Health insurance Simulator
According to the Mandatory Uniform Policy Provisions , what is the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid ? 07 days 10 days 31 days 60 days
Correct . According to the Mandatory Uniform Policy Provisions , the maximum amount of time after the premium due date during which the policy remains in force even though the premium has not been paid is 31 days .
Which type of insurance company allows their policyowners to elect a governing body ? Stock Mixed Admitted Mutual
Correct . Policyholders elect the governing bodies of mutual insurance companies .
According to Florida Law , in which of the following situations would a dependent handicapped child NOT be covered under a Family Health policy ? The handicapped child has reached the limiting age . The premiums for the handicapped child are not paid The handicapped child becomes a full - time student The family moves outside the provider network
ANTIITINIAI Correct Under a Family Health policy issued in Florida , a handicapped child must continue to be covered in all of these situations EXCEPT when premium payments cease to be paid .
What would be an accurate definition of " controlled business " ? Insurance business that is written on the agent's own life , property , or interests Insurance business obtained by an agent through coercion , intimidation , or boycotting Insurance business that is obtained through false advertising Insurance business that is obtained by replacing an existing policy through misrepresentation
Correct " Controlled business " is insurance business that is written on the agent's own life , property , or interests .
An insured owns an individual Disability Income policy with a 30 - day Elimination Period for sickness and accidents and a monthly indemnity benefit of $ 500 . If the insured is disabled for 3 1/2 months , what the MAXIMUM amount he would receive for an approved claim ? $ 500 $ 1,000 $ 1,250 $ 1,750
Correct . 3.5 months - 1 month elimination period 2.5 months , 2.5 months X $ 500 monthly indemnity $ 1,250 .
A Business Overhead Expense policy would cover which of the following if a business owner becomes disabled? Contributions to employee retirement plans Utilities and office rent Owner's salary Meals and entertainment
Correct . A Business Overhead Expense policy is designed to cover certain overhead expenses ( rent , taxes , utility bills , employee's salaties etc ) that continue when the business owner is disabled .
Which of the following types of organizations are prepaid group health plans , where members pay in advance for the services of participating physicians and hospitals that have agreements ? PPO HMO MEWA POS
Correct . A Health Maintenance Organization ( HMO ) is a prepaid group health where members pay in advance for the services participating physicians and hospitals that have agreements
This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year : Individual deductible Corridor deductible Family maximum deductible Common accident deductible
Correct . A family maximum deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year .
Bryce purchased a disability income policy with a rider that guarantees him the option of purchasing additional amounts of coverage at predetermined times without requiring to provide evidence of insurability . What kind of rider is this ? Guaranteed insurability rider Additional coverage rider Paid - up option rider Extended insurability rider
Correct . A guaranteed insurability rider guarantees the insured the option of purchasing additional amounts of disability income coverage at predetermined times without requiring the insured to provide evidence of insurability
R had received full disability income benefits for 6 months . When he returns to work , he is only able to resume half his normal daily workload . Which provision pays reduced benefits to R while he is not working at full capacity ? Residual Disability Recurrent Disability Presumptive Disability Occupational Disability
Correct . A residual disability benefit is usually a percentage of the total disability benefit for periods when the insured is unable to perform some of the duties of his / her occupation .
Which of the following statements about the classification of applicants is INCORRECT ? Substandard applicants are never declined by underwriters Substandard applicants are occasionally declined by underwriters Preferred risk applicants typically have better premium rates than standard risk applicants An applicant can be classified as substandard risk because of a hazardous job
Correct . A substandard risk is below the insurer's average risk guidelines . An Individual can be rated substandard for a number of reasons and can even be rejected outright .
All of the following will result in the suspension of an agent's license EXCEPT intentionally misrepresenting the provisions of a policy acting with fiduciary responsibility forging a name on an insurance application being convicted of a felony
Correct . Acting as a fiduciary would not result in suspension of an agent's license .
V is insured under an individual Disability Income policy with a 30 - day Elimination period . On July 1 , he is involved in an accident and temporarily disabled . He returns to work on December 1. How many months of benefit are payable ? 6 months 5 months 4 1/2 months 4 months
Correct . After the 30 - day Elimination period has been satisfied , there will be 4 months of benefit payments .
Which of these do NOT constitute policy delivery ? Policy mailed to applicant Policy mailed to producer Policy delivered to the applicant by the producer Policy issued with a rating
Correct . All of these constitute delivery of the policy EXCEPT issuing a rated policy .
M applies for a health insurance policy and pays the initial premium . When the agent completes the department request's M's medical application , a conditional receipt is left with the applicant . The insurance company's underwriting records and determines that M has had asthma for many years . All of the following are probable underwriting outcomes , EXCEPT : Deny coverage Approve with a higher premium Changing the policy's provisions Attach a rider excluding specified coverages
Correct . All of these would be acceptable underwriting outcomes EXCEPT for " Changing the policy's provisions "
An insurance application may be rejected on the basis of all of these factors EXCEPT Medical history Hobbies Gender Weight
Correct . An insurance company may NOT reject a prospective insured's application on the basis of gender .
T is covered by an Accidental Death and Dismemberment ( AD & D ) beneficiary . What action will the insurance company take if T requests a change of beneficiary ? policy that has an irrevocable Request will be accepted only if in writing by the insured Change will be made only if premiums are paid current Change will be made immediately Request of the change will be refused
Correct . An irrevocable designation may not be changed without the written consent of the beneficiary .
What kind of Accidental Death and Dismemberment ( AD & D ) insurance beneficiary requires his / her consent when a change of beneficiary is made ? Irrevocable beneficiary Tertiary beneficiary Primary beneficiary Revocable beneficiary
Correct . An irrevocable designation may not be changed without the written conserit of the beneficiary
Insurance contracts are known as because certain future conditions or acts must occur before any claims can be paid . consideration unilateral aleatory conditional
Correct . Because certain future conditions or acts must occur before any claims can be paid , insurance contracts are known as conditional .
K is the insured and P is the sole beneficiary on an Accidental Death and Dismemberment ( AD & D ) insurance policy . Both are involved in a fatal accident where K dies before P. Under the Common Disaster provision , which of these statements is true ? Proceeds will be paid to P's estate Proceeds will be divided equally between K's and P's estate Proceeds will be paid to K's estate The courts will decide who will receive death benefits
Correct . Because the sole beneficiary outlived the insured , the proceeds will be payable to the estate of the deceased beneficiary
Which of the following medical expenses does Cancer insurance NOT cover ? Chemotherapy Radiation treatment Physician visit Arthritis
Correct . Cancer insurance typically covers all of these medical expenses except for arthritis
J was reviewing her Health Insurance policy and noticed the phrase " This policy will only pay for a semi - private room " . This phrase is considered to be a ( n ) hidden deductible internal limit Restricted provision stop loss
Correct . Certain types of expenses may have limits placed on the dollar amount of certain services or on the type of service provided
The difference between group insurance and blanket health policies is : Blanket health policies do not issue certificates Group health policies do not issue certificates Group health plans may be issued to an airline to cover its passengers Blanket health policies are sometimes called wholesale plans
Correct . Certificates are not issued in blanket policies .
