Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023), Exams of Nursing

Download Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) and more Exams Nursing in PDF only on Docsity! Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following is NOT a form of medical insurance? -Business overhead expense -Surgical expense -Hospital expense -Long term care - Correct Answer ✅Business overhead expense (Explanation:Business Overhead Expense insurance is designed to reimburse a business for overhead expenses in the event a business owner becomes disabled. Expenses such as rent, utilities, telephone, equipment, employees' salaries, etc.) All of the following are state or federal government programs that provide health insurance, EXCEPT? -Medicare -OASDI disability -Medicaid -Medigap - Correct Answer ✅Medigap (Explanation:A Medigap policy is a Medicare supplement insurance policy sold by private insurance companies to fill "gaps" in Medicare Parts A and B.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) What type of health insurance is available to assist low-income individuals? - Correct Answer ✅Medicaid What types of reserves are set aside and held by health insurance companies? - Correct Answer ✅Premium and Claims reserves (Explanation:Reserves are set aside for the payment of future claims.) Group health insurance is generally written on a basis that provides for dividends or experience rating. What is the basis called? - Correct Answer ✅Participating (Explanation:Group plans written by mutual companies provide for dividends while stock companies frequently issue experience- rated plans.) Which of the following is NOT TRUE regarding eligibility for subsidies for families under the new health care act? -For those who make between 100-400% of the Federal Poverty -Level -Cannot be covered by an employer -Cannot be eligible for Medicare -Can be eligible for Medicaid - Correct Answer ✅Can be eligible for Medicaid Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Must deposit $100,000 with the Rehabilitation Administration Expense Fund -Must be sold by agents licensed and appointed as health insurance agents - Correct Answer ✅Must deposit $100,000 with the Rehabilitation Administration Expense Fund (Explanation: They must deposit $10,000 with the Rehabilitation Administration Expense Fund.) What is "capitation" as it relates to an HMO? -Amount to be collected by the HMO from participating health care providers -Fixed amount paid by an HMO during a policy period -Fixed amount paid by an HMO to a physician for medical services -Amount required to be deposited with the State of Florida - Correct Answer ✅Fixed amount paid by an HMO to a physician for medical services When a person is covered by an HMO, the contract certificate or member's handbook must be delivered within how many days after approval of the enrollment by the HMO? -20 days Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -10 days -5 days -14 days - Correct Answer ✅10 days Which of the following statements about health service organizations is true? -They reimburse Policyowners directly for physicians' fees -They provide loss of income benefits to Policyowners -They reimburse Policyowners directly for all medical expenses -They provide benefit payments directly to the hospitals and physicians providing services - Correct Answer ✅They provide benefit payments directly to the hospitals and physicians providing services What is the period of time for an HMO "open enrollment"? -45 days during every 18-month period -30 days during every 12-month period -30 days during every 18-month period -45 days during every 12-month period - Correct Answer ✅30 days during every 18-month period Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can be charged? -Up to $50,000 -Up to $150,000 -Up to $200,00 -Up to $100,000 - Correct Answer ✅Up to $200,00 Which of the following statements about Worker's Compensation laws is INCORRECT? -Employers can purchase coverage through the state program, private insurers or can self-insure -Worker's compensation provides benefits for work-related injuries, illness or death -Not all states have a workers compensation law -Basic principle is that work-related injuries are compensable by the employer without regard to fault - Correct Answer ✅Not all states have a workers compensation law Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Grouping small businesses together to obtain health insurance as one large group is a characteristic of what type of group? -Multiple Employer Trust (MET) -Franchise Health plan -Health Maintenance Organization (HMO) -Blue Cross/Blue Shield - Correct Answer ✅Multiple Employer Trust (MET) Casey has a medical expense policy that provides a fixed rate of $150 per day for hospitalization. Casey is hospitalized for 10 days and incurred covered medical expenses of $20,000. What will her medical expense policy pay? -$1,500 -$20,000 -$15,000 -$3,000 - Correct Answer ✅$1,500 (Explanation: Casey's policy will only cover a fixed rate per day for hospitalization of $150. If she is hospitalized for 10 days, then her policy will pay $1,500 ($150 x 10) of the total $20,000 in expenses.