Chapter 29: Florida Statutes, Rules & Regulations Pertinent to Health Insurance. (18%) Exam

Chapter 29: Florida Statutes, Rules & Regulations Pertinent to Health Insurance. (18%) Exam Required & Optional Coverage - answerMedical Providers Diabetes Coverage (Equipment, Supplies & Outpatient Self-Management Training Osteoporosis Coverage Coverage for newborn children (30 days) Coverage for adopted, foster, custodial and natural born children Coverage for children w/disabilities Coverage for mastectomies Coverage for mammograms Required & Optional Coverage Part 2 - answerCannot be excluded for fibrocystic condition Coverage for cleft lip & cleft palate of children Rebates for participation in wellness program Prohibited Provisions - answerInpatient Hospital coverage from being limited Denial or excluded from coverage for breast cancer if the person has remained breast cancer free for 2 years Breast cancer follow-up care from being considered an evaluation for pre-existing condition unless if found prohibited cancellation for HIV/AIDS Eligible Groups - answerTrustee group policy Employee group policy Associations Labor unions Small employer health alliance Debtor group policy Blanket Health Insurance Continuation - answerTo ensure continued access to affordable health insurance coverage to employees of small employers and their dependents (Mini-COBRA) Conversion - answerTo convert one policy to another Previous policy was terminated by employer for reasons other than lack of payment First premium must be paid no later than 63 days after termination. Coordination of Benefits - answerIf the insured has 2 types of insurance they must both agree to cover the cost within an order Outline of Coverage - answerCompleted and delivered to the applicant at the time of application Renewal Agreements/Nonrenewal and Cancellation - answerAn insurer that provides individual or group health insurance coverage must renew the coverage at the option of the individual or group policyholder 90 days before date of nonrenewal by insurer. If a particular health insurance is discontinued 180 days notice before date of nonrenewal if discontinued in Florida (All plans) Advertising - answerAdvertising materials must clearly indicate that it is related to insurance products Certificate of Coverage - answerEach employee covered under a group policy must receive a certificate of coverage when they enroll in a group health insurance plan Must contain the group # & ensential features of the insurance coverage. Group Blanket Health - answerCovers special groups of individuals -Passengers on common carriers Institution of learning (school, college) Volunteer fire dept. or first aid group An organization (Boy scouts, FFA) Newspaper carriers Health care provider covering patient