Which of the following is an example of an Unfair Trade Practice ? Shared commissions Fiduciary Replacement Coercion
Correct . Coercion is considered an unfair trade practice in this state .
Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures ? Administrative - services - only plan Commercial insurer Preferred provider organization Health maintenance organization
Correct . Commercial health insurance companies use the reimbursement approach , which allows policyowners to seek medical treatment then submit the charges to the insurer for reimbursement .
Which of the following reimburses its insureds for covered medical expenses ? Health maintenance organizations Preferred provider organizations Commercial insurers Service providers
Correct . Commercial insurance companies function on the reimbursement approach . Policyowners obtain medical treatment from whatever source they feel is most appropriate and submit their charges to their insurer for reimbursement .
Dental care coverage is designed to cover the costs of all of the following EXCEPT : Oral Surgery Preventative care Orthodontia loss of income .
Correct . Dental care coverage is designed to cover the costs of : Oral Surgery , Preventative , Orthodontia , and more . However , dental care does NOT cover loss of income .
T is an agent and when hired , is reminded that he has a responsibility to handle clients ' funds in an honest and ethical manner . This responsibility is referred to as fiduciary responsibility Reasonable trust ethical behavior Legal competence
Correct . Fiduciary responsibility involves an agent handling funds of a client or insurance company honestly and fairly , and not using them for the agent's own purposes .
Agents that have been licensed for less than six years must complete hours of continuing education every two years . 08 20 24 36
Correct . Florida agents licensed less than six years are required to complete 24 hours of continuing education
According to Florida law , when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant ? At the time of application At the time of policy delivery Within 14 days of the time of application Within 14 days of policy delivery
Correct . Florida insurance law requires that if a Medicare Supplement policy is sold , the agent must deliver an Outline of Coverage to the applicant no later than when the application is taken
A Health Reimbursement Arrangement MUST be established . with employee funding with other employer - sponsored benefit plans by the employer only during specific open enrollment periods
Correct . HRAs are employer - established benefit plans that must be funded by the employer .
A prospective insured completes and signs an application for health insurance but intentionally conceals information about a pre - existing heart condition . The company issues the policy . Two months later , the insured suffers a heart attack and submits a claim . While processing the claim , the company discovers the pre - existing condition . In this situation , the company will : continue coverage but request a corrected application deny coverage and increase premiums continue coverage but exclude the heart condition rescind the coverage and return the premiums
Correct . If the insured did not cite the condition on the application and the insurer did not exclude the condition , the pre - existing condition provision still applies . Exclusions are subject to the " time limit on certain defenses " provision , however .
How many days does an insurance company have to reject a reinstatement application before it is automatically reinstated ? 31 45 60 120
Correct . If the insurer takes no action within 45 days , the policy will be reinstated automatically .
In Florida , what is the maximum percentage of controlled business an agent may produce ? 30 % 40 % 50 % 60 %
Correct . In Florida , an agent's controlled business may NOT exceed a maximum of 50 % .
Which health policy clause specifies the amount of benefits to be paid ? Insuring Consideration Free - look Payment mode
Correct . In an Accident & Health policy , the insuring clause states the amount of benefits to be paid .
C was injured while 80/20 coinsurance clause and a $ 400 deep sea diving and requires a hospital stay . C deductible . What is the MAXIMUM C will pay if the covered has a Major Medical policy with a medical expenses are 2000$? $ 0 $ 400 $ 720 $ 1,000
Correct . In this situation , $ 400 deductible + 20 % of the remaining medical bill = $ 720 .
An individual has a Major Medical policy with a 5,000 deductible and an 80/20 Coinsurance clause . How much will the INSURED have to pay if a total of $ 15,000 in covered medical expenses are incurred ? $ 2,000 $ 5,000 $ 7,000 $ 10,000
Correct . In this situation , $ 5,000 + 20 % of the remaining bill = $ 7,000
B is a teacher who was injured in a car accident and cannot work . She is now receiving monthly benefits as a result of this accident . Which type of policy does B have ? Major Medical Blanket Disability Income Indemnity
Correct . In this situation , a Disability Income policy will pay monthly benefits to a teacher who is unable to work as a result of a car accident
T was insured under an individual Disability Income policy and was severely burned in a fire . As a result , T became totally disabled . The insurer began making monthly benefit payments , but later discovered that the fire was set by T in what was described as arson . What actions will the insurer take ? The insurer will rescind the policy , deny the claim , and recover all payments made Due to the policy not being post - claim underwritten , the insurer must continue to pay this claim Claim will be rejected because of this criminal act , but no recovery of payments will be made Claim will be denied but the policy will remain in force without further premium payments due to the insured's total disability
Correct . In this situation , the insurer will rescind the policy , deny the claim , and recover all payments made .
What action should a producer take if the initial premium is NOT submitted with the application ? Keep the application until premium is paid Forward the application to the insurer after giving the applicant a binding receipt Forward the application to the insurer without the initial premium Forward the application to the insurer after giving the applicant a conditional receipt
Correct . In this situation , the producer should submit the application to the insurance company without the prernium . However , if a premium is not paid with the application , the policy will not become valid until the initial premium is collected
When must insurable interest exist for a life insurance contract to be valid ? Inception of the contract Throughout the entire length of the contract When the insured dies During the contestable period
Correct . Insurable interest must only exist at the inception of the contract .
Nursing home benefits must be provided for at least 12 consecutive months in which of the following types of policies ? Blanket custodial Long - Term Care Critical Illness Medicare Supplements
Correct . Long - Term Care policies are designed to provide nursing home benefits n an extended basis of at least twelve consecutive months .
All of the following statements about Major Medical benefits are true , EXCEPT : The deductible can be expressed as a fixed dollar amount The benefit period begins only after a specified amount of expenses have accrued Benefits are generally expressed as a percentage of eligible expenses Benefits have no maximum limit
Correct . Major Medical benefits normally have a maximum limit .
Major Medical policies typically : pay 100 % of covered expenses contain a deductible and coinsurance require use of in - network facilities only do not contain a deductible and coinsurance
Correct . Major Medical policies typically contain a deductible and coinsurance
Which Unfair Trade Practice involves making a false statement on an insurance application in order to receive money from an insurer ? Rebating Coercion Sliding Misrepresentation
Correct . Making a fraudulent statement on an insurance application would be considered an act of misrepresentation .
What is Medicare ? A disability program hospital and medical expense insurance program Offers assistance in making health insurance premiums Part D provides payment for surgeon expenses
Correct . Medicare is a hospital and medical expense insurance program .
Which of the following statements is true about most Blue Cross / Blue Shield organizations ? They are the same as private insurance companies They are federally sponsored They are nonprofit organizations They are owned by hospitals and physicians
Correct . Most Blue Cross / Blue Shield organizations are considered to be nonprofit
Which of the following BEST describes how pre - admission certifications are used ? Used to assist in underwriting Used to prevent nonessential medical costs Used to minimize hospital lawsuits Used to help process claims
Correct . Pre - admission certification is used to prevent unnecessary medical costs .
