Download ✅ Simulator FL 2-40 Health and Accident Insurance State Exam Prep | 100% Correct Answers and more Exams Insurance law in PDF only on Docsity!
Simulator FL 2 - 40 Health and Accident
Insurance State Exam Prep | 100% Correct
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Multiple Employer Welfare Arrangement (MEWA) provides what type of benefits? - ✔✔Insurance XYZ Company pays the entire premium for its group health plan. The MINIMUM percentage of eligible employees that must be covered is - ✔✔100% In Major Medical Expense policies, what is the intent of Stop Loss provision? - ✔✔Limits an insured's out-of-pocket medical expenses Q is hospitalized for 3 days and receives a bill for $10,100. Q has a Major Medical policy with a $ deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? - ✔✔$2, Omitting information that affects the issuance or the rate of an insurance contract is called - ✔✔concealment Florida requires that coverage for newborns begins "from the moment of birth" and continues for - ✔✔18 months In order to establish a Health Reimbursement Arrangement (HRA), it MUST - ✔✔be established by the employer Which provision allows a portion of any used medical benefits to be restored following a particular amount of benefits has been used, or after the policy has been in effect for a particular period of time? - ✔✔Restoration of used benefit Disability policies do NOT normally pay for disabilities arising from which of the following? - ✔✔War
According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare Supplement applicant? - ✔✔At the time of application An agent selling Medicare Supplement policies must provide every applicant with a(n) - ✔✔Suitability form One definition of replacement is "the act of replacing an existing insurance policy with another". Replacement is - ✔✔closely regulated and requires full disclosure Who makes the legally enforceable promises in a unilateral insurance policy? - ✔✔insurance company Which of the following acts is an agent NOT authorized to do on behalf of an insurer? - ✔✔Authorize claim payments Which of the following BEST describes a Hospital Indemnity policy? - ✔✔Coverage that pays a stated amount PER DAY of a covered hospitalization What is required in the Florida Employee Health Care Access Act? - ✔✔Small group benefit plan are to be issued on a "guarantee-issue" basis The waiting period for a pre-existing condition under a Medicare Supplement policy may NOT go beyond
- ✔✔6 months J purchased a Disability Income Policy that ONLY J can terminate and on which the rates will never increase above those illustrated in the policy. Which of the following types of policies did J purchase? - ✔✔Noncancelable What is the elimination period of an individual disability policy? - ✔✔Time period a disabled person must wait before benefits are paid This type of deductible provision waives the deductible for all family members after some of them have satisfied individual deductibles within the same year - ✔✔Family maximum deductible
In Florida, which of the following practitioners normally do NOT receive payment from health insurance policies? - ✔✔Naturopaths Which of the following statements BEST describes the intent of a Coinsurance clause in a Major Medical policy? - ✔✔Discourages overutilization of the insurance coverage In Florida, the underwritting and issuance of a master group health policy requires that all employees - ✔✔are eligible to participate, regardless of their individual health history Employers with less than __ employees are affected by Florida's Health Insurance Coverage Continuation Act (Mini COBRA). - ✔✔ 20 An assignment of benefits of a Health Policy - ✔✔transfers payments to someone other than the policyowner The situation in which a group of physicians are salaried employees and conduct business in an HMO facility is called a(n) - ✔✔closed panel Which required disclosure helps a buyer choose the amount and type of insurance to buy, and how to save money by comparing the cost of similar policies? - ✔✔Buyers Guide A stock life insurance company that issues both participating and nonparticipating policies is doing business on - ✔✔a mixed plan Within how many days must a licensee notify the Department of Financial Services of a change of address? - ✔✔ 30 The guarantee of insurability option provides a long-term care policyowner the ability to - ✔✔buy additional coverage at a later date 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
Health insurance benefits NOT covered due to an act of war are - ✔✔excluded by the insurer in the contract provisions Which of the following claims are typically excluded from Medical expense policies? - ✔✔Intentionally self-inflicted injuries J is an agent who recently told a claimant that his rights might be impaired if he does not complete a release form within a specified time. What could this agent be found guilty of? - ✔✔Coercion Which of the following is the MOST important factor when deciding how much Disability Income coverage an applicant should purchase? - ✔✔Applicants monthly income How can an agent-in-charge have more than one location? - ✔✔Only if the agent-in-charge is present when insurance activity occurs A Disability Income policyowner recently submitted a claim for a chronic neck problem that has now resulted in total disability. The original neck injury occurred before the application was taken 5 years prior. The neck injury was never disclosed to the insurer at the time of the application. How will the insurer handle this claim? - ✔✔Claim will be paid and coverage will remain in force If the insured and primary beneficiary are both killed in the same accident and it cannot be determined who died first, where are the death proceeds to be directed under the Uniform Simultaneous Death Act?
