Chapter 7 insurance quiz

If a parent would like to enroll a child over the age of 5 into the Florida Healthy Kids program, their family income must be under a certain percentage of the federal poverty level. What percentage?

200%

Which of the following government health programs provides health insurance coverage to children who do not have access to adequate health care services?

DFlorida Healthy Kids

All of the following would be legal activities for an HMO to engage in EXCEPT?

Health insurance solicitation.

Which of the following groups would most likely be covered under a blanket accident policy?

Students at a public school

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

Within 3 months of the end of each fiscal year

What is the statute of limitation on lawsuits for health insurance policies?

5 years. No legal action may be brought on a health insurance policy within 60 days after written proof of loss has been given. After 60 days, in the state of Florida, legal action may be brought against the insurer for up to 5 years after filing proof of loss.

A corporation can be considered a "small group employer" if it has at least one and a maximum of how many employees?

50. "Small Group Employer" means any person, firm, corporation, partnership, or association that is actively engaged in business that has no more than 50 eligible employees.

Question 9 of 15 Most HMOs operate through what type of system?

A group enrollment system either at their place of employment or as a member of an association

Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy?

Basic information about supplementary policies

HMOs that contract with outside physicians to provide health care service to their subscribers compensate those providers on a?

Capitation basis. HMOs generally pay the provider a fixed amount per subscriber in exchange for the medical services agreed upon, called a capitation basis.

In a long-term care policy, pre-existing condition limitations?

Must appear as a separate paragraph and be clearly labeled. If there are any limitations in the policy with respect to pre-existing conditions these limitations must appear in a separate paragraph in the policy labeled "Pre-existing Condition Limitations." A long-term care policy cannot deny a claim for losses incurred more than 6 months from the effective date of coverage because of a pre-existing condition.

When may an insurer require an insured to provide genetic information?

Never

At what age are individuals become INELIGIBLE for Florida Healthy Kids coverage?

Only children under the age of 19 are eligible for Florida Healthy Kids coverage.

When does Medicare cover nursing home care?

Only if it is part of treatment for a covered illness or injury

Which document helps ensure that full and fair disclosure is provided to the recipient of a policy?

Outline of Coverage

WHICH OF THE FOLLOWING FACTORS WOULD BE AN UNDERWRITING CONSIDERATION FOR A SMALL EMPLOYER CARRIER?

PERCENTAGE OF PARTICIPATION BY THE EMPLOYEES

A medical insurance plan in which the health care provider is paid a regular fixed amount for providing care to the insured and does not receive additional amounts of compensation dependent upon the procedure performed is called?

Pre paid

Which of the following does NOT have to be disclosed in a long-term care (LTC) policy?

The aggregate amount of premiums due

When a child reaches the limiting age of a health insurance policy of the insured parent, and has an intellectual or physical disability, the insurer may require proof that the child?

The laws prohibit the insurance company from terminating coverage on a dependent who is and continues to be both incapable of self-sustaining employment because of an intellectual or physical disability, and chiefly dependent upon the policyholder or subscriber for support and maintenance.

Long-term care policies require that in addition to the applicant at least one person must be designated in the policy. What is the role of that designated person?

To receive notice of policy lapse or termination

When an HMO knowingly makes any misleading representations, incomplete or fraudulent comparisons for the purpose of inducing any person to lapse, forfeit, terminate, surrender or convert any insurance policy or contract with another insurance company or HMO, they are in violation of the unfair trade practice of?

Twisting.