Florida Health Insurance (current)
Which of the following statements concerning worker's compensation is correct?
Benefits include medical cares costs, rehabilitation benefits and disability income
Which of the following is an example of risk avoidance?
Bill never invests in the stock market because he is worried about a market crash
An airline that wants group health coverage for its passengers would purchase what kind of insurance?
Blanket health insurance
A new licensee must complete a total of how many hours of approved continuing education every two years?
24 hours
Which of the following statements concerning workers' compensation is correct?
Benefits include medical care costs, rehabilitation benefits and disability income
Sam's basic medical expense policy limits the misc. expense benefit to 10 times the $80 daily room and board benefit. During his recent hospital stay, misc. expenses totaled $2,100 - how much of this amount will Sam have to pay?
$1,300
Toni is covered by her employer's noncontributory group disability income plan, the premium for which is $35 a month. If she were to become disabled and receive $1500 month , how much of each benefit payment would be taxable income to her?
$1500
Pam is covered under her employer-sponsored disability group plan. The premium is $50 a month. Pam pays $20 and the employer pays $30. Assuming Pam were to become disabled and receive monthly disability benefits of $600 from the plan, how much if any of the monthly benefit would be tax free income?
$240
Pam is covered under her employer-sponsored disability group plan. The premium is $50 a month...Pam pays $20...$30
$240
If the coinsurance feature in a major medical insurance policy is 80/20 with a $400 deductible, how much of a $2400 bill would the insured pay?
$800
Garrett has a monthly benefit of $3,000 for total disability under a residual disability income policy. If he suffers a 30% loss of his pre-disability income how much will his benefit be?
$900
Garrett has a monthly benefit of $3,000 for total disability under a residual disability income policy. If he suffers a 30% loss of his pre-disability income, how much will his benefits be?
$900
The grace period for paying premiums on an HMO contract is
10 days
What is the maximum number of days that Medicare will pay benefits for skilled nursing facility care?
100
On receipt of Notice of Claim, under an individual policy, the insurance company must provide the claimant with claim forms within a maximum of how many days
15 days
On receipt of a notice of claim, under an individual policy the insurance company must provide the claimant with claim forms within a maximum of how many days?
15 days
A licensee who has been licensed for six or more years must complete a minimum of how many hours of elective continuing education and how often?
15, 2
In 2010, the FICA tax rate for a self-employed person was
15.30%
How long does the insurer usually have to contest the validity of a life insurance contract?
2 years
According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after the loss occurs?
20
According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after the loss occurs?
20
According to the notice of claims provision in a health insurance policy, a claimant normally must notify the insurance company of loss within how many days after a loss occurs?
20 days
Dee works part time to supplement her family's income. Last year she earned $4,900 and worked at least part of every month. With how many quarters of FICA coverage will she be credited for?
3
A licensee must notify the Department in writing within how many days after a change of name, residence address principal business street address, mailing address, contract telephone number or email address?
30
A licensee must notify the Department in writing within how many days after a change of name, residence address, principal business street address, mailing address, contract telephone number or email address?
30 days
If an insurance company fails to notify an applicant that a reinstatement application was not approved insurance will be placed back in force within how many days?
45 days
What is the earliest date that a beneficiary can take legal action against the insurer in a claim dispute?
60 days following the submission of proof of loss
Which of the following situations can cause a plan to lose grandfathered status?
All of the above (An increase in percentage cost sharing requirements / An increase in fixed amount copayment / Decrease in contribution rates by employers and employee organizations)
Which of the following statements is correct?
A contract having an illegal purpose is void and neither party to the contract can enforce it
Which of the following statements regarding Social Security survivor benefits is correct?
A deceased covered worker was providing one half of the support for an 80 year old parent who is confined to a nursing home. The parent is entitled to a survivor's benefit
Which of the following statements regarding riders is not correct?
A guaranteed insurability rider guarantees the insured the right to purchase additional amounts of disability income coverage as long as the insured provides evidence of insurability
Which of the following statements regarding insurable interest is not correct?
