Chapter 19/6: FLORIDA REVIEW HEALTH

What is the rule on mentioning the Consumer Assistance Plan during the sale of an HMO contract?

Florida prohibits mentioning the Consumer Assistance Plan (CAP) in any way during the sale of HMO contracts. The correct answer is: CAP must never be mentioned.

An advertisement for a health insurance policy must give an appropriate definition or description for which of the following terms?

An advertisement for a health insurance policy must give an appropriate definition or description of the term "pre-existing." The correct answer is: Pre-existing

Which of the following would be found in an advertisement for a policy that is a specified illness, disease, or accident only policy?

An advertisement for a health policy that is a specified illness, disease, or accident only policy must disclose the limited nature of the policy in words such as "THIS IS A CANCER ONLY POLICY" or "THIS IS A LIMITED POLICY." The correct answer is: "THIS IS A LIMITED POLICY."

An advertisement for a health policy that is an invitation to buy a contract must disclose the existence of all the following, EXCEPT:

An advertisement for a health policy that is an invitation to buy a contract must disclose the existence of a waiting period, elimination period, or probationary period. The correct answer is: Grace period

ERISA governs an employee benefit plan and its jurisdiction is:

ERISA governs an employee benefit plan, but its jurisdiction is not exclusive. The correct answer is: Not exclusive

Under an HMO contract, when does coverage for newborns begin?

A newborn child of an HMO subscriber is covered from the moment of birth. The correct answer is: The moment of birth

What is the free look period for a Medicare supplement policy?

A policyholder has the right to return a Medicare supplement policy within 30 days of its delivery. The correct answer is: 30 days

A Medicare supplement insurer cannot deny an application for a Medicare supplement policy if the applicant is both 65 and enrolled in:

A Medicare supplement insurer cannot deny an application for a Medicare supplement policy if the applicant is both 65 and enrolled in Medicare Part B. The correct answer is: Medicare Part B

A Medicare supplement policy cannot exclude benefits for a pre-existing condition for a person who had how many months of continuous creditable coverage prior to their application?

A Medicare supplement policy cannot exclude benefits for a pre-existing condition for a person who had 6 months of continuous creditable coverage prior to their application. The correct answer is: 6 months

The definition of "Medicare eligible expense" for a Medicare supplement policy cannot be:

A Medicare supplement policy cannot have a definition of "Medicare eligible expense" that is more restrictive than Medicare's. The correct answer is: More restrictive than Medicare's

An HMO contract must be delivered within how many working days of enrollment?

An HMO contract, certificate or member's handbook must be delivered within 10 working days of enrollment. The correct answer is: 10 days

ERISA states that no employee benefit plan or trust shall be deemed to be what kind of company?

ERISA states that no employee benefit plan or trust shall be deemed to be an insurance company or other insurer or be engaged in the business of insurance. The correct answer is: Insurance company

Florida Healthy Kids is mainly for school age children who are ineligible for Medicaid and whose family income is below:

Florida Healthy Kids is mainly for school age children whose family income is below 200% of the federal poverty level and are ineligible for Medicaid. The correct answer is: 200% of the federal poverty level

Florida Healthy Kids provides health insurance to children who are eligible for assistance under:

Florida Healthy Kids provides health insurance to children who are eligible for assistance under Title XXI of the Social Security Act. The correct answer is: Title XXI of the Social Security Act

What organization did Florida create to improve access to health insurance for uninsured children in Florida?

Florida created the Florida Healthy Kids Corporation to improve access to health insurance for uninsured children in Florida. The correct answer is: Florida Healthy Kids Corporation

Florida created the Small Employers Access Program to specifically target employers with up to how many employees?

Florida created the Small Employers Access Program to specifically target employers with up to 25 employees. The correct answer is: 25

HMO contracts must provide coverage for newborn children of a family member from the moment of birth for at least:

HMO contracts that provide coverage for a family member of the insured must also provide coverage for the insured's newborn children from the moment of birth. Coverage must be also be provided for the newborn child of a covered family member (such as the newborn of a daughter) for 18 months after the birth. The correct answer is: 18 months

HMOs are based on all of the following, EXCEPT:

HMOs are based on early detection, prevention care and volume discount, not fee-for-service. The correct answer is: Fee-for-service

Health insurance advertisements may use which of the following?

Health insurance advertisements may not use the phrases "tax free," "extra cash," "extra income," or "extra pay" in a manner that would mislead someone to believe they could make a profit by bing hospitalized. The correct answer is: Hospitalization

In Florida, HMOs are exclusively through the:

In Florida, HMOs are exclusively through the group enrollment system. The correct answer is: Group enrollment system

In Florida, what is the minimum number of employees to be considered a "small employer?"

In Florida, a "small employer" has at least 1 and not more than 50 employees. The correct answer is: 1

In Florida, what is the maximum number of employees to be considered a "small employer?"

In Florida, a "small employer" has at least 1 and not more than 50 employees. The correct answer is: 50

In Florida, what is the minimum number of employees for a small employer health plan to be guaranteed issuer?

In Florida, all small employer health plans must be guaranteed issue to every small employer with 2 to 50 employees. The correct answer is: 2

In Florida, all small employer health plans must be:

In Florida, all small employer health plans must be guaranteed issue to every small employer with 2 to 50 employees. The correct answer is: Guaranteed issue

In Florida, comprehensive health care services includes all the following types of care, EXCEPT:

In Florida, comprehensive health care services includes services, equipment and supplies for medical care, surgical care, dental care, psychological care, optometric, optical, chiropractic, podiatric, nursing, physical therapy, pharmaceutical services, health education preventive medical, rehabilitative services, home health services, inpatient and outpatient hospital services, extended care, nursing home care, convalescent institutional care, pathology lab services, laboratory and ambulance services, services, and any other care, service or treatment of disease or correction of defects in human beings. The correct answer is: Homeopathic

Individual health policies may give a rebate of up what percentage of premiums for individuals who participate in health wellness, maintenance or improvement programs?

Individual health insurance policies may give a rebate of up 10% of premiums for individuals who participate in health wellness, maintenance or improvement programs. The correct answer is: 10%

What was created in Florida to protect subscribers of HMOs from insolvent HMOs?

The Consumer Assistance Plan (CAP) was created in Florida to protect subscribers of HMOs from insolvent HMOs. The correct answer is: Consumer Assistance Plan

What act is meant to promote the availability of health insurance coverage to small employers in Florida?

The Florida Employee Health Care Access Act is meant to promote the availability of health insurance coverage to small employers. The correct answer is: Florida Employee Health Care Access Act

What Florida statute ensures coverage for employees of small businesses not covered by COBRA 1985?

The purpose of the Florida Health Insurance Coverage Continuation Act (Mini-COBRA) is to ensure coverage for employees of small businesses not covered by COBRA 1985. The correct answer is: Mini-COBRA