Guaranteed Exam

An applicant misstates his age on his application for a health insurance policy. He states that he is 39, but his actual age is 49. When he files a claim, what will most likely happen?

Benefits paid will be those that would have been purchased at the correct age (If the insured misstated his or her age at the time of the application, the benefits paid will be those that the premium would have purchased at the correct age. This provision is similar to the one found in life insurance policies)

Which of the following is NOT normally an excluded cause of disability in an individual disability income policy?

Complications from pregnancy (injury resulting from illegal activity, suicide, war)

Which of the following elements of an insurance contract requires paying premium and providing a statement of good health?

Consideration

The "stop-loss" feature on a major medical policy is intended to

Establish a maximum amount of out-of-pocket expense that an insured will have to pay for medical expense in a calendar year.

All of following are true of a multiple employer trust (MET) EXCEPT

The employee has a right of conversion upon leaving leaving the group coverage

What is the only difference between blanket insurance and group health insurance?

The insured memebers are not named

All of the following are characteristics of group health insurance plans EXCEPT

The parties that hold a group health insurance contract are the employees and the emplyer

Medicare is a health insurance program for all the following individuals EXCEPT

Those with low income and low assets (medicare is a federal program for those over 65, those that have been on social security for 2 years, and those with permanent kidney failure. Assets and income have nothing to do with Medicare eligibility)

In addition to participation requirements, how does and insurer guard against adverse selection when underwriting group health?

by requiring that the insurance be incidental to the group (the group must form for a reason other than buying group insurance.)

Policy delivery refers to the delivery of the

completed insurance policy to the policyowner (physical delivery to the person who applied for the contract constitutes delivery. This also starts the free look period)

What guarantees that the information explained in the insurance contracts is true?

A warranty

HMO contracts may only be sold by a licensed and appointed health insurance agent or a full-time salaried employee or officer of an HMO who devotes most of his or her services to

Activities other than soliciting HMO contracts from the public and who recieves no commisions or compensation for procuring such contracts

What is the latest point at which an Outline of Coverage may be presented?

At the time of policy delivery

A Major Medical Expense policy would exclude coverage fr all of the follow treatments EXCEPT

Drug addiction (Dental Care, Cosmetic surgery, eye refractions) Treatmeant for drug and alcohol addiction is provided on a limited basis.

All of the following are excluded from coverage in an individual health insurance policy EXCEPT

Mental illness Covered with some limitations

Why does Florida have state laws regulating Medicare Supplement Insurance?

States cannot enforce and prosecute federal laws

Under the mandatory uniform provision "Notice of Claim", written notice of a claim must be submitted to the insurer within what time parameters?

within 20 days (this mandatory provision requires the insured to give the insurer, or its agent, written notice if a claim within 20 days of the loss or as soon as reasonably possible. If the nature of disability is such that the insured is legally incapacitated, this requirement is waived)

what is the maximum age that a disabled insured worker may receive social security disability benefits?

65 (for a person at age 65 who is receiving social security disability benefits, those benefits will stop and will be replaced with retirement benefits)

An insured' s cancelable health insurance policy is being cancelled. One day before the policy is scheduled to end, he is involved in a major accident and is hospitalized for week. Which of the following best describes the coverage that he would receive?

Full benefits, as if the policy were still completely in effect.

An insured has an individual disability income policy with a 30 day elimination period. He becomes disabled on june 1st for 15 days. When will he collect on his disability income payments?

He wont collect anything (the insured cannot collect anything b/c he did not satisfy the elimination period)

an individual long-term care policy cannot be issued until the insurer has recieved from the applicant a written designation of at least

1 person

Florida law requires that both individual and group health insurance policies coverage for a newborn child of a covered family member, other than the insured, for a period of

18 months

Florida law requires that both individual and group health insurance policies provide coverage for a newborn child of a covered family, other than the insured, for a period of

18 months (state law requires that both individual and group health insurance policies ... covered family member for a period of 18 months)

According to the Time Limit on Certain Defenses provision, statements or misstatements made in the application at the time of issue cannot be used to deny a claim after the policy has been in force for a minimum of how many years?

2 years

Which of following would be required to become licensed as an insurance producer?

A customer service representative who solicits no more than one policy a year

The probationary period is

A specified period of time that a person joining a group has to wait before becoming eligible for coverage

The probationary period is

A specified period of time that a person joining a group has to wait before becoming eligible for coverage.

Agents in this state are required to promptly report all of following to the Department EXCEPT

Change in marital status

The "stop-loss" feature on a major medical policy is intended to

Establish a maximum amount of out of pocket expense that an insured will have to pay for medical expense in a calendar year (Stop loss feature is a provision that gives the insured financial Security by limiting the maximum amount that would have to be paid in deductibles and co-payments during a calendar year.)

Which of the following is provided by skilled medical personnel to those who need occasional medical assistance or rehabilitative care?

Intermediate Care

When may HIV-related test results be provided to the MIB?

Only if the individual is not identified

Which of the following is NOT mandatory under the Uniform Provisions Law as applied to accident and health policies?

Probationary Period

An insured was diagnosed two years ago with kidney cancer. She was treated with surgeries and chemotherapy and is now in remission. She has also had a 30-year smoking history. The insured is now healthy enough to work and has just started a full-time job. Which describes the health insurance that she will most likely to receive?

She would be covered under her employer's group health insurance plan, without higher premiums (b/c the insured was hired for a full time job, she would be eligible for her employer's group health insurance plan. group plans cover employees equally, regardless of their age, gender, and past medical history)

If a basic medical insurance plan's benefits are exhausted, what type of plan will then begin covering those losses?

Supplementary major medical

If an agent wants to represents more than one insurer, which of the following will be true?

The agent must be appointed by each insurer

What is the purpose of the impairment rider in health insurance policy?

To exclude coverage for a specific impairment

Which of the following services will NOT be provided by an HMO?

Unlimited coverage for treatment for drug rehabilitation

A husband and wife both incur expenses that are attributed to a single major medical insurance deductible. Which type of deductible do they have in their policy?

family (with a family deductible, expenses for two or more family members can satisfy a common deductible in a given year, regardless of the amount of expenses incurred by other family members)

What happens to the copy of the application for health insurance once the policy is issued?

it becomes part of the entire contract (if the policy is issued, a copy of this application is stapled in the back of the policy and it becomes part of the entire contract)

On an Accidental Death and Dismemberment (AD&D) insurance policy, the death benefit payable is known as the

principle sum (in accidental death and dismemberment (AD&D) coverage, the principle sum is paid for accidental death)

all of the following are characteristics of group health insurance plans EXCEPT

the parties that hold a group health insurance contract are the employees and the employer (the contract for coverage is btwn the employer and the insurance company. Only one policy is issued (master policy) to the employer; covered employees receive a certificate of insurance)