Florida Insurance
What is the required minimum percentage of employee participation for a noncontributory group health insurance plan according to Florida Law?
0%
What percentage of eligible persons must a policy cover in a noncontributory group?
100%
Employers with less than ____ employees are affected by Florida's Health Insurance Coverage Continuation Act (Mini COBRA).
20
How many hours of continuing education must a newly licensed agent complete every two years?
24
Within how many days after policy delivery can a Medicare Supplement policy be returned for 100% premium refund?
30
Within how many days must a licensee notify the Department of Financial Services of a change in address?
30
An insured pays premiums on an annual basis for an individual health insurance policy. What is the MINIMUM number of days for the Grace Period provision?
31
A group plan was recently terminated. In Florida, how many days are covered individuals guaranteed coverage after a group plan's termination?
31 days
M's insurance company denied a reinstatement application for her lapsed health insurance policy. The company did not notify M of this denial. How many days from the reinstatement application date does the insurance company have to notify M of the denial before the policy will be automatically placed back in force?
45 days
Florida requires that an insurance agent must complete ___ hours of continuing education of the subject of law and ethics every two years.
5
In Florida, what is the maximum percentage of controlled business an agent may produce?
50%
The individual most likely to buy a Medicare Supplement policy would be a(n)
68-year old male covered by Medicare
What do families pay that are covered by the Florida Healthy Kids Corporation?
A portion of the premium
What do Dread Disease policies cover?
A specific disease or illness
Which of the following statements describes what an Accident and Health policyowner may NOT do?
Adjust the premium payments
What type of insurance company is domiciled in England, but conducts business in Florida?
Alien
Under which of the following circumstances do the benefits under COBRA continuation coverage expire?
All group health plans are eliminated by the employer
All of the following entries are classified under the four principal areas of Florida insurance law EXCEPT
An agent's commission
Which of the following statements BEST describes what the Legal Actions provision of an Accident and Health policy requires?
An insured must wait at least 60 days after Proof of Loss has been submitted before a lawsuit can be filed
Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase?
Applicant's monthly income
According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant?
At the same time of application
All of the following are Nonforfeiture Options EXCEPT
Automatic Premium Loan Option
All of the following statements about Major Medical benefits are true EXCEPT
Benefits have no maximum limit
Many small business owners worry how their business would survive financially if the owner becomes disabled. The policy which BEST addresses this concern is
Business Overhead Expense
Which of these circumstances is a Business Disability Buy-Sell policy designed to help in the sale of a business?
Business owner becoming disabled
A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The orginal neck injury occurred before the application. How will the insurer handle this claim?
Claim will be paid and coverage will remain in force
In Florida, which of the following is considered an Unfair Trade Practice?
Coercion
N has a Major Medical policy that only pays a portion of N's medical expenses. N is responsible for paying the remaining balance. This provision is known as
Coinsurance
An insurance company receives E's application for an individual health policy. E did not complete all of the medical history questions because she could not remember the exact dates. E signed the policy and submitted it to the insurance company anyway. A few weeks later, E suffers a heart attack and is hospitalized without completing the medical history questions and paying the initial premium. E is not insured. Which of the following clauses details the conditions that E did not meet?
Consideration clause
When an employee is required to pay a portion of the premium for an employer/employee group health plan, the employee is covered under which of the following plans?
Contributory
All of the following are eligibility requirements for an association group EXCEPT
Contributory plans require a minimum of 25 participants
Which two entities regulate variable annuities?
Department of Financial Services; and Securities Exchange Commission
M is insured under a basic Hospital/Surgical Expense policy. A physician performs surgery on M. What determines the claim M is eligible for?
Determined by the terms of the policy
K becomes ill after traveling overseas and is unable to work for 3 months. What kind of policy would cover her loss of income?
Disability Income
A characteristic of Preferred Provider Organizations (PPOs) would be:
Discounted fees for the patient
Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy?
Discourages overutilization of the insurance coverage
Which health policy clause stipulates that an insurance company must attach a copy of the application to the policy to ensure that it is part of the contract?
Entire Contract
In Florida, when agents recommend changes be made for existing coverage, the agent must follow established procedures. The name of this rule is called the
Florida Replacement Rule
Which of these is considered a true statement regarding Medicaid?
Funded by both states and federal governments
A medical care provider which typically delivers health services at its own local medical facility is known as a
Health Maintenance Organization
Which type of provider is known for stressing preventative medical care?
Health Maintenance Organizations (HMO's)
Which of the following statements about Health Reimbursement Arrangements (HRA) is CORRECT?
If the employee paid for qualified medical expenses, the reimbursements may be tax-free
T was treated for an ailment 2 moths prior to applying for a health insurance policy. This condition was noted on the application and the policy was issued shortly afterwards. How will the insurer likely consider this condition?
Insurer will likely treat as a pre-existing condition which may not be covered for one year
Which of the following actions will an insurance company most likely NOT take if an applicant, who has diabetes, applies for a Disability Income policy?
Issue the policy with an altered Time of Payment of Claims provision
According to Florida law, which of the following statements accurately describes an admitted mail order insurance company?
It may solicit insurance business by mail without the assistance of a licensed agent
Who is a mutual insurance company owned by?
Its policyholders
Which of the following statements BEST describes how a policy that uses the "accidental bodily injury" definition of an accident differs from one that used the "accidental means" definition?
Less restrictive
Which of the following situations does a Critical Illness plan cover?
Leukemia
In Major Medical Expense policies, what is the intent of a Stop Loss provision?
Limits an insured's out-of-pocket medical expenses
Which of the following are NOT managed care organizations?
