Unit 29
Individual and group health insurance policies and HMO contracts can be canceled for all of the following reasons except
A failure to pay premiums B The insured develops a serious illness C The insurer ceases to offer coverage in the market D fraud or international misrepresentation of a material fact Answer - B
Florida is "mini-COBRA" applies to employers with which of the following?
A five or more employees B 20 or more employees C Less than 20 employees D less than five employees Answer: c
Health insurance proof of loss form must be given to the insurer within how many days after a loss has occurred?
A immediately B 20 days C 90 days D 15 days Answer- C
Florida's long-term care partnership program must provide which of the following coverage?
A medical expense coverage B disability coverage C inflation coverage D outpatient hospital treatment Answer: C
At what point in time can I policyholder file suit against a health insurance company for failure to pay a claim?
A 60 days from date of loss B 120 days from date of loss C 60 days after filing proof of loss D 120 days after filing proof of loss Answer C
Florida's long-term care partnership program provides which of the following?
A Asset protection B Medicare coverage C Inpatient hospital treatment D Medicaid Medical expense coverage Answer: A
If an insured changes their occupation to one classified by the ensurer as less hazardous than that stated in the policy, the insurer, upon receipt of proof of such a change of occupation, will:
A reduce the premium rate accordingly and will return the excess pro rata on unearned premium from the date of change of occupation B reduce the benefits accordingly and will increase the premiums from the date of change of occupation C Increase the benefits accordingly and will decrease the premiums from the date of change of occupation D increase the premium rate accordingly and will return the earned premium from the original date of application Answer - a
Which of the following practitioners is not to find as a "physician" under Florida law?
A surgeon and an ambulatory surgical center. B. Dentist performing surgery in an office. C. Optometrist rendering services at an eye clinic. D. Sports therapist performing services in a health club Answer: D
The minimum number of persons to be insured under group health insurance plan is established by which of the following
A the NAIC B State law C Federal Law D the employer Answer- B
Which of the following statements is correct about coverage for a handicapped family member who reaches adulthood?
A. Coverage ceases for the family member at the limiting age in the policy B coverage continues if the member is chiefly dependent on the policyholder C Group health policies must continue coverage, unlike individual policies D coverage automatically ceases when the family member obtains employment Answer- B
Which of the following applies to the 10 day free look privilege in a health insurance contract?
A. It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund B. It allows the insured an additional 10 days to pay the initial premium C. It can be waived only by the insurance company D it is granted only at the option of the agent Correct: A
A grandfathered health plan means a health plan that was issued on or prior to what date?
A march 23, 2011 B march 23, 2013 C march 23, 2012 D march 23, 2010 Answer: D
All of the following are correct about the required provisions of a health insurance policy except
A A grace period of 31 days is found in an annual pay policy B The entire contract clause means the policy, endorsements, and attachments constitute the entire contract C reinstated policy provides immediate coverage for an illness. D Proof of loss forms must be sent to the insured within 15 days of notice of claim Answer: C
All the following statements regarding group health insurance are correct except?
A Coordination of benefits is required between group policies and Medicare supplements B coordination of benefits helps to reduce costs C duplication of benefits results in overpayment D coordination of benefits is permitted so long as the insured is completely reimbursed for covered expenses Answer: A
All of the following provisions are required by the Florida Employed Health Care Access Act EXCEPT:
A Coverage must always be renewed by carriers B Carriers must use a "modified community rating methodology" C all small group health benefit plans must be issue on a "guarantee-issue" basis D Small explorer means an employer with 1-50 employees Answer: A
A health maintenance organization provides which of the following?
A Free health care for Medicare patients B preventative health care for its members C a program of "pay as you go" medicine D an extension of VA hospital treatment for veterans Answer: B
All of the following statements about the outline of coverage for health insurance policies are correct except
A It must be provided at the time of application or delivery of policy B principal benefits also shown in the policy need not be excluded C and is to include a summary statement of principal exclusions D it must include any rate the insurer reserves to change premiums Answer- B
A group credit disability policy may be issued to a creditor if the expected new entrants in the plan are what?
A More than 25 B at least 100 persons yearly C about the same each year D subject to insurability Answer: B
If a health insurance company tests a person for AIDS/HIV which of the following must be signed?
A Notice of informed consent B AIDS/HIV rate disclosure form C AIDS/HIV underwriting disclosure form D Outline of coverage Answer:
Legal action may not be taken after how many years from filing a health insurance claim proof of loss?
A One year B four years C Five years D Two years Answer: 5
In which of the following situations is a group health insurance policy NOT required to provide coverage?
A Qualified services performed in an ambulatory surgical center B outpatient services that would have been paid if rendered for an inpatient C specified services by a licensed podiatrist D treatment for an occupational illness or injury Answer- D
All of the following provisions are mandatory and health insurance policies except
A Time limit on certain defenses B Grace period C change of occupation D Time of claims payment Answer: C
Which of the following statements is correct about a group health insurance policy?
A cannot exclude coverage from an occupational accident B it can exclude newborn children from coverage C it cannot exclude coverage for VA hospital treatment D it can provide coverage for handicapped children Answer- D
The time of payment claims provision requires which of the following?
A claims must be paid after the insurer is notified of a loss B claims must be paid after the insurer is notified and receives proof of loss C The insurance must submit proof of loss within a specified time, or the claim may be denied D The insured must periodically submit proof of loss in order to receive the claim Answer: B
Group health insurance policies are required to provide all of the following except
A coverage for hospitalization during disability B coverage for a newborn child of a family member C coverage for a newborn child from the moment of birth D coverage for dental expenses Answer- D
All of the following provisions are required by Florida law for group health insurance policies except
A coverage for mental and nervous disorders must be available to the group policyholder B A newborn child is to be provided coverage from the moment of birth C coverage must continue until age 25 for handicapped child that is a family member D A newborn child have a covered family member is to be provided coverage for 18 months Answer - C
The notice to the insurance of a health insurance claim must include which of the following ?
A estimated amount of claim B name of the insured C nature of sickness or injury D date of loss Answer: B
