FLORIDA 2-15 INSURANCE LICENSE EXAM paper
with Correct Answers 2025 Graded A+
◉ Group Health Insurance. Answer: Issued by commercial insurers and
service organizations, provides coverage under a master contract to members
of a specified group. (Mandatory maternity for group) -can be participating
but rare.
◉ Medicaid. Answer: State level, purpose is to provide matching federal funds
to states for their medical public assistance plans to help needy persons,
regardless of age.
◉ Medicare. Answer: 1966. Primary source for health insurance. Federal
government provides hospital and medical expense insurance protection to
those age 65+, to those any age suffering from chronic kidney disease, or
those who receive SS disability benefits. (10 supplements, 30 day free look)
◉ Renewability Provisions. Answer: Cancellable, Optionally Renewable, Non-
cancellable, Guaranteed Renewable (CONG)
◉ Premium Factors & Modes. Answer: Interest, expense, types of benefits, and
morbidity.
◉ Claims. Answer: The amount of insurance coverage is readily determined by
the policy, and benefits are payable if the insured has died.
,◉ Contract of Reimbursement. Answer: The benefit an insured receives is not
fixed but instead is dependent on the amount of the loss.
◉ Commercial Insurance Providers. Answer: Including life insurance
companies, casualty insurance companies or mono line companies that
specialize in one or more types of medical expense and disability income
insurance.
◉ Debit Companies. Answer: Sell industrial policies (home service companies)
◉ Reimbursement approach. Answer: Policyowners obtain medical treatment
from whatever source they feel is most appropriate and, per the terms of their
policy, submit their charges to their insurer for reimbursement.
◉ Right of Assignment. Answer: Insurance company and hospital work
directly with each other
◉ State worker's compensation programs. Answer: Provides benefits for
works who suffer from occupational injuries or illnesses.
◉ Self-Insurance. Answer: For businesses and individuals, an alternative to a
commercial or service health insurance plan. Administered by insurance
companies or other organizations that are paid a fee for handling the
paperwork and processing the claims - ASO or TPA
◉ Basic Medical Insurance. Answer: Limits coverage to select types of medical
care, no deductibles, no co-insurance - pay first (1st dollar). Provides benefits
upfront.
,◉ Major Medical Insurance. Answer: Can work as a supplement to a basic plan
or as a comprehensive standalone plan, more complete coverage. (Everything:
deductibles & co-insurance)
◉ Basic Hospital Expenses. Answer: Room & Board / Miscellaneous Expenses:
Drugs, X-rays. Reimburses policy owners for the cost of hospital confinement
or outpatient care if its provided instead of hospitalized care.
◉ Basic Surgical Expense. Answer: SAP: Surgeons, Anesthesiologist and any
Post-Operative Care.
◉ Surgical Schedule. Answer: Flat-Rate, every surgical procedure is assigned a
dollar amount by the insurer.
◉ Reasonable and Customary Approach. Answer: Surgical expense is
compared to what is deemed reasonable and customary for the geographical
part of the country where the surgery was performed.
◉ Relative Value Scale. Answer: Similar to the surgical schedule, except
instead of a flat dollar amount being assigned to every surgical procedure, a
set of points is assigned.
◉ Basic Physicians' Expense (Nonsurgical). Answer: Office visits & care by
physician.
◉ Nurses' expense coverage. Answer: Limited to private duty nursing care
, ◉ Convalescent Care. Answer: Provides a maximum daily benefit for
confinement in a skilled nursing facility for a specified recovery period
following discharge from a hospital.
◉ Supplementary Major Medical. Answer: Supplements a basic plan. Provides
coverage for expenses that are in excess of the dollar maximums specified in
the basic policy & those expenses no longer covered.
◉ Comprehensive Major Medical. Answer: Any Doctor, stand alone plan. Cover
virtually all medical expenses.
◉ Deductibles. Answer: A stated initial dollar amount that the individual
insured is required to pay before insurance benefits are paid. (Flat, corridor,
or integrated)
◉ Flat Deductible. Answer: Stated amount that the insured must pay before
policy benefits become payable. Family deductible - usually equal to 3x the
individual deductible amount.
