WorksheetsHealth exam part1
Total questions: 77
Worksheet time: 39mins
An agency was accused of allowing one of its agents to fraudulently sign an application. What is the potential penalty for this violation?
A fine of up to 1,000 dollars for non willful violations and a fine of up to 25,000 dollars for willful violations, plus potential license suspension or revocation
A fine of up to 2,500 dollars for non willful violations and a fine of up to 100,000 dollars for willful violations, plus potential license suspension or revocation
A fine of up to 5,000 dollars for non willful violations and a fine of up to 75,000 dollars for willful violations. Insurers may be fined up to 20,000 dollars per non willful violation plus potential license suspension or revocation
A fine of up to 25,000 dollars for non willful violations and a fine of up to 75,000 dollars for willful violations, plus potential license suspension or revocation
A particular state's version of the federal COBRA legislation is commonly called WHICH of the following?
Little COBRA
Minimized COBRA
Mini COBRA
State COBRA
An insured submitted a claim to the insurance company, but owed past due premium when the claim was submitted. WHAT may the insurer do in this situation?
The insurer may obtain a legal judgment that forces the insured to pay the premium
Deny the claim until the past due premiums are paid, and then pay the claim
Deduct the premium owed from any claims payment
Delay paying the claim until the insured can prove he has the financial ability to pay the premiums
Gail's policy contains an 80 percent coinsurance provision and a 2,500 deductible. She suffered a 22,500 dollar loss. How much will Gail have to pay on this loss?
6500
16000
20000
19500
A person who has suffered a disability must go through a waiting period before benefits will be paid. WHAT is this waiting period called?
An elimination period
The self insured period
A deductible
A self insured retention amount
An insurer formed outside of Florida, but still within the United States is a:
An alien company
None of these
A foreign company
A domestic company
The Florida Act known as The Right to Try Act covers WHICH of the following?
Experimental medical treatments for those diagnosed as terminally ill, under certain circumstances
Patients have the right to access medical treatments not available in their health plan
The law gives Florida residents the right to try other medical providers that are not part of their medical plan's network
Hospice coverage for those who are terminally ill but desire to keep trying alternative medical treatments to cure the disease
The illegal act or practice of telling a client that ancillary coverage or benefits must be purchased at the same time as the policy is known as:
Churning
Sliding
Curling
Rebating
Insurers must retain copies of advertisements for HOW LONG?
Four years or until approved by the state, whichever period is shorter
Four years, or until the next examination by the Office, whichever is longer
For only as long as the advertisement is actually being used. Once it has been discontinued, the insurer is no longer required to keep files on the ads
For as long as the policy being advertised is still able to be sold by the carrier's agent force
When the applicant was issued a health insurance policy, he noticed that the premium increased because of his medical background. This means the policy has been subject to:
Increased premium rider
Rating, or rated-up policy
Large exposure rating
Non-standard risk rate
A person receiving disability income payment must receive the payments:
Not less frequently than semi annually
Not less frequently than monthly
Not less frequently than quarterly
Not less frequently than daily
The benefit period for Medicare Part A is HOW LONG?
90 days
120 days
60 days
150 days
Coverage for autism must be covered if the initial diagnosis was made before WHAT age of the insured?
It must have been diagnosed at four years of age or younger, and eligible individuals are those under the age of 16
It must have been diagnosed at 14 years of age or younger, and eligible individuals are those under the age of 18
It must have been diagnosed at ten years of age or younger, and eligible individuals are those under the age of 18
It must have been diagnosed at eight years of age or younger, and eligible individuals are those under the age of 18
How will an insured be rated in terms of the premium charged if he or she has more than one occupation?
The occupation in which the insured spends the most time on the job
Insured are only allowed to work one occupation to be covered by any health insurance policy
The more hazardous of the two occupations
The least hazardous occupation
Which of these statements would best describe coverage for a newborn child?
They are covered from the moment of birth, and notice of the birth must be given to the insurer within 30 days of the event
The parents will have to buy a new policy for any children that are born into the family
Children are only covered when the parents notify the insurance company, which must be done within 60 days
Children are only covered once they reach 15 days of age, and the parents of the child must provide notice to the insurer within 31 days of the birth
What is the maximum fine for failure to respond to a DFS request on a complaint in a timely manner?
500
250
1000
2500
An insured desiring to purchase more disability insurance coverage, but doesn't want to have to prove health, would purchase which of these riders?
