Wrong Test answers

The Florida Health Insurance Coverage Continuation Act requires insurers that sell health plans to small employers to offer in those plans a right to elect to continue coverage, without providing evidence of insurability, to employees who lose their coverage and are unable to replace it. The premium rate for this coverage may NOT exceed

115% of the regular group rate.

How many consecutive months of coverage (other than in an acute care unit of a hospital) must LTC insurance provide in this state?

12

Under special circumstances, continuing education requirements may be extended beyond the 2-year period for a maximum period of

12 months.

The relation of earnings to insurance provision allows the insurance company to limit the insured's benefits to his/her average income over the last

24 months

. In order for an employee to be considered eligible for small group insurance, he/she must work at least how many hours per week?

25

Within how many days of requesting an investigative consumer report must an insurer notify the consumer in writing that the report will be obtained?

3 days

Medicare supplement policies, by law, must provide a free-look provision of

30 days.

When a disabled dependent child reaches the age limit for coverage, how long does the policy owner have to provide proof of dependency in order to remain covered under the policy?

31 days

Once the person meets the stringent requirements for disability benefits under Social Security, how long is the waiting period before any benefits will be paid?

5 months

Ray has an individual major medical policy that requires a coinsurance payment. Ray very rarely visits his physician and would prefer to pay the lowest premium possible. Which coinsurance arrangement would be best for Ray?

50/50

How long is an open enrollment period for Medicare supplement policies

6 months

At what age may an individual make withdrawals from an HSA for nonhealth purposes without being penalized?

65

Which of the following is true regarding the agent's appointments?

A person may hold several appointments at one time.

Under the mandatory uniform provision Notice of Claim, the first notice of injury or sickness covered under an accident and health policy must contain

A statement that is sufficiently clear to identify the insured and the nature of the claim.

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?

All providers will have the same coverage options and conditions for each plan.

Long-term care insurance policies must cover which of the following?

Alzheimer's disease

Under which condition would an employee's group medical benefits be exempt from income taxes?

An employee's group medical benefits are generally exempt from taxation as income.

f an insurance company makes a statement that its policies are guaranteed by the existence of the Insurance Guaranty Association, that would be considered

An unfair trade practice.

How often must domestic insurance companies be examined by the Chief Financial Officer in Florida?

At least every 5 years

Which of the following is not true of Disability Buy-Sell coverage?

Benefits are considered taxable income to the business.

Which of the following is NOT true regarding Workers Compensation?

Benefits are offered by the insurer.

How are state Insurance Guaranty Associations funded?

By their members - authorized insurers

If an agent advises a policyholder to replace an insurance policy but only does so for the purpose of making commissions, the agent has committed an act of

Churning.

Which of the following is NOT an exclusion in medical expense insurance policies?

Coverage for dependents

Which of the following authorities grants and revokes licenses?

Department of Financial Services

All of the following could be considered rebates if offered to an insured in the sale of insurance EXCEPT

Dividends from a mutual insurer.

Circulating deceptive sales material to the public is what type of Unfair Trade Practice?

False advertising

An insured is involved in an accident that renders him permanently deaf, although he does not sustain any other major injuries. The insured is still able to perform his current job. To what extent will he receive Presumptive Disability benefits?

Full benefits

A typical Accidental Death & Dismemberment policy covers all of the following losses EXCEPT

Income.

Underwriting a group health insurance plan that is paid for by the employer requires all of the following EXCEPT

Individual members of the group may select the level of benefits for their own coverage.

Which of the following entities protects policyowners, insureds, and beneficiaries under insurance contracts when insurers fail to perform contractual obligations due to financial impairment?

Insurance Guaranty Association

The type of dental plan which is incorporated into a major medical expense plan is a/an

Integrated dental plan.

Which of the following is true regarding a risk retention group?

It is a liability insurance company owned by its members.

In a group health policy, a probationary period is intended for people who

Join the group after the effective date.

Every insurer marketing Long-Term Care insurance must establish marketing procedures to ensure all of the following EXCEPT

LTC policies are marketed effectively to prospective insureds.

All of the following statements describe a MEWA EXCEPT

MEWAs are groups of at least 3 employers.

Which of the following programs expands individual public assistance programs for people with insufficient income and resources?

Medicaid

Don has both a basic expense and a major medical policy. He is injured in an accident, which requires several major surgeries. This quickly exhausts Don's basic expense policy. What must Don do before his major medical policy can pick up where the basic expense policy left off?

Pay a special deductible on his major medical policy

A participating insurance policy may do which of the following?

