Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2024, Exams of Nursing

Download Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2024 and more Exams Nursing in PDF only on Docsity! Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2024 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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.) 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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) All of the following are correct regarding Florida regulation of HMOs, EXCEPT? -Must obtain a Certificate of Authority -Must file a report of its activities within 3 months of the end of each fiscal year -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) All of the following are true about a multiple employer welfare arrangement (MEWA), EXCEPT? -Required by law to have an employment-related common bond -Often provide insurance on a self-insured basis -Tax-exempt entities -Large employers who have joined together to provide health insurance benefits - Correct Answer ✅Large employers who have joined together to provide health insurance benefits (Explanation: MEWAs consist of small employers who join together to provide health insurance benefits for their employees) 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) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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.) 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: Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -$11,900 -$2,400 - Correct Answer ✅$17,600 (Explanation: Total expenses are $20,000. Basic medical will pay the first $10,000 which leaves $10,000 remaining. Roberta will pay the first $500 of this $10,000 with $9,500 remaining. Company will now pay 80% of $9,500 or $7,600. Total company pays will be $10,000 from the basic medical plus $7,600 from the major medical = $17,600) Which of the following statements is TRUE about basic hospital, medical and surgical expense policies? -The benefits provided are usually equal to the actual expenses incurred -They contain high deductibles -They usually have a stated limit for specific expenses -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 -$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).) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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).) 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: Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Limited risk or dread disease policies are designed specifically to cover the high costs associated with a specific illness.) William was involved in a 2-car accident in which he is disabled and his passenger and the driver of the other car are injured. Which of the following would most likely be covered by William's disability income policy? -Disability of the other driver -His lost income -William's medical expenses -Dismemberment of the passenger's leg - Correct Answer ✅His lost income 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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? -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) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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? -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Joseph has a disability income policy stating a flat amount of $2,000 monthly benefit. He has been totally disabled for 6 months but is now able to work part-time. What can he expect to receive from his disability income policy if the policy also covers partial disability? -$1,000 monthly benefit -$500 monthly benefit -$0 benefit -$2,000 monthly benefit - Correct Answer ✅$1,000 monthly benefit What form of insurance is the primary form of pure accident coverage? -Major Medical -Disability Income -Medical Expense -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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 An individual accidental death and dismemberment policy (AD&D) will pay benefits if an insured dies from... -Heart attack Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 Which of the following is an example of a limited risk policy? -Surgical policy -Medical expense policy Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Must cover pre-existing conditions from the date the policy goes into effect -Must automatically adjust its benefits to reflect statutory changes in Medicare -Must cover all expenses not covered by Part A from the 61st to the 90th day -Must supplement both Part A and Part B of Medicare - Correct Answer ✅Must cover pre-existing conditions from the date the policy goes into effect Which of the following is NOT a requirement for an agent soliciting Medicare supplements? -Explain to prospect where there will be overlapping coverage -Send a signed form to the company explaining why coverage could not be placed -Inquire from each prospect if they already have coverage -Have prospect sign a form acknowledging information has been provided - Correct Answer ✅Send a signed form to the company explaining why coverage could not be placed Which of the following is NOT a category level of long-term care? -Custodial care Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 -Intermediate nursing care -Skilled nursing care - Correct Answer ✅Custodial care Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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) All of the following are ways in which to classify employees for a group health insurance policy, EXCEPT? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Group must have been formed for some reason other than to obtain insurance -Group must be consist of natural born citizens -Group must have ten (10) or more members - Correct Answer ✅Group must have been formed for some reason other than to obtain insurance All of the following are correct regarding group health insurance, EXCEPT? -Major medical coverage may be written on a group basis -Employees receive separate policies -Debtor groups are eligible for group plans -Employer is issued a master policy - Correct Answer ✅Employees receive separate policies Which of the following is CORRECT regarding group health insurance? -Insurer must ask health questions of each individual in the group -Labor unions are not eligible -A group may be eligible that is formed just for the purpose of purchasing insurance Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Lodges are eligible - Correct Answer ✅Lodges are eligible 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Contributory plans require 100% participation - Correct Answer ✅Non- contributory plans require 100% participation 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -180 days - Correct Answer ✅31 days Jake purchased group "credit disability" insurance to cover a loan. He was injured and disabled for 7 months. What benefits were paid under this policy? -Insured's loan is paid off at the beginning of his disability -Creditor receives monthly payments equal to the monthly loan payments -Creditor receives monthly payments equal to the loan amount less loan interest charges -Insured receives monthly disability income payments - Correct Answer ✅Creditor receives monthly payments equal to the monthly loan payments Generally what type of health insurance policies offer dental and vision care benefits? -Individual -Franchise -Blanket -Group - Correct Answer ✅Group Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) COBRA is a federal law that provides for an extension of health benefits for what length of time after employment is terminated? -24 months -6 months -12 months -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -Indemnity -Individual - Correct Answer ✅Group Blanket health plans may provide coverage for which of the following groups? -School covering students -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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Why were Cafeteria Plans designed? -Provide insurer greater control over benefits selected for employees -Allow employees to pick and choose from a menu of benefits to tailor their own benefit package -Allow employers to pick and choose benefits from a menu that best suits their company needs -Provide diversity of insurance company and HMO - Correct Answer ✅Allow employees to pick and choose from a menu of benefits to tailor their own benefit package Which of the following will NOT be covered under Business Overhead Expense Insurance? -Leased equipment -Mortgage payments -Owner's salary -Employees' salaries - Correct Answer ✅Owner's salary (Explanation: Business Overhead Expense insurance is designed to reimburse a business for overhead expenses in the event a businessowner becomes disabled.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) As compared to individual disability income policies, group disability income policies are generally? -More costly and have less liberal provisions -Tied more closely to Social Security disability benefits -Less costly and have more liberal provisions -More restrictive in terms of covered medical expenses - Correct Answer ✅Less costly and have more liberal provisions 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 -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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) All of the following are additional risk factors used in underwriting a health insurance policy, EXCEPT? -Avocations -Policy premiums of other health insurance -Age -Family history - Correct Answer ✅Policy premiums of other health insurance Barry suffered a heart attack 26 months ago. What type of risk would he be considered? -Standard risk -Restricted risk -Special risk -Substandard risk - Correct Answer ✅Substandard risk (Explanation: A substandard risk applicant is one who poses a higher-than-average risk for one or more reasons. Substandard applicants may represent a very low risk on moral and occupational considerations and still pose a high risk because of their physical condition.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) When must insurable interest exist in health insurance? -During the policy period -Both at the time of application and time of claim -At the time of a claim -At the time of application - Correct Answer ✅At the time of application (Explanation: Insurable interest for health insurance is the same as for life insurance. Insurable interest must exist at the time of application.) All of the following are used in underwriting an applicant's health application, EXCEPT? -Parents ages -Weight -Age -Sex - Correct Answer ✅Parents ages Who is the one that determines the classification of an applicant for health insurance? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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 -Preferred risk -Special risk -Substandard risk - Correct Answer ✅Special risk (Explanation: Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) An insurer authorized to do business within this state is considered what type of insurer? A) Foreign B) Domestic C) Admitted D) Certified - Correct Answer ✅Admitted (An insurer authorized to do business in this state is referred to as admitted, and could be either domestic, foreign, or alien domiciled.) Charging different rates or providing different benefits to insureds of the same actuarial class or hazard category is which of the following? A) Sliding B) Unfair discrimination C) Fictitious grouping D) Defamation - Correct Answer ✅Unfair discrimination Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (Unfair discrimination is knowingly making or permitting individuals of the same actuarially supportable class and equal expectation of life to be charged different rates, paid different dividends or have different terms/conditions regarding any life insurance contract.) A bank or credit union will not give a loan unless the borrower buys insurance from a specific company. This is known as? A) Misrepresentation B) Rebating C) Churning D) Coercion - Correct Answer ✅Coercion (It is an unfair trade practice to enter into any agreement to commit, any act of boycott, coercion, or intimidation resulting in an unreasonable restraint of, or monopoly in, the business of insurance.) An agent may have no more than ________ of his total business within a 12- month period be from controlled business. A) 25% Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 (An agent may write excess or rejected business with another company after the agent's company rejected it or accepted it on a substandard basis, or a portion of a risk is above the limits of that which the agent's own insurer will accept.) Which of the following is INCORRECT about life insurance company appointments? A) Also applies to health applications B) An agent must be appointed for life and health insurance separately C) An agent may not use the same insurer appointment to sell life insurance and excess business D) An agent may present a proposal to a company without being appointed - Correct Answer ✅An agent must be appointed for life and health insurance separately Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (The department may issue a single appointment covering both life and health insurances to an individual licensed for both kinds of insurance and appointed as agent for both kinds by the same insurer.) Which of the following is NOT a qualification to apply for an insurance license in Florida? A) Must be at least 18 years old B) Must have a high school diploma or GED C) U.S. Citizen D) Legal alien with U.S. work authorization - Correct Answer ✅Must have a high school diploma or GED (The person must also be trustworthy and competent and a resident of Florida.) All insurance carriers authorized in Florida must be audited by the Office of Financial Regulation once every __________. A) Year B) 3 years Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) C) 5 years D) 7 years - Correct Answer ✅3 years (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.