215 Health Test

When comparing a group health plan with an 80/20-coinsurance provision with one, which has a 75/25-coinsurance provision, the employee will pay ____for the 80/20 provisions. A. More premium B. Less premium C. Significantly less premium D. About the same

A. More premium

Are coverage's in health insurance policies required to pay for services performed in an ambulatory surgical center? A. Yes B. No

A. Yes

Voluntary cosmetic surgery, under the typical health insurance policy, is generally: A. excluded B. included C. included, but an extra premium is charged when voluntary cosmetic surgery is performed. D. None of the above.

A. excluded

If an application is filed for the Reinstatement of a health insurance policy but the company takes no action on such reinstatement, the policy is automatically reinstated after how many days? A. 30 B. 45 C. 60 D. 120

B. 45

Disabilities for women under age 55 have: A. A shorter duration than disabilities for men B. A greater frequency and longer duration than among men C. Generally been excluded in health insurance contracts D. None of above

B. A greater frequency and longer duration than among men

A "cafeteria plan" is a benefit arrangement which: A. Restricts choice of benefits to the employer. B. Allows employees to tailor their benefit package to meet their specific needs. C. None of the above.

B. Allows employees to tailor their benefit package to meet their specific needs.

From the insured's point of view, it is most advantageous to have a disability policy which defines total disability as being unable to work at: A. Any occupation B. His/her own occupation C. Any occupation and being confined in a hospital D. None of above

B. His/her own occupation

Which of the following statements about Worker's Compensation laws is incorrect? A. Worker's Compensation provides benefits for work-related injuries. B. Not all states have worker compensation laws. C. Employers can purchase Worker's Compensation coverage through state programs and private insurer's, or they can self-insure D. None of the above

B. Not all states have worker compensation laws.

Which part of Medicare requires premium payment by eligible participants? A. Part A, basic hospital insurance B. Part B, supplementary medical insurance C. Respite Care D. All of above

B. Part B, supplementary medical insurance

Primary support for Medicare Part A comes from: A. General tax revenues B. Social Security payroll taxes C. Private Funding D. A combination of the above

B. Social Security payroll taxes

When an insured holds more than one occupation, and occupation is used to classify the risk, the insurer will generally classify the insured according to the occupation: A. at which he insured spends the majority of hours each week. B. That is most hazardous. C. In which the insured has been employed for the longest period of time. D. That which produces the lowest premium.

B. That is most hazardous.

Which of the following statements about health service organizations is true? A. They provide loss of income benefits to policy owners B. They provide benefit payments directly to the hospitals and physicians providing service C. They reimburse policy owners directly for physicians' fees D. They reimburse policy owners directly for all medical expenses

B. They provide benefit payments directly to the hospitals and physicians providing service

Mary-Margaret has a special risk policy. It will pay a benefit for: A. Dreaded Diseases B. Unusual hazard not covered on other policies C. An accident on a commercial flight D. None of above

B. Unusual hazard not covered on other policies

When does a company generally engage in "individual underwriting" under a group health plan? A. Never, this is prohibited by law. B. When an eligible employee tries to join the plan after initially electing not to participate. C. On an annual review. D. All of the above.

B. When an eligible employee tries to join the plan after initially electing not to participate.

According to the NAIC model law, health insurance contracts have what number of mandatory provisions? A. 5 B. 11 C. 12 D. 15

C. 12

Which of the following is an example of a limited risk policy? A. Travel accident policy B. Aviation policy C. Automobile policy D. All of above

D. All of above A. Travel accident policy B. Aviation policy C. Automobile policy

Delayed Disability will usually provide income if the disability appears within: A. 30 days B. 60 days C. 90 days D. All of above depending on policy

D. All of above depending on policy A. 30 days B. 60 days C. 90 days

Which of the following statements about deductibles in health insurance contracts is correct? A. A higher deductible will help limit claims. B. The average deductible has increased in recent years. C. Deductibles for individuals are generally in the $400 to $800 range today. D. All of the above.

D. All of the above. A. A higher deductible will help limit claims. B. The average deductible has increased in recent years. C. Deductibles for individuals are generally in the $400 to $800 range today.

Under social security, when does the blackout period begin for a surviving spouse? A. When the youngest child becomes 16 B. When the youngest child becomes 18 C. At age 60 D. At age 65

A. When the youngest child becomes 16

Is coverage for chiropractic care required to be offered to the employees in a group plan? A. Yes B. No, it can be offered but it is not required

A. Yes

Which policy described below pays a death benefit? A. Disability income B. Accident and health C. Accidental death and dismemberment D. Hospital indemnity

C. Accidental death and dismemberment

What type of disability policy covers a fixed period of time and provides funds for long-term commitments if an owner or key employee of a business is disabled? A. Decreasing term disability coverage B. Key person disability coverage C. Business overhead expense coverage D. Disability buy-out coverage

C. Business overhead expense coverage

Which of the following is an optional provision of most health insurance policies? A. Grace period provision B. Notice of claims provision C. Change of occupation provision D. All of above

C. Change of occupation provision

Which of the following types of insurance policies combines several types of benefits and provides more coverage than any of the others? A. Hospital Expense B. Surgical Expense C. Comprehensive Major Medical D. Hospital Indemnity policy

C. Comprehensive Major Medical

An employer who fails to comply with COBRA can be subject to: I. Fines II. Prison III. Lose tax deduction A. I & II B. I & III C. III only D. All of above

C. III only III. Lose tax deduction

According to optional Provisions 8 in a standard health policy, if the insurance company cancels a policy, on what basis must prepaid premiums be returned to the insured? A. Short rate basis, which means all unearned premiums, is returned to the insured. B. Short rate basis, which means the insurer, may retain part of the unearned premium in order to cover its expenses. C. Pro rata basis, which means all unearned premium, is returns to the insured. D. Pro rata basis, which means the insurer, may retain part of the unearned premium in order to cover its expense.

C. Pro rata basis, which means all unearned premium, is returned to the insured.

Which of the following statements is true about basic hospital, medical and surgical expense policies? A. They contain high deductibles B. The benefits provided are usually equal to the actual expenses incurred C. They usually have a stated limit for specific expenses D. Benefits are provided for loss of income

C. They usually have a stated limit for specific expenses

What is the incontestable clause in health insurance? A. Entire contract B. Grace period C. Time limit on certain defenses D. There is none

C. Time limit on certain defenses

Which of the following statements is not true concerning a coordination of benefits situation? A. The group insurer for the person with the claim is primary B. The group insurer for the spouse of the person with the claim is secondary C. To prevent over-insurance, the secondary insurer does not pay benefits D. Where children are involved the primary group insurer is the insurer for the parent whose birthday comes first in the year

C. To prevent over-insurance, the secondary insurer does not pay benefits

Roberta has a basic hospital expense policy with a $10,000 limit for benefits, coordinated with a major medical policy with a $500 corridor deductible and 80/20 coinsurance provision. If she incurs a loss of $20,000, how much will the insurer pay? A. $16,000 B. $15,600 C. $7,600 D. $17,600

D. $17,600

A life insurance policy is considered incontestable after it has been in force for a period of: A. 45 days B. 6 months C. 3 years D. 2 years

D. 2 years

If an individual becomes totally and permanently disabled, social security disability benefits may begin after: A. 15 days B. 30 days C. 60 days D. 5 months

D. 5 months

A state insurance department licensed insurance company that is domiciled in, and is permitted to do business in the licensing state is called: A. A fraternal company B. A permitted company C. An authorized company D. A domestic company

D. A domestic company

Persons over 65 may be entitled to: A. Medicare A B. Medicare B C. Medicaid D. A, B & C

D. A, B & C A. Medicare A B. Medicare B C. Medicaid

Which of the following statements about group health insurance is correct? A. More Americans are covered by group health plans than by individual health plans. B. The cost of a group plan is less than a comparable individual health plans. C. Most group plans have conversion privileges. D. All of the above

D. All of the above A. More Americans are covered by group health plans than by individual health plans. B. The cost of a group plan is less than a comparable individual health plans. C. Most group plans have conversion privileges.

Fraternal benefit programs have all the following, except: A. Lodge system B. Hold regular meetings C. Noted for charitable and benevolent activities D. Always operate as a corporation

D. Always operate as a corporation

All of the following statements about major medical benefits are true, except: A. The deductible can be expressed as a fixed dollar amount B. Benefit period begins only after a specified amount of expenses that have been accrued within the accumulation period C. Benefits are generally expressed as a percentage of eligible expenses D. Benefits have no maximum limit

D. Benefits have no maximum limit

The following groups are eligible for group life insurance, except: A. Employer - employee groups B. Labor unions C. Debtor groups D. Encounter groups

D. Encounter groups

Which of the following is an eligible requirement for social security disability? A. At least one year of total or partial disability B. Be at least fifty years old C. Currently insured status D. Fully insured status

D. Fully insured status

Florida rules on disclosure require: I. A buyers guide and summary prior to acceptance of a premium II. A ten day free look and buyers guide provided a policy delivery III. Florida does not require a buyers guide A. I only B. II only C. III only D. I and II

D. I and II I. A buyers guide and summary prior to acceptance of a premium II. A ten day free look and buyers guide provided a policy delivery

Social programs administered by state government: I. Medicare II. Medicaid III. Workers Compensation A. I and II B. All of above C. I and III D. II and III

D. II and III II. Medicaid III. Workers Compensation

In regard to group insurance, who has the responsibility to apply for coverage, provide information about the group, maintain the policy and pay premiums? A. Agent that wrote the group coverage B. Insurer that provides the group coverage C. Individuals that make up the group D. Master policy owner

D. Master policy owner

The time payment of claims provision required that an insurance company pay disability income benefits no less frequently than: A. Annually B. Semi-annually C. Quarterly D. Monthly

D. Monthly

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? A. 5 days B. 10 days C. 20 days D. 60 days

B. 10 days

What is the typical maximum coverage provided to an individual by a group disability insurance policy? A. 50% of pre-disability gross earnings B. 60% of pre-disability gross earnings C. 75% of pre-disability gross earnings D. 100% of pre-disability gross earnings

B. 60% of pre-disability gross earnings

With the exception of instances of legal incapacity. Proof of Loss for Surgical Expense benefits must be furnished to the insurance company within__________after receiving the forms from the company. A. 60 days B. 90 days C. 6 months D. 1 year

B. 90 days

A company's unpaid claim reserve is: A. The same as the unearned premium reserve B. An estimate of the company's liability on open claims C. Money held for those people who have not applied for benefits under their policies D. The same as the earned premium reserve

B. An estimate of the company's liability on open claims

The Florida replacement rule requires a written comparison and summary statement at the request of the insurance commissioner? A. True B. False

