215 FL License exam | Questions and Correct
Solutions | latest Update 2024/2025| Graded A+
s:
1. What is the primary purpose of health insurance?
o A) To provide income during unemployment
o B) To cover medical expenses
o C) To offer life coverage
o D) To provide retirement benefits
Answer...
1. What is the primary purpose of health insurance?
o A) To provide income during unemployment
o B) To cover medical expenses
o C) To offer life coverage
o D) To provide retirement benefits
Answer: B) To cover medical expenses
Rationale: Health insurance is specifically designed to help cover the costs of
medical care, including hospital stays, surgeries, and prescriptions.
2. Which of the following is a characteristic of a Preferred Provider Organization
(PPO)?
o A) Requires members to select a primary care physician
o B) Offers higher benefits for in-network services
o C) Does not cover out-of-network care
o D) Is the same as a Health Maintenance Organization (HMO)
Answer: B) Offers higher benefits for in-network services
Rationale: PPOs allow members to choose any provider but provide better
coverage for services obtained from in-network providers.
3. What is the term for the maximum amount an insurance company will pay for
covered services in a policy year?
o A) Deductible
o B) Copayment
o C) Out-of-pocket maximum
o D) Coverage limit
Answer: C) Out-of-pocket maximum
Rationale: The out-of-pocket maximum is the cap on what an insured individual
must pay for covered services in a policy year, after which the insurer covers
100% of costs.
4. Which of the following is NOT typically covered by health insurance?
o A) Preventive care
o B) Cosmetic surgery
o C) Emergency services
o D) Prescription medications
Answer: B) Cosmetic surgery
Rationale: Most health insurance plans do not cover cosmetic procedures that are
not medically necessary.
5. In Florida, what is the minimum age for obtaining a health insurance license?
o A) 18
o B) 21
o C) 16
, o D) 25
Answer: A) 18
Rationale: Applicants must be at least 18 years old to obtain a health insurance
license in Florida.
6. What is a "deductible"?
o A) The fixed amount paid for each visit
o B) The total amount the insurer will pay
o C) The amount paid out of pocket before coverage kicks in
o D) The percentage of costs covered by the insurer
Answer: C) The amount paid out of pocket before coverage kicks in
Rationale: A deductible is the amount a policyholder must pay before their
insurance begins to pay for covered expenses.
7. What does "pre-existing condition" refer to?
o A) A condition that arises after the policy is issued
o B) A condition diagnosed before coverage begins
o C) Any condition that cannot be treated
o D) A rare medical condition
Answer: B) A condition diagnosed before coverage begins
Rationale: A pre-existing condition is any health issue that was present before the
start of a health insurance policy, which may affect coverage.
8. What is an "exclusion" in an insurance policy?
o A) A type of coverage
o B) A provision that eliminates coverage for certain conditions
o C) A discount on premiums
o D) A guaranteed renewal clause
Answer: B) A provision that eliminates coverage for certain conditions
Rationale: Exclusions specify what is not covered by the insurance policy.
9. Which of the following describes the "coinsurance" feature of an insurance policy?
o A) A fixed amount paid for services
o B) A percentage of costs that the insured pays after the deductible
o C) The total out-of-pocket expense
o D) A premium discount
Answer: B) A percentage of costs that the insured pays after the deductible
Rationale: Coinsurance is the share of costs covered by the insured after they
have met their deductible, usually expressed as a percentage.
10. Which type of health plan typically has the lowest premiums but requires referrals
for specialists?
o A) PPO
o B) HMO
o C) EPO
o D) POS
Answer: B) HMO
Rationale: Health Maintenance Organizations (HMOs) generally offer lower
premiums but require members to use a primary care physician for referrals to
specialists.
, s:
21. What is "primary care"?
o A) Specialty care for complex conditions
o B) General healthcare services provided by a primary physician
o C) Emergency medical services
o D) Preventive screenings
Answer: B) General healthcare services provided by a primary physician
Rationale: Primary care refers to the first point of contact for individuals seeking
healthcare and typically involves routine check-ups and preventive care.
22. Which of the following refers to the practice of insurance fraud?
o A) Reporting a false claim
o B) Underwriting policies accurately
o C) Negotiating provider contracts
o D) Performing preventive care
Answer: A) Reporting a false claim
Rationale: Insurance fraud occurs when an individual intentionally misrepresents
facts to receive an undeserved insurance benefit.
23. What is "preventive care"?
o A) Treatment for existing illnesses
o B) Services aimed at preventing diseases or detecting them early
o C) Emergency medical services
o D) Rehabilitation services
Answer: B) Services aimed at preventing diseases or detecting them early
Rationale: Preventive care includes services like vaccinations and screenings to
prevent illness and promote health.
24. What does the term "subrogation" refer to in insurance?
o A) The right of an insurer to seek reimbursement from a third party
o B) The process of underwriting a policy
o C) The reassessment of premium rates
o D) The adjustment of claims
Answer: A) The right of an insurer to seek reimbursement from a third party
Rationale: Subrogation allows insurers to pursue a third party that caused a loss
to recover the amount they paid to the insured.
25. What is a "high-deductible health plan" (HDHP)?
o A) A plan with low premiums and high out-of-pocket costs
o B) A plan that covers only preventive care
o C) A policy without a deductible
o D) A type of Medicare plan
Answer: A) A plan with low premiums and high out-of-pocket costs
Rationale: HDHPs generally have lower premiums but higher deductibles,
encouraging insured individuals to take a more active role in their healthcare
expenses.
26. What is the purpose of the Affordable Care Act (ACA)?
o A) To increase insurance premiums
o B) To reduce the number of uninsured individuals
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