A policy obtained by a person without an insurable risk in the insured can be enforced
Which of the following statements regarding utmost good faith in insurance contracts is not correct?
A warranty in insurance is the contractual agreement made by the insurer regarding the payment of benefits to the policyowner
Which of the following examples pertaining to accidental death and dismemberment insurance is not correct?
Alan, 40,000 AD&D heart attack, 40,000
Competent parties who can enter into insurance contracts are
All of the above (Business entities / Applicants / Trusts and estates)
Which of the following statements about deductible provisions in medical insurance policies is correct?
ALL OF THE ABOVE They help to eliminate small claims / they provide that initial expenses up to a specified amount are to be paid by the insured / they help to hold down premium rates
Which of the followng statements about elimination periods in disability income policies is correct?
ALL OF THE ABOVE the longer the elimination period, the lower the premium for comparable disability benefits / elimination period follows the start of a disability
Which type of group health coverage typically does not contain a conversion privilege?
Accidental death and dismemberment
Which of the following is a provision of NAIC's Life Insurance Illustrations Model Regulations?
All of the above (Each policy illustration must have a written explanation or policy summary / must be labeled with specific information identifying the source of the illustration / each policy illustration must show that cash values and coverage vary depending on changes in an insurer's costs and dividends
Which of the following are basic forms of health insurance coverage?
All of the above (Medical expense / Accidental death and dismemberment / Disability income)
Which of the following are primary risk factors in underwriting individual health insurance policies?
All of the above (physical condition / moral hazard / occupation)
Which of the following are primary risk factors in underwriting individual health policies?
All of the above (physical condition / moral hazard / occupation)
Which of the following statements about elimination periods in disability income policies is correct?
All of the above (the longer the elimination period, the lower the premium for comparable disability benefits / elimination periods help keep premiums down / an elimination period follows the start of a disability)
Which of the following statements pertaining to health maintenance organizations is not correct?
An insurance company may sponsor an HMO or assist an HMO by providing contractual services
Insurance contracts are contracts of adhesion - this statement means that
An insurance contract is prepared by one party, the insurer rather than by negotiation between the contracting parties
No person may act as an insurance agent unless they are currently licensed by the Department and are what by an insurer or other appropriate entity?
Appointed
It is seldom in the best interest of a policyholder to replace a life insurance policy with a new policy which of the following reasons does not correctly support this statememt?
Are never in the best interest of the policyowner because they generate higher first year sales commissions
A reinsurer is a company that
Assumes a portion of the risk from another insurer
With life and health contracts, when must an insurable interest exist?
At the time of application
A business owner has a fear of flying so he always drives or takes the train when he needs to travel this is an example of risk
Avoidance
All of the following are required uniform provisions in individual health insurance policies except
Cancellation
Natasha receives a $500,000 cash benefit from her $1,000,000 accidental death and dismemberment policy for the accidental loss of one eye. The amount she received could be identified as the policy's
Capital sum
Tim, while alligator hunting, falls out of his boat and encounters a hungry alligator. Upon being helped back into the boat, he notices that his left arm is missing. Under what form of policy will Tim receive a benefit?
Capital sum
Tim, while alligator hunting, falls out of his boat and encounters a hungry alligator. Upon being helped back into the boat he notices that his left arm is missing. Under which form of policy will Tim receive a benefit?
Capital sum
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?
Commercial insurer
Accidental death and dismemberment policies may be referred to all of the following except
Contracts of indemnity
An act of making, issuing, circulating or causing to be issued, an estimate, illustration, circular or statement of any kind that does not represent the correct policy terms, dividends or share of the surplus, or the name or title for any policy or class of policies that does not in fact reflect its true nature is known as which of the following?
Misrepresentation
Referring to a policy as anything other than insurance, such as a wealth building plan is an unethical practice called
Misrepresentation
Which of the following methods of insurance sales does not involve and agent or broker?
Direct selling method
An insurance company that is organized and headquartered in Florida can be described as what type of company in Florida
Domestic
Which of the following is not one of the activities of daily living (ADLS)
Driving
What is the policy provision that prevents an insurance company from altering its agreement with a policyowner by referring to documents or other items not contained in the policy?
