Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - ANSWER Business overhead expense (Explanation:Business Overhead
Expense insurance is designed to reimburse a business for overhead expenses in the event a
business owner becomes disabled. Expenses such as rent, utilities, telephone, equipment,
employees' salaries, etc.)
What type of health insurance is available to assist low-income individuals? - ANSWER
Medicaid
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 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.)
1
,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
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?
2
,-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
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
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 - ANSWER Fixed amount paid
by an HMO to a physician for medical services
Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
3
, -They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing services -
ANSWER They provide benefit payments directly to the hospitals and physicians
providing services
When a person is covered by an HMO, the contract certificate or member's handbook must
be delivered within how many days after approval of the enrollment by the HMO?
-20 days
-10 days
-5 days
-14 days - ANSWER 10 days
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
-45 days during every 12-month period - ANSWER 30 days during every 18-month period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can be
charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - ANSWER Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can self-
insure
4
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care - ANSWER Business overhead expense (Explanation:Business Overhead
Expense insurance is designed to reimburse a business for overhead expenses in the event a
business owner becomes disabled. Expenses such as rent, utilities, telephone, equipment,
employees' salaries, etc.)
What type of health insurance is available to assist low-income individuals? - ANSWER
Medicaid
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 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.)
1
,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
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?
2
,-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
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
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 - ANSWER Fixed amount paid
by an HMO to a physician for medical services
Which of the following statements about health service organizations is true?
-They reimburse Policyowners directly for physicians' fees
3
, -They provide loss of income benefits to Policyowners
-They reimburse Policyowners directly for all medical expenses
-They provide benefit payments directly to the hospitals and physicians providing services -
ANSWER They provide benefit payments directly to the hospitals and physicians
providing services
When a person is covered by an HMO, the contract certificate or member's handbook must
be delivered within how many days after approval of the enrollment by the HMO?
-20 days
-10 days
-5 days
-14 days - ANSWER 10 days
What is the period of time for an HMO "open enrollment"?
-45 days during every 18-month period
-30 days during every 12-month period
-30 days during every 18-month period
-45 days during every 12-month period - ANSWER 30 days during every 18-month period
If an HMO is found guilty of unfair trade practices, what is the maximum penalty that can be
charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000 - ANSWER Up to $200,00
Which of the following statements about Worker's Compensation laws is INCORRECT?
-Employers can purchase coverage through the state program, private insurers or can self-
insure
4
