Health Insurance Florida 2-40 Practice Exam Questions 2
Which of the following is NOT a form of medical Business overhead expense (Explanation:Business Overhead Expense
insurance? insurance is designed to reimburse a business for overhead expenses in the
-Business overhead expense event a business owner becomes disabled. Expenses such as rent, utilities,
-Surgical expense telephone, equipment, employees' salaries, etc.)
-Hospital expense
-Long term care
All of the following are state or federal government Medigap (Explanation:A Medigap policy is a Medicare supplement insurance
programs that provide health insurance, EXCEPT? policy sold by private insurance companies to fill "gaps" in Medicare Parts A and
-Medicare B.)
-OASDI disability
-Medicaid
-Medigap
What type of health insurance is available to assist low- Medicaid
income individuals?
What types of reserves are set aside and held by health Premium and Claims reserves (Explanation:Reserves are set aside for the
insurance companies? payment of future claims.)
Group health insurance is generally written on a basis Participating (Explanation:Group plans written by mutual companies provide for
that provides for dividends or experience rating. What is dividends while stock companies frequently issue experience-rated plans.)
the basis called?
Which of the following is NOT TRUE regarding eligibility Can be eligible for Medicaid
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
Which of the following operates as a corporation, society, B) Fraternal associations
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
What does each member pay in a typical HMO plan? Fixed premium whether or not plan is used
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used
Which of the following is correct about those who are They must be told that'll be getting all the benefits from the Medicare Advantage
eligible for Medicare and wish to join an HMO? plan
-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
Joyce is totally disabled. Her HMO policy just terminated. Coverage ends after 18 months
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
, Health Insurance Florida 2-40 Practice Exam Questions 2
All of the following are correct regarding Florida Must deposit $100,000 with the Rehabilitation Administration Expense Fund
regulation of HMOs, EXCEPT? (Explanation:
-Must obtain a Certificate of Authority They must deposit $10,000 with the Rehabilitation Administration Expense
-Must file a report of its activities within 3 months of the Fund.)
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
What is "capitation" as it relates to an HMO? Fixed amount paid by an HMO to a physician for medical services
-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
When a person is covered by an HMO, the contract 10 days
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
Which of the following statements about health service They provide benefit payments directly to the hospitals and physicians providing
organizations is true? services
-They reimburse Policyowners directly for physicians'
fees
-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
What is the period of time for an HMO "open 30 days during every 18-month period
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
If an HMO is found guilty of unfair trade practices, what Up to $200,00
is the maximum penalty that can be charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000
Which of the following statements about Worker's Not all states have a workers compensation law
Compensation laws is INCORRECT?
-Employers can purchase coverage through the state
program, private insurers or can self-insure
-Worker's compensation provides benefits for work-
related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are
compensable by the employer without regard to fault
What year was the Social Security Act amended to add 1965
health insurance protection for the aged and disabled?
-1973
-1965
-1985
-1935
, Health Insurance Florida 2-40 Practice Exam Questions 2
All of the following are true statements about Workers Benefits are not paid unless there is employer negligence
Compensation, EXCEPT..?
-Benefits are not paid unless there is employer
negligence
-Pays benefits for work related injuries and illnesses
-Employee does not contribute to the plan
-All states have Workers Compensation laws
Which of the following is a state administered disability Workers Compensation
plan?
-Social Security
-Workers Compensation
-Medigap
-Medicare
All of the following are nontraditional methods of Commercial insurers
providing health insurance, EXCEPT?
-Multiple Employer Trusts
-Multiple Employer Welfare Arrangements
-Self-insurance
-Commercial insurers
All of the following are true about a multiple employer Large employers who have joined together to provide health insurance benefits
welfare arrangement (MEWA), EXCEPT? (Explanation:
-Required by law to have an employment-related MEWAs consist of small employers who join together to provide health insurance
common bond benefits for their employees)
-Often provide insurance on a self-insured basis
-Tax-exempt entities
-Large employers who have joined together to provide
health insurance benefits
Grouping small businesses together to obtain health Multiple Employer Trust (MET)
insurance as one large group is a characteristic of what
type of group?