Entire contract provision
The authority that an insurer gives to its agent by means of the agents contract is known as
Express authority
The authority that an insurer gives to its agents by means of the agents contracts is known as
Express authority
Which of the following statements about authority is not correct?
Express authority is determined by a principals conduct
Which of the following terms does not relate to disability income insurance?
Fixed period provision
A program that serves as a source of funds by collecting local, state and family money to assist in paying premiums to commercial health insurance companies in order to assist families who would otherwise be unable to afford the desired coverage falls under which program?
Florida healthy kids corporation
A life insurance company organized and incorporated in Georgia, home office in North Carolina is licensed to conduct business in Florida, in Florida this company is classified as
Foreign company
All of the following factors would affect a health insurance policy's premium rate except
Geographical location
A delivery business owner worries that one of his drivers may have an accident due to drug or alcohol abuse this is an example of
Moral hazard
Which kind of health insurance policy assures renewability up to a specific age of the insured, although the company reserves the right to change the premium rate on a class basis?
Guaranteed renewable
Which of the following statements pertaining to health insurance policy premium factor is not correct?
Health insurance policies provide many premium payment options
Grace owns a small shoe store and is covered under a business overhead expense policy. If she becomes disabled she can expect all of the following expense to be covered except
Her salary
Grace owns a small shoe store, covered under a business overhead expense policy. If she becomes disabled she can expect all of the following to be covered except
Her salary
An individual who busy a membership in a prepaid health clinic because the premium is less than an HMO should be aware that the clinic cannot provide
Hospitalization
All of the following regarding statements regarding levels of nursing care are correct except
Intermediate nursing care provides assistance in meeting daily living requirements
An insurer is considered competent if it
Is licensed or authorized by the state
All of the following characteristics are associated with a disability buy out plan except
It is a non-binding arrangement funded with both life and disability income policies
Which of the following statements about Medicare Part B is correct?
It is designed to provide supplementary medical insurance for services and supplies not covered by Part A
Which of the following statements about waiver of premium in health insurance policies is not correct?
It normally applies to both medical expenses and disability income policies
Jennifer owns a medical expense policy that provides a fixed rate of $150 per day for each day of hospitalization. She is hospitalized for 10 days, incurring medical expenses of $10,000. Which of the following statements is not correct?
Jennifer would receive $8500 in benefits
Which of the following insurance concepts is founded on the ability to predict the approximate number of deaths or likelihood of disabilities within a certain group during a specific time?
Law of large numbers
Fred's daughter is worried that her father is taking unnecessary risks by driving recklessly and participating in dangerous physical activities. What kind of hazard is described?
Morale hazard
Debbie purchases round trip travel accident policy, airport - business trip, which type of insurance?
Limited risk
The head of the state office of insurance regulation is generally responsible for all of the following except
Making insurance laws
Which of the following would probably not be considered in underwriting a health insurance risk?
Marital risk
Which of the following statements pertaining to Medicaid is correct?
Medicaid is intended to help needy persons, regardless of age
Which of the following statements regarding health insurance claims is not correct?
Medical expense insurance is typically a valued contract, where the insured receives fixed benefits independent of the amount of loss
Which of the following statements regarding health insurance claims is not true?
Medical expense insurance is typically a valued contract, where the insured receives fixed benefits independent of the amount of loss
The primary source of health insurance at the federal level which provides hospital and medical expense insurance protection to those of any age who suffer from chronic kidney disease is known as
Medicare
The primary source of health insurance, at the federal level which provides hospital and medical expense insurance protection to those of any age who suffer from chronic kidney disease is known as
Medicare
Fred's daughter is worried that her father is taking unnecessary risks by driving recklessly participating in dangerous physical activities. What kind of hazard is described?
Morale hazard
Fred's daughter, driving recklessly, what kind of hazard?
Morale hazard
Which of the following premium factors is unique to health insurance opposed to life insurance?
