simulate exam

All of the following could be considered rebates

-An offer of employment. -Stocks, securities, or bonds. -An offer to share in commissions generated by the sale.

Key Person disability income policy

-The income may be used to find a replacement for the key employee. -Premiums are not deductible to the business. -It is typically written to protect the company in the event a key employee becomes disabled and is unable to work.

If a licensee changes his or her residence address, mailing address, principal business street address, within how many days must the department be notified?

30 days

Insurers must either affirm or deny a claim within a reasonable amount of time, but no later than...

30 days

Which is NOT a characteristic of group health insurance?

A policy is issued to each insured individual.

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

A statement that is sufficiently clear to identify the insured and the nature of the claim.

Which of the following is the closest term to an authorized insurer?

Admitted

What is the maximum period of time during which an insurer may contest fraudulent misstatements made in a health insurance application?

As long as the policy is in force No other statement or misstatement made in the application at the time of issue will be used to deny a claim after the policy has been in force for 2 years.

What provides coverage on a first-dollar basis (no deductible). After the limits of the basic policy are exhausted, the insured must pay a corridor deductible before the major medical coverage will pay benefits.

Basic Expense policy

All of the following are true of the Key Person disability income policy EXCEPT

Benefits are considered taxable income to the business.

In a basic expense policy, after the limits of the basic policy are exhausted, the insured must pay what kind of deductible?

Corridor derives its name from the fact that it is applied between the basic coverage and the major medical coverage.

A waiver of premium provision may be included with which kind of health insurance policy?

Disability income

All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT

Dividends from a mutual insurer. are not considered to be a rebate because the policy specifies that they might be paid.

Which of the following would be an example of an unfair claims settlement practice?

Failing to acknowledge a claim within 30 days

If an insured is not required to pay a deductible, what kind of coverage does he/she have?

First dollar

Which of the following was designed to ensure continued access to affordable health insurance coverage for employees of small employers, their dependents, and other qualified beneficiaries not currently protected by COBRA?

Florida Health Insurance Coverage Continuation Act

It is illegal for insurers to state that their policies are guaranteed by the existence of a

Guaranty Association.

What are the three basic coverages for medical expense insurance?

Hospital, Surgical, Medical

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is the

Insuring clause.

Which of the following does NOT describe hospice care?

It provides care to people with life expectancies of 1 to 2 years.

In a group health policy, a probationary period is intended for people who

Join the group after the effective date.

An insured is involved in a car accident. In addition to general, less serious injuries, he permanently loses the use of his leg and is rendered completely blind. The blindness improves a month later. To what extent will he receive Presumptive Disability benefits?

No benefits Because the insured's blindness was only temporary and the loss of use in only 1 leg, he does not qualify for presumptive disability benefits.

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?

Payment of Claims

Who might receive dividends from a mutual insurer? not taxable

Policyholders

is the period of time after a policy is in effect before claims arising out of an illness are covered. This is to prevent adverse selection, persons waiting until they have been exposed to a cause of loss before purchasing coverage.

Probationary Period

What is the initial period of time specified in a disability income policy that must pass, after the policy is in force, before a loss can be covered?

Probationary period

Which of the following may NOT be included in an insurance company's advertisement?

That its policies are covered by a state Guaranty Association

Which of the following is NOT covered under Plan A in Medigap insurance?

The Medicare Part A deductible

When an insurer appoints an agent...

The insurer is bound by the agent's acts.

In accordance with the Code of Ethics, agents must provide a completed application to

The prospective insured and the insurer.

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as

Usual, customary and reasonable.

_____ approach for determining insurance benefits is based upon the fees normally charged for specific procedures in the geographic location where the services are provided.

Usual, customary and reasonable.

In forming an insurance contract, when does acceptance usually occur?

When an insurer's underwriter approves coverage

When are HMOs required to file a report of their activities with the Department of Financial Services?

Within 3 months of the end of every other fiscal year The Department may require reports more frequently if it is deemed necessary.

How soon following the occurrence of a covered loss must an insured submit written proof of such loss to the insurance company?

Within 90 days or as soon as reasonably possible, but not to exceed 1 year

The Insurance Code requires that each policy must include

Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible".

Mutual Insurer

a corporation owned by the policyholders. Dividends received by policyholders of a mutual insurer are not taxable

Insurers who meet the state's financial requirements and are approved to transact business in the state are considered

authorized or admitted into the state

First dollar

coverages do not require the insured to pay a deductible.

The purpose and intent of the Florida Health Insurance Coverage Continuation Act is to

ensure continued access to affordable health insurance coverage for employees of small employees, their dependents and other qualified beneficiaries not currently protected by the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985.

A waiver of premium rider....

generally is included with guaranteed renewable and noncancellable individual disability income policies. It is a valuable provision because it exempts the insured from paying the policy's premium during periods of total disability.

In the event of loss, after a notice of claim is submitted to the insurer, who is responsible for providing claims forms and to which party?

insurer to the insured within a specific amount of days

Under an individual disability policy, the MINIMUM schedule of time in which claim payments must be made to an insured is

monthly

Presumptive Disability plans

offer full benefits for specified conditions. These policies typically require the loss of use of at least two limbs, total and permanent blindness, or loss of speech or hearing. Benefits are paid, even if the insured is able to work.

The insuring clause

on the first page of the policy that states the coverage and when it applies and limits of policy, what insurance company will pay for (cover) for the insured

Hospice care

provides short-term, continuous care in a home-like setting to terminally-ill people with life expectancies of 6 months or less.

The "proof of loss" provision states

the claimant must submit a proof of loss within 90 days; however, if it is not possible to comply, the time parameter is extended to 1 year. The one-year limit does not apply if the claimant is not legally competent to comply with this provision.

The Payment of Claims provision states that

the claims must be paid to the policyowner, unless the death proceeds need to be paid to a beneficiary.