◉ Corridor Deductible. Answer: Part of a supplemental plan works in
conjunction with a basic medical expense policy. (2)
◉ Integrated Deductible. Answer: Supplemented. Integrated into the amounts
covered by the basic plan.
with Correct Answers 2025 Graded A+
◉ Group Health Insurance. Answer: Issued by commercial insurers and
service organizations, provides coverage under a master contract to members
of a specified group. (Mandatory maternity for group) -can be participating
but rare.
◉ Medicaid. Answer: State level, purpose is to provide matching federal funds
to states for their medical public assistance plans to help needy persons,
regardless of age.
◉ Medicare. Answer: 1966. Primary source for health insurance. Federal
government provides hospital and medical expense insurance protection to
those age 65+, to those any age suffering from chronic kidney disease, or
those who receive SS disability benefits. (10 supplements, 30 day free look)
◉ Renewability Provisions. Answer: Cancellable, Optionally Renewable, Non-
cancellable, Guaranteed Renewable (CONG)
◉ Premium Factors & Modes. Answer: Interest, expense, types of benefits, and
morbidity.
◉ Claims. Answer: The amount of insurance coverage is readily determined by
the policy, and benefits are payable if the insured has died.
,◉ Contract of Reimbursement. Answer: The benefit an insured receives is not
fixed but instead is dependent on the amount of the loss.
◉ Commercial Insurance Providers. Answer: Including life insurance
companies, casualty insurance companies or mono line companies that
specialize in one or more types of medical expense and disability income
insurance.
◉ Debit Companies. Answer: Sell industrial policies (home service companies)
◉ Reimbursement approach. Answer: Policyowners obtain medical treatment
from whatever source they feel is most appropriate and, per the terms of their
policy, submit their charges to their insurer for reimbursement.
◉ Right of Assignment. Answer: Insurance company and hospital work
directly with each other
◉ State worker's compensation programs. Answer: Provides benefits for
works who suffer from occupational injuries or illnesses.
◉ Self-Insurance. Answer: For businesses and individuals, an alternative to a
commercial or service health insurance plan. Administered by insurance
companies or other organizations that are paid a fee for handling the
paperwork and processing the claims - ASO or TPA
◉ Basic Medical Insurance. Answer: Limits coverage to select types of medical
care, no deductibles, no co-insurance - pay first (1st dollar). Provides benefits
upfront.
,◉ Major Medical Insurance. Answer: Can work as a supplement to a basic plan
or as a comprehensive standalone plan, more complete coverage. (Everything:
deductibles & co-insurance)
◉ Basic Hospital Expenses. Answer: Room & Board / Miscellaneous Expenses:
Drugs, X-rays. Reimburses policy owners for the cost of hospital confinement
or outpatient care if its provided instead of hospitalized care.
◉ Basic Surgical Expense. Answer: SAP: Surgeons, Anesthesiologist and any
Post-Operative Care.
◉ Surgical Schedule. Answer: Flat-Rate, every surgical procedure is assigned a
dollar amount by the insurer.
◉ Reasonable and Customary Approach. Answer: Surgical expense is
compared to what is deemed reasonable and customary for the geographical
part of the country where the surgery was performed.
◉ Relative Value Scale. Answer: Similar to the surgical schedule, except
instead of a flat dollar amount being assigned to every surgical procedure, a
set of points is assigned.
◉ Basic Physicians' Expense (Nonsurgical). Answer: Office visits & care by
physician.
◉ Nurses' expense coverage. Answer: Limited to private duty nursing care
, ◉ Convalescent Care. Answer: Provides a maximum daily benefit for
confinement in a skilled nursing facility for a specified recovery period
following discharge from a hospital.
◉ Supplementary Major Medical. Answer: Supplements a basic plan. Provides
coverage for expenses that are in excess of the dollar maximums specified in
the basic policy & those expenses no longer covered.
◉ Comprehensive Major Medical. Answer: Any Doctor, stand alone plan. Cover
virtually all medical expenses.
◉ Deductibles. Answer: A stated initial dollar amount that the individual
insured is required to pay before insurance benefits are paid. (Flat, corridor,
or integrated)
◉ Flat Deductible. Answer: Stated amount that the insured must pay before
policy benefits become payable. Family deductible - usually equal to 3x the
individual deductible amount.
◉ Corridor Deductible. Answer: Part of a supplemental plan works in
conjunction with a basic medical expense policy. (2)
◉ Integrated Deductible. Answer: Supplemented. Integrated into the amounts
covered by the basic plan.