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Jamie has a reimbursement type medical expense policy with a maximum benefit of $500,000. She is hospitalized and incurs $25,000 in covered medical expenses. What will her policy provide in coverage? -$20,000 -$25,000 -$10,000 -$12,500 - Correct Answer ✅$25,000 (Explanation: A reimbursement type policy will provide coverage for expenses incurred. In this case that would be the total $25,000.) Which of the following will not be covered under "Miscellaneous Expenses" of a hospital expense policy? -Drugs -Lab fees -Daily room and board -Use of operating room - Correct Answer ✅Daily room and board Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) There are three different approaches used by insurers in providing basic surgical expense coverage and determining the benefits payable. Which of the following is NOT one of these approaches? -Reasonable and customary approach -Physician schedule approach -Relative value scale approach -Surgical schedule approach - Correct Answer ✅Physician schedule approach Charlie has a hospital expense policy and a surgical expense policy. The hospital pays $100 a day for room and board and a maximum of $1,000 for miscellaneous hospital charges. The surgical policy pays a maximum of $500 for any one operation. If Charlie was hospitalized for 10 days and had charges of $200 per day for room and board, $1,500 for miscellaneous expenses, and $2,000 for surgical expenses. What will his policies pay of these expenses? -$3,500 -$1,000 -$5,500 -$2,500 - Correct Answer ✅$2,500 (Explanation: Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Benefits are provided for loss of income - Correct Answer ✅They usually have a stated limit for specific expenses Which of the following types of insurance policies combines several types of benefits and provides more coverage than any of the others? -Hospital expense -Comprehensive major medical -Hospital indemnity -Surgical expense - Correct Answer ✅Comprehensive major medical (Explanation: Comprehensive major medical plans cover virtually all medical expenses in a single policy. Such as hospital, physician and surgeon, nursing care, drugs, physical therapy, x-rays, medical supplies, etc.) Wanda has a Major Medical policy with a flat deductible of $250, coinsurance of 80%/20% and a stop-loss of $5,000. She has a covered claim for $5,500. What will Wanda pay? -$1,100 -$250 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -$1,300 -$4,450 - Correct Answer ✅$1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total amount of $1,300 ($250 deductible, plus 20% of 5,250).) Travis has a Major Medical policy with a flat deductible of $500 and coinsurance of 80%/20% on the next $5,000 in covered expenses with 100% coverage for any remaining covered expenses. On an claim of $10,000, what amount will Travis pay? -$2,500 -$1,500 -$2,000 -$1,000 - Correct Answer ✅$1,500 (Explanation: Travis will pay the first $500 (deductible) and then 20% of the next $5,000 ($5,000 x .20 = $1,000. So Travis will pay a total of $1,500 (deductible plus 20% of $5,000).) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) When comparing a major medical policy having an 80%/20% coinsurance provision with one having a 75%/25% coinsurance provision, the insured will pay more or less premium for the 80%/20% provision? -Less premium -The same premium -Significantly less premium -More premium - Correct Answer ✅More premium (Explanation: Because the insured will be responsible for less of the cost for medical expenses (20% verses 25%), he will pay more in premium costs.) Jason has a Major Medical policy with a flat deductible of $500, coinsurance of 80%/20% and a stop-loss of $5,000. If he has a covered claim of $5,500, what will the insurance company pay? -$0 -$4,400 -$1,500 -$4,000 - Correct Answer ✅$4,000 (Explanation: Jason will pay the first $500 (his deductible amount) of the total medical bills. After this Jason will pay 20% of the remainder ($5,000) and the Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Cathy is a dentist and decides to purchase insurance that would cover a large portion of her income should she become disabled. What type of coverage will she purchase? -Disability income insurance -Business overhead expense insurance -Medical expense insurance -Lump sum disability - Correct Answer ✅Disability income insurance All of the following are true regarding a disability income policy defining total disability as "own occupation", EXCEPT? -Insured is unable to work at their own occupation as a result of an accident or sickness -Difficult to qualify for -More advantageous to the insurer -More expensive than a policy providing "any occupation" - Correct Answer ✅More advantageous to the insurer Which of the following terms relates to payments made for partial disabilities? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Residual amount -Gross amount -Net amount -Recurrent amount - Correct Answer ✅Residual amount (Explanation: The amount of benefit payable when a policy covers partial disabilities depends on whether the policy stipulates a flat amount or a residual amount) Daniel's disability income policy defines total disability as "the insured's inability to perform the duties of any occupation for which he or she is reasonably qualified by education, training or experience". This definition is known as? -Own occupation and is less restrictive than other definitions -Any occupation and is more restrictive than other definitions -Any occupation and is less restrictive than other definitions -Own occupation and is more restrictive than other definitions - Correct Answer ✅Any occupation and is more restrictive than other definitions Which of the following is NOT correct about partial disability? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Benefit period is usually 3 to 6 months -Flat amount benefit is usually 50% of the total disability benefit -Proof of disability is not required for partial disabilities -Follows period of total disability - Correct Answer ✅Proof of disability is not required for partial disabilities For individual disability income policies there are basically two types of benefit periods, which are? -Short-term and long-term -Short term and interim term -Basic term and broad term -Full term and partial term - Correct Answer ✅Short-term and long-term Tad earns $2,000 a month and currently has a disability income policy with Company X and is limited to a monthly benefit of $400. If Tad decides to purchase another disability income policy from Company Z and Company Z's limit on benefits is 70% of his monthly income, how much coverage can he purchase with this second disability policy? -$1,200 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Accidental Death and Dismemberment - Correct Answer ✅Accidental Death and Dismemberment George was in an accident. His Accident, Death and Dismemberment policy will cover all of the following, EXCEPT? -Loss of sight -Loss of use of a limb -Broken arm -Death - Correct Answer ✅Broken arm (Explanation: AD&D is the primary form of pure accident coverage. It provides a stated lump-sum benefit in the event of accidental death or in the event of loss of bodily members due to an accidental injury.) What does the principal sum represent in an AD&D policy? -Amount payable for accidental loss of sight -Amount payable as a death benefit -Amount payable for dismemberment -Amount payable for accidental loss of sight or dismemberment - Correct Answer ✅Amount payable as a death benefit Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) An individual accidental death and dismemberment policy (AD&D) will pay benefits if an insured dies from... -Heart attack -Catastrophic illness -Head injury resulting from an auto accident -Occupational disease - Correct Answer ✅Head injury resulting from an auto accident Michael has an AD&D policy. Which of the following statements is CORRECT? -The benefit for the loss of both eyes is 75% of the principal sum -Michael's beneficiary will receive the capital sum of $100,000 as a death benefit -Principal sum is the amount paid for the accidental loss of sight or dismemberment -The benefit amount for the loss of one foot or one hand is 50% of the principal sum - Correct Answer ✅The benefit amount for the loss of one foot or one hand is 50% of the principal sum Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following is an example of a limited risk policy? -Surgical policy -Medical expense policy -Hospital policy -Aviation policy - Correct Answer ✅Aviation policy A famous dancer decides to take out a special policy covering her legs for $1 million. What type of accident policy is this? -Disability income policy -Limited risk policy -Major Medical policy -Special risk policy - Correct Answer ✅Special risk policy Margaret has a special risk policy. It will pay a benefit for... -Unusual hazards normally not covered by other policies -Death or dismemberment resulting from an aviation accident during a specified trip -Dreaded diseases Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following is NOT a category level of long-term care? -Custodial care -Intermediate nursing care -Hospitalization care -Skilled nursing care - Correct Answer ✅Hospitalization care Long-term care insurance also provides for a short rest period for a family caregiver. What is the known as? -Home care -Custodial care -Continuing care -Respite care - Correct Answer ✅Respite care What type of care, in a long-term care policy, is described as providing assistance in meeting daily living requirements, such as bathing, dressing, getting out of bed or toileting? -Custodial care -Respite care Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Intermediate nursing care -Skilled nursing care - Correct Answer ✅Custodial care Which of the following conditions would NOT typically be covered by a Long Term Care policy? -Dementia -Drug dependency -Diabetes -Alzheimer's disease - Correct Answer ✅Drug dependency Florida requires a minimum participation of how many people for a group policy to be issued? -25 persons -15 persons -10 persons -No minimum percentage - Correct Answer ✅No minimum percentage (It can be one person) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) All of the following are ways in which to classify employees for a group health insurance policy, EXCEPT? -Age -Duties -Length of service -Type of payroll - Correct Answer ✅Age All of the following are requirements in Florida to be eligible to purchase group health insurance, EXCEPT? -Natural group -Minimum of 15 employees -No specific minimum percentage participation -Group formed for reasons other than obtaining insurance - Correct Answer ✅Minimum of 15 employees (There is no minimum) All of the following are TRUE statements regarding group health insurance, EXCEPT? -It contributes to the morale of employees. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Florida requires what percentage of participation by employees in a contributory group health plan? -100% -50% -No minimum percentage -75% - Correct Answer ✅No minimum percentage (Explanation: Most noncontributory group health plans require 100% participation by eligible members, whereas contributory group health plans often require participation by 75% of eligible members. Under Florida law there is no specific minimum percentage participation for employees covered by group health insurance.) Which of the following is CORRECT about a group health insurance plan? -Non-contributory plans are paid for by the employer and employee -Non-contributory plans require 100% participation -Contributory plans are paid for by the employer only -Contributory plans require 100% participation - Correct Answer ✅Non- contributory plans require 100% participation Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) All of the following are characteristics of group health insurance, EXCEPT? -Group plans may be contributory or noncontributory -More Americans are covered by individual health plans than by group health plans -Benefits are predetermined by the employer -Cost for insuring an individual under a group plan is less than the cost under an individual plan - Correct Answer ✅More Americans are covered by individual health plans than by group health plans Generally when would an insurer engage in "individual underwriting" under a group health plan? -Never, this is prohibited by law -When the insurer is underwriting and evaluating the group -When an eligible employee tries to join the plan after initially electing not to participate -On an annual review - Correct Answer ✅When an eligible employee tries to join the plan after initially electing not to participate Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) What is the plan called if the