Health insurance Fl

Legal Action provision

requires the insured to wait at least 60 days after proof of loss is submitted before legal action can be brought against the insurer

Office of Insurance Regulation

responsible for licensing and certificates, COA , policy forms , viatical settlements etc

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

the insured members are not named , blanket membership- can change at any time

Notice of Claim provision

the insured must give written notice to the insurer within 20 days after a covered loss occurs

which of the following entities is considered the principal

the insurer issuing policy

All of the following are characteristics of a geroup health insurance plan except

the parties that hold a health insurance contract are the employees and the employer

Notice to buyer located in every Medicare Supplemental policy

this policy may not cover all your medical expenses

How long is the Free Look period for individual and senior products?

14 days for individual policies 30 days for senior policies

Denial of claims provision

15 days to appeal physician decision

Florida law requires that both individual ad group health insurers cover newborns for a period of

18months

How ling does the law require agents to to maintain records regarding premium payments

3 years

How many days do you have to notify your insurer of a newly born child?

30 days

how long must the insured wait before filling a lawsuit against the insurer

60 days after filling proof of loss

under the mandatory unifrom provision legal actions, an insured is prevented from bringing a suit against the insurer to recover on a health policy prior to

60 days after written proof of losses has been submitter

Grace Period Provision

7 days for weekly 10 days for monthly \ 31 +

Agent R is charged with committed a crime in another state an is sentenced to 1 year in prison. Who is required to report charges to the Florida Dept of Insurance

Agent R

Who makes up the Insurance Guaranty Association/Fund?

All insurance companies selling life and/or health insurance in the state

Fiduciary Responsibility

An ethical and legal obligation to perform a person's duties in a trustworthy manner.

Controlled business

Any coverage written on a producer's own life, health or property, and/or that of the producer's immediate family or business associates

the unifrom provision law that prevents an insurance company from altering its agreement with a policyholder by referring to documents or other items not contained in the policy is called

Entire Contract

Who issues a temporary license and how long is it good for?

Florida Department of Insurance 6 months

Guaranty Association

Fromed to protect policyowners, insureds, beneficiaries and anyone entitled to payment under an insurance policy from the incompetence and insolvency of insurers.

Which of the following terms refers to solicitation, negotitation , effectuation or advising related to an insurance contract

Insurance transaction

Concealment

Intentional withholding of information of a material fact that is crucial in making a decision.

Which of the following is incorrect

Medicare and Medigap provide coverage for LTC custodial and nursing home

When must the Outline of Coverage be delivered to the insured?

Must be deliver to the insured prior to the application or enrollment form

an insurance company that is owned by policy holders

Mutual insurer

Entire Contract Provision

No change in this policy will be valid until approved by an executive officer of the insurer

AN insured 44 year old fall while mountain climbing on vacation. He is left paralyzed. After a year doctors feel he will never recover from his injuries. From which of the following programs will he be able to collect the disability income

Social Security

Change of Benificiary

Unlesss irrevocable , the right to change beneficiary is reserved to the insured and the consent of the beneficiary is not required

No fewer than 1, no more than 50 eligible employees

Work the minimum of 25 hrs/week and meet the waiting period requirements

Which of the following statements is not true regarding health insurance policy provisions

all additional provisions written by insurers are cataloged by their respective state

insurance contract

an agreement between policyowner and an insurer, where the insurer agrees , for a consideration to indemnify for loss

Penalty for violating Cease and desist

fined 50,000 suspension or revocation of Certificate of authority any other relief provided by Insurance coded

Which of the following statements about HMOS are false

hmo's can engage in selling insurance contracts

Reinstatment Provision

if any renewal is not paid by grace period , coverage is automatically reinstated within 45 days from the date of receipt if not refused

When an insured reinstated his major medical policy , he was involved in an accident that required hospitalization When would this accident be covered upon reinstatement of the policy

immediately

an agent must keep funds belonging to each insurer for which an agent is not appointed

in a separate account

Related costs incurred by the CFO

will be charged against the subpoenaed person , failure to comply with such order will be a contempt of court

Which of the following best defines the probationary period in group policies

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

the guaranteed purchase option is also referred to as

Future increase option

All of the following are features of a catastrophic plan except

High premiums

Jeremy wants to get his producer license to sell to his friends and their families. Would this be considered controlled business?

