HEALTH INSURANCE FLORIDA 2-40 PRACTICE EXAM
QUESTIONS #2 WITH ACCURATE ANSWERS 2024 -25
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care ANS -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.)
All of the following are state or federal government programs that provide health insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap ANS -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 type of health insurance is available to assist low-income individuals? ANS -Medicaid
What types of reserves are set aside and held by health insurance companies? ANS -Premium and
Claims reserves (Explanation:Reserves are set aside for the payment of future claims.)
Group health insurance is generally written on a basis that provides for dividends or experience rating.
What is the basis called? ANS -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 ANS -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 ANS -B) Fraternal associations
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 ANS -Fixed premium whether or not plan is used
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 ANS -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?
-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 ANS -Coverage ends after 18 months
,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 ANS -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 ANS -Fixed amount paid by an HMO to a
physician for medical 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 ANS -10 days
Which of the following statements about health service organizations is true?
-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 ANS -They
provide benefit payments directly to the hospitals and physicians providing services
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 ANS -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 ANS -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
-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
ANS -Not all states have a workers compensation law
What year was the Social Security Act amended to add health insurance protection for the aged and
disabled?
-1973
-1965
-1985
-1935 ANS -1965
All of the following are true statements about Workers 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
QUESTIONS #2 WITH ACCURATE ANSWERS 2024 -25
Which of the following is NOT a form of medical insurance?
-Business overhead expense
-Surgical expense
-Hospital expense
-Long term care ANS -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.)
All of the following are state or federal government programs that provide health insurance, EXCEPT?
-Medicare
-OASDI disability
-Medicaid
-Medigap ANS -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 type of health insurance is available to assist low-income individuals? ANS -Medicaid
What types of reserves are set aside and held by health insurance companies? ANS -Premium and
Claims reserves (Explanation:Reserves are set aside for the payment of future claims.)
Group health insurance is generally written on a basis that provides for dividends or experience rating.
What is the basis called? ANS -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 ANS -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 ANS -B) Fraternal associations
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 ANS -Fixed premium whether or not plan is used
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 ANS -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?
-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 ANS -Coverage ends after 18 months
,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 ANS -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 ANS -Fixed amount paid by an HMO to a
physician for medical 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 ANS -10 days
Which of the following statements about health service organizations is true?
-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 ANS -They
provide benefit payments directly to the hospitals and physicians providing services
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 ANS -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 ANS -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
-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
ANS -Not all states have a workers compensation law
What year was the Social Security Act amended to add health insurance protection for the aged and
disabled?
-1973
-1965
-1985
-1935 ANS -1965
All of the following are true statements about Workers 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