Pay dividends to the policyowner

An insured pays her Major Medical Insurance premium annually on March 1. Last March she forgot to mail her premium to the company. On March 19, she had an accident and broke her leg. The insurance company would

Pay the claim.

Which of the following provisions would prevent an insurance company from paying a reimbursement claim to someone other than the policyowner?

Payment of Claims

Pertaining to insurance, what is the definition of a fiduciary responsibility?

Performing reviews of insured's coverage

Regarding the taxation of Business Overhead policies,

Premiums are deductible and benefits are taxed.

A long-term care shopper's guide must be presented at what point?

Prior to the time of application

When an insurer terminates an agent's appointment, the insurer must do all of the following EXCEPT

Provide a 30-day advance notice to the Commissioner.

ll of the following are true regarding rebates EXCEPT

Rebates are allowed if it's in the best interest of the client.

Which health insurance provision describes the insured's right to cancel coverage?

Renewal provision

Who examines the books and records of insurance companies in Florida?

The Chief Financial Officer

Which of the following is NOT covered under Plan A in Medigap insurance?

The Medicare Part A deductible

Whose responsibility is it to determine if all of the questions on an application have been answered?

The agent

Which of the following is true about the requirements regarding HIV exams?

The applicant must give prior informed written consent.

An insured who has an Accidental Death and Dismemberment policy loses her left arm in an accident. What type of benefit will she most likely receive from this policy?

The capital amount in a lump sum

What type of information is NOT included in a certificate of insurance?

The cost the company is paying for monthly premiums

How do employer contributions to a health savings account affect insured's taxes?

The employer contributions are not included in the individual insured's taxable income

If a person accumulates more continuing education hours than is necessary to fulfill the requirements for a 2-year period, which of the following will occur?

The extra hours may be continued into the next period.

Which of the following is an agreement between an insured and an insurer, where the insurer agrees to indemnify the insured for specific losses in exchange for a premium?

The insurance contract

When Linda suffered a broken hip, she notified her agent, in writing within 12 days of loss. However, her agent did not notify the insurance company until 60 days after the loss, Which of the following statements correctly explains how this claim would be handled?

The insurer is considered to be notified since the notification to agent equals notification to the insurer.

Which of the following is an example of a producer's fiduciary duty?

The trust that a client places in the producer in regard to handling premiums.

Which provision states that the insurance company must pay Medical Expense claims immediately?

Time of Payment of Claims

An insured submits a proof of loss form within 10 days of a loss. The insurer, however, does not acknowledge the form for 3 months. Which of the following violations has the insurer committed?

Unfair claims settlement

Which characteristic does NOT describe managed care?

Unlimited access to providers

A medical expense policy that establishes the amount of benefit paid based upon the prevailing charges which fall within the standard range of fees normally charged for a specific procedure by a doctor of similar training and experience in that geographic area is known as

Usual, customary and reasonable.

Social Security Supplement (SIS) or Social Security Riders would provide for the payment of income benefits in each of the situations below EXCEPT

When the amount payable under Social Security is more than the amount payable under the rider.

When do HMOs file reports of their activities to the Department?

Within 3 months of the end of each fiscal year

Which of the following is NOT a factor in determining qualifications for Social Security disability benefits?

Worker's occupation

All of the following are correct about the required provisions of a health insurance policy EXECPT

a reinstated policy provides immediate coverage for an illness

Which of the following is the closest term to an authorized insurer?

admitted

A waiver of premium provision may be included with which kind of health insurance policy?

disablility income

Which of the following riders would NOT increase the premium for a policyowner?

impairment rider

The section of a health policy that states the causes of eligible loss under which an insured is assumed to be disabled is

insuring clause

The office of insurance regulation is responsible for all of the following insurer activities EXCEPT

issues of securities

An insured purchased an insurance policy 5 years ago. last year, she received a divided check from the insurance company that was not taxable. This year, she did not receive a check from the insurer. From what type of insurer did the insured purchase the policy?

mutual

On a participating insurance policy issued by a mutual insurance company, dividends paid to policy holders are

not taxable since the IRS treats them as a return of a portion of the premium paid

All of the following are true regarding a key person disability insurance EXCEPT

premiums are tax deductable as a business expense

All of the following are activities of daily living EXCEPT

speaking

Worker compensation benefits are regulated by which entity?

state government

Which statement is NOT true regarding underwriting group health insurance?

the group is assessed individually for insurability

The expense for an autopsy covered under the physical exam and autopsy provision is paid by

the insurer

Which of the following is NOT a feature of a noncancelable policy?

the insurer may terminate the contract only at renewal for certain contitions

Most policies will pay the accident death benefits as long as the death is caused by the accident and occurs within

90 days.