A Double Indemnity death benefit rider
An impairment rider
Waiver of premium riders
A Guaranteed Insurability rider, also called an Additional Purchase Option
All of the following may be charged to a person under the Balance Billing Law if treatment was received from a non participating provider except:
The difference between what the carrier paid on a claim and the amount of the provider's billing
Deductibles
Coinsurance
Copayments
Physicians and surgeons are covered under what part of Medicare?
Part A
Part B
Part C
Part D
How often can an insurer require an insured who is receiving disability income benefits to undergo a physical examination to prove that he is still disabled?
6 months
12 months
Month
3 months
What rider can pay the premiums that are due on a policy if the policyholder is disabled and cannot make the premium payment?
Reduction of premiums rider
Refund of premium provisions
Waiver of the cost of insurance
Waiver of Premium
When an agent got mad at another insurer, he took out an advertisement that lied about the other company's claims practices. This is an example of:
Negative advertising
Defamation, which includes slander and libel
Comprehensive personal liability
Property damage liability, if done via written media
The term length of the Chief Financial Officer in Florida is:
There is no term limit
Four years
Six years
Two years
A grace period exists for what reason?
These are periods of time that require the insured to furnish the insurer with claims forms once a loss occurs
Grace periods provide the insured with extra time to file proof of loss forms once a loss has occurred
If added as a rider to the policy, it will give the insured more time to select an amount of coverage for a disability income contract
It gives the insured a period of time to make a premium payment after the due date and keeps the policy in force
Unclaimed property assets are to be held for a set period of time. That time is normally:
Six years
Two years
Four years
Five years
An employee that works for a company that has 75 employees has lost his group coverage due to not working enough hours to be considered full time. How may he continue coverage?
Conversion plan coverage
A choice of either COBRA or a state continuation plan
An individual plan only
COBRA continuation
What kind of policy pays a specified amount in the event of a covered loss?
Indemnification policy
Valued policy
Actual loss policy
Replacement cost policy
Insurers are allowed to require an insured receiving disability income benefits undergo a physical examination every:
Annually
Six months
Three months
Quarterly
WHICH of these renewal provisions says that the insurer must renew the policy until at least age 60 or 65?
Guaranteed renewable
Noncancellable
Cancellable policies
Future Purchase Option renewal provision
If a person contributes too much money to their Health Savings Account, WHAT is that referred to, and what is the federal penalty for these over contributions?
They are called redundant contributions, and the IRS will require a 10 percent penalty to be paid prior to the end of the tax year
They are referred to as extra fund contributions, and there is no penalty. The insured must adjust contributions for the next year to be compliant
They are excess contributions, and there is a six percent excise tax penalty unless the error is corrected in a specific manner
These are known as Over Contributions, and a 7 percent penalty must be paid to the IRS for each year over contributions were made
An applicant is aware that he has multiple health issues, but wants to apply for a disability contract anyways. The insurer is going to review the application, and look for:
Charging a premium that is high enough to cover the risk he presents
Making sure that when the policy is issued that there are plenty of pre-existing conditions attached to the contract.
Adverse selection
His finances and bank account activities
WHICH of the following best describes the coverage under COBRA continuation?
It converts the former group coverage to an individual insurance policy without proof of health
It allows families to select from many different individual policies if it loses group coverage
It is a continuation of the group insurance policy after a person separates from employment for other than gross or willful misconduct
COBRA only applies to employers that have purchased health care coverage through the insurance agents
WHAT is the coinsurance percentage in Medicare Part B?
20%
30%
25%
10%
Kelly, an applicant for health insurance, misstated gender on the application and filed a claim. Can the insurer do anything about this?
The claim will be denied
The insurer must pay the claim, but will only pay based on what the premium paid would have paid had the insurer known the correct gender of the insured
The insurer will suspend coverage under the policy until the insured pays the difference in premium to the insurer
The insurer will pay the claim, but cancel the policy afterwards due to fraud on the application for insurance
Pre authorization or prior approval for hospitalization is required for all of the following EXCEPT:
An insured that needs to have his hip replaced
Emergencies
The insured needs to have tests done to check for a disease
Having a bum knee repaired for an insured that has had the issue for some time
Regarding the Florida Life and Health Insurance Guaranty Fund, what is the maximum payable on an individual health insurance policy?
100000
250000
500000
1000000
David was just released from his disability claim with a clean bill of health. Three weeks later, he fell and reinjured his back, which was the loss that triggered the disability benefit. WHICH of these statements would be more accurate concerning his reinjury?
David will have to serve a brand new elimination period
He will not receive any benefits, as he cannot have more than one loss per year covered under his policy
He will not have to go through another elimination period due to the recurrent disability provision in his policy, as the reoccurrence happened within six months
He will not have to serve another elimination period, but his benefits will be cut in half
WHAT provision states that if any part of the policy does not conform with law, the policy will automatically change to comply with the law?
