2024 FLORIDA STATUTES, RULES
AND REGULATIONS PERTINENT TO
HEALTH INSURANCE EXAM WITH
CORRECT ANSWERS
Minimum Benefit Standards - CORRECT ANSWERS- Florida law regulates the
minimum standards for coverage.
Grandfathered Health Plan - CORRECT ANSWERS- Section 42&18011 of the
US Code says that any group health plans participants have the right to
maintain coverage when the insured's changes plans and to have creditable
coverage count toward HIPAA eligibility relating to pre-existing conditions
exclusions.
Non-grandfathered health plans - CORRECT ANSWERS- Plans or policy
contracts that do to have to provide the creditable coverage benefits.
Florida Healthy Kids Corporation - CORRECT ANSWERS- Provides health
coverage for children without comprehensive affordable health care services.
Eligibility Requirements
1. must be Fl residents
2. Under the age of 19
3. Family income below 200%of federal poverty level
4. Must not qualify for Medicaid
5. Not covered by any employers health care coverage
Requirements relating to HIV/Aids - CORRECT ANSWERS- HIPAA dictates that
protected health information must be kept private.
Privacy Rule - CORRECT ANSWERS- Pat=i.e. to have the right to view their
own records and who's access those records in the last 6 years.
If insurers needs the information that applicant has the right to refuse access
and permission.
Individual Health Insurance Policies - CORRECT ANSWERS- Cannot exclude
coverage for pre-existing conditions for longer than 24 months following the
effective date of coverage.
, Insurer are required to credit to provide credit for pre-existing conditions for
the time their person was covered under the previous coverage in the new
policy. If previous coverage was effective 63 days prior to the new coverage .
*The application must clearly request information about p[re-existing
conditions if the provision is to apply.*
Group Health Insurance Polcies - CORRECT ANSWERS- Must make available
to policy holders coverage for mental and nervous disorders. These benefits
must meet minimum standards
Individual and Group Health Coverage: Minimum Standards - CORRECT
ANSWERS- BOTH MUST
• Provide coverage for handicapped children
• Provide coverage for a newly born child for the 1st 18 months
• Must be renewable at the option of the individual
Coverage Exceptions or Exclusions - CORRECT ANSWERS- Exceptions:
Florida Law provides that individual and group health insurance policies and
HOM contracts must be renewable at the option of the policy holder UNLESS:
• Failure to pay premiums in a timely manner
• Fraud or misrepresenting of material fact
• Failure to meet minimum participation or minimum contribution
requirements of a group policy.
• Insurer ceases offering that coverage in a market
• For network plans or bonfire assoc. there isn't an individual or group
enrollee resides or works in the service area, provided that this requirements
is applied uniformly.
Health Insurers may exclude payment of benefits under a health plan that
are covered under Workers Compensation or are services rendered by the
Veterans Administration.
Coordination of Benefits - CORRECT ANSWERS- Insurance companies may
work together between group insurance and ind. health insurance benefits.
Does not include Indemnity plans.
HMO's FLorida Statues and Regulations: - CORRECT ANSWERS- HMO's:
• Can only offer plans approved by the Department and cannot engage in
any other activity.
• An insurance company can own or sponsor an HMO
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