Worksheetshealth exam part2
Total questions: 73
Worksheet time: 37mins
An Accidental Death and Dismemberment policy has a principal sum of $500,000 dollars, and the insured person lost one arm in an accident. How much will the policy pay?
250000
1000000
100000
500000
WHAT are insurance companies formed in Florida called?
An alien company
A domestic company
None of these
A foreign company
WHICH part of Medicare is the medical portion, and requires a monthly premium and annual deductible?
Part A
Part B
Part C
Part D
Convincing a policyholder to drop an in-force policy in favor of a replacement policy without fully disclosing the positive and negative facts regarding the replacement is WHAT type of illegal trade practice?
Shifting
Rebating
Twisting
Twirling
There are contracts that are not subject to bargaining or negotiation. WHAT type of contracts are these?
Contracts of adhesion
Multilateral contracts
Unilateral contracts
Aleatory contracts
Books and records pertaining to premium payments must be retained for HOW long?
Four years
Five years
Until the agency closes
Three years
If a carrier wants to cancel a health insurance policy, ALL of the following reasons are allowed EXCEPT:
The insured did not pay the required premium by the end of the grace period
The insured refused to pay his copayments that were due
The health of the insured has taken a turn for the worse, and the carrier is concerned over the potential for large claims in the future
The insured has purposely misrepresented material facts when submitting a claim
If a person is terminally ill, a doctor must certify that the beneficiary has HOW much life expectancy remaining in order to qualify for Medicare hospice coverage?
Six months
Eight months
No minimum, as long as a doctor certifies the need
Three months
Proof of loss forms must be filed by the insured within HOW MANY days, unless the insured is determined to be legally incapacitated?
30
180
14
90
An insurer ran an applicant's credit, and the applicant wants to know the scope and nature of the inquiry. The insurer must provide this information within HOW many days of the request?
Three days
Five days
14 days
30 days
For other than premium payment records, agencies are required to maintain policy records for:
Three years in all cases
For five years after the policy has expired
There is no requirement to keep policy records once they have been submitted to the insurance company
For as long as the agency remains in business
Which part of Medicare has a per occurrence deductible?
Part B
Part A
Part D
Part C
The Affordable Care Act mandates that insurance plans may be either of the following:
ACA compliant or NON-ACA compliant plans
Grandfathered or nongrandfathered plans
Approved plans or unapproved plans
Compliant or noncompliant plans
Premium rate increases on ACA plans may only be done on WHICH of the following bases?
If the insured has had losses in excess of the national averages
Based on the age of the insured
If it can prove that its losses are attributable to a class of specific insureds, such as electricians
The ACA prevents rate increases and they are not allowed under any circumstances
General Lines agents may transact all of the following types of insurance EXCEPT:
Property insurance
Life insurance
Automobile insurance
Marine insurance
WHO is the only party to an insurance contract that makes any promises?
The insured
The insurer
The applicant for the policy
Both the insured and the insurance company make promises
If a policy contains any unclear or ambiguous language, the law says that it must be ruled against the party that drew up the contract. This rule is called the:
Rule of seven
Rule of valued contracts
Rule of strict construction
Rule of insurable interest
The ACA requires that plans purchased through the marketplace have a grace period of:
90 days
14 days
180 days
120 days
All of the following are required coverages in Florida EXCEPT for:
Gambling addiction
Diabetes and cleft palate
Osteoporosis
Mammograms and Mastectomies
A Notice of Claim must be provided by the insured within how many days following a loss?
30
20
180
90
When taking an application from a prospective insured, when should the initial premium be taken by the agent?
Agents should never accept initial premium directly from the applicant. Instead, the insurer will send the applicant a bill for the premium
Agents should always attempt to get the initial premium from the applicant, as it shows commitment on the part of the insured
Only when the applicant states that the premium will be drawn from a bank account on a pre-authorized basis
If, in the agent's opinion, the insured represents a standard or better risk to the insurer
Licensees are required to respond to a written request from the Department of Financial Services regarding a written complaint within:
30 days
20 days
They must reply as soon as reasonably possible
15 days
An insurer issued a policy that did not meet state law, but the policy has a provision that will automatically make the policy conform to the law's minimum requirements. WHAT is this provision?