B. False

The suicide clause provides that proceeds will never be paid in cases of self destruction: A. True B. False

B. False

A & H coverage becomes effective when the: A. First premium has been paid and received in the insurance company home office B. First premium has been paid and the application has been approved C. Agent delivers the policy to insured D. Medical exam has been completed and the premium paid

B. First premium has been paid and the application has been approved

What is a fixed rate approach policy? A. Reimburses up to loss of insurer B. Flat amount per day or benefit amount C. Stated amount per day for room and board, and miscellaneous benefits D. Surgical expenses

B. Flat amount per day or benefit amount

Which of the following common exclusions in a health policy may not be excluded in all instances? A. Committing a felony B. Foreign travel C. Drinking or drugs D. Self-inflicted injuries

B. Foreign travel

The primary beneficiary designation in an Accidental Death & Dismemberment policy may be: A. Irreconcilable B. Irrevocable C. Secondary D. Contingent

B. Irrevocable

A 40-year-old woman is insured under a $500.00 per month disability income policy that contains a change of occupation provision. After her policy was issued, she changed her occupation from insurance agent to farmer without notifying the insurance company and recently became injured. She would most likely receive which of the following from the company? A. No benefits B. Less than $500.00 per month C. $500,00 per month D. More than $500.00 per month

B. Less than $500.00 per month

Dread disease, travel accident, vision care, and hospital indemnity policies are all examples of: A. LTC policies B. Limited policies C. Group policies D. Blanket policies

B. Limited policies

In order to sell HMO contracts an agent must do all of the following except: A. Keep and renew his or her appointment B. Maintain a bond of not less than $10,000 C. Abide by the Unfair Trade Practices Act D. Obey all regulations of the Department of Insurance

B. Maintain a bond of not less than $10,000

All below are characteristics of a mutual company, except: A. Owned and controlled by policy owners B. Makes a profit for stockholders C. The policyholders elect a broad of trustees or directors to manage the firm D. Pays dividends from surplus

B. Makes a profit for stockholders

A major medical policy with $500 deductible and 80% coinsurance provision would pay how much of the following expenses: Hospital room and board-$3000, Surgeon's fee-$2500, Operating expenses-$700, Medication-$300? A. $4800 B. $5200 C. $6000 D. $6500

A. $4800

The insured is required to submit a notice of claim to the insurance company within how many days after loss? A. 20 days B. 30 days C. 60 days D. 90 days

A. 20 days

Proof of loss must be furnished by: A. 90 days but no later than 1 year B. 90 days but no later than 5 years C. 60 days but no later than 1 year D. 60 days but no later than 5 years

A. 90 days but no later than 1 year

Which of the following qualifies as a compensable injury under Workers Compensation coverage? A. A factory worker fractures an elbow while working overtime B. An employee is struck by a car and seriously injured while walking back to work following a lunch break C. A worker is involved in an auto accident while driving to work D. All of above qualify

A. A factory worker fractures an elbow while working overtime

The usual payment arrangement under a Preferred Provider Organization (PPO) contract is: A. A fee for each service B. A flat monthly amount for each subscriber C. Reimbursement to the individual subscriber D. Any of above

A. A fee for each service

Under the Uniform Provisions Law which of the following provisions is optional for a health policy? A. Change of occupation B. Entire contract C. Physical examination and autopsy D. Time limit on certain defenses

A. Change of occupation

Which of the following provisions, under the uniform provisions law, are optional for an Accident and Health policy? A. Change of occupation B. Entire contract C. Physical exam and autopsy D. Time limit on certain diseases

A. Change of occupation

Jon Smith is involved in a 2-car accident in which he is disabled and Mr. Smith's passenger and the other driver are injured. Which of the following would most likely be covered by his Disability Income policy? A. His lost income B. Disability of other driver C. Jon's medical expenses D. Dismemberment of an arm of the passenger

A. His lost income

Federally funded programs: I. Medicare II. Medicaid III. Medicare supplements IV. Group health A. I and II B. I and III C. I, II and III D. All of above

A. I and II I. Medicare II. Medicaid

All of the following are correct about an individual disability policy, except: A. Premiums are tax deductible B. Benefits are received tax free C. Elimination periods set by insured D. Probationary period is a one time period

A. Premiums are tax deductible

Required Provision 10 indicates that if the insurer wants to have an autopsy performed while a claim is pending the insurer: A. Must have the permission of the insured's beneficiary or estate administrator in order to do so B. May do so if it is not forbidden by law and if the insurer pays for it C. May do so only if it presents evidence that substantiates the insurer's opinion that an autopsy is required D. Must first pay the claim and then may order an autopsy for which the insurer pays

B. May do so if it is not forbidden by law and if the insurer pays for it

The conversion or change of plan rule states that when an insured has industrial life insurance policies with a single insurance company, the insured has the option to convert all of these policies into one ordinary life insurance policy without evidence of insurability if the amount of industrial insurance totals at least: A. $1000 B. $2000 C. $3000 D. $5000

C. $3000

John goes into the hospital for 3 days and accrues bills totaling $4500. He is covered under a major medical policy that offers a $500.00 deductible, 80/20 co-insurance, and a stop loss of $2000. What will the company pay? A. $4000 B. $3600 C. $3200 D. $3800

C. $3200

If an insurance company fails to notify an applicant that a reinstatement application was not approved the insurance will be placed back in force in how many days? A. 90 B. 60 C. 45 D. 20

C. 45

Required Provision 4 addresses reinstatement of a lapsed policy. According to this provision, when an insured applies for reinstatement and receives a conditional receipt how long does the insurer have to approve or deny reinstatement before the policy will be automatically reinstated? A. 180 days from the date the unpaid premium was due B. 30 days from the date the insurer receives the application for reinstatement C. 45 days from the date of the conditional receipt D. There is no such automatic reinstatement

C. 45 days from the date of the conditional receipt

Select the one correct statement: A. Each individual must sign the application for a group policy B. In a contributory plan, less than half of the employees must want the coverage C. In a non-contributory plan, all employees must be covered by the plan D. There is no master policy with a non-contributory group plan

C. In a non-contributory plan, all employees must be covered by the plan

What plan has a prearranged cost to the insured? A. DPO B. ASO C. PPO D. CIA

C. PPO

In a $60,000.00 accidental death and dismemberment policy, the amount payable for the loss of one limb is equal to: A. $30,000 B. $60,000 C. $120,000 D. Nothing

A. $30,000

Heinrich suffers an injury from an accident and accrued bills of $4000. He filed a claim under his major medical. The company was ready to send the check and discovered alcohol had caused the accident, what will they pay? A. -0- B. $4000 C. They will return the premium paid D. $1000

A. -0-

In a group health policy in the State of Florida, coverage is required to be provided to the employee for which of the following? A. Chiropractic care B. Alcoholism C. Drug dependency D. All of above

A. Chiropractic care

Eligible deductions on the insured's IRS-1040 form for Medical expenses include all but: A. Disability premium B. Prescriptions C. Coinsurance D. Insulin

A. Disability premium

Charlie owns a hospital expense policy and a surgical expense policy. The hospital policy pays $100 a day for room and board and a maximum of $1000 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, $1500 for miscellaneous expenses, and $2000 for surgical expenses. What will the policies pay? A. $1000 B. $2500 C. $3500 D. $5500

B. $2500

The purpose of medical cost management is to: A. Require pre-certification B. Control how policy holders utilize their policies C. Control what is paid to the doctor and hospital D. Require second opinions

B. Control how policy holders utilize their policies

Rafael Nader advised his insurance company of loss covered by his major medical. If the company does not provide Mr. Nader with proper claim forms within 15 days, he has which of the following rights? A. He is eligible to receive immediate payment. B. He may submit a description of the loss in any form. C. He can file a suit against insurance company immediately. D. He can refuse to submit required proof of loss and receive payment anyway.

B. He may submit a description of the loss in any form.

Medicare part "A" covers all the following costs except: A. Inpatient hospital services B. Physician services C. Post-hospital home health care D. Post hospital nursing care

B. Physician services

A policy lapses when: A. Premiums are paid in advance B. Premiums are not paid within the grace period C. Both A & B D. Neither A nor B

B. Premiums are not paid within the grace period

Cobra is a federal law, which provides for extension of health benefits for what length of time after employment is terminated? A. 15 minutes B. 6 months C. 12 months D. 18 months

D. 18 months

What is the minimum grace period, provided in the Required Provision 3, for all policies other than monthly or weekly premium policies? A. 7 days B. 10 days C. 15 days D. 31 days

D. 31 days

An individual health insurance policy may be cancelled in Florida after the company has given the insured how many days notice? A. 5 days B. 20 days C. 30 days D. 45 days

D. 45 days

An outside organization providing administration: A. ASO B. PPO C. RPA D. MPP

A. ASO

When an insurance company administers a self-insured plan and is paid a fee, it is called: A. ASO B. TSA C. DPO D. SEC

A. ASO

A blanket insurance contract normally covers: A. All of a class of persons, not individually identified B. Groups of five or more individuals working in the same type of business C. All of a class of persons, individually identified D. Retired individuals

A. All of a class of persons, not individually identified

The Department of Financial Services is concerned with: I. Assets and investments of insurance companies II. The types and degree of risk of investments made by insurance companies III. Examinations of records IV. Limiting the dollar amount that can be invested in different types of investments A. All of above B. I, II, & III C. I, III, IV D. I, II

A. All of above I. Assets and investments of insurance companies II. The types and degree of risk of investments made by insurance companies III. Examinations of records IV. Limiting the dollar amount that can be invested in different types of investments

Brenda names her husband as the beneficiary of the accidental death in her health policy. She has relinquished her right to change the beneficiary designation. According to required Provision 12, Brenda's husband is: A. An irrevocable beneficiary B. A revocable beneficiary C. A contingent beneficiary D. A tertiary beneficiary

A. An irrevocable beneficiary

Lulu Lilac names her husband as the beneficiary of the accidental death benefit in her health policy. She has relinquished her right to change the beneficiary designation. According to required Provision 12 Lulu's husband is: A. An irrevocable beneficiary B. A revocable beneficiary C. A contingent beneficiary D. A tertiary beneficiary

A. An irrevocable beneficiary

After filing proof of loss, the insured is prevented from filing suit against the insurance company for: A. At least 60 days and not longer than five years from the proof of loss. B. At least 90 days and not longer than one year from there date of proof of loss. C. At least 20 days and not longer than five years from the date of proof of loss. D. At least 30 days and not longer than three years from the date of proof of loss.