-Multiple Employer Trust (MET)
-Franchise Health plan
-Health Maintenance Organization (HMO)
-Blue Cross/Blue Shield
Casey has a medical expense policy that provides a $1,500 (Explanation:
fixed rate of $150 per day for hospitalization. Casey is Casey's policy will only cover a fixed rate per day for hospitalization of $150. If
hospitalized for 10 days and incurred covered medical she is hospitalized for 10 days, then her policy will pay $1,500 ($150 x 10) of the
expenses of $20,000. What will her medical expense total $20,000 in expenses.)
policy pay?
-$1,500
-$20,000
-$15,000
-$3,000
Jamie has a reimbursement type medical expense policy $25,000 (Explanation:
with a maximum benefit of $500,000. She is hospitalized A reimbursement type policy will provide coverage for expenses incurred. In this
and incurs $25,000 in covered medical expenses. What case that would be the total $25,000.)
will her policy provide in coverage?
-$20,000
-$25,000
-$10,000
-$12,500
Which of the following will not be covered under Daily room and board
"Miscellaneous Expenses" of a hospital expense policy?
-Drugs
-Lab fees
-Daily room and board
-Use of operating room
There are three different approaches used by insurers in Physician schedule approach
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
, Health Insurance Florida 2-40 Practice Exam Questions 2
Charlie has a hospital expense policy and a surgical $2,500 (Explanation:
expense policy. The hospital pays $100 a day for room Hospital will pay - $1,000 for room and board ($100 per day for 10 days) and
and board and a maximum of $1,000 for miscellaneous $1,000 (maximum allowed) for miscellaneous expenses. Surgical will pay - $500
hospital charges. The surgical policy pays a maximum of (maximum allowed) for surgery)
$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
Once the insured has paid a specified amount of his 100%
expenses, under the stop-loss feature of a health
insurance policy, how much will the company then pay?
-75%
-20%
-80%
-100%
How will the "miscellaneous expenses" benefit be Multiple of daily room and board rate
expressed in a basic health insurance policy?
-Reasonable, usual and customary rates
-Multiple of daily room and board rate
-Approved charge per day rate
-Percentage of daily room and board rate
Roberta has a basic hospital expense policy with a $17,600 (Explanation:
$10,000 limit for benefits, coordinated with a major Total expenses are $20,000. Basic medical will pay the first $10,000 which
medical policy with a $500 corridor deductible and 80/20 leaves $10,000 remaining. Roberta will pay the first $500 of this $10,000 with
coinsurance provision. If she incurs a loss of $20,000, $9,500 remaining. Company will now pay 80% of $9,500 or $7,600. Total
how much will the insurer pay? company pays will be $10,000 from the basic medical plus $7,600 from the major
-$17,600 medical = $17,600)
-$18,000
-$11,900
-$2,400
Which of the following statements is TRUE about basic They usually have a stated limit for specific expenses
hospital, medical and surgical expense policies?
-The benefits provided are usually equal to the actual
expenses incurred
-They contain high deductibles
-They usually have a stated limit for specific expenses
-Benefits are provided for loss of income
Which of the following types of insurance policies Comprehensive major medical (Explanation:
combines several types of benefits and provides more Comprehensive major medical plans cover virtually all medical expenses in a
coverage than any of the others? single policy. Such as hospital, physician and surgeon, nursing care, drugs,
-Hospital expense physical therapy, x-rays, medical supplies, etc.)
-Comprehensive major medical
-Hospital indemnity
-Surgical expense
Wanda has a Major Medical policy with a flat deductible $1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the
of $250, coinsurance of 80%/20% and a stop-loss of remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total
$5,000. She has a covered claim for $5,500. What will amount of $1,300 ($250 deductible, plus 20% of 5,250).)
Wanda pay?
-$1,100
-$250
-$1,300
-$4,450
Travis has a Major Medical policy with a flat deductible of $1,500 (Explanation:
$500 and coinsurance of 80%/20% on the next $5,000 in Travis will pay the first $500 (deductible) and then 20% of the next $5,000
covered expenses with 100% coverage for any ($5,000 x .20 = $1,000. So Travis will pay a total of $1,500 (deductible plus 20%
remaining covered expenses. On an claim of $10,000, of $5,000).)
what amount will Travis pay?
-$2,500
-$1,500
-$2,000
-$1,000
Which of the following is NOT a form of medical Business overhead expense (Explanation:Business Overhead Expense
insurance? insurance is designed to reimburse a business for overhead expenses in the
-Business overhead expense event a business owner becomes disabled. Expenses such as rent, utilities,
-Surgical expense telephone, equipment, employees' salaries, etc.)
