasonable" and "customary" 'd) Any limitations or conditions of eligibility for LTC benefits - Answer: b) The aggregate amount of premiums due. Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability? - Answer: Residual disability Page 6 of 15 A residual disability will pay an amount to make up the difference between what the insured would have earned before the loss. An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits? - Answer: Full benefits Presumptive Disability plans offer full benefits for specified conditions. Which of the following is NOT provided by an HMO? a) Reimbursement b) Services c) Financing d) Patient care - Answer: a) Reimbursement The HMO provides benefits in the form of services rather than in the form of reimbursement for the services of the physician or hospital. In order to maintain coverage under COBRA, how soon from termination of employment must an employee exercise extension of benefits? - Answer: 60 days Page 7 of 15 An individual applies for a life policy. Two years ago he suffered a head injury from an accident, so he cannot remember parts of his past, but is otherwise competent. He has also been hospitalized for drug abuse, but does not remember this when applying for insurance. The insurer issues the policy and learns of his history one year later. What will probably happen? - Answer: The policy will not be affected. In insurance, fraud is the intentional misrepresentation of material information that is crucial when deciding whether or not to write a contract for an applicant. If an insurer finds that an applicant has committed fraud, it can void the contract, provided that the discovery occurs within the first two years of the effective policy date. In this particular instance the applicant did not commit intentional fraud. A long-term care shopper's guide must be presented at what point? - Answer: Prior to the time of application A long-term care insurance shopper's guide must be provided in the format developed by the National Association of Insurance Commissioners (NAIC). The shopper's guide must be presented to the applicant prior to completing the application. In individual health insurance coverage, the insurer must cover a newborn from the moment of birth, and if additional premium payment is required, how many days should be allowed for payment? - Answer: Within 30 days of birth Page 10 of 15 The insured must notify the insurer of a newly born dependent, and if additional payment is required, pay within 30 days. In order to maintain an insurance license, an agent will need to satisfy Florida's continuing education requirement of : - Answer: 24 hours of continuing education in every 2-year period. An insured submits a proof of loss form within 10 days of a loss. The insurer, however, does not acknowledge the form for 3 months. Which of the following violations has the insurer committed? - Answer: Unfair claims settlement Failing to affirm or deny coverage of claims within a reasonable time after proof of loss statements are completed and submitted by insureds is an example of unfair claims settlement. If a person accumulates more continuing education hours than is necessary to fulfill the requirements for a 2-year period, what will occur? - Answer: The extra hours may be continued into the next period, Excess classroom hours accumulated during any 2-year period may be carried forward to the next 2-year period. All small employer group health plans, in order to comply with the requirements of the Florida Employee Health Care Access Act, must be issued on what basis? - Answer: Guaranteed issue Page 11 of 15 A small group plan must be issued on a guaranteed-issue basis, which means an insurance policy must be offered to an employer, employee, or dependent of the employee, regardless of health status, pre-existing conditions or claims history. If an agent is in the military, which of the following is true? a) The agent cannot sell a policy to someone outside of the military base. b) The agent cannot sell any policies during times of war or conflict. c) The agent cannot sell policies while on active duty. d) The agent cannot sell a policy to another active military person who is of a lower rank. - Answer: d) The agent cannot sell a policy to another active military person who is of a lower rank. Which of the following will NOT be considered unfair discrimination by insurers? a) Cancelling individual coverage based on the insured's marital status b) Assigning different risk classifications to applicants based on gender identity c) Discriminating in benefits and coverages based on the insured's habits and lifestyle d) Charging applicants with similar health histories different premiums based on their ethnicity - Answer: c) Discriminating in benefits and coverages based on the insured's habits and lifestyle Page 12 of 15