The Automatic Increase in Coverage feature
Conformity with State Statutes
Legal Requirement provisions
Liberalization clause
Regarding Medicare Supplements, WHICH of the following would be a correct statement?
Medicare Supplement policies cannot duplicate Medicare's benefits
A person may have as many Medigap plans as desired
Only those persons at or below the federal poverty level may purchase Medicare Supplement plans
Medicare Supplement policies require the insured to seek all treatment from within the insurer's network of providers
Of the following, WHICH provision is NOT a required policy provision?
Illegal drugs and narcotics provisions
Entire contract and changes provision
Legal actions and payment of claims provisions
Grace periods and notice of claim provisions
What are the minimum benefits required in an Affordable Care Act medical policy?
The ten essential benefits as laid out by the ACA
The ability of children to remain on their parent's policy once they turn age 26
A guarantee that coverage will be applied, no matter the reason or source of a loss
Coverage for accidental death and dismemberment losses
In Florida, HOW LONG is a Medicare Supplement policy's Right to Examine, or free look, by law?
60 days
30 days
31 days
90 days
Regarding the order of succession for beneficiaries, who is the second in line to receive death benefits?
The tertiary beneficiaries
The contingent beneficiaries
The estate of the insured
The primary beneficiary
If a physician want to perform a mammography on a patient, what is the test looking for?
Diabetes
Sickle cell anemia
Colon cancer
Breast cancer and abnormalities of the breast tissue
An admitted insurer receives WHAT as its permission to sell insurance in this state directly to consumers:
An Authorization to Operate letter
A certificate of authority
An approval certification
An admitted insurer registration certificate
COBRA continuation applies to employers with at least HOW MANY employees?
100
20
50
2
How are Medicare Supplement plans standardized?
The numbers 1 through 10, with plan 1 being the core plan
The letters A through N, with plan A being the core plan
The state insurance divisions who will determine which plan must be designated as the core plan
The names assigned to the policy by the issuing insurance companies, one of which must be designated the core plan
Are agents and insurers ever allowed to discriminate in the offering of insurance?
They are only allowed to discriminate based on race, ethnicity, or religion
The only time an insurer may discriminate is if the application shows that the person is single, as insurers prefer married couples due to lesser losses
Discrimination is not allowed in any form in the state of Florida, for any reason.
Only if the discrimination is based on actuarial data that shows a connection between the discrimination and potential for loss, for example, age differences are actuarially shown to make differences in terms of loss potential
Florida's laws on domestic violence would be best described as WHICH of these?
Domestic violence losses may only be used when an insurer considers renewing a policy
Insurers legally and regularly decline applications for insurance for those who have been victims of domestic violence
Domestic violence may only be considered if the victim contributed to the loss
Insurers are prohibited from considering domestic violence when underwriting or renewing a policy
WHAT basis for payment in a medical expense policy is based on the geographical region where the treatment was performed?
Scheduled coverage
Usual, Reasonable and Customary charges
Coinsurance
A benefit schedule
HOW quickly must insurers pay medical expense and disability claims?
Medical claims must be paid immediately upon proof of loss, and disability claims cannot be paid less frequently than monthly.
Medical claims must be paid immediately upon proof of loss, and disability claims cannot be paid less frequently than daily
Medical claims must be paid within 60 days of proof of loss, and disability claims cannot be paid less frequently than weekly
Medical claims must be paid with 14 days of proof of loss, and disability claims cannot be paid less frequently than quarterly
If a person wants to enroll in Medicare, HOW LONG is the initial open enrollment period?
One month
Three months
Six months
Seven months
Five employers would like to join together to purchase group insurance. WHAT type of group is this?
Multiple coverage groups
Multiple employer purchasing groups
Multiple Employer Trusts
Multiple group indemnity plans
WHAT type of Medicare Supplement policy requires that the insured receive all medical treatment from a network of providers, except for emergencies?
Part A of traditional Medicare
Major medical long term care policies
Medicare Advantage
Medicare Select
Bob has an Accidental Death and Dismemberment policy, and was killed in an accident. WHAT sum will be paid?
The total loss sum
The death benefit sum
The principal sum
The capital sum
Of the following policies, WHICH does not apply a deductible and pays from the first dollar spent on treatment?
Major medical insurance
Health Maintenance Organizations
Preferred Provider Organizations
Basic medical, surgical and hospital policies
Who are insurance contracts between?