Entire contract and changes provision
Incontestability provision
Conformity with State Statutes
Time limit on certain defenses provision
Sandra told her insurer that she was 35 years old, when she was really 40. She paid 100 dollars per month, when she should have paid 150 dollars per month. Sandra had a covered loss of 30,000 dollars. How much will Sandra receive on this claim?
30000
The claim will be denied, and nothing will be paid to the insured.
20000
10000
"Insurance on insurance" is another way of referring to:
Double insurance
Reinsurance
Follow-up insurance
Reciprocal insurance
WHICH of the following statements best describes Medicare?
A federal health care program for those age 65 and over, and certain people under age 65 with qualifying disabilities
A state run program for those who cannot afford medical insurance
A federal savings program that uses private insurance companies to provide benefits
A program meant for those at or below the federal poverty level
If a person continues coverage under the Florida Health Insurance Coverage Continuation Act, HOW MUCH is the premium?
150 percent of the group insurance rate
100 percent of the group insurance rate
120 percent of the group insurance rate
115 percent of the group insurance rate
Once an insurer has received the proper notice of claim from an insured, it must get claim forms to the insured within:
15 days
30 days
90 days
As soon as reasonably possible
For those enrolled in an HMO, a primary care physician is also known as:
The primary provider
The gatekeeper and referral physician
The provider doctor
The governing physician
WHAT regulatory body oversees Medicare and Medicaid in the United States?
The Centers for Medicare and Medicaid Services, or the CMS
The individual states oversee Medicaid on a federal level
The individual insurance companies that have members on a regulatory committee
The United States Treasury Department
An agent that has sold a Medicare Supplement policy was paid a first year commission of 300 dollars. What is the MOST the agent could be paid for the second year commission?
400
200
150
No limit, it depends on how much the premium is
How many hours of continuing education must a licensee complete if they have been licensed for two years?
19 hours
15 hours
5 hours
21 hours
Of the following plans, which plan has a network but allows non-network access at any time?
PPOs
Gatekeeper plans
Major medical policies
HMOs
Connie has a Health Savings Account. What else must Connie have in order to be compliant with the law?
A PPO plan
A high deductible health plan, or HDHP
An HMO plan
Individual major medical coverage
All of these are powers shared by the DFS and OIR except:
The power to enforce the provisions of the Insurance Code
The power to approve policies
The power to perform investigations of insurance matters
The power to employ actuaries as at-will employees
Sally was mad that her insurer denied her health insurance claim, and she wants to sue the carrier. Sally must wait how long after she has filed proof of loss to sue her insurer?
60 days
90 days
180 days
30 days
Medicaid is funded through:
Excise taxes on imports to the United States
Voluntary contributions from charities
State and federal revenues
Taxes on Social Security benefits
If a person knowingly helps or represents an unauthorized and nonadmitted insurer, the person is guilty of which of the following crimes?
A felony of the third degree
A felony of the first degree
A fine of $5,000 per violation
Nothing; this practice is allowed in Florida
If a medical expense policy is reinstated, how long will the insured have to wait for illness to be covered?
45 days
Ten days
60 days
30 days
If an insurer authorizes a policy to be delivered to the agent instead of the policyholder, that is known as:
Transfer of Authority
Constructive delivery of the policy
Policy acceptance authority
Actual policy delivery
The Hospital portion of Medicare is which part of Medicare?
Hearing aids, eyeglasses, and assisted living help for disabled individuals
Hospitals and other facilities
Medical claims from doctors and other individual providers
Prescription drugs
Insurers must file a policy for approval with the OIR how long prior to its use?
