Unit 30

Which of the following persons may solicit applications for HMO coverage?

(a) Licensed health agent

5. How often must HMOs file a report of their activities to the Office of Insurance Regulation?

(c) Within three months after the close of a fiscal year

An individual who buys a membership in a prepaid health clinic because the premium is less than an HMO should be aware that the clinic cannot provide

(c) hospitalization These are clinics and cannot provide hospitalization.

Which of the following items must an HMO contract contain? (a) rate of payment (b) the premium, since it is subject to change (c) the length of the grace period (d) all of the above

d) all of the above

Savings of the HMO system are based on all of the following EXCEPT (a) keeping the premium high enough to net a profit (b) volume discounts with hospitals (c) capitation arrangements with physicians (d) encouraging members to see their doctors early

keeping the premium high enough to net a profit

HMOs are known for stressing

preventive care and early intervention

What is the grace period for paying premiums on an HMO contract?

(a) There is a 10-day grace period.

The term "co-payment" means

(a) a fixed amount per visit or per service the subscriber must pay

An HMO contract must contain all of the following EXCEPT (b) the premium, since it is subject to change (c) the length of the grace period (d) procedures to be followed for emergencies

(a) a listing of the surgical schedules by which surgeons are paid

In what way must the "Notice to Buyer" be conveyed to an HMO subscriber who is eligible for Medicare?

(b) Typing the notice on the first page of the application and the contract

The term capitation means the

(b) amount paid to the physician for each member

8. The term "capitation" means the

(b) amount paid to the physician for each member It is a stipulated amount

13. In order to sell HMO contracts, an agent must do all of the following EXCEPT (a) keep and renew his or her appointment (b) maintain a bond of not less than $10,000 (c) abide by the Unfair Trade Practices Act (d) obey all regulations of the Department of Financial Services

(b) maintain a bond of not less than $10,000

3. If an agent signs up an HMO subscriber who is eligible for Medicare

(b) the subscriber is disenrolled from Medicar You give up Medicare A and B when you join the HMO.

The grace period for paying premiums on an HMO contract is

(c) 10 days

In what way must the "Notice to Buyer" be conveyed to an HMO subscriber who is eligible for Medicare?

(c) Typing the notice on the first page of the application and the contract "on the application and the contract"

Savings of the HMO system are based on which of the following principles? (a) encouraging members to see their doctors early (b) capitation arrangements with physicians (c) volume discounts with hospitals (d) all of the above

(d) all of the above

HMOs offering group coverage must have an open enrollment at least

(d) for 30 days every 18 month Can be less than every 18 months, but not longer than 18 months.

11. The written agreement between the subscriber and the HMO is called a

(d) health maintenance contract The written agreement is a health maintenance contract.

2. The Florida HMO Consumer Assistance Plan

(d) provides coverage for subscribers to HMOs that become insolvent It does protect consumer's of HMOs that become insolvent.

The term co-payment means

(d) a fixed amount per visit or per service the subscriber must pay

1. All of the following are considered unfair trade practices with regard to HMOs EXCEPT (a) defamation (b) misrepresentation (d) twisting

(c) conversion Conversion is not an unfair trade practice.

2. The Legislature stated that the purpose of HMOs is to do all of the following EXCEPT (a) deliver high-quality health care (b) provide an alternative method of health care (d) control the escalating cost of health care

(c) provide health care coverage for everyone

7. The Office of Insurance Regulation will NOT issue a Certificate of Authority to an HMO until it has

(c) received a valid Health Care Provider Certificate from the Agency for Health Care Administration of Florida The certificate must come from the agency for health care administration of Florida.