HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM QUESTIONS -2 WITH CORRECT ANSWERS

HEALTH INSURANCE FLORIDA 2-40
PRACTICE EXAM QUESTIONS #2
WITH CORRECT ANSWERS GRADED
A+ FOR 2026-2027 ASSURED EXCEL!!
WhichjofjthejfollowingjisjNOTjajformjofjmedicaljinsurance?

-Businessjoverheadjexpense

-Surgicaljexpense

-Hospitaljexpense

-Longjtermjcarej-jjCORRECTjANSWERS-
Businessjoverheadjexpensej(Explanation:BusinessjOverheadjExpensejinsurancejisjdesignedjtojreim
bursejajbusinessjforjoverheadjexpensesjinjthejeventjajbusinessjownerjbecomesjdisabled.jExpensesjs
uchjasjrent,jutilities,jtelephone,jequipment,jemployees'jsalaries,jetc.)



Alljofjthejfollowingjarejstatejorjfederaljgovernmentjprogramsjthatjprovidejhealthjinsurance,jEXCEPT
?

-Medicare

-OASDIjdisability

-Medicaid

-Medigapj-jjCORRECTjANSWERS-
Medigapj(Explanation:AjMedigapjpolicyjisjajMedicarejsupplementjinsurancejpolicyjsoldjbyjprivateji
nsurancejcompaniesjtojfillj"gaps"jinjMedicarejPartsjAjandjB.)



Whatjtypejofjhealthjinsurancejisjavailablejtojassistjlow-incomejindividuals?j-jjCORRECTjANSWERS-
Medicaid



Whatjtypesjofjreservesjarejsetjasidejandjheldjbyjhealthjinsurancejcompanies?j-jjCORRECTjANSWERS-
PremiumjandjClaimsjreservesj(Explanation:Reservesjarejsetjasidejforjthejpaymentjofjfuturejclaims.)

,Groupjhealthjinsurancejisjgenerallyjwrittenjonjajbasisjthatjprovidesjforjdividendsjorjexperiencejratin
g.jWhatjisjthejbasisjcalled?j-jjCORRECTjANSWERS-
Participatingj(Explanation:Groupjplansjwrittenjbyjmutualjcompaniesjprovidejforjdividendsjwhilejsto
ckjcompaniesjfrequentlyjissuejexperience-ratedjplans.)



WhichjofjthejfollowingjisjNOTjTRUEjregardingjeligibilityjforjsubsidiesjforjfamiliesjunderjthejnewjhealt
hjcarejact?

-Forjthosejwhojmakejbetweenj100-400%jofjthejFederaljPovertyj-Level

-Cannotjbejcoveredjbyjanjemployer

-CannotjbejeligiblejforjMedicare

-CanjbejeligiblejforjMedicaidj-jjCORRECTjANSWERS-CanjbejeligiblejforjMedicaid



Whichjofjthejfollowingjoperatesjasjajcorporation,jsociety,jorjassociationjtojprovidejlifejinsurancejpri
marilyjforjthejmutualjbenefitjofjitsjmembers,jhasjajlodgejorjsocialjsystemjwithjritualsjandjrepresenta
tivejformjofjgovernment?

A)jMutualjcompanies

B)jFraternaljassociations

C)jStockjcompanies

-Fraternaljbenefitjsocietyj-jjCORRECTjANSWERS-B)jFraternaljassociations



WhatjdoesjeachjmemberjpayjinjajtypicaljHMOjplan?

-Fixedjpremiumjbasedjonjajdeductiblejandjcopay

-Fixedjpremiumjwhetherjorjnotjplanjisjused

-Premiumjbasedjonjhowjoftenjplanjisjusedj-jjCORRECTjANSWERS-
Fixedjpremiumjwhetherjorjnotjplanjisjused



WhichjofjthejfollowingjisjcorrectjaboutjthosejwhojarejeligiblejforjMedicarejandjwishjtojjoinjanjHMO?