The federal income tax treatment of employer - provided group Medical Expense insurance can be accurately described as : Employee's coverage paid for by the employer is considered taxable income to the employee Employee's premiums paid by the employer is tax - deductible to the employer as a business expenditure Employer is given tax credits for contributions made to an employer - provided group health plan Benefits are taxable to the employee
Correct . Premiums paid by an employer for an employee's coverage are deductible by the employer as a business expense .
Which of these is NOT a legal entity for selling life insurance in Florida ? Independent agency system Risk management advisers Career agency system Personal producing general agency
Correct . Risk management advisers do not qualify as a legal entity for selling life insurance
Statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called : representations consideration warranties guarantees
Correct . Statements made on an insurance application that are believed to be true to the best of the applicant's knowledge are called representations .
Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party ? Indemnity Subrogation Legal action Consideration
Correct . Subrogation is the right for an insurer to pursue a third party that caused an insurance loss to the insured . This is done as a A means of recovering the amount of the clair paid to the insured for the loss
The Bureau of Unclaimed Property is overseen by the Unclaimed Property Commissioner Chief Financial Officer Governor Insurance Department
Correct . The Chief Financial Officer oversees the Bureau of Unclaimed Property .
The Coordination of Benefits provision : allows an insured covered by two health plans to make a profit on a covered loss prevents an insured covered by two health plans from making a profit on a covered loss allows an insurer to defer paying a claim for a work - related injury until Workers ' Compensation Benefits have expired prevents an insured to change insurers during a claim for a covered loss
Correct . The Coordination of Benefits prevents an insured covered by two health plans from making a profit on a covered loss .
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract ? Consideration Entire Contract Free - look Insuring
Correct . The Entire Contract provision states that the health insurance policy , together with a copy of the signed application and attached riders and amendments , constitutes the entire contract .
The Financial Services Commission may hold hearings for any reason deemed necessary only when a felony is involved when approved by the NAIC only if there is a complaint filed
Correct . The Financial Services Commission may hold hearings for any purpose within the scope of the insurance code deemed necessary .
Which organization was established to provide funds to protect an insured in the event of an insurer's insolvency ? National Association of Insurance Commissioners ( NAIC ) Florida Insurance Guaranty Fund Association Department of Financial Services Office of Insurance Regulation
Correct . The Florida Insurance Guaranty Fund Association exists to protect an insured in the event of an insurer's insolvency
Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires ? An insured must settle a claim within 60 days after Proof of Loss is submitted An insured must wait at least 30 days after Proof of Loss has been submitted before a lawsuit can be filed An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed An insured must settle a claim within 30 days after Proof of Loss is submitted
Correct . The Legal Actions provision of an Accident & Health policy requires that the insurer settle a claim within 60 days after receipt of Proof of Loss .
The provision that defines to whom the insurer will pay benefits to is called : Entire Contract Proof of Loss Claim Forms Payment of Claims
Correct . The Payment of in a Health Insurance policy states to whom claims will be paid
Which Accident and Health policy provision addresses preexisting conditions ? Proof of Loss Legal Actions Time Limit on Certain Defenses Payment of Claims
Correct . The Time Limit on Certain Defenses provision limits the period during which an insurer can deny a claim on the basis of a preexisting condition
Why must an Accident & Health insurance applicant answer all questions on the application ? Statements and representations on the application are part of the consideration for issuing a policy The National Association of Insurance Commissioners ( NAIC ) requires all questions be answered The Medical Information Bureau ( MIB ) requires this for an insurer to be a member Statements and representations are considered guarantees
Correct . The application statements and representations are part of the consideration for issuing a policy .
J has a Disability Income policy that does NOT provide benefits for losses occurring as the result of his employment . What kind of coverage is this ? Limited coverage Workers ' Compensation coverage Occupational coverage Nonoccupational coverage
Correct . The coverage provided by a Disability Income policy that does not provide benefits for losses occurring as the result of the insured's employment is called nonoccupational coverage .
R becomes disabled and owns an individual Disability Income policy . When is R eligible to receive disability benefits ? Upon being laid off from employer Upon paying a deductible Upon being examined by a physician Upon satisfying the elimination period requirement
Correct . The elimination period of an individual disability insurance policy refers to the amount of time a disabled person must wait before benefits are paid .
The free - look period for all qualified Long - term care policies sold i Florida is days . 10 20 30 40
Correct . The free - look period for all qualified Long - term care policies sold in Florida is 30 days .
Which type of provider is known for stressing preventative medical care and routine physical examinations ? Multiple Employer Welfare Arrangements ( MEWA ) Major medical provider Health Maintenance Organ ons ( HMO's ) Preferred Provider Organizations ( PPO's
Correct . The health provider that stresses preventive medical care is known as a Health Maintenance Organization
What is the initial source of underwriting for an insurance policy ? Application containing statements from the insured MIB report Credit report Medical exam
Correct . The initial source of underwriting for an insurance policy is the application containing statements from the insured
Which of the following health insurance policy provisions specifies the health care services a policy will provide ? Insuring clause Usual , Customary , and Reasonable clause Consideration clause Benefit clause
Correct . The insuring clause identifies the specific type of health care services that are covered by that policy .
J has an Accidental Death and Dismemberment policy with a principal sum of $ 50,000 . While trimming the hedges , J cuts off one of his fingers . What is the MAXIMUM J will receive from his policy ? 0 $ 100,000 $ 25,000 $ 50,000
Correct . The maximum sum payable would be the capital sum , or $ 25,000
On an Accidental Death and Dismemberment ( AD & D ) insurance policy , who is qualified to change the beneficiary designation ? Payer Primary beneficiary Policyowner Insurer
Correct . The policyowner has the right to change the beneficiary designation . However , consent may needed by the current beneficiary if designated as irrevocable .
When an insurance application is taken by a producer , which of these statements is true ? The applicant should have an attorney present during the application process Any changes made on the application require the applicant's initials Any changes made on the application can later be initialed by the producer if the applicant is unavailable The producer has the discretion to ask or not to ask any of the questions listed on the application
Correct . The producer should have the applicant initial any changes made on the application .
What is required in the Florida Employee Health Care Access Act ? OSmall group benefit plans are to be issued on a " conditionally - issue basis Small group benefit plans are to be issued on a " guarantee - issue " basis All small group benefit plans have a 60 day grace period A small group benefit plans have no lifetime benefit limits
Correct . The provisions of the Florida Employee Health Care Access Act require that all small group health benefits be issued on a " guaranteed - issue " basis .
The Florida Employee Health Care Access Act was established to make group health insurance available to employers with up to 50 employees health insurance affordable for families with children individual health insurance available to all Floridians health insurance affordable to retired individuals
Correct . The purpose of the Florida Employee Health Care Access Act is to make group health insurance available to employers with 50 or fewer employees .
According to the Time Payment of Claims provision , the insurer must pay Disability Income benefits no less frequently than which of the following options ? Annually Semiannually Quarterly Monthly
Correct . The time of payment for claims is usually specified in different policies as 60 days , 45 days , or 30 days . However , if the claim involves disability income benefits , the benefits must be paid not less frequently than monthly
An agent who makes misleading statements that lead to the termination of an existing insurance policy so that a new policy with another insurer can be taken out has committed coercion rebating defamation twisting
Correct . Twisting is knowingly making misleading statements that would cause an insured to lapte , assign , or terminate an Insurance policy in order to switch companies
What is the initial requirement for an insured to become eligible for benefits under the Waiver of Premium provision ? Insured must be unemployed Insured must be hospitalized Insured must demonstrate financial need Insured must be under a physician's
Correct . Under Walver of Premium , which is a rider that will pay your premium while you're disabled , you must have a doctor certify that you meet the definition of disability as contained in the rider .