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -The agent who ran the ad -The advertising association -The Agency of Ethical Conduct - Correct Answer ✅The insurer Must a mail-order insurance company be authorized to solicit insurance in the state of Florida? -Yes, and the applications must be taken by a Florida State Agent -No, since there is no personal contact any company can solicit by mail -Yes, but the applications do not have to be sent to a Florida address -No, Florida prohibits the sale of insurance without personal contact - Correct Answer ✅Yes, and the applications must be taken by a Florida State Agent Which of the following is NOT considered one of the renewability classifications? A) Optionally renewable B) Guaranteed renewable C) Conditionally cancellable Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) D) Conditionally renewable - Correct Answer ✅Conditionally cancellable __________ are set aside by an insurance company and designated for the payment of future claims. A) Reserves B) Dividends C) Capital accounts D) Premiums - Correct Answer ✅Reserves Most individual health insurance is written on a ________ basis. A) Nonparticipating B) Participating C) Group D) Franchise - Correct Answer ✅Nonparticipating (Individual is commonly nonparticipating, group is commonly participating.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health protection is offered in three different forms, which is NOT one of those forms? A) Accidental Death and Dismemberment B) Group Coverage C) Medical Expense D) Disability Income - Correct Answer ✅Group Coverage (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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) -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).) Fred's group health offers prepaid routine medical exams to provide early treatment and preventive care. He has what type of coverage? A) Blue Cross B) Hospital Indemnity C) PPO D) HMO - Correct Answer ✅HMO (HMOs emphasize preventive medicine and early treatment with prepaid routine medical exams, stress management, and diagnostic screening techniques.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) A firm that provides administrative services for employers, acts as liaison between the insurer and employer and processes claims, etc. is a(n)? A) Third Party Administrator B) Administrative Services Only C) Staff Plan D) Gatekeeper - Correct Answer ✅Third Party Administrator (The key words are acts as liaison between the insurer and employer.) Sylvia is a participant in a Preferred Provider Organization (PPO) and finds that if she opts to use a provider other than a preferred provider, that? A) Her PPO will not pay at all. B) Her PPO will pay only if the circumstances for care were precipitated by an emergency. C) Her PPO will pay a reduced amount with Sylvia paying the balance. D) Her PPO will cover any charges in full. - Correct Answer ✅Her PPO will pay a reduced amount with Sylvia paying the balance. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following is TRUE of traditional commercial insurers? A) They offer only individual plans of insurance. B) They offer only group plans of insurance. C) They traditionally market reimbursement type contracts that pay directly to the insured. D) They traditionally market service type contracts that pay directly to the provider of the service. - Correct Answer ✅They traditionally market reimbursement type contracts that pay directly to the insured. '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? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (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. (Remember, a Major Medical Plan provides protection against health losses that may be catastrophic in nature with a lifetime maximum limit; usually there are no schedules included.) Hank was in the hospital last month for 3 days, today he received a check for $330. Is this a refund or a payment from a health policy? A) A benefit payment from his Hospital Income or Indemnity Policy. B) A refund from his doctor. Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) C) A refund of premium triggered by hospitalization. D) He submitted the claim wrong and this is the total benefit. - Correct Answer ✅A benefit payment from his Hospital Income or Indemnity Policy. (The Hospital Income or Indemnity Policy pays directly to the insured a specified dollar (cash) amount per day during hospitalization.) Which type of insurance policy combines Basic Medical Expense Coverage with Major Medical Coverage? A) Supplemental Major Medical B) Hospital Expense C) Comprehensive Major Medical D) Surgical Expense - Correct Answer ✅Comprehensive Major Medical (A Comprehensive Major Medical Policy combines the best features of the basic policies and Major Medical policy into a single policy and provides the most complete hospital coverage.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Many insurers pay benefits based on the average fee charged in a geographical area. This is referred to as? A) Reimbursement B) Cash C) Scheduled D) Usual Customary and Reasonable - Correct Answer ✅Usual Customary and Reasonable (UCR is not scheduled, but is based on the average fee charged by all doctors in a given geographical area.) 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 B) Elimination Period C) Grace Period D) Contingency Period - Correct Answer ✅Elimination Period (The Elimination Period is a period of time that must expire after onset of an illness or occurrence of an accident before benefits will be payable.