,-TheyjmustjhavejajcurrentjMedicarejsupplementjpolicy

-Theyjmustjbejtoldjthat'lljbejgettingjalljthejbenefitsjfromjthejMedicarejAdvantagejplan

-Theyjmustjbejagej70jandjabove

-TheyjmustjhavejbeenjenrolledjpreviouslyjinjanjHMOj-jjCORRECTjANSWERS-
Theyjmustjbejtoldjthat'lljbejgettingjalljthejbenefitsjfromjthejMedicarejAdvantagejplan



Joycejisjtotallyjdisabled.jHerjHMOjpolicyjjustjterminated.jAlljofjthejfollowingjarejcorrectjregardingj"e
xtensionjofjbenefits"jforjJoyce,jEXCEPT?

-Coveragejendsjoncejmaximumjbenefitsjhavejbeenjexhausted

-Coveragejendsjoncejanotherjcarrierjassumesjcoverage

-Coveragejendsjifjnojlongerjtotallyjdisabled

-Coveragejendsjafterj18jmonthsj-jjCORRECTjANSWERS-Coveragejendsjafterj18jmonths



AlljofjthejfollowingjarejcorrectjregardingjFloridajregulationjofjHMOs,jEXCEPT?

-MustjobtainjajCertificatejofjAuthority

-Mustjfilejajreportjofjitsjactivitiesjwithinj3jmonthsjofjthejendjofjeachjfiscaljyear

-Mustjdepositj$100,000jwithjthejRehabilitationjAdministrationjExpensejFund

-Mustjbejsoldjbyjagentsjlicensedjandjappointedjasjhealthjinsurancejagentsj-jjCORRECTjANSWERS-
Mustjdepositj$100,000jwithjthejRehabilitationjAdministrationjExpensejFundj(Explanation:

Theyjmustjdepositj$10,000jwithjthejRehabilitationjAdministrationjExpensejFund.)



Whatjisj"capitation"jasjitjrelatesjtojanjHMO?

-AmountjtojbejcollectedjbyjthejHMOjfromjparticipatingjhealthjcarejproviders

-FixedjamountjpaidjbyjanjHMOjduringjajpolicyjperiod

-FixedjamountjpaidjbyjanjHMOjtojajphysicianjforjmedicaljservices

-AmountjrequiredjtojbejdepositedjwithjthejStatejofjFloridaj-jjCORRECTjANSWERS-
FixedjamountjpaidjbyjanjHMOjtojajphysicianjforjmedicaljservices

, WhenjajpersonjisjcoveredjbyjanjHMO,jthejcontractjcertificatejorjmember'sjhandbookjmustjbejdelive
redjwithinjhowjmanyjdaysjafterjapprovaljofjthejenrollmentjbyjthejHMO?

-20jdays

-10jdays

-5jdays

-14jdaysj-jjCORRECTjANSWERS-10jdays



Whichjofjthejfollowingjstatementsjaboutjhealthjservicejorganizationsjisjtrue?

-TheyjreimbursejPolicyownersjdirectlyjforjphysicians'jfees

-TheyjprovidejlossjofjincomejbenefitsjtojPolicyowners

-TheyjreimbursejPolicyownersjdirectlyjforjalljmedicaljexpenses

-Theyjprovidejbenefitjpaymentsjdirectlyjtojthejhospitalsjandjphysiciansjprovidingjservicesj-
jjCORRECTjANSWERS-


Theyjprovidejbenefitjpaymentsjdirectlyjtojthejhospitalsjandjphysiciansjprovidingjservices



WhatjisjthejperiodjofjtimejforjanjHMOj"openjenrollment"?

-45jdaysjduringjeveryj18-monthjperiod

-30jdaysjduringjeveryj12-monthjperiod

-30jdaysjduringjeveryj18-monthjperiod

-45jdaysjduringjeveryj12-monthjperiodj-jjCORRECTjANSWERS-30jdaysjduringjeveryj18-monthjperiod



IfjanjHMOjisjfoundjguiltyjofjunfairjtradejpractices,jwhatjisjthejmaximumjpenaltyjthatjcanjbejcharged?

-Upjtoj$50,000

-Upjtoj$150,000

-Upjtoj$200,00

-Upjtoj$100,000j-jjCORRECTjANSWERS-Upjtoj$200,00