Medical Information Bureau (MIB)
Which Unfair Trade Practice involves an agent telling a prospective client that a policy's dividends are guaranteed?
Misrepresentation
According to the Time Payment of Claims provision, the insurer must pay Disability Income benefits no less frequently than which of the following options?
Monthly
Which of the following professional organizations has its code of ethics incorporated into Florida law?
National Association of Insurance and Financial Advisors (NAIFA)
Which of the following is NOT an unfair claim settlement practice?
Needing written documentation of claim details
Which of the following BEST describes a short-term medical expense policy?
Nonrenewable
Which entity approves the insurance policy forms used in Florida?
Office of Insurance Regulation (OIR)
Which of these statements accurately describes the Waiver of Premium provision in an Accident and Health policy?
Premiums are waived after the insured has been totally disabled for a specified time period
What is considered to be a characteristic of a Conditionally Renewable Health Insurance policy?
Premiums may increase at time of renewal
The individual who provides general medical care for a patient as well as the referral for specialized care is known as a
Primary Care Physician
T is covered by two health insurance plans: a group plan through his employer and his spouse's plan as a dependent. When T submits a claim, his employer's plan is considered what type of carrier under the Model Group Coordination of Benefits provision?
Primary carrier
Which of the following is NOT required in the Outline of Coverage for a health insurance policy?
Projection of the policy's future
A Disability Income policyowner suffers a disability which was due to the same cause as a previous disability. Both disabilities occurred within a five-month period. The insurer may cover the second disability without a new elimination period under the
Recurrent Disability provision
R had received full disability income benefits for 6 months. when he returns to work, he is only able to resume half his normal daily workload. Which provision pays reduced benefits to R while he is not working at full capacity?
Residual Disability
Which of the following statements BEST describes dental care indemnity coverage?
Services are reimbursed after insurer receives the invoice
Which of the following is NOT considered rebating?
Sharing commission with an agent licensed in the same line of business
A mutual insurance company and a stock insurance company have one main difference between them. What is this major contrast?
Stock company is owned by its shareholders. Mutual company is owned by its policyholders.
What should an insured do if the insurer does not send claims forms within the time period set forth in a health policy's Claims Forms provision?
Submit the claim in any form
Which statement is TRUE regarding a group accident & health policy issued to an employer?
The employer is the policyowner and each employee receives a certificate of coverage
J, an Accidental Death and Dismemberment (AD&D) policy holder, dies after injuries sustained in an accident. J's ages as stated on the application five years ago was found to be understated by ten years. Which of the following actions will the insurance company take?
The insurer will adjust the benefit to what the premiums paid would have purchased at the time the insured's actual age
Which of the following statements BEST defines usual, customary, and reasonable (UCR) charges?
The maximum amount considered eligible for reimbursement by an insurance company under a health plan
Which of the following statements is true about most Blue Cross/Blue Shield organizations?
They are nonprofit organizations
Medicare is intended for all of the following groups EXCEPT
Those enrolled as a full-time student
A person insured under a health policy is required to give the insurance company a Notice of Claim within how many days after a covered loss?
Twenty
J is an agent who has induced through misrepresentation to surrender an existing insurance policy. What is J guilty of?
Twisting
Which of the following BEST describes how pre-admission certificates are used?
Used to prevent nonessential medical costs
Which of the following phrases refers to the fees charged by a healthcare professional?
Usual, customary, and reasonable expenses
The provision in a Group Health policy that allows the insurer to postpone coverage for aa covered illness 30 days after the policy's effective date is referred to as the
Waiting Period
In Florida, deceptive advertising is considered to be
a form of misrepresentation
A stock life insurance company that issues both participating and nonparticipating policies is doing business on
a mixed plan
All of the following will result in the suspension of an agent's license EXCEPT
acting with fiduciary responsibility
Insurance companies that are organized in countries outside the United States are referred to as
alien
An example of an unfair trade practice is
an agent making a material misrepresentation to the insured
In Florida, the underwriting and issuance of a master group health policy requires that all employees
are eligible to participate, regardless of their individual health history
An example of sliding would be
charging for an additional product without the applicant's consent
Major Medical policies typically
contain a deductible and coinsurance
M becomes disabled and is unable to work for six months. M dies soon after from complications arising from his disability. M has a Disability Income policy that pays $2,000 a month. Which of the following statements BEST describes what is owed to her estate?
earned, but unpaid benefits
The first portion of a covered Major Medical insurance expense that the insured is required to pay is called the
initial deductible
In Florida, an element of an insurance transaction would be
issuing an insurance contract
Basic Hospital and Surgical policy benefits are
lower than the actual expenses incurred
During the course of an insurance transaction, if an agent makes a false or incomplete statement, he/she could be found guilty of
misrepresentation
If an insurance company issues a Disability Income policy that it cannot cancel or for which it cannot increase premiums, the type of renewability that best describes this policy is called
noncancellable
The Notice of Claims provision requires a policyowner to
notify an insurer of a claim within a specified time
An example of unfair discrimination would be
offering different terms of coverage for different policyowners having the same risk classification
Deductibles are used in health policies to lower
overuse of medical services
With Optionally Renewable Health policies, the insurer may
review the policy annually and determine whether or not to renew it
An individual Disability Income insurance applicant may be required to submit all of the following EXCEPT
spouse's occupation
Which of the following statements is correct regarding an employer/employee group health plan?
the employer receives a master policy and the employees receive certificates
During the application process, the agent's primary responsibility is to
the insurance company
Association Plans that are designed to provide health benefits to their members are regulated by the state because
they are insured by an authorized insurer
An agent's license can be suspended or revoked by
writing primarily controlled business