Which of the following statements about Health Reimbursement Arrangements ( HRA ) is CORRECT ? If the employee had a qualified medical leave from work , lost wages can be reimbursed If the employee paid for qualified medical expenses , the reimbursements may be tax - free Any unused amounts are added to employee's gross income Health insurance premin can be reimbursed to the employee
Correct . Under a Health Reimbursement Arrangement , reimbursements may be tax free if the employee paid for qualified medical expenses
beneficiary . M has the M purchased an Accidental Death and Dismemberment ( AD & D ) policy and named his son as right to change the beneficiary designation at anytime type of beneficiary is his son ? Tertiary Irrevocable Revocable Contingent
Correct . With a revocable beneficiary designation , the policyowner may change the beneficiary at any time without notifying or getting permission from the beneficiary .
Which of the following costs would Basic Hospital / Surgical policy likely cover ? Surgically removing a facial birthmark Care given at a nursing home Treating a wound from a soldier injured at war Lost income caused by a hospital stay
Correct A Basic Hospital / Surgical policy would most likely cover cosmetic surgery to remove a facial birthmark
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled . The type of policy which BEST addresses this concern is Business Overhead Expense Disability Income Key Employee Life Contributory
Correct A Business Overhead Expense policy's purpose is to cover certain overhead expenses that continue when the busines owner is disabled
G is an accountant who has ten employees and is concerned about how the business would survive financially if G became disabled . The type of policy which BEST addresses this concern is : Business Overhead Expense Disability Income Key Employee Life Contributory
Correct A Business Overhead Expense policy's purpose is to cover certain overhead expenses that continue when the business owner is disabled .
A Multiple Employer Welfare Arrangement ( MEWA ) provides what type of benefits ? Unemployment Banking Retirement Insurance
Correct A Multiple Employer Welfare Arrangement ( MEWA ) provides insurance benefits .
A contract where one party either accepts or rejects the terms of a contract written by another party is called a contract of adherence assimilation aleatory adhesion
Correct A contract of adhesion is a contract offered intact to one party by another under circumstances requiring the second party accept or reject the contract in total without having the opportunity to bargain over the wording . Insurance policies are contracts of adhesion and , as such , are construed strictly against the party writing them ( Le . , the insurer ) .
N is covered under an individual Disability policy with a 30 - day Elimination period and a monthly benefit of $ 500 . N is totally disabled for 3 1/2 months . N's total benefit received on this claim is : $ 2,000 $ 1,750 $ 1,500 $ 1,250
Correct After the 30 - day Elimination period has been satisfied , the total benefit paid on this claim is $ 1,250 ( $ 500 + $ 500 + $ 250 )
A comprehensive major medical health insurance policy contains an Eligible Expenses provision which identifies the types of health care services that are covered . All of the following health care services are typically covered , EXCEPT for : hospital charges physician fees experimental and investigative services nursing services
Correct All of these services are typically covered under a comprehensive major medical health insurance policy EXCEPT for " experimental and investigative services "
Advertising gifts not to exceed are allowed to be given by an agent to a prospective client . $ 25 $ 50 $ 75 $ 100
Correct An agent is allowed to give advertising gifts to a prospective customer , provided they do not exceed $ 100 .
An application for Medicare Supplement coverage may NOT be was submitted within month ( s ) after applicant reaches the age of 65 . denied by the insurer if the application one three six nine
Correct An application for Medicare Supplement coverage may NOT be denied by the insurer if the application was submitted within six month ( s ) after the applicant reaches the age of 65 .
Which of the following is the best description of ' insurer ' ? A professional organization that typically handles only administration functions Any business location where insurance discussions take place Any person , corporation , association , or society that writes insurance contracts Any person , corporation , association , society that only manages insurance claims
Correct An insurer is any person , corporation , association , or society that writes insurance contracts .
A policyowner would like to change the beneficiary on an Accidental Death and Dismemberment ( AD & D ) insurance policy and make the change permanent . Which type of designation would fulfill this need ? Revocable Contingent Irrevocable Primary
Correct An irrevocable designation may not be changed without the written consent of the beneficiary .
Insurance policies are offered on a " take it or leave it " basis , which make them : Conditional Contracts Aleatory Contracts Unilateral Contracts . Contracts of Adhesion
Correct Because Insurance policies are offered on a " take it or leave it " basis , they are referred to as Contracts of Adhesion
Under an Individual Disability policy in Florida , what is the minimum schedule of time in which claims must be made to an insured ? Annually Weekly Monthly Daily
Correct Claims on an individual disability policies must be paid out at monthly intervals , at minimum ,
D the agent met with a prospect and ended up selling an insurance policy . While filling out the insurance application , D makes mistake . In this situation , D MUST correct the information with no further action from prospect necessary receive a verbal acknowledgement from prospect of the mistake made request that the insurer issue the policy with a rating correct the information and have the prospect initial the change
Correct If an agent makes an error on an insurance application the agent must correct the information and have the plicant initial the changes .
When an insured has the same disability within a specified time period and the insurance company provides the same benefits without a new waiting period , the second disability is covered under which of the following benefits ? Residual Disability Presumptive Disability Recurrent Disability Repeat Disability
Correct In this situation , the insurer will provide the same benefits without a new elimination period under the Recurrent Disability benefit
Insurers / agents must , in Florida , offer and issue all small employer health plans on a basis : fair nonrenewal discounted guaranteed - issue
Correct Insurers / agents must , in Florida , offer and issue all small employer health plans on a guaranteed - issue basis .
A catastrophic illness would be best covered by which of the following health insurance plans ? Major Medical Limited Indemnity Surgical Expense
Correct Major Medical health insurance coverage is best suited for meeting catastrophic illness expenses .
Within how many days after policy delivery can a Medicare Supplement policy be returned for a 100 % premium refund ? 15 20 25 30
Correct Medicare Supplement policies may be returned for a premium refund within a MAXIMUM of 30 days .
Which of the following statements is correct regarding an employer / employee group health plan ? The employer receives a certificate and the employees receive a master policy The employer receives a master policy and the employees receive certificates The employer receives both the certificates and master policy The employees receives both the certificates and master policy
Correct Under an employer / employee group health plan the employer receives a master policy and the employees receive certificates .
A life insurance policy would be considered a wagering contract WITHOUT : insurable interest premium payment agent solicitation constructive delivery
Correct Without insurable interest , a life insurance policy would be considered a wagering contract .
Which of the following involves analyzing a case before admission to determine what type of treatment is necessary ? Concurrent Review Prospective Review Retrospective Review Utilization Review
Correct. Prospective Review involves analyzing a case before admission to determine what type of treatment is necessary .