A. At least 60 days and not longer than five years from the proof of loss.

Comprehensive medical expense insurance combines which of the following coverage into one policy? A. Basic hospital/surgical and major medical B. Disability income and AD & D C. Disability income and basic hospital/surgical D. Major medical and AD & D

A. Basic hospital/surgical and major medical

The type of health insurance policy most likely used to cover all students attending a large university is: A. Blanket policy B. Franchise policy C. ASO D. Self-insured plan

A. Blanket policy

Individuals covered by a group plan must receive: A. Certificates of insurance B. Individual insurance policies C. Notices of proposed insurance D. A copy of the master insurance policies

A. Certificates of insurance

Students at a large university: A. Could obtain group health insurance with a blanket policy B. Could not obtain group health insurance because there would be no master policy owner C. Could not obtain group health insurance because they do not constitute a class D. Could obtain group insurance through a TPA only

A. Could obtain group health insurance with a blanket policy

When premiums remain unpaid at the time a claim is submitted the insurer may as a result of Optional Provision 7: A. Deduct unpaid premiums from benefits before paying the claim B. Deny the claim even though it has not cancelled the policy C. Charge a low rate of interest for each period premiums remain unpaid D. Take all the actions described above

A. Deduct unpaid premiums from benefits before paying the claim

Under optional Provisions 7 of a standard health policy, when premiums are unpaid at the time a claim is submitted, the insurer may: A. Deduct unpaid premiums from benefits before paying the claim. B. Deny the claim even though it has not cancelled the policy. C. Charge a low rate of interest for each period premiums remain unpaid. D. Take any of the actions described above.

A. Deduct unpaid premiums from benefits before paying the claim.

Medicare deductibles are always expressed as: A. Dollar amounts B. Percentages C. 2% D. 20%

A. Dollar amounts

Durwood is hospitalized with leukemia and upon checking his disability income policy, learns that he will not be eligible for benefits for at least 30 days. That would indicate his policy probably has a 30 day: A. Elimination period B. Suspension period C. Benefit period D. Disability period

A. Elimination period

Which of the following best describes the purpose of a Medicare Supplement policy? A. Help cover costs not met by Medicare B. Meet long term care costs C. Pay for non-essential medical services D. Extend group health coverage past retirement

A. Help cover costs not met by Medicare

Blue Cross covers_____expences and Blue Shield covers_______expenses. A. Hospitalization; medical and surgical B. Medical and surgical; hospital C. Loss of income; hospital. D. Disability income; medical and surgical

A. Hospitalization; medical and surgical

AD&D covers: I. Accidental death II. Loss of use due to an accident III. Accidental loss of sight IV. Broken arm A. I & III B. I, II & IV C. I & IV D. All of above

A. I & III I. Accidental death III. Accidental loss of sight

An agent has just taken an application for an individual disability income policy and has received the initial premium. He has given the prospect a conditional receipt. At this time it would be appropriate for him to tell the prospect which of the following? I. Medical examination may be required II. Investigation report may be required III. Medical Information Bureau (MIB) will send its report directly to the prospect A. I and II B. I and III C. II and III D. All of above

A. I and II I. Medical examination may be required II. Investigation report may be required

Which of the following statements about the ten day free look provision in an A&H policy is/are true? I. It assures the applicant the opportunity to review the policy at no cost II. The ten day period begins on the date of the application A. I only B. II only C. I and II D. None of above

A. I only I. It assures the applicant the opportunity to review the policy at no cost

In health insurance the length of the grace period varies according to which: I. Mode of premium payment II. Length of benefit period III. Length of elimination period A. I only B. I & II C. II & III D. None of the above

A. I only I. Mode of premium payment

Which of the following statements about surgical expense benefits is true? I. The amount on the benefit schedule is typically expressed in terms of the maximum benefit payable II. Benefits are typically subject to deductible - $250 or more A. I only B. II only C. I and II D. None of above

A. I only I. The amount on the benefit schedule is typically expressed in terms of the maximum benefit payable

An insurance application submitted to the insurance company with the initial premium provides coverage beginning when the: A. Insurance company determines that the applicant is insurable and acceptable and the policy is issued B. Policy is mailed to agent regardless of when policy is delivered to insured C. Application is signed by both agent and insured, and policy is countersigned by insurance company president D. Insured is accepted by insurance company, the next month's premium is paid, and continued good health statement is signed

A. Insurance company determines that the applicant is insurable and acceptable and the policy is issued

Which benefits are provided by PPOs? A. Members can go outside for services by paying the difference B. Protection against large unpredictable losses C. Opportunity for companies to self insure D. Monopolistic state fund

A. Members can go outside for services by paying the difference

Premium is best defines as: A. Money an insured pays to an insurance company in consideration for benefits provided in the policy. B. Money an insurance company pays to an insured for benefits provided in the policy. C. Money paid by the insured to legalize an insurance contract. D. Money invested by the insurance company to increase its earnings.

A. Money an insured pays to an insurance company in consideration for benefits provided in the policy.

Which of the following premium payment modes will result in the highest total premium? A. Monthly B. Quarterly C. Semi-annually D. Annually

A. Monthly

When may agent change policy or waive its provisions, according to required Provision 1 of a standard health policy? A. Never B. With the approval and signatures of the insured and of an executive officer of the insurance company. C. With the approval and signature of the insured. D. With the approval and signature of and executive officer of the insurance company.

A. Never

Gene Autrey's individual health insurance policy was reinstated effective June 1. On June 8 Gene became ill, was hospitalized and returned to work on June 15. His policy would provide which of the following? A. No benefits B. Full benefits C. Benefits from June 11 through June 15 D. Partial benefits from June 8 through June 15

A. No benefits

Embezzlement includes all of the following, except: A. None of the following are exceptions B. Converting premiums to agent's own use C. Converting a claim payment to agent's own use D. Converting policy loan values to agent's own use

A. None of the following are exceptions B. Converting premiums to agent's own use C. Converting a claim payment to agent's own use D. Converting policy loan values to agent's own use

What type of HMO is characteristic by utilizing a network of physicians working out of their own offices on a part- time basis? A. Open-panel HMO B. Closed-panel HMO C. Group-panel HMO D. Network-panel HMO

A. Open-panel HMO

With Medicare coverage the part that is compulsory and provides coverage for hospitalization is known as __________. A. Part A B. Part B

A. Part A

Which of the following would be found in the insuring clause of a health policy? A. Parties to the contract B. Premium mode C. Benefits D. Exclusions

A. Parties to the contract

Which of the following statements is true about Partial disability benefits? A. Payments may be based on loss of time, income or function B. Insured is entitled to a principal sum benefit for the partial loss of a limb C. Payments may be based on termination or employment D. Payments are reduced when an insured is not under a doctor's care

A. Payments may be based on loss of time, income or function

Which of the following statements about the 10-day free look provision is or are true? A. Policies issued can be returned for 100% refund of premium within 10 days from the date the policy is delivered. B. During the 10-day period, coverage is totally in force and claims must be paid even if the insured returns the policy. C. Both A and B D. Neither A nor B is true

A. Policies issued can be returned for 100% refund of premium within 10 days from the date the policy is delivered.

James takes a skiing trip and breaks his keg. Upon returning home, purchases a major medical policy and files a claim which the company disapproves. The reason is: A. Pre-existing condition B. Consideration C. Entire contract D. Insuring clause

A. Pre-existing condition

Which statement describes the purpose of the Uniform Provisions Law? A. Provide each state with a law that will permit the use of uniform standard provisions, resulting in some standardization of policy forms B. Provide each state with a law that will specify requirements for policy coverage, amount of benefits, and grace periods C. Both A and B D. None of above

A. Provide each state with a law that will permit the use of uniform standard provisions, resulting in some standardization of policy forms

A disability that is presumed to result from the same or a related cause of prior disability is called: A. Recurrent disability B. Residual disability C. Presumptive disability D. Delayed disability

A. Recurrent disability

Six months ago Pedro fell down a flight of stairs, resulting in complete paralysis from which he is not expected to recover and return to his employment. Forty-nine year old Pedro will probably be able to collect disability benefits from: A. Social Security B. Medicaid C. Medicare D. None of above

A. Social Security

Select the correct statement about benefits paid for non-disabling injuries: A. Some policies pay a small percentage (often 10%) of the total disability payment if the insured loses time away from work to obtain medical or surgical treatment B. Most policies pay the full total disability payment if the insured loses time away from work to obtain medical or surgical treatment C. Both of the above are correct D. None of above

A. Some policies pay a small percentage (often 10%) of the total disability payment if the insured loses time away

The cost of living adjustment rider (COLA) in disability income policies is usually tied to: A. The Consumer Price Index B. The Gross National Product C. Equity investments of the company D. All of above

A. The Consumer Price Index

Capital sum is the term for: A. The amount paid for accidental dismemberment under a health policy B. The total reserves required for an insurance company C. The amount paid for accidental death under a health policy D. The limit of coverage that may be provided by one insurance

A. The amount paid for accidental dismemberment under a health policy

The principal sum of a health insurance policy is: A. The sum specified in the policy payable for loss of life caused by accident B. The maximum amount of all benefits for disability during the life of the policy C. The sum of all benefits paid during the life of a policy D. The maximum amount of all benefits that may be paid for any one loss, regardless of the cause of loss

A. The sum specified in the policy payable for loss of life caused by accident

Which of the following statements about long-term care health policies is correct? A. They provide a daily indemnity benefit B. They are not issued to people over 70 years of age C. They have benefit periods of less than 12 months D. All of above

A. They provide a daily indemnity benefit

Tom Jones is named by the insured, Jennifer Jones, as the first in line to receive the death benefit provided by Jennifer's accident policy. Their daughter, Jane, is named as the second in line to receive the benefit. Which statement is correct? A. Tom is the primary beneficiary, Jane is the contingent beneficiary B. Tom is the contingent beneficiary, Jennifer is the primary beneficiary C. Jennifer is the primary beneficiary, Jane is the contingent beneficiary D. Both Tom and Jane are primary beneficiaries

A. Tom is the primary beneficiary, Jane is the contingent beneficiary

A fraternal insurance policy can best be defined as a type of cooperative insurance provided by fraternal benefits societies for their members. The society has a lodge or social system, certain rituals and a representative form of government: A. True B. False

A. True

Florida law requires that applications and policy deliveries be completed by a licensed agent who will receive regular commissions. A. True B. False

A. True

Premiums for industrial policies are somewhat higher than ordinary policies that have the same face amount. A. True B. False

A. True

The common disaster provision in a beneficiary designation provides a sequence of policy proceeds distribution: A. True B. False

A. True

Must a health company return unearned premium on a canceled policy? A. Yes B. No

A. Yes

Must a mail order insurance company be authorized to solicit insurance in the state of Florida? A. Yes B. No

A. Yes

An insured's disability income 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: A. "Own occupation" definition and is more restrictive than other definitions. B. "Any occupation" definition and is more restrictive than other definitions. C. "Own occupation" definition and is less restrictive than other definitions. D. "Any occupation" definition and is less restrictive than other definitions.