- ✔✔Insured's contingent beneficiary Which of the following types of insureds are life insurance companies allowed to make policy rate discrimination against? - ✔✔People that smoke P received Disability income benefits for 3 months then returns to work. She is able to work one month before her condition returns, leaving her disabled once again. What would the insurance company most likely regard this second period of disability as? - ✔✔Recurrent disability
A CEO's Personal assistant suffered injuries at home and as a result, was unable to work for four months. Which type of policy will pay a monthly benefit to the personal assistant? - ✔✔Disability Income Which mode of payment is NOT used by health insurance policies? - ✔✔Single premium In Florida, a health policy that is paid on a quarterly basis requires a grace period of - ✔✔31 days J is an agent who has induced an insured through misrepresentation to surrender an existing insurance policy. What is J guilty of? - ✔✔Twisting Which of the following is an example of an Unfair Trade Practice? - ✔✔Coercion Qualified Long-Term Care policies may take into consideration an applicant's pre-existing conditions for a maximum of not more than __ month(s) prior to the effective date of coverage. - ✔✔ 6 Which of the following is the reimbursement of benefits for the treatment of a beneficiary's injuries caused by a third party? - ✔✔Subrogation Deformation occurs when an agent makes a false statement intended to - ✔✔Malign another insurer Agents that have been licensed for less than six years must complete __ hours of continuing education every two years. - ✔✔ 24 S takes out a health insurance policy which contains a provision that states that the agent does not have the authority to change the policy or waive any of its provisions. Which health policy provision is this? - ✔✔Entire Contract Pre-hospitalization authorization is considered an example of - ✔✔managed care If a policyowner does not pay the premium by the due date, the - ✔✔policyowner can make the premium payment during the grace period
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 Which of these arrangements allows one to bypass insurable interest laws? - ✔✔Investor-Originated Life Insurance What must an insurer obtain to conduct an HIV test? - ✔✔Written consent Which of the following correctly explains the actions an agent should if a customer wants to apply for an insurance policy? - ✔✔Complete the application and review the information with the customer prior to obtaining the customer's signature, then send the application off to the insurance company S is employed by a large corporation that provides group health coverage for its employees and their dependents. If S dies, the company must allow his surviving spouse and dependents to continue their group health coverage for a maximum of how many months under COBRA regulations? - ✔✔ 36 The reason for a business having a Business Overhead Expense Disability Plan is to cover - ✔✔fixed business expenses Which type of plan normally includes hospice benefits? - ✔✔Managed care plans What type of insurance company is domiciled in England, but conducts business in Florida? - ✔✔Alien According to Florida Law, in which of the following situations would a dependent handicapped child NOT be covered under a Family Health policy? - ✔✔The premiums for the handicapped child are not paid All of the following will result in suspension of an agents' license EXCEPT - ✔✔acting with fiduciary responsibility
T is receiving $3,000/month from a Disability Income policy in which T's employer had paid the premiums. How are the $3,000 benefit payments taxable? - ✔✔Benefits are taxable to T During the course of an insurance transaction, if an agent makes a false or incomplete statement, he/she could be found guilty of - ✔✔Misrepresentation Under Florida law, which of the following provisions is NOT required in a Medicare Supplement policy? - ✔✔Limitation on pre-existing conditions for up to12 months A license may be denied, suspended, or revoked if the licensee - ✔✔is found guilty of misrepresentation Which statement is TRUE regarding a group accident & health policy issued to an employer? - ✔✔The employer receives the policy and each employee is issued a certificate Under what system do a group of doctors and hospitals in a designated area contract with an insurer to provide services at a prearranged cost to the insured? - ✔✔PPO The coordination of benefits (COB) provision exists in order to - ✔✔avoid duplication of benefit payments Insurance policies are considered aleatory contracts because - ✔✔performance is conditioned upon a future occurrence Under which of the following circumstances will the benefits under COBRA continuation coverage end? - ✔✔All group health plans are terminated by the employer In order for a domestic, foreign, or alien insurance company to conduct business, it must be authorized by whom? - ✔✔The state where they are conducting business