An insured pays premiums on an annual basis for an individual health insurance policy . What is the MINIMUM number of days for the Grace Period provision ? 07 10 20 31
The correct answer is " 31 " . The grace period is a minimum of 31 days for policies that are paid for on an annual basis .
A day notice to the policyholder is required for any health insurer that wishes to cancel a health insurance policy . 30 45 60 90
The correct answer is " 45 " . A health insurer that wishes to cancel a health insurance policy must provide a 45 day notice the policyholder .
P received Disability income benefits for 3 months then returns to work . She is able to work one month before her condition returns , leaving her disabled once again . What would the insurance company most likely regard this second period of disability as ? A presumptive disability An occupational disability A residual disability A recurrent disability
The correct answer is " A recurrent disability " . A second period of disability from the same or related cause of a prior disability is called a recurrent disability .
Which of the following statements BEST defines usual , customary , and reasonable UCR ) charges ? The maximum premium an insurer can charge for their health insurance based on geography The maximum amount a employer can contribute to a contributory health plan The maximum deductible an insured can be charged The maximum amount considered eligible for reimbursement by an insurance company under a health plan
The correct answer is " The maximum amount considered eligible for reimbursement by an insurance company under a health plan " Usual , customary , and reasonable ( UCR ) charges are the maximum amount the insurer will consider eligible for reimbursement under a health insurance
Which of these is considered a statement that is assured to be true in every respect ? Estoppel Warranty Guarantee Representation
The correct answer is " Warranty " . A warranty is a statement that is considered guaranteed to be true .
Under an individual Health Insurance policy , the Time Limit of Certain Defenses provision states that nonfraudulent misstatements first become incontestable two years from the date that the policy was issued from the date that the application was signed from the date initial premium was collected from the date of the sales appointment
The correct answer is " from the date that the policy was issued " .
A disability elimination period is best described as a time deductible dollar deductible eligibility period probation period
The correct answer is " time deductible " . The best way to describe a disability elimination period is a " time deductible " .
Which of the following actions will an insurance company most likely NOT take if an applicant , who has diabetes , applies for a Disability Income policy ? Issue the policy with a diabetes exclusion Issue the policy with an altered Time of Payment of Claims provision Issue the policy with a rating Decline the applicant
de Correct . The insurance company may take all of these actions EXCEPT issue the policy with an altered Time Payment of Clairns provision .
Which statement is TRUE regarding a group accident & health policy issued to an employer ? Neither the employer or employee are policyowners . The employer is issued a certificate of coverage and each employee receives a policy The employer receives the policy and each employee is issued a certificate Both the employer and employee are policyowners
de Correct . With a group accident and health plan , a master policy is issued to the employer and each employee receives a certificate of insurance .
J is a subscriber to a plan which contracts with doctors and hospitals to provide medical benefits at a predetermined price . What type of plan does J belong to ? O Multiple Employer Welfare Arrangement Multiple Employer Trust Health Maintenance Organization Co - op Arrangement
do Correct . A Health Maintenance Organization ( HMO ) contracts with doctors and hospitals to provide medical enefits to subscribers at a predetermined price .
Association Plans that are designed to provide health benefits to their members are regulated by the state because they are insured by an authorized insurer they conduct business in Florida they provide a service to their members they require a certain level of member participation
Correct , Association Plans must be fully insured by an authorized insurer . The insurer is subject to state regulation .
What must the policyowner provide to the insurer for validation that a loss has occurred ? Proof of Coverage Proof of Claim Proof of Loss Proof of Payment
Correct . A Proof of Loss statement must be provided to an insurance company to show that a loss actually occurred .
Under which circumstance may a licensed agent in Florida represent an unauthorized entity ? Only if the agent holds a special designation Only if the agent is given written permission from the DFS Only if the agent is also an attorney Never
Correct . A licensed agent in Florida may never represent an unauthorized entity
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums , the type of renewability that best desribes this policy is called : noncancellable conditionally renewable cancellable guaranteed renewable
Correct . A noncancellable policy is one which the insurance company cannot cancel and which premiums cannot be increased .
Which of the following BEST describes a short - term medical expense policy ? Conditionally renewable Noncancellable Guaranteed renewable Nonrenewable
Correct . A typical short - term medical expense policy is best described as nrenewable .
In Florida , deceptive advertising is considered to be a form of coercion a form of sliding a form of rebating a form of misrepresentation
Correct . According to Florida law , deceptive advertising is considered a form of misrepresentation .
Which of the following are NOT managed care organizations ? Point - of - Service plan ( POS ) Preferred Provider Organization ( PPO ) Medical Information Bureau ( MIB ) Maintenance Organization ( HMO )
Correct . All of the following entities are managed care organizations EXCEPT MIB ( Medical Information Bureau )
Which of the following is NOT a limited benefit plan ? Dental policy Life insurance policy Critical illness policy Cancer policy
Correct . All of these are limited benefit plans EXCEPT life insurance
An insurance company must act on an Accident and Health insurance application for reinstatement . within days . 45 60 75 90
Correct . An insurance company must act on an Accident and Health insurance application for reinstatement within 45 days
In Florida , an insurer licensed to conduct business in Florida , but domiciled in New Jersey , is called a ( n ) Non - admitted company foreign company domestic company alien company
Correct . An insurance company that is domiciled in New Jersey and licensed to conduct business in Florida is referred to in Florida as a foreign company .
A license may be denied , suspended , or revoked if the licensee engages in replacement of an existing policy . is found guilty of misrepresentation does not meet a sales quota files for bankruptcy
Correct . Being found guilty of misrepresentation may result in the Department of Financial Services denying , suspending , revoking , or not renewing any license .
A Business Overhead Expense policy : covers any loss of income by the business owner covers business expenses such as rent and utilities covers employee wages only reimburses the company for any reduction in sales due to the owner's disability
Correct . Business Overhead Expense insurance covers eligible expenses for utilities , rent , and staff
save money by comparing the cost of similar policies ? Which required disclosure helps a buyer choose the amount and type of insurance to buy and how to Buyer's Guide Ⓒ Policy Summary Outline of Coverage Certificate of Coverage
Correct . Buyer's Guide provides basic information about an insurance policy . It helps a buyer choose the amount and type of insurance to buy. It is required
Upon reaching the limiting age , a disabled child may extend their health insurance coverage as a dependent . only if the child is incapable of employment and chiefly dependent on the policyowner for up to an additional 10 years only only if physically disabled only if mentally disabled
Correct . Coverage may be extended if the handicapped child is incapable of employment and chiefly dependent on the policyowner A
P is self - employed and owns an Individual Disability Income policy . He becomes totally disabled on June 1 and receives $ 2,000 a month for the next 10 months . How much of this income is subject to federal income tax ? $ 20,000 $ 14,000 $ 6,000 0
Correct . Disability income benefits that derive from an individual policy which was paid entirely by the policyowner is not subject to federal income tax
What type of policy would only provide coverage for specific types of illnesses ( cancer , stroke , etc ) ? MEWA Blanket insurance Dread disease insurance Disability insurance
Correct . Dread disease insurance provides benefits for ONLY specific types of illnesses such as cancer or stroke .
Florida requires that an insurance agent must complete_hours of continuing education on the subject of law and ethics every two years . 03 4 5 6
Correct . Florida requires that an insurance agent must complete 4 hours of continuing education on the subject of law and ethics every two years .