The insurance company, the insured, and all financial institutions who hold loans with the insured
The insurance company and the policyowner
The insured and the carrier
The insurance company and the claims department
Stock insurers are owned by:
The State of Florida
Its policyholders
Its stockholders
Its board of directors
Another name for Medicare Part C plans is:
Part B plans
Medicare Advantage, or MA plans
Medicare Select plans
Medicare Supplement plans
For Affordable Care Act plans, are they allowed to have either lifetime or annual policy limits?
Only if purchased after January 1, 2020
Yes, but only for grandfathered plans
Yes, in all cases, assuming the state approves the filing from the insurer
Only if the insured agrees, in exchange for a less expensive premium
John wants conversion coverage under the Florida Health Insurance Coverage Continuation Act. How long must John have been insured through his group plan?
Six months
Three months
Two years
One Year
The Office of Insurance Regulation must examine authorized insurers at least once every:
One year (annually)
Four years
Two years
Five years
Jason has a multiple indemnity rider that will double his face amount in his policy if he dies accidentally. He is in an accident, but dies more than 13 months after the accident due to complication. Will the policy pay?
No, these riders only pay if the insured dies in a common carrier accident, like Amtrak, or United Airlines
No, these riders require that the insured die within a specified period of time after the accident, which is typically six to twelve months after the occurrence
Yes, but it will only pay if Jason had medical expense coverage that pays for his medical treatments
Yes, as long as it was shown that the accident was the primary cause of death
The period of time that a disability insured must wait after a loss, and before a claim is paid, is called:
A deductible
A waiting period
The probationary period
An elimination period
If a major medical policy has a monthly premium payment mode, WHAT would be the length of the grace period?
seven days
31 days
60 days
Ten days
If a policy lapses because the premium has not been paid, WHAT provision may allow the policyholder to get back the coverage?
The reinstatement provision
The grace period provision
The settlement provision
The recall provision
Doctors that accept whatever Medicare pays and cannot bill the beneficiary for additional charges is WHAT kind of physician according to Medicare?
An emergency room physician
An assignment physician
An HMO doctor
An any provider physician
An exchange of values is WHICH of the following contract elements?
Legal Purpose
Consideration
Offer and Acceptance
Competent Parties
In order to receive disability income benefits, WHICH of the following is the primary qualification?
An inability to perform the duties of one's occupation
The fact that the insured could be out of work for up to at least one week
An injury that prevents the insured from getting a different job
The insured must file a claim stating that he or she wants to receive benefits.
WHAT are the deductible choices for converted policies under the Florida Health Insurance Coverage Continuation Act?
2,500, 5,000, or 10,000 dollar deductibles
1,000, 2,500, or 5,000 dollar deductibles
250, 500, or 1,000 dollar deductibles
500, 1,000, or 2,500 dollar deductibles
Rebating is legal in Florida if all of the following conditions are met EXCEPT
It must be available to all insureds in the same actuarial class and be in accordance with the rebating schedule filed by the agent
The person paying the rebate cannot be a licensed insurance agent, as only unlicensed personnel may pay rebates to a policyholder
The rebate schedule must be prominently displayed in public view
Rebates must be applied uniformly so that those who purchase the same coverage receive the same rebate percentage
For insureds that seek emergency treatment outside of their network, are those claims covered?
No, non participating medical providers are only covered if they are within the insurer's network of providers
Only if the patient obtained a referral from his physician prior to being transported to the non participating hospital
Yes, out of network emergency services must be covered under Florida law, but the insurer may impose deductibles and coinsurance requirements that are different than the network requirements
Yes, however the patient will have a state required deductible of at least five thousand dollars
HOW do ACA plans treat maternity and pregnancy?
Only grandfathered plans cover maternity and pregnancy under the ACAs rules
ACA plans may not consider pregnancy a pre existing condition and must cover pregnancy and maternity concerns
Pregnancy may only be considered a pre existing condition if the applicant is pregnant at the time the policy is issued
The only type of contracts that are required to cover pregnancy are group insurance plans
A major medical policy has a 5,000 deductible and a coinsurance feature, and Cara suffered a 100,000 loss. How much of the loss will be subject to coinsurance?
95000
100000
75000
20000
Modal premium is another term for:
It is the insurer deciding on what type of premium payment they will allow the insured to make
Premium payment mode, which is the frequency of premium payments
The amount of each premium to be paid
It is the method of how the premiums are paid, like from a checking account or credit card, etc.
A policy labeled guaranteed renewable may only increase premium rates:
Only after a loss has occurred
When requested by the policyholder
It cannot raise rates at any time
Once per year
Mutual insurers are owned by:
Its board of directors
Its stockholders
The State of Florida
Its policyholders
