Health insurance Fl
Legal Action provision
requires the insured to wait at least 60 days after proof of loss is submitted before legal action can be brought against the insurer
Office of Insurance Regulation
responsible for licensing and certificates, COA , policy forms , viatical settlements etc
What is the only difference between blanket insurance and group health insurance
the insured members are not named , blanket membership- can change at any time
Notice of Claim provision
the insured must give written notice to the insurer within 20 days after a covered loss occurs
which of the following entities is considered the principal
the insurer issuing policy
All of the following are characteristics of a geroup health insurance plan except
the parties that hold a health insurance contract are the employees and the employer
Notice to buyer located in every Medicare Supplemental policy
this policy may not cover all your medical expenses
How long is the Free Look period for individual and senior products?
14 days for individual policies 30 days for senior policies
Denial of claims provision
15 days to appeal physician decision
Florida law requires that both individual ad group health insurers cover newborns for a period of
18months
How ling does the law require agents to to maintain records regarding premium payments
3 years
How many days do you have to notify your insurer of a newly born child?
30 days
how long must the insured wait before filling a lawsuit against the insurer
60 days after filling proof of loss
under the mandatory unifrom provision legal actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to
60 days after written proof of losses has been submitter
Grace Period Provision
7 days for weekly 10 days for monthly \ 31 +
Agent R is charged with committed a crime in another state an is sentenced to 1 year in prison. Who is required to report charges to the Florida Dept of Insurance
Agent R
Who makes up the Insurance Guaranty Association/Fund?
All insurance companies selling life and/or health insurance in the state
Fiduciary Responsibility
An ethical and legal obligation to perform a person's duties in a trustworthy manner.
Controlled business
Any coverage written on a producer's own life, health or property, and/or that of the producer's immediate family or business associates
the unifrom provision law that prevents an insurance company from altering its agreement with a policyholder by referring to documents or other items not contained in the policy is called
Entire Contract
Who issues a temporary license and how long is it good for?
Florida Department of Insurance 6 months
Guaranty Association
Fromed to protect policyowners, insureds, beneficiaries and anyone entitled to payment under an insurance policy from the incompetence and insolvency of insurers.
Which of the following terms refers to solicitation, negotitation , effectuation or advising related to an insurance contract
Insurance transaction
Concealment
Intentional withholding of information of a material fact that is crucial in making a decision.
Which of the following is incorrect
Medicare and Medigap provide coverage for LTC custodial and nursing home
When must the Outline of Coverage be delivered to the insured?
Must be deliver to the insured prior to the application or enrollment form
an insurance company that is owned by policy holders
Mutual insurer
Entire Contract Provision
No change in this policy will be valid until approved by an executive officer of the insurer
AN insured 44 year old fall while mountain climbing on vacation. He is left paralyzed. After a year doctors feel he will never recover from his injuries. From which of the following programs will he be able to collect the disability income
Social Security
Change of Benificiary
Unlesss irrevocable , the right to change beneficiary is reserved to the insured and the consent of the beneficiary is not required
No fewer than 1, no more than 50 eligible employees
Work the minimum of 25 hrs/week and meet the waiting period requirements
Which of the following statements is not true regarding health insurance policy provisions
all additional provisions written by insurers are cataloged by their respective state
insurance contract
an agreement between policyowner and an insurer, where the insurer agrees , for a consideration to indemnify for loss
Penalty for violating Cease and desist
fined 50,000 suspension or revocation of Certificate of authority any other relief provided by Insurance coded
Which of the following statements about HMOS are false
hmo's can engage in selling insurance contracts
Reinstatment Provision
if any renewal is not paid by grace period , coverage is automatically reinstated within 45 days from the date of receipt if not refused
When an insured reinstated his major medical policy , he was involved in an accident that required hospitalization When would this accident be covered upon reinstatement of the policy
immediately
an agent must keep funds belonging to each insurer for which an agent is not appointed
in a separate account
Related costs incurred by the CFO
will be charged against the subpoenaed person , failure to comply with such order will be a contempt of court
Which of the following best defines the probationary period in group policies
A specified period of time that a person joining a group would have to wait before becoming eligible for coverage
the guaranteed purchase option is also referred to as
Future increase option
All of the following are features of a catastrophic plan except
High premiums
Jeremy wants to get his producer license to sell to his friends and their families. Would this be considered controlled business?
