2-40 Health and Accident Insurance State Exam Prep with 100% verified correct answers

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 $100 deductible and 80/20 coinsurance. How much will Q be responsible for paying on this claim? $2,100 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 Under an Individual Disability policy in Florida, what is the minimum schedule of time in which claims must be made to an insured? Monthly Under a Long Term Care policy, which benefit would be typically excluded or limited? Alcohol rehabilitation P is a Major Medical policyowner who is hospitalized as a result of injuries sustained from participating in a carjacking. How will the insurer most likely handle this claim? Claim will be denied A mutual insurance company and a stock insurance company have one main difference between them. What is the Major contrast? Stock company is owned by its shareholders. Mutual company is owned by its policyholders. Upon reaching the limiting age, a handicapped child can extend their health insurance coverage as a dependent only if the child is incapable of employment and chiefly dependent on the policyowner Which Unfair Trade Practice involves an agent suggesting that an insurance policy is like a share of stock? Misrepresentation Which of the following provisions is NOT required in HMO contracts/certificates? Seven-day grace period As a condition for a bank loan, a bank requires the borrower to purchase credit insurance from a specific company. What is the bank guilty of? Coercion Long Term Care policies will usually pay for eligible benefits using which of the following methods? Expense incurred What is the main reason for regulating the insurance industry? Maintain the solvency of insurance companies 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 prepaid application for individual Disability Income insurance was recently submitted to an insurer. When the insurer received the Medical Information Bureau (MIB) report, the report showed that the applicant had suffered a stroke 18 months ago, something that was not disclosed on the application. Which of the following actions would the insurance company NOT take? Send a notice to the MIB that the applicant was denied Which Unfair Trade Practice involves an agent telling a prospective client that a policy's dividends are guaranteed? Misrepresentation