Final Exam - Florida Life and Health
A 66 year-old is covered under a group health plan while employed with a business that has 40
employees. If she injures herself while walking in the park, what coverage would be considered
primary? - ANS -Her group health plan.
If the employer has more than 20 employees, the group health plan generally pays first.
\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 application. How
will the insurer handle this claim? - ANS -Claim will be paid and coverage will remain in force.
After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in
which the insurer may not deny a claim based on information not disclosed at the time of
application.
\A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The
policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two
claims were paid in September 2013, each incurring medical expenses in excess of the
deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as
well. What would be this family's out-of-pocket medical expenses for 2013? - ANS -1,000.
In this situation, the insured's maximum out-of-pocket expenses for 2013 would be $1,000.
\A life insurance policy that provides a policyowner with cash value along with a level face
amount is called - ANS -Whole life-
Whole life provides the insured with a cash value as well as a level face amount.
\A life insurance policyowner may sell their policy to a(n) _____ in order to receive a percentage
of the policy's face value. - ANS -viatical settlement provider.
To receive a percentage of the policy face value, an owner of a life policy may sell the policy to a
viatical settlement provider.
\A life policy loan in Florida cannot charge a fixed rate of interest higher than - ANS -The
maximum fixed interest rate permitted on a life policy loan is 10%.
\A mutual insurance company and a stock insurance company have one main difference
between them. What is this major contrast? - ANS -Stock company is owned by its
shareholders. Mutual company is owned by its policyholders.
\A policyowner's rights are limited under which beneficiary designation? - ANS -Irrevocable.
An irrevocable beneficiary designation requires the consent and signature of that named
beneficiary before a change of beneficiary occurs.
\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? - ANS -Send a notice to the MIB that the applicant was declined.
The MIB does not need to be notified that coverage was denied.
Submit
\A prospective insured completes and signs an application for health insurance but intentionally
conceals information about a pre-existing heart condition. The company issues the policy. Two
months later, the insured suffers a heart attack and submits a claim. While processing the claim,
the company discovers the pre-existing condition. In this situation, the company will - ANS
-continue coverage but exclude the heart condition.
If the insured did not cite the condition on the application and the insurer did not exclude the
conditon, the pre-existing condition provision still applies. Exclusions are subject to the "time
limit on certain defenses" provision, however.
\A Return of Premium life insurance policy is - ANS -Whole life and Increasing term.
A Return of Premium life insurance policy is whole life insurance with a death benefit rider of
increasing term insurance equal to the amount of premiums paid. If the insured dies within the
period of term, the beneficiary will receive face amount plus the value of all paid premiums.
\A statement made by an insured in an insurance application that must be true to the best of
one's knowledge and which becomes a part of the contract is known as - ANS -A representation
is a statement made by an insured in an insurance application that must be true to the best of
one's knowledge and which becomes a part of the contract.
\A stock life insurance company that issues both participating and nonparticipating policies is
doing business on - ANS -a mixed plan.
When a stock life insurance company issues both participating and nonparticipating policies, the
company is doing business on a mixed plan.
\A term life insurance policy matures - ANS -upon the insured's death during the term of the
policy.
Term life policies can only mature (pay out the face amount) if death occurs during the term of
the policy.
\According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare
Supplement applicant? - ANS -At the time of application.
Florida insurance law requires that if a Medicare Supplement policy is sold, the agent must
deliver an Outline of Coverage to the applicant no later than when the application is taken.
\According to Florida law, which of the following information does NOT need to be obtained by
an agent recommending an annuity purchase? - ANS -Marital status.
Florida law requires an agent who is recommending the purchase of an annuity to a person to
obtain information regarding all of these EXCEPT the person's marital status.
A 66 year-old is covered under a group health plan while employed with a business that has 40
employees. If she injures herself while walking in the park, what coverage would be considered
primary? - ANS -Her group health plan.
If the employer has more than 20 employees, the group health plan generally pays first.
\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 application. How
will the insurer handle this claim? - ANS -Claim will be paid and coverage will remain in force.
After a policy has been in force for 2 (sometimes 3) years, it enters the incontestable period, in
which the insurer may not deny a claim based on information not disclosed at the time of
application.
\A Hospital/Surgical Expense policy was purchased for a family of four in March of 2013. The
policy was issued with a $500 deductible and a limit of four deductibles per calendar year. Two
claims were paid in September 2013, each incurring medical expenses in excess of the
deductible. Two additional claims were filed in 2014, each in excess of the deductible amount as
well. What would be this family's out-of-pocket medical expenses for 2013? - ANS -1,000.
In this situation, the insured's maximum out-of-pocket expenses for 2013 would be $1,000.
\A life insurance policy that provides a policyowner with cash value along with a level face
amount is called - ANS -Whole life-
Whole life provides the insured with a cash value as well as a level face amount.
\A life insurance policyowner may sell their policy to a(n) _____ in order to receive a percentage
of the policy's face value. - ANS -viatical settlement provider.
To receive a percentage of the policy face value, an owner of a life policy may sell the policy to a
viatical settlement provider.
\A life policy loan in Florida cannot charge a fixed rate of interest higher than - ANS -The
maximum fixed interest rate permitted on a life policy loan is 10%.
\A mutual insurance company and a stock insurance company have one main difference
between them. What is this major contrast? - ANS -Stock company is owned by its
shareholders. Mutual company is owned by its policyholders.
\A policyowner's rights are limited under which beneficiary designation? - ANS -Irrevocable.
An irrevocable beneficiary designation requires the consent and signature of that named
beneficiary before a change of beneficiary occurs.
\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? - ANS -Send a notice to the MIB that the applicant was declined.
The MIB does not need to be notified that coverage was denied.
Submit
\A prospective insured completes and signs an application for health insurance but intentionally
conceals information about a pre-existing heart condition. The company issues the policy. Two
months later, the insured suffers a heart attack and submits a claim. While processing the claim,
the company discovers the pre-existing condition. In this situation, the company will - ANS
-continue coverage but exclude the heart condition.
If the insured did not cite the condition on the application and the insurer did not exclude the
conditon, the pre-existing condition provision still applies. Exclusions are subject to the "time
limit on certain defenses" provision, however.
\A Return of Premium life insurance policy is - ANS -Whole life and Increasing term.
A Return of Premium life insurance policy is whole life insurance with a death benefit rider of
increasing term insurance equal to the amount of premiums paid. If the insured dies within the
period of term, the beneficiary will receive face amount plus the value of all paid premiums.
\A statement made by an insured in an insurance application that must be true to the best of
one's knowledge and which becomes a part of the contract is known as - ANS -A representation
is a statement made by an insured in an insurance application that must be true to the best of
one's knowledge and which becomes a part of the contract.
\A stock life insurance company that issues both participating and nonparticipating policies is
doing business on - ANS -a mixed plan.
When a stock life insurance company issues both participating and nonparticipating policies, the
company is doing business on a mixed plan.
\A term life insurance policy matures - ANS -upon the insured's death during the term of the
policy.
Term life policies can only mature (pay out the face amount) if death occurs during the term of
the policy.
\According to Florida law, when must an agent deliver the Outline of Coverage to a Medicare
Supplement applicant? - ANS -At the time of application.
Florida insurance law requires that if a Medicare Supplement policy is sold, the agent must
deliver an Outline of Coverage to the applicant no later than when the application is taken.
\According to Florida law, which of the following information does NOT need to be obtained by
an agent recommending an annuity purchase? - ANS -Marital status.
Florida law requires an agent who is recommending the purchase of an annuity to a person to
obtain information regarding all of these EXCEPT the person's marital status.