Employers with less than employees are affected by Florida's Health Insurance Coverage . Continuation Act ( Mini COBRA ) . 40 30 20 10
Correct . Florida's Mini COBRA regulation entities individuals to continuation of coverage for groups with less than 20 full - time employees .
How does group insurance differ from individual insurance ? Evidence of insurability is required Premiums are higher Premiums are lower Pre - existing conditions not covered
Correct . Group insurance differs from individual insurance in that it provides coverage at a lower cost
Which of these require an offer , acceptance , and consideration ? Warranty Estoppel Contract Representation
Correct . Offer , acceptance , and consideration are all elements of a contract .
Deductibles are used in health policies to lower : the incidents of fraud the coinsurance amount overuse of medical services adverse selection
Correct . One of the primary reasons for using deductibles in health policies is to reduce the overuse of medical services .
What is being delivered during a policy delivery ? A binding receipt to the proposed insured Insurance contract to the proposed insured i Application and initial premium to the insurer Policy summary sheet and disclosure material to the proposed insured .
Correct . Policy deliver refers to the delivery of the insurance contract to the applicant .
Which mode of payment is NOT used by health insurance policies ? Monthly premium Annual premium Single premium Semi - annual premium
Correct . Single premium is not used when paying for health insurance policies .
Which of the following policy features allows an insured to defer current health charges to the following year's deductible instead of the current year's deductible ? Deferral provision Carryover provision Stop Loss provision Corridor provision
Correct . The Carryover provision permits expenses incurred during the last three months of the calendar year to be carried over into the new year if needed to satisfy the deductible for the next year .
The Consolidated Omnibus Budget Reconciliation Act ( COBRA ) gives workers ( and their families ) whose employment has been terminated the right to : continue group health benefits take out an individual health policy transfer their coverage to another insurer convert to disability coverage
Correct . The Consolidated Omnibus Budget Reconciliation Act ( COBRA ) gives workers ( and their families ) whose employment has been terminated the right to continue group health benefits .
When an insurance company sends a policy to the insured with an attached application , the element that makes the application part of the contract between the insured and the insurer is called the : Entire Contract provision Insuring clause Time Limit on Certain Defense provision Legal Contract clause
Correct . The Entire Contract provision states that the application and policy contain all provisions and constitute the entire contract .
" A producer does not have the authority to change a policy or waive any of its provisions " . The health provision that best describes this statement is called the Grace Period Incontestable Entire Contract Time Limit on Certain Defenses
Correct . The Entire Contract provision states that the producer does NOT have the authority to change the policy or waive any of its provisions .
Which Federal law allows an insurer to obtain an inspection report on a potential insured ? Medical Information Bureau Act Freedom of Information Act Fair Credit Reporting Act Medical Information Act
Correct . The Fair Credit Reporting Act of 1970 , or FCRA , established procedures for the collection and disclosure of information obtained on consumers through investigation and credit reports
Which parts of a health insurance policy are guaranteed to be true ? Rating Representation Statement Warranty
Correct . Warranties are statements that are considered literally true Awarranty that is not literally true in every detail , even if made in error , is sufficient to render a policy vold
When is a Group Health policy required to provide coverage for a newborn child ? When the policyowner notifies the insurance company At the moment of birth When the required additional premium is paid No more than 10 days after date of birth
Correct A Group Health policy is required to provide coverage for a newbom child at the moment of birth
An agent's license can be suspended or revoked by writing primarily controlled business not meeting annual sales quota replacing an existing insurance policy with a new one issuing a binding receipt
Correct An agent's license can be suspended or revoked by writing primarily controlled business
A licensed agent must be appointed by an insurance company to solicit insurance in Florida . The agent's license will terminate if a certain period of time elapses without being appointed . How long is this period of time ? 12 months 24 months 36 months 48 months
Correct An agent's license will terminate if the agent allows 48 months to elapse without being appointed for the class or classes of insurance listed on the license
What is the consideration given by an insurer in the Consideration clause of a life policy ? Promise to never cancel coverage Promise to pay a death benefit to a named beneficiary Promise to not raise premiums Promise to accept an insured's assignment of benefits
Correct Consideration is given by the insurer by promising to pay a death benefit to a named beneficiary .
In order for a domestic , foreign , or alien insurance company to conduct business , it must be authorized by whom ? The National Association of Insurance Commissioners ( NAIC ) The state where they are conducting business The attorney general in the state where they are domiciled Homeland Security
Correct Domestic , foreign , or alien companies must be authorized by each state where they conduct business .
What do Dread Disease policies cover ? A specific disease or illness All diseases or illnesses Only terminal illnesses Only heart - related diseases
Correct Dread Disease policies cover only a single disease or illness .
What is issued to each employee of an employer health plan ? Provision Receipt Policy Certificate
Correct Employees covered by an employer health plan are issued an insurance certificate .
K has a health policy that must be renewed by the insurer and the premiums can only be increased if applied to the entire class of insureds . This type of policy is considered : optionally renewable conditionally renewable guaranteed renewable noncancellable
Correct Guaranteed renewable is best described as a policy that must be renewed and premium rate increases can only be applied for an entire class of insureds
Which of the following statements does NOT accurately describe the tax treatment of premiums and benefits of individual Accident and Health insurance ? Disability income policy premiums are NOT tax - deductible Disability income policy premiums are tax - deductible Major medical policy benefits are normally not taxed Disability income policy benefits are normally not taxed
The correct answer is " Disability income policy premiums are tax - deductible " . Premiums paid by individuals for Disability income policies are NOT tax - deductible . However , the benefits would be considered tax - free to the individual .
The provision in a Group Health policy that allows the insurer to postpone coverage for a covered illness 30 days after the policy's effective date is referred to as the : Grace Period Waiting Period Postponement Period Elimination Period
The correct answer is " Waiting Period " . The waiting period in a Group rights to delay coverage for a covered sickness for a specified number of days after the effective date of the policy . Health policy gives an insurance company the
An insurance company normally has 2 years to contest information provided on an accident and health application . This 2 year period begins on the date that the medical examination is given producer completes the application insurer dates the policy the first premium is paid
* Incorrect . The correct answer is " insurer dates the policy " . An insurance company can usually contest the information contained in an accident and health application for two years from the date the insurance company dates the policy .
The first portion of a covered Major Medical insurance expense that the insured required to pay is called the Corridor deductible initial deductible stop - loss deductible coinsurance deductible
A Correct . A provision that requires the insured to pay the first portion of covered expenses before Major Medical coverage applies in called an initial deductible
Basic Medical Expense insurance normally has a deductible and coinsurance covers an illness but not an accident Pays for lost wages while hospitalized has lower benefit limits than Major Medical insurance
A Correct . Basic Medical Expense insurance typically has lower benefit limits than Major Medical insurance .
Which of the following is NOT an unfair claim settlement practice ? Failing to acknowledge and act promptly with respect to an insurance claim Compelling an insured to initiate a lawsuit by offering less on an insurance claim Failing to accept or deny a claim within reasonable time after proof of loss is submitted Needing written documentation of claim details
Conect All of these are unfair claim settlement practices except " Needing written documentation of claim details " .