20 days
60 days
25 days
30 days
Kim participates in her school's basketball program. What kind of insurance policy will cover her while she is playing in practice or in a game?
Disability insurance
Cancer coverage
An HMO
A blanket policy
A medical plan that offers prepaid coverage and has prevention as its emphasis is which of the following plans?
HMOs
PPOs
Major medical policies
Limited benefit plans
An insured has a policy which will pay an additional amount in the event of accidental death. This is known as:
A multiple indemnity rider or policy
Extra benefit option
Future purchase options, or FPO
The increased benefit guarantee
The renewal provision that states that the insurer can nonrenew a disability income policy if the insured is unemployed at the time of renewal is WHICH of the following?
Cancelable policies
Conditionally renewable
Optionally Renewable
Guaranteed renewable
To be fully insured, Social Security recipients must have HOW MANY calendar quarters of credit?
At least 40 calendar quarters of work credits
At least 40,000 dollars average salary per year
The beneficiary must have accumulated at least 30 work credits to be considered fully insured
Not less than 10 quarters of credit earned in the past 20 years
Stanley misstated his age on his insurance application. WHAT actions may be taken by the insurance company?
The insurance company will give the insured a period of 180 days to correct the deficiency
Age misstatements are considered fraudulent misrepresentations, so the policy will be canceled immediately
The insurer may cancel the policy with at least 10 days notice
An insurer cannot cancel a policy due to age misstatements, and can only adjust either the benefits payable or the premium.
If a policyholder designated a beneficiary as irrevocable, this means WHICH of the following?
The only way the beneficiary may be changed is with permission of the insurance company
Only group life insurance policies may have irrevocable beneficiaries
The policyholder cannot change the beneficiary without the written consent of the irrevocable person named
Once named, a policyholder can never change any kind of beneficiary designation
Agents that have been found guilty of twisting or churning violations may be disciplined in WHICH of the following ways?
A fine of up to 25,000 dollars for non willful violations and a fine of up to 75,000 dollars for willful violations
A fine of up to 5,000 dollars for non willful violations and a fine of up to 75,000 dollars for willful violations
A fine of up to 1,000 dollars for non willful violations and a fine of up to 25,000 dollars for willful violations
A fine of up to 2,500 dollars for non willful violations and a fine of up to 100,000 dollars for willful violations
How many days must a beneficiary have been in a hospital in order to qualify for Skilled Nursing Facility coverage?
One month
Ten
Five
Three
A person that has gone on Medicaid may place their Medicare Supplement policy in suspension for up to HOW LONG?
Indefinitely while on Medicaid
One year
Four years
Two years
HOW LONG does an insurance company have to contest statements that have been made on the application for insurance under the Time Limit on Certain Defenses provision?
There is no time limit, insurers may contest payment under the policy for misrepresentations made in the application for insurance
Two years
Five years
Three years
WHAT part of Medicare covers prescription drugs?
Part A
Part B
Part C
Part D
William's insurance company issues his policy, but with a preexisting exclusion. WHAT form is used by the insurer for this purpose?
There is no form for this, the insurer will simply deny all claims associated with the preexisting condition
An impairment rider or waiver
A medical declination provision
This cannot happen, as no insurance policy may exclude coverage for pre existing conditions due to the Affordable Care Act
If a person owns a bus company, WHAT kind of policy would they sell to their passengers to cover accidents while on a bus?
A travel accident policy, which is a form of blanket insurance
A small group health insurance policy
A term health insurance contract
A credit insurance group policy
WHAT parties are required to sign applications for insurance?
The agent
The insured
The underwriter
The applicant, the agent, and the insured, if different than the applicant
XYZ insurer was formed in Canada. WHAT type of insurer is XYZ?
A foreign company
An alien company
A domestic company
None of these
WHAT is a primary difference between a Medicare Supplement policy and a Medicare Advantage, or Part C policy?
