Unit 29 - Florida Laws and Rules Pertinent to Health Insurance

22. 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

A. Asset protection (Unit 29)

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

A. It permits the insured to reject the policy within 10 days of policy delivery and receive a full refund. (Unit 29)

18. All of the following provisions are required by the Florida Employee 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 issued on a "guarantee- issue" basis D. small employer means an employer with 1-50 employees

A. coverage must always be renewed by carriers (Unit 29)

All of the following statements regarding group health insurance are correct EXCEPT A. coverage must continue until age 25 for a handicapped child that is a family member 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

A. coverage must continue until age 25 for a handicapped child that is a family member (Unit 29)

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

A. notice of informed consent (Unit 29)

19. 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.

B. Coverage continues if the member is chiefly dependent on the policyholder. (Unit 29)

14. A health maintenance organization provides which of the following! A. Free health care for Medicare patients B. Preventive health care for its members C. A program of "pay as you go" medicine D. An extension of VA hospital treatment for veterans

B. Preventive health care for its members (Unit 29)

16. A group credit disability policy may be issued to a creditor if the expected new entrants into the plan A. are more than 25 B. are at least 100 persons yearly C. are about the same each year D. are subject to insurability

B. are at least 100 persons yearly (Unit 29)

10. The notice to the insurance company of a health insurance claim must include A. estimated amount of claim B. name of the insured C. nature of sickness or injury D. date of loss

B. name of the insured (Unit 29)

All of the following statements about the Outline of Coverage for health insurance policies are correct EXCEPT A. it must be provided at time of application or delivery of policy B. principal benefits also shown in the policy need not be included C. it is to include a summary statement of principal exclusions D. it must include any right the insurer reserves to change premiums

B. principal benefits also shown in the policy need not be included (Unit 29)

21. 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 intentional misrepresentation of a material fact

B. the insured develops a serious illness (Unit 29)

At what point in time can a 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

C. 60 days after filing proof of loss (Unit 29)

11. In health insurance, proof of loss must be given to the insurer within how many days after a loss? A. Immediately B. 20 days C. 90 days D. 15 days

C. 90 days (Unit 29)

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 vears

C. Five years (Unit 29)

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

C. Inflation coverage (Unit 29)

9. 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. a reinstated policy provides immediate coverage for an illness D. claim forms must be sent to the insured within 15 days of notice of claim

C. a reinstated policy provides immediate coverage for an illness (Unit 29)

All of the following provisions are mandatory in health insurance policies EXCEPT A. time limit on certain defenses B. grace period C. change of occupation D. time of claims payment

C. change of occupation (Unit 29)

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 a handicapped child that is a family member D. a newborn child of a covered family member is to be provided coverage for 18 months

C. coverage must continue until age 25 for a handicapped child that is a family member (Unit 29)

17. Florida's "mini-COBRA" applies to employers with? A. five or more employees B. 20 or more employees C. less than 20 employees D. less than five emplovees

C. less than 20 employees (Unit 29)

13. If a health insurance policyowner changes jobs to a more hazardous occupation, which of the following could apply? A. Benefits could be increased if the policy so provides. B. Premiums would be increased and collected from date of change to more hazardous occupation. C. Premiums would be decreased and refunded from date of change to more hazardous occupation. D. Benefits could be reduced if the policy so provides.

D. Benefits could be reduced if the policy so provides. (Unit 29)

Which of the following statements is CORRECT about a group health insurance policy? A. It 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.

D. It can provide coverage for handicapped children. (Unit 29)

15. A grandfathered health plan means a health plan that was issued on or prior to A. March 23, 2011 B. March 23, 2013 C. March 23, 2012 D. March 23, 2010

D. March 23, 2010 (Unit 29)

Which of the following practitioners is NOT defined as a "physician" under Florida law? A. Surgeon in 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

D. Sports therapist performing services in a health club (Unit 29)

8. 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

D. Treatment for an occupational illness or injury (Unit 29)

20. 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

D. coverage for dental expenses (Unit 29)