B. "Any occupation" definition and is more restrictive than other definitions.

Mr. Clean was hospitalized for 2 weeks and received a bill for $2,100. He has a Major Medical policy with a $100 deductible. His coinsurance is 80/20, after reducing the bill by the deductible amount Mr. Clean is expected to pay a total of: A. $400 B. $500 C. $520 D. $1,600

B. $500

In Florida how many days must an insured wait after submission of proof of loss before legal action against an insurance company can be taken? A. 30 days B. 60 days C. 120 days D. 180 days

B. 60 days

What is a cancelable policy? A. A policy which only the insured may cancel B. A policy which the company may cancel at any time by returning the unearned premium C. A policy which only the insured may cancel at the policy anniversary date D. A policy which the company may not cancel unless the insured has failed to make all premium payments when due

B. A policy which the company may cancel at any time by returning the unearned premium

Which of the following most accurately and completely describes an application A. A form furnished by the insurer requesting certain information to become part of the insurance policy. B. A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in the application. C. An oral request from an agent to an insurer to issue an insurance policy. D. An application can be any of the above.

B. A written request from an applicant to an insurer requesting the insurer to issue a policy on the basis of the information in the application.

If an insurance company has rejected an applicant for coverage on the basis of a Medical Information Bureau (MIB) report the MIB will release medical information contained in the report to which of the following, if any? A. Applicant B. Applicant's physician C. Agent of record D. None of above, report is strictly confidential

B. Applicant's physician

The transfer of the insured's rights to receive benefits of a health insurance policy for a particular claim is known as: A. Facility of payment B. Assignment C. Rebating D. Waiver

B. Assignment

The specific duties of the Chief Financial Officer are all of the following, except: A. Enforce the insurance laws and codes of Florida. B. Assist companies in selling and marketing. C. Investigate reported violations of insurance laws. D. Conduct hearing for agents suspected of unfair practices.

B. Assist companies in selling and marketing.

In order to comply with the Fair Credit Reporting Act at which of the following times must an agent notify an applicant that a credit report may be requested? A. At the initial interview B. At the time of application C. When applicant's credit is actually checked D. When policy is delivered

B. At the time of application

In an AD&D policy, the amount payable for the accidental loss of sight or accidental dismemberment is referred to as: A. Double indemnity B. Capital sum C. Principal sum D. Elective dismemberment

B. Capital sum

Second surgical opinions, pre-certification, concurrent and retrospective reviews and outpatient/ambulatory services are all elements of a cost containment system commonly known as: A. COBRA B. Case management C. Prior authorization D. LTC

B. Case management

All of the following are alternatives a company has when asked to insure a substandard risk, except: A. Reject the risk B. Charge a lower than normal premium C. Attach a rider to the policy excluding certain coverages D. Charge a higher than normal premium, rate

B. Charge a lower than normal premium

A provision stating that the insured and the insurer will share covered losses in an agreed proportion is called: A. Percentage sharing B. Coinsurance C. Comprehensive insurance D. Stop loss provision

B. Coinsurance

An applicant for insurance may pay the initial premium and receive a document from the agent indicating that if the policy is issued as requested, coverage begins on the date of the document. What is this document called? A. Executing agreements B. Conditional receipt C. Warranty D. Notice of inspection

B. Conditional receipt

The employees of Ace Trucking Company must each pay a portion of the premium for their group insurance. This means they are members of: A. Noncontributory group B. Contributory group C. Participating plan D. Nonparticipating plan

B. Contributory group

A Guaranteed Insurability clause can be attached to which of the following type of health policies? A. Hospital Indemnity policy B. Disability Income policy C. Major Medical policy D. Cancer policy

B. Disability Income policy

Waiver of premium is found: A. Most medical expense policies B. Disability income C. Basic D. Only in life insurance

B. Disability income

Which of the following requires insured's to be advised that reports about them are being requested? A. Medical Information Act B. Fair Credit Reporting Act C. Reciprocals D. COBRA

B. Fair Credit Reporting Act

All fraternal insurance organizations operate as "associations" and functions as profit making businesses. A. True B. False

B. False

The Financial Institutions Agent Act restricts the sale of insurance, other than credit life insurance, by agents who are associated with financial institutions: A. True B. False

B. False

Define a legal reserve: A. The amount set aside by federal reserve banks as required by law B. Future liabilities to policy owners C. A leeway provision D. None of above

B. Future liabilities to policy owners

Which of the following about group health insurance is/are true? I. Insurance company underwriting practices are generally less liberal for groups than for individuals II. Claims experience is often utilized in large groups A. I only B. II only C. I and II D. Neither I nor II

B. II only II. Claims experience is often utilized in large groups

John Johnson purchased group Credit Disability Insurance to cover a loan. He was injured and disabled for 7 months. What benefits were paid under his policy? I. The insured received disability income benefits II. The insured's creditor received the equivalent of the monthly payment owed by the insured A. I only B. II only C. I and II D. Neither I nor II

B. II only II. The insured's creditor received the equivalent of the monthly payment owed by the insured

Personal health insurance policies do not normally include benefits for: A. Injuries suffered while using an unsafe ladder B. Injuries that are covered by Workers Compensation C. Injuries suffered in an auto accident D. Rehabilitation for alcoholism

B. Injuries that are covered by Workers Compensation

Under the optional "illegal occupation" provision, which of the following applies if a loss occurs while the insured is participating in a felony or an illegal occupation? A. Insured's policy is automatically cancelled B. Insurer is not liable for the loss C. Benefits are reduced by 80% D. Insurer has the right to immediately increase premiums

B. Insurer is not liable for the loss

Defamation is all of the following, except: A. Act of defamation is considered a tort B. Is an ailment C. Can be written (libel) D. Can be spoken (slander)

B. Is an ailment

All of the following relate to the Rights of Ownership except: A. Reinstatement provision B. Listed exclusions C. Free look provision D. Incontestable provision

B. Listed exclusions

When proof of loss has been furnished, periodic benefit payments must be made not less frequently than: A. Weekly B. Monthly C. Semi-annually D. Annually

B. Monthly

Laura has been disabled by sickness covered in her individual health policy, and has been collecting disability benefit payments from her insurance company. She is also receiving disability benefits from federal Social Security. If she receives an increase in federal Social Security benefits, her insurance company: A. May reduce its benefit in an amount equal to the increase in Social Security benefit so that Laura will continue to receive the same total disability income. B. Must continue to make full benefit payments to Laura just as though she had received nothing additional from Social Security C. May stop benefit payments to Laura since federal Social Security benefits preempt company benefits D. Must adjust its benefit payments to match the Social Security benefit payments

B. Must continue to make full benefit payments to Laura just as though she had received nothing additional from Social Security

The minimum number of members required for a group life policy in Florida is: A. Ten as long as the organization is eligible B. No minimum as long as the organization is eligible C. Three as long as the organization is eligible D. Five as long as the organization is eligible

B. No minimum as long as the organization is eligible

Under the illegal occupation provision included in most health insurance policies, the company is: A. Liable for a loss even though the insured is engaged in an illegal occupation B. Not liable for a loss when the insured is engaged in a felony or illegal occupation C. Required to notify local law enforcement agencies when it suspects an insured is engaged in an illegal occupation D. None of above

B. Not liable for a loss when the insured is engaged in a felony or illegal occupation

Required Provision 7 in a standard health policy indicates that except in the absence of the insured's legal capacity, if it was not reasonably possible for the insured to provide proof of loss as required in a policy, the latest time the proof of loss: A. Three years from the time proof is otherwise required B. One year from the time proof is otherwise required C. Within 90 days of a final notice from insurer D. Unlimited

B. One year from the time proof is otherwise required

What will the insurer do if its Disability Income policy contains a Change of Occupation provision and the insured changes to a more hazardous job and then is subsequently injured? A. The insurer can do nothing as long as the policy owner pays the premiums B. Policy benefits will be reduced to an amount the premium would have purchased originally based on the more hazardous occupation C. The policy owner will have to pay an additional premium to cover the higher risk D. The premium penalty will be charged against the benefits when a claim is filed

B. Policy benefits will be reduced to an amount the premium would have purchased originally based on the more hazardous occupation

The entire contract provision in an A&H policy states which of the following? A. Entire contract is on file with the agent and may be examined by the applicant at any time B. Policy with attached endorsements and other papers constitutes the entire contract between policy owner and insurance company C. Specific rules, regulations and procedures concerning the policy are maintained in the insurance company's home office D. Policy delivered to the insured is a brief summary of the entire contract, which is on file with the appropriate state insurance department

B. Policy with attached endorsements and other papers constitutes the entire contract between policy owner and insurance company

In an effort to eliminate pre-existing disabilities and adverse selection, the contract will usually contain: A. Elimination period B. Probationary period C. Delayed disability D. Recurrent disability

B. Probationary period

The "one time only" period in a health policy when the policy first starts is called the _______. A. Elimination period B. Probationary period C. Contestable period D. Coverage period

B. Probationary period

Disability due to the same or related cause of a previous disability is known as: A. Partial B. Recurrent C. Residual D. Delayed

B. Recurrent

Health insurance is: A. Aleatory B. Reimbursement C. Valued D. Conditional

B. Reimbursement

When an insurer transfers part of an insured's coverage to another insurance company, retaining only part of the risk for itself, the insurer is engaging in: A. Expense loading B. Reinsurance C. Unfair discrimination D. Misrepresentation

B. Reinsurance

When disability policy pays benefits in direct proportion to actual earnings lost, it is called: A. Partial disability B. Residual disability C. Delayed disability D. Recurrent disability

B. Residual disability

Which of the following is not true about an application for health insurance? A. The information on the application helps identify the applicant B. Statements on the application made by the applicant are warranties C. When attached to the policy, the application becomes part of the policy D. The application is part of the "consideration clause"

B. Statements on the application made by the applicant are warranties

Mr. Adams advised his insurance company of a loss covered by his major medical. If the company does not provide Mr. Adams with proper claim forms within 15 days, he has which of the following rights? A. To receive immediate payment of the claims B. Submit a description of loss C. File a suit against insurance company immediately D. Refuse to submit required proof of loss

B. Submit a description of loss

Under the unpaid premiums provision included in most health insurance contracts, the company is entitled to: A. Deny a claim when a premium is due B. Subtract the unpaid premium from claim payments C. Cancel a policy when a premium is due D. None of above

B. Subtract the unpaid premium from claim payments

Employer paid premiums for employee group health insurance are generally: A. Tax deductible to the employer but taxable to the employee B. Tax deductible to the employer and nontaxable to the employee C. Non tax deductible to the employer and nontaxable to the employee D. Non tax deductible to the employer but taxable to the employee

B. Tax deductible to the employer and nontaxable to the employee

Optional Provisions 9 of a standard Health policy, which deals with conformity to state statutes, provide: A. That states may revise their insurance regulations to conform to policies normally written within that individuals states. B. That policy provisions in conflict with state statutes where the insured resides are automatically amended to conform to the minimum requirements of the law. C. Both of the above D. None of the above

B. That policy provisions in conflict with state statutes where the insured resides are automatically amended to conform to the minimum requirements of the law.

