HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM
(ACTUAL 2026/2027) QUESTIONS & ANSWERS
(VERIFIED)
There are three different approaches used by insurers in
providing basic surgical expense coverage and determining
the benefits payable. Which of the following is NOT one of
these approaches?
-Reasonable and customary approach
-Physician schedule approach
-Relative value scale approach
-Surgical schedule approach - <<<Answers>>>Physician
schedule approach
Charlie has a hospital expense policy and a surgical expense
policy. The hospital pays $100 a day for room and board and
a maximum of $1,000 for miscellaneous hospital charges. The
surgical policy pays a maximum of $500 for any one
operation. If Charlie was hospitalized for 10 days and had
charges of $200 per day for room and board, $1,500 for
miscellaneous expenses, and $2,000 for surgical expenses.
What will his policies pay of these expenses?
-$3,500
-$1,000
-$5,500
-$2,500 - <<<Answers>>>$2,500 (Explanation:
Hospital will pay - $1,000 for room and board ($100 per day
for 10 days) and $1,000 (maximum allowed) for
,)
miscellaneous expenses. Surgical will pay - $500 (maximum
allowed) for surgery)
Proof of loss is required within days of loss.
A) 45
B)180
C) 60
D) 90 - <<<Answers>>>90
(The Proof of Loss Provision (a Mandatory Uniform
Provision) stipulates the insured is to prove their loss within
90 days of the loss, or in the shortest time possible, but not to
exceed 1 year unless the insured suffers legal incapacity.)
Which of the following is not a Mandatory Uniform
Provision?
A) Payments of Claims
B) Reinstatement
C) Conformity with State Statutes
D) Physical Exam & Autopsy - <<<Answers>>>Conformity
with State Statutes
Harry was hospitalized in a coma for 6 months. Since no one
knew about his health care coverage, when does proof of loss
have to be submitted?
A) Within 1 year, unless he suffers legal incapacity.
,B) Anytime, since he was in a coma and obviously could not
submit a claim.
C) Within 2 years, covered under the contestable period.
D) An executor would be appointed by the courts to handle
the necessary paperwork - <<<Answers>>>Within 1 year,
unless he suffers legal incapacity.
(The Proof of Loss Provision (a Mandatory Uniform
Provision) stipulates the insured is to prove their loss within
90 days of the loss, or in the shortest time possible, but not to
exceed 1 year unless the insured suffers legal incapacity.)
Which statement is INACCURATE regarding the Change of
Occupation Provision?
A) Change to a less hazardous occupation, insured may apply
for a rate reduction.
B) Change to a more hazardous occupation, upon claim,
benefits will be reduced to that which premiums paid would
have purchased at the more hazardous occupation.
C) Insured must notify the insurer of a change of occupation,
or policy will be cancelled.
D) If the insured works at two occupations, rates for the most
hazardous occupation will be charged. -
<<<Answers>>>Insured must notify the insurer of a change
of occupation, or policy will be cancelled.
, )
(Failure to notify the insurer of a change of occupation will
not result in cancellation of the policy.)
Optional Uniform Provisions are included in the contract at
the option.
A) Insured's
B) Insurer's
C) Commissioner's
D) No one's option, they are regulated by statute. -
<<<Answers>>>Insurer's
(The Optional Uniform Provisions are included at the insurer's
option; however, if used they must conform to that state's
Insurance Code.)
If liability is denied due to the insured being intoxicated or
under the influence, it is because of which provision?
A) Legal Actions
B) Illegal Act
C) Conformity with State Statutes
D) Intoxicants and Narcotics - <<<Answers>>>Intoxicants
and Narcotics
(ACTUAL 2026/2027) QUESTIONS & ANSWERS
(VERIFIED)
There are three different approaches used by insurers in
providing basic surgical expense coverage and determining
the benefits payable. Which of the following is NOT one of
these approaches?
-Reasonable and customary approach
-Physician schedule approach
-Relative value scale approach
-Surgical schedule approach - <<<Answers>>>Physician
schedule approach
Charlie has a hospital expense policy and a surgical expense
policy. The hospital pays $100 a day for room and board and
a maximum of $1,000 for miscellaneous hospital charges. The
surgical policy pays a maximum of $500 for any one
operation. If Charlie was hospitalized for 10 days and had
charges of $200 per day for room and board, $1,500 for
miscellaneous expenses, and $2,000 for surgical expenses.
What will his policies pay of these expenses?
-$3,500
-$1,000
-$5,500
-$2,500 - <<<Answers>>>$2,500 (Explanation:
Hospital will pay - $1,000 for room and board ($100 per day
for 10 days) and $1,000 (maximum allowed) for
,)
miscellaneous expenses. Surgical will pay - $500 (maximum
allowed) for surgery)
Proof of loss is required within days of loss.
A) 45
B)180
C) 60
D) 90 - <<<Answers>>>90
(The Proof of Loss Provision (a Mandatory Uniform
Provision) stipulates the insured is to prove their loss within
90 days of the loss, or in the shortest time possible, but not to
exceed 1 year unless the insured suffers legal incapacity.)
Which of the following is not a Mandatory Uniform
Provision?
A) Payments of Claims
B) Reinstatement
C) Conformity with State Statutes
D) Physical Exam & Autopsy - <<<Answers>>>Conformity
with State Statutes
Harry was hospitalized in a coma for 6 months. Since no one
knew about his health care coverage, when does proof of loss
have to be submitted?
A) Within 1 year, unless he suffers legal incapacity.
,B) Anytime, since he was in a coma and obviously could not
submit a claim.
C) Within 2 years, covered under the contestable period.
D) An executor would be appointed by the courts to handle
the necessary paperwork - <<<Answers>>>Within 1 year,
unless he suffers legal incapacity.
(The Proof of Loss Provision (a Mandatory Uniform
Provision) stipulates the insured is to prove their loss within
90 days of the loss, or in the shortest time possible, but not to
exceed 1 year unless the insured suffers legal incapacity.)
Which statement is INACCURATE regarding the Change of
Occupation Provision?
A) Change to a less hazardous occupation, insured may apply
for a rate reduction.
B) Change to a more hazardous occupation, upon claim,
benefits will be reduced to that which premiums paid would
have purchased at the more hazardous occupation.
C) Insured must notify the insurer of a change of occupation,
or policy will be cancelled.
D) If the insured works at two occupations, rates for the most
hazardous occupation will be charged. -
<<<Answers>>>Insured must notify the insurer of a change
of occupation, or policy will be cancelled.
, )
(Failure to notify the insurer of a change of occupation will
not result in cancellation of the policy.)
Optional Uniform Provisions are included in the contract at
the option.
A) Insured's
B) Insurer's
C) Commissioner's
D) No one's option, they are regulated by statute. -
<<<Answers>>>Insurer's
(The Optional Uniform Provisions are included at the insurer's
option; however, if used they must conform to that state's
Insurance Code.)
If liability is denied due to the insured being intoxicated or
under the influence, it is because of which provision?
A) Legal Actions
B) Illegal Act
C) Conformity with State Statutes
D) Intoxicants and Narcotics - <<<Answers>>>Intoxicants
and Narcotics