Accidental Death coverage is provided to commercial airline passengers in which of the following types of policies ? Disability Income policy Accident Reimbursement Accounts Accident Savings Plans Blanket Accident policy
Correct . A Blanket Accident policy provides Accidental Death coverage to airplane passengers
Disability policies do NOT normally pay for disabilities arising from which of the following ? Accidents War Negligence Sickness
Correct . Disability policies do NOT normally pay for disabilities arising from an act of was
Florida requires that coverage for newborns begins " from the moment of birth " and continues for 31 days 6 months 12 months 18 month
Correct . Florida requires that newbom coverage begins from the moment of birth and continues for eighteen ( 18 ) months .
An applicant's medical information received from the Medical Information Bureau ( MIB ) may be furnished to the : producer applicant's spouse National Association of Insurance Commissioners ( NAIC ) applicant's physician .
Correct information received from the Medical Information Bureau about a proposed insured may be released to the proposed insured's physician ,
All of the following statements regarding group health insurance is true , EXCEPT : Premiums are usually determined by the claims experience of the group A master contract is issued for the group An individual policy is given each member Group health insurance premiums are typically lower than individual health insurance premiums
The correct answer is " An individual policy is given to each member " . In group health insurance , each member receives a certificate of insurance , not an individual policy .
In Florida , when agents recommend changes be made for existing coverage , the agent must follow established procedures . The name of this rule is Gramm - Leach - Blley Act Florida Solicitation Law Existing Coverage Statute Florida Replacement Rule
The correct answer is " Florida Replacement Rule " . The Florida Replacement Rule sets forth the requirements and procedures to be followed by insurance companies and producers when replacing existing life insurance contracts .
Under a Guaranteed Renewable health insurance policy , the insurer may refuse to continue coverage upon policy renewal is permitted to require proof of insurability upon policy renewal will typically decrease the premium upon policy renewal may cancel the policy for nonpayment only
de Correct . Under a Guaranteed Renewable health insurance policy , the insurer may cancel the policy for nonpayment of premium only
Which of the following consists of an offer , acceptance , and consideration ? Warranty Estoppel Contract . Representation
Correct . Offer , acceptance , and consideration are all elements of a contract
When is it acceptable to share commissions with another agent ? as long as both agents are licensed for the same lines of insurance as long as both agents work for the same insurance company as long as both agents are licensed in the same state it is never acceptable
Correct . It is acceptable to share commissions as long as both agents are licensed for the same lines of insurance .
The individual Health Insurance policy that offers the broadest protection is a ( n ) policy Surgical Benefit Indemnity Medical Major Medical Hospital Expense
Correct . Major Medical provides the broadest protection .
X is insured with a Disability Income policy that provides coverage until age 65. This policy allows the insurer to change the premium rate for the overall risk class assigned . Which of these renewability features does this policy contain ? Guaranteed Assignable Guaranteed Renewable Optionally Cancellable Noncancellable
Correct . Guaranteed Renewable individual disability income policies provides the right to continue a policy ( normally through age 65 ) if the client pays the premium on time . Where the insurance company cannot change the benefits or features of the policy , they may change the premium of the policy .
In Florida , which of the following practitioners normally do NOT receive payment from health insurance policies ? ⒸOptometrists Pediatricians Dentists Naturopaths
Correct . Health insurance policies in Florida must cover payment to all of these practitioners EXCEPT naturopaths
A physician opens up a new practice and qualifies for a $ 7,000 / month Disability Income policy . What rider would the physician add if he wants the ability to increase his policy benefit as his practice and income grow ? Extended Term rider Cost of Living Adjustment rider Guaranteed Insurability Option rider Waiver of Premium rider
Correct . If a physician wants to ensure he can increase the benefit for his disability policy as his practice and income grow , he would want to include a Guaranteed Insurability Option rider
If a policyowner does not pay the premium by the due date , the policy must be reinstated policyowner is automatically assessed a late charge . insurance company cancels the policy policyowner can make the premium payment during the grace period
Correct . If a policyowner does not pay the premium by the due date , the premium may be paid during the grace period .
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision ? File a lawsuit Submit the claim in any form Wait for the claim form to arrive Resubmit the request for a claim form
Correct . If forms are not furnished , the insured should submit the claim in any form , which must be accepted by the company as adequate proof of loss .
According to Florida law , an additional lapse notice must be issued after the standard grace period has expired for policyowners age 21 and under 59 1/2 or older 64 years or older 69 or older
Correct . In Florida , insurers are required to issue an additional lapse n applicable statutory grace Ariod has expired for policyholders 64 years of age or older .
In Florida , monthly - premium health insurance policies must provide a grace period of at least 7 days 10 days . 14 days 31 days
Correct . In Florida , monthly premium health insurance policies must provide a grace period of at least 10 days .
If a contract of adhesion contains complicated language , to whom would the interpretation be in favor of ? Insurer Beneficiary Reinsurer Insured
Correct . In a contract of adhesion , any confusing language would be interpreted in the favor of the insured .
The insured and insurance company will share the cost of covered losses under which health policy feature ? O Subrogation clause Assignment provision Share clause Payment of Claims provision
Correct . In a health policy , the Payment of Claims provision states that the insured and insurance company will share the cost of covered losses .
K made a fraudulent statement on her health insurance policy application . In the event of a claim on this policy , the insurance company is required to pay nothing 50 % of the claim a figure to be determined by arbitration all of the claim
Correct . In the event of a fraudulent health insurance policy application , the insurer is not required to pay a claim on this policy
An individual Disability Income insurance applicant may be required to submit all of the following information , EXCEPT Medical history Gross income occupation spouse's occupation
Correct . In this situation , a spouse's occupation is not necessary for the application .
An insurance company would MOST likely pay benefits under an Accidental Death and Dismemberment policy for which of the following losses ? Loss of life due to a heart attack Loss of eyesight due to an accidental injury Loss of the spleen due to an accidental injury Partial paralysis due to a stroke
Correct . In this situation , an Accidental Death and Dismemberment policy will most likely pay benefits for loss of eyesight due to an accidental injury .
K failed to pay a renewal premium within the time granted by the insurer . K then sends in a payment which the insurer subsequently accepts . Which policy provision specifies that coverage may be restored in this situation ? Free - look Reinstatement Grace Period Consideration
Correct . In this situation , coverage may be restored under the reinstatement provision
An insured covered by Accidental Death and Dismemberment ( AD & D ) insurance has just died . What will happen if the primary beneficiary had already died before the insured and contingent beneficiary ? Proceeds will go to the primary beneficiary's estate Probate will decide who receives proceeds . Proceeds will go to the contingent beneficiary Proceeds will go to the insured's estate
Correct . In this situation , the contingent beneficiary will receive the proceeds .