employer pays the whole premium on a group policy? -Qualified -Non-qualified -Contributory -Non-contributory - Correct Answer ✅Non-contributory Which of the following is NOT true about "coordination of benefits"? -Establishes which health plan is primary -Found in group and individual health plans -Limits total amount of claims paid from all involved insurers -Purpose is to avoid duplication of benefits and overinsurance - Correct Answer ✅Found in group and individual health plans What is the purpose of COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985)? -Allow terminated employees to continue their group medical expense coverage for up to 18 months Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -18 months - Correct Answer ✅18 months Which of the following is CORRECT about "franchise" health plans? -It doesn't matter if the plan is contributory or noncontributory -It can only be sold to a franchise -Plans are guaranteed issue -Individual policies are issued to individual members - Correct Answer ✅Individual policies are issued to individual members The Coordination of Benefits (COB) clause is found in what kind of policy? -Fictitious -Group -Indemnity -Individual - Correct Answer ✅Group Blanket health plans may provide coverage for which of the following groups? -School covering students Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Company covering employees -Multiple employer group covering members -Association covering members - Correct Answer ✅School covering students Under a credit health policy, what is the maximum amount of any accidental death benefit? -Multiple of the monthly loan payments -Amount of original debt -Amount of outstanding debt -$100,000 - Correct Answer ✅Amount of outstanding debt For an individual to be able to take a tax deduction for individual contributions to a group medical plan, his medical expenses must exceed what percentage of his adjusted gross income? -7.0% -6.5% -7.5% -5.5% - Correct Answer ✅7.5% Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following would NOT be considered important when choosing the proper health insurance program? -Will I be able to deduct the premium payments from my taxes? -Is coverage available from a group plan or social insurance program? -Is the coverage for a family, individual, or business? -What are the deductibles and coinsurance? - Correct Answer ✅Will I be able to deduct the premium payments from my taxes? Cafeteria plans are also known as? -Section 125 plans -Flexible plans -Menu plans -Section 1040 plans - Correct Answer ✅Section 125 plans Which of the following is a TRUE statement regarding premiums and benefits for business overhead insurance? -Both premiums and benefits are tax-deductible -Both premiums and benefits are taxable -Premiums-tax-deductible, Benefits-taxable Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) What is the typical maximum coverage provided to an individual by a group disability income insurance policy? -100% of pre-disability gross earnings -60% of pre-disability gross earnings -75% of pre-disability gross earnings -50% of pre-disability gross earnings - Correct Answer ✅60% of pre-disability gross earnings Which of the following is NOT a reform provided by the new Health Care Reform Act? -Companies cannot deny pre-existing conditions -Children can stay on parent's insurance plans until age 26 -There will be a fine for those who do not purchase health insurance -Illegal immigrants now eligible for Medicaid - Correct Answer ✅Illegal immigrants now eligible for Medicaid All of the following are considered "rights of ownership" for a life insurance policy, EXCEPT? -Right to change irrevocable beneficiary Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Right to assign ownership of the policy to someone else -Right to cancel the policy and select a nonforfeiture option -Right to select how the death proceeds will be paid - Correct Answer ✅Right to change irrevocable beneficiary When someone other than the insured is the owner of a life insurance policy, the owner may do all of the following without consent of the insured, EXCEPT? -Change the beneficiary -Take out a policy loan -Increase the amount of insurance -Surrender the policy for its cash value - Correct Answer ✅Increase the amount of insurance Group health insurance is generally written on a basis that provides for dividends or experience rating. What is the basis called? -Participating -Contributory -Noncontributory Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Nonparticipating - Correct Answer ✅Participating (Explanation: Group plans written by mutual companies provide for dividends while stock companies frequently issue experience-rated plans.) Workers Compensation will not provide which of the following benefits? -Rehabilitation to return the person to work -Unemployment insurance -Replacement of wages due to disability -Payment for medical expenses - Correct Answer ✅Unemployment insurance Which of the following is NOT one of the three most important factors in underwriting a health insurance policy? -Parents' medical history -Occupation -Physical condition -Moral hazards - Correct Answer ✅Parents' medical history When an application for health insurance is submitted without an initial premium, the earliest effective date is the date on which the? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Sex - Correct Answer ✅Parents ages Who is the one that determines the classification of an applicant for health insurance? -Underwriter -Agent -Risk manager -Actuary - Correct Answer ✅Underwriter All of the following are techniques commonly used by insurers in issuing health insurance policies to substandard risks, EXCEPT? -Add a waiting period of 6 months -Charge extra premium -Attach exclusion or impairment rider or waiver -Limit the type of policy - Correct Answer ✅Add a waiting period of 6 months All of the following are classifications of applicants for health insurance, EXCEPT? -Standard risk Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Preferred risk -Special risk -Substandard risk - Correct Answer ✅Special risk (Explanation: The classifications of applicants for health insurance are: preferred risk, standard risk, substandard risk and uninsurable risk.) When an insured holds more than one occupation, and occupation is used to classify the risk, what occupation will the insurer generally use to classify the insured? -Occupation that would produce the lowest premium -Occupation where insured spends the majority of hours -Occupation insured has been employed the longest -Occupation that is most hazardous - Correct Answer ✅Occupation that is most hazardous Which of the following is NOT a factor affecting health insurance premiums? -Marital status -Sex -Age Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Hobbies - Correct Answer ✅Marital status With all other factors being equal, who of the following would have the highest premiums for a health insurance policy? -25 year old female -45 year old male -25 year old male -45 year old female - Correct Answer ✅45 year old female (Explanation: Health insurance costs tend to increase as the age of the insured increases. The older the insured, the higher the applicable premium rate. Disabilities among women under the age of 55, on the average, have a greater frequency and longer duration than among men, so female premium rates for certain coverages are higher than premium rates for males.) Both life and health insurance use all of the following factors in determine premiums, EXCEPT? -Interest factor -Expense factor -Morbidity Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) B) 35% C) 50% D) 65% - Correct Answer ✅50% (Controlled business is the practice of an agent selling policies or annuity contracts to himself or family members, officers, directors, stockholders, partners, or employees of a business in which he or a family member is engaged, or the debtors of a firm, association, or corporation of whom he or she is an officer, director, stockholder, partner, or employee.) If you are found guilty of any crime punishable by imprisonment one year or more, you must report it to the Insurance Department within how many days? A) 15 B) 20 C) 30 D) 60 - Correct Answer ✅30 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (If you are declared guilty of any crime that is punishable by imprisonment for 1 year or more, you must report it to the Insurance Department within 30 days, even if you pleaded 'no contest' or it occurred outside of Florida or even the U.S.) An insurance license may NOT be suspended for which of the following? A) Cheating on the license exam B) Twisting C) Over-insuring a health insurance risk D) Violating the code of ethics - Correct Answer ✅Over-insuring a health insurance risk (An agent's license will not be suspended for over-insuring a health insurance risk unless the agent willfully over-insured it.) Which of the following is NOT true about a fiduciary? A) A fiduciary holds a position of special trust and confidence B) Giving an agent a premium payment is the same as giving it to the insurer Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) C) If an agent is holding a premium payment for less than 3 days, it can be put in his personal account D) A fiduciary responsibility is to offer advice about financial security - Correct Answer ✅If an agent is holding a premium payment for less than 3 days, it can be put in his personal account (An agent or agency must keep funds belonging to each insurer in a separate account so it can be properly audited. An agent must never commingle the insurer's premium with personal funds, or otherwise use it for personal purposes.) An agent may write insurance under which of the following circumstances? A) Agent's company rejected the insurance so the agent submitted it to another company B) An agent may not broker rejected business to another company C) An agent may share commissions with another agent who is licensed, but not appointed with the insurer D) An agent may not be paid a fee for making a recommendation regarding group health insurance - Correct Answer ✅Agent's company rejected the insurance so the agent submitted it to another company Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (The Office of Financial Regulation protects the public against unauthorized behavior by audited insurance companies at least once every 3 years, and more frequently if warranted.) Which of the following is NOT true of a nonadmitted carrier? A) A nonadmitted carrier is also unauthorized B) The Florida Guaranty Association protects residents who buy from a nonadmitted carrier C) A nonadmitted carrier is not licensed in Florida D) An agent may not do business with a nonadmitted carrier - Correct Answer ✅The Florida Guaranty Association protects residents who buy from a nonadmitted carrier (Nonadmitted companies are not state licensed nor regulated by Florida, and the Florida Guaranty Association does not extend protection for Floridians who buy from these companies.) The entities of state government involved in the regulation of the insurance business in Florida are? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -The State Legislature -The Florida Dept of Financial Service -The State Courts -All of the above - Correct Answer ✅All of the above The Office of Insurance Regulation is NOT concerned with which of the following? -The assets and investments of insurance companies -The types and degree of risks of investments made by insurance companies -The examination of agent's income records -Limiting the amount that insurers can invest in different types of investments - Correct Answer ✅The examination of agent's income records The best definition of a legal reserve is? -The amount set aside by federal reserve banks as required by law -The amount set aside by the company for future liabilities as required by law -A leeway provision Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -None of the above - Correct Answer ✅The amount set aside by the company for future liabilities as required by law Fines and penalties for violating provisions of the agent's qualification laws include? -The denial, suspension, revocation and nonrenewal of License -A misdemeanor fine of not less than $500 nor more than $3500 -Imprisonment for not more than 6 months as well A misdemeanor fine of not less than $500 nor more than $3500 -All of the above - Correct Answer ✅All of the above Florida holds which of the following responsible for the content of any Medicare Supplement as using their name even if they did not approve the ad? -The insurer -The agent who ran the ad -The advertising association -The Agency of Ethical Conduct - Correct Answer ✅The insurer Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (Group is how those plans may be distributed) The two types of reserves set aside by insurers are? A) Premium and loss reserves B) Premium and liability reserves C) Claim and settlement reserves D) Earned and Unearned premium reserves - Correct Answer ✅Premium and liability reserves Reimbursement benefits may be paid directly to the medical providers under which condition? A) Scheduled benefits B) Assignment of benefits C) Loss of income benefits D) Injury benefits - Correct Answer ✅Assignment of benefits When a group is covered by a MET, who is issued the Master Policy? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) A) The sponsor B) The insurer C) The trust D) None is issued - Correct Answer ✅The trust (The sponsor develops the plan, sets the underwriting rules and administers the plan, but the trust itself is the Master Policy owner.) When a Medical Expense plan pays eligible expenses directly to the hospital, physician, or surgeon, it is paying on a? A) Reimbursement basis B) Service basis C) Cash basis D) Scheduled basis - Correct Answer ✅Service basis Which is not a provider type? A) Service B) Reimbursement Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) C) Blue Cross/Blue Shield D) Self-Insured - Correct Answer ✅Blue Cross/Blue Shield (Blue Cross/Blue Shield falls under the Service classification of provider. The 3 types of providers are Service, Reimbursement, and Self-Insured (Self- Funded).) What are the 3 provider types? -Service, Blue Cross/Blue Shield & Self-Insured -Blue Cross/Blue Shield, Service & Reimbursement -Service, Reimbursement & Self-Insured -None of the above - Correct Answer ✅Service, Reimbursement & Self- Insured (Blue Cross/Blue Shield falls under the Service classification of provider. The 3 types of providers are Service, Reimbursement, and Self-Insured (Self- Funded).) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 'Insurance Transaction' includes? A) Negotiations. B) Informal conversation among producers. C) Setting up an unattended brochure stand. D) Taking a random phone survey. - Correct Answer ✅Negotiations A policy that covers inpatient doctor visits and may be expanded to include payment for office visits, diagnostic x-ray, laboratory charges, ambulance and nurses expenses when not hospitalized, and maternity benefits for an additional premium, is considered which of the following? A) Medical Expense Policy B) Basic Physician's Expense Policy C) Major Medical Policy D) Supplementary Major Medical Policy - Correct Answer ✅Medical Expense Policy (Key word was in the question "expenses". The question is describing a Medical Expense Policy, sometimes referred to as a Regular (Basic) Medical Expense Policy.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Ed and Mavis own a Major Medical Policy for their entire family with a $250 per person/per accident deductible, 80/20 coinsurance and a stop-loss of $2,000. Their contract also contains the Carry-Over Provision, the Common Accident Provision and the Restoration of Benefits Provision. In June, Ed and 2 of his daughters were injured in an auto accident with a total medical bill of $2,000. In July, Ed and his son were also injured in a different incident for a total of $4,500 medical expenses. How much did the insurer have to pay for both accidents? A) $3,400 B) $1,700 C) $4,800 D) $4,500 - Correct Answer ✅$4,800 (Read Carefully: Since Ed and Mavis's Major Medical Policy contains a Common Accident Provision, only one deductible applies per claim even though more than one person was injured. Claim #1 ($2,000 - $250 deductible=$1750 X 80%=$1,400 the insurer's portion); Claim #2 ($4,500 - $250 deductible=$4,250 X 80%=$3,400 the insurer's portion). Insurer's total for the two claims=$4,800.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) A Medical Expense Policy list of the amount the insurer will pay for each medical expense incurred is known as a _____ _____ _____. ? A) Conclusion of Benefits B) Schedule of Benefits C) Secluded Emergency Benefits D) Social Insurance Benefits - Correct Answer ✅Schedule of Benefits (Under a Schedule of Benefits, the amount payable is itemized for each medical expense covered by the plan.) The percentage of Scheduled Coverage in a Major Medical Plan is how much greater than in a Basic Medical Expense Plan? A) There are no schedules in a Major Medical Policy. B) 40% better coverage. C) 20% better coverage. D) Same coverage, major medical has more exclusions. - Correct Answer ✅There are no schedules in a Major Medical Policy. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which policy may be written with Basic Medical Expense Coverage utilizing a Corridor Deductible after the basic plan benefits have been exhausted and before Major Medical benefits begin? A) Supplementary Major Medical B) Hospital Expense C) Comprehensive Major Medical D) Surgical Expense - Correct Answer ✅Supplementary Major Medical (The question is describing the characteristics and mechanics of a Supplemental Major Medical Policy.) Which type of Accident and Health policy would provide reimbursement for expenses involved with a broken hip? A) Endowment Policy. B) Medical Expense Policy. C) Accidental Death and Dismemberment Policy. D) Disability Income Policy. - Correct Answer ✅Medical Expense Policy. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (Key word is in the question "expenses". The question specifies to reimburse for expenses, not death, dismemberment, or loss of income.) Jasper owns a policy that combines the best features of the traditional Basic Plans and Major Medical Insurance into a single policy to give him the most complete hospital coverage. Jasper owns a? A) Supplementary Major Medical Policy B) Combination Major Medical Policy C) Comprehensive Major Medical Policy D) Blanket Major Medical Policy - Correct Answer ✅Comprehensive Major Medical Policy (Jasper owns a Comprehensive Major Medical policy. It combines the best features on the Basic Plans and Major Medical insurance into a single policy.) Sandra owns a Medical Expense Plan that contains a 60/40 Participation Provision (Coinsurance) after the deductible has been met. If a claim was filed and $7,200 in costs remained after Sandra met the $200 deductible? A) The insurer would pay $2,880, and Sandra would pay $4,320. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) B) The insurer would pay $4,440, and Sandra would pay $2,960. C) The insurer would pay $2,960, and Sandra would pay $4,440. D) The insurer would pay $4,320, and Sandra would pay $2,880. - Correct Answer ✅The insurer would pay $4,320, and Sandra would pay $2,880. A specified period before new coverage goes into effect for a specified condition is known as which of the following? A) Waiting period B) Exclusion C) Probationary period D) Morbidity table - Correct Answer ✅Probationary period (The question establishes a period before coverage goes into effect for specified conditions, not a period before an employee is even eligible to enroll for group benefits, which would be a waiting period.) Beth has a contract stating she must be disabled for 3 months before benefits will be paid. This is considered the? A) Probationary Period Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) C) Partial Disability D) Residual Disability - Correct Answer ✅Presumptive Disability (Presumptive Disability is where a loss is presumed to be total and permanent due to loss of sight, hearing, speech or loss of two limbs.) This provision states that if there is a second disability due to the same cause within a specified period, then the elimination period may not apply the second time. It is which provision? A) Rehabilitation Disability B) Residual Disability C) Recurrent Disability D) Second Disability - Correct Answer ✅Recurrent Disability (Under Recurrent Disability, if a second disability - NOT a left over as in Residual, is suffered due to the same cause as the first, within a given period, the elimination period may not apply the second time. The benefit period will be considered as a continuous period of disability.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following would meet the definition of Presumptive Disability? A) The loss of a leg below the knee. B) The loss of sight in an eye. C) The loss of the ability to speak. D) The loss of hearing in an ear. - Correct Answer ✅The loss of the ability to speak (The only response that reflects complete loss of a function is the ability to speak. 'The loss of a leg below the knee does not represent loss of two limbs, and loss of sight in an eye or hearing in an ear does not reflect loss of all sight or hearing.) Which provision provides a loss of earnings benefit to an employee who returns to work after sustaining a total disability, if the insured's earnings are less than they were before the disability? A) Recurrent Disability B) Presumptive Disability C) Residual Disability D) Restorative Disability - Correct Answer ✅Residual Disability Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Stephen must be disabled 60 days before he will receive any benefits from his disability policy. This 60-day period is the? A) Waiting Period B) Elimination Period C) Policy Period D) Probationary Period - Correct Answer ✅Elimination Period (Upon reinstatement accidents are covered immediately, and sickness after 10 days. This avoids the motivation for one to want to reinstate a policy because they are already sick.) Martha's Disability Income policy contains a definition of 'Presumptive Disability'. Each of the following situations would meet this definition, except? A) Loss of a limb B) Loss of sight C) Loss of hearing D) Loss of speech - Correct Answer ✅Loss of a limb Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (A Limited Accident Policy provides specific benefits for specific injuries from specific causes such as travel.) Which statement is INCORRECT concerning an Accidental Death and Dismemberment Policy? A) It provides a specified payment for a specified injury. B) May be written separately or added to a Health/Disability or Life Policy as a rider. C) It usually provides that the death benefit (Principal) will also be paid if the insured loses sight in both eyes or loses any two limbs. D) A smaller amount (Capital) may be paid for the loss of sight in one eye or the loss of one limb. - Correct Answer ✅It provides a specified payment for a specified injury. (This is describing a Limited Accident Policy, not an Accidental Death and Dismemberment Policy.) Which is the best definition of a Limited Accident Policy? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) A) Provides specific benefits for specific injuries from specific causes. B) Only covers for a limited time after the accident. C) Limited in geographical scope (i.e. only in the state where written). D) All answers are correct. - Correct Answer ✅Provides specific benefits for specific injuries from specific causes. Raymond owns an Accidental Death and Dismemberment Policy with a Principal amount of $50,000, and a Capital amount of $25,000. After owning the policy several months, Raymond dies as the result of coronary artery disease. Lynn, his beneficiary, can expect to receive what amount of benefit from the policy? A) $0 B) $25,000 C) $50,000 D) $75,000 - Correct Answer ✅$0 (Lynn will receive no benefit from this policy since Raymond died of coronary artery disease, not an accident. Hopefully, Raymond owned additional life insurance.