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which is NOT a reason insurers limit disability income benefits to 70% or less of the insured's past earnings? A) Insurers limit the benefits simply because it keeps their expenses down. B) The full income is not paid in order to reduce malingering. C) The insurer considers other sources of disability income in order to prevent overinsurance. D) Insurers limit the length of the benefit to encourage the return to work. - Correct Answer ✅Insurers limit the benefits simply because it keeps their expenses down. (Although insurers are always sensitive to controlling expenses, that is not a factor in this question.) A court reporter develops arthritis making it impossible to continue this employment. The reporter now has other employment at a reduced salary and receives a monthly benefit from an insurance contract due to which of the following policy provisions? A) Residual Disability Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) B) Recurrent Disability C) Partial Disability D) Total Disability - Correct Answer ✅Residual Disability (Residual Disability recognizes one's ability to continue to work, but at a reduction of earnings.Arthritis is what forms as a result of an injury from an accident or otherwise, therefore it's considered a residual disability.) Steve Borden, a kindergarten teacher, was in a boating accident and lost both legs. Although he will continue to teach, his disability policy pays full benefits because of this provision? A) Presumptive Disability B) Total Disability 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.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 (Presumptive Disability involves the loss of two or more limbs, not the loss of one limb only.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which measure could an underwriter use to reduce the risk when underwriting a Disability Income Policy? A) Increase the benefit period and shorten the elimination period. B) Shorten the elimination period and increase the amount of the benefit. C) Shorten the benefit period and increase the elimination period. D) Increase the benefit period and increase the amount of the benefit. - Correct Answer ✅Shorten the benefit period and increase the elimination period. (All other possible answers actually increase the risk.) Penelope received benefits from her disability policy and went back to work. After 30 days she found she was not able to work and began to immediately receive her disability payments. Which of following provisions made this possible? A) Recurrent Disability Provision B) Residual Disability Provision C) Presumptive Disability Provision Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) D) Second Injury Provision - Correct Answer ✅Recurrent Disability Provision Accident and Health Insurance, insures for two major perils, they are? A) Driving under the influence and driving while intoxicated. B) On the job and off the job. C) Accidental injury and sickness. D) Automobile and home health care. - Correct Answer ✅Accidental injury and sickness. Which contract would a bus line passenger purchase to cover injuries sustained while traveling across the United States? A) Blanket B) Limited Accident C) Common Carrier Insurance D) Liability Insurance - Correct Answer ✅Limited Accident (A Limited Accident Policy provides specific benefits for specific injuries from specific causes such as travel.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) 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 C) Outpatient Hospital Treatment Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) D) Post-hospital Skilled Nursing Facility Care - Correct Answer ✅Outpatient Hospital Treatment (Part A of Medicare is Hospital Insurance or (Inpatient); Part B of Medicare is Medical Insurance or (Outpatient).) Which of the following is INCORRECT regarding how Medicare works? A) Part B is optional and offered to applicants when they become entitled to Part A. B) Part A is premium free to those who qualify through Social Security or railroad retirement or government employment. C) Part B covers routine physical exams and dialysis for those with kidney failure. D) Part B - outpatient service benefits are determined by consulting a national fee schedule. - Correct Answer ✅Part B covers routine physical exams and dialysis for those with kidney failure. A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as? Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) A) Medicaid (In California, Medi-Cal) B) Medicare Part A C) Supplemental Security Income D) State Supplemental Payment Program - Correct Answer ✅Medicaid (In California, Medi-Cal) (Medicaid (in California, Medi-Cal) is the federal and state administered program that provides increased assistance to those who are unable to pay for their own medical needs.) Part A of Medicare is known as? A) Medical Insurance B) Medicare + Choice C) Outpatient Insurance D) Hospital Insurance - Correct Answer ✅Hospital Insurance (Part A of Medicare is formally known as Hospital Insurance (Inpatient). Part B is formally known as Medical Insurance (Outpatient)) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (This is the definition of Home Convalescent Care, not Residential Care, which occurs within a long-term care facility.) 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 Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) (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? A) A skilled nursing facility B) A sanitarium for weight loss C) An intermediate care facility D) A custodial care facility - Correct Answer ✅A sanitarium for weight loss Which optional LTC coverage is designed to provide relief to the actual caregiver in an LTC situation? A) Respite Care B) Adult Day Care C) Hospice Care D) Home Health Care - Correct Answer ✅Respite Care (All responses are optional coverages to LTC insurance, but the question is specifically making reference to the caregiver, not the insured.) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023) Which of the following is CORRECT concerning an LTC policy? A) Defining a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage. B) Providing coverage for only skilled nursing care instead of lower levels of care. C) Cancelling, nonrenewing, or terminating a policy on the grounds of age. D) Establishing a new waiting period when existing coverage is converted or replaced by a new form, except when the insured voluntarily selects an increase in benefits. - Correct Answer ✅Defining a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage. The policy, a copy of the application, any riders and policy endorsements constitute the _____ _____. A) Entire contract B) Legal actions C) Time limit Health Insurance Florida 2-40 Practice Exam Questions #2 with Answers (latest Update 2023)