-Hospital expense
-Long term care
All of the following are state or federal government Medigap (Explanation:A Medigap policy is a Medicare supplement insurance
programs that provide health insurance, EXCEPT? policy sold by private insurance companies to fill "gaps" in Medicare Parts A and
-Medicare B.)
-OASDI disability
-Medicaid
-Medigap
What type of health insurance is available to assist low- Medicaid
income individuals?
What types of reserves are set aside and held by health Premium and Claims reserves (Explanation:Reserves are set aside for the
insurance companies? payment of future claims.)
Group health insurance is generally written on a basis Participating (Explanation:Group plans written by mutual companies provide for
that provides for dividends or experience rating. What is dividends while stock companies frequently issue experience-rated plans.)
the basis called?
Which of the following is NOT TRUE regarding eligibility Can be eligible for Medicaid
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
Which of the following operates as a corporation, society, B) Fraternal associations
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
What does each member pay in a typical HMO plan? Fixed premium whether or not plan is used
-Fixed premium based on a deductible and copay
-Fixed premium whether or not plan is used
-Premium based on how often plan is used
Which of the following is correct about those who are They must be told that'll be getting all the benefits from the Medicare Advantage
eligible for Medicare and wish to join an HMO? plan
-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
Joyce is totally disabled. Her HMO policy just terminated. Coverage ends after 18 months
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
, Health Insurance Florida 2-40 Practice Exam Questions 2
All of the following are correct regarding Florida Must deposit $100,000 with the Rehabilitation Administration Expense Fund
regulation of HMOs, EXCEPT? (Explanation:
-Must obtain a Certificate of Authority They must deposit $10,000 with the Rehabilitation Administration Expense
-Must file a report of its activities within 3 months of the Fund.)
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
What is "capitation" as it relates to an HMO? Fixed amount paid by an HMO to a physician for medical services
-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
When a person is covered by an HMO, the contract 10 days
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
Which of the following statements about health service They provide benefit payments directly to the hospitals and physicians providing
organizations is true? services
-They reimburse Policyowners directly for physicians'
fees
-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
What is the period of time for an HMO "open 30 days during every 18-month period
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
If an HMO is found guilty of unfair trade practices, what Up to $200,00
is the maximum penalty that can be charged?
-Up to $50,000
-Up to $150,000
-Up to $200,00
-Up to $100,000
Which of the following statements about Worker's Not all states have a workers compensation law
Compensation laws is INCORRECT?
-Employers can purchase coverage through the state
program, private insurers or can self-insure
-Worker's compensation provides benefits for work-
related injuries, illness or death
-Not all states have a workers compensation law
-Basic principle is that work-related injuries are
compensable by the employer without regard to fault
What year was the Social Security Act amended to add 1965
health insurance protection for the aged and disabled?
-1973
-1965
-1985
-1935
, Health Insurance Florida 2-40 Practice Exam Questions 2
All of the following are true statements about Workers Benefits are not paid unless there is employer negligence
Compensation, EXCEPT..?
-Benefits are not paid unless there is employer
negligence
-Pays benefits for work related injuries and illnesses
-Employee does not contribute to the plan
-All states have Workers Compensation laws
Which of the following is a state administered disability Workers Compensation
plan?
-Social Security
-Workers Compensation
-Medigap
-Medicare
All of the following are nontraditional methods of Commercial insurers
providing health insurance, EXCEPT?
-Multiple Employer Trusts
-Multiple Employer Welfare Arrangements
-Self-insurance
-Commercial insurers
All of the following are true about a multiple employer Large employers who have joined together to provide health insurance benefits
welfare arrangement (MEWA), EXCEPT? (Explanation:
-Required by law to have an employment-related MEWAs consist of small employers who join together to provide health insurance
common bond benefits for their employees)
-Often provide insurance on a self-insured basis
-Tax-exempt entities
-Large employers who have joined together to provide
health insurance benefits
Grouping small businesses together to obtain health Multiple Employer Trust (MET)
insurance as one large group is a characteristic of what
type of group?