Medicare Supplement policies provide long term care coverage, whereas Medicare Advantage policies do not
They are exactly the same kinds of policies
A Medicare Advantage, or MA policy typically provides more coverage than a Medigap policy, for example vision and dental coverage
There is no real difference, other than the fact that Medicare Supplements have been standardized by the federal government
HOW LONG may an individual disability income policy exclude for preexisting conditions?
Preexisting condition exclusions are no longer allowed under the Affordable Care Act
Up to six months after the effective date of the policy
Up to one year from the policy issue date
A maximum of three months
Under the Affordable Care Act, a child is no longer eligible to remain on his parent's policy as of WHAT age?
16
26
18
21
Funds that are received by an agent must be held in WHICH of the following?
The licensee must keep it in the same account as all the other funds, but designated as trust funds
The licensee is not allowed to accept these kinds of funds, in any capacity
The licensee must open a new account to keep the trust funds, and close the account when the transaction is finished
The licensee must keep it in a separate account
WHAT is a small amount of money paid at the time that services are rendered, and primarily associated with HMOs called?
Cost reduction provision
Copayment
Cost sharing amount
Deductible
Licensees must notify the DFS if they change addresses, phones, or business location within HOW many days?
15
45
10
30
Of the following, all of these scenarios create a special enrollment period for medical coverage EXCEPT:
A person loses their coverage under Medicare, Medicaid or the Children's Health Insurance Plan
Death of the insured employee in a group plan
An insured chooses the wrong plan, and decides that a different plan would work better
The insured got divorced from the insured employee
WHEN must the outline of coverage and buyer's guide be delivered to an applicant for a Medicare Supplement policy?
No later than the time of application
As soon as reasonably possible
These are not required for Medicare Supplement policies, but are required for Medicare Advantage contracts
When the policy is delivered to the insured
Agents receive premium funds in their fiduciary capacity. WHAT does this mean?
It means the licensee is acting as both "owner" and "custodian" of the funds - and that they are in a special position of trust and confidence
It means the licensee may keep the funds and use as they see fit
It means the licensee is the "trustee" or "custodian" of the funds, and not the owner - and that they are in a special position of trust and confidence
A licensee will never receive funds in a "fiduciary capacity"
WHAT policy would people want if they desired the ability to see any provider and not be restricted to a network?
All plans allow the insured to seek treatment from any medical provider by law, and a policy cannot restrict the providers a patient can see
Major Medical insurance
A PPO plan
An HMO plan
Blanket health insurance policies have WHICH of the following renewal provisions?
Period of Time for Renewal provision
Renewable at the option of the Insured provision
They are Period of Time, or Term Health contracts, and do not renew. A new policy would be purchased if the coverage was wanted for a new situation, like the new school year
Conditionally renewable
In terms of taxes, WHICH of the following statements would be correct?
If a person can deduct premiums on their tax forms any benefit received will usually be taxable
Benefits from insurance policies are only taxable if someone other than the insured paid the premiums
Taxes paid health insurance benefits are always taxed as long term capital gains
Insurance benefits are never taxable
WHAT are the three parts, or sections, of a health insurance policy?
Two parts, including the insuring agreement part and the representational part
There are 3 parts, the general information part, the medical information part, and the agent's report
There is only one part, which is the entire application
There are three parts to the application, and they are the information part, the signature line part, and the agent's report
For agents to legally sell long term care in Florida, what qualifications are required?
Have a health insurance license, and then complete a one-time four-hour LTC training course
Attend at least three educational courses that are provided by long-term care insurance companies
Have a health insurance license, complete an initial eight-hour training course, and a four-hour refresher course each licensing period thereafter
Obtain a health insurance license only
A Health Savings Account, or HSA, has WHICH of the following attributes?
HSAs require that the account owner earn compensation of at least $50,000 per year
It allows pre-tax contributions to the account, and if used for qualified medical expenses, is a tax-free benefit
It provides taxable benefits to the account owner if used for qualified medical expenses
HSAs are only available in individual contracts, but are prohibited in group contracts
