FLORIDA 2-40 HEALTH INSURANCE EXAM
REVISION HANDBOOK 2026 UNDERWRITING
CLAIMS AND REGULATORY COMPLIANCE
◉ All of the following are state or federal government programs that
provide health insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap.
Answer: Medigap (Explanation:A Medigap policy is a Medicare
supplement insurance policy sold by private insurance companies to
fill "gaps" in Medicare Parts A and B.)
◉ What type of health insurance is available to assist low-income
individuals?.
Answer: Medicaid
◉ What types of reserves are set aside and held by health insurance
companies?.
Answer: Premium and Claims reserves (Explanation:Reserves are
set aside for the payment of future claims.)
,◉ Group health insurance is generally written on a basis that
provides for dividends or experience rating. What is the basis
called?.
Answer: Participating (Explanation:Group plans written by mutual
companies provide for dividends while stock companies frequently
issue experience-rated plans.)
◉ Which of the following is NOT TRUE regarding eligibility for
subsidies for families under the new health care act?
-For those who make between 100-400% of the Federal Poverty -
Level
-Cannot be covered by an employer
-Cannot be eligible for Medicare
-Can be eligible for Medicaid.
Answer: Can be eligible for Medicaid
◉ Which of the following operates as a corporation, society, or
association to provide life insurance primarily for the mutual benefit
of its members, has a lodge or social system with rituals and
representative form of government?
A) Mutual companies
B) Fraternal associations
C) Stock companies
-Fraternal benefit society.
,Answer: B) Fraternal associations
◉ What does each member pay in a typical HMO plan?
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used.
Answer: Fixed premium whether or not plan is used
◉ Which of the following is correct about those who are eligible for
Medicare and wish to join an HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the
Medicare Advantage plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO.
Answer: They must be told that'll be getting all the benefits from the
Medicare Advantage plan
◉ Joyce is totally disabled. Her HMO policy just terminated. All of the
following are correct regarding "extension of benefits" for Joyce,
EXCEPT?
-Coverage ends once maximum benefits have been exhausted
-Coverage ends once another carrier assumes coverage
, -Coverage ends if no longer totally disabled
-Coverage ends after 18 months.
Answer: Coverage ends after 18 months
◉ All of the following are correct regarding Florida regulation of
HMOs, EXCEPT?
-Must obtain a Certificate of Authority
-Must file a report of its activities within 3 months of the end of each
fiscal year
-Must deposit $100,000 with the Rehabilitation Administration
Expense Fund
-Must be sold by agents licensed and appointed as health insurance
agents.
Answer: Must deposit $100,000 with the Rehabilitation
Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration
Expense Fund.)
◉ What is "capitation" as it relates to an HMO?
-Amount to be collected by the HMO from participating health care
providers
-Fixed amount paid by an HMO during a policy period
-Fixed amount paid by an HMO to a physician for medical services
-Amount required to be deposited with the State of Florida.
REVISION HANDBOOK 2026 UNDERWRITING
CLAIMS AND REGULATORY COMPLIANCE
◉ All of the following are state or federal government programs that
provide health insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap.
Answer: Medigap (Explanation:A Medigap policy is a Medicare
supplement insurance policy sold by private insurance companies to
fill "gaps" in Medicare Parts A and B.)
◉ What type of health insurance is available to assist low-income
individuals?.
Answer: Medicaid
◉ What types of reserves are set aside and held by health insurance
companies?.
Answer: Premium and Claims reserves (Explanation:Reserves are
set aside for the payment of future claims.)
,◉ Group health insurance is generally written on a basis that
provides for dividends or experience rating. What is the basis
called?.
Answer: Participating (Explanation:Group plans written by mutual
companies provide for dividends while stock companies frequently
issue experience-rated plans.)
◉ Which of the following is NOT TRUE regarding eligibility for
subsidies for families under the new health care act?
-For those who make between 100-400% of the Federal Poverty -
Level
-Cannot be covered by an employer
-Cannot be eligible for Medicare
-Can be eligible for Medicaid.
Answer: Can be eligible for Medicaid
◉ Which of the following operates as a corporation, society, or
association to provide life insurance primarily for the mutual benefit
of its members, has a lodge or social system with rituals and
representative form of government?
A) Mutual companies
B) Fraternal associations
C) Stock companies
-Fraternal benefit society.
,Answer: B) Fraternal associations
◉ What does each member pay in a typical HMO plan?
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used.
Answer: Fixed premium whether or not plan is used
◉ Which of the following is correct about those who are eligible for
Medicare and wish to join an HMO?
-They must have a current Medicare supplement policy
-They must be told that'll be getting all the benefits from the
Medicare Advantage plan
-They must be age 70 and above
-They must have been enrolled previously in an HMO.
Answer: They must be told that'll be getting all the benefits from the
Medicare Advantage plan
◉ Joyce is totally disabled. Her HMO policy just terminated. All of the
following are correct regarding "extension of benefits" for Joyce,
EXCEPT?
-Coverage ends once maximum benefits have been exhausted
-Coverage ends once another carrier assumes coverage
, -Coverage ends if no longer totally disabled
-Coverage ends after 18 months.
Answer: Coverage ends after 18 months
◉ All of the following are correct regarding Florida regulation of
HMOs, EXCEPT?
-Must obtain a Certificate of Authority
-Must file a report of its activities within 3 months of the end of each
fiscal year
-Must deposit $100,000 with the Rehabilitation Administration
Expense Fund
-Must be sold by agents licensed and appointed as health insurance
agents.
Answer: Must deposit $100,000 with the Rehabilitation
Administration Expense Fund (Explanation:
They must deposit $10,000 with the Rehabilitation Administration
Expense Fund.)
◉ What is "capitation" as it relates to an HMO?
-Amount to be collected by the HMO from participating health care
providers
-Fixed amount paid by an HMO during a policy period
-Fixed amount paid by an HMO to a physician for medical services
-Amount required to be deposited with the State of Florida.