-Multiple Employer Trust (MET)
-Franchise Health plan
-Health Maintenance Organization (HMO)
-Blue Cross/Blue Shield
Casey has a medical expense policy that provides a $1,500 (Explanation:
fixed rate of $150 per day for hospitalization. Casey is Casey's policy will only cover a fixed rate per day for hospitalization of $150. If
hospitalized for 10 days and incurred covered medical she is hospitalized for 10 days, then her policy will pay $1,500 ($150 x 10) of the
expenses of $20,000. What will her medical expense total $20,000 in expenses.)
policy pay?
-$1,500
-$20,000
-$15,000
-$3,000
Jamie has a reimbursement type medical expense policy $25,000 (Explanation:
with a maximum benefit of $500,000. She is hospitalized A reimbursement type policy will provide coverage for expenses incurred. In this
and incurs $25,000 in covered medical expenses. What case that would be the total $25,000.)
will her policy provide in coverage?
-$20,000
-$25,000
-$10,000
-$12,500
Which of the following will not be covered under Daily room and board
"Miscellaneous Expenses" of a hospital expense policy?
-Drugs
-Lab fees
-Daily room and board
-Use of operating room
There are three different approaches used by insurers in Physician schedule approach
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
, Health Insurance Florida 2-40 Practice Exam Questions 2
Charlie has a hospital expense policy and a surgical $2,500 (Explanation:
expense policy. The hospital pays $100 a day for room Hospital will pay - $1,000 for room and board ($100 per day for 10 days) and
and board and a maximum of $1,000 for miscellaneous $1,000 (maximum allowed) for miscellaneous expenses. Surgical will pay - $500
hospital charges. The surgical policy pays a maximum of (maximum allowed) for surgery)
$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
Once the insured has paid a specified amount of his 100%
expenses, under the stop-loss feature of a health
insurance policy, how much will the company then pay?
-75%
-20%
-80%
-100%
How will the "miscellaneous expenses" benefit be Multiple of daily room and board rate
expressed in a basic health insurance policy?
-Reasonable, usual and customary rates
-Multiple of daily room and board rate
-Approved charge per day rate
-Percentage of daily room and board rate
Roberta has a basic hospital expense policy with a $17,600 (Explanation:
$10,000 limit for benefits, coordinated with a major Total expenses are $20,000. Basic medical will pay the first $10,000 which
medical policy with a $500 corridor deductible and 80/20 leaves $10,000 remaining. Roberta will pay the first $500 of this $10,000 with
coinsurance provision. If she incurs a loss of $20,000, $9,500 remaining. Company will now pay 80% of $9,500 or $7,600. Total
how much will the insurer pay? company pays will be $10,000 from the basic medical plus $7,600 from the major
-$17,600 medical = $17,600)
-$18,000
-$11,900
-$2,400
Which of the following statements is TRUE about basic They usually have a stated limit for specific expenses
hospital, medical and surgical expense policies?
-The benefits provided are usually equal to the actual
expenses incurred
-They contain high deductibles
-They usually have a stated limit for specific expenses
-Benefits are provided for loss of income
Which of the following types of insurance policies Comprehensive major medical (Explanation:
combines several types of benefits and provides more Comprehensive major medical plans cover virtually all medical expenses in a
coverage than any of the others? single policy. Such as hospital, physician and surgeon, nursing care, drugs,
-Hospital expense physical therapy, x-rays, medical supplies, etc.)
-Comprehensive major medical
-Hospital indemnity
-Surgical expense
Wanda has a Major Medical policy with a flat deductible $1,300 (Wanda will pay the first $250 (her deductible) and then 20% of the
of $250, coinsurance of 80%/20% and a stop-loss of remainder ($5,250, remainder amount, x .20 = $1,050. So Wanda will pay a total
$5,000. She has a covered claim for $5,500. What will amount of $1,300 ($250 deductible, plus 20% of 5,250).)
Wanda pay?
-$1,100
-$250
-$1,300
-$4,450
Travis has a Major Medical policy with a flat deductible of $1,500 (Explanation:
$500 and coinsurance of 80%/20% on the next $5,000 in Travis will pay the first $500 (deductible) and then 20% of the next $5,000
covered expenses with 100% coverage for any ($5,000 x .20 = $1,000. So Travis will pay a total of $1,500 (deductible plus 20%
remaining covered expenses. On an claim of $10,000, of $5,000).)
what amount will Travis pay?
-$2,500
-$1,500
-$2,000
-$1,000