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which statement regarding Medicare is NOT true? A) Medicare may be the primary payor to any employer group health plan coverage. B) It is a federal health program for people 65 and older and others of any age, who have received Social Security Disability Benefits for at least 2 years. C) The initial enrollment period lasts 7 months and begins on the 1st day of the 3rd month before one is eligible for Medicare. D) Hospitals and other providers of health care wanting to participate in the Medicare program must be licensed by the state. - Correct Answer ✅Medicare may be the primary payor to any employer group health plan coverage. (Group health plans with 20 or more employees are primary to Medicare and pay first.) Which of the following is NOT provided under Part A of Medicare? A) Hospice Care B) Home Health Care Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) This is a product designed to provide coverage for necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital. This product is called? A) Long-Term Care B) Medicare Supplement C) Retirement Benefits D) Outpatient Care - Correct Answer ✅Long-Term Care (The question is describing a Long-Term Care Policy. Medicare Supplement is incorrect as it covers skilled nursing care only, and then on a limited basis by number of days.) Exclusions listed in the policy are NOT covered. Which of the following is not an exclusion? A) Intentionally self-inflicted injuries B) Elective cosmetic surgery C) Nonoccupational injuries D) Care in a government facility - Correct Answer ✅Nonoccupational injuries Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (Nonoccupational injuries are covered. Job related or occupational injuries are typically excluded as they are covered by Workers' Compensation.) Which Long-Term Care definition does not match the coverage? A) Residential Care - health care provided in one's home under a planned program established by his/her attending physician. B) Respite Care - provides relief to the caregiver not the long-term care patient. C) Custodial Care Facility - a licensed facility, operated according to the laws of the state, under the supervision of an R.N. D) Skilled Nursing Facility - a licensed facility, operated in accordance with the laws of the state, providing skilled nursing care under the supervision of a physician. - Correct Answer ✅Residential Care - health care provided in one's home under a planned program established by his/her attending physician. (This is the definition of Home Convalescent Care, not Residential Care, which occurs within a long-term care facility.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Every LTC Policy that provides benefits of homecare or community-based services shall provide all of the following except? A) Adult day care B) Hospice services C) Respite care D) Acute care - Correct Answer ✅Acute care An insurer offering Medicare Supplements to the senior clients of this state must? A) Offer Core Benefit Plan A if they sell any of the other plans. B) Offer the broader coverage plans only. C) Offer any plan from C to S. D) Offer Core Benefit Plans only. - Correct Answer ✅Offer Core Benefit Plan A if they sell any of the other plans (If an insurer is going to offer Medicare Supplement insurance, they must make Plan A available if they offer any of the 10 plans.) All of the following could be approved as Long-Term Care facilities, except? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Notice of claim is required within _____ days of loss. A) 90 B) 15 C) 20 D) 10 - Correct Answer ✅20 (The insured under the Notice of Claim Provision (a Mandatory Uniform Provision) is required to notify the insurer, in writing, within 20 days of any loss.) Proof of loss is required within _____ days of loss. A) 45 B)180 C) 60 D) 90 - Correct Answer ✅90 (The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) time possible, but not to exceed 1 year unless the insured suffers legal incapacity.) Which of the following is not a Mandatory Uniform Provision? A) Payments of Claims B) Reinstatement C) Conformity with State Statutes D) Physical Exam & Autopsy - Correct Answer ✅Conformity with State Statutes Harry was hospitalized in a coma for 6 months. Since no one knew about his health care coverage, when does proof of loss have to be submitted? A) Within 1 year, unless he suffers legal incapacity. B) Anytime, since he was in a coma and obviously could not submit a claim. C) Within 2 years, covered under the contestable period. D) An executor would be appointed by the courts to handle the necessary paperwork - Correct Answer ✅Within 1 year, unless he suffers legal incapacity. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (The Proof of Loss Provision (a Mandatory Uniform Provision) stipulates the insured is to prove their loss within 90 days of the loss, or in the shortest time possible, but not to exceed 1 year unless the insured suffers legal incapacity.) Which statement is INACCURATE regarding the Change of Occupation Provision? A) Change to a less hazardous occupation, insured may apply for a rate reduction. B) Change to a more hazardous occupation, upon claim, benefits will be reduced to that which premiums paid would have purchased at the more hazardous occupation. C) Insured must notify the insurer of a change of occupation, or policy will be cancelled. D) If the insured works at two occupations, rates for the most hazardous occupation will be charged. - Correct Answer ✅Insured must notify the insurer of a change of occupation, or policy will be cancelled. (Failure to notify the insurer of a change of occupation will not result in cancellation of the policy.)