No
Unfair trade practice
any statement that an insurer's policies are guaranteed by existence of the Insurance Guaranty Association
Mutual Companies
are owned by policyowners and issues out policies
stock companies
are owned by stockholders
How frequently are market conduct examinations held
at least one every 5 years
Why does Florida have state laws regulating Medicare Supplement
states cannot enforce and prosecute federal laws
Time Limit on Certain Defenses
states that after the policy has been in force for two years, the insurer cannot void the policy or deny a claim on the basis of misstatements in the application, except for fraudulent misstatements
A man is an attorney when he applies for health policy. He decides to become a professional bungee jumper. he files a claim. what should happen?
the insurance company will pay the claim according to benefits available if the correct premium has been paid.
claim forms provision
the insurer is required to send the insured a claim form within 15 days after notice is received
What is the purpose of impairment rider
to exclude coverage for specific impairment
What is the purpose of a benefit schedule
to state what and how much is covered in the plan
Coercion
unfair trade practice in which an agent uses physical or mental force with the intent of inducing an applicant to purchase insurance
Rebating
Any inducement offered in the sale of insurance products that is not specified in the policy.
What is the definition of a Small Employer?
No fewer than 1, no more than 50 eligible employees
List what would cause a small employer to not renew coverage
Nonpayment of premiums Fraud/misrepresentation Failure to comply with plan's contractual provisions Insurer does not offer plan
which of the following provisions is mandatory for health insurance
Physical examination and autopsy
Which of the following would make a child over 5 ineligible for florida healthy kids coverage
Qualifying for Medicaid
Proof of Loss provision
Policy owner has 90 days from date of loss to submit proof of loss to Insurer.
All of the following are true regarding key person disability income insurance except
Premiums are taxed deductible as a business expense
Agent Jack is offering individuals tickets to the Super Bowl is they sign up with him. This is considered what illegal act?
Rebate
Consumer Services
Responds to complaints by consumers
Office of Financial Regulation
Responsible for all activities concerning insurers. Office of Financial Regulation: • Regulation of banks • Credit unions • Finance companies • Security industry • Includes the Bureau of Financial Investigations - ruination a as a criminal justice agency • The Office of Financial Regulations
IN contrasting stock insurers to mutual insures which statement is true
Stock insurers are owned by the shareholders and issue non participating policies
what entities do appointments need to be filled out with
The department
domicile
location of incorporation
Defamation
oral or written statement is made that is intended to injure a person engaged in the insurance business
Fraternal benefit society
org formed to provide insurance benefits for members of an affiliated lodge
Which of the following is consideration on part of an insurer
paying a claim
participating policies
policyowners are entitled to dividends.
nonparticipating policies
policyowners do not share in profits or losses
When must the shopper's guide be presented?
prior to completing application
Which of the following is NOT mandatory under the Uniform Provisions law as applied to accident and health policies
probationary period
Misrepresentation
publish or circulate any illustration or sales material that is false , misleading , or deceptive as to policy benefits or terms etc
Churning
replacing insurance policies for the sole purpose of making commissions
within how many days of from termination of employment must an insured provide notice to the insurer in order to continue coverage under the employers plan
63 days
What is the max age that a disabled insured worker may receive Social security benefits
65
When may HIV related test results be provided to the MIB
only if the individual will not be identified
who administer insurance laws in Florida
Chief Financial officer (CFO)
Head of the Financial regulation Dept
Commissioner of Financial Regulation
Sliding
The illegal practice of falsely leading an applicant to believe that a specified additional coverage or product is required by law , or included without any additional charges
under a health insurance policy benefits , other than death benefits that have not otherwise been assigned will be paid to
The insured
What does it mean if an insurance company is nonadmitted?
The insurer has not applied or has applied and been denied the Certificate of Authority
In addition to participation reqs. how does the insurer guard against adverse selection when underwriting
by requiring that the insurance be incidental to the group
Agents in this state are required to promptly report all of the following to the Department EXCEPT
change in marital status
Every licensee Must notify the department in writing within 30 days when
change of name, address, or email address
Agent M uses his big size implication of his connections to intimidate applicants into purchasing life insurance from him. what is he guilty of
coercion
Reinsurance
contract under which one of the insurance company indemnifies another insurance company for all of its parts.
A major medical expense policy would exclude coverage for all of the following treatments except
drug addiction
Dept of Financial Services
enforce the provisions of the Insurance Code
the "stop-loss' feature on major medical policy is intended to
establish the max amount of out of pocket expense that an insured will have to pay in a calendar year.
Twisting
incomplete or fraudulent comparison of insurance policies that persuades an insured , to thei detriment , to cancel , lapse , switch policies or take out policy with another user.
CFO (Chief Financial Officer)
independently elected and serves as the head of the Dept. and as a member of the financial services.
Alien
insurance company is incorporated in another country
Foreign
insurance company is incorporated in another state
Domestic insurer
insurance company is incorporated in the same state