An insured covered by a group Major Medical plan is hospitalized after sustaining injuries that resulted from an automobile accident . Assuming the plan had a $ 1,000 deductible and an 80/20 Coinsurance clause , how much will the INSURED be responsible to pay with $ 11,000 in covered medical expenses ? 0 $ 3.000 . $ 8,000 $ 11,000
Correct . In this situation , the insured in responsible for $ 1,000 deductible + 20 % of the remaining bill - $ 3,000
A Hospital / Surgical Expense policy was purchased for a family of four in March of 2013. The policy was issued with a $ 500 deductible and a limit of four deductibles per calendar year . Two claims were paid in September 2013 , each incurring medical expenses in excess of the deductible . Two additional claims were filed in 2014 , each in excess of the deductible amount as well . What would be this family's out - of pocket medical expenses for 2013 ? 500 $ 1,000 $ 1,500 $ 2,000
Correct . In this situation , the insured's maximum out - of - pocket expenses for 2013 would be $ 1,000 .
Insurers may request a hearing within if their policy is rejected 20 Days 30 Days 60 Days 90 Days
Correct . Insurers may request a hearing within 20 Days if their policy is rejected .
A prepaid application for individual Disability Income insurance was recently submitted to an insurer . When the insurer received the Medical Information Bureau ( MIB ) report , the report showed that the applicant had suffered a stroke 18 months ago , something that was not disclosed on the application . Which of the following actions would the insurance company NOT take ? Send the initial premium back to the applicant Send a notice to the applicant that the coverage was declined Send a notice to the MIB that the applicant was declined Send a notice to the agent that the applicant was declined
Correct . The MIB does not need to be notified that coverage was denied .
Which of these would the Medical Information Bureau ( MIB ) identify ? Testing positive for marijuana use from a previous screening Existing life insurance coverage with other carriers Credit scores Primary physician
Correct . The Medical Information Bureau ( MIB ) report will identify marijuana use determined by a previous screening
Which of the following is considered to be the time period after a Health Policy is issued , during which no benefits are provided for illness ? Incontestable Period Probationary Period Trial Period Subrogation Period
Correct . The Probationary Period the period of time between the effective date of a Health Policy and the date of coverage begins sickness
The provision in a health insurance policy that suspends premiums being paid to the insurer while the insured is disabled is called the : Probation Period Grace Period Waiver of Premium Elimination Period
Correct . The Waiver of Premium provision in a health insurance contract suspends the insurer's right to receive premiums during a covered period of disability .
Under a Basic Medical Expense policy , what does the hospitalization expense portion cover ? hospital room and board hospital administration expenses surgeon's fees Physician fees
Correct . The hospitalization expense of a Basic Medical Expense policy pays for hospital room and board .
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a : Physician's assistant Primary Care Physician Secondary Care Physician Third Party Administrator
Correct . The individual who provides general medical care for a patient as well as the referral for specialized care is known as a Primary Care Physician .
T and S are named co - primary beneficiaries on a $ 500,000 Accidental Death and Dismemberment policy insuring their father . Their mother was named contingent beneficiary . Five years later , S dies of natural causes and the father is killed in a scuba accident shortly afterwards . How much of the death benefit will the mother receive ? $ 1,000,000 $ 500,000 $ 250,000 0
Correct . The mother receives 50 because T is still alive and the sole primary beneficiary , while the mother is still the contingent beneficiary
What is the main reason for regulating the insurance industry ? Add revenue to Florida's treasury Maintain the solvency f insurance companies Controlling the replacement of existing insurance policies Setting sales quotas for insurers
Correct . The primary purpose of regulation of the insurance industry is to promote the public welfare by maintaining the solvency of insurance companies .
In Major Medical Expense policies , what is the objective of a Stop Loss provision ? Limits an insurer's premium increases Limits an insurer's liability Limits insured's out - of - pocket medical expenses Limits an insured's coverage for pre - existing conditions
Correct . The purpose of a Stop Loss provision in Major Medical Expense policies is to limit the amount of an insured's out - of - pocket medical expenses .
The coordination of benefits ( COB ) provision exists in order to avoid duplication of benefit payments avoid excessive hospitalization lower insurance premiums maximize patient care
Correct . The purpose of the coordination of benefits ( COB ) provision , found only in group health plans , is to avoid duplicion of benefit payments
Consumer reports requested by an underwriter during the application process of a health insurance policy can be used to determine : driving history probability of making timely premium payments applicant is a tobacco user overall health of the applicant
Correct . The purpose of these reports is to provide a picture of an applicant's general character and reputation , mode of living , finances , and any exposure to abnormal hazards .
In health insurance policies , a waiver of premium provision keeps the coverage in force without premium payments : Whenever insured is unable to work . During the time an insured is confined in a hospital Following an accidental injury , but not during sickness After an insured has become totally disabled as defined in the policy
Correct . The waiver of premium provision keeps the coverage in force without premium payments if the insured has become totally disabled as defined in the policy .
Under Florida law , which of the following provisions is NOT required in a Medicare Supplement policy ? Suitability form Guaranteed issue Free - look period of 30 days Limitation on pre - existing conditions for up to 12 months
Correct . There is only a 6 - month limitation on pre - existing conditions for Medicare Supplements .
Select The policy provision that entitles the insurer to establish conditions the insured must meet while a claim is pending is : Grace Period Physical Examination and Autopsy Entire Contract Time Limit on Certain Defenses
Correct . This provision limits the period during which an insurer can deny a claim f on a misstatement made by the insured .
T sends proof of loss to her insurer for an acceptable medical expense claim under her individual Health Insurance policy . Upon receipt , the insurer must pay the benefits immediately within 6 months at the insurer's discretion within 3 months
Correct . Under the Time of Payment of Claims provision , the insurer must pay the benefits immediately after receiving proof of loss
The part of a life insurance policy guaranteed to be true is called a ( n ) : representation exclusion warranty waiver
Correct . Warranties are statements that are considered literally true . A warranty that is not literally true in every detail , even if made A in error , is sufficient to render a policy void .
Which statement is true regarding a minor beneficiary ? Normally , the death proceeds are required to be held in trust until the beneficiary reaches the age of 21 Normally , a guardian is required to be appointed in the Beneficiary clause of the contract The minor must pay the debts of the insured's estate before receiving any of the proceeds The minor is entitled to receive the death proceeds immediately
Correct In most cases , insurers require that a guardian be appointed in the Beneficiary clause of the policy or that a guardian be esignated in the will
Medicare Part C is : government insurance available to those who are enrolled in a Medicare Supplement Plan with income under $ 12,000 per year original Part A and B Medicare available to those who are enrolled in Medicare Part A and Part B
Correct Medicare Part C ( Medicare Advantage ) is offered by private insurers and available to those who are enrolled in Medicare Part A and Part B.
One definition of replacement is " the act of replacing an existing insurance policy with another " . Replacement is Olegal and requires no disclosure closely regulated and requires full disclosure not legal in the state of Florida allowed only if the policy originated outside the state of Florida
Correct Replacement of insurance policies is strictly regulated and requires full disclosure
Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party ? Indemnity Subrogation Legal action Consideration
Correct Subrogation is the right for an insurer to pursue a third party that caused an insurance loss to the insured . This is done as a meeris of recovering the amount of the claim paid to the insured for the loss .
Which of the following phrases refers to the fees charged by a healthcare professional ? Deductible Coinsurance Usual , customary , and reasonable expenses Hospital expense
Correct The insurance phrase which considers a particular fee charged by a physician or other health professional is usual , customary , and reasonable expenses .