No

Unfair trade practice

any statement that an insurer's policies are guaranteed by existence of the Insurance Guaranty Association

Mutual Companies

are owned by policyowners and issues out policies

stock companies

are owned by stockholders

How frequently are market conduct examinations held

at least one every 5 years

Why does Florida have state laws regulating Medicare Supplement

states cannot enforce and prosecute federal laws

Time Limit on Certain Defenses

states that after the policy has been in force for two years, the insurer cannot void the policy or deny a claim on the basis of misstatements in the application, except for fraudulent misstatements

A man is an attorney when he applies for health policy. He decides to become a professional bungee jumper. he files a claim. what should happen?

the insurance company will pay the claim according to benefits available if the correct premium has been paid.

claim forms provision

the insurer is required to send the insured a claim form within 15 days after notice is received

What is the purpose of impairment rider

to exclude coverage for specific impairment

What is the purpose of a benefit schedule

to state what and how much is covered in the plan

Coercion

unfair trade practice in which an agent uses physical or mental force with the intent of inducing an applicant to purchase insurance

Rebating

Any inducement offered in the sale of insurance products that is not specified in the policy.

What is the definition of a Small Employer?

No fewer than 1, no more than 50 eligible employees

List what would cause a small employer to not renew coverage

Nonpayment of premiums Fraud/misrepresentation Failure to comply with plan's contractual provisions Insurer does not offer plan

which of the following provisions is mandatory for health insurance

Physical examination and autopsy

Which of the following would make a child over 5 ineligible for florida healthy kids coverage

Qualifying for Medicaid

Proof of Loss provision

Policy owner has 90 days from date of loss to submit proof of loss to Insurer.

All of the following are true regarding key person disability income insurance except

Premiums are taxed deductible as a business expense

Agent Jack is offering individuals tickets to the Super Bowl is they sign up with him. This is considered what illegal act?

Rebate

Consumer Services

Responds to complaints by consumers

Office of Financial Regulation

Responsible for all activities concerning insurers. Office of Financial Regulation: • Regulation of banks • Credit unions • Finance companies • Security industry • Includes the Bureau of Financial Investigations - ruination a as a criminal justice agency • The Office of Financial Regulations

IN contrasting stock insurers to mutual insures which statement is true

Stock insurers are owned by the shareholders and issue non participating policies

what entities do appointments need to be filled out with

The department

domicile

location of incorporation

Defamation

oral or written statement is made that is intended to injure a person engaged in the insurance business

Fraternal benefit society

org formed to provide insurance benefits for members of an affiliated lodge

Which of the following is consideration on part of an insurer

paying a claim

participating policies

policyowners are entitled to dividends.

nonparticipating policies

policyowners do not share in profits or losses

When must the shopper's guide be presented?

prior to completing application

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

probationary period

Misrepresentation

publish or circulate any illustration or sales material that is false , misleading , or deceptive as to policy benefits or terms etc

Churning

replacing insurance policies for the sole purpose of making commissions

within how many days of from termination of employment must an insured provide notice to the insurer in order to continue coverage under the employers plan

63 days

What is the max age that a disabled insured worker may receive Social security benefits

65

When may HIV related test results be provided to the MIB

only if the individual will not be identified

who administer insurance laws in Florida

Chief Financial officer (CFO)

Head of the Financial regulation Dept

Commissioner of Financial Regulation

Sliding

The illegal practice of falsely leading an applicant to believe that a specified additional coverage or product is required by law , or included without any additional charges

under a health insurance policy benefits , other than death benefits that have not otherwise been assigned will be paid to

The insured

What does it mean if an insurance company is nonadmitted?

The insurer has not applied or has applied and been denied the Certificate of Authority

In addition to participation reqs. how does the insurer guard against adverse selection when underwriting

by requiring that the insurance be incidental to the group

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

change in marital status

Every licensee Must notify the department in writing within 30 days when

change of name, address, or email address

Agent M uses his big size implication of his connections to intimidate applicants into purchasing life insurance from him. what is he guilty of

coercion

Reinsurance

contract under which one of the insurance company indemnifies another insurance company for all of its parts.

A major medical expense policy would exclude coverage for all of the following treatments except

drug addiction

Dept of Financial Services

enforce the provisions of the Insurance Code

the "stop-loss' feature on major medical policy is intended to

establish the max amount of out of pocket expense that an insured will have to pay in a calendar year.

Twisting

incomplete or fraudulent comparison of insurance policies that persuades an insured , to thei detriment , to cancel , lapse , switch policies or take out policy with another user.

CFO (Chief Financial Officer)

independently elected and serves as the head of the Dept. and as a member of the financial services.

Alien

insurance company is incorporated in another country

Foreign

insurance company is incorporated in another state

Domestic insurer

insurance company is incorporated in the same state