Morbidity
Assume the following individuals are issued health insurance policies with varying renewability provisions. All other factors being equal who would pay the highest premium?
Noncancelable
Which of the following statements regarding risk is not correct?
Only speculative risks are insurable
The misc. expense benefit in a basic hospital expense policy normally will cover all of the following except
Physician's services
The right to competitive pricing practices and marketing methods that enables an insured to determine the best value among comparable policies is known as which of the following?
Policyholder's rights
The right to competitive pricing practices and marketing methods...determine the best value
Policyholders rights
Which of the following can an individual include as qualifying expenses for purposes of determining a medical tax deduction?
Premium contributions paid by the individual to a group medical expense plan
Which of the following statements about long term care insurance policies is not correct?
Premiums for a long term care policy are based solely on the insured's age health and type of benefits provided
The amount payable as a death benefit in an accidental death and dismemberment policy is known as
Principal sum
What is the initial period of time specified in a disability income policy that might pass after a policy is in force before a loss due to sickness can be covered?
Probationary period
Which of the following is an example of churning?
Replacing a policy with the intent of earning additional premiums or commissions
Which of the following is not part of a sales presentation?
Review the product application
All of the following are general duties and powers of the Department of financial services except
Shall have additional powers and duties as provided by other laws of any state
All of the following are types of deductible provisions associated with major medical policies except
Stop-loss
The state guarantee association guarantees
That a claim will be paid if an insurer becomes solvent
Regarding landmark cases and laws involving the regulation of insurance, which of the following statements is not correct?
The Federal Trade Commission FTC controls all advertising and sales literature used by the health insurance industry
In determining Social Security retirement benefits, which of the following statements is not correct?
The PIA is a determination of the amount of equal to the worker's full retirement benefit at the worker's full retirement age
Which of the following statements pertaining to the basic benefit of Plan A, developed by the NAIC as a standard Medicare supplement policy, is not correct?
The basic benefits policy covers the Medicare Part A deductible amount
Which of the following statements pertaining to the basic benefits of Plan A, developed by the NAIC as a standard Medicare supplement policy, is not correct?
The basic benefits policy covers the Medicare Part A deductible amount
Insurance contracts are contracts of adhesions
The contract is prepared by one party, the insurer and is not the result of negotiation between the parties
All of the following are general duties and powers of the department financial services except
The department shall have additional powers and duties as provided by other laws of any state
Which of the following statements about COBRA is not correct?
The employee is typically offered a reduced premium for continued group medical coverage
Which of the following statements about Cobra is not correct?
The employee is typically offered a reduced premium for continued group medical coverage
What is the income tax consequence if Marjorie pays the entire premium for her group disability income coverage?
The employer can deduct the premium payments
Which of the following statements does not describe an element of an insurable risk?
The loss must be catastrophic
All of the following statements regarding medical cost management are correct except
The purpose of medical cost management is to encourage individuals to seek medical help only as a last resort, eliminating unnecessary expenses
Which is the effect of an impairment rider attached to a health insurance policy?
To exclude from coverage losses resulting from specific conditions
What is the effect of an impairment rider attached to a healthy insurance policy?
To exclude from coverage losses resulting from specified conditions
Buying insurance is one of the most effective ways of
Transferring risk
In the insurance business, risk can be defined as
Uncertainty regarding financial loss
Which of the following phrases should agents avoid using when explaining policies to prospective applicants or clients?
Vanishing premium
Which of the following terms is used for the voluntary relinquishments of a known right?
Waiver
How often must HMO's file a report of their activities to the office of insurance regulation?
Within 3 months after close of fiscal year
How often must HMO's file a report of their activities to the Office of Insurance Regulation?
Within 3 months after the close of a fiscal year
In determining Social Security retirement benefits which of the following statements is not correct?
Workers retiring past 62 can receive 100% of the PIA
In determining social security retirement benefits which of the following statements is not correct?
Workers retiring past age 62 can receive 100% of their PIA
HMOs offering group coverage must have an open enrollment at least
for 30 days every 18 months