All of the following statements are applicable to the insuring clause except: A. The clause identifies the insured and the insurer B. The clause defines loses not covered by the policy C. The clause usually specifies that benefits are subject to all provisions and terms specified in the policy D. It states the insurers promise to pay benefits for specific losses

B. The clause defines loses not covered by the policy

Pre-existing conditions are referred to in which of the following required A&H policy provisions: A. Claim forms B. Time limit in certain diseases C. Insuring clause D. Legal actions

B. Time limit in certain diseases

According to required Provision 2, unless an insured has made fraudulent misstatements, a policy is incontestable after? A. One year B. Two years C. Insurer has accepted initial premium D. Insurer has signified its intent to pay a claim

B. Two years

With regards to an insurance policy, giving up established right or privilege knowingly is called: A. Adhesion B. Waiver C. Estoppel D. Execitpru agreement

B. Waiver

To reinstate a health insurance policy, the insured: A. Will not have to pay back premiums, but must submit an application for reinstatement B. Will have to pay all back premiums, and may be required to submit an application for reinstatement C. Must reapply for the policy, showing proof of insurability; an increase in premium will be necessary D. Must apply directly to an executive officer of the company as policies are not normally reinstated

B. Will have to pay all back premiums, and may be required to submit an application for reinstatement

If Lenora Lena is not entirely satisfied with the policy issued to her, she may return it to the insurance company for voiding and receive a refund of premium at which of the following times? A. Within a specified period after the first renewal premium falls due B. Within a specified period from the date she receives the contract C. Within a specified period from the date the agent receives the contract D. Within a specified period from the date the insurance company issues the policy

B. Within a specified period from the date she receives the contract

Under Medicare Part A, a benefit period starts when a patient enters the hospital and ends when a patient has been out of the hospital for: A. 30 days B. 45 days C. 60 days D. 90 days

C. 60 days

Group insurance is issued to cover: A. Any number of people having a common employer B. Any number of people all of whom have an interest in obtaining insurance C. A specified minimum number of people having the same employer or common affiliation of interests other than for the specific purpose of securing insurance D. A specified minimum number of people having the same employer or common affiliation of interests for the purpose of securing insurance.

C. A specified minimum number of people having the same employer or common affiliation of interests other than for the specific purpose of securing insurance

When applicable, all of the following forms require an applicant's signature, except: A. Aviation questionnaire B. Authorization form C. Agent's report D. Application

C. Agent's report

Which is the correct statement regarding replacement? A. State laws prohibit unauthorized replacement B. Twisting and replacement are synonymous terms C. Agents must follow the replacement procedure outlined in Florida Law D. Cash value buildups are always better

C. Agents must follow the replacement procedure outlined in Florida Law

Which of the following accurately describes the "free look" provision? A. Allows the proposed insured to look over a policy carefully before applying for it. B. Allows the proposed insured to look over the application carefully before completing it. C. Allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired. D. Allows the insurance company to obtain an inspection report and medical examination on the proposed insured prior to issuing the policy.

C. Allows the insured to look over the issued policy for a specific number of days and return it for a premium refund if desired.

"Capitation" as used by HMOs means: A. Amount paid to an HMO by a physician for administrative costs B. Amount paid by an HMO to the state in order to do business C. Amount paid by an HMO to a physician for medical services rendered D. None of above

C. Amount paid by an HMO to a physician for medical services rendered

A dually licensed agent is: A. An agent representing two insurance companies B. An agent who has completed this course and passed the state exam for Life and Health C. An agent who holds an insurance and a securities license at the same time D. An agent whose oath was administered by Tom Dually

C. An agent who holds an insurance and a securities license at the same time

Which charges will Medicare pay? A. Reasonable B. Usual and customary C. Approved D. All charges

C. Approved

Which of the following might be described as a managed health care system? A. Health Maintenance Organizations B. Preferred Provider Organizations C. Both A & B D. Neither A nor B

C. Both A & B A. Health Maintenance Organizations B. Preferred Provider Organizations

Which of the following does Florida law regard as unfair settlement practices? A. Attempting to settle claims on the basis of an application when serving as a binder or intended to become part of the policy, or any other material document which as altered without notice to, or knowledge or consent of the insured. B. A material misrepresentation made to an insured or any other person having any interest in the proceeds payable under such contract or policy on less favorable terms than those provided in, and contemplated by such contract or policy. C. Both A and B D. Neither A nor B, they are too restrictive

C. Both A and B A. Attempting to settle claims on the basis of an application when serving as a binder or intended to become part of the policy, or any other material document which as altered without notice to, or knowledge or consent of the insured. B. A material misrepresentation made to an insured or any other person having any interest in the proceeds payable under such contract or policy on less favorable terms than those provided in, and contemplated by such contract or policy.

Business health insurance is: A. Disability buy out B. Key person disability C. Both A and B D. None of above

C. Both A and B A. Disability buy out B. Key person disability

From a legal standpoint Constructive Delivery of a policy is accomplished when: A. Company sends the policy to the agent with instructions to obtain a statement attesting to the insured's continued good health B. Agent delivers the policy for inspection but the initial premium has not yet been paid C. Company relinquishes all control over the policy and turns it over to someone acting for the policy owner including the company's own agent D. Agent mails a policy to the policy owner with a note that he or she will stop by later to collect the first premium

C. Company relinquishes all control over the policy and turns it over to someone acting for the policy owner including the company's own agent

Some major medical policies begin with basic first dollar coverage that pays to its limits, then the insured must pay a certain dollar amount of expenses before the major medical portion steps in. What term applies to this dollar amount the insured must pay? A. Coinsurance percentage B. Stop loss limit C. Corridor deductible D. Internal limit

C. Corridor deductible

Medicare Part A has all the following exclusions, except: A. Deductible B. 90 days in hospital C. Durable medical equipment D. Blood deductible

C. Durable medical equipment

331.Who regulates retirement plans in Florida? A. State of Florida B. NASD C. ERISA D. None of above

C. ERISA

Business overhead includes all of the following, except: A. Employees income B. Mortgage C. Employers income D. Utilities

C. Employers income

The policy provision that prevents an insurance company from altering it's agreement with a policy owner by referring to documents or other items not contained in the policy is called: A. Incontestable clause B. Benefits provisions C. Entire contract D. Legal actions

C. Entire contract

Greta Garbo is named as the insured in an AD&D policy. Gilbert Garbo is the first in line to receive the death benefit provided by Greta's accident policy. Their daughter Gretchen is named as second in line to receive the benefit. Which statement is correct? A. Greta is the primary beneficiary, Gretchen is the contingent beneficiary B. Greta is the contingent beneficiary, Gretchen is the primary beneficiary C. Gilbert is the primary beneficiary, Gretchen is the contingent beneficiary D. Both Gilbert and Gretchen are primary beneficiaries

C. Gilbert is the primary beneficiary, Gretchen is the contingent beneficiary

Of the following plans, which is the most likely to pay for regular preventative check-ups? A. Blue Cross B. Blue Shield C. Health Maintenance Organization D. Preferred Provider Plans

C. Health Maintenance Organization

Medicare Part B includes all of the following, except: I. Hospitalization II. Ambulance service III. X-rays IV. Post hospital care A. I & II B. II, III, & IV C. I & IV D. All of above

C. I & IV I. Hospitalization IV. Post hospital care

Which of the following statements about the role of the agent in completing health insurance applications is true? I. Agent must understand the importance of Moral Risk II. Problems with claims will probably occur if the agent fails to include all pertinent facts and medical history on the forms provided A. I only B. II only C. I and II D. Neither I nor II

C. I and II I. Agent must understand the importance of Moral Risk II. Problems with claims will probably occur if the agent fails to include all pertinent facts and medical history on the forms provided

On the delivery of an insurance policy that contains an exclusion rider for a past health condition an agent must do which of the following? I. Explain to the best of his/her ability the rider and specific exclusions II. Obtain the insured's signature on the amendment form III. Change any statement on the application that he/she thinks may be incorrect A. I only B. II only C. I and II D. All of above

C. I and II I. Explain to the best of his/her ability the rider and specific exclusions II. Obtain the insured's signature on the amendment form

A&H insurance provides coverage for sickness and injury that includes which of the following benefits? I. Income benefits due to loss of time from work II. Benefit payments for hospital care A. I only B. II only C. I and II D. None of above

C. I and II I. Income benefits due to loss of time from work II. Benefit payments for hospital care

Which of the following policies can be written on a non-cancelable and guaranteed renewable basis? I. Major medical and expense policy II. Disability policy A. I only B. II only C. I and II D. None of above

C. I and II I. Major medical and expense policy II. Disability policy

Medicare (Part A) provides: I. Custodial care in nursing home II. Part-time home health care aides III. Ambulance IV. Post hospital physical therapy A. I only B. I, II and III C. II & III D. None of above

C. II & III II. Part-time home health care aides III. Ambulance

Which of the following statements is true about the conditional receipt issued to an applicant for an individual disability income policy? A. Coverage begins immediately as of the date of the conditional receipt B. Agent should give an applicant the conditional receipt after taking an application even if the applicant has not been paid the premium C. If an applicant is an acceptable risk the conditional receipt binds the insurance company as of either the date of the receipt or the date of the medical examination, whichever is later D. If unfavorable information is discovered during the underwriting process the conditional receipt guarantees standard coverage

C. If an applicant is an acceptable risk the conditional receipt binds the insurance company as of either the date of the receipt or the date of the medical examination, whichever is later

Required Provisions 8 and 9 of a standard health policy, addressing claims payment, indicate all of the following, except: A. Claims for payment of non-periodic indemnities must be made no less than once a month B. In order to facilitate payment, the insurer may pay an indemnity up to $3000 to certain people who appear to be entitled to it C. If there is no beneficiary designated for any death benefits payable, the insurer will pay the benefit to any relative of the insured by blood or marriage who appears to be entitled to it D. The insurer may pay benefits directly to hospitals and/or medical practitioners unless the insured has specifically stated otherwise

C. If there is no beneficiary designated for any death benefits payable, the insurer will pay the benefit to any relative of the insured by blood or marriage who appears to be entitled to it

For a misstatements made on an application to affect the validity of the policy, the misstatement must be: A. Intentional only B. Material only C. Intentional and material. D. Merely an incorrect statement

C. Intentional and material.

As compared to individual disability income policies, group disability income policies are generally: A. More costly and have less liberal provisions B. More restrictive in terms of covered medical expense C. Less costly and have more liberal provisions D. Tied more closely to Social Security disability benefits

C. Less costly and have more liberal provisions

Which of the following most specifically describes a type of policy intended to cover extended residence in a nursing home? A. Limited policies B. Blanket policies C. Long term care policies D. Franchise policies

C. Long term care policies

Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO) are sometimes grouped together under the name: A. Blue Cross/Blue Shield B. Internal medicine C. Managed health care systems D. Community rating

C. Managed health care systems

Medical benefits for welfare recipients not qualified for Medicare may be available from what other program? A. Workers compensation B. Railroad retirement C. Medicaid D. Any of above

C. Medicaid

What is the non-disabling injury benefit? A. Total disability B. Partial disability C. Medical expense D. Partial disability income and medical expense

C. Medical expense

Which of the following is made up of two parts and for one of the two the insured helps to pay the cost? A. Blue Shield B. Blue Cross C. Medicare D. Medicaid

C. Medicare

Grouping small businesses together to obtain group insurance as one large group is characteristic of which of the following? A. Health Maintenance Organization (HMO) B. Franchise Health Plan C. Multiple Employer Trust (MET) D. Fictitious Group

C. Multiple Employer Trust (MET)

An Agent has just been told by a policy owner that she is ten years younger than listed oh their application. A. Write a new policy at the correct age immediately so there is no gap in the coverage. B. Notify insurance company for possible review of application. C. Notify insurance company to adjust existing policy to the correct age. D. Determine whether there has been any change in health since application for the policy.

C. Notify insurance company to adjust existing policy to the correct age.

Before Tyler was disabled, he was a full time engineer earning about $70,000 annually. Now, two years later, he is only able to work part-time, earning about $25,000 annually. It is likely that Tyler would be classified as: A. Totally and permanently disabled B. Presumptively disabled C. Partially disabled D. Not disabled at all

C. Partially disabled

A coinsurance clause, as used in health insurance, requires insured's to: A. Carry insurance coverage equal to 100% of estimated medical expenses. B. Purchase the needed insurance from two or more different companies. C. Pay a percentage of incurred medical expenses, usually above a deductible. D. Settle on a percentage basis when they own two or more policies.

C. Pay a percentage of incurred medical expenses, usually above a deductible.

Medicare Part B includes all the following, except: A. Health care aids B. Psychiatric care C. Post hospital skilled nursing D. Physicians services in hospital, clinic or home

C. Post hospital skilled nursing

Giving a prospect or policy owner anything of significant values as an inducement to but insurance is illegal and is called: A. Discounting B. Misrepresentation C. Rebating D. Twisting

C. Rebating

Select the correct statement about Long Term Care policies: A. Activities of Daily Living (ADL) are not generally a consideration under these policies B. Most Long Term Care (LTC) policies are guaranteed renewable up to age 70, after which they revert to optionally renewable policies C. The best such policies are those that will pay benefits regardless of the level of care required by the insured D. Virtually all Long Term Care policies require prior hospitalization before benefits will be paid

C. The best such policies are those that will pay benefits regardless of the level of care required by the insured

Select the correct statement about long term care policies from the following: A. ADLs are not generally a consideration under these policies B. Most LTC policies are guaranteed renewable up to age 70 after which they revert to optionally renewable policies C. The best such policies are those that will pay benefits regardless of the level of care required by the insured D. Virtually all LTC policies require prior hospitalization before benefits will be paid

C. The best such policies are those that will pay benefits regardless of the level of care required by the insured

All of the following statements about a non-cancelable policy are true, except: A. The term of most non-cancelable policies is to age 65 B. The only right to cancel the non-cancelable policy is for nonpayment of premiums. C. The company can increase the premium rate after the policy is in effect. D. The company cannot increase the premium rate once it has been established for the policy.

C. The company can increase the premium rate after the policy is in effect.

Which element of the contract are the application and premium payment? A. The entire contract provision B. The insuring clause C. The consideration D. The rights of ownership

C. The consideration

The elimination period in a Disability Income policy refers to: A. The same period of time for both accident and sickness. B. The period before the insured is eligible for a health plan. C. The period after a disability commences and before the insured may begin receiving benefits. D. All of the above.

C. The period after a disability commences and before the insured may begin receiving benefits.

The definition of "transaction insurance" includes all of the following, except: A. Soliciting a contract of insurance B. Negotiating a contract of insurance C. Underwriting a contract of insurance D. Effectuating a contract of insurance

C. Underwriting a contract of insurance

Mary has a special risk policy that will only pay a benefit for: A. Dreaded diseases B. Accident on commercial flight C. Unusual hazard not covered on other policies D. None of above

C. Unusual hazard not covered on other policies

All are true about social security disability, except: A. Must be fully insured B. Disability must last at least 12 months C. You can apply anytime after disability is deemed permanent D. Disabled applicant must be under 65

C. You can apply anytime after disability is deemed permanent

The misstatement of age provision gives the insurance company the right to: A. Cancel the contract B. Void due to fraud C. Reduce dividends payable D. Adjust benefits payable

D. Adjust benefits payable

The pre-existing condition exclusion in an A&H policy is designed to protect the insurance company against: A. Malingering B. Over-insurance C. Over-utilization D. Adverse selection

D. Adverse selection

What is found on part III of the application? A. Medical information B. Inspection report C. Credit report D. Agent's report

D. Agent's report

Under the typical HMO contract, the provider could be: A. A physician B. A hospital C. A registered physical therapist D. All of above

D. All of above A. A physician B. A hospital C. A registered physical therapist

Which of the following is an example of how disability insurance is used for business continuation? A. Business overhead expense insurance B. Business health insurance C. Disability buy-sell agreements D. All of above

D. All of above A. Business overhead expense insurance B. Business health insurance C. Disability buy-sell agreements

Which of the following will be used by insurers issuing policies to substandard risks? A. Exclusion rider/waiver B. Limiting type of policy C. Extra premium D. All of above

D. All of above A. Exclusion rider/waiver B. Limiting type of policy C. Extra premium

Which of the following is available as group coverage? A. Hospital expense B. Accidental Death and Dismemberment C. Surgical expense D. All of above

D. All of above A. Hospital expense B. Accidental Death and Dismemberment C. Surgical expense

The agencies of state government involved in the regulation of the insurance business in the state of Florida are: A. State Legislature B. Insurance Department and Commissioner C. State court D. All of above

D. All of above A. State Legislature B. Insurance Department and Commissioner C. State court

Which of the following deductibles are used in major medical policies? I. Flat II. Corridor III. Integrated A. I only B. I & II C. II & III D. All of above

D. All of above I. Flat II. Corridor III. Integrated

Under a Major Medical policy the cost of which of the following would usually be considered a covered medical expense? I. Heart surgery II. An emergency appendectomy III. Plastic surgery for scars received in an auto accident A. I only B. III only C. I and II D. All of above

D. All of above I. Heart surgery II. An emergency appendectomy III. Plastic surgery for scars received in an auto accident

304.Health insurance can be written by: I. Life insurance companies II. Casualty companies III. Monoline companies IV. Industrial companies A. I and II B. I, II and III C. III and IV D. All of above

D. All of above I. Life insurance companies II. Casualty companies III. Monoline companies IV. Industrial companies

Riders or endorsements may do which of the following to a health insurance policy? I. Restrict benefits II. Limit coverage III. Increase premiums A. III only B. II and III C. I and II D. All of above

D. All of above I. Restrict benefits II. Limit coverage III. Increase premiums

Physicians working in HMOs can work: I. Salaried staff member in clinic for straight salary II. Individual care in own office III. Group practice IV. On a per capita basis A. I and II B. I, II and III C. I and III D. All of above

D. All of above I. Salaried staff member in clinic for straight salary II. Individual care in own office III. Group practice IV. On a per capita basis

"Transacting insurance" included: I. Solicitation or inducement to purchase insurance II. Effectuation of a contract III. Preliminary negotiations toward sale of insurance A. I only B. II only C. III only D. All of above

D. All of above I. Solicitation or inducement to purchase insurance II. Effectuation of a contract III. Preliminary negotiations toward sale of insurance

Fines and Penalties for violating provisions of the agents qualification laws include: A. Denial, suspension, revocation, and non-renewal of license B. Misdemeanor fine of not less than $100.00 nor more than $1000.00 or an administrative penalty of $1000.00 C. Imprisonment for not more than six months as well as "B" above D. All of the above

D. All of the above A. Denial, suspension, revocation, and non-renewal of license B. Misdemeanor fine of not less than $100.00 nor more than $1000.00 or an administrative penalty of $1000.00 C. Imprisonment for not more than six months as well as "B" above

Which of the following is not a type of agent authority? A. Apparent B. Implied C. Expressed D. Authorized

D. Authorized

A company that is licensed to sell insurance in a particular state is: A. Domestic company B. Alien company C. Non-admitted company D. Authorized company

D. Authorized company

To be eligible for benefits under the Waiver of Premium provision the insured must: A. Be confined to house/home B. Take a physical examination every 3 months C. Pay all premiums due D. Be under physician's care

D. Be under physician's care

A "fictitious" group involves organizing any of the following to buy group insurance: I. A group of neighbors II. Several independent realtors III. An association or electrical contractors A. I only B. II only C. III only D. I and II

D. I and II I. A group of neighbors II. Several independent realtors

The Florida Uniform Simultaneous Death Act: I. Provides that when it is impossible to determine who died last it is assumed the insured died last II. It was designed to clear the way for paying claims III. It determines who should be the surviving beneficiary A. I only B. II only C. III only D. I and II

D. I and II I. Provides that when it is impossible to determine who died last it is assumed the insured died last II. It was designed to clear the way for paying claims

A cancelable health insurance policy allows the insurer to: I. Change premium rates for all persons in that class of insureds II. Cancel the policy due to health reasons III. Change the mandatory policy provisions during the time the policy is in force A. All of above B. II and III C. I and II D. I only

D. I only I. Change premium rates for all persons in that class of insureds

Which of the following statements is/are true about a Medicare Supplement policy? I. Only insurance companies affiliated with Medicare can provide Medicare Supplement policies II. These policies may be issued to anyone 59 1⁄2 or older without evidence of insurability III. Anyone who qualifies for Medicaid benefits may be issued these policies IV. These policies are designed to cover the deductibles and co-insurance A. III and IV B. I only C. II and III D. IV only

D. IV only IV. These policies are designed to cover the deductibles and co-insurance

Among the provisions a health or accident policy can contain is a provision that frees the company from liability if the insured is accidentally injured or killed: A. While engaged in the commission of a felony B. While engaged in an illegal occupation C. While under the influence of a drug not prescribed by a physician D. In any of the above

D. In any of the above While engaged in the commission of a felony B. While engaged in an illegal occupation C. While under the influence of a drug not prescribed by a physician

Which of the following is considered to be misrepresentation? A. Circulating any untrue oral derogatory statements calculated to injure any person engaged in the business of insurance B. Issuing a true statement about the terms of a policy issued or to be issued C. Returning a portion issued or to be issued on a basis not specified in the contract D. Making a statement which is not entirely true about the terms of a policy issued or to be issued

D. Making a statement which is not entirely true about the terms of a policy issued or to be issued

In a basic policy that covers daily room and board, out-patient services that pay a stated amount per day, what does the miscellaneous expense benefit pay? A. Approved charge per day B. Percentage of the daily room and board C. Reasonable, usual and customary charges D. Multiple of the daily room and board rate

D. Multiple of the daily room and board rate

Minimum participation required by Florida law for employee group before policy can be issued: A. A. 100% B. 75% C. 50% D. No Minimum

D. No Minimum

A health insurance company may refuse coverage or require a higher premium solely based on: A. Applicant's sex B. Applicant's marital status C. Applicant having trait for sickle cell D. None of above

D. None of above A. Applicant's sex B. Applicant's marital status C. Applicant having trait for sickle cell

Which of the following statements about Medicaid is true? I. It is one of the benefits of Medicare II. It is funded entirely by state government A. I only B. II only C. I and II D. None of above

D. None of above I. It is one of the benefits of Medicare II. It is funded entirely by state government

An insured has a policy which the insurance company declines to renew at the policy anniversary date. This policy is: A. Guaranteed renewable policy B. Cancelable policy C. Renewable policy D. Optionally renewable policy

D. Optionally renewable policy

The optional provisions covering changes of occupation and misstatement of age permit the insurer to do which of the following? A. Cancel the policy B. Request the insured to fill out a new application to correct previous misstatements or alter information that has changed since the application was originally submitted C. Charge a "back-end" premium to make up for the premium the insurer would have charged had the true situation been known D. Pay benefits equal to what would have been purchased at the premium paid had the insurer known the facts when the premium was established

D. Pay benefits equal to what would have been purchased at the premium paid had the insurer known the facts when the premium was established

Which of the following are not eligible for Medicare coverage? A. People age 65 and older who are eligible for Social Security B. People age 65 and older not eligible for Social Security, but willing to pay a monthly premium C. People of any age who have been entitled to disability benefits and disabled 2 years D. People with an life threatening condition

D. People with an life threatening condition

All of the following are benefits provided under Part A of Medicare, Except: A. Inpatient hospital care B. Skilled nursing facility care C. Hospice care D. Physician's services for inpatient care

D. Physician's services for inpatient care

When an application for health insurance is submitted without an initial premium, the earliest effective date is the date on which the: A. Application is taken by the agent B. Insurance company issues the policy C. Policy is received by the agent D. Policy is delivered to the prospect by the agent and the premium is collected

D. Policy is delivered to the prospect by the agent and the premium is collected

In a disability income policy there is a period during which no benefits will be paid for illness of any kind. This period usually does not apply to accidents, only to illness. The term that describes this interim is the: A. Elimination period B. Benefit period C. Waiver period D. Probationary period

D. Probationary period

"Twisting" in policy replacement involves all the below, except: A. A form of misrepresentation. B. Failure to disclose all relevant facts C. Stripping cash values to make speculative investments. D. Replacing policies after full disclosure of all relevant values and facts.

D. Replacing policies after full disclosure of all relevant values and facts.

An applicant for Accident and Health insurance has a heart condition of which he is unaware. He answers "NO" to the questions pertaining to heart problems. His answers are considered A. Warranty B. Fraud C. Concealment D. Representation

D. Representation

The following penalties may be imposed upon an agent by the insurance commissioner, except: A. $1000 for failure to answer a subpoena B. Up to $50,000 for violation of a cease and desist order C. Assess fines equal to the agent's earned commission in a fraudulent case D. Revocation of the agent's company contract

D. Revocation of the agent's company contract

The Medical Information Bureau (MIB) is: A. A non-profit agency supported by life insurance companies to aid in underwriting B. Supplies member companies with information concerning the insurability of proposed insureds C. Must be authorized by the applicant to give information to member companies D. Satisfies all of the above

D. Satisfies all of the above

A policy owner has which of the following rights under a health policy? A. Refusal of cancellation B. Return of premium refund C. Extension of renewal period D. Selection of beneficiaries

D. Selection of beneficiaries

Insurance is not regulated by: A. State Legislature B. Department of Financial Services C. State Court D. Self-regulation

D. Self-regulation

Which of the following is not a characteristic of Blue Cross/Blue Shield plans? A. Blue Cross is a hospital expense protection plan, which makes payments directly to the hospital. B. Blue Shield is a medical-surgical expense plan, which makes payment directly to the doctor. C. Participants are called subscribers. D. Service providers agree to receive a caption fee as a payment.

D. Service providers agree to receive a caption fee as a payment.

Many major medical policies include a provision that states when expenses reach a certain dollar amount the insured no longer shares in the cost of expenses; the insurer pays 100% of remaining covered charges. This is referred to as: A. Maximum benefit B. Benefit restoration C. Coinsurance percentage D. Stop-loss limit

D. Stop-loss limit

HMO's include all of the following, except: A. Preventative health care B. Diagnostic surgery C. Federal funding D. Subscribers can choose any doctor of their choice

D. Subscribers can choose any doctor of their choice

All of the following are reasons why an insurance application is important, except: A. The application becomes a part of the policy, if a copy is attached. B. The application more fully identifies the applicant. C. Statements made in the application become the basis for insurance of the policy. D. The application becomes a part of the insuring clause.

D. The application becomes a part of the insuring clause.

A health insurance policy includes an endorsement indicating the insurer will allow the policy to continue in force without further premiums if the insured is totally and permanently disabled. What endorsement is attached to this policy? A. Guaranteed insurability B. Impairment C. Multiple Indemnity D. Waiver of premium

D. Waiver of premium

When are disability income benefits received as nontaxable income to the recipient? A. Always B. Never C. When the employer has paid the premium D. When the employee has paid the premium

D. When the employee has paid the premium

Under the basic policy, which one is considered miscellaneous expenses? A. Emergency treatment B. Physician's fees C. Room and board D. X-rays

D. X-rays

Under individual and group health insurance sold in Florida, coverage for a newborn child of the insured begins how soon after birth? A. Immediately B. 24 hours C. 48 hours D. 72 hours

A. Immediately

Which of the following methods is not used for marketing long-term-care coverage? A. Medicare B. An individual policy C. A group policy D. A rider to a life insurance policy

A. Medicare

Daniel Webster'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 the: A. "Own occupation" definition and is more restrictive than other definitions B. "Any occupation" definition and is more restrictive than other definitions C. "Own occupation" definition and is less restrictive than other definitions D. "Any occupation" definition and is less restrictive than other definitions

B. "Any occupation" definition and is more restrictive than other definitions

On a reinstated health policy, how long after the policy is reinstated will coverage for sickness become effective? A. Immediately B. 10 Days C. 30 Days D. 60 Days

B. 10 Days

If an agent accepts a premium for a lapsed disability policy, coverage for illness becomes effective in how many days after the acceptance of the premium? A. Coverage is immediate B. 10 days C. 90 days D. None of above

B. 10 days

In Florida, Medicare Supplement policies require a free look. How long is it? A. 10 days B. 30 days C. 45 days D. 60 days

B. 30 days

In the State of Florida, coverage for services provided by ambulatory centers is provided by: A. Individual health insurance only B. Both individual and group insurance C. Group health insurance only D. Neither individual nor group health insurance

B. Both individual and group insurance

The coordination of benefits (COB) clause is found in what kind of policy? A. Individual B. Group C. Indemnity D. Fictitious

B. Group

Mattie was in an accident. AD & D insurance covers______ as a result of the accident. I. Death II. The loss of use of a limb III. The loss of sight IV. A broken arm A. I & III B. I, II & III C. I & IV D. I, II, III & IV

B. I, II & III I. Death II. The loss of use of a limb III. The loss of sight

To be an association allowed to purchase insurance in Florida, which of the following apply? I. If contributory must have less than 50 members III. Been in existence at least 2 years II. Must be a natural group IV. $10,000 A. I & III B. II & III C. I, II & III D. II, III & IV

B. II & III II. Must be a natural group III. Been in existence at least 2 years

The Probationary Period on a health policy is true of all the following statements except: A. It is found in the insuring clause B. It is one of the twelve (12) Mandatory clauses C. It requires a certain waiting period of illness D. It requires no waiting period for accidents

B. It is one of the twelve (12) Mandatory clauses

All of the following are reasons an application is important except: A. The application becomes part of the policy when attached to the policy. B. The application becomes part of the insuring clause when attached to the policy. C. The application helps to more fully identify the applicant. D. Statements made in the application become the basis for issuing the policy.

B. The application becomes part of the insuring clause when attached to the policy.

To qualify for group health coverage, a group of persons must be a "natural group." This means that: A. The group should be made up of people who in good health B. The group must have been formed for some reason other than to obtain insurance C. The group must have ten (10) or more members D. None of the above

B. The group must have been formed for some reason other than to obtain insurance

Which of the following statements about the differences between PPO's (Preferred Provider Organization) and HMO's is incorrect? A. HMO's operate on a prepaid basis, PPO's operate on a fee-for-service rendered basis. B. Unlike physicians in HMO, PPO health care providers are normally in private practice. C. PPO stresses preventative care while HMO does not D. None of the above.

B. Unlike physicians in HMO, PPO health care providers are normally in private practice.

What is the limitation imposed on number of days in post-hospital skilled nursing care under Medicare? A. 7 days B. 10 days C. 100 days D. 365 days

C. 100 days

Once an insured has paid a specified amount of his covered expenses, usually $1,000 to $2,000 under the stop-loss feature of health insurance, the company pays: A. 75% B. 90% C. 100% D. None of these

C. 100%

In what year was the Social Security Act amended to add health insurance protection for the aged and disabled? A. 1910 B. 1939 C. 1965 D. 1990

C. 1965

In a disability income policy, the waiver of premium rider will exempt the insured from paying the policy premiums once the insured has been totally disabled for a period of: A. 10 or 20 days B. 2 to 4 weeks C. 3 or 6 months D. None of above

C. 3 or 6 months

The "open enrollment" period allows each eligible member to enroll in an HMO during every 18 month period regardless of his/her health history. This open enrollment period is not less than: A. 10 days B. 20 days C. 30 days D. 60 days

C. 30 days

In health insurance, a smaller employer is one with a maximum of _____ employees. A. 10 B. 25 C. 50 D. 100

C. 50

A chef who is receiving Disability Income benefits is unable to return to work full time but continues his occupation on a part time basis. Which of the following would allow the chef to continue to receive benefits long-term? A. A Presumptive Disability provision B. A Contingent Disability Benefit clause C. A Partial Disability Benefit clause D. A Guaranteed Insurability clause

C. A Partial Disability Benefit clause

Under a typical HMO plan, each member pays: A. A premium based on the size of the deductible. B. A premium based on how often he/she uses the health plan. C. A fixed premium whether or not he/she uses the health plan. D. None of the above.

C. A fixed premium whether or not he/she uses the health plan.

Cafeteria plans were designed to: A. Provide insurer greater control of benefits selected for employees. B. Provide diversity of insurance company and HMO. C. Allow employees to pick and choose to tailor their own benefit package. D. Allow employees to eat lunch employees to eat lunch in a cafeteria.

C. Allow employees to pick and choose to tailor their own benefit package.

Under Florida law, a handicapped child is one who: A. Is incapable of employment or self-support B. Has a mental or physical handicap C. Both D. Neither

C. Both A. Is incapable of employment or self-support B. Has a mental or physical handicap

Health insurance may be ____________. A. Participating B. Nonparticipating C. Both A & B D. Neither A or B

C. Both A & B A. Participating B. Nonparticipating

Select the correct statement below: A. COBRA permits companies who have terminated employees to stop their group coverage as of the date of termination B. When employers discontinue group coverage, employees must prove they are insurable in order to convert to individual coverage C. COBRA protects dependents of employees by mandating for them the same extension and conversion privileges available to employees covered by group plans. D. All of the above are correct

C. COBRA protects dependents of employees by mandating for them the same extension and conversion privileges available to employees covered by group plans.

The Internal Revenue Service (IRS) considers Disability Income benefits paid under an employer-paid group Disability Income policy to be: A. Taxable for 13 weeks only B. Nontaxable for 26 weeks only C. Fully taxable as ordinary income D. Exempt from taxation

C. Fully taxable as ordinary income

With a disability buy-out, which of the following are included in this agreement? I. The length of time before buy-out is required. II. The proper definition of disability. III. Whether the benefits are paid lump sum or in installments. IV. Define how business will continue without the key person. A. I only B. I & IV C. I, II & III D. All of above

C. I, II & III I. The length of time before buy-out is required. II. The proper definition of disability. III. Whether the benefits are paid lump sum or in installments.

An HMO found guilty of unfair trade practices act could be charged a penalty of: I. Up to $2,500 II. Up to $50,000 III. If the violation is criminal, it can result in imprisonment IV. $10,000 A. I & II B. III & IV C. II & III D. II only

C. II & III II. Up to $50,000 III. If the violation is criminal, it can result in imprisonment

Which of the following statements regarding claims payments is not included in Time Payment of claims and Payment of Claims? A. Claims for payments of periodic indemnities must be made no less often than once a month. B. In order to facilitate payment, the insurer may pay an indemnity up to $3,000 to certain people who appear to be entitled to it. C. If there is no beneficiary designated for any death benefits payable, the insurer will pay the benefit to any relative of the insured by blood or marriage that appears to be entitled to it. D. The insurer may pay benefits directly to hospitals and/or medical practitioners unless the insured has specifically stated otherwise.

C. If there is no beneficiary designated for any death benefits payable, the insurer will pay the benefit to any relative of the insured by blood or marriage that appears to be entitled to it.

Which would not be covered under an AD & D policy? A. Dismemberment of limbs B. Loss of eyesight C. Medical expense D. Accidental loss of life

C. Medical expense

The N.A.I.C. refers to the: A. National Accounting Independent Chapters B. National Association of Insurance Companies C. National Association of Insurance Commissioners D. Networking Association of Internet Connections

C. National Association of Insurance Commissioners

If an employer pays the premiums for an insurance plan that automatically covers all eligible employees, the plan is known as: A. Salary savings insurance B. Contributory group insurance C. Noncontributory group insurance D. Franchise group insurance

C. Noncontributory group insurance

All of the following provisions are required by the Florida employee health care access act except: A. The method of rating will be modified community rating. B. The policies will be guaranteed issue. C. Pre-existing will be limited to 24 months for conditions manifested during previous 24 months for small employers with groups of 3 to 50 workers. D. All carriers must renew coverage, with certain exceptions.

C. Pre-existing will be limited to 24 months for conditions manifested during previous 24 months for small employers with groups of 3 to 50 workers.

Which is not a requirement of agents soliciting Medicare supplements? A. Inquire from each client if they already have coverage. B. Explain to the client where there will be overlapping coverage. C. Send a signed form to company explaining why policy can't be sold. D. Have client sign a form acknowledging information was provided.

C. Send a signed form to company explaining why policy can't be sold.

Under a credit health policy, what is the maximum amount of any accidental death benefit included? A. $20,000 B. The amount of the original indebtedness C. The amount of outstanding indebtedness at any given time D. A specified multiple of the monthly loan payment

C. The amount of outstanding indebtedness at any given time

All are true about Social Security Disability except: A. The worker must be fully insured. B. The disability must be expected to last at least 12 months. C. The worker can apply anytime after disability is deemed permanent D. The worker entitled to monthly benefit equal to his/her PIA at time the disability occurred

C. The worker can apply anytime after disability is deemed permanent

Pre-existing conditions are referred to in which of the following required health policy provisions? A. Claims Forms B. Payment of claims C. Time limit on certain defenses D. Legal actions

C. Time limit on certain defenses

When completing an application for medical insurance, an agent should do which of the following? A. Review the applicant's statement and bind the coverage. B. Complete the Medical Information Bureau report. C. Witness the applicant's signature. D. Sign the applicant's name if the applicant lives out-of-state.

C. Witness the applicant's signature.

A basic policy miscellaneous expense benefit will be expressed as: A. The approved charge per day B. A percentage of the daily room rate C. Reasonable, usual and customary D. A multiple of the daily room and board rate

D. A multiple of the daily room and board rate

Besides individual health insurance and group insurance, which of the following government plans also to provide health insurance: A. Medicaid B. Medicare C. OASDI disability D. All of above

D. All of above A. Medicaid B. Medicare C. OASDI disability

What is required before an HMO is allowed to start doing business in Florida? A. Receive a certificate of authority from the Department of Insurance B. Become a member of the Florida Health Maintenance Organization Consumer Assistance Plan. C. Pay all required fees. D. All of the above.

D. All of the above. A. Receive a certificate of authority from the Department of Insurance B. Become a member of the Florida Health Maintenance Organization Consumer Assistance Plan. C. Pay all required fees.

Which of the following is a requirement for payment of social security benefits? A. Total and permanent disability for at least five (5) months. B. Fully insured and disability insured. C. Expected disability of twelve (12) months or longer or ending in death. D. All of the above.

D. All of the above. A. Total and permanent disability for at least five (5) months. B. Fully insured and disability insured. C. Expected disability of twelve (12) months or longer or ending in death.

Which one of the following does not fall into the general category of medical expense insurance? A. Accident and sickness policies B. Hospital policies C. Major medical policies D. Disability income policies

D. Disability income policie

An agent takes an application for health insurance on Ward and Lulu Cleaver and their family. When the agent returns to her office she discovers two unanswered questions on the application. Of the following, which actions should she take? A. Call the cleavers and get the information over the phone. B. Reconstruct the sales interview and answer the questions based on the information she can remember. C. Submit the application to company as is. D. Go back to the Cleavers and have them complete the unanswered questions.

D. Go back to the Cleavers and have them complete the unanswered questions.

Define an association group: I. Usually a group of professionals II. Must have been in existence for 2 years III. Can be formed to purchase insurance A. I only B. II only C. III only D. I & II

D. I & II I. Usually a group of professionals II. Must have been in existence for 2 years

A difference between life & health policies is: I. Life is a valued contract, health policies can be indemnity contracts II. Life is an indemnity contract, health is a valued contract III. Life is a valued contract, health policies can be reimbursement contracts A. I only B. II only C. III only D. I & III

D. I & III I. Life is a valued contract, health policies can be indemnity contracts III. Life is a valued contract, health policies can be reimbursement contracts

In a disability policy, what factor when increased causes a decrease in benefits? A. Interest B. Pool of insureds C. Benefits D. Morbidity

D. Morbidity

Does Florida law require maternity coverage in individual or group policies? A. Individual B. Group C. Both D. Neither

D. Neither A. Individual B. Group

Which of the following is a type of benefit payment under a partial disability policy? A. Short term proportional benefit B. Probationary benefit C. Both A & B D. Neither A or B

D. Neither A or B A. Short term proportional benefit B. Probationary benefit

Willie Sutton purchased a health insurance policy and was told that the insurance company cannot raise the premium or terminate the coverage. Which of the following types of renewability clauses does this policy contain? A. Optionally Renewable B. Conditionally Renewable C. Provisionally Renewable D. Non-cancelable - Guaranteed renewable

D. Non-cancelable - Guaranteed renewable

A benefit that can be paid when the insured is not disabled is: A. Total disability payments B. Partial disability payments C. Residual disability payments D. Non-disabling injury benefit

D. Non-disabling injury benefit

What is the stop loss point in Medicare? A. $1,000 B. $2,000 C. $5,000 D. None

D. None A. $1,000 B. $2,000 C. $5,000

Which of the following statements about the benefit period in a disability income policy is correct? A. The shorter the benefit period, the higher the premium B. The longer the benefit period, the lower the premium C. The benefit period will not begin until the 1 to 2 year waiting period is over D. None of above

D. None of above A. The shorter the benefit period, the higher the premium B. The longer the benefit period, the lower the premium C. The benefit period will not begin until the 1 to 2 year waiting period is over

Which of the following is required information on the first page of an application for health insurance? A. The name of the agent B. The name of the insurance company C. The agent's identification number D. None of the above

D. None of the above A. The name of the agent B. The name of the insurance company C. The agent's identification number