Florida 240 Practice exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025, Exams of Insurance law

Download Florida 240 Practice exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 and more Exams Insurance law in PDF only on Docsity! Florida 240 Practice exam QUESTIONS WITH COMPLETE 100% VERIFIED SOLUTIONS 2024/2025 A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as Usual, customary and reasonable What provision would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner? Payment of Claims All of the following are true about group disability Income insurance EXCEPT a) The longer the waiting period, the lower the premium. b) Coverage applies both on and off the job. c) Benefits are usually short term. d) The waiting period starts at the onset of the injury or sickness. Coverage applies both on and off the job. Which of the following statements regarding Business Overhead Expense policies is NOT true? a) Premiums paid for BOE are tax-deductible. b) Any benefits received are taxable to the business. c) Leased equipment expenses are covered by the plan. d) Benefits are usually limited to six months, d) Benefits are usually limited to six months In long-term care insurance, what type of care is provided with intermediate care? 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. 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. 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 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? $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 b) Broker c) Producer d) Insurer's executive officer d) Insurer's executive officer Only an executive officer of the company, not an agent, has authority to make any changes to the policy. The insurer must have the insured's written agreement to the change. All of the following statements about Medicare supplement insurance policies are correct EXCEPT a) They cover the cost of extended nursing home care. b) They cover Medicare deductibles and copayments. c) They supplement Medicare benefits. d) They are issued by private insurers. a) They cover the cost of extended nursing home care. Long-term care coverage may be available as any of the following options EXCEPT: a) Endorsement to a life policy. b) Endorsement to a health policy. c) Group long-term care d) Individual long-term care. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits? 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 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? 60 days Under COBRA, terminated employees must exercise extension of benefits within 60 days of separation from employment. When Linda suffered a broken hip, she notified her agent, in writing, within 12 days of the loss. However, her agent did not notify the insurance company until 60 days after the loss. how would this claim be handled? The insurer is considered to be notified since the notification to agent equals notification to the insurer. Notice to the agent equals notice to the insurer. The agent is the insurer's representative. Which of the following is NOT a feature of a guaranteed renewable provision? a) The insured has a unilateral right to renew the policy for the life of the contract. b) Coverage is not renewable beyond the insured's age 65. c) The insured's benefits cannot be reduced d) The insurer can increase the policy premium on an individual basis. d) The insurer can increase the policy premium on an individual basis. Guaranteed renewable provision has all the same features that the noncancellable provision does, with the exception that the insurer can increase the policy premium on the policy anniversary date. However, the premiums can only be increased on a class basis, not on an individual policy. Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy? a) The right to return the policy for a refund b) Basic information about the insurance company c) Basic information about supplementary policies d) The policy number c) Basic information about supplementary policies outline of coverage must follow standard format included in insurance regulations. Must include information about the insurance company, the policy number, important features of the policy, and explain the right to return the policy for a refund. All of the following are required provisions in all individual health insurance policies delivered in this state EXCEPT a) Grace period. b) Reinstatement. c) Misstatement of age. d) Entire contract. c) Misstatement of age. Misstatement of age is an optional health insurance policy provision, meaning that it may be included in a policy at the option of the insurer. 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? 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? 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? Within 30 days of birth 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 : 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? 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